Comparison of Myocardial Transmural Perfusion Gradient by Magnetic Resonance Imaging to Fractional Flow Reserve in Patients With Suspected Coronary Artery Disease  Jingwei Pan, MD, Siyi Huang, MD, Zhigang Lu, MD, Jingbo Li, MD, Qing Wan, MD, Jiayin Zhang, MD, Chengjie Gao, MD, Xin Yang, PhD, Meng Wei, MD  American Journal of Cardiology  Volume 115, Issue 10, Pages 1333-1340 (May 2015) DOI: 10.1016/j.amjcard.2015.02.039 Copyright © 2015 Elsevier Inc. Terms and Conditions

Figure 1 Results of ROC analysis of MPRendo, MPRepi, MPRtrans, TPG, and TPGR for the diagnostic accuracy to detect a patient with an FFR ≤0.75. These ROC curves demonstrate superiority of MPRendo over MPRtrans and MPRepi for detection of perfusion impairment, supporting that endocardium is more sensitive to hypoperfusion than epicardium. TPGR yielded significantly better sensitivity and specificity of CAD diagnosis compared with TPG (p <0.0001) and conventional MPRtrans (p <0.0001). AUC for each parameter is provided. American Journal of Cardiology 2015 115, 1333-1340DOI: (10.1016/j.amjcard.2015.02.039) Copyright © 2015 Elsevier Inc. Terms and Conditions

Figure 2 Scatter plot shows distribution of TPG and TPGR values according to FFR cut-off value of 0.75. The best cut-off values for detection of hemodynamic significant CAD are shown (TPG ≤0.85 and TPGR ≤0.81). American Journal of Cardiology 2015 115, 1333-1340DOI: (10.1016/j.amjcard.2015.02.039) Copyright © 2015 Elsevier Inc. Terms and Conditions

Figure 3 ROC curves on a per-coronary basis show the diagnostic accuracy of TPGR in LAD, LCX, and RCA. Corresponding value distributions and best cut-off values are provided in scatter plot graphs, respectively. AUC is provided. American Journal of Cardiology 2015 115, 1333-1340DOI: (10.1016/j.amjcard.2015.02.039) Copyright © 2015 Elsevier Inc. Terms and Conditions

Figure 4 Three cases illustrate CMR perfusion analysis in midventricular short-axis and angiographic findings in patients with CAD. Adenosine-induced stress CMR perfusion imaging (first row) and rest myocardium perfusion imaging (third row) are provided. Corresponding color-encoded perfusion images derived from CMR quantitative MBF analysis are provided on the next rows (second and the fourth rows), respectively. Each perfusion segments were subdivided into endocardium and epicardium equally as we mentioned in the “Methods” section. The fifth and sixth rows represent the results of invasive angiography and FFR study. In patient A, stress CMR shows reversible ischemia in the anterior wall and septum (red arrows show area of hypoperfusion). Corresponding TPG and TPGR values reduce significantly (TPG = 0.65, TPGR = 0.58). Coronary angiography confirms a 76% stenosis in the left anterior descending coronary artery with FFR = 0.69. In patient B, stress CMR reveals inducible hypoperfusion in inferior lateral wall without late gadolinium enhancement (TPG = 0.81, TPGR = 0.67). Coronary angiography confirms an 81% stenosis in medial left circumflex artery with FFR = 0.66. In patient C, reversible hypoperfusion is detected in inferior wall with TPG = 0.84 and TPGR = 0.80 and an 85% stenosis in right coronary artery with FFR = 0.67. American Journal of Cardiology 2015 115, 1333-1340DOI: (10.1016/j.amjcard.2015.02.039) Copyright © 2015 Elsevier Inc. Terms and Conditions

Figure 5 Pearson correlation analysis showed a close correlation between TPGR with FFR. Further analysis on a per-coronary basis revealed similar results. Corresponding values are provided in graphs. American Journal of Cardiology 2015 115, 1333-1340DOI: (10.1016/j.amjcard.2015.02.039) Copyright © 2015 Elsevier Inc. Terms and Conditions