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Title: Cardiovascular magnetic resonance myocardial perfusion mapping for the assessment of coronary artery disease
Author: Kotecha, Tushar
ISNI:       0000 0004 9353 1934
Awarding Body: UCL (University College London)
Current Institution: University College London (University of London)
Date of Award: 2020
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Pixelwise myocardial perfusion mapping is a novel cardiovascular magnetic resonance (CMR) technique enables quantitative measurement of myocardial blood flow (MBF) at a pixel level. This could improve the accuracy of detection of obstructive coronary artery disease (CAD) and may also have a role in the diagnosis and assessment of coronary microvascular dysfunction (CMD). In this thesis, I explore the use of this novel technique in cohorts of clinical patients and controls with suspected CAD or CMD. Firstly, I demonstrate that stress MBF measured using perfusion mapping is accurate for the detection of CAD using invasive fractional flow reserve (FFR) as the reference standard, and that global stress MBF can be used as a marker of CMD using invasive index of microcirculatory resistance (IMR) as the reference standard. One limitation of adenosine stress testing is the confirmation of adequate hyperaemia with lack of gold standard non-invasive marker. Here, I demonstrate that regional stress MBF can be utilised as a non-invasive marker of adequate stress response. Another limitation of stress MBF is the relatively poor performance for the detection of multivessel disease. In a cohort of patients with confirmed two- and three-vessel disease I demonstrate that perfusion mapping is superior to visual analysis for the correct identification of disease severity. Perfusion mapping provides a host of options for quantitative image analysis. I show that the most reliable method for detection of coronary disease at a patient level is the presence of reduced MBF in two adjacent myocardial segments. In summary, in this thesis I performed a series of studies investigating the clinical utilisation of CMR perfusion mapping that can be translated to clinical practice to enhance the performance of stress perfusion CMR.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available