RETRACTED: Gadolinium-Free Cardiac MR Stress T1-Mapping to Distinguish Epicardial From Microvascular Coronary Disease
Authors: Stefan Neubauer
Alexander Liu
Joanna M Liu
Michael Jerosch-Herold
Andreas Greiser
John C Forfar
Keith M Channon
Vanessa M Ferreira
Rohan S Wijesurendra
Stefan K Piechnik
Rajesh K Kharbanda
Journal: Journal of the American College of Cardiology (2018)
Discipline: CLINICAL MEDICINE
Keywords: T1 mapping; adenosine stress; cardiac magnetic resonance; coronary artery disease; myocardial ischemia.
Affiliations: Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom., Siemens Healthcare GmbH, Erlangen, Germany., Brigham and Women's Hospital, Radiology, Cardiovascular Imaging, Boston, Massachusetts., Oxford Heart Centre, John Radcliffe Hospital, Oxford, United Kingdom., Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom., Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom. Electronic address: .

Abstract:  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 &lt;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 (ΔT1) 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 (ΔT1 = 0.7 ± 0.7%). Myocardium downstream of nonobstructive coronary arteries with microvascular dysfunction showed less-blunted T1 reactivity (ΔT1 = 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 &lt; 0.001). A ΔT1 of 1.5% accurately detected obstructive CAD (sensitivity: 93%; specificity: 95%; p &lt; 0.001), whereas a less-blunted ΔT1 of 4.0% accurately detected microvascular dysfunction (area under the receiver-operating characteristic curve: 0.95 ± 0.03; sensitivity: 94%; specificity: 94%: p &lt; 0.001). Conclusions: CMR stress T1 mapping accurately detected and differentiated between obstructive epicardial CAD and microvascular dysfunction, without contrast agents or radiation. 

Retracted: Yes

PubPeer comments:
 From: https: retractionwatch.com 2020 09 28 major-heart-journal-retracts-two-papers-from-oxford-group-for-misconduct This article has been retracted: please see Elsevier Policy on Article Withdrawal . The JACC Journals Ethics Board has voted to retract this paper, relying on the findings of misconduct after an investigation by the University of Oxford (outlined below). The decision to retract the paper follows the conclusion of an investigation under the University of Oxford s (u201cthe University su201d) Code of Practice and Procedure on Academic Integrity in Research (u201cthe Codeu201d). The Registrar of the University convened a Panel under the Code. The Panel considered a number of issues, including in relation to this paper. The Panel concluded that the first author, Dr Alexander Liu, was responsible for misconduct in research. The Panel s findings with regards to misconduct were limited to the actions of the first author. No other co-author was found to be involved in the misconduct. It is understood that the first author disagrees with the Panel s findings. The first author has raised a complaint with the Office of the Independent Adjudicator for Higher Education (OIA) (The OIA reviews complaints from students about their higher education provider). In relation to this paper, the Panel s findings included that: u2022 certain data had been fabricated by the first author amending the actual study data so that the paper and the central illustration would show a compelling case that T1 mapping could distinguish between epicardial obstructive coronary artery disease and coronary microvascular dysfunction; u2022 the number of control subjects, their age, and the statistical test to calculate the significance of a difference between the patients in this paper were incorrect; and u2022 Figure 2 had been fabricated. The Panel s view was that this paper would likely need to be retracted from the literature as it had major irregularities and its conclusions were unsafe. The following co-authors agree that a retraction is appropriate: Vanessa Ferreira, Rajesh Kharbanda, Stefan Neubauer, Stefan Piechnik, Keith Channon, John C. Forfar, Michael Jerosch-Herold, Andreas Greiser, Joanna Liu and Rohan Wijesurendra. ,