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Hillier E, Covone J, Friedrich MG. The reproducibility of breathing maneuvers as a vasoactive stimulus in the heart: an oxygenation-sensitive resonance imaging study. J Cardiovasc Magn Reson 2023; 25:81. [PMID: 38151725 PMCID: PMC10753842 DOI: 10.1186/s12968-023-00983-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 11/12/2023] [Indexed: 12/29/2023] Open
Abstract
BACKGROUND Endothelial dysfunction and impaired oxygenation of the heart is a hallmark of several diseases, including coronary artery disease, hypertension, diabetes, and sleep apnea. Recent studies indicate that oxygenation-sensitive cardiovascular magnetic resonance (OS-CMR) imaging combined with breathing maneuvers may allow for assessing coronary vascular responsiveness as a marker for coronary vascular function in various clinical settings. However, despite the use of OS-CMR in evaluating tissue oxygenation, the reproducibility of these standardized, combined breathing maneuvers as a vasoactive stimulus has yet to be systematically assessed or validated. In this study, we aimed to assess the reproducibility of vasoactive breathing maneuvers to assess vascular function in a population of healthy volunteers. METHODS Eighteen healthy volunteers were recruited for the study. Inclusion criteria were an age over 18 years and absence of any evidence or knowledge of cardiovascular, neurological, or pulmonary disease. MRI was performed on a clinical 3 T MRI system (MAGNETOM Skyra, Siemens Healthineers, Erlangen, Germany). The OS-CMR acquisition was performed as previously described (1 min hyperventilation followed by a maximal, voluntary breath-hold). Standard statistical tests were performed as appropriate. RESULTS Data from 18 healthy subjects was analyzed. The healthy volunteers had a mean age of 42 ± 15 years and a mean BMI of 25.4 ± 2.8 kg/m2, with an average heart rate of 72 ± 11 beats per minute, and ten of whom (56%) were female. There were no significant differences between global myocardial oxygenation (%[Formula: see text] SI) after hyperventilation (HV1: - 7.82 [Formula: see text] 5.2; HV2: - 7.89 [Formula: see text] 6.4, p = 0.9) or breath-hold (BH1: 5.34 [Formula: see text] 3.1; BH2: 6.0 [Formula: see text] 3.3, p = 0.5) between the repeated breathing maneuvers. The Bland-Altman analysis showed good agreement (bias: 0.074, SD of bias: 2.93). CONCLUSION We conclude that in healthy individuals, the myocardial oxygenation response to a standardized breathing maneuver with hyperventilation and a voluntary breath-hold is consistent and highly reproducible. These results corroborate previous evidence for breathing-enhanced OS-CMR as a robust test for coronary vascular function.
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Affiliation(s)
- Elizabeth Hillier
- Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Jason Covone
- Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
| | - Matthias G Friedrich
- Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada.
- Departments of Medicine and Diagnostic Radiology, McGill University, 1001 Decarie Blvd, Montreal, QC, H4A 3J1, Canada.
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2
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Muñiz-Sáenz-Diez J, Ezponda A, Caballeros M, de la Fuente A, Gavira JJ, Bastarrika G. Safety, feasibility, and hemodynamic response of regadenoson for stress perfusion CMR. Int J Cardiovasc Imaging 2023; 39:1765-1774. [PMID: 37354385 PMCID: PMC10520095 DOI: 10.1007/s10554-023-02877-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 05/15/2023] [Indexed: 06/26/2023]
Abstract
Owing to its pharmacodynamics and posology, the use of regadenoson for stress cardiac magnetic resonance (CMR) has potential advantages over other vasodilators. We sought to evaluate the safety, hemodynamic response and diagnostic performance of regadenoson stress-CMR in routine clinical practice. All regadenoson stress-CMR examinations performed between May 2017 and July 2020 at our institution were retrospectively reviewed. A total of 698 studies were included for the final analysis. A conventional stress/rest protocol was performed using a 1.5T MRI scanner (Magnetom Aera, Siemens Healthineers, Erlangen, Germany). Adverse events, clinical symptoms, and hemodynamic response were assessed. Diagnostic accuracy of the test was evaluated in patients who underwent invasive coronary angiography. Nearly half of patients (48.5%) remained asymptomatic. Most common clinical symptoms included dyspnea (137, 19.6%), chest pain (116, 16.6%) and flushing (44, 6.3%). Two patients (0.28%) could not complete the examination due to severe hypotension or unbearable chest pain. Overall, an increase in heart rate (HR) response (36.2% [IQR: 22.5?50.9]) and a decrease in systolic and diastolic blood pressure (BP) (median systolic BP response of -5% [IQR: -11.5-0.6]; median diastolic BP response of -6.3 mmHg [IQR: -13.4-0]) was observed. Patients with symptoms induced by regadenoson showed higher HR response (40.3%, IQR: 26.4?56.1 vs. 32.4%, IQR: 19-45.6, p < 0.001), whereas a blunted HR response was observed in diabetic (29.6%, IQR: 18.4?42 p < 0.001), obese (31.7%, IQR: 20.7?46.2 p = 0.005) and patients aged 70 years or older (32.9%, IQR: 22.6?43.1 p < 0.001). Overall, regadenoson stress-CMR showed 95.65% (IQ 91.49?99.81) sensitivity, 54.84% (IQ 35.71?73.97) specificity, 86.99% (IQ 82.74?94.68) positive predictive value, and 77.27% (IQ 57.49?97.06) negative predictive value for detecting significant coronary stenosis as compared with invasive coronary angiography. Regadenoson is a well-tolerated vasodilator that can be safely employed for stress perfusion CMR, with high diagnostic performance.
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Affiliation(s)
- Javier Muñiz-Sáenz-Diez
- Department of Cardiology, Clínica Universidad de Navarra, Avenida Pío XII, 36, Pamplona, 31007, Spain.
| | - Ana Ezponda
- Department of Radiology, Clínica Universidad de Navarra, Pamplona, Spain
| | - Meylin Caballeros
- Department of Radiology, Clínica Universidad de Navarra, Madrid, Spain
| | - Ana de la Fuente
- Department of Cardiology, Clínica Universidad de Navarra, Madrid, Spain
| | - Juan J Gavira
- Department of Cardiology, Clínica Universidad de Navarra, Avenida Pío XII, 36, Pamplona, 31007, Spain
| | - Gorka Bastarrika
- Department of Radiology, Clínica Universidad de Navarra, Pamplona, Spain
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Weberling LD, Lossnitzer D, Frey N, André F. Coronary Computed Tomography vs. Cardiac Magnetic Resonance Imaging in the Evaluation of Coronary Artery Disease. Diagnostics (Basel) 2022; 13:diagnostics13010125. [PMID: 36611417 PMCID: PMC9818886 DOI: 10.3390/diagnostics13010125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 12/23/2022] [Accepted: 12/28/2022] [Indexed: 01/04/2023] Open
Abstract
Coronary artery disease (CAD) represents a widespread burden to both individual and public health, steadily rising across the globe. The current guidelines recommend non-invasive anatomical or functional testing prior to invasive procedures. Both coronary computed tomography angiography (cCTA) and stress cardiac magnetic resonance imaging (CMR) are appropriate imaging modalities, which are increasingly used in these patients. Both exhibit excellent safety profiles and high diagnostic accuracy. In the last decade, cCTA image quality has improved, radiation exposure has decreased and functional information such as CT-derived fractional flow reserve or perfusion can complement anatomic evaluation. CMR has become more robust and faster, and advances have been made in functional assessment and tissue characterization allowing for earlier and better risk stratification. This review compares both imaging modalities regarding their strengths and weaknesses in the assessment of CAD and aims to give physicians rationales to select the most appropriate modality for individual patients.
