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Rapid Fire Abstracts

Rapid Fire 05- CAD: Chronic Coronary Syndromes

Stress T1 Mapping and Quantitative Perfusion Cardiac Magnetic Resonance in Patients with Suspected Obstructive Coronary Artery Disease (RF_FR_291)

Friday, January 31, 2025
9:30 AM – 9:40 AM East Coast USA Time
Location: Blue Room PreFunction
Background: CMR-derived T1 mapping reflects the cardiac microvascular state and myocardial blood volume. Therefore, the change in T1 mapping values at rest and after a vasodilator-induced stress (T1 mapping reactivity; ∆T1) has been proposed as a novel contrast-free technique to detect obstructive coronary artery disease (CAD). The aims of the study are: 1) to compare the CMR-derived ∆T1 with fully automated quantitative perfusion (QP CMR) measures; 2) to assess the influence of sex and comorbidities on ∆T1; and 3) to assess the diagnostic accuracy of ∆T1 to detect obstructive CAD diagnosed with the invasive coronary angiography (ICA) and/or fractional flow reserve.

Methods: This study retrospectively analyzed patients with suspected obstructive CAD who underwent adenosine stress perfusion CMR including rest and adenosine stress T1 mapping (MOLLI) and first-pass perfusion. T1 mapping measures were determined for the three main vascular territories and compared with QP-derived myocardial blood flow (MBF), myocardial perfusion reserve (MPR) and results of ICA.

Results:

The final analysis included 51 patients (mean age 61±10 years, 57% male, 61% underwent ICA). A moderate correlation was found between pooled rest and stress native T1 mapping and MBF (Pearson’s r=0.476; p< 0.001). When stratified by MPR, ischemic myocardium had significantly lower stress T1 mapping values (p< 0.001) and ∆T1 (p=0.005) vs. nonischemic myocardium (Figure 1). Male gender and history of diabetes were independently associated with lower ∆T1. The optimal cut-off value of ∆ T1 to detect impaired MPR on a per-vessel basis was ≤5.4%, with a corresponding AUC of 0.662 (95% CI: 0.563-0.752, p=0.003), sensitivity of 84% (95% CI: 67-95), specificity of 46% (95% CI: 34 - 58), PPV of 41% (35-47%), NPV of 87% (74-94%; Figure 2). When validated against ICA, stress T1 and ∆ T1 failed to reach the statistical significance to detect obstructive CAD.

Conclusion: ∆T1 is significantly influenced by sex and comorbidities and has poor diagnostic accuracy to detect myocardial ischemia. Therefore, the clinical utility of ∆T1 in a real-world cohort of patients to detect obstructive CAD is limited.