1
|
Leungratanamart N, Wanitchung K, Prechawuttidech S, Karaketklang K, Kaolawanich Y. Prognostic value of stress perfusion cardiac magnetic resonance in patients with prediabetes and suspected coronary artery disease. PLoS One 2024; 19:e0311875. [PMID: 39388498 PMCID: PMC11466432 DOI: 10.1371/journal.pone.0311875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2024] [Accepted: 09/25/2024] [Indexed: 10/12/2024] Open
Abstract
BACKGROUND Stress perfusion cardiac magnetic resonance (CMR) is an accurate and comprehensive modality for evaluating patients with suspected coronary artery disease (CAD), but its prognostic value in prediabetic patients is uncertain. METHODS This retrospective study included 452 consecutive prediabetic patients without prior diagnoses of CAD who underwent adenosine stress perfusion CMR. The primary endpoint was major adverse cardiovascular events (MACE), defined as cardiovascular death, nonfatal myocardial infarction (MI), hospitalization for heart failure, ischemic stroke, and late coronary revascularization (>90 days post-CMR). The secondary endpoint was a composite of cardiovascular death, nonfatal MI, and hospitalization for heart failure. RESULTS The mean age was 68±11 years (49% male). Over a median follow-up time of 8.1 (IQR 5.7, 10.4) years, 55 patients experienced MACE, and 24 met the secondary endpoint. Patients with inducible ischemia had significantly greater annualized event rates for MACE (5.7% vs. 0.7%, p<0.001) and for the secondary endpoint (2.0% vs. 0.3%, p<0.001) than those without ischemia. Multivariable analysis revealed inducible ischemia as a consistent predictor for MACE (HR 3.36, 95%CI 1.90-5.94, p<0.001) and for the secondary endpoint (HR 2.89, 95%CI 1.22-6.80, p = 0.01). Late gadolinium enhancement (LGE) was an independent predictor of the secondary endpoint (HR 3.56, 95%CI 1.25-10.13; p = 0.02). Incorporating inducible ischemia and LGE data significantly improved the model's ability to discriminate MACE risk (C-statistic increase from 0.77 to 0.83; net reclassification improvement 0.42; integrated discrimination improvement 0.05). CONCLUSION Stress perfusion CMR offers substantial independent prognostic value and effectively aids in reclassifying cardiovascular risk among prediabetic patients with suspected CAD.
Collapse
Affiliation(s)
- Norapat Leungratanamart
- Division of Cardiology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Kasinee Wanitchung
- Division of Cardiology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Sumet Prechawuttidech
- Division of Cardiology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Khemajira Karaketklang
- Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Yodying Kaolawanich
- Division of Cardiology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| |
Collapse
|
2
|
Ge Y, Antiochos P, Bernhard B, Heydari B, Steel K, Bingham S, Mikolich JR, Arai AE, Bandettini WP, Patel AR, Shanbhag SM, Farzaneh-Far A, Heitner JF, Shenoy C, Leung SW, Gonzalez JA, Shah DJ, Raman SV, Ferrari VA, Schulz-Menger J, Stuber M, Simonetti OP, Kwong RY. Stress CMR Perfusion Imaging in the Medicare-Eligible Population: Insights From the SPINS Study. JACC Cardiovasc Imaging 2024:S1936-878X(24)00346-2. [PMID: 39425725 DOI: 10.1016/j.jcmg.2024.07.029] [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: 10/16/2023] [Revised: 07/01/2024] [Accepted: 07/24/2024] [Indexed: 10/21/2024]
Abstract
BACKGROUND Patients aged ≥65 years account for a disproportionately large portion of cardiovascular (CV) events and pose a challenge for noninvasive detection of coronary artery disease. OBJECTIVES This study sought to determine the prognostic value of stress cardiac magnetic resonance (CMR) in a Medicare-eligible group of patients in a multicenter setting in the United States. METHODS From a multicenter U.S. registry, the study identified patients aged ≥65 years who were referred for stress CMR for evaluation of myocardial inducible ischemia. The primary outcome was defined as CV death or nonfatal myocardial infarction, whereas the secondary outcome was defined as any primary outcome, hospitalization for unstable angina, hospitalization for congestive heart failure, and unplanned late coronary artery bypass grafting. The associations of CMR findings with CV outcomes adjusted to clinical risk markers and health care cost spending were determined. RESULTS Among 1,780 patients (aged 73 ± 5.7 years; 46% female), study investigators observed 144 primary events and 323 secondary events, over a median follow-up of 4.8 years. The presence of inducible ischemia and late gadolinium enhancement (LGE) was associated with incrementally higher event rates. Patients with neither inducible ischemia nor LGE experienced a <1% annualized rate of primary outcome. In a multivariable model adjusted for CV risk factors, inducible ischemia and LGE maintained an independent association with primary (HR: 2.80 [95% CI: 1.93-4.05]; P < 0.001; and HR: 1.85 [95% CI: 1.21-2.82]; P = 0.004, respectively) and secondary (HR: 2.46 [95% CI: 1.90-3.19]; P < 0.001; and HR: 1.72 [95% CI: 1.30-2.27]; P < 0.001, respectively) outcomes. Rates of revascularization, as well as downstream costs for patients without CMR-detected inducible ischemia, remained low throughout the follow-up period. CONCLUSIONS In a multicenter cohort of Medicare-eligible older patients, stress CMR was effective in providing risk stratification. (Stress CMR Perfusion Imaging in the United States [SPINS] study; NCT03192891).