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Affiliation(s)
- Lukas D. Weberling
- Department of Cardiology, Angiology and Pneumology, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Heidelberg/Mannheim, 69120 Heidelberg, Germany
- Correspondence: ; Tel.: +49-6221-8676
| | - Dirk Lossnitzer
- Department of Cardiology, Angiology and Pneumology, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
| | - Norbert Frey
- Department of Cardiology, Angiology and Pneumology, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Heidelberg/Mannheim, 69120 Heidelberg, Germany
| | - Florian André
- Department of Cardiology, Angiology and Pneumology, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Heidelberg/Mannheim, 69120 Heidelberg, Germany
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4
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Duran SR, Huffaker T, Dixon B, Gooty V, Abou Zahr R, Arar Y, Greer JS, Butts RJ, Hussain MT. Feasibility and safety of quantitative adenosine stress perfusion cardiac magnetic resonance imaging in pediatric heart transplant patients with and without coronary allograft vasculopathy. Pediatr Radiol 2021; 51:1311-1321. [PMID: 33791838 DOI: 10.1007/s00247-021-04977-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 11/11/2020] [Accepted: 01/21/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Pediatric heart transplant patients require cardiac catheterization to monitor for coronary allograft vasculopathy. Cardiac catheterization has no safe and consistent method for measuring microvascular disease. Stress perfusion cardiac magnetic resonance imaging (MRI) assessing microvascular disease has been performed in adults. OBJECTIVE To investigate the feasibility and safety of performing cardiac MRI with quantitative adenosine stress perfusion testing in pediatric heart transplant patients with and without coronary allograft vasculopathy. MATERIALS AND METHODS All pediatric heart transplant patients with coronary vasculopathy at our institution were asked to participate. Age- and gender-matched pediatric heart transplant patients without vasculopathy were recruited for comparison. Patients underwent cardiac MRI with adenosine stress perfusion testing. RESULTS Sixteen pediatric heart transplant patients, ages 6-22 years, underwent testing. Nine patients had vasculopathy by angiography. No heart block or other complications occurred during the study. The myocardial perfusion reserve for patients with vasculopathy showed no significant difference with comparison patients (median: 1.43 vs. 1.48; P=0.49). Values for both groups were lower than expected values based on previous adult studies. The patients were also analyzed for time after transplant and the number of rejection episodes. Patients within 6 years of transplantation had a nonsignificant trend toward a higher myocardial perfusion reserve (median: 1.57) versus patients with older transplants (median: 1.47; P=0.46). Intra- and interobserver reproducibility were 97% and 92%, respectively. CONCLUSION Myocardial perfusion reserve is a safe and feasible method for estimating myocardial perfusion in pediatric heart transplant patients. There is no reliable way to monitor microvascular disease in pediatric patients. This method shows potential and deserves investigation in a larger cohort.
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Affiliation(s)
- Silvestre R Duran
- Department of Pediatrics, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390, USA. .,Division of Pediatric Cardiology, Children's Medical Center Dallas, Dallas, TX, USA. .,Division of Pediatric Cardiology, University Hospitals Rainbow Babies & Children's Hospital, Cleveland, OH, USA.
| | - Tyler Huffaker
- Department of Pediatrics, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390, USA
| | - Bryant Dixon
- Department of Pediatrics, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390, USA
| | - Vasu Gooty
- Department of Pediatrics, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390, USA.,Division of Pediatric Cardiology, Children's Medical Center Dallas, Dallas, TX, USA
| | - Riad Abou Zahr
- Department of Pediatrics, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390, USA.,Division of Pediatric Cardiology, Children's Medical Center Dallas, Dallas, TX, USA
| | - Yousef Arar
- Department of Pediatrics, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390, USA.,Division of Pediatric Cardiology, Children's Medical Center Dallas, Dallas, TX, USA
| | - Joshua S Greer
- Department of Pediatrics, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390, USA
| | - Ryan J Butts
- Department of Pediatrics, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390, USA.,Division of Pediatric Cardiology, Children's Medical Center Dallas, Dallas, TX, USA
| | - Mohammad T Hussain
- Department of Pediatrics, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390, USA.,Division of Pediatric Cardiology, Children's Medical Center Dallas, Dallas, TX, USA
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5
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Ochs MM, Kajzar I, Salatzki J, Ochs AT, Riffel J, Osman N, Katus HA, Friedrich MG. Hyperventilation/Breath-Hold Maneuver to Detect Myocardial Ischemia by Strain-Encoded CMR: Diagnostic Accuracy of a Needle-Free Stress Protocol. JACC Cardiovasc Imaging 2021; 14:1932-1944. [PMID: 33865775 DOI: 10.1016/j.jcmg.2021.02.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 02/04/2021] [Accepted: 02/18/2021] [Indexed: 12/28/2022]
Abstract
OBJECTIVES The purpose of this study was to evaluate the diagnostic accuracy of a fast, needle-free test for myocardial ischemia using fast Strain-ENCoded (fSENC) cardiovascular MR (CMR) after a hyperventilation/breath-hold maneuver (HVBH). BACKGROUND Myocardial stress testing is one of the most frequent diagnostic tests performed. Recent data indicate that CMR first-pass perfusion outperforms other modalities. Its use, however, is limited by the need for both, a vasodilatory stress and the intravenous application of gadolinium. Both are associated with added cost, safety concerns, and patient inconvenience. The combination of 2 novel CMR approaches, fSENC, an ultrafast technique to visualize myocardial strain, and HVBH, a physiological vasodilator, may overcome these limitations. METHODS Patients referred for CMR stress testing underwent an extended protocol to evaluate 3 different tests: 1) adenosine-perfusion; 2) adenosine-strain; and 3) HVBH-strain. Diagnostic accuracy was assessed using quantitative coronary angiography as reference. RESULTS A total of 122 patients (age 66 ± 11years; 80% men) suspected of obstructive coronary artery disease were enrolled. All participants completed the protocol without significant adverse events. Adenosine-strain and HVBH-strain provided significantly better diagnostic accuracy than adenosine-perfusion, both on a patient level (adenosine-strain: sensitivity 82%, specificity 83%; HVBH-strain: sensitivity 81%, specificity 86% vs. adenosine-perfusion: sensitivity 67%, specificity 92%; p < 0.05) and territory level (adenosine-strain: sensitivity 67%, specificity 93%; HVBH-strain: sensitivity 63%, specificity 95% vs. adenosine-perfusion: sensitivity 49%, specificity 96%; p < 0.05). However, these differences in diagnostic accuracy disappear by excluding patients with history of coronary artery bypass graft or previous myocardial infarction. The response of longitudinal strain differs significantly between ischemic and nonischemic segments to adenosine (ΔLSischemic = 0.6 ± 5.4%, ΔLSnonischemic = -0.9 ± 2.7%; p < 0.05) and HVBH (ΔLSischemic = 1.3% ± 3.8%, ΔLSnonischemic = -0.3 ± 1.8%; p = 0.002). Test duration of HVBH-strain (t = 64 ± 2 s) was significantly shorter compared with adenosine-strain (t = 184 ± 59 s; p < 0.0001) and adenosine-perfusion (t = adenosine-perfusion: 172 ± 59 s; p < 0.0001). CONCLUSIONS HVBH-strain has a high diagnostic accuracy in detecting significant coronary artery stenosis. It is not only significantly faster than any other method but also neither requires contrast agents nor pharmacological stressors.
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Affiliation(s)
- Marco M Ochs
- Department of Cardiology, University of Heidelberg, Heidelberg, Germany; DZHK (German Centre for Cardiovascular Research), partner site Heidelberg, Germany.
| | - Isabelle Kajzar
- Department of Cardiology, University of Heidelberg, Heidelberg, Germany; DZHK (German Centre for Cardiovascular Research), partner site Heidelberg, Germany
| | - Janek Salatzki
- Department of Cardiology, University of Heidelberg, Heidelberg, Germany; DZHK (German Centre for Cardiovascular Research), partner site Heidelberg, Germany
| | - Andreas T Ochs
- Department of Cardiology, University of Heidelberg, Heidelberg, Germany; DZHK (German Centre for Cardiovascular Research), partner site Heidelberg, Germany
| | - Johannes Riffel
- Department of Cardiology, University of Heidelberg, Heidelberg, Germany; DZHK (German Centre for Cardiovascular Research), partner site Heidelberg, Germany
| | - Nael Osman
- MyocardialSolutions, Morrisville, North Carolina, USA
| | - Hugo A Katus
- Department of Cardiology, University of Heidelberg, Heidelberg, Germany; DZHK (German Centre for Cardiovascular Research), partner site Heidelberg, Germany
| | - Matthias G Friedrich
- Department of Cardiology, University of Heidelberg, Heidelberg, Germany; DZHK (German Centre for Cardiovascular Research), partner site Heidelberg, Germany; Departments of Medicine and Diagnostic Radiology, McGill University Health Centre, Montreal, Quebec, Canada
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6
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WITHDRAWN: The impact of dark-blood versus conventional bright-blood late gadolinium enhancement on the myocardial ischemic burden. Eur J Radiol 2021. [DOI: 10.1016/j.ejrad.2021.109728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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7
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Milidonis X, Franks R, Schneider T, Sánchez-González J, Sammut EC, Plein S, Chiribiri A. Influence of the arterial input sampling location on the diagnostic accuracy of cardiovascular magnetic resonance stress myocardial perfusion quantification. J Cardiovasc Magn Reson 2021; 23:35. [PMID: 33775247 PMCID: PMC8006361 DOI: 10.1186/s12968-021-00733-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 01/12/2021] [Accepted: 02/09/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Quantification of myocardial blood flow (MBF) and myocardial perfusion reserve (MPR) by cardiovascular magnetic resonance (CMR) perfusion requires sampling of the arterial input function (AIF). While variation in the AIF sampling location is known to impact quantification by CMR and positron emission tomography (PET) perfusion, there is no evidence to support the use of a specific location based on their diagnostic accuracy in the detection of coronary artery disease (CAD). This study aimed to evaluate the accuracy of stress MBF and MPR for different AIF sampling locations for the detection of abnormal myocardial perfusion with expert visual assessment as the reference. METHODS Twenty-five patients with suspected or known CAD underwent vasodilator stress-rest perfusion with a dual-sequence technique at 3T. A low-resolution slice was acquired in 3-chamber view to allow AIF sampling at five different locations: left atrium (LA), basal left ventricle (bLV), mid left ventricle (mLV), apical left ventricle (aLV) and aortic root (AoR). MBF and MPR were estimated at the segmental level using Fermi function-constrained deconvolution. Segments were scored as having normal or abnormal perfusion by visual assessment and the diagnostic accuracy of stress MBF and MPR for each location was evaluated using receiver operating characteristic curve analysis. RESULTS In both normal (300 out of 400, 75 %) and abnormal segments, rest MBF, stress MBF and MPR were significantly different across AIF sampling locations (p < 0.001). Stress MBF for the AoR (normal: 2.42 (2.15-2.84) mL/g/min; abnormal: 1.71 (1.28-1.98) mL/g/min) had the highest diagnostic accuracy (sensitivity 80 %, specificity 85 %, area under the curve 0.90; p < 0.001 versus stress MBF for all other locations including bLV: normal: 2.78 (2.39-3.14) mL/g/min; abnormal: 2.22 (1.83-2.48) mL/g/min; sensitivity 91 %, specificity 63 %, area under the curve 0.81) and performed better than MPR for the LV locations (p < 0.01). MPR for the AoR (normal: 2.43 (1.95-3.14); abnormal: 1.58 (1.34-1.90)) was not superior to MPR for the bLV (normal: 2.59 (2.04-3.20); abnormal: 1.69 (1.36-2.14); p = 0.717). CONCLUSIONS The AIF sampling location has a significant impact on MBF and MPR estimates by CMR perfusion, with AoR-based stress MBF comparing favorably to that for the current clinical reference bLV.
