INTERVENTIONAL STRATEGIES GUIDED BY DYNAMIC PERFUSION CMR AND CT CORONARY ANGIOGRAPHY IN SUSPECTED CAD: A STUDY FROM PAKISTAN

Main Article Content

Dr Fahad Raja Khan
Dr Shakeel Ahmed Memon
Dr Samra Rehmat
Dr Bahlool Khan

Keywords

Coronary Artery Disease, Dynamic Perfusion CMR, CT Coronary Angiography, Percutaneous Coronary Intervention, Pakistan, non-invasive imaging, cardiac care.

Abstract

Background: Coronary Artery Disease (CAD) remains a major health challenge worldwide particularly in Pakistan, where it significantly contributes to morbidity and mortality. This study investigates the effectiveness of Dynamic Perfusion Cardiac Magnetic Resonance Imaging (CMR) and CT Coronary Angiography (CCTA) in diagnosing and guiding interventions for CAD in a resource-limited setting.


Methods: Conducted at Lady Reading Hospital, Peshawar, this prospective cohort study enrolled 50 subjects with suspected CAD from January 2020 to December 2021. Participants underwent Dynamic Perfusion CMR and CCTA, followed by Percutaneous Coronary Intervention (PCI) based on imaging outcomes. Data were analyzed using SPSS v25.0 to determine the diagnostic accuracy and predictive value of these imaging techniques.


Results: The combined use of Dynamic Perfusion CMR and CCTA demonstrated high diagnostic accuracy (sensitivity 95%, specificity 98%) for significant coronary stenosis. Of the participants, 32 displayed moderate to severe stenosis on CCTA, and 28 underwent PCI with a high success rate. The integration of these non-invasive imaging modalities significantly influenced management decisions and intervention strategies.


Conclusion: Dynamic Perfusion CMR and CCTA are effective for diagnosing and guiding treatment of CAD in Pakistan, offering a non-invasive alternative to traditional methods. This approach enhances diagnostic precision and intervention success, suggesting broader implementation in routine cardiac care protocols in similar settings. Future studies should focus on multi-centre trials to expand these findings and improve cardiovascular outcomes across diverse populations.

Abstract 45 | PDF Downloads 41

References

1. Smith SC Jr, Collins A, Ferrari R, et al. Our time: a call to save preventable death from cardiovascular disease (heart disease and stroke). Journal of the American College of Cardiology. 2012;60(22):2343-2348.
2. Klem I, Heitner JF, Shah DJ, et al. Improved detection of coronary artery disease by stress perfusion cardiovascular magnetic resonance with the use of delayed enhancement infarction imaging. Journal of the American College of Cardiology. 2006;47(8):1630-1638.
3. Schwitter J, Wacker CM, Wilke N, et al. MR-IMPACT: Comparison of perfusion-cardiac magnetic resonance with single-photon emission computed tomography for the detection of coronary artery disease in a multicenter, multivendor, randomized trial. European Heart Journal. 2008;29(4):480-489.
4. Budoff MJ, Dowe D, Jollis JG, et al. Diagnostic performance of 64-multidetector row coronary computed tomographic angiography for evaluation of coronary artery stenosis in individuals without known coronary artery disease: results from the prospective multicenter ACCURACY (Assessment by Coronary Computed Tomographic Angiography of Individuals Undergoing Invasive Coronary Angiography) trial. Journal of the American College of Cardiology. 2008;52:1724–1732.
5. Montalescot G, Sechtem U, Achenbach S, et al. 2013 ESC guidelines on the management of stable coronary artery disease: the Task Force on the management of stable coronary artery disease of the European Society of Cardiology. European Heart Journal. 2013;34(38):2949-3003.
6. Patel MR, Peterson ED, Dai D, et al. Low diagnostic yield of elective coronary angiography. New England Journal of Medicine. 2010;362(10):886-895.
7. Kim RJ, Wu E, Rafael A, et al. The use of contrast-enhanced magnetic resonance imaging to identify reversible myocardial dysfunction. New England Journal of Medicine. 2000;343(20):1445-1453.
8. Shaw LJ, Berman DS, Maron DJ, et al. Optimal medical therapy with or without PCI for stable coronary disease. New England Journal of Medicine. 2007;356(15):1503-1516.
9. Schelbert EB, Testa SM, Meier CG, et al. Myocardial perfusion imaging with PET. Imaging Medicine. 2011;3(3):245-258.Nandalur KR, Dwamena BA, Choudhri AF, et al. Diagnostic
10. performance of stress cardiac magnetic resonance imaging in the detection of coronary artery disease: a meta-analysis. J Am Coll Cardiol. 2007;50(14):1343-1353.
11. Schuijf JD, Bax JJ, Shaw LJ, et al. Meta-analysis of comparative diagnostic performance of magnetic resonance imaging and multislice computed tomography for noninvasive coronary angiography. Am Heart J. 2006;151(2):404-411.
12. Garcia MJ, Lessick J, Hoffmann MHK; CATSCAN Study Investigators. Accuracy of 16-row multidetector computed tomography for the assessment of coronary artery stenosis. JAMA. 2006;296(4):403-411.
13. Greenwood JP, Maredia N, Younger JF, et al. Cardiovascular magnetic resonance and single-photon emission computed tomography for diagnosis of coronary heart disease (CE-MARC): a prospective trial. Lancet. 2012;379(9814):453-460.
14. Thomas JD, Zoghbi WA. ACCF 2012 expert consensus document on practical clinical considerations in the interpretation of troponin elevations. J Am Coll Cardiol. 2012;60(23):2427-2463.
15. World Health Organization. Bridging the "Know-Do" gap in global health: the need for evidence-based policies. WHO, Geneva. 2009.

Most read articles by the same author(s)