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Lim P, Agarwal V, Patel KK. How to assess nonresponsiveness to vasodilator stress. J Nucl Cardiol 2024; 36:101850. [PMID: 38518887 PMCID: PMC11180564 DOI: 10.1016/j.nuclcard.2024.101850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Revised: 03/12/2024] [Accepted: 03/13/2024] [Indexed: 03/24/2024]
Abstract
Myocardial perfusion imaging (MPI) is a powerful tool for the functional assessment of ischemia in patients with suspected or known coronary artery disease (CAD). Given that the diagnostic accuracy and prognostic value of MPI and post-test management are highly dependent on achieving an adequate stress vasodilatory response, it is critical to identify those who may not have adequately responded to vasodilator pharmacological stress agents such as adenosine, dipyridamole, and regadenoson. Caffeine, a potent inhibitor of the adenosine receptor, is a compound that can affect vasodilatory hemodynamics, result in false negative studies, and potentially alter management in cases of inaccurate test results. Vasodilator non-responsiveness can be suspected by examining hemodynamics, quantitative positron emission tomography (PET) metrics such as myocardial flow reserve (MFR), and splenic response to stress. Quantitative MFR values of 1-1.2 should raise suspicion for nonresponsiveness in the setting of normal perfusion, along with the absence of a splenic switch off. Newer metrics, such as splenic response ratio, can be used to aid in the identification of potential nonresponders to pharmacologic vasodilators.
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Affiliation(s)
- Phillip Lim
- Department of Medicine (Cardiology), Mount Sinai Morningside Hospital, Zena and Michael A. Weiner Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Vikram Agarwal
- Department of Medicine (Cardiology), Mount Sinai Morningside Hospital, Zena and Michael A. Weiner Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Krishna K Patel
- Department of Medicine (Cardiology), Mount Sinai Morningside Hospital, Zena and Michael A. Weiner Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, USA; Department of Population Health Science and Policy, Blavatnik Family Women's Health Research Institute, Icahn School of Medicine at Mount Sinai, New York, USA.
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2
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Brorson J, Gormsen LC, Madsen S, Tolbod LP, Jochumsen MR. Splenic switch-off in [ 15O]H 2O-positron emission tomography myocardial perfusion imaging using parametric blood flow images. J Nucl Cardiol 2024:101868. [PMID: 38685397 DOI: 10.1016/j.nuclcard.2024.101868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Revised: 03/29/2024] [Accepted: 04/22/2024] [Indexed: 05/02/2024]
Abstract
BACKGROUND Evaluation of sufficient adenosine response constitutes a significant challenge in myocardial perfusion imaging (MPI). Splenic switch-off in MPI studies denotes a visually (qualitatively) reduced splenic radiotracer signal during adenosine stress and is considered indicative of sufficient cardiac vasodilation. In this study, we examined semi-quantitative and quantitative approaches to splenic switch-off assessment using [15O]H2O-PET with either summed activity images or calculated parametric splenic blood flow images. METHODS Cohort 1: 90 clinical patients undergoing [15O]H2O MPI in whom adenosine response was considered clinically adequate were identified to characterize the corresponding splenic switch-off. Spleen stress/rest-ratio (SSR-ratio) was calculated as spleen stress signal intensity/spleen rest signal intensity on both summed activity and parametric blood flow images. Cohort 2: Twenty-five patients with repeat MPI due to suspected insufficient adenosine response were identified to observe if splenic switch-off on the initial MPI could predict the outcome of the repeat MPI. Cohort 3: Fifty-four patients who were considered adenosine responders on MPI and who had a coronary angiogram (CAG) follow-up within 3 months after MPI served as a separate validation group. RESULTS Splenic switch-off was present in most patients with a clinically sufficient adenosine response (Cohort 1), illustrated by both visual (74.4%-86.7%), semi-quantitative (summed activity images) (85.6%), and quantitative (parametric blood flow images) (92.2%) evaluation, which corresponds to the distribution in patients with sufficient adenosine response and follow-up CAG (Cohort 3). In patients suspected of insufficient adenosine response on the initial MPI (Cohort 2), the repeat MPI only yielded different myocardial blood flow (MBF) results if the initial SSR-ratio was >0.90 on splenic parametric blood flow images. CONCLUSION quantitative splenic switch-off assessment on parametric blood flow images was superior to the semi-quantitative splenic switch-off approach. Patients with a suspected insufficient initial adenosine response and SSR-ratio >0.90 can benefit from a repeat MPI. Thus, the integration of quantitative splenic switch-off using parametric blood flow images in the evaluation of adenosine response may support future clinical decision-making.
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Affiliation(s)
- Jonas Brorson
- Department of Nuclear Medicine and PET-Centre, Aarhus University Hospital, Denmark; Department of Biomedicine, Aarhus University, Denmark.
| | - Lars Christian Gormsen
- Department of Nuclear Medicine and PET-Centre, Aarhus University Hospital, Denmark; Department of Clinical Medicine, Aarhus University, Denmark
| | - Simon Madsen
- Department of Nuclear Medicine and PET-Centre, Aarhus University Hospital, Denmark; Department of Clinical Medicine, Aarhus University, Denmark
| | - Lars Poulsen Tolbod
- Department of Nuclear Medicine and PET-Centre, Aarhus University Hospital, Denmark; Department of Clinical Medicine, Aarhus University, Denmark
| | - Mads Ryø Jochumsen
- Department of Nuclear Medicine and PET-Centre, Aarhus University Hospital, Denmark; Department of Clinical Medicine, Aarhus University, Denmark
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3
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Saad JM, Ahmed AI, Han Y, El Nihum LI, Alahdab F, Nabi F, Al-Mallah MH. Splenic switch-off in regadenoson 82Rb-PET myocardial perfusion imaging: assessment of clinical utility. J Nucl Cardiol 2023; 30:1484-1496. [PMID: 36607537 DOI: 10.1007/s12350-022-03158-3] [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: 10/11/2022] [Accepted: 11/05/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND Splenic switch-off (SSO) is a phenomenon describing a decrease in splenic radiotracer uptake after vasodilatory stress. We aimed to assess the diagnostic utility of regadenoson-induced SSO. METHODS We included consecutive patients who had clinically indicated Regadenoson Rb-82 PET-MPI for suspected CAD. This derivation cohort (no perfusion defects and myocardial flow reserves (MFR) ≥ 2) was used to calculate the splenic response ratio (SRR). The validation cohort was defined as patients who underwent both PET-MPI studies and invasive coronary angiography (ICA). RESULTS The derivation cohort (n = 100, 57.4 ± 11.6 years, 77% female) showed a decrease in splenic uptake from rest to stress (79.9 ± 16.8 kBq⋅mL vs 69.1 ± 16.2 kBq⋅mL, P < .001). From the validation cohort (n = 315, 66.3 ± 10.4 years, 67% male), 28% (via SRR = 0.88) and 15% (visually) were classified as splenic non-responders. MFR was lower in non-responders (SRR; 1.55 ± 0.65 vs 1.76 ± 0.78, P = .02 and visually; 1.18 ± 0.33 vs 1.79 ± 0.77, P < .001). Based on ICA, non-responders were more likely to note obstructive epicardial disease with normal PET scans especially in patients with MFR < 1.5 (SRR; 61% vs 34% P = .05 and visually; 68% vs 33%, P = .01). CONCLUSION Lack of splenic response based on visual or quantitative assessment of SSO may be used to identify an inadequate vasodilatory response.
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Affiliation(s)
- Jean Michel Saad
- Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA
| | | | - Yushui Han
- Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA
| | | | - Fares Alahdab
- Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA
| | - Faisal Nabi
- Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA
| | - Mouaz H Al-Mallah
- Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA.
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Lassen ML, Wissenberg M, Byrne C, Sheykhzade M, Hurry PK, Schmedes AV, Kjær A, Hasbak P. Image-derived and physiological markers to predict adequate adenosine-induced hyperemic response in Rubidium-82 myocardial perfusion imaging. J Nucl Cardiol 2022; 29:3207-3217. [PMID: 35149976 PMCID: PMC9834126 DOI: 10.1007/s12350-022-02906-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 12/22/2021] [Indexed: 01/22/2023]
Abstract
AIMS This study aimed to investigate the potential of different markers to identify adequate stressing in subjects with and without caffeine intake prior to Rubidium-82 myocardial imaging. METHODS AND RESULTS This study comprised 40 healthy subjects who underwent four serial Rubidium-82 rest/adenosine stress MPI; two with 0mg caffeine consumption (baseline MPIs) and two with controlled consumption of caffeine (arm 1: 100 and 300mg, or arm 2: 200 and 400mg). We report the sensitivity and specificity of seven markers ability to predict adequate adenosine-induced hyperemic response: (1) the splenic response ratio (SRR); (2) splenic stress-to-rest intensity ratios (SIR); (3) changes in heart rate (ΔHR); (4) percentwise change in heart rate (Δ%HR); (5) changes in the rate pressure product (ΔRPP); (6) changes in the systolic blood pressure (ΔSBP); and (7) changes in the cardiovascular resistance (ΔCVR). Adequate stressing was determined as stress myocardial blood flow > 3ml/g/min and a corresponding myocardial flow reserve >68% of the individual maximum myocardial flow reserve obtained in the baseline MPIs. RESULTS 129 MPI sessions (obtained in 39 subjects) were considered for this study. The following sensitivities were obtained: SSR = 72.7%, SIR = 63.6%, ΔHR = 45.5%, Δ%HR = 77.3%, ΔRPP = 54.5%, ΔSBP = 47.7%, and ΔCVR =40.9%, while the specificities were SSR = 80.9%, SIR = 85.0%, ΔHR = 90.4%, Δ%HR = 81.6%, ΔRPP=81.1%, ΔSBP = 86.4%, and ΔCVR =90.4%. CONCLUSION The image-derived and physiological markers all provide acceptable sensitivities and specificities when patients follow the caffeine pausation before MPI. However, their use warrants great care when caffeine consumption cannot be ruled out.
