被撤回的出版物: Gadolinium-Free Cardiac MR Stress T1-Mapping to Distinguish Epicardial From Microvascular Coronary Disease (Retracted article. See vol. 76, pg. 1915, 2020)

BACKGROUND Novel cardiac magnetic resonance (CMR) stress T1 mapping can detect ischemia and myocardial blood volume changes without contrast agents and may be a more comprehensive ischemia biomarker than myocardial blood flow. OBJECTIVES This study describes the performance of the first prospective validation of stress T1 mapping against invasive coronary measurements for detecting obstructive epicardial coronary artery disease (CAD), defined by fractional flow reserve (FFR <0.8), and coronary microvascular dysfunction, defined by FFR >= 0.8 and the index of microcirculatory resistance (IMR >= 25 U), compared with first-pass perfusion imaging. METHODS Ninety subjects (60 patients with angina; 30 healthy control subjects) underwent CMR (1.5- and 3-T) to assess left ventricular function (cine), ischemia (adenosine stress/rest T1 mapping and perfusion), and infarction (late gadolinium enhancement). FFR and IMR were assessed <= 7 days post-CMR. Stress and rest images were analyzed blinded to other information. RESULTS Normal myocardial T1 reactivity (Delta T1) was 6.2 +/- 0.4% (1.5-T) and 6.2 +/- 1.3% (3-T). Ischemic viable myocardium downstream of obstructive CAD showed near-abolished T1 reactivity (Delta T1 = 0.7 +/- 0.7%). Myocardium downstream of nonobstructive coronary arteries with microvascular dysfunction showed less-blunted T1 reactivity (Delta T1 = 3.0 +/- 0.9%). Stress T1 mapping significantly outperformed gadolinium-based first-pass perfusion, including absolute quantification of myocardial blood flow, for detecting obstructive CAD (area under the receiver-operating characteristic curve: 0.97 +/- 0.02 vs. 0.91 +/- 0.03, respectively; p < 0.001). A Delta T1 of 1.5% accurately detected obstructive CAD (sensitivity: 93%; specificity: 95%; p < 0.001), whereas a less-blunted Delta T1 of 4.0% accurately detected microvascular dysfunction (area under the receiver-operating characteristic curve: 0.95 +/- 0.03; sensitivity: 94%; specificity: 94%: p < 0.001). CONCLUSIONS CMR stress T1 mapping accurately detected and differentiated between obstructive epicardial CAD and microvascular dysfunction, without contrast agents or radiation. (c) 2018 The Authors. Published by Elsevier on behalf of the American College of Cardiology Foundation. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).