Author + information
- Sven Plein, MD⁎ (, )
- John P. Greenwood, PhD,
- John P. Ridgway, PhD,
- Gillian Cranny, MSc,
- Stephen G. Ball, PhD and
- Mohan U. Sivananthan, MD
- ↵⁎BHF Cardiac Magnetic Resonance Unit, Room 170, D-Floor, Jubilee Building, The General Infirmary at Leeds, Great George Street, Leeds LS1 3EX, United Kingdom
We are grateful to Dr. Bellenger for his interesting comments. We share his enthusiasm regarding the potential of cardiac magnetic resonance (CMR) to provide a guide to revascularization in patients presenting with acute coronary syndromes and also in other clinical scenarios.
Some of the information Dr. Bellenger requests is indeed inherent in our data (1). Of the 56 patients with significant coronary artery disease (CAD) in our study, 49 had perfusion defects (the sensitivity of perfusion analysis to detect the presence of CAD on X-ray angiography was therefore 87.5%, as reported in our study). Seven patients thus had no perfusion defects on CMR despite the presence of significant CAD on X-ray angiography. Only three patients in our population showed transmural scar on late contrast-enhanced CMR imaging. Two of these patients underwent percutaneous intervention to vessels supplying myocardium that appeared on CMR to be predominantly nonviable (one of these is shown in Figure 4C of our study ).
However, other than reporting these results, our study design does not permit us to draw conclusions regarding the appropriateness of revascularization decisions in these patients. In the absence of a true standard for the detection of “significant” CAD, we used X-ray angiography as the reference test to determine the need for coronary revascularization therapy. We cannot therefore conclude that in patients with discrepant results between CMR and X-ray angiography, coronary revascularization was inappropriate or unnecessary.
Our study (1) is the first report of using CMR in patients with acute coronary syndromes. In this work it was our aim to establish whether CMR can be applied safely to this group of patients and whether it can accurately detect CAD. We fully agree with Dr. Bellenger that the potential future role of CMR, as we have discussed in our report, could exceed this relatively narrow application we have studied, and could include guiding revascularization decisions by providing comprehensive data on myocardial function, perfusion, and viability. This potential role should be explored in future work with an appropriately designed study.
- American College of Cardiology Foundation