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Utility of stress perfusion-cardiac magnetic resonance in follow-up of patients undergoing percutaneous coronary interventions of the left main coronary artery

  • Samuele Nanni
  • Luigi Lovato
  • Gabriele Ghetti
  • Fabio Vagnarelli
  • GianGaspare Mineo
  • Rossella Fattori
  • Francesco Saia
  • Antonio Marzocchi
  • Cinzia Marrozzini
  • Maurizio Zompatori
  • Letizia Bacchi Reggiani
  • Franco Semprini
  • Giovanni Melandri
  • Elena Biagini
  • Anna Corsini
  • Giulia Norscini
  • Claudio Rapezzi
Original Paper

Abstract

To assess the accuracy of cardiac magnetic resonance (CMR) for the diagnosis of angiographic stenosis after percutaneous coronary intervention (PCI) of left main coronary artery (LMCA). Patients undergone in the last year PCI of unprotected LMCA and scheduled for conventional X-ray coronary angiography (CXA) were evaluated with stress perfusion CMR within 2 weeks before CXA. Main contraindications to CMR were exclusion criteria. Stress perfusion CMR was performed to follow a bolus of contrast Gadobutrol after 3 min of adenosine infusion. Between the 50 patients enrolled, only 1 did not finish the CMR protocol and 49 patients with median age 71 (65–75) years (38 male, 11 female) were analyzed. Between 784 coronary angiographic segments evaluated we found 75 stenosis or occlusions (prevalence 9.5%), but only 13 stenosis or occlusions in proximal segments (prevalence 6.6%). Patients with coronary stenosis (n = 12, 24%) showed a significantly (p = 0.002) higher prevalence of diabetes (7 of 12, 58%). At CMR examination, late gadolinium enhancement was present in 25 (51%), reversible perfusion defects in 12 (24%), and fixed perfusion defects in 6 subjects (12%). The only patient with LMCA restenosis resulted positive at perfusion CMR. The accuracy of stress perfusion CMR in diagnosis of coronary stenosis was higher when the analysis was performed only in proximal coronary arteries (95%, CI 86–99) compared to overall vessels (84%, CI 70–92). Stress perfusion CMR could strongly reduce the need for elective CXA in follow up of LMCA PCI and should be validated in further multicenter prospective studies.

Keywords

Cardiac magnetic resonance Diagnostic accuracy Left main coronary artery disease Percutaneous coronary intervention 

Notes

Compliance with ethical standards

Conflict of interest

No relevant conflict of interest in this manuscript to disclose.

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Copyright information

© Springer Science+Business Media Dordrecht 2017

Authors and Affiliations

  • Samuele Nanni
    • 1
  • Luigi Lovato
    • 2
  • Gabriele Ghetti
    • 1
  • Fabio Vagnarelli
    • 1
  • GianGaspare Mineo
    • 2
  • Rossella Fattori
    • 3
  • Francesco Saia
    • 1
  • Antonio Marzocchi
    • 1
  • Cinzia Marrozzini
    • 1
  • Maurizio Zompatori
    • 2
  • Letizia Bacchi Reggiani
    • 1
  • Franco Semprini
    • 1
  • Giovanni Melandri
    • 1
  • Elena Biagini
    • 1
  • Anna Corsini
    • 1
  • Giulia Norscini
    • 1
  • Claudio Rapezzi
    • 1
  1. 1.Istituto di CardiologiaUniversità di Bologna, Policlinico S.Orsola-MalpighiBolognaItaly
  2. 2.Istituto di RadiologiaUniversità di Bologna, Policlinico S.Orsola-MalpighiBolognaItaly
  3. 3.Istituto di CardiologiaOspedale San SalvatorePesaroItaly

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