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Affiliation(s)
- Xenios Milidonis
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK.
| | - Russell Franks
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Torben Schneider
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
- Philips Healthcare, Guilford, UK
| | | | - Eva C Sammut
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
- Bristol Heart Institute and Translational Biomedical Research Centre, Faculty of Health Science, University of Bristol, Bristol, UK
| | - Sven Plein
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Amedeo Chiribiri
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
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8
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Raj V, Pudhiavan A, Hrishikesh VJ, Ali A, Kothari R. Safety profile of adenosine stress cardiac MRI in a tertiary hospital in India. Indian J Radiol Imaging 2021; 30:459-464. [PMID: 33737775 PMCID: PMC7954153 DOI: 10.4103/ijri.ijri_283_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 06/17/2020] [Accepted: 09/01/2020] [Indexed: 11/22/2022] Open
Abstract
Background: Coronary artery disease (CAD) is a major cause of morbidity and mortality in India. Stress Cardiac Magnetic Resonance (CMR) using vasodilator agent is well established in assessing the functional significance of CAD. Adenosine is the preferred agent, but can have severe side effects including dyspnoea, chest pain, atrioventricular block or bronchospasm. The stress CMR examination is not routinely performed in many of the clinical imaging departments in India. Objective: The aim of this study was to establish safety of adenosine as a pharmacological stressor agent for CMR in a tertiary care radiology department in India. Methods: A review of all patients undergoing stress CMR in our institution from May 2018 to May 2019 was made. Records were reviewed to collect response parameters and documented adverse reactions. Results: A total of 1057 patients underwent stress CMR during this period. No death, myocardial infarction or atrio-ventricular block related complications were seen. Transient hypotension was seen in 20 patients (1.8') with spontaneous recovery after stopping infusion. Chest pain and breathlessness severe enough to discontinue the scan were seen in 6 (0.5') and 10 (0.9') patients, respectively. All patients with breathlessness recovered on low flow oxygen therapy with three requiring bronchodilator. Out of six patients with chest pain, three had immediate relief with sublingual nitroglycerin, and three required hospital admission for unstable angina. Of the latter three, 1 underwent revascularization on the same day and other two later in the week. Conclusion: Stress CMR using adenosine in appropriately selected patients is a highly safe procedure with significant side effects seen in less than 1’ of patients. Therefore, it is safe to perform stress CMR studies in a fully equipped and well-trained radiology department in India.
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Affiliation(s)
- Vimal Raj
- Cardiothoracic Imaging Unit, Narayana Institute of Cardiac Sciences, Narayana Health City, Hosur Road, Bommasandra Industrial Estate, Bangalore, Karnataka, India
| | - A Pudhiavan
- Cardiothoracic Imaging Unit, Narayana Institute of Cardiac Sciences, Narayana Health City, Hosur Road, Bommasandra Industrial Estate, Bangalore, Karnataka, India
| | - V J Hrishikesh
- Cardiothoracic Imaging Unit, Narayana Institute of Cardiac Sciences, Narayana Health City, Hosur Road, Bommasandra Industrial Estate, Bangalore, Karnataka, India
| | - Asik Ali
- Cardiothoracic Imaging Unit, Narayana Institute of Cardiac Sciences, Narayana Health City, Hosur Road, Bommasandra Industrial Estate, Bangalore, Karnataka, India
| | - Richa Kothari
- Cardiothoracic Imaging Unit, Narayana Institute of Cardiac Sciences, Narayana Health City, Hosur Road, Bommasandra Industrial Estate, Bangalore, Karnataka, India
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9
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Buffa V, Di Renzi P. CMR in the diagnosis of ischemic heart disease. Radiol Med 2020; 125:1114-1123. [PMID: 32936388 DOI: 10.1007/s11547-020-01278-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 09/03/2020] [Indexed: 12/11/2022]
Abstract
Cardiovascular magnetic resonance has always been more often used in the last 10 years in evaluation of heart disease. Role in diagnosis of ischemia and in evaluation of myocardial infarction is well established by many scientific papers and included in current guidelines. High accuracy in evaluation of stress-induced ischemia, tissue characterization and functional parameters are the pillars the make the method widely used. In this paper are described role and techniques in diagnosis of ischemia, myocardial infarction and its sequelae.
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Affiliation(s)
- Vitaliano Buffa
- Department of Radiology, Azienda Ospedaliera San Camillo Forlanini, Rome, Italy.
| | - Paolo Di Renzi
- Department of Radiology, Ospedale San Giovanni Calibita FBF, Rome, Italy
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10
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Fares M, Critser PJ, Arruda MJ, Wilhelm CM, Rattan MS, Lang SM, Alsaied T. Pharmacologic stress cardiovascular magnetic resonance in the pediatric population: A review of the literature, proposed protocol, and two examples in patients with Kawasaki disease. CONGENIT HEART DIS 2019; 14:1166-1175. [PMID: 31498562 DOI: 10.1111/chd.12840] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 08/13/2019] [Accepted: 08/29/2019] [Indexed: 12/01/2022]
Abstract
Pharmacologic stress cardiovascular magnetic resonance (PSCMR) is a well-established and reliable diagnostic tool for evaluation of coronary artery disease in the adult population. Stress imaging overall and PSCMR in particular is less utilized in the pediatric population with limited reported data. In this review, we highlight the potential use of PSCMR in specific pediatric cohorts with congenital and acquired heart disease, and we review the reported experience. A suggested protocol is presented in addition to two case examples of patients with Kawasaki disease where PSCMR aided decision making.
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Affiliation(s)
- Munes Fares
- Division of Pediatric Cardiology, UH Rainbow Babies & Children's Hospital, Cleveland, Ohio
| | - Paul J Critser
- Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Maria J Arruda
- Division of Pediatric Cardiology, UH Rainbow Babies & Children's Hospital, Cleveland, Ohio
| | - Carolyn M Wilhelm
- Division of Pediatric Cardiology, UH Rainbow Babies & Children's Hospital, Cleveland, Ohio
| | - Mantosh S Rattan
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Sean M Lang
- Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,Faculty of Medicine, Heart Institute, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio
| | - Tarek Alsaied
- Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,Faculty of Medicine, Heart Institute, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio
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11
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Gulsin GS, Abdelaty AMSEK, Shetye A, Lai FY, Bajaj A, Das I, Deshpande A, Rao PPG, Khoo J, McCann GP, Arnold JR. Haemodynamic effects of pharmacologic stress with adenosine in patients with left ventricular systolic dysfunction. Int J Cardiol 2018; 278:157-161. [PMID: 30528627 DOI: 10.1016/j.ijcard.2018.12.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 11/13/2018] [Accepted: 12/03/2018] [Indexed: 11/15/2022]
Abstract
BACKGROUND In patients with heart failure, downregulation of adenosine receptor gene expression and impaired adenosine-related signal transduction may result in a diminished response to adenosine. This may have implications for cardiac stress testing. We evaluated the haemodynamic response to intravenous adenosine in patients with left ventricular systolic dysfunction (LVSD) undergoing stress cardiovascular magnetic resonance imaging (CMR). METHODS AND RESULTS We retrospectively examined 497 consecutive patients referred for clinical stress CMR. Blood pressure and heart rate responses with intravenous adenosine were compared in patients with normal, mild-moderately impaired and severely impaired LV systolic function (ejection fraction [EF] > 55%, 36-55% and < 35%, respectively). Following 2 min of adenosine infusion, there was a significant difference between the groups in the heart rate change from baseline, with a diminished heart rate response in patients with LVSD (p < 0.001). An increase in the dose of adenosine (up to 210 μg/kg/min) was required to achieve a sufficient haemodynamic response in more patients with severe LVSD (41%) than those with mild-moderately impaired and normal LV systolic function (24% and 19%, respectively, p < 0.001). Even with increased doses of adenosine in subjects with severe LVSD, peak haemodynamic response remained blunted. With multivariate analysis age (p < 0.001) and LVEF (p = 0.031) were independent predictors of heart rate response to adenosine. CONCLUSION Patients with reduced LVEF referred for stress CMR may have a blunted heart rate response to adenosine. Further study is warranted to determine whether this may be associated with reduced diagnostic accuracy and also the potential utility of further dose increases or alternative stressors.
