Noninvasive MR-guided perfusion imaging as initial management in stable angina, CAD
Noninvasive magnetic resonance (MR) perfusion imaging may be effective as initial guided management in patients with stable angina and intermediate-to-high risk for coronary artery disease (CAD) compared with invasive angiography and fractional flow reserve (FFR), according to the MR-INFORM* trial presented at the American College of Cardiology’s 66th Annual Scientific Session (ACC.17) held in Washington, DC, US.
“Cardiovascular MR perfusion imaging has demonstrated the highest accuracy of noninvasive testing without requiring radiation as well as gaining significant information on anatomy, function, and myocardial structure in a single session,” said Professor Eike Nagel from the Institute for Experimental and Translational Cardiovascular Imaging at the University Hospital Frankfurt, Germany.
Nine hundred and eighteen patients (mean age, 62 years, 72 percent male) were randomized in a 1:1 ratio to FFR-informed group (n=464, invasive angiography + FFR) or MR-informed group (n=454, noninvasive MR perfusion imaging). [ACC 2017, abstract LB-15126]
Results of index test procedure in the FFR-informed group showed that 47.5 percent of patients had positive angiography and FFR, 13.4 percent had positive angiography but negative FFR, and 35.6 percent had negative angiography.
In the MR-informed group, 41.5 percent of patients had positive MR and angiography, 8.1 percent had positive MR but negative angiography, and 48.8 percent had negative MR and did not undergo invasive angiography.
“ ... More patients had a positive anatomical and functional test in the FFR-informed side than positive anatomical and functional test on the MR-informed side,” said the researchers.
In addition, researchers stated that the number of revascularization procedures was significantly lower with MR-guided perfusion imaging compared with invasive angiography and FFR (36 percent vs 44.2 percent). “[However], both strategies are safe and result in a low total event rate,” they said.
“A combination of optimal medical therapy with MR-perfusion imaging seems [to be] the current best noninvasive management strategy for patients with stable angina,” the researchers noted.
“It is important to understand that you can do noninvasive test first which guides patient management safely and is the way to go rather than going towards invasive angiography as a first-line test,” said Nagel.
*MR-INFORM: MR perfusion imaging to guide management of patients with stable coronary artery disease