Background The relationship between anatomy and associated pathophysiology in coronary artery disease (CAD) is complex and incompletely understood yet is important for patient management. This information cannot be comprehensively provided by a single investigative modality. A hybrid x-ray and MRI (XMR) laboratory can potentially overcome this limitation. However, the feasibility of combined invasive and non-invasive studies and percutaneous coronary intervention (PCI) in an XMR laboratory is unknown.
Methods 10 patients with angina scheduled for coronary angiography or PCI underwent combined procedures an XMR laboratory. 3T Cardiovascular Magnetic Resonance (CMR) exams included serial high-resolution perfusion, functional and scar imaging. Invasive procedures included diagnostic coronary angiography, PCI and fractional flow reserve (FFR) measurements pre and post PCI.
Results Four females and 6 males with mean age 73 (range 51–86) were included. All procedures were completed and well tolerated without complication. Mean study duration was 117 min (range 36–208). The procedures and outcomes are summarised in Abstract 025 table 1. Eight patients underwent both CMR and invasive studies. Six patients had single vessel PCI. FFR and stress perfusion imaging were both performed in 14 coronary territories (4 post PCI). Management was guided by functional information in eight patients. An example case is shown in Abstract 025 figure 1. End-diastolic (B) and end-systolic (C) frames from the short axis cine demonstrate an anterior/anteroseptal wall motion abnormality. Stress perfusion imaging pre PCI demonstrated a severe perfusion defect in the LAD territory from base to apex (E–G; blue arrows) and a defect in the RCA territory (E; green arrows). There were corresponding severe lesions in the proximal LAD with an FFR of 0.45 (D) and RCA (A). Following PCI to the LAD FFR increased to 0.98 and stress perfusion was significantly improved (I–K). The RCA territory defect remained (I; green arrows) but there was also persistent hypoperfusion in the mid anterior slice (J; blue arrow) and apical lateral wall (K; blue arrow) despite the absence of scar on late gadolinium enhancement imaging (L–N).
Conclusions Combined CMR and interventional coronary procedures are feasible and well tolerated in an XMR laboratory. This set-up has exciting research and clinical applications which should improve knowledge and management of coronary artery disease.
- Cardiovascular magnetic resonance
- percutaneous coronary intervention
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