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Affiliation(s)
- Gaurav S Gulsin
- Department of Cardiovascular Sciences, University of Leicester and the NIHR Biomedical Research Centre, Glenfield Hospital, Groby Road, Leicester LE3 9QP, UK
| | - Ahmed M S E K Abdelaty
- Department of Cardiovascular Sciences, University of Leicester and the NIHR Biomedical Research Centre, Glenfield Hospital, Groby Road, Leicester LE3 9QP, UK
| | - Abhishek Shetye
- Department of Cardiovascular Sciences, University of Leicester and the NIHR Biomedical Research Centre, Glenfield Hospital, Groby Road, Leicester LE3 9QP, UK
| | - Florence Y Lai
- Department of Cardiovascular Sciences, University of Leicester and the NIHR Biomedical Research Centre, Glenfield Hospital, Groby Road, Leicester LE3 9QP, UK
| | - Amrita Bajaj
- Department of Cardiovascular Sciences, University of Leicester and the NIHR Biomedical Research Centre, Glenfield Hospital, Groby Road, Leicester LE3 9QP, UK
| | - Indrajeet Das
- Department of Cardiovascular Sciences, University of Leicester and the NIHR Biomedical Research Centre, Glenfield Hospital, Groby Road, Leicester LE3 9QP, UK
| | - Aparna Deshpande
- Department of Cardiovascular Sciences, University of Leicester and the NIHR Biomedical Research Centre, Glenfield Hospital, Groby Road, Leicester LE3 9QP, UK
| | - Praveen P G Rao
- Department of Cardiovascular Sciences, University of Leicester and the NIHR Biomedical Research Centre, Glenfield Hospital, Groby Road, Leicester LE3 9QP, UK
| | - Jeffrey Khoo
- Department of Cardiovascular Sciences, University of Leicester and the NIHR Biomedical Research Centre, Glenfield Hospital, Groby Road, Leicester LE3 9QP, UK
| | - Gerry P McCann
- Department of Cardiovascular Sciences, University of Leicester and the NIHR Biomedical Research Centre, Glenfield Hospital, Groby Road, Leicester LE3 9QP, UK
| | - Jayanth R Arnold
- Department of Cardiovascular Sciences, University of Leicester and the NIHR Biomedical Research Centre, Glenfield Hospital, Groby Road, Leicester LE3 9QP, UK.
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Magnetic Resonance Myocardial Perfusion Imaging: Safety and Indications in Pediatrics and Young Adults. Pediatr Cardiol 2018; 39:275-282. [PMID: 29063953 DOI: 10.1007/s00246-017-1752-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Accepted: 10/07/2017] [Indexed: 10/18/2022]
Abstract
The purpose of this study was to assess the safety and indications for cardiac magnetic resonance (CMR) with myocardial perfusion imaging (MPI) in a cohort of children and young adults. A retrospective review of 178 children and young adults who underwent CMR with MPI was performed. Studies were categorized based on study protocols as MPI with resting perfusion only, adenosine stress MPI, exercise-induced stress MPI, and MPI for cardiac mass diagnosis. Relevant clinical history, exam indications, and adverse reactions following gadolinium-based contrast agent and adenosine administration were recorded. Studies were reviewed for the presence of myocardial perfusion defects, wall motion abnormalities, and delayed myocardial enhancement. The most common indications from MPI were congenital heart disease (CHD), Kawasaki disease, anomalous coronary artery, or myocardial mass characterization. Of these, 51% were protocoled with adenosine stress, 23% without stress, 6% with exercise stress, and 20% for cardiac mass evaluation. Excluding patients for myocardial mass evaluation, MPI defects were present in 16% (14 with adenosine stress, 1 with exercise stress, 8 on resting studies only). For cardiac mass evaluation, a mass was confirmed in 58%. No adverse reactions occurred with intravenous administration of a gadolinium-based contrast agent. Three self-limited adverse reactions, 2 patients with chest pain, and 1 patient with bradycardia, occurred following adenosine administration. MPI is a safe modality for the evaluation of pediatric and young adults with minimal adverse events. The most common indications for MPI were for the evaluation of CHD, Kawasaki disease, anomalous coronary artery, or myocardial mass characterization.
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Thomas DM, Minor MR, Aden JK, Lisanti CJ, Steel KE. Effects of adenosine and regadenoson on hemodynamics measured using cardiovascular magnetic resonance imaging. J Cardiovasc Magn Reson 2017; 19:96. [PMID: 29202847 PMCID: PMC5713097 DOI: 10.1186/s12968-017-0409-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Accepted: 11/20/2017] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Adenosine or regadenoson vasodilator stress cardiovascular magnetic resonance (CMR) is an effective non-invasive strategy for evaluating symptomatic coronary artery disease. Vasodilator injection typically precedes ventricular functional sequences to efficiently reduce overall scanning times, though the effects of vasodilators on CMR-derived ventricular volumes and function are unknown. METHODS We prospectively enrolled 25 healthy subjects to undergo consecutive adenosine and regadenoson administration. Short axis CINE datasets were obtained on a 1.5 T scanner following adenosine (140mcg/kg/min IV for 6 min) and regadenoson (0.4 mg IV over 10 s) at baseline, immediately following administration, at 5 min intervals up to 15 min. Hemodynamic response, bi-ventricular volumes and ejection fractions were determined at each time point. RESULTS Peak heart rate was observed early following administration of both adenosine and regadenoson. Heart rate returned to baseline by 10 min post-adenosine while remaining elevated at 15 min post-regadenoson (p = 0.0015). Left ventricular (LV) ejection fraction (LVEF) increased immediately following both vasodilators (p < 0.0001 for both) and returned to baseline following adenosine by 10 min (p = 0.8397). Conversely, LVEF following regadenoson remained increased at 10 min (p = 0.003) and 15 min (p = 0.0015) with a mean LVEF increase at 15 min of 4.2 ± 1.3%. Regadenoson resulted in a similar magnitude reduction in both LV end-diastolic volume index (LVEDVi) and LV end-systolic volume index (LVESVi) at 15 min whereas LVESVi resolved at 15 min following adenosine and LVEDVi remained below baseline values (p = 0.52). CONCLUSIONS Regadenoson and adenosine have significant and prolonged impact on ventricular volumes and LVEF. In patients undergoing vasodilator stress CMR where ventricular volumes and LVEF are critical components to patient care, ventricular functional sequences should be performed prior to vasodilator use or consider the use of aminophylline in the setting of regadenoson. Additionally, heart rate resolution itself is not an effective surrogate for return of ventricular volumes and LVEF to baseline.
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Affiliation(s)
- Dustin M. Thomas
- Cardiology Division, San Antonio Military Medical Center, San Antonio, TX USA
| | - Matthew R. Minor
- Department of Radiology, San Antonio Military Medical Center, San Antonio, TX USA
| | - James K. Aden
- Graduate Medical Education, San Antonio Military Medical Center, San Antonio, TX USA
| | | | - Kevin E. Steel
- Cardiology Division, San Antonio Military Medical Center, San Antonio, TX USA
- Deputy Chief Scientist, 59 MDW/ST 2200 Bergquist Drive, JBSA-Lackland, Texas, 78236 USA
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Gulsin GS, Shetye A, Khoo J, Swarbrick DJ, Levelt E, Lai FY, Squire IB, Arnold JR, McCann GP. Does stress perfusion imaging improve the diagnostic accuracy of late gadolinium enhanced cardiac magnetic resonance for establishing the etiology of heart failure? BMC Cardiovasc Disord 2017; 17:98. [PMID: 28390413 PMCID: PMC5385076 DOI: 10.1186/s12872-017-0529-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 03/31/2017] [Indexed: 12/28/2022] Open
Abstract
Background Late gadolinium enhanced cardiovascular magnetic resonance (LGE-CMR) has excellent specificity, sensitivity and diagnostic accuracy for differentiating between ischemic cardiomyopathy (ICM) and non-ischemic dilated cardiomyopathy (NICM). CMR first-pass myocardial perfusion imaging (perfusion-CMR) may also play role in distinguishing heart failure of ischemic and non-ischemic origins, although the utility of additional of stress perfusion imaging in such patients is unclear. The aim of this retrospective study was to assess whether the addition of adenosine stress perfusion imaging to LGE-CMR is of incremental value for differentiating ICM and NICM in patients with severe left ventricular systolic dysfunction (LVSD) of uncertain etiology. Methods We retrospectively identified 100 consecutive adult patients (median age 69 years (IQR 59–73)) with severe LVSD (mean LV EF 26.6 ± 7.0%) referred for perfusion-CMR to establish the underlying etiology of heart failure. The cause of heart failure was first determined on examination of CMR cine and LGE images in isolation. Subsequent examination of complete adenosine stress perfusion-CMR studies (cine, LGE and perfusion images) was performed to identify whether this altered the initial diagnosis. Results On LGE-CMR, 38 patients were diagnosed with ICM, 46 with NICM and 16 with dual pathology. With perfusion-CMR, there were 39 ICM, 44 NICM and 17 dual pathology diagnoses. There was excellent agreement in diagnoses between LGE-CMR and perfusion-CMR (κ 0.968, p<0.001). The addition of adenosine stress perfusion images to LGE-CMR altered the diagnosis in only two of the 100 patients. Conclusion The addition of adenosine stress perfusion-CMR to cine and LGE-CMR provides minimal incremental diagnostic yield for determining the etiology of heart failure in patients with severe LVSD.
