Quantitative assessment of myocardial blood flow in coronary artery disease by cardiovascular magnetic resonance: comparison of Fermi and distributed parameter modeling against invasive methods.
Quantitative assessment of myocardial blood flow in coronary artery disease by cardiovascular magnetic resonance: comparison of Fermi and distributed parameter modeling against invasive methods.
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DOI：
10.1186/s12968-016-0270-1
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发表时间：
2016-09-13
期刊：
影响因子：
--
通讯作者：
Semple SI
中科院分区：
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作者：
Papanastasiou G;Williams MC;Dweck MR;Alam S;Cooper A;Mirsadraee S;Newby DE;Semple SI
灌注心血管磁共振 (CMR) 数据的数学模型可以对心肌血流量进行绝对量化，并有可能改善阻塞性冠状动脉疾病 (CAD) 的诊断和预后，与当前视觉评估的临床标准相比。本研究将分布式参数模型 (DP) 与标准费米模型的诊断性能进行比较，以检测阻塞性 CAD，针对每条血管和每名患者进行分析。由 28 名患有已知或疑似 CAD 的受试者（最终分析中包括 24 名）组成的试点队列在 3T 时接受了腺苷应激静息灌注 CMR。使用 Fermi 和 DP 模型对所有受试者采集的侵入性冠状动脉造影和血流储备分数进行数据分析。阻塞性 CAD 定义为仅管腔狭窄≥70%，或管腔狭窄≥50%且血流储备分数≤0.80。在 ROC 分析中，DP 模型在每条血管和每名患者的分析中优于标准费米模型。在每个患者的分析中，DP 模型衍生的应激心肌血流在检测阻塞性 CAD 方面表现出最高的敏感性和特异性（0.96，0.92），而费米模型（0.78，0.88）和视觉评估（0.79，0.88）分别。与 Fermi 模型相比，DP 模型的诊断性能持续提高，并表明它对于对至少一根血管患有阻塞性 CAD 的患者进行分层可能具有优点。临床试验注册：ClinicalTrials.gov NCT01368237 于 2011 年 6 月 6 日注册。 URL：https://clinicaltrials.gov/ct2/show/NCT01368237 本文的在线版本 (doi:10.1186/s12968-016-0270-1) 包含补充材料，可供授权用户使用。
Mathematical modeling of perfusion cardiovascular magnetic resonance (CMR) data allows absolute quantification of myocardial blood flow and can potentially improve the diagnosis and prognostication of obstructive coronary artery disease (CAD), against the current clinical standard of visual assessments. This study compares the diagnostic performance of distributed parameter modeling (DP) against the standard Fermi model, for the detection of obstructive CAD, in per vessel against per patient analysis. A pilot cohort of 28 subjects (24 included in the final analysis) with known or suspected CAD underwent adenosine stress-rest perfusion CMR at 3T. Data were analysed using Fermi and DP modeling against invasive coronary angiography and fractional flow reserve, acquired in all subjects. Obstructive CAD was defined as luminal stenosis of ≥70 % alone, or luminal stenosis ≥50 % and fractional flow reserve ≤0.80. On ROC analysis, DP modeling outperformed the standard Fermi model, in per vessel and per patient analysis. In per patient analysis, DP modeling-derived myocardial blood flow at stress demonstrated the highest sensitivity and specificity (0.96, 0.92) in detecting obstructive CAD, against Fermi modeling (0.78, 0.88) and visual assessments (0.79, 0.88), respectively. DP modeling demonstrated consistently increased diagnostic performance against Fermi modeling and showed that it may have merit for stratifying patients with at least one vessel with obstructive CAD. Clinical Trial Registration: Clinicaltrials.gov NCT01368237 Registered 6 of June 2011. URL: https://clinicaltrials.gov/ct2/show/NCT01368237 The online version of this article (doi:10.1186/s12968-016-0270-1) contains supplementary material, which is available to authorized users.