Collapse
Affiliation(s)
- Yin Ge
- Noninvasive Cardiovascular Imaging Section, Cardiovascular Division, Departments of Medicine and Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA; Division of Cardiology, Department of Medicine, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Panagiotis Antiochos
- Noninvasive Cardiovascular Imaging Section, Cardiovascular Division, Departments of Medicine and Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA; Division of Cardiology, University Hospital of Lausanne, Lausanne, Switzerland
| | - Benedikt Bernhard
- Noninvasive Cardiovascular Imaging Section, Cardiovascular Division, Departments of Medicine and Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Bobak Heydari
- Stephenson Cardiac Imaging Center, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
| | - Kevin Steel
- St Joseph Medical Center, Bellingham, Washington, USA
| | | | - J Ronald Mikolich
- Department of Cardiovascular Medicine, Sharon Regional Health System, Sharon, Pennsylvania, USA
| | - Andrew E Arai
- National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - W Patricia Bandettini
- National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Amit R Patel
- Division of Cardiology, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Sujata M Shanbhag
- National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Afshin Farzaneh-Far
- Division of Cardiology, University of Illinois at Chicago, Chicago, Illinois, USA
| | - John F Heitner
- Cardiovascular Division, New York University Grossman School of Medicine, New York, New York, USA
| | - Chetan Shenoy
- Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Steve W Leung
- Gill Heart and Vascular Institute, Division of Cardiovascular Medicine, University of Kentucky, Lexington, Kentucky, USA
| | - Jorge A Gonzalez
- Division of Cardiology and Radiology, Scripps Clinic, La Jolla, California, USA
| | - Dipan J Shah
- Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
| | - Subha V Raman
- Indiana University Cardiovascular Institute and Krannert Cardiovascular Research Center, Indianapolis, Indiana, USA
| | - Victor A Ferrari
- Cardiovascular Division, Perelman School of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jeanette Schulz-Menger
- Working Group on Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center, Berlin, and Helios Clinics, Berlin, Germany
| | - Matthias Stuber
- Department of Radiology, University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Orlando P Simonetti
- Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Raymond Y Kwong
- Noninvasive Cardiovascular Imaging Section, Cardiovascular Division, Departments of Medicine and Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA.
| |
Collapse
|
3
|
Bernhard B, Ge Y, Antiochos P, Heydari B, Islam S, Sanchez Santiuste N, Steel KE, Bingham S, Mikolich JR, Arai AE, Bandettini WP, Patel AR, Shanbhag SM, Farzaneh-Far A, Heitner JF, Shenoy C, Leung SW, Gonzalez JA, Raman SV, Ferrari VA, Shah DJ, Schulz-Menger J, Stuber M, Simonetti OP, Kwong RY. Association of Adverse Clinical Outcomes With Peri-Infarct Ischemia Detected by Stress Cardiac Magnetic Imaging. J Am Coll Cardiol 2024; 84:417-429. [PMID: 39048273 DOI: 10.1016/j.jacc.2024.04.062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 03/20/2024] [Accepted: 04/09/2024] [Indexed: 07/27/2024]
Abstract
BACKGROUND Early invasive revascularization guided by moderate to severe ischemia did not improve outcomes over medical therapy alone, underlying the need to identify high-risk patients for a more effective invasive referral. CMR could determine the myocardial extent and matching locations of ischemia and infarction. OBJECTIVES This study sought to investigate if CMR peri-infarct ischemia is associated with adverse events incremental to known risk markers. METHODS Consecutive patients were included in an expanded cohort of the multicenter SPINS (Stress CMR Perfusion Imaging in the United States) study. Peri-infarct ischemia was defined by the presence of any ischemic segment neighboring an infarcted segment by late gadolinium enhancement imaging. Primary outcome events included acute myocardial infarction and cardiovascular death, whereas secondary events included any primary events, hospitalization for unstable angina, heart failure hospitalization, and late coronary artery bypass surgery. RESULTS Among 3,915 patients (age: 61.0 ± 12.9 years; 54.7% male), ischemia, infarct, and peri-infarct ischemia were present in 752 (19.2%), 1,123 (28.8%), and 382 (9.8%) patients, respectively. At 5.3 years (Q1-Q3: 3.9-7.2 years) of median follow-up, primary and secondary events occurred in 406 (10.4%) and 745 (19.0%) patients, respectively. Peri-infarct ischemia was the strongest multivariable predictor for primary and secondary events (HRadjusted: 1.72 [95% CI: 1.23-2.41] and 1.71 [95% CI: 1.32-2.20], respectively; both P < 0.001), adjusted for clinical risk factors, left ventricular function, ischemia extent, and infarct size. The presence of peri-infarct ischemia portended to a >6-fold increased annualized primary event rate compared to those with no infarct and ischemia (6.5% vs 0.9%). CONCLUSIONS Peri-infarct ischemia is a novel and robust prognostic marker of adverse cardiovascular events.