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Affiliation(s)
- Gaurav S Gulsin
- Department of Cardiovascular Sciences, University of Leicester, Glenfield Hospital, Groby Road, Leicester, LE3 9QP, UK. .,The NIHR Leicester Cardiovascular Biomedical Research Unit, Glenfield Hospital, Leicester, UK.
| | - Abishek Shetye
- Department of Cardiovascular Sciences, University of Leicester, Glenfield Hospital, Groby Road, Leicester, LE3 9QP, UK.,The NIHR Leicester Cardiovascular Biomedical Research Unit, Glenfield Hospital, Leicester, UK
| | - Jeffrey Khoo
- Department of Cardiovascular Sciences, University of Leicester, Glenfield Hospital, Groby Road, Leicester, LE3 9QP, UK.,The NIHR Leicester Cardiovascular Biomedical Research Unit, Glenfield Hospital, Leicester, UK
| | - Daniel J Swarbrick
- Department of Cardiovascular Sciences, University of Leicester, Glenfield Hospital, Groby Road, Leicester, LE3 9QP, UK.,The NIHR Leicester Cardiovascular Biomedical Research Unit, Glenfield Hospital, Leicester, UK
| | - Eylem Levelt
- Department of Cardiovascular Sciences, University of Leicester, Glenfield Hospital, Groby Road, Leicester, LE3 9QP, UK.,The NIHR Leicester Cardiovascular Biomedical Research Unit, Glenfield Hospital, Leicester, UK
| | - Florence Y Lai
- Department of Cardiovascular Sciences, University of Leicester, Glenfield Hospital, Groby Road, Leicester, LE3 9QP, UK.,The NIHR Leicester Cardiovascular Biomedical Research Unit, Glenfield Hospital, Leicester, UK
| | - Iain B Squire
- Department of Cardiovascular Sciences, University of Leicester, Glenfield Hospital, Groby Road, Leicester, LE3 9QP, UK.,The NIHR Leicester Cardiovascular Biomedical Research Unit, Glenfield Hospital, Leicester, UK
| | - Jayanth R Arnold
- Department of Cardiovascular Sciences, University of Leicester, Glenfield Hospital, Groby Road, Leicester, LE3 9QP, UK.,The NIHR Leicester Cardiovascular Biomedical Research Unit, Glenfield Hospital, Leicester, UK
| | - Gerry P McCann
- Department of Cardiovascular Sciences, University of Leicester, Glenfield Hospital, Groby Road, Leicester, LE3 9QP, UK.,The NIHR Leicester Cardiovascular Biomedical Research Unit, Glenfield Hospital, Leicester, UK
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Zhang P, Chen S, Li Y, Du Q, Wang L, Sun Y, Li Y. Adenosine triphosphate stress 99mTc-methoxyisobutylisonitrile gated myocardial perfusion imaging efficacy in diagnosing stent restenosis following coronary stent implantation. Exp Ther Med 2017; 12:3897-3904. [PMID: 28101172 PMCID: PMC5228297 DOI: 10.3892/etm.2016.3875] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Accepted: 09/20/2016] [Indexed: 01/12/2023] Open
Abstract
Coronary stent restenosis rate following implantation is considerably high. The adenosine stress gated myocardial perfusion imaging (G-MPI) method has been widely used in the diagnosis, risk stratification and prognosis evaluation of coronary heart disease; however, the high cost of adenosine limits its clinical application. The aim of the present study was to investigate the efficacy of adenosine triphosphate (ATP) stress 99mTc-methoxyisobutylisonitrile (99mTc-MIBI) G-MPI for diagnosis in-stent restenosis following coronary stent implantation. Data from 66 patients with typical angina pectoris symptoms who had undergone percutaneous coronary stent implantation >3 months prior to participation in the study were analyzed. All the patients underwent ATP stress 99mTc-MIBI G-MPI and coronary artery angiography as the criterion diagnostic standard within 1 month. The sensitivity, specificity, and accuracy of ATP stress 99mTc-MIBI G-MPI in the assessment of in-stent restenosis were calculated. In addition, Fisher's exact probability methods were used to compare differences between experimental groups. Among 66 patients with a total of 99 implanted coronary arterial branches, 39 patients (59%) with 45 coronary arteries (45%) presented in-stent restenosis. The diagnostic sensitivity, specificity, accuracy, positive predictive and negative predictive value of ATP stress 99mTc-MIBI G-MPI for assessing stent restenosis in all patients were 85, 89, 86, 92 and 80%, respectively. Similarly, these values in patients with myocardial infarction were 79, 88, 83, 88 and 78%, respectively, while in patients without myocardial infarction the values were 90, 91, 90, 95 and 83%, respectively. Therefore, the diagnostic efficacy of ATP stress 99mTc-MIBI G-MPI in patients without myocardial infarction was higher compared with those with myocardial infarction; however, no significant difference was observed between the two groups. Furthermore, the sensitivity, specificity and accuracy for diagnosing LAD stent restenosis were higher compared with LCX and RCA stent restenosis, but with no significant differences observed (P>0.05). The present results indicated that ATP stress 99mTc-MIBI G-MPI had a high clinical application value for diagnosing in-stent restenosis following coronary stent implantation as a non-invasive examination tool, with the advantages of safety and low cost.
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Affiliation(s)
- Pengfei Zhang
- Department of Cardiology, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning 110001, P.R. China
| | - Song Chen
- Department of Nuclear Medicine, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning 110001, P.R. China
| | - Yang Li
- Department of Cardiology, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning 110001, P.R. China
| | - Qiuhong Du
- Department of Cardiology, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning 110001, P.R. China
| | - Lijuan Wang
- Department of Cardiology, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning 110001, P.R. China
| | - Yingxian Sun
- Department of Cardiology, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning 110001, P.R. China
| | - Yaming Li
- Department of Nuclear Medicine, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning 110001, P.R. China
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Burnstock G, Pelleg A. Cardiac purinergic signalling in health and disease. Purinergic Signal 2015; 11:1-46. [PMID: 25527177 PMCID: PMC4336308 DOI: 10.1007/s11302-014-9436-1] [Citation(s) in RCA: 99] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Accepted: 11/25/2014] [Indexed: 01/09/2023] Open
Abstract
This review is a historical account about purinergic signalling in the heart, for readers to see how ideas and understanding have changed as new experimental results were published. Initially, the focus is on the nervous control of the heart by ATP as a cotransmitter in sympathetic, parasympathetic, and sensory nerves, as well as in intracardiac neurons. Control of the heart by centers in the brain and vagal cardiovascular reflexes involving purines are also discussed. The actions of adenine nucleotides and nucleosides on cardiomyocytes, atrioventricular and sinoatrial nodes, cardiac fibroblasts, and coronary blood vessels are described. Cardiac release and degradation of ATP are also described. Finally, the involvement of purinergic signalling and its therapeutic potential in cardiac pathophysiology is reviewed, including acute and chronic heart failure, ischemia, infarction, arrhythmias, cardiomyopathy, syncope, hypertrophy, coronary artery disease, angina, diabetic cardiomyopathy, as well as heart transplantation and coronary bypass grafts.
