RETRACTED: Diagnosis of Microvascular Angina Using Cardiac Magnetic Resonance
Authors: Stefan Neubauer
Alexander Liu
Joanna M Liu
Michael Jerosch-Herold
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: cardiac magnetic resonance; index of microcirculatory resistance; inducible ischemia; microvascular dysfunction; myocardial perfusion reserve index.
Affiliations: Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom., Oxford Heart Centre, John Radcliffe Hospital, Oxford, United Kingdom., Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom., Brigham and Women's Hospital, Radiology, Cardiovascular Imaging, Boston, Massachusetts., 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: In patients with angina and nonobstructive coronary artery disease (NOCAD), confirming symptoms due to coronary microvascular dysfunction (CMD) remains challenging. Cardiac magnetic resonance (CMR) assesses myocardial perfusion with high spatial resolution and is widely used for diagnosing obstructive coronary artery disease (CAD). Objectives: The goal of this study was to validate CMR for diagnosing microvascular angina in patients with NOCAD, compared with patients with obstructive CAD and correlated to the index of microcirculatory resistance (IMR) during invasive coronary angiography. Methods: Fifty patients with angina (65 ± 9 years of age) and 20 age-matched healthy control subjects underwent adenosine stress CMR (1.5- and 3-T) to assess left ventricular function, inducible ischemia (myocardial perfusion reserve index [MPRI]; myocardial blood flow [MBF]), and infarction (late gadolinium enhancement). During subsequent angiography within 7 days, 28 patients had obstructive CAD (fractional flow reserve [FFR] ≤0.8) and 22 patients had NOCAD (FFR &gt;0.8) who underwent 3-vessel IMR measurements. Results: In patients with NOCAD, myocardium with IMR &lt;25 U had normal MPRI (1.9 ± 0.4 vs. controls 2.0 ± 0.3; p = 0.49); myocardium with IMR ≥25 U had significantly impaired MPRI, similar to ischemic myocardium downstream of obstructive CAD (1.2 ± 0.3 vs. 1.2 ± 0.4; p = 0.61). An MPRI of 1.4 accurately detected impaired perfusion related to CMD (IMR ≥25 U; FFR &gt;0.8) (area under the curve: 0.90; specificity: 95%; sensitivity: 89%; p &lt; 0.001). Impaired MPRI in patients with NOCAD was driven by impaired augmentation of MBF during stress, with normal resting MBF. Myocardium with FFR &gt;0.8 and normal IMR (&lt;25 U) still had blunted stress MBF, suggesting mild CMD, which was distinguishable from control subjects by using a stress MBF threshold of 2.3 ml/min/g with 100% positive predictive value. Conclusions: In angina patients with NOCAD, CMR can objectively and noninvasively assess microvascular angina. A CMR-based combined diagnostic pathway for both epicardial and microvascular CAD deserves further clinical validation. 

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 (OIA) (The OIA reviews complaints from students about their higher education provider). In relation to this paper, the Panel s findings included that: u2022 rather than 50 individual patients in the study (28 CAD providing 35 vessels and 22 NOCAD providing 66), there were actually 26 CAD patients, providing 31 vessels and 25 NOCAD patients providing 60 vessels, but three patients each providing two vessels were double counted, providing 66 vessels in all. Only six patients met the stated definition of NOCAD; u2022 5 controls with discrepant ages were included in the study; u2022 controls had been iteratively excluded from the analysis as the paper was revised, without explanation; u2022 that subjects used as controls in the study were patient volunteers and not healthy controls; and u2022 Figure 5 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, Michael Jerosch-Herold, Keith Channon, John C. Forfar, Joanna Liu and Rohan Wijesurendra. ,