Collapse
Affiliation(s)
- Benedikt Bernhard
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA
| | - Yin Ge
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA
| | | | - Bobak Heydari
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA
| | - Sabeeh Islam
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Natalia Sanchez Santiuste
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Kevin E Steel
- St Joseph Medical Center, Bellingham, Washington, USA
| | | | - J Ronald Mikolich
- Department of Cardiovascular Medicine, Sharon Regional Health System, Sharon, Pennsylvania, USA
| | - Andrew E Arai
- Division of Intramural Research, Cardiology Branch, National Heart, Lung, and Blood Institute, Bethesda, Maryland, USA
| | - W Patricia Bandettini
- Division of Intramural Research, Cardiology Branch, National Heart, Lung, and Blood Institute, Bethesda, Maryland, USA
| | - Amit R Patel
- Division of Cardiology, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Sujata M Shanbhag
- Division of Intramural Research, Cardiology Branch, National Heart, Lung, and Blood Institute, Bethesda, Maryland, USA
| | | | - John F Heitner
- Cardiovascular Division, New York University Grossman School of Medicine, New York, New York, USA
| | - Chetan Shenoy
- Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Steve W Leung
- Division of Cardiovascular Medicine, Gill Heart and Vascular Institute, University of Kentucky, Lexington, Kentucky, USA
| | - Jorge A Gonzalez
- Division of Cardiology and Radiology, Scripps Clinic, La Jolla, California, USA
| | | | - Victor A Ferrari
- Hospital of the University of Pennsylvania and Penn Cardiovascular Institute, Philadelphia, Pennsylvania, USA
| | - Dipan J Shah
- Weill Cornell Medical College, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
| | - Jeanette Schulz-Menger
- Charité, Medical Faculty of the Humboldt University, Experimental and Clinical Research Center, Berlin, Germany; Helios Clinics, Cardiology, Berlin, Germany
| | - Matthias Stuber
- Department of Radiology, University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Orlando P Simonetti
- Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio University, Columbus, Ohio, USA
| | - Raymond Y Kwong
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA.
| |
Collapse
|
4
|
Tong MS, Slivnick JA, Sharif B, Kim HW, Young AA, Sierra-Galan LM, Mukai K, Farzaneh-Far A, Al-Kindi S, Chan AT, Dibu G, Elliott MD, Ferreira VM, Grizzard J, Kelle S, Lee S, Malahfji M, Petersen SE, Polsani V, Toro-Salazar OH, Shaikh KA, Shenoy C, Srichai MB, Stojanovska J, Tao Q, Wei J, Weinsaft JW, Wince WB, Chudgar PD, Judd M, Judd RM, Shah DJ, Simonetti OP. The Society for Cardiovascular Magnetic Resonance Registry at 150,000. J Cardiovasc Magn Reson 2024; 26:101055. [PMID: 38971501 PMCID: PMC11314894 DOI: 10.1016/j.jocmr.2024.101055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2024] [Accepted: 06/28/2024] [Indexed: 07/08/2024] Open
Abstract
BACKGROUND Cardiovascular magnetic resonance (CMR) is increasingly utilized to evaluate expanding cardiovascular conditions. The Society for Cardiovascular Magnetic Resonance (SCMR) Registry is a central repository for real-world clinical data to support cardiovascular research, including those relating to outcomes, quality improvement, and machine learning. The SCMR Registry is built on a regulatory-compliant, cloud-based infrastructure that houses searchable content and Digital Imaging and Communications in Medicine images. The goal of this study is to summarize the status of the SCMR Registry at 150,000 exams. METHODS The processes for data security, data submission, and research access are outlined. We interrogated the Registry and presented a summary of its contents. RESULTS Data were compiled from 154,458 CMR scans across 20 United States sites, containing 299,622,066 total images (∼100 terabytes of storage). Across reported values, the human subjects had an average age of 58 years (range 1 month to >90 years old), were 44% (63,070/145,275) female, 72% (69,766/98,008) Caucasian, and had a mortality rate of 8% (9,962/132,979). The most common indication was cardiomyopathy (35,369/131,581, 27%), and most frequently used current procedural terminology code was 75561 (57,195/162,901, 35%). Macrocyclic gadolinium-based contrast agents represented 89% (83,089/93,884) of contrast utilization after 2015. Short-axis cines were performed in 99% (76,859/77,871) of tagged scans, short-axis late gadolinium enhancement (LGE) in 66% (51,591/77,871), and stress perfusion sequences in 30% (23,241/77,871). Mortality data demonstrated increased mortality in patients with left ventricular ejection fraction <35%, the presence of wall motion abnormalities, stress perfusion defects, and infarct LGE, compared to those without these markers. There were 456,678 patient-years of all-cause mortality follow-up, with a median follow-up time of 3.6 years. CONCLUSION The vision of the SCMR Registry is to promote evidence-based utilization of CMR through a collaborative effort by providing a web mechanism for centers to securely upload de-identified data and images for research, education, and quality control. The Registry quantifies changing practice over time and supports large-scale real-world multicenter observational studies of prognostic utility.
Collapse
Affiliation(s)
- Matthew S Tong
- Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University, Columbus, Ohio, USA.
| | - Jeremy A Slivnick
- Division of Cardiovascular Medicine, The University of Chicago Medicine, Chicago, Illinois, USA
| | - Behzad Sharif
- Krannert Cardiovascular Research Center, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Han W Kim
- Division of Cardiology, Department of Medicine, Duke University, Durham, North Carolina, USA
| | - Alistair A Young
- Department of Anatomy and Medical Imaging, University of Auckland, Auckland, New Zealand; School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Lilia M Sierra-Galan
- Cardiology Department of the Cardiovascular Division of The American British Cowdray Medical Center, Mexico City, Mexico
| | - Kanae Mukai
- Ryan Ranch Center for Advanced Diagnostic Imaging, Salinas Valley Health, Salinas, California, USA
| | - Afshin Farzaneh-Far
- Division of Cardiology, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Sadeer Al-Kindi
- Harrington Heart and Vascular Institute, University Hospitals and Case Western Reserve University, Cleveland, Ohio, USA
| | - Angel T Chan
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - George Dibu
- Ascension St. Vincent's Medical Center, Jacksonville, Florida, USA
| | - Michael D Elliott
- Sanger Heart & Vascular Institute, Atrium Health, Charlotte, North Carolina, USA
| | - Vanessa M Ferreira
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom
| | - John Grizzard
- Department of Radiology, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Sebastian Kelle
- Deutsches Herzzentrum der Charité, Department of Cardiology, Angiology and Intensive Care Medicine, Campus Virchow Clinic, Berlin, Germany; German Centre for Cardiovascular Research, Berlin, Germany
| | - Simon Lee
- Heart Center, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Maan Malahfji
- Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
| | - Steffen E Petersen
- William Harvey Research Centre, Queen Mary University London, London, United Kingdom; Barts Heart Centre, St Bartholomew's Hospital, Barts Health National Health Service Trust, London, United Kingdom
| | | | - Olga H Toro-Salazar
- Pediatric Cardiology, Connecticut Children's Medical Center, University of Connecticut School of Medicine, Hartford, Connecticut, USA
| | - Kamran A Shaikh
- Seton Heart Institute, Seton Medical Center, Kyle, Texas, USA
| | - Chetan Shenoy
- Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Monvadi B Srichai
- Departments of Cardiology and Radiology, Georgetown University School of Medicine, Washington, District of Columbia, USA
| | - Jadranka Stojanovska
- Department of Radiology, Langone Health, New York University, New York, New York, USA
| | - Qian Tao
- Department of Imaging Physics, Delft University of Technology, Delft, the Netherlands
| | - Janet Wei
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Jonathan W Weinsaft
- Division of Cardiology, Department of Medicine, Weill Cornell Medicine - New York Presbyterian Hospital, New York, New York, USA
| | | | - Priya D Chudgar
- Department of Radiology, Jupiter Hospital, Mumbai, Maharashtra, India
| | - Matthew Judd
- Heart Imaging Technologies, LLC, Durham, North Carolina, USA
| | - Robert M Judd
- Division of Cardiology, Department of Medicine, Duke University, Durham, North Carolina, USA
| | - Dipan J Shah
- Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
| | - Orlando P Simonetti
- Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University, Columbus, Ohio, USA; Department of Radiology, The Ohio State University, Columbus, Ohio, USA
| |
Collapse
|
5
|
Fu Q, Alabed S, Hoole SP, Abraham G, Weir-McCall JR. Prognostic Value of Stress Perfusion Cardiac MRI in Cardiovascular Disease: A Systematic Review and Meta-Analysis of the Effects of the Scanner, Stress Agent, and Analysis Technique. Radiol Cardiothorac Imaging 2024; 6:e230382. [PMID: 38814186 PMCID: PMC11211944 DOI: 10.1148/ryct.230382] [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: 11/28/2023] [Revised: 04/02/2024] [Accepted: 04/15/2024] [Indexed: 05/31/2024]
Abstract
Purpose To perform a systematic review and meta-analysis to assess the prognostic value of stress perfusion cardiac MRI in predicting cardiovascular outcomes. Materials and Methods A systematic literature search from the inception of PubMed, Embase, Web of Science, and China National Knowledge Infrastructure until January 2023 was performed for articles that reported the prognosis of stress perfusion cardiac MRI in predicting cardiovascular outcomes. The quality of included studies was assessed using the Quality in Prognosis Studies tool. Reported hazard ratios (HRs) of univariable regression analyses with 95% CIs were pooled. Comparisons were performed across different analysis techniques (qualitative, semiquantitative, and fully quantitative), magnetic field strengths (1.5 T vs 3 T), and stress agents (dobutamine, adenosine, and dipyridamole). Results Thirty-eight studies with 58 774 patients with a mean follow-up time of 53 months were included. There were 1.9 all-cause deaths and 3.5 major adverse cardiovascular events (MACE) per 100 patient-years. Stress-inducible ischemia was associated with a higher risk of all-cause mortality (HR: 2.55 [95% CI: 1.89, 3.43]) and MACE (HR: 3.90 [95% CI: 2.69, 5.66]). For MACE, pooled HRs of qualitative, semiquantitative, and fully quantitative methods were 4.56 (95% CI: 2.88, 7.22), 3.22 (95% CI: 1.60, 6.48), and 1.78 (95% CI: 1.39, 2.28), respectively. For all-cause mortality, there was no evidence of a difference between qualitative and fully quantitative methods (P = .79). Abnormal stress perfusion cardiac MRI findings remained prognostic when subgrouped based on underlying disease, stress agent, and field strength, with HRs of 3.54, 2.20, and 3.38, respectively, for all-cause mortality and 3.98, 3.56, and 4.21, respectively, for MACE. There was no evidence of subgroup differences in prognosis between field strengths or stress agents. There was significant heterogeneity in effect size for MACE outcomes in the subgroups assessing qualitative versus quantitative stress perfusion analysis, underlying disease, and field strength. Conclusion Stress perfusion cardiac MRI is valuable for predicting cardiovascular outcomes, regardless of the analysis method, stress agent, or magnetic field strength used. Keywords: MR-Perfusion, MRI, Cardiac, Meta-Analysis, Stress Perfusion, Cardiac MR, Cardiovascular Disease, Prognosis, Quantitative © RSNA, 2024 Supplemental material is available for this article.
Collapse
Affiliation(s)
- Qing Fu
- From the Department of Radiology, Union Hospital, Tongji Medical
College, Huazhong University of Science and Technology, Wuhan, China (Q.F.);
Department of Radiology, Cambridge Biomedical Campus, University of Cambridge,
Box 219, Level 5, Cambridge CB2 0QQ, England (Q.F., J.R.W.M.);
Departments of Radiology (Q.F., J.R.W.M., S.A.) and Cardiology (S.P.H., G.A.),
Royal Papworth Hospital, Cambridge, England; and School of Medicine &
Population Health and INSIGNEO, Institute for In Silico Medicine, University of
Sheffield, Sheffield, England (S.A.)
| | - Samer Alabed
- From the Department of Radiology, Union Hospital, Tongji Medical
College, Huazhong University of Science and Technology, Wuhan, China (Q.F.);
Department of Radiology, Cambridge Biomedical Campus, University of Cambridge,
Box 219, Level 5, Cambridge CB2 0QQ, England (Q.F., J.R.W.M.);
Departments of Radiology (Q.F., J.R.W.M., S.A.) and Cardiology (S.P.H., G.A.),
Royal Papworth Hospital, Cambