Visualization and functional assessment of proximal and middle left anterior descending coronary stenoses in humans with magnetic resonance imaging

W. Gregory Hundley, Craig A. Hamilton, Geoffrey D. Clarke, L. David Hillis, David M. Herrington, Richard A. Lange, Robert J. Applegate, Mark S. Thomas, Jerri Payne, Kerry M. Link, Ronald M Peshock

Research output: Contribution to journalArticle

67 Citations (Scopus)

Abstract

Background - Coronary artery bypass grafting improves survival in patients with >70% luminal diameter narrowing of the 3 major epicardial coronary arteries, particularly if there is involvement of the proximal portion of the left anterior descending (LAD) coronary artery. Measurement of coronary flow reserve can be used to identify functionally important luminal narrowing of the LAD artery. Although magnetic resonance imaging (MRI) has been used to visualize coronary arteries and to measure flow reserve noninvasively, the utility of MRI for detecting significant LAD stenoses is unknown. Methods and Results - Thirty subjects (23 men, 7 women, age 36 to 77 years) underwent MRI visualization of the left main and LAD coronary arteries as well as measurement of flow in the proximal, middle, or distal LAD both at rest and after intravenous adenosine (140 μg/kg per minute). Immediately thereafter, contrast coronary angiography and when feasible, intracoronary Doppler assessments of coronary flow reserve, were performed. There was a statistically significant correlation between MRI assessments of coronary flow reserve and (a) assessments of coronary arterial stenosis severity by quantitative coronary angiography and (b) invasive measurements of coronary flow reserve (P<0.0001 for both). In comparison to computer-assisted quantitative coronary angiography, the sensitivity and specificity of MRI for identifying a stenosis >70% in the distal left main or proximal/middle LAD arteries was 100% and 83%, respectively. Conclusions - Noninvasive MRI measures of coronary flow reserve correlated well with similar measures obtained with the use of intracoronary Doppler flow wires and predicted significant coronary stenoses (>70%) with a high degree of sensitivity and specificity. MRI-based measurement of coronary flow reserve may prove useful for identification of patients likely to obtain a survival benefit from coronary artery bypass grafting.

Original languageEnglish (US)
Pages (from-to)3248-3254
Number of pages7
JournalCirculation
Volume99
Issue number25
StatePublished - Jun 29 1999

Fingerprint

Coronary Stenosis
Magnetic Resonance Imaging
Coronary Vessels
Coronary Angiography
Coronary Artery Bypass
Arteries
Survival
Adenosine
Pathologic Constriction
Sensitivity and Specificity

Keywords

  • Blood flow
  • Coronary disease
  • Magnetic resonance imaging
  • Stenosis

ASJC Scopus subject areas

  • Physiology
  • Cardiology and Cardiovascular Medicine

Cite this

Hundley, W. G., Hamilton, C. A., Clarke, G. D., Hillis, L. D., Herrington, D. M., Lange, R. A., ... Peshock, R. M. (1999). Visualization and functional assessment of proximal and middle left anterior descending coronary stenoses in humans with magnetic resonance imaging. Circulation, 99(25), 3248-3254.

Visualization and functional assessment of proximal and middle left anterior descending coronary stenoses in humans with magnetic resonance imaging. / Hundley, W. Gregory; Hamilton, Craig A.; Clarke, Geoffrey D.; Hillis, L. David; Herrington, David M.; Lange, Richard A.; Applegate, Robert J.; Thomas, Mark S.; Payne, Jerri; Link, Kerry M.; Peshock, Ronald M.

In: Circulation, Vol. 99, No. 25, 29.06.1999, p. 3248-3254.

Research output: Contribution to journalArticle

Hundley, WG, Hamilton, CA, Clarke, GD, Hillis, LD, Herrington, DM, Lange, RA, Applegate, RJ, Thomas, MS, Payne, J, Link, KM & Peshock, RM 1999, 'Visualization and functional assessment of proximal and middle left anterior descending coronary stenoses in humans with magnetic resonance imaging', Circulation, vol. 99, no. 25, pp. 3248-3254.
Hundley WG, Hamilton CA, Clarke GD, Hillis LD, Herrington DM, Lange RA et al. Visualization and functional assessment of proximal and middle left anterior descending coronary stenoses in humans with magnetic resonance imaging. Circulation. 1999 Jun 29;99(25):3248-3254.
Hundley, W. Gregory ; Hamilton, Craig A. ; Clarke, Geoffrey D. ; Hillis, L. David ; Herrington, David M. ; Lange, Richard A. ; Applegate, Robert J. ; Thomas, Mark S. ; Payne, Jerri ; Link, Kerry M. ; Peshock, Ronald M. / Visualization and functional assessment of proximal and middle left anterior descending coronary stenoses in humans with magnetic resonance imaging. In: Circulation. 1999 ; Vol. 99, No. 25. pp. 3248-3254.
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abstract = "Background - Coronary artery bypass grafting improves survival in patients with >70{\%} luminal diameter narrowing of the 3 major epicardial coronary arteries, particularly if there is involvement of the proximal portion of the left anterior descending (LAD) coronary artery. Measurement of coronary flow reserve can be used to identify functionally important luminal narrowing of the LAD artery. Although magnetic resonance imaging (MRI) has been used to visualize coronary arteries and to measure flow reserve noninvasively, the utility of MRI for detecting significant LAD stenoses is unknown. Methods and Results - Thirty subjects (23 men, 7 women, age 36 to 77 years) underwent MRI visualization of the left main and LAD coronary arteries as well as measurement of flow in the proximal, middle, or distal LAD both at rest and after intravenous adenosine (140 μg/kg per minute). Immediately thereafter, contrast coronary angiography and when feasible, intracoronary Doppler assessments of coronary flow reserve, were performed. There was a statistically significant correlation between MRI assessments of coronary flow reserve and (a) assessments of coronary arterial stenosis severity by quantitative coronary angiography and (b) invasive measurements of coronary flow reserve (P<0.0001 for both). In comparison to computer-assisted quantitative coronary angiography, the sensitivity and specificity of MRI for identifying a stenosis >70{\%} in the distal left main or proximal/middle LAD arteries was 100{\%} and 83{\%}, respectively. Conclusions - Noninvasive MRI measures of coronary flow reserve correlated well with similar measures obtained with the use of intracoronary Doppler flow wires and predicted significant coronary stenoses (>70{\%}) with a high degree of sensitivity and specificity. MRI-based measurement of coronary flow reserve may prove useful for identification of patients likely to obtain a survival benefit from coronary artery bypass grafting.",
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T1 - Visualization and functional assessment of proximal and middle left anterior descending coronary stenoses in humans with magnetic resonance imaging

AU - Hundley, W. Gregory

AU - Hamilton, Craig A.

AU - Clarke, Geoffrey D.

AU - Hillis, L. David

AU - Herrington, David M.

AU - Lange, Richard A.

AU - Applegate, Robert J.

AU - Thomas, Mark S.

AU - Payne, Jerri

AU - Link, Kerry M.

AU - Peshock, Ronald M

PY - 1999/6/29

Y1 - 1999/6/29

N2 - Background - Coronary artery bypass grafting improves survival in patients with >70% luminal diameter narrowing of the 3 major epicardial coronary arteries, particularly if there is involvement of the proximal portion of the left anterior descending (LAD) coronary artery. Measurement of coronary flow reserve can be used to identify functionally important luminal narrowing of the LAD artery. Although magnetic resonance imaging (MRI) has been used to visualize coronary arteries and to measure flow reserve noninvasively, the utility of MRI for detecting significant LAD stenoses is unknown. Methods and Results - Thirty subjects (23 men, 7 women, age 36 to 77 years) underwent MRI visualization of the left main and LAD coronary arteries as well as measurement of flow in the proximal, middle, or distal LAD both at rest and after intravenous adenosine (140 μg/kg per minute). Immediately thereafter, contrast coronary angiography and when feasible, intracoronary Doppler assessments of coronary flow reserve, were performed. There was a statistically significant correlation between MRI assessments of coronary flow reserve and (a) assessments of coronary arterial stenosis severity by quantitative coronary angiography and (b) invasive measurements of coronary flow reserve (P<0.0001 for both). In comparison to computer-assisted quantitative coronary angiography, the sensitivity and specificity of MRI for identifying a stenosis >70% in the distal left main or proximal/middle LAD arteries was 100% and 83%, respectively. Conclusions - Noninvasive MRI measures of coronary flow reserve correlated well with similar measures obtained with the use of intracoronary Doppler flow wires and predicted significant coronary stenoses (>70%) with a high degree of sensitivity and specificity. MRI-based measurement of coronary flow reserve may prove useful for identification of patients likely to obtain a survival benefit from coronary artery bypass grafting.

AB - Background - Coronary artery bypass grafting improves survival in patients with >70% luminal diameter narrowing of the 3 major epicardial coronary arteries, particularly if there is involvement of the proximal portion of the left anterior descending (LAD) coronary artery. Measurement of coronary flow reserve can be used to identify functionally important luminal narrowing of the LAD artery. Although magnetic resonance imaging (MRI) has been used to visualize coronary arteries and to measure flow reserve noninvasively, the utility of MRI for detecting significant LAD stenoses is unknown. Methods and Results - Thirty subjects (23 men, 7 women, age 36 to 77 years) underwent MRI visualization of the left main and LAD coronary arteries as well as measurement of flow in the proximal, middle, or distal LAD both at rest and after intravenous adenosine (140 μg/kg per minute). Immediately thereafter, contrast coronary angiography and when feasible, intracoronary Doppler assessments of coronary flow reserve, were performed. There was a statistically significant correlation between MRI assessments of coronary flow reserve and (a) assessments of coronary arterial stenosis severity by quantitative coronary angiography and (b) invasive measurements of coronary flow reserve (P<0.0001 for both). In comparison to computer-assisted quantitative coronary angiography, the sensitivity and specificity of MRI for identifying a stenosis >70% in the distal left main or proximal/middle LAD arteries was 100% and 83%, respectively. Conclusions - Noninvasive MRI measures of coronary flow reserve correlated well with similar measures obtained with the use of intracoronary Doppler flow wires and predicted significant coronary stenoses (>70%) with a high degree of sensitivity and specificity. MRI-based measurement of coronary flow reserve may prove useful for identification of patients likely to obtain a survival benefit from coronary artery bypass grafting.

KW - Blood flow

KW - Coronary disease

KW - Magnetic resonance imaging

KW - Stenosis

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VL - 99

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EP - 3254

JO - Circulation

JF - Circulation

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