Assessment of coronary artery stenosis severity and socation quantitative analysis of transmural perfusion gradients by high-resolution MRI versus FFR

OBJECTIVES This study sought to test the hypothesis that transmural perfusion gradients (TPG) on adenosine stress myocardial perfusion cardiac magnetic resonance (CMR) predict hemodynamically significant coronary artery disease (CAD) as defined by fractional flow reserve (FFR). BACKGROUND Myocardial ischemia affects the subendocardial layers of the left ventricular myocardium earlier and more severely than the outer layers, and the identification of TPG should be sensitive and specific for the diagnosis of CAD. Previous studies have shown that high spatial resolution myocardial perfusion CMR allows quantitation of TPG between the subendocardium and the subepicardium. METHODS Sixty-seven patients (53 men, age 61 +/- 9 years) underwent coronary angiography and high-resolution (1.2 x 1.2-mm in-plane) adenosine stress perfusion CMR at 3.0-1. TPG was calculated for 3 coronary territories. Visual analysis was performed to identify myocardial ischemia. FFR was measured in all vessels with >= 50% severity stenosis. FFR