Stress T1 mapping and quantitative perfusion cardiovascular magnetic resonance in patients with suspected obstructive coronary artery disease

T1 mapping reactivity (ΔT1) has been proposed as a novel contrast-free technique to detect obstructive coronary artery disease (CAD). The aims of the study are: (i) to compare the cardiovascular magnetic resonance (CMR)-derived ΔT1 with quantitative perfusion (QP CMR) measures; (ii) to assess the influence of sex and comorbidities on ΔT1; and (iii) to assess the diagnostic accuracy of ΔT1 to detect obstructive CAD diagnosed with the invasive coronary angiography (ICA) and/or fractional flow reserve.

This study retrospectively analysed 51 patients with suspected obstructive CAD who underwent CMR including rest and adenosine stress first-pass perfusion and native T1 mapping (MOLLI). A moderate correlation was found between pooled rest and stress native T1 mapping and myocardial blood flow (Pearson’s r = 0.476; P < 0.001). When stratified by myocardial perfusion reserve (MPR), ischaemic myocardium had significantly lower stress T1 mapping values (P < 0.001) and ΔT1 (P = 0.005) vs. nonischaemic myocardium. Male sex and history of diabetes were independently associated with lower ΔT1. The optimal cut-off value of ΔT1 to detect impaired MPR on a per-vessel basis was ≤5.4%, with an area under the curve of 0.662 (95% CI: 0.563–0.752, P = 0.003), sensitivity of 84% (95% CI: 67–95), and specificity of 46% (95% CI: 34–58). When validated against ICA, stress T1 and ΔT1 did not reach statistical significance in detecting obstructive CAD.

ΔT1 is significantly influenced by sex and comorbidities and has poor diagnostic accuracy for detecting myocardial ischaemia. Therefore, the clinical utility of ΔT1 in a real-world cohort of patients to detect obstructive CAD is limited.