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Affiliation(s)
- Martin Lyngby Lassen
- Department of Clinical Physiology, Nuclear Medicine & PET and Cluster for Molecular Imaging, of Biomedical Sciences, Section 4011, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen, Denmark.
| | - Mads Wissenberg
- Department of Cardiology, Copenhagen University Hospital, Gentofte, Denmark
| | - Christina Byrne
- Department of Clinical Physiology, Nuclear Medicine & PET and Cluster for Molecular Imaging, of Biomedical Sciences, Section 4011, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Majid Sheykhzade
- Department of Drug Design and Pharmacology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Preetee Kapisha Hurry
- Department of Clinical Physiology, Nuclear Medicine & PET and Cluster for Molecular Imaging, of Biomedical Sciences, Section 4011, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | | | - Andreas Kjær
- Department of Clinical Physiology, Nuclear Medicine & PET and Cluster for Molecular Imaging, of Biomedical Sciences, Section 4011, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Philip Hasbak
- Department of Clinical Physiology, Nuclear Medicine & PET and Cluster for Molecular Imaging, of Biomedical Sciences, Section 4011, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen, Denmark
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5
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Silva M, Paiva L, Teixeira R, Ferreira MJ, Gonçalves L. Microcirculation function assessment in acute myocardial infarction: A systematic review of microcirculatory resistance indices. Front Cardiovasc Med 2022; 9:1041444. [DOI: 10.3389/fcvm.2022.1041444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Accepted: 10/28/2022] [Indexed: 11/12/2022] Open
Abstract
BackgroundUp to 50% of acute myocardial infarction (MI) patients present with microvascular dysfunction, after a successful percutaneous coronary intervention (PCI), which leads to worse clinical outcomes. The main purpose of this study is to provide a critical appraisal of the emerging role of invasive microvascular resistance indices in the MI setting, using the index of microcirculatory resistance (IMR), hyperemic microvascular resistance (HMR) and zero-flow pressure (Pzf).MethodsWe systematically explored relevant studies in the context of MI that correlated microcirculation resistance indices with microvascular dysfunction on cardiac magnetic resonance (CMR), microvascular dysfunction occurring in infarct related arteries (IRA) and non-IRA and its relation to clinical outcomes.ResultsThe microcirculation resistance indices correlated significantly with microvascular obstruction (MVO) and infarct size (IS) on CMR. Although HMR and Pzf seem to have better diagnostic accuracy for MVO and IS, IMR has more validation data. Although, both IMR and HMR were independent predictors of adverse cardiovascular events, HMR has no validated cut-off value and data is limited to small observational studies. The presence of microvascular dysfunction in non-IRA does not impact prognosis.ConclusionMicrovascular resistance indices are valuable means to evaluate microcirculation function following MI. Microvascular dysfunction relates to the extent of myocardial damage and clinical outcomes after MI.Systematic review registration[https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021228432], identifier [CRD42021228432].
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Higuchi S, Ota H. Editorial for “Assessment of Splenic Switch‐Off With Arterial Spin Labeling in Adenosine Perfusion Cardiac
MRI
”. J Magn Reson Imaging 2022. [DOI: 10.1002/jmri.28465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Revised: 09/23/2022] [Accepted: 09/23/2022] [Indexed: 11/06/2022] Open
Affiliation(s)
- Satoshi Higuchi
- Department of Diagnostic Radiology Tohoku University Hospital Sendai Japan
| | - Hideki Ota
- Department of Diagnostic Radiology Tohoku University Hospital Sendai Japan
- Department of Advanced MRI Collaboration Research Tohoku University Graduate School of Medicine Sendai Japan
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7
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Bakula A, Patriki D, von Felten E, Benetos G, Sustar A, Benz DC, Wiedemann-Buser M, Treyer V, Pazhenkottil AP, Gräni C, Gebhard C, Kaufmann PA, Buechel RR, Fuchs TA. Splenic switch-off as a novel marker for adenosine response in nitrogen-13 ammonia PET myocardial perfusion imaging: Cross-validation against CMR using a hybrid PET/MR device. J Nucl Cardiol 2022; 29:1205-1214. [PMID: 33354759 PMCID: PMC9163112 DOI: 10.1007/s12350-020-02448-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 11/09/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND No methodology is available to distinguish truly reduced myocardial flow reserve (MFR) in positron emission tomography myocardial perfusion imaging (PET MPI) from seemingly impaired MFR due to inadequate adenosine response. The adenosine-induced splenic switch-off (SSO) sign has been proposed as a potential marker for adequate adenosine response in cardiac magnetic resonance (CMR). We assessed the feasibility of detecting SSO in nitrogen-13 ammonia PET MPI using SSO in CMR as the standard of reference. METHODS AND RESULTS Fifty patients underwent simultaneous CMR and PET MPI on a hybrid PET/MR device with co-injection of a gadolinium-based contrast agent and nitrogen-13 ammonia during rest and adenosine-induced stress. In CMR, SSO was assessed visually (positive vs negative SSO) and quantitatively by calculating the ratio of the peak signal intensity of the spleen during stress over rest (SIR). In PET MPI, the splenic signal activity ratio (SAR) was calculated as the maximal standard uptake value of the spleen during stress over rest. The median SIR was significantly lower in patients with positive versus negative SSO in CMR (0.57 [IQR 0.49 to 0.62] vs 0.89 [IQR 0.76 to 0.98]; P < .001). Similarly, median SAR in PET MPI was significantly lower in patients with positive versus negative SSO (0.40 [IQR 0.32 to 0.45] vs 0.80 [IQR 0.47 to 0.98]; P < .001). CONCLUSION Similarly to CMR, SSO can be detected in nitrogen-13 ammonia PET MPI. This might help distinguish adenosine non-responders from patients with truly impaired MFR due to microvascular dysfunction or multivessel coronary artery disease.
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Affiliation(s)
- Adam Bakula
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
| | - Dimitri Patriki
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
| | - Elia von Felten
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
| | - Georgios Benetos
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
| | - Aleksandra Sustar
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
| | - Dominik C Benz
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
| | - Muriel Wiedemann-Buser
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
| | - Valerie Treyer
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
| | - Aju P Pazhenkottil
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
| | - Christoph Gräni
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
| | - Catherine Gebhard
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
| | - Philipp A Kaufmann
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
| | - Ronny R Buechel
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
| | - Tobias A Fuchs
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland.
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8
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Sakuma H, Ishida M. Advances in Myocardial Perfusion MR Imaging: Physiological Implications, the Importance of Quantitative Analysis, and Impact on Patient Care in Coronary Artery Disease. Magn Reson Med Sci 2022; 21:195-211. [PMID: 34108304 PMCID: PMC9199984 DOI: 10.2463/mrms.rev.2021-0033] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 04/27/2021] [Indexed: 11/09/2022] Open
Abstract
Stress myocardial perfusion imaging (MPI) is the preferred test in patients with intermediate-to-high clinical likelihood of coronary artery disease (CAD) and can be used as a gatekeeper to avoid unnecessary revascularization. Cardiac magnetic resonance (CMR) has a number of favorable characteristics, including: (1) high spatial resolution that can delineate subendocardial ischemia; (2) comprehensive assessment of morphology, global and regional cardiac functions, tissue characterization, and coronary artery stenosis; and (3) no radiation exposure to patients. According to meta-analysis studies, the diagnostic accuracy of perfusion CMR is comparable to positron emission tomography (PET) and perfusion CT, and is better than single-photon emission CT (SPECT) when fractional flow reserve (FFR) is used as a reference standard. In addition, stress CMR has an excellent prognostic value. One meta-analysis study demonstrated the annual event rate of cardiovascular death or non-fatal myocardial infarction was 4.9% and 0.8%, respectively, in patients with positive and negative stress CMR. Quantitative assessment of perfusion CMR not only allows the objective evaluation of regional ischemia but also provides insights into the pathophysiology of microvascular disease and diffuse subclinical atherosclerosis. For accurate quantification of myocardial perfusion, saturation correction of arterial input function is important. There are two major approaches for saturation correction, one is a dual-bolus method and the other is a dual-sequence method. Absolute quantitative mapping with myocardial perfusion CMR has good accuracy in detecting coronary microvascular dysfunction. Flow measurement in the coronary sinus (CS) with phase contrast cine CMR is an alternative approach to quantify global coronary flow reserve (CFR). The measurement of global CFR by quantitative analysis of perfusion CMR or flow measurement in the CS permits assessment of microvascular disease and diffuse subclinical atherosclerosis, which may provide improved prediction of future event risk in patients with suspected or known CAD. Multi-institutional studies to validate the diagnostic and prognostic values of quantitative perfusion CMR approaches are required.
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Affiliation(s)
- Hajime Sakuma
- Department of Radiology, Mie University Graduate School of Medicine, Tsu, Mie, Japan
| | - Masaki Ishida
- Department of Radiology, Mie University Graduate School of Medicine, Tsu, Mie, Japan
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9
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Kotecha T, Monteagudo JM, Martinez-Naharro A, Chacko L, Brown J, Knight D, Knott KD, Hawkins P, Moon JC, Plein S, Xue H, Kellman P, Lockie T, Patel N, Rakhit R, Fontana M. Quantitative cardiovascular magnetic resonance myocardial perfusion mapping to assess hyperaemic response to adenosine stress. Eur Heart J Cardiovasc Imaging 2021; 22:273-281. [PMID: 33188683 DOI: 10.1093/ehjci/jeaa252] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Indexed: 11/13/2022] Open
Abstract
AIMS Assessment of hyperaemia during adenosine stress cardiovascular magnetic resonance (CMR) remains a clinical challenge with lack of a gold-standard non-invasive clinical marker to confirm hyperaemic response. This study aimed to validate maximum stress myocardial blood flow (SMBF) measured using quantitative perfusion mapping for assessment of hyperaemic response and compare this to current clinical markers of adenosine stress. METHODS AND RESULTS Two hundred and eighteen subjects underwent adenosine stress CMR. A derivation cohort (22 volunteers) was used to identify a SMBF threshold value for hyperaemia. This was tested in a validation cohort (37 patients with suspected coronary artery disease) who underwent invasive coronary physiology assessment on the same day as CMR. A clinical cohort (159 patients) was used to compare SMBF to other physiological markers of hyperaemia [splenic switch-off (SSO), heart rate response (HRR), and blood pressure (BP) fall]. A minimum SMBF threshold of 1.43 mL/g/min was derived from volunteer scans. All patients in the coronary physiology cohort demonstrated regional maximum SMBF (SMBFmax) >1.43 mL/g/min and invasive evidence of hyperaemia. Of the clinical cohort, 93% had hyperaemia defined by perfusion mapping compared to 71% using SSO and 81% using HRR. There was no difference in SMBFmax in those with or without SSO (2.58 ± 0.89 vs. 2.54 ± 1.04 mL/g/min, P = 0.84) but those with HRR had significantly higher SMBFmax (2.66 1.86 mL/g/min, P < 0.001). HRR >15 bpm was superior to SSO in predicting adequate increase in SMBF (AUC 0.87 vs. 0.62, P < 0.001). CONCLUSION Adenosine-induced increase in myocardial blood flow is accurate for confirmation of hyperaemia during stress CMR studies and is superior to traditional, clinically used markers of adequate stress such as SSO and BP response.
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Affiliation(s)
- Tushar Kotecha
- Institute of Cardiovascular Science, University College London, London, UK.,Department of Cardiology, Royal Free Hospital, Pond Street, London, UK
| | | | - Ana Martinez-Naharro
- Department of Cardiology, Royal Free Hospital, Pond Street, London, UK.,Division of Medicine, University College London, London, UK
| | - Liza Chacko
- Department of Cardiology, Royal Free Hospital, Pond Street, London, UK.,Division of Medicine, University College London, London, UK
| | - James Brown
- Institute of Cardiovascular Science, University College London, London, UK.,Department of Cardiology, Royal Free Hospital, Pond Street, London, UK
| | - Daniel Knight
- Institute of Cardiovascular Science, University College London, London, UK.,Department of Cardiology, Royal Free Hospital, Pond Street, London, UK
| | - Kristopher D Knott
- Institute of Cardiovascular Science, University College London, London, UK.,Department of Cardiovascular Magnetic Resonance, Barts Heart Centre, London, UK
| | - Philip Hawkins
- Department of Cardiology, Royal Free Hospital, Pond Street, London, UK.,Division of Medicine, University College London, London, UK
| | - James C Moon
- Institute of Cardiovascular Science, University College London, London, UK.,Department of Cardiovascular Magnetic Resonance, Barts Heart Centre, London, UK
| | - Sven Plein
- Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Hui Xue
- Medical Signal and Imaging Processing Program, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Peter Kellman
- Medical Signal and Imaging Processing Program, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Tim Lockie
- Department of Cardiology, Royal Free Hospital, Pond Street, London, UK
| | - Niket Patel
- Institute of Cardiovascular Science, University College London, London, UK.,Department of Cardiology, Royal Free Hospital, Pond Street, London, UK
| | - Roby Rakhit
- Institute of Cardiovascular Science, University College London, London, UK.,Department of Cardiology, Royal Free Hospital, Pond Street, London, UK
| | - Marianna Fontana
- Department of Cardiology, Royal Free Hospital, Pond Street, London, UK.,Division of Medicine, University College London, London, UK
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10
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Farzaneh-Far A, Wong J. Stressed enough? Hyperaemic thresholds during quantitative cardiovascular magnetic resonance perfusion mapping. Eur Heart J Cardiovasc Imaging 2021; 22:282-284. [PMID: 33338199 DOI: 10.1093/ehjci/jeaa268] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Indexed: 11/13/2022] Open
Affiliation(s)
- Afshin Farzaneh-Far
- Division of Cardiology, Department of Medicine, University of Illinois at Chicago, 840 South Wood St. M/C 715, Suite 920 S, Chicago, IL 60612, USA.,Division of Cardiology, Department of Medicine, Duke University, Durham, NC, USA
| | - Joyce Wong
- Department of Cardiology, Harefield Hospital, Royal Brompton and Harefield NHS Foundation Trust, Harefield, UK
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11
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Brown LAE, Saunderson CED, Das A, Craven T, Levelt E, Knott KD, Dall’Armellina E, Xue H, Moon JC, Greenwood JP, Kellman P, Swoboda PP, Plein S. A comparison of standard and high dose adenosine protocols in routine vasodilator stress cardiovascular magnetic resonance: dosage affects hyperaemic myocardial blood flow in patients with severe left ventricular systolic impairment. J Cardiovasc Magn Reson 2021; 23:37. [PMID: 33731141 PMCID: PMC7971951 DOI: 10.1186/s12968-021-00714-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 01/26/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Adenosine stress perfusion cardiovascular magnetic resonance (CMR) is commonly used in the assessment of patients with suspected ischaemia. Accepted protocols recommend administration of adenosine at a dose of 140 µg/kg/min increased up to 210 µg/kg/min if required. Conventionally, adequate stress has been assessed using change in heart rate, however, recent studies have suggested that these peripheral measurements may not reflect hyperaemia and can be blunted, in particular, in patients with heart failure. This study looked to compare stress myocardial blood flow (MBF) and haemodynamic response with different dosing regimens of adenosine during stress perfusion CMR in patients and healthy controls. METHODS 20 healthy adult subjects were recruited as controls to compare 3 adenosine perfusion protocols: standard dose (140 µg/kg/min for 4 min), high dose (210 µg/kg/min for 4 min) and long dose (140 µg/kg/min for 8 min). 60 patients with either known or suspected coronary artery disease (CAD) or with heart failure and different degrees of left ventricular (LV) dysfunction underwent adenosine stress with standard and high dose adenosine within the same scan. All studies were carried out on a 3 T CMR scanner. Quantitative global myocardial perfusion and haemodynamic response were compared between doses. RESULTS In healthy controls, no significant difference was seen in stress MBF between the 3 protocols. In patients with known or suspected CAD, and those with heart failure and mild systolic impairment (LV ejection fraction (LVEF) ≥ 40%) no significant difference was seen in stress MBF between standard and high dose adenosine. In those with LVEF < 40%, there was a significantly higher stress MBF following high dose adenosine compared to standard dose (1.33 ± 0.46 vs 1.10 ± 0.47 ml/g/min, p = 0.004). Non-responders to standard dose adenosine (defined by an increase in heart rate (HR) < 10 bpm) had a significantly higher stress HR following high dose (75 ± 12 vs 70 ± 14 bpm, p = 0.034), but showed no significant difference in stress MBF. CONCLUSIONS Increasing adenosine dose from 140 to 210 µg/kg/min leads to increased stress MBF in patients with significantly impaired LV systolic function. Adenosine dose in clinical perfusion assessment may need to be increased in these patients.
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Affiliation(s)
- Louise A. E. Brown
- Multidisciplinary Cardiovascular Research Centre (MCRC) & Biomedical Imaging Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Clarendon Way, Leeds, LS2 9JT UK
| | - Christopher E. D. Saunderson
- Multidisciplinary Cardiovascular Research Centre (MCRC) & Biomedical Imaging Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Clarendon Way, Leeds, LS2 9JT UK
| | - Arka Das
- Multidisciplinary Cardiovascular Research Centre (MCRC) & Biomedical Imaging Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Clarendon Way, Leeds, LS2 9JT UK
| | - Thomas Craven
- Multidisciplinary Cardiovascular Research Centre (MCRC) & Biomedical Imaging Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Clarendon Way, Leeds, LS2 9JT UK
| | - Eylem Levelt
- Multidisciplinary Cardiovascular Research Centre (MCRC) & Biomedical Imaging Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Clarendon Way, Leeds, LS2 9JT UK
| | - Kristopher D. Knott
- The Cardiovascular Magnetic Resonance Imaging Unit and The Inherited Cardiovascular Diseases Unit, Barts Heart Centre, St Bartholomew’s Hospital, West Smithfield, London, UK
- National Heart, Lung, and Blood Institute, National Institutes of Health, DHHS, Bethesda, MD USA
| | - Erica Dall’Armellina
- Multidisciplinary Cardiovascular Research Centre (MCRC) & Biomedical Imaging Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Clarendon Way, Leeds, LS2 9JT UK
| | - Hui Xue
- National Heart, Lung, and Blood Institute, National Institutes of Health, DHHS, Bethesda, MD USA
| | - James C. Moon
- The Cardiovascular Magnetic Resonance Imaging Unit and The Inherited Cardiovascular Diseases Unit, Barts Heart Centre, St Bartholomew’s Hospital, West Smithfield, London, UK
- National Heart, Lung, and Blood Institute, National Institutes of Health, DHHS, Bethesda, MD USA
| | - John P. Greenwood
- Multidisciplinary Cardiovascular Research Centre (MCRC) & Biomedical Imaging Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Clarendon Way, Leeds, LS2 9JT UK
| | - Peter Kellman
- Multidisciplinary Cardiovascular Research Centre (MCRC) & Biomedical Imaging Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Clarendon Way, Leeds, LS2 9JT UK
- The Cardiovascular Magnetic Resonance Imaging Unit and The Inherited Cardiovascular Diseases Unit, Barts Heart Centre, St Bartholomew’s Hospital, West Smithfield, London, UK
- National Heart, Lung, and Blood Institute, National Institutes of Health, DHHS, Bethesda, MD USA
| | - Peter P. Swoboda
- Multidisciplinary Cardiovascular Research Centre (MCRC) & Biomedical Imaging Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Clarendon Way, Leeds, LS2 9JT UK
| | - Sven Plein
- Multidisciplinary Cardiovascular Research Centre (MCRC) & Biomedical Imaging Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Clarendon Way, Leeds, LS2 9JT UK
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12
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Patriki D, von Felten E, Bakula A, Giannopoulos AA, Kamani CH, Schwyzer M, Messerli M, Benz DC, Gebhard C, Gräni C, Pazhenkottil AP, Kaufmann PA, Fuchs TA, Buechel RR. Splenic switch-off as a predictor for coronary adenosine response: validation against 13N-ammonia during co-injection myocardial perfusion imaging on a hybrid PET/CMR scanner. J Cardiovasc Magn Reson 2021; 23:3. [PMID: 33407586 PMCID: PMC7789581 DOI: 10.1186/s12968-020-00696-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 12/09/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Inadequate coronary adenosine response is a potential cause for false negative ischemia testing. Recently, the splenic switch-off (SSO) sign has been identified as a promising tool to ascertain the efficacy of adenosine during vasodilator stress cardiovascular magnetic resonance imaging (CMR). We assessed the value of SSO to predict adenosine response, defined as an increase in myocardial blood flow (MBF) during quantitative stress myocardial perfusion 13 N-ammonia positron emission tomography (PET). METHODS We prospectively enrolled 64 patients who underwent simultaneous CMR and PET myocardial perfusion imaging on a hybrid PET/CMR scanner with co-injection of gadolinium based contrast agent (GBCA) and 13N-ammonia during rest and adenosine-induced stress. A myocardial flow reserve (MFR) of > 1.5 or ischemia as assessed by PET were defined as markers for adequate coronary adenosine response. The presence or absence of SSO was visually assessed. The stress-to-rest intensity ratio (SIR) was calculated as the ratio of stress over rest peak signal intensity for splenic tissue. Additionally, the spleen-to-myocardium ratio, defined as the relative change of spleen to myocardial signal, was calculated for stress (SMRstress) and rest. RESULTS Sixty-one (95%) patients were coronary adenosine responders, but SSO was absent in 18 (28%) patients. SIR and SMRstress were significantly lower in patients with SSO (SIR: 0.56 ± 0.13 vs. 0.93 ± 0.23; p < 0.001 and SMRstress: 1.09 ± 0.47 vs. 1.68 ± 0.62; p < 0.001). Mean hyperemic and rest MBF were 2.12 ± 0.68 ml/min/g and 0.78 ± 0.26 ml/min/g, respectively. MFR was significantly higher in patients with vs. patients without presence of SSO (3.07 ± 1.03 vs. 2.48 ± 0.96; p = 0.038), but there was only a weak inverse correlation between SMRstress and MFR (R = -0.378; p = 0.02) as well as between SIR and MFR (R = -0.356; p = 0.004). CONCLUSIONS The presence of SSO implies adequate coronary adenosine-induced MBF response. Its absence, however, is not a reliable indicator for failed adenosine-induced coronary vasodilatation.
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Affiliation(s)
- Dimitri Patriki
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich and University Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
| | - Elia von Felten
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich and University Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
| | - Adam Bakula
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich and University Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
| | - Andreas A Giannopoulos
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich and University Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
| | - Christel H Kamani
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich and University Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
| | - Moritz Schwyzer
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich and University Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
| | - Michael Messerli
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich and University Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
| | - Dominik C Benz
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich and University Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
| | - Catherine Gebhard
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich and University Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
| | - Christoph Gräni
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich and University Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
| | - Aju P Pazhenkottil
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich and University Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
| | - Philipp A Kaufmann
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich and University Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
| | - Tobias A Fuchs
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich and University Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
| | - Ronny R Buechel
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich and University Zurich, Ramistrasse 100, 8091, Zurich, Switzerland.
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13
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Gezmiş E, Peebles C, Flett A, Abbas A, Harden S, Shambrook J. Comparison of MOLLI and ShMOLLI in Terms of T1 Reactivity and the Relationship between T1 Reactivity and Conventional Signs of Response during Adenosine Stress Perfusion CMR. Balkan Med J 2020; 37:260-268. [PMID: 32319279 PMCID: PMC7424177 DOI: 10.4274/balkanmedj.galenos.2020.2019.12.161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Background: One of the most important techniques of cardiac magnetic resonance in assessment of coronary heart diseases is adenosine stress myocardial first-pass perfusion imaging. Using this imaging method, there should be an adequate response to the drug adenosine to make an accurate evaluation. The conventional signs of drug response are not always observed and are often subjective. Methods based on splenic perfusion might possess limitations as well. Therefore, T1 mapping presents as a novel, quantitative and reliable method. There are several studies analyzing this newly discovered property of different T1 mapping sequences. However most of these studies are enrolling only one of the techniques. Aims: To compare modified look-locker inversion recovery and shortened modified look-locker inversion recovery sequences in terms of T1 reactivity and to determine the relationship between T1 reactivity and conventional stress adequacy assessment methods in adenosine stress perfusion cardiac magnetic resonance. Study Design: A cross-sectional study using STARD reporting guideline. Methods: Thirty-four consecutive patients, who were referred for adenosine stress perfusion cardiac magnetic resonance with suspect of myocardial ischemia, were prospectively enrolled into the study. Four patients were disqualified, and thirty patients were included in the final analysis. Using both modified look-locker inversion recovery and shortened modified look-locker inversion recovery, midventricular short axis slices of T1 maps were acquired at rest and during peak adenosine stress before gadolinium administration. Then, they were divided into six segments according to the 17-segment model proposed by the American Heart Association, and separate measurements were made from each segment. Mean rest and mean stress T1 values of remote, ischemic, and infarcted myocardium were calculated individually per subject. During adenosine administration, patients’ heart rates and blood pressures are measured and recorded every one minute. Adenosine stress perfusion images were examined for the presence of splenic switch-off. Results: There was a significant difference between rest and stress T1 values of remote myocardium in both modified look-locker inversion recovery and shortened modified look-locker inversion recovery (p<0.001). In both modified look-locker inversion recovery and shortened modified look-locker inversion recovery there was no significant correlation between T1 reactivity and heart rates response (modified look-locker inversion recovery p=0.30, shortened modified look-locker inversion recovery p=0.10), blood pressures response (modified look-locker inversion recovery p=0.062, shortened modified look-locker inversion recovery p=0.078), splenic perfusion (modified look-locker inversion recovery p=0.35, shortened modified look-locker inversion recovery p=0.053). There was no statistically significant difference between modified look-locker inversion recovery and shortened modified look-locker inversion recovery regarding T1 reactivity of remote (p=0.330), ischemic (p=0.068), and infarcted (p=0.116) myocardium. Conclusion: T1 reactivity is independent of the other stress response signs and modified look-locker inversion recovery and shortened modified look-locker inversion recovery do not differ in terms of T1 reactivity.
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Affiliation(s)
- Esin Gezmiş
- Department of Radiology, Başkent University Hospital İzmir Practice and Research Center, İzmir, Turkey
| | - Charles Peebles
- Department of Cardiothoracic Radiology, Southampton University Hospital, Southampton, United Kingdom
| | - Andrew Flett
- Department of Cardiology, Southampton University Hospital, Southampton, United Kingdom
| | - Ausami Abbas
- Department of Cardiothoracic Radiology, Southampton University Hospital, Southampton, United Kingdom
| | - Stephen Harden
- Department of Cardiothoracic Radiology, Southampton University Hospital, Southampton, United Kingdom
| | - James Shambrook
- Department of Cardiothoracic Radiology, Southampton University Hospital, Southampton, United Kingdom
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14
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Schindler TH, Bateman TM, Berman DS, Chareonthaitawee P, De Blanche LE, Dilsizian V, Dorbala S, Gropler RJ, Shaw L, Soman P, Winchester DE, Verberne H, Ahuja S, Beanlands RS, Di Carli MF, Murthy VL, Ruddy TD, Schwartz RG. Appropriate Use Criteria for PET Myocardial Perfusion Imaging. J Nucl Med 2020; 61:1221-1265. [PMID: 32747510 DOI: 10.2967/jnumed.120.246280] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 03/31/2020] [Indexed: 12/18/2022] Open
Affiliation(s)
| | | | - Daniel S Berman
- Society of Nuclear Medicine and Molecular Imaging, Reston, Virginia
| | - Panithaya Chareonthaitawee
- Society of Nuclear Medicine and Molecular Imaging, Reston, Virginia.,American Society of Nuclear Cardiology, Fairfax, Virginia
| | | | - Vasken Dilsizian
- Society of Nuclear Medicine and Molecular Imaging, Reston, Virginia.,American Society of Nuclear Cardiology, Fairfax, Virginia
| | - Sharmila Dorbala
- Society of Nuclear Medicine and Molecular Imaging, Reston, Virginia
| | - Robert J Gropler
- Society of Nuclear Medicine and Molecular Imaging, Reston, Virginia
| | - Leslee Shaw
- American College of Cardiology, Washington, D.C.,Society of Cardiovascular Computed Tomography, Arlington, Virginia
| | - Prem Soman
- Society of Nuclear Medicine and Molecular Imaging, Reston, Virginia.,American College of Cardiology, Washington, D.C
| | | | - Hein Verberne
- European Association of Nuclear Medicine, Vienna, Austria
| | - Sukhjeet Ahuja
- Society of Nuclear Medicine and Molecular Imaging, Reston, Virginia
| | - Rob S Beanlands
- Society of Nuclear Medicine and Molecular Imaging, Reston, Virginia.,American Society of Nuclear Cardiology, Fairfax, Virginia.,American College of Cardiology, Washington, D.C.,Canadian Society of Cardiovascular Nuclear and CT Imaging, Ottawa, Ontario, Canada.,Canadian Cardiovascular Society, Ottawa, Ontario, Canada; and
| | - Marcelo F Di Carli
- Society of Nuclear Medicine and Molecular Imaging, Reston, Virginia.,American Heart Association, Dallas, Texas
| | | | - Terrence D Ruddy
- Society of Nuclear Medicine and Molecular Imaging, Reston, Virginia.,Canadian Society of Cardiovascular Nuclear and CT Imaging, Ottawa, Ontario, Canada.,Canadian Cardiovascular Society, Ottawa, Ontario, Canada; and
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15
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Giusca S, Wolf D, Hofmann N, Hagstotz S, Forschner M, Schueler M, Nunninger P, Kelle S, Korosoglou G. Splenic Switch-Off for Determining the Optimal Dosage for Adenosine Stress Cardiac MR in Terms of Stress Effectiveness and Patient Safety. J Magn Reson Imaging 2020; 52:1732-1742. [PMID: 32557923 DOI: 10.1002/jmri.27248] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 05/18/2020] [Accepted: 05/20/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Adenosine stress MRI is well established for the evaluation of known and suspected coronary artery disease. However, a proportion of patients might be "under-stressed" using the standard adenosine dose. PURPOSE To compare three different adenosine dosages for stress MRI in terms of stress adequacy based on splenic switch-off (SSO) and limiting side effects. STUDY TYPE Prospective. POPULATION In all, 100 patients were randomized in group 1 (33 pts), group 2 (34 pts), and group 3 (33 pts), receiving dosages of 140 μg/kg/min, 175 μg/kg/min, or 210 μg/kg/min, respectively. SSO was evaluated visually and quantitatively. SEQUENCE Stress perfusion was performed using a 1.5T scanner in three short axes using a standard single-shot, saturation recovery gradient-echo sequence. ASSESSMENT Three blinded experienced operators evaluated SSO on stress and rest perfusion acquisitions in the three groups. The signal intensity of the spleen and myocardium and the presence of inducible ischemia and late gadolinium enhancement were assessed. STATISTICAL ANALYSIS T-test, analysis of variance (ANOVA), chi-squared test, and Pearson's correlation coefficient. RESULTS SSO was present more frequently in patients receiving 175 μg/kg/min and 210 μg/kg/min (31/33 [94%] and 27/29 [93%], respectively) compared to those receiving the standard dose (19/33 [58%], P < 0.05). A positive stress result was noted in 3/33 (9%) patients receiving 140 μg/kg/min vs. 9/33 (27%) patients receiving 175 μg/kg/min and 10/31 (33%) patients receiving 210 μg/kg/min (P < 0.05 for all, P < 0.05 for group 1 vs. groups 2, 3). The relative decrease of splenic signal intensity at hyperemia vs. baseline was significantly lower in group 1 compared to groups 2 and 3 (-33% vs. -54%, -56%, respectively; P < 0.05). No adverse events during scanning were noted in groups 1 and 2, whereas in group 3 four examinations were stopped due to severe dyspnea (n = 2) and AV-blockage (n = 2). DATA CONCLUSION A dosage of 175 μg/kg/min adenosine results in a higher proportion of SSO, which may be an indirect marker of adequate coronary vasodilatation and simultaneously offers similar safety compared to the standard 140 μg/kg/min dosage. LEVEL OF EVIDENCE 1 TECHNICAL EFFICACY STAGE: 2 J. MAGN. RESON. IMAGING 2020;52:1732-1742.
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Affiliation(s)
- Sorin Giusca
- Department of Cardiology Angiology and Pneumology, GRN Hospital Weinheim, Weinheim, Germany
| | - David Wolf
- Department of Cardiology Angiology and Pneumology, GRN Hospital Weinheim, Weinheim, Germany
| | - Nina Hofmann
- Department of Cardiology Angiology and Pneumology, GRN Hospital Weinheim, Weinheim, Germany
| | - Saskia Hagstotz
- Department of Cardiology Angiology and Pneumology, GRN Hospital Weinheim, Weinheim, Germany
| | | | - Melanie Schueler
- Department of Cardiology Angiology and Pneumology, GRN Hospital Weinheim, Weinheim, Germany
| | | | - Sebastian Kelle
- Department of Internal Medicine/Cardiology, German Heart Center Berlin, Berlin, Germany.,Department of Internal Medicine/Cardiology, Charité Campus Virchow Clinic, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Grigorios Korosoglou
- Department of Cardiology Angiology and Pneumology, GRN Hospital Weinheim, Weinheim, Germany
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16
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Bastarrika G, Ezponda A, García Baizan A, Calvo M, Pueyo J, Gavira J, Caballeros M. Safety of regadenoson for vasodilation in cardiac MRI stress tests. RADIOLOGIA 2020. [DOI: 10.1016/j.rxeng.2020.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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17
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Bastarrika G, Ezponda A, Baizan AG, Calvo M, Pueyo JC, Gavira JJ, Caballeros M. Safety of regadenoson for vasodilation in cardiac MRI stress tests. RADIOLOGIA 2019; 62:213-221. [PMID: 31862182 DOI: 10.1016/j.rx.2019.11.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 09/09/2019] [Accepted: 11/04/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To determine the safety of regadenoson for vasodilation in cardiac MRI stress tests to detect myocardial ischemia. MATERIAL AND METHODS We retrospectively analyzed cardiac MRI studies done in 120 patients (mean age, 67±11.6 years; 88 men) with suspected ischemic heart disease or known coronary disease who had clinical indications for cardiac MRI stress tests. All studies were done on a 1.5 T scanner (MAGNETOM Aera, Siemens Healthineers) using regadenoson (5ml, 0.4mg) for vasodilation. We recorded cardiovascular risk factors, medications, and indications for the test as well as vital signs at rest and under stress and the symptoms and adverse effects induced by the drug. RESULTS No symptoms developed in 52.6% of patients. The most common symptoms were central chest pain (25%) and dyspnea (12%). At peak stress, the mean increase in heart rate was 23.9±11.4 beats per minute and the mean decreases in systolic and diastolic blood pressure were 7.1±18.8mmHg and 5.3±9.2mmHg, respectively (p <0.001). The response to regadenoson was less pronounced in obese and diabetic patients. The increase in heart rate was greater in symptomatic patients (27.4±11.2 bpm vs. 20.6±10.7 bpm in asymptomatic patients, p=0.001). No severe adverse effects were observed. CONCLUSION Regadenoson is well tolerated and can be safely used for cardiac MRI stress tests.
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Affiliation(s)
- G Bastarrika
- Servicio de Radiología, Clínica Universidad de Navarra, Pamplona. Navarra, España.
| | - A Ezponda
- Servicio de Radiología, Clínica Universidad de Navarra, Pamplona. Navarra, España
| | - A García Baizan
- Servicio de Radiología, Clínica Universidad de Navarra, Pamplona. Navarra, España
| | - M Calvo
- Servicio de Radiología, Clínica Universidad de Navarra, Pamplona. Navarra, España
| | - J C Pueyo
- Servicio de Radiología, Clínica Universidad de Navarra, Pamplona. Navarra, España
| | - J J Gavira
- Departamento de Cardiología, Clínica Universidad de Navarra, Pamplona. Navarra, España
| | - M Caballeros
- Servicio de Radiología, Clínica Universidad de Navarra, Madrid, España
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18
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Rischpler C, Totzeck M. Are you stressed? J Nucl Cardiol 2019; 26:1898-1900. [PMID: 29948893 DOI: 10.1007/s12350-018-1332-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Accepted: 05/22/2018] [Indexed: 11/26/2022]
Affiliation(s)
- C Rischpler
- Department of Nuclear Medicine, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.
| | - M Totzeck
- Department of Cardiology and Vascular Medicine, University Hospital Essen, West German Heart and Vascular Center, University of Duisburg, Essen, Germany
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19
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Wijesurendra RS, Liu A, Notaristefano F, Ntusi NAB, Karamitsos TD, Bashir Y, Ginks M, Rajappan K, Betts TR, Jerosch‐Herold M, Ferreira VM, Neubauer S, Casadei B. Myocardial Perfusion Is Impaired and Relates to Cardiac Dysfunction in Patients With Atrial Fibrillation Both Before and After Successful Catheter Ablation. J Am Heart Assoc 2018; 7:e009218. [PMID: 30371239 PMCID: PMC6201472 DOI: 10.1161/jaha.118.009218] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2018] [Accepted: 06/27/2018] [Indexed: 02/06/2023]
Abstract
Background Atrial fibrillation ( AF ) is associated with myocardial infarction, and patients with AF and no obstructive coronary artery disease can present with symptoms and evidence of cardiac ischemia. We hypothesized that microvascular coronary dysfunction underlies these observations. Methods and Results Myocardial blood flow ( MBF ) at baseline and during adenosine stress and left ventricular and left atrial function were evaluated by magnetic resonance in 49 patients with AF (25 paroxysmal, 24 persistent) with no history of epicardial coronary artery disease or diabetes mellitus, before and 6 to 9 months after ablation. Findings were compared with those obtained in matched controls in sinus rhythm (n=25). Before ablation, patients with AF had impaired left atrial function and left ventricular ejection fraction and strain indices (all P<0.05 versus controls). MBF was impaired in patients both under baseline conditions (1.21±0.24 mL/min per g·[mm Hg·bpm/104]-1 versus 1.34±0.28 mL/min per g·[mm Hg·bpm/104]-1 in controls, P=0.044) and during adenosine stress (2.29±0.48 mL/min per g versus 2.73±0.37 mL/min per g in controls, P<0.001). Under baseline conditions, MBF correlated with left ventricular strain and left atrial function (all P≤0.001), so that cardiac function was most impaired in patients with the lowest MBF . Baseline and stress MBF remained unchanged postablation (both P=ns), and baseline MBF showed similar correlations with functional indices to those present preablation (all P≤0.001). Conclusions Baseline and stress MBF are significantly impaired in patients with AF but no epicardial coronary artery disease. Reduction in MBF is proportional to severity of left ventricular and left atrial dysfunction, even after successful ablation. Coronary microvascular dysfunction may be a relevant pathophysiological mechanism in patients with a history of AF .
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Affiliation(s)
- Rohan S. Wijesurendra
- Division of Cardiovascular MedicineUniversity of OxfordOxfordUnited Kingdom
- University of Oxford Centre for Clinical Magnetic Resonance ResearchOxfordUnited Kingdom
- Oxford Heart CentreOxford University Hospitals NHS Foundation TrustOxfordUnited Kingdom
| | - Alexander Liu
- Division of Cardiovascular MedicineUniversity of OxfordOxfordUnited Kingdom
- University of Oxford Centre for Clinical Magnetic Resonance ResearchOxfordUnited Kingdom
| | - Francesco Notaristefano
- Division of Cardiovascular MedicineUniversity of OxfordOxfordUnited Kingdom
- University of Oxford Centre for Clinical Magnetic Resonance ResearchOxfordUnited Kingdom
| | - Ntobeko A. B. Ntusi
- Division of Cardiovascular MedicineUniversity of OxfordOxfordUnited Kingdom
- University of Oxford Centre for Clinical Magnetic Resonance ResearchOxfordUnited Kingdom
| | - Theodoros D. Karamitsos
- Division of Cardiovascular MedicineUniversity of OxfordOxfordUnited Kingdom
- University of Oxford Centre for Clinical Magnetic Resonance ResearchOxfordUnited Kingdom
| | - Yaver Bashir
- Oxford Heart CentreOxford University Hospitals NHS Foundation TrustOxfordUnited Kingdom
| | - Matthew Ginks
- Oxford Heart CentreOxford University Hospitals NHS Foundation TrustOxfordUnited Kingdom
| | - Kim Rajappan
- Oxford Heart CentreOxford University Hospitals NHS Foundation TrustOxfordUnited Kingdom
| | - Tim R. Betts
- Oxford Heart CentreOxford University Hospitals NHS Foundation TrustOxfordUnited Kingdom
| | | | - Vanessa M. Ferreira
- Division of Cardiovascular MedicineUniversity of OxfordOxfordUnited Kingdom
- University of Oxford Centre for Clinical Magnetic Resonance ResearchOxfordUnited Kingdom
| | - Stefan Neubauer
- Division of Cardiovascular MedicineUniversity of OxfordOxfordUnited Kingdom
- University of Oxford Centre for Clinical Magnetic Resonance ResearchOxfordUnited Kingdom
| | - Barbara Casadei
- Division of Cardiovascular MedicineUniversity of OxfordOxfordUnited Kingdom
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Prognostic value of vasodilator response using rubidium-82 positron emission tomography myocardial perfusion imaging in patients with coronary artery disease. Eur J Nucl Med Mol Imaging 2017; 45:538-548. [PMID: 29177706 DOI: 10.1007/s00259-017-3878-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 11/06/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Prognostic value of positron emission tomography (PET) myocardial perfusion imaging (MPI) is well established. There is paucity of data on how the prognostic value of PET relates to the hemodynamic response to vasodilator stress. We hypothesize that inadequate hemodynamic response will affect the prognostic value of PET MPI. METHODS AND RESULTS Using a multicenter rubidium (Rb)-82 PET registry, 3406 patients who underwent a clinically indicated rest/stress PET MPI with a vasodilator agent were analyzed. Patients were categorized as, "responders" [increase in heart rate ≥ 10 beats per minute (bpm) and decrease in systolic blood pressure (SBP) ≥10 mmHg], "partial responders" (either a change in HR or SBP), and "non-responders" (no change in HR or SBP). Primary outcome was all-cause death (ACD), and secondary outcome was cardiac death (CD). Ischemic burden was measured using summed stress score (SSS) and % left ventricular (LV) ischemia. After a median follow-up of 1.68 years (interquartile range = 1.17- 2.55), there were 7.9% (n = 270) ACD and 2.6% (n = 54) CD. Responders with a normal PET MPI had an annualized event rate (AER) of 1.22% (SSS of 0-3) and 1.58% (% LV ischemia = 0). Partial and non-responders had higher AER with worsening levels of ischemic burden. In the presence of severe SSS ≥12 and LV ischemia of ≥10%, partial responders had an AER of 10.79% and 10.36%, compared to non-responders with an AER of 19.4% and 12.43%, respectively. Patient classification was improved when SSS was added to a model containing clinical variables (NRI: 42%, p < 0.001) and responder category was added (NRI: 61%, p < 0.001). The model including clinical variables, SSS and hemodynamic response has good discrimination ability (Harrell C statistics: 0.77 [0.74-0.80]). CONCLUSION Hemodynamic response during a vasodilator Rb-82 PET MPI is predictive of ACD. Partial and non-responders may require additional risk stratification leading to altered patient management.
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Kuijpers D, van Dijk R, van Assen M, Kaandorp TAM, van Dijkman PRM, Vliegenthart R, van der Harst P, Oudkerk M. Disagreement between splenic switch-off and myocardial T1-mapping after caffeine intake. Int J Cardiovasc Imaging 2017; 34:625-632. [PMID: 29177579 PMCID: PMC5859139 DOI: 10.1007/s10554-017-1274-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Accepted: 11/11/2017] [Indexed: 10/27/2022]
Abstract
Caffeine is an adenosine receptor antagonist and a possible cause of inadequate stress perfusion. Splenic switch-off (SSO) and splenic rest-stress T1-mapping have been proposed as indicators of stress adequacy during perfusion cardiac magnetic resonance (CMR). We compared myocardial rest-stress T1-mapping with SSO and splenic rest-stress T1-mapping in patients with and without recent coffee intake. We analyzed 344 consecutive patients suspected of myocardial ischemia with adenosine perfusion CMR. All 146 normal CMR studies with a normal T1-rest of the myocardium, used as standard of reference, were included and divided in two groups. 22 patients accidentally ingested coffee < 4 h before CMR, compared to control group of 124 patients without self-reported coffee intake. Two independent readers graded SSO visually. T1-reactivity (ΔT1) was defined as percentual difference in T1-rest and T1-stress. Follow-up data were extracted from electronic patients records. In patients with recent coffee intake SSO was identified in 96%, which showed no significant difference with SSO in controls (94%, p = 0.835), however event rates were significantly different (13.6 and 0.8%, respectively (p < 0.001), median FU 17 months). Myocardial ΔT1 in the coffee group (- 5.2%) was significantly lower compared to control (+ 4.0%, p < 0.001), in contrast to the splenic ΔT1 (- 3.7 and - 4.0%, p = 0.789). The splenic T1-mapping results failed to predict false negative results. SSO and splenic rest-stress T1-mapping are not reliable indicators of stress adequacy in patients with recent coffee intake. Therefore, the dark spleen sign does not indicate adequate myocardial stress in patients with recent caffeine intake. Myocardial rest-stress T1-mapping is an excellent indicator of stress adequacy during adenosine perfusion CMR.
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Affiliation(s)
- Dirkjan Kuijpers
- Center for Medical Imaging, University of Groningen, University Medical Center Groningen, Hanzeplein 1 EB 45, Groningen, The Netherlands.,Department of Cardiovascular Imaging HMC-Bronovo, The Hague, The Netherlands
| | - Randy van Dijk
- Center for Medical Imaging, University of Groningen, University Medical Center Groningen, Hanzeplein 1 EB 45, Groningen, The Netherlands.,Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Marly van Assen
- Center for Medical Imaging, University of Groningen, University Medical Center Groningen, Hanzeplein 1 EB 45, Groningen, The Netherlands
| | | | | | - Rozemarijn Vliegenthart
- Center for Medical Imaging, University of Groningen, University Medical Center Groningen, Hanzeplein 1 EB 45, Groningen, The Netherlands.,Department of Radiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Pim van der Harst
- Center for Medical Imaging, University of Groningen, University Medical Center Groningen, Hanzeplein 1 EB 45, Groningen, The Netherlands.,Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Matthijs Oudkerk
- Center for Medical Imaging, University of Groningen, University Medical Center Groningen, Hanzeplein 1 EB 45, Groningen, The Netherlands.
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Gholoobi A, Ayati N, Baghyari A, Mouhebati M, Atar B, Dabbagh Kakhki VR. Relationship between gated myocardial perfusion SPECT findings and hemodynamic, electrocardiographic, and heart rate changes after Dipyridamole infusion. Int J Cardiovasc Imaging 2017; 33:951-956. [PMID: 28150082 DOI: 10.1007/s10554-017-1074-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Accepted: 01/13/2017] [Indexed: 11/29/2022]
Abstract
After dipyridamole infusion, electrocardiographic (ECG), blood pressure and heart rate (HR) changes were seen. We tried to investigate whether there is a relationship between hemodynamic, ECG and HR changes after dipyridamole infusion and gated myocardial perfusion SPECT findings. We studied 206 consecutive patients which underwent a 2-day protocol Dipyridamole Stress/Rest Tc99m-Sestamibi gated myocardial perfusion SPECT. Systolic blood pressure (SBP), diastolic blood pressure (DBP), HR and ECG were recorded. HR was mildly increased while SBP and DBP were mildly decreased after Dipyridamole infusion. There was only statistically significant difference between ECG changes as well as transient ischemic dilation (TID) ratio between normal scans and scans with ischemia (P = 0.02 and P = 0.01 respectively). There was correlation between these variables and summed stress score (SSS) and summed difference score (SDS). Patients with ischemia in their scans, 44.3% had ST depression after Dipyridamole infusion. Also ST depression most frequently was seen in patients with left anterior descending artery disease. From patients with abnormal scan + ST depression after Dipyridamole infusion (33 patient), 27 patient (81.81%) had ischemia. There was an association between TID ratio as well as ECG changes after Dipyridamole infusion and SSS, SDS and coronary artery territory abnormality. Difference between calculated left ventricular ejection fraction using stress and rest images had significant correlation with SSS and SDS. ST depression after Dipyridamole infusion and TID ratio had association with ischemia, SSS and SDS. So in equivocal Gated SPECT findings, they could be very useful for interpretation.
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Affiliation(s)
- Arash Gholoobi
- Department of Cardiology, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Narjess Ayati
- Department of Nuclear Medicine, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Alireza Baghyari
- Department of Nuclear Medicine, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mohsen Mouhebati
- Department of Nuclear Medicine, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Baharak Atar
- Department of Nuclear Medicine, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Vahid Reza Dabbagh Kakhki
- Department of Nuclear Medicine, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran.
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Liu A, Wijesurendra RS, Ariga R, Mahmod M, Levelt E, Greiser A, Petrou M, Krasopoulos G, Forfar JC, Kharbanda RK, Channon KM, Neubauer S, Piechnik SK, Ferreira VM. Splenic T1-mapping: a novel quantitative method for assessing adenosine stress adequacy for cardiovascular magnetic resonance. J Cardiovasc Magn Reson 2017; 19:1. [PMID: 28081721 PMCID: PMC5234250 DOI: 10.1186/s12968-016-0318-2] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2016] [Accepted: 12/20/2016] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Perfusion cardiovascular magnetic resonance (CMR) performed with inadequate adenosine stress leads to false-negative results and suboptimal clinical management. The recently proposed marker of adequate stress, the "splenic switch-off" sign, detects splenic blood flow attenuation during stress perfusion (spleen appears dark), but can only be assessed after gadolinium first-pass, when it is too late to optimize the stress response. Reduction in splenic blood volume during adenosine stress is expected to shorten native splenic T1, which may predict splenic switch-off without the need for gadolinium. METHODS Two-hundred and twelve subjects underwent adenosine stress CMR: 1.5 T (n = 104; 75 patients, 29 healthy controls); 3 T (n = 108; 86 patients, 22 healthy controls). Native T1spleen was assessed using heart-rate-independent ShMOLLI prototype sequence at rest and during adenosine stress (140 μg/kg/min, 4 min, IV) in 3 short-axis slices (basal, mid-ventricular, apical). This was compared with changes in peak splenic perfusion signal intensity (ΔSIspleen) and the "splenic switch-off" sign on conventional stress/rest gadolinium perfusion imaging. T1spleen values were obtained blinded to perfusion ΔSIspleen, both were derived using regions of interest carefully placed to avoid artefacts and partial-volume effects. RESULTS Normal resting splenic T1 values were 1102 ± 66 ms (1.5 T) and 1352 ± 114 ms (3 T), slightly higher than in patients (1083 ± 59 ms, p = 0.04; 1295 ± 105 ms, p = 0.01, respectively). T1spleen decreased significantly during adenosine stress (mean ΔT1spleen ~ -40 ms), independent of field strength, age, gender, and cardiovascular diseases. While ΔT1spleen correlated strongly with ΔSIspleen (rho = 0.70, p < 0.0001); neither indices showed significant correlations with conventional hemodynamic markers (rate pressure product) during stress. By ROC analysis, a ΔT1spleen threshold of ≥ -30 ms during stress predicted the "splenic switch-off" sign (AUC 0.90, p < 0.0001) with sensitivity (90%), specificity (88%), accuracy (90%), PPV (98%), NPV (42%). CONCLUSIONS Adenosine stress and rest splenic T1-mapping is a novel method for assessing stress responses, independent of conventional hemodynamic parameters. It enables prediction of the visual "splenic switch-off" sign without the need for gadolinium, and correlates well to changes in splenic signal intensity during stress/rest perfusion imaging. ΔT1spleen holds promise to facilitate optimization of stress responses before gadolinium first-pass perfusion CMR.
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Affiliation(s)
- Alexander Liu
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Rohan S. Wijesurendra
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Rina Ariga
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Masliza Mahmod
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Eylem Levelt
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | | | - Mario Petrou
- Department of Cardiothoracic Surgery, John Radcliffe Hospital, Oxford, UK
| | - George Krasopoulos
- Department of Cardiothoracic Surgery, John Radcliffe Hospital, Oxford, UK
| | - John C. Forfar
- Oxford Heart Centre, John Radcliffe Hospital, Oxford, UK
| | - Rajesh K. Kharbanda
- Oxford Heart Centre, John Radcliffe Hospital, Oxford, UK
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Keith M. Channon
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Stefan Neubauer
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Stefan K. Piechnik
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Vanessa M. Ferreira
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
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Hosking A, Koulouroudias M, Zemrak F, Moon JC, Rossi A, Lee A, Barnes MR, Boubertakh R, Pugliese F, Manisty C, Petersen SE. Evaluation of splenic switch off in a tertiary imaging centre: validation and assessment of utility. Eur Heart J Cardiovasc Imaging 2016; 18:1216-1221. [DOI: 10.1093/ehjci/jew205] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Accepted: 09/08/2016] [Indexed: 12/29/2022] Open
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Caffeine intake inverts the effect of adenosine on myocardial perfusion during stress as measured by T1 mapping. Int J Cardiovasc Imaging 2016; 32:1545-53. [PMID: 27473274 PMCID: PMC5021723 DOI: 10.1007/s10554-016-0949-2] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Accepted: 07/22/2016] [Indexed: 11/08/2022]
Abstract
Caffeine intake before adenosine stress myocardial perfusion imaging may cause false negative findings. We hypothesized that the antagonistic effect of caffeine can be measured by T1 relaxation times in rest and adenosine stress cardiac magnetic resonance imaging (CMR), as T1 mapping techniques are sensitive to changes in myocardial blood volume. We prospectively analyzed 105 consecutive patients with adenosine stress perfusion CMR on a 1.5-T MRI system. Rest and stress T1 mapping was performed using Modified Look-Locker Inversion recovery. T1 reactivity was defined as difference in T1rest and T1stress (∆T1). Fifteen patients drank coffee within 4 h of CMR (<4H caffeine group), and 10 patients had coffee the day before (>8H caffeine group). Comparison was made to patients without self-reported coffee intake: 50 with normal CMR (control group), 18 with myocardial ischemia, and 12 with myocardial infarction. The national review board approved the study; all patients gave written informed consent. The <4H caffeine group showed inverted ∆T1 of −7.8 % (T1rest 975 ± 42 ms, T1stress 898 ± 51 ms, p < 0.0005). The >8H caffeine group showed reduced T1 reactivity (1.8 %; T1rest 979 ms, T1stress 997 ms) compared to the controls (4.3 %; T1rest 977 ± 40 ms, T1stress 1018 ± 40 ms), p < 0.0005. Ischemic and infarcted myocardium showed minimal T1 reactivity (0.2 and 0.3 %, respectively). Caffeine intake inverts the adenosine effect during stress perfusion CMR as measured by T1 mapping. T1 reactivity can assess the adequacy of adenosine-induced stress in perfusion CMR.
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27
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Manisty C, Ripley DP, Herrey AS, Captur G, Wong TC, Petersen SE, Plein S, Peebles C, Schelbert EB, Greenwood JP, Moon JC. Splenic Switch-off: A Tool to Assess Stress Adequacy in Adenosine Perfusion Cardiac MR Imaging. Radiology 2015; 276:732-40. [PMID: 25923223 DOI: 10.1148/radiol.2015142059] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
PURPOSE To investigate the pharmacology and potential clinical utility of splenic switch-off to identify understress in adenosine perfusion cardiac magnetic resonance (MR) imaging. MATERIALS AND METHODS Splenic switch-off was assessed in perfusion cardiac MR examinations from 100 patients (mean age, 62 years [age range, 18-87 years]) by using three stress agents (adenosine, dobutamine, and regadenoson) in three different institutions, with appropriate ethical permissions. In addition, 100 negative adenosine images from the Clinical Evaluation of MR Imaging in Coronary Heart Disease (CE-MARC) trial (35 false and 65 true negative; mean age, 59 years [age range, 40-73 years]) were assessed to ascertain the clinical utility of the sign to detect likely pharmacologic understress. Differences in splenic perfusion were compared by using Wilcoxon signed rank or Wilcoxon rank sum tests, and true-negative and false-negative findings in CE-MARC groups were compared by using the Fisher exact test. RESULTS The spleen was visible in 99% (198 of 200) of examinations and interobserver agreement in the visual grading of splenic switch-off was excellent (κ = 0.92). Visually, splenic switch-off occurred in 90% of adenosine studies, but never in dobutamine or regadenoson studies. Semiquantitative assessments supported these observations: peak signal intensity was 78% less with adenosine than at rest (P < .001), but unchanged with regadenoson (4% reduction; P = .08). Calculated peak splenic divided by myocardial signal intensity (peak splenic/myocardial signal intensity) differed between stress agents (adenosine median, 0.34; dobutamine median, 1.34; regadenoson median, 1.13; P < .001). Failed splenic switch-off was significantly more common in CE-MARC patients with false-negative findings than with true-negative findings (34% vs 9%, P < .005). CONCLUSION Failed splenic switch-off with adenosine is a new, simple observation that identifies understressed patients who are at risk for false-negative findings on perfusion MR images. These data suggest that almost 10% of all patients may be understressed, and that repeat examination of individuals with failed splenic switch-off may significantly improve test sensitivity.
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Affiliation(s)
- Charlotte Manisty
- From the Heart Hospital Imaging Centre, University College London, 16-18 Westmoreland St, London W1G 8PH, England (C.M., A.S.H., G.C., J.C.M.); Multidisciplinary Cardiovascular Research Centre and Leeds Institute of Genetics, Health and Therapeutics, University of Leeds, Leeds, England (D.P.R., S.P., J.P.G.); Department of Medicine (T.C.W., E.B.S.) and UPMC Cardiovascular Magnetic Resonance Center (E.B.S.), University of Pittsburgh School of Medicine, Pittsburgh, Pa; NIHR Cardiovascular Biomedical Research Unit, Barts Health NHS Trust and Queen Mary University of London, London, England (S.E.P.); and Wessex Cardiothoracic Unit, Southampton University Hospitals NHS Trust, Southampton, England (C.P.)
| | - David P Ripley
- From the Heart Hospital Imaging Centre, University College London, 16-18 Westmoreland St, London W1G 8PH, England (C.M., A.S.H., G.C., J.C.M.); Multidisciplinary Cardiovascular Research Centre and Leeds Institute of Genetics, Health and Therapeutics, University of Leeds, Leeds, England (D.P.R., S.P., J.P.G.); Department of Medicine (T.C.W., E.B.S.) and UPMC Cardiovascular Magnetic Resonance Center (E.B.S.), University of Pittsburgh School of Medicine, Pittsburgh, Pa; NIHR Cardiovascular Biomedical Research Unit, Barts Health NHS Trust and Queen Mary University of London, London, England (S.E.P.); and Wessex Cardiothoracic Unit, Southampton University Hospitals NHS Trust, Southampton, England (C.P.)
| | - Anna S Herrey
- From the Heart Hospital Imaging Centre, University College London, 16-18 Westmoreland St, London W1G 8PH, England (C.M., A.S.H., G.C., J.C.M.); Multidisciplinary Cardiovascular Research Centre and Leeds Institute of Genetics, Health and Therapeutics, University of Leeds, Leeds, England (D.P.R., S.P., J.P.G.); Department of Medicine (T.C.W., E.B.S.) and UPMC Cardiovascular Magnetic Resonance Center (E.B.S.), University of Pittsburgh School of Medicine, Pittsburgh, Pa; NIHR Cardiovascular Biomedical Research Unit, Barts Health NHS Trust and Queen Mary University of London, London, England (S.E.P.); and Wessex Cardiothoracic Unit, Southampton University Hospitals NHS Trust, Southampton, England (C.P.)
| | - Gabriella Captur
- From the Heart Hospital Imaging Centre, University College London, 16-18 Westmoreland St, London W1G 8PH, England (C.M., A.S.H., G.C., J.C.M.); Multidisciplinary Cardiovascular Research Centre and Leeds Institute of Genetics, Health and Therapeutics, University of Leeds, Leeds, England (D.P.R., S.P., J.P.G.); Department of Medicine (T.C.W., E.B.S.) and UPMC Cardiovascular Magnetic Resonance Center (E.B.S.), University of Pittsburgh School of Medicine, Pittsburgh, Pa; NIHR Cardiovascular Biomedical Research Unit, Barts Health NHS Trust and Queen Mary University of London, London, England (S.E.P.); and Wessex Cardiothoracic Unit, Southampton University Hospitals NHS Trust, Southampton, England (C.P.)
| | - Timothy C Wong
- From the Heart Hospital Imaging Centre, University College London, 16-18 Westmoreland St, London W1G 8PH, England (C.M., A.S.H., G.C., J.C.M.); Multidisciplinary Cardiovascular Research Centre and Leeds Institute of Genetics, Health and Therapeutics, University of Leeds, Leeds, England (D.P.R., S.P., J.P.G.); Department of Medicine (T.C.W., E.B.S.) and UPMC Cardiovascular Magnetic Resonance Center (E.B.S.), University of Pittsburgh School of Medicine, Pittsburgh, Pa; NIHR Cardiovascular Biomedical Research Unit, Barts Health NHS Trust and Queen Mary University of London, London, England (S.E.P.); and Wessex Cardiothoracic Unit, Southampton University Hospitals NHS Trust, Southampton, England (C.P.)
| | - Steffen E Petersen
- From the Heart Hospital Imaging Centre, University College London, 16-18 Westmoreland St, London W1G 8PH, England (C.M., A.S.H., G.C., J.C.M.); Multidisciplinary Cardiovascular Research Centre and Leeds Institute of Genetics, Health and Therapeutics, University of Leeds, Leeds, England (D.P.R., S.P., J.P.G.); Department of Medicine (T.C.W., E.B.S.) and UPMC Cardiovascular Magnetic Resonance Center (E.B.S.), University of Pittsburgh School of Medicine, Pittsburgh, Pa; NIHR Cardiovascular Biomedical Research Unit, Barts Health NHS Trust and Queen Mary University of London, London, England (S.E.P.); and Wessex Cardiothoracic Unit, Southampton University Hospitals NHS Trust, Southampton, England (C.P.)
| | - Sven Plein
- From the Heart Hospital Imaging Centre, University College London, 16-18 Westmoreland St, London W1G 8PH, England (C.M., A.S.H., G.C., J.C.M.); Multidisciplinary Cardiovascular Research Centre and Leeds Institute of Genetics, Health and Therapeutics, University of Leeds, Leeds, England (D.P.R., S.P., J.P.G.); Department of Medicine (T.C.W., E.B.S.) and UPMC Cardiovascular Magnetic Resonance Center (E.B.S.), University of Pittsburgh School of Medicine, Pittsburgh, Pa; NIHR Cardiovascular Biomedical Research Unit, Barts Health NHS Trust and Queen Mary University of London, London, England (S.E.P.); and Wessex Cardiothoracic Unit, Southampton University Hospitals NHS Trust, Southampton, England (C.P.)
| | - Charles Peebles
- From the Heart Hospital Imaging Centre, University College London, 16-18 Westmoreland St, London W1G 8PH, England (C.M., A.S.H., G.C., J.C.M.); Multidisciplinary Cardiovascular Research Centre and Leeds Institute of Genetics, Health and Therapeutics, University of Leeds, Leeds, England (D.P.R., S.P., J.P.G.); Department of Medicine (T.C.W., E.B.S.) and UPMC Cardiovascular Magnetic Resonance Center (E.B.S.), University of Pittsburgh School of Medicine, Pittsburgh, Pa; NIHR Cardiovascular Biomedical Research Unit, Barts Health NHS Trust and Queen Mary University of London, London, England (S.E.P.); and Wessex Cardiothoracic Unit, Southampton University Hospitals NHS Trust, Southampton, England (C.P.)
| | - Erik B Schelbert
- From the Heart Hospital Imaging Centre, University College London, 16-18 Westmoreland St, London W1G 8PH, England (C.M., A.S.H., G.C., J.C.M.); Multidisciplinary Cardiovascular Research Centre and Leeds Institute of Genetics, Health and Therapeutics, University of Leeds, Leeds, England (D.P.R., S.P., J.P.G.); Department of Medicine (T.C.W., E.B.S.) and UPMC Cardiovascular Magnetic Resonance Center (E.B.S.), University of Pittsburgh School of Medicine, Pittsburgh, Pa; NIHR Cardiovascular Biomedical Research Unit, Barts Health NHS Trust and Queen Mary University of London, London, England (S.E.P.); and Wessex Cardiothoracic Unit, Southampton University Hospitals NHS Trust, Southampton, England (C.P.)
| | - John P Greenwood
- From the Heart Hospital Imaging Centre, University College London, 16-18 Westmoreland St, London W1G 8PH, England (C.M., A.S.H., G.C., J.C.M.); Multidisciplinary Cardiovascular Research Centre and Leeds Institute of Genetics, Health and Therapeutics, University of Leeds, Leeds, England (D.P.R., S.P., J.P.G.); Department of Medicine (T.C.W., E.B.S.) and UPMC Cardiovascular Magnetic Resonance Center (E.B.S.), University of Pittsburgh School of Medicine, Pittsburgh, Pa; NIHR Cardiovascular Biomedical Research Unit, Barts Health NHS Trust and Queen Mary University of London, London, England (S.E.P.); and Wessex Cardiothoracic Unit, Southampton University Hospitals NHS Trust, Southampton, England (C.P.)
| | - James C Moon
- From the Heart Hospital Imaging Centre, University College London, 16-18 Westmoreland St, London W1G 8PH, England (C.M., A.S.H., G.C., J.C.M.); Multidisciplinary Cardiovascular Research Centre and Leeds Institute of Genetics, Health and Therapeutics, University of Leeds, Leeds, England (D.P.R., S.P., J.P.G.); Department of Medicine (T.C.W., E.B.S.) and UPMC Cardiovascular Magnetic Resonance Center (E.B.S.), University of Pittsburgh School of Medicine, Pittsburgh, Pa; NIHR Cardiovascular Biomedical Research Unit, Barts Health NHS Trust and Queen Mary University of London, London, England (S.E.P.); and Wessex Cardiothoracic Unit, Southampton University Hospitals NHS Trust, Southampton, England (C.P.)
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Yıldırım Poyraz N, Özdemir E, Poyraz BM, Kandemir Z, Keskin M, Türkölmez Ş. Predictors and Diagnostic Significance of the Adenosine Related Side Effects on Myocardial Perfusion SPECT/CT Imaging. Mol Imaging Radionucl Ther 2014; 23:89-95. [PMID: 25541932 PMCID: PMC4288229 DOI: 10.4274/mirt.85057] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Accepted: 04/08/2014] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE The aim of this study was to investigate the relationship between patient characteristics and adenosine-related side-effects during stress myocard perfusion imaging (MPI). The effect of presence of adenosine-related side-effects on the diagnostic value of MPI with integrated SPECT/CT system for coronary artery disease (CAD), was also assessed in this study. METHODS Total of 281 patients (109 M, 172 F; mean age:62.6±10) who underwent standard adenosine stress protocol for MPI, were included in this study. All symptoms during adenosine infusion were scored according to the severity and duration. For the estimation of diagnostic value of adenosine MPI with integrated SPECT/CT system, coronary angiography (CAG) or clinical follow-up were used as gold standard. RESULTS Total of 173 patients (61.6%) experienced adenosine-related side-effects (group 1); flushing, dyspnea, and chest pain were the most common. Other 108 patients completed pharmacologic stress (PS) test without any side-effects (group 2). Test tolerability were similar in the patients with cardiovascular or airway disease to others, however dyspnea were observed significantly more common in patients with mild airway disease. Body mass index (BMI) ≥30 kg/m2 and age ≤45 years were independent predictors of side-effects. The diagnostic value of MPI was similar in both groups. Sensitivity of adenosine MPI SPECT/CT was calculated to be 86%, specificity was 94% and diagnostic accuracy was 92% for diagnosis of CAD. CONCLUSION Adenosine MPI is a feasible and well tolerated method in patients who are not suitable for exercise stress test as well as patients with cardiopulmonary disease. However age ≤45 years and BMI ≥30 kg/m2 are the positive predictors of adenosine-related side-effects, the diagnostic value of adenosine MPI SPECT/CT is not affected by the presence of adenosine related side-effects.
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Affiliation(s)
- Nilüfer Yıldırım Poyraz
- Ankara Atatürk Training and Research Hospital, Clinic of Nuclear Medicine, Ankara, Turkey. E-ma-il:
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Berry C, Layland J, Sood A, Curzen NP, Balachandran KP, Das R, Junejo S, Henderson RA, Briggs AH, Ford I, Oldroyd KG. Fractional flow reserve versus angiography in guiding management to optimize outcomes in non-ST-elevation myocardial infarction (FAMOUS-NSTEMI): rationale and design of a randomized controlled clinical trial. Am Heart J 2013; 166:662-668.e3. [PMID: 24093845 PMCID: PMC3807653 DOI: 10.1016/j.ahj.2013.07.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2013] [Accepted: 07/01/2013] [Indexed: 01/21/2023]
Abstract
BACKGROUND In patients with acute non-ST-elevation myocardial infarction (NSTEMI), coronary arteriography is usually recommended; but visual interpretation of the angiogram is subjective. We hypothesized that functional assessment of coronary stenosis severity with a pressure-sensitive guide wire (fractional flow reserve [FFR]) would have additive diagnostic, clinical, and health economic utility as compared with angiography-guided standard care. METHODS AND DESIGN A prospective multicenter parallel-group 1:1 randomized controlled superiority trial in 350 NSTEMI patients with ≥1 coronary stenosis ≥30% severity (threshold for FFR measurement) will be conducted. Patients will be randomized immediately after coronary angiography to the FFR-guided group or angiography-guided group. All patients will then undergo FFR measurement in all vessels with a coronary stenosis ≥30% severity including culprit and nonculprit lesions. Fractional flow reserve will be disclosed to guide treatment in the FFR-guided group but not disclosed in the "angiography-guided" group. In the FFR-guided group, an FFR ≤0.80 will be an indication for revascularization by percutaneous coronary intervention or coronary artery bypass surgery, as appropriate. The primary outcome is the between-group difference in the proportion of patients allocated to medical management only compared with revascularization. Secondary outcomes include the occurrence of cardiac death or hospitalization for myocardial infarction or heart failure, quality of life, and health care costs. The minimum and average follow-up periods for the primary analysis are 6 and 18 months, respectively. CONCLUSIONS Our developmental clinical trial will address the feasibility of FFR measurement in NSTEMI and the influence of FFR disclosure on treatment decisions and health and economic outcomes.
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Affiliation(s)
- Colin Berry
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, United Kingdom; BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom.
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Hage FG, Iskandrian AE. The effect of caffeine on adenosine myocardial perfusion imaging: time to reassess? J Nucl Cardiol 2012; 19:415-9. [PMID: 22297853 DOI: 10.1007/s12350-012-9519-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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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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Brunken RC. Challenges for measurement of myocardial perfusion and perfusion reserve by SPECT imaging. J Nucl Cardiol 2007; 14:145-9. [PMID: 17386375 DOI: 10.1016/j.nuclcard.2007.01.034] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Boger LA, Volker LL, Hertenstein GK, Bateman TM. Best patient preparation before and during radionuclide myocardial perfusion imaging studies. J Nucl Cardiol 2006; 13:98-110. [PMID: 16464724 DOI: 10.1016/j.nuclcard.2005.12.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Lisa A Boger
- Cardiovascular Consultants, PC, Kansas City, MO 64111, USA
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Hägg U, Wandt B, Bergström G, Volkmann R, Gan LM. Physical exercise capacity is associated with coronary and peripheral vascular function in healthy young adults. Am J Physiol Heart Circ Physiol 2005; 289:H1627-34. [PMID: 15937100 DOI: 10.1152/ajpheart.00135.2005] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Short-term exercise training has been shown to improve cardiovascular function, whereas long-term effects of a physically active lifestyle, on coronary artery function in particular, are still not well studied. We explored possible relationships between physical exercise capacity and coronary and peripheral vascular function in healthy young adults. Twenty-nine healthy young male and female volunteers participated in the study. They underwent 1) basic clinical and echocardiographic characterization, 2) coronary flow velocity reserve (CFVR) measurement of the left anterior descending coronary artery (LAD), 3) common carotid artery (CCA) intima-media thickness (IMT) measurement, 4) assessment of CCA stiffness index (SI), 5) forearm flow-mediated vasodilation (FMD), and 6) submaximal exercise test. The calculated weight-adjusted maximal oxygen uptake capacity (V̇o2 maxc) was positively correlated to LAD CFVR and inversely correlated to IMT and SI. Also, subjects with high compared with moderate exercise capacity had higher FMD. In addition, subjects with LAD CFVR in the upper median had greater ratios between endothelium-dependent and -independent vasodilation in the forearm and lower SI in CCA. High exercise capacity due to a physically active lifestyle is associated with high coronary and peripheral artery function, indicating an early protective role of physical exercise for cardiovascular health.
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Affiliation(s)
- Ulrika Hägg
- Institute of Physiology and Pharmacology, Sahlgrenska Academy, Göteborg University, Göteborg, Sweden
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Affiliation(s)
- Raymond J Gibbons
- Division of Cardiovascular Diseases and Internal Medicine, Department of Medicine, Rochester, Minnesota 55905, USA
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