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Affiliation(s)
- Geoffrey Burnstock
- Autonomic Neuroscience Centre, University College Medical School, Rowland Hill Street, London, NW3 2PF, UK,
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Nguyen KL, Bandettini WP, Shanbhag S, Leung SW, Wilson JR, Arai AE. Safety and tolerability of regadenoson CMR. Eur Heart J Cardiovasc Imaging 2014; 15:753-60. [PMID: 24451179 PMCID: PMC4060784 DOI: 10.1093/ehjci/jet278] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
AIMS Knowledge of adverse events associated with regadenoson perfusion cardiac magnetic resonance (CMR) and patient tolerability has implications for patient safety and staff training. We sought to assess the safety and tolerability of regadenoson stress CMR. MATERIALS AND METHODS A group of 728 consecutive patients (median age 58, 44% female) and 25 normal volunteers (median age 21, 24% female) were recruited from August 2009 to March 2012 using a prospective, cross-sectional study design. Subjects were stressed using fixed-dose regadenoson and imaged using a 1.5T MRI scanner. Symptoms and adverse events including death, myocardial infarction (MI), ventricular tachycardia (VT)/ventricular fibrillation (VF), hospitalization, arrhythmias, and haemodynamic stability were assessed. RESULTS There were no occurrences of death, MI, VT/VF, high-grade atrioventricular block, or stress-induced atrial fibrillation. Notable adverse events included one case of bronchospasm and one case of heart failure exacerbation resulting in hospitalization. The most common symptoms in patients were dyspnoea (30%, n = 217), chest discomfort (27%, n = 200), and headache (15%, n = 111). There was minimal change between baseline and peak systolic and diastolic blood pressure in both patients and volunteers (P > 0.05). A blunted heart rate response to regadenoson was noted in patients with body mass index (BMI) ≥ 30 kg/m(2) (P < 0.001), and diabetes (P = 0.001). CONCLUSIONS Regadenoson CMR is well tolerated and can be performed safely with few adverse events.
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Affiliation(s)
- Kim-Lien Nguyen
- Cardiovascular and Pulmonary Branch, National Heart, Lung and Blood Institute, National Institutes of Health, 10 Center Drive Bldg 10, Rm B1D416, MSC 1061, Bethesda, MD 20892-1061, USA Division of Cardiology, David Geffen School of Medicine at UCLA, Los Angeles, CA 90073, USA
| | - W Patricia Bandettini
- Cardiovascular and Pulmonary Branch, National Heart, Lung and Blood Institute, National Institutes of Health, 10 Center Drive Bldg 10, Rm B1D416, MSC 1061, Bethesda, MD 20892-1061, USA
| | - Sujata Shanbhag
- Cardiovascular and Pulmonary Branch, National Heart, Lung and Blood Institute, National Institutes of Health, 10 Center Drive Bldg 10, Rm B1D416, MSC 1061, Bethesda, MD 20892-1061, USA
| | - Steve W Leung
- Cardiovascular and Pulmonary Branch, National Heart, Lung and Blood Institute, National Institutes of Health, 10 Center Drive Bldg 10, Rm B1D416, MSC 1061, Bethesda, MD 20892-1061, USA Division of Cardiovascular Medicine, University of Kentucky, Lexington, KY 40536, USA
| | - Joel R Wilson
- Cardiovascular and Pulmonary Branch, National Heart, Lung and Blood Institute, National Institutes of Health, 10 Center Drive Bldg 10, Rm B1D416, MSC 1061, Bethesda, MD 20892-1061, USA Division of Cardiovascular Medicine, University of California, San Diego, San Diego, CA 92103, USA
| | - Andrew E Arai
- Cardiovascular and Pulmonary Branch, National Heart, Lung and Blood Institute, National Institutes of Health, 10 Center Drive Bldg 10, Rm B1D416, MSC 1061, Bethesda, MD 20892-1061, USA
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Burnstock G, Ralevic V. Purinergic signaling and blood vessels in health and disease. Pharmacol Rev 2013; 66:102-92. [PMID: 24335194 DOI: 10.1124/pr.113.008029] [Citation(s) in RCA: 219] [Impact Index Per Article: 19.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Purinergic signaling plays important roles in control of vascular tone and remodeling. There is dual control of vascular tone by ATP released as a cotransmitter with noradrenaline from perivascular sympathetic nerves to cause vasoconstriction via P2X1 receptors, whereas ATP released from endothelial cells in response to changes in blood flow (producing shear stress) or hypoxia acts on P2X and P2Y receptors on endothelial cells to produce nitric oxide and endothelium-derived hyperpolarizing factor, which dilates vessels. ATP is also released from sensory-motor nerves during antidromic reflex activity to produce relaxation of some blood vessels. In this review, we stress the differences in neural and endothelial factors in purinergic control of different blood vessels. The long-term (trophic) actions of purine and pyrimidine nucleosides and nucleotides in promoting migration and proliferation of both vascular smooth muscle and endothelial cells via P1 and P2Y receptors during angiogenesis and vessel remodeling during restenosis after angioplasty are described. The pathophysiology of blood vessels and therapeutic potential of purinergic agents in diseases, including hypertension, atherosclerosis, ischemia, thrombosis and stroke, diabetes, and migraine, is discussed.
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Affiliation(s)
- Geoffrey Burnstock
- Autonomic Neuroscience Centre, University College Medical School, Rowland Hill Street, London NW3 2PF, UK; and Department of Pharmacology, The University of Melbourne, Australia.
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Shao Y, Redfors B, Mattson-Hultén L, Scharing Täng M, Daryoni E, Said M, Omerovic E. Adenosine prevents isoprenaline-induced cardiac contractile and electrophysiological dysfunction. Eur J Pharmacol 2013; 718:475-83. [DOI: 10.1016/j.ejphar.2013.07.031] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2012] [Revised: 07/06/2013] [Accepted: 07/16/2013] [Indexed: 12/20/2022]
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Khan SA, Williamson EE, Foley TA, Cullen EL, Young PM, Araoz PA. Cardiac MRI of acute coronary syndrome. Future Cardiol 2013; 9:351-70. [DOI: 10.2217/fca.13.23] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Acute coronary syndrome (ACS) is a major cause of morbidity and mortality worldwide. New serological biomarkers, such as troponins, have improved the diagnosis of ACS; however, the diagnosis of ACS can still be difficult as there is marked heterogeneity in its presentation and significant overlap with other disorders presenting with chest pain. Evidence is accumulating that cardiac MRI provides information that can aid the detection and differential diagnosis of ACS, guide clinical decision-making and improve risk-stratification after an event. In this review, we present the relevant cardiac MRI techniques that can be used to detect ACS accurately, provide differential diagnosis, identify the sequelae of ACS, and determine prognostication after ACS.
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Affiliation(s)
- Shamruz Akerem Khan
- Department of Radiology, Mayo Clinic, 200 First Street, Southwest Rochester, MN 55905, USA
| | - Eric E Williamson
- Department of Radiology, Mayo Clinic, 200 First Street, Southwest Rochester, MN 55905, USA
| | - Thomas A Foley
- Department of Radiology, Mayo Clinic, 200 First Street, Southwest Rochester, MN 55905, USA
| | - Ethany L Cullen
- Department of Radiology, Mayo Clinic, 200 First Street, Southwest Rochester, MN 55905, USA
| | - Phillip M Young
- Department of Radiology, Mayo Clinic, 200 First Street, Southwest Rochester, MN 55905, USA
| | - Philip A Araoz
- Department of Radiology, Mayo Clinic, 200 First Street, Southwest Rochester, MN 55905, USA.
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Jaarsma C, Nagel E, Schalla S. A Critical Review of Different Imaging Methods for the Assessment of Myocardial Ischemia. CURRENT CARDIOVASCULAR IMAGING REPORTS 2013. [DOI: 10.1007/s12410-012-9185-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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von Knobelsdorff-Brenkenhoff F, Schulz-Menger J. Cardiovascular magnetic resonance imaging in ischemic heart disease. J Magn Reson Imaging 2012; 36:20-38. [PMID: 22696124 DOI: 10.1002/jmri.23580] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Ischemic heart disease is the most frequent etiology for cardiovascular morbidity and mortality. Early detection and accurate monitoring are essential to guide optimal patient treatment and assess the individual's prognosis. In this regard, cardiovascular magnetic resonance (CMR), which entered the arena of noninvasive cardiovascular imaging over the past two decades, became a very important imaging modality, mainly due to its unique versatility. CMR has proven accuracy and is a robust technique for the assessment of myocardial function both at rest and during stress. It also allows stress perfusion analysis with high spatial and temporal resolution, and provides a means by which to differentiate tissue such as distinguishing between reversibly and irreversibly injured myocardium. In particular, the latter aspect is a unique benefit of CMR compared with other noninvasive imaging modalities such as echocardiography and nuclear medicine, and provides novel information concerning the presence, size, transmurality, and prognosis of myocardial infarction. This article is intended to provide the reader with an overview of the various applications of CMR for the assessment of ischemic heart disease from a clinical perspective.
