[Assessment of myocardial perfusion by cardiovascular magnetic resonance: comparison with coronary angiography].
INTRODUCTION AND OBJECTIVES: The assessment of regional myocardial perfusion by cardiovascular magnetic resonance imaging makes it possible to detect significant coronary artery lesions. The purpose of this study was to determine the usefulness of this technique in non-selected patients with ischemic heart disease. PATIENTS AND METHOD: The study group included 32 patients (26 men; mean age: 65 years old). Gadolinium (0.05 mmol/kg) for first-pass imaging was administered through a peripheral vein, both at rest and after adenosine infusion (140 mg/kg for 6 min). The presence of a regional perfusion defect was assessed visually, and these images were compared against coronary angiographic images. RESULTS: Angiography showed 49 significant (> 70%) obstructive lesions in a coronary artery. Magnetic resonance showed a perfusion defect at rest (fixed) in 35 myocardial segments, and only after adenosine infusion (reversible) in 16 additional regions, for a total of 51 segments with perfusion defect. Sensitivity for the detection of an angiographically significant coronary lesion was 78%, with a specificity of 75%. These figures decreased to 54% and 65%, respectively, when only fixed defects were considered. There were no visible defects in 26% of the myocardial territories with proven previous necrosis, although effective reperfusion and patent culprit arteries were frequently seen in these cases. CONCLUSIONS: The detection of a regional myocardial perfusion defect by visual analysis with first-pass gadolinium and cardiovascular magnetic resonance imaging shows good diagnostic accuracy for the presence of significant coronary artery obstruction, provided that both rest and pharmacological stress studies are performed.