150 Chapter 7 to exclude obstructive CAD). After exclusion of coronary territories with LGE (n = 19), in total 56 vessels were analyzed (18 left anterior descending arteries (LAD; 32%), 18 right coronary arteries (RCA; 32%) and 20 circumflex arteries (Cx; 36%). Based on ICA and/ or FFR, obstructive CAD was found in 10 (40%) patients including 6 patients with single vessel disease and 4 patients with 2-vessel disease. FFR was determined in a minority of vessels (7/56; 5 LAD, 1 Cx and 1 RCA) whereas 3 vessels had a critical stenosis (> 95% of luminal narrowing). Significant coronary artery obstruction was found in 9 coronary arteries, including 4 LAD (22%), 2 RCA (11%) and 3 Cx (15%). Typical examples of acquired images, AIF stress and rest curves, and results of the QP CMR analysis in patients without and with obstructive CAD are shown in Figure 2 and 3, respectively. In a patient without obstructive CAD, no perfusion defect was visible on both the conventional gray-scale first-pass perfusion images and QP CMR results, and the average stress MBF value was 3.1 ml/g/min (Figure 2). In a patient with obstructed RCA, both the conventional firstpass perfusion images and QP CMR results show a perfusion defect and reduced stress MBF, respectively, in the corresponding RCA perfusion territory segments. In the hypoperfused, ischemic segments, the average stress MBF value was 1.3 ml/g/min, whereas the average MBF in the remote myocardium was 2.6 ml/g/min. In the total population, the mean stress MBF was significantly lower in myocardial territories supplied by a vessel with a significant obstruction (ischemic myocardium) when compared to regions supplied by a vessel with no significant lesion (non-ischemic myocardium; 1.89 ± 0.41 vs. 2.41 ± 0.57 ml/g/min, p = 0.01; Figure 4). The mean rest MBF in ischemic myocardium was 1.13 ± 0.18 ml/g/min, whereas in non-ischemic myocardium the mean value was 1.00 ± 0.17 ml/g/min (p = 0.04; Figure 4). Table 1. Baseline characteristics Age (years) 60 (IQR 54–71) Male 16 (64%) Body mass index (kg/m2) 26 ± 4 History of coronary artery disease 10 (40%) PCI 7 (28%) MI 4 (16%) Risk factors Family history of CAD 9/23 (39%) Hypertension 11 (44%) Dyslipidemia 10 (40%) Diabetes mellitus 4 (16%) Smoking 13 (52%)
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