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Affiliation(s)
- Florian von Knobelsdorff-Brenkenhoff
- Working Group on Cardiovascular Magnetic Resonance, Medical University Berlin, Experimental Clinical Research Center, a joint cooperation of the Charité and the Max-Delbrueck-Center, Berlin, Germany
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Hall ME, Miller CD, Hundley WG. Adenosine stress cardiovascular magnetic resonance-observation unit management of patients at intermediate risk for acute coronary syndrome: a possible strategy for reducing healthcare-related costs. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2012; 14:117-25. [PMID: 22127744 DOI: 10.1007/s11936-011-0156-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
OPINION STATEMENT Although clear algorithms for diagnosis and treatment of patients with chest pain at low or high risk for an acute coronary syndrome (ACS) exist, they are less well delineated for patients presenting with chest pain with an intermediate risk for ACS. In patients presenting acutely or subacutely to emergency departments (EDs) at high risk for ACS, such as those with ST segment elevation on their 12-lead electrocardiogram (ECG), immediate contrast coronary angiography is performed. On the other hand, chest pain observation units (OUs) are recommended for managing those with chest pain at low risk for an ACS event. In this setting, these OUs are associated with lower healthcare resource utilization and improved cost-effectiveness. Cost-effective diagnosis and treatment options are important goals in healthcare delivery systems. The presentation of patients at intermediate risk for ACS represents an emerging source of resource utilization for EDs. These patients often exhibit pre-existing coronary artery disease, may have sustained prior myocardial infarction, and exhibit multiple comorbidities such as diabetes and hypercholesterolemia. Importantly, however, they will not have evidence of ST elevation on their 12-lead ECG nor will they exhibit serum markers (troponin or creatinine kinase elevations) indicative of ACS. As a consequence of existing co-morbidities, their management becomes time-consuming and may require inpatient monitoring, observation, and cardiac stress testing. Cardiovascular magnetic resonance (CMR) is a powerful tool for risk stratification and prognosis determination in patients in need of stress testing at intermediate risk of ACS. For those who present with acute chest pain syndromes, the combination of CMR in an OU setting represents a potentially attractive option for reducing healthcare-related expenditures without compromising patient outcomes. Recent study results from single centers suggest that CMR-OU care may result in fewer unnecessary hospital admissions and invasive procedures in those presenting with intermediate risk ACS. Further research utilizing stress CMR testing from multiple centers in OU settings is needed to determine if this model of care improves efficiency, reduces healthcare costs, and delivers optimum care in individuals presenting to EDs with chest pain at intermediate risk of ACS.
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Affiliation(s)
- Michael E Hall
- Department of Internal Medicine/Cardiology, Wake Forest University Health Sciences, Winston-Salem, NC, USA
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Khoo JP, Grundy BJ, Steadman CD, Sonnex EP, Coulden RA, McCann GP. Stress cardiovascular MR in routine clinical practice: referral patterns, accuracy, tolerance, safety and incidental findings. Br J Radiol 2012; 85:e851-7. [PMID: 22457320 DOI: 10.1259/bjr/14829242] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE The use of stress cardiovascular MR (CMR) to evaluate myocardial ischaemia has increased significantly over recent years. We aimed to assess the indications, incidental findings, tolerance, safety and accuracy of stress CMR in routine clinical practice. METHODS We retrospectively examined all stress CMR studies performed at our tertiary referral centre over a 20-month period. Patients were scanned at 1.5 T, using a standardised protocol with routine imaging for late gadolinium enhancement. Angiograms of patients were assessed by an interventional cardiologist blinded to the CMR data. RESULTS 654 patients were scanned (mean age 65±29 years; 63 inpatients; 9.6%). 14% of patients had incidental extracardiac findings, the commonest being liver or renal cysts (6%) and pulmonary nodules (4%). 639 patients (97.7%) received intravenous adenosine, 10 received intravenous dobutamine and 5 patients had both. Of the 15 patients who received dobutamine, 12 had no side-effects/complications, 2 experienced nausea and 1 chest tightness. Of the 644 patients who received adenosine, 43% experienced minor symptoms, 1% had transient heart block and 0.2% had severe bronchospasm requiring termination of infusion. There were no cases of hospitalisation or myocardial infarction. 241 patients also had coronary angiography. For detecting at least moderate stenosis of ≥50%, sensitivity was 86%, specificity 98% and accuracy 89%. For detecting severe stenoses of ≥70%, sensitivity was 91%, specificity 86% and overall accuracy 90%. These results compare very favourably with previous smaller research studies and meta-analyses. CONCLUSION We conclude that stress CMR, with adenosine as the main stress agent, is well tolerated, safe and accurate in routine clinical practice.
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Affiliation(s)
- J P Khoo
- Department of Cardiology, University Hospitals of Leicester NHS Trust, Glenfield Hospital, Leicester, UK
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Abstract
Imaging has a central role in the evaluation of patients with heart failure (HF). Cardiovascular magnetic resonance (CMR) is rapidly evolving as a versatile imaging modality that often provides additional information to echocardiography in patients with suspected or known HF. CMR is the only imaging modality that has the ability to assess, without exposure to ionizing radiation, cardiac function, structure (tissue characterization), perfusion, and viability. Moreover, magnetic resonance spectroscopy techniques can assess the pathophysiologic role of deranged cardiac energetics in HF. In this review we discuss the role of CMR in the evaluation of patients with HF giving particular emphasis to recent developments and the additional information that can be obtained with this imaging modality, over and above standard echocardiography.
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Affiliation(s)
- Theodoros D Karamitsos
- Department of Cardiovascular Medicine, John Radcliffe Hospital, University of Oxford, OX3 9DU, Oxford, UK.
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Myerson SG, Holloway CJ, Francis JM, Neubauer S. Cardiovascular magnetic resonance (CMR)--an update and review. PROGRESS IN NUCLEAR MAGNETIC RESONANCE SPECTROSCOPY 2011; 59:213-222. [PMID: 21920218 DOI: 10.1016/j.pnmrs.2010.12.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2010] [Accepted: 12/11/2010] [Indexed: 05/31/2023]
Affiliation(s)
- Saul G Myerson
- University of Oxford Centre for Clinical Magnetic Resonance Research (OCMR), John Radcliffe Hospital, Headley Way, Oxford OX3 9DU, United Kingdom.
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Prevalence of cardiomyopathy in asymptomatic patients with left bundle branch block referred for cardiovascular magnetic resonance imaging. Int J Cardiovasc Imaging 2011; 28:1133-40. [DOI: 10.1007/s10554-011-9931-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2011] [Accepted: 07/20/2011] [Indexed: 01/19/2023]
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Voigtländer T, Schmermund A, Bramlage P, Elsässer A, Magedanz A, Kauczor HU, Mohrs OK. The adverse events and hemodynamic effects of adenosine-based cardiac MRI. Korean J Radiol 2011; 12:424-30. [PMID: 21852902 PMCID: PMC3150669 DOI: 10.3348/kjr.2011.12.4.424] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2010] [Accepted: 03/31/2011] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE We wanted to prospectively assess the adverse events and hemodynamic effects associated with an intravenous adenosine infusion in patients with suspected or known coronary artery disease and who were undergoing cardiac MRI. MATERIALS AND METHODS One hundred and sixty-eight patients (64 ± 9 years) received adenosine (140 µg/kg/min) during cardiac MRI. Before and during the administration, the heart rate, systemic blood pressure, and oxygen saturation were monitored using a MRI-compatible system. We documented any signs and symptoms of potential adverse events. RESULTS In total, 47 out of 168 patients (28%) experienced adverse effects, which were mostly mild or moderate. In 13 patients (8%), the adenosine infusion was discontinued due to intolerable dyspnea or chest pain. No high grade atrioventricular block, bronchospasm or other life-threatening adverse events occurred. The hemodynamic measurements showed a significant increase in the heart rate during adenosine infusion (69.3 ± 11.7 versus 82.4 ± 13.0 beats/min, respectively; p < 0.001). A significant but clinically irrelevant increase in oxygen saturation occurred during adenosine infusion (96 ± 1.9% versus 97 ± 1.3%, respectively; p < 0.001). The blood pressure did not significantly change during adenosine infusion (systolic: 142.8 ± 24.0 versus 140.9 ± 25.7 mmHg; diastolic: 80.2 ± 12.5 mmHg versus 78.9 ± 15.6, respectively). CONCLUSION This study confirms the safety of adenosine infusion during cardiac MRI. A considerable proportion of all patients will experience minor adverse effects and some patients will not tolerate adenosine infusion. However, all adverse events can be successfully managed by a radiologist. The increased heart rate during adenosine infusion highlights the need to individually adjust the settings according to the patient, e.g., the number of slices of myocardial perfusion imaging.
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Chotenimitkhun R, Hundley WG. Pharmacological stress cardiovascular magnetic resonance. Postgrad Med 2011; 123:162-70. [PMID: 21566427 DOI: 10.3810/pgm.2011.05.2295] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Over the past decade, cardiovascular magnetic resonance (CMR) has evolved into a cardiac stress testing modality that can be used to diagnose myocardial ischemia using intravenous dobutamine or vasodilator perfusion agents such as adenosine or dipyridamole. Because CMR produces high-resolution tomographic images of the human heart in multiple imaging planes, it has become a highly attractive noninvasive testing modality for those suspected of having myocardial ischemia. The purpose of this article is to review the clinical, diagnostic, and prognostic utility of stress CMR testing for patients with (or suspected of having) coronary artery disease.
