Advanced Cardiac Magnetic Resonance Imaging for Assessment of Obstructive Coronary Artery Disease: ADVOCATE-CMR

Study design: Single-center, observational, prospective, cross-sectional cohort study performed at the Amsterdam University Medical Centers - Location VUmc.

Study population: 182 symptomatic patients with suspected obstructive CAD (without a previous CAD history), scheduled for invasive coronary angiography (ICA) according to the decision of the treating clinician.

Methods:

1. CMR image acquisition prior to clinically scheduled ICA, using the following pulse sequences: cine imaging, OS-CMR with breathing maneuvers, adenosine-stress and rest T1 mapping, adenosine-stress and rest QP-CMR, late gadolinium enhancement; 2. Fractional flow reserve (FFR), instantaneous wave-free ratio (iFR), ratio between proximal and distal coronary pressures over entire resting cycle period (Pd/Pa ratio), coronary flow reserve (CFR) and index of microcircular resistance (IMR) in all main coronary arteries during ICA; 3. Follow-up CMR according to the abovementioned protocol 3 months after ICA (or 3 months after revascularization, if performed separately more than 1 day following ICA); 4. Clinical follow-up - 3, 6 months, 1 and 3 years after ICA or revascularization (if performed separately more than 1 day following ICA)

• Diagnostic accuracy of ΔT1 to detect obstructive CAD, as defined by FFR [Срок оценки: ICA + hemodynamic measurements within 6 weeks of the initial CMR scan]
• Diagnostic accuracy of OS CMR (breathing-induced myocardial oxygenation reserve; B-MORE) to detect obstructive CAD, as defined by FFR [Срок оценки: ICA + hemodynamic measurements within 6 weeks of the initial CMR scan]
• Head-to-head comparison of diagnostic accuracies of QP CMR (stress MBF, stress rMBF, MPR, rMPR), ΔT1, OS CMR (B-MORE) and conventional visual assessment of GBCA-based first pass perfusion imaging to detect obstructive CAD, as defined by FFR [Срок оценки: ICA + hemodynamic measurements within 6 weeks of the initial CMR scan]
• Diagnostic accuracy of QP CMR (stress MBF, stress rMBF, MPR and rMPR) to detect obstructive CAD, as defined by iFR and resting Pd/Pa [Срок оценки: ICA + hemodynamic measurements within 6 weeks of the initial CMR scan]
• Diagnostic accuracy of ΔT1 to detect obstructive CAD, as defined by iFR and resting Pd/Pa [Срок оценки: ICA + hemodynamic measurements within 6 weeks of the initial CMR scan]
• Diagnostic accuracy of OS CMR (B-MORE) to detect obstructive CAD, as defined by iFR and resting Pd/Pa [Срок оценки: ICA + hemodynamic measurements within 6 weeks of the initial CMR scan]
• Head-to-head comparison of diagnostic accuracies of QP CMR (stress MBF, stress rMBF, MPR, rMPR), ΔT1, OS CMR (B-MORE) and conventional visual assessment of first pass perfusion imaging to detect obstructive CAD, as defined by iFR and resting Pd/Pa [Срок оценки: ICA + hemodynamic measurements within 6 weeks of the initial CMR scan]
• Relation of stress and rest MBF and rMBF, MPR and rMPR, ΔT1 and B-MORE to Seattle Angina Questionnaire (SAQ)-7 Summary score [Срок оценки: Before ICA and 3, 6 months, 1 and 3 years after the ICA (or revascularization if applicable)]
• Relation of stress and rest MBF and rMBF, MPR and rMPR, ΔT1 and B-MORE to SAQ-7 Angina Frequency score [Срок оценки: Before ICA and 3, 6 months, 1 and 3 years after the ICA (or revascularization if applicable)]
• Relation of stress and rest MBF and rMBF, MPR and rMPR, ΔT1 and B-MORE to SAQ-7 Physical Limitation score [Срок оценки: Before ICA and 3, 6 months, 1 and 3 years after the ICA (or revascularization if applicable)]
• Relation of stress and rest MBF and rMBF, MPR and rMPR, ΔT1 and B-MORE to SAQ-7 Quality of Life score [Срок оценки: Before ICA and 3, 6 months, 1 and 3 years after the ICA (or revascularization if applicable)]
• Relation of stress and rest MBF and rMBF, MPR and rMPR, ΔT1 and B-MORE to Rose Dyspnea Scale score [Срок оценки: Before ICA and 3, 6 months, 1 and 3 years after the ICA (or revascularization if applicable)]