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Affiliation(s)
- Runyawan Chotenimitkhun
- Department of Internal Medicine, Cardiology Section, Wake Forest University School of Medicine, Winston-Salem, NC 27157-1045, USA
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Karamitsos TD, Dall'Armellina E, Choudhury RP, Neubauer S. Ischemic heart disease: comprehensive evaluation by cardiovascular magnetic resonance. Am Heart J 2011; 162:16-30. [PMID: 21742086 DOI: 10.1016/j.ahj.2011.04.011] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2010] [Accepted: 04/11/2011] [Indexed: 10/18/2022]
Abstract
Considerable technical advances over the past decade have increased the clinical application of cardiovascular magnetic resonance (CMR) imaging. A comprehensive CMR examination can accurately measure left and right ventricular size and function, identify the presence and extent of reversible versus irreversible myocardial injury, and detect inducible ischemia. Streamlined protocols allow such a CMR examination to be a time-efficient diagnostic tool in patients with coronary artery disease. Moreover, edema imaging with T2-weighted CMR allows the detection of acute coronary syndromes. In this review, we present the relevant CMR methods and discuss practical uses of CMR in acute and chronic ischemic heart disease.
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Kirschbaum SW, Nieman K, Springeling T, Weustink AC, Ramcharitar S, Mieghem CV, Rossi A, Duckers E, Serruys PW, Boersma E, de Feyter PJ, van Geuns RJM. Non-Invasive Diagnostic Workup of Patients With Suspected Stable Angina by Combined Computed Tomography Coronary Angiography and Magnetic Resonance Perfusion Imaging. Circ J 2011; 75:1678-84. [DOI: 10.1253/circj.cj-10-1154] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Sharon W. Kirschbaum
- Department of Cardiology, Erasmus University Medical Center
- Department of Radiology, Erasmus University Medical Center
| | - Koen Nieman
- Department of Cardiology, Erasmus University Medical Center
- Department of Radiology, Erasmus University Medical Center
| | - Tirza Springeling
- Department of Cardiology, Erasmus University Medical Center
- Department of Radiology, Erasmus University Medical Center
| | - Annick C. Weustink
- Department of Cardiology, Erasmus University Medical Center
- Department of Radiology, Erasmus University Medical Center
| | | | | | - Alexia Rossi
- Department of Radiology, Erasmus University Medical Center
| | - Eric Duckers
- Department of Cardiology, Erasmus University Medical Center
| | | | - Eric Boersma
- Department of Cardiology, Erasmus University Medical Center
| | - Pim J. de Feyter
- Department of Cardiology, Erasmus University Medical Center
- Department of Radiology, Erasmus University Medical Center
| | - Robert-Jan M. van Geuns
- Department of Cardiology, Erasmus University Medical Center
- Department of Radiology, Erasmus University Medical Center
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Chotenimitkhun R, Hundley WG. Identification of left ventricular myocardial ischemia and cardiac prognosis with cardiovascular magnetic resonance: updates from 2008 to 2010. Curr Cardiol Rep 2010; 13:77-85. [PMID: 21125353 DOI: 10.1007/s11886-010-0154-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Noninvasive imaging modalities are often used to manage patients with cardiovascular disease. Cardiovascular magnetic resonance (CMR) is increasingly used for diagnosing and evaluating myocardial ischemia and viability; moreover, stress CMR study results can be used to determine cardiac prognosis. In this article, we review recently published material regarding the performance of stress testing with CMR including a brief update regarding techniques, stress agents, diagnostic accuracy, prognosis, economic implications, and ongoing trials and future developments.
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Affiliation(s)
- Runyawan Chotenimitkhun
- Department of Internal Medicine, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157-1045, USA
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Karamitsos TD, Ntusi NAB, Francis JM, Holloway CJ, Myerson SG, Neubauer S. Feasibility and safety of high-dose adenosine perfusion cardiovascular magnetic resonance. J Cardiovasc Magn Reson 2010; 12:66. [PMID: 21080924 PMCID: PMC2996376 DOI: 10.1186/1532-429x-12-66] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2010] [Accepted: 11/16/2010] [Indexed: 12/01/2022] Open
Abstract
INTRODUCTION Adenosine is the most widely used vasodilator stress agent for cardiovascular magnetic resonance (CMR) perfusion studies. With the standard dose of 140 mcg/kg/min some patients fail to demonstrate characteristic haemodynamic changes: a significant increase in heart rate (HR) and mild decrease in systolic blood pressure (SBP). Whether an increase in the rate of adenosine infusion would improve peripheral and, likely, coronary vasodilatation in those patients is unknown. The aim of the present study was to assess the tolerance and safety of a high-dose adenosine protocol in patients with inadequate haemodynamic response to the standard adenosine protocol when undergoing CMR perfusion imaging. METHODS 98 consecutive patients with known or suspected coronary artery disease (CAD) underwent CMR perfusion imaging at 1.5 Tesla. Subjects were screened for contraindications to adenosine, and an electrocardiogram was performed prior to the scan. All patients initially received the standard adenosine protocol (140 mcg/kg/min for at least 3 minutes). If the haemodynamic response was inadequate (HR increase < 10 bpm or SBP decrease < 10 mmHg) then the infusion rate was increased up to a maximum of 210 mcg/kg/min (maximal infusion duration 7 minutes). RESULTS All patients successfully completed the CMR scan. Of a total of 98 patients, 18 (18%) did not demonstrate evidence of a significant increase in HR or decrease in SBP under the standard adenosine infusion rate. Following the increase in the rate of infusion, 16 out of those 18 patients showed an adequate haemodynamic response. One patient of the standard infusion group and two patients of the high-dose group developed transient advanced AV block. Significantly more patients complained of chest pain in the high-dose group (61% vs. 29%, p = 0.009). On multivariate analysis, age > 65 years and ejection fraction < 57% were the only independent predictors of blunted haemodynamic responsiveness to adenosine. CONCLUSIONS A substantial number of patients do not show adequate peripheral haemodynamic response to standard-dose adenosine stress during perfusion CMR imaging. Age and reduced ejection fraction are predictors of inadequate response to standard dose adenosine. A high-dose adenosine protocol (up to 210 mcg/kg/min) is well tolerated and results in adequate haemodynamic response in nearly all patients.
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Affiliation(s)
- Theodoros D Karamitsos
- Department of Cardiovascular Medicine, University of Oxford, John Radcliffe Hospital, UK
| | - Ntobeko AB Ntusi
- Department of Cardiovascular Medicine, University of Oxford, John Radcliffe Hospital, UK
| | - Jane M Francis
- Department of Cardiovascular Medicine, University of Oxford, John Radcliffe Hospital, UK
| | - Cameron J Holloway
- Department of Cardiovascular Medicine, University of Oxford, John Radcliffe Hospital, UK
| | - Saul G Myerson
- Department of Cardiovascular Medicine, University of Oxford, John Radcliffe Hospital, UK
| | - Stefan Neubauer
- Department of Cardiovascular Medicine, University of Oxford, John Radcliffe Hospital, UK
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Karamitsos TD, Francis JM, Myerson S, Selvanayagam JB, Neubauer S. The role of cardiovascular magnetic resonance imaging in heart failure. J Am Coll Cardiol 2009; 54:1407-24. [PMID: 19796734 DOI: 10.1016/j.jacc.2009.04.094] [Citation(s) in RCA: 275] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2009] [Revised: 04/14/2009] [Accepted: 04/28/2009] [Indexed: 01/08/2023]
Abstract
Noninvasive imaging plays a central role in the diagnosis of heart failure, assessment of prognosis, and monitoring of therapy. Cardiovascular magnetic resonance (CMR) offers a comprehensive assessment of heart failure patients and is now the gold standard imaging technique to assess myocardial anatomy, regional and global function, and viability. Furthermore, it allows assessment of perfusion and acute tissue injury (edema and necrosis), whereas in nonischemic heart failure, fibrosis, infiltration, and iron overload can be detected. The information derived from CMR often reveals the underlying etiology of heart failure, and its high measurement accuracy makes it an ideal technique for monitoring disease progression and the effects of treatment. Evidence on the prognostic value of CMR-derived parameters in heart failure is rapidly emerging. This review summarizes the advantages of CMR for patients with heart failure and its important role in key areas.
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Affiliation(s)
- Theodoros D Karamitsos
- University of Oxford Centre for Clinical Magnetic Resonance Research, Department of Cardiovascular Medicine, John Radcliffe Hospital, Oxford, United Kingdom
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van der Wall EE. Pharmacological stress: a useful exercise? Int J Cardiovasc Imaging 2009; 25:285-8. [PMID: 19145471 DOI: 10.1007/s10554-008-9420-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2008] [Accepted: 12/12/2008] [Indexed: 10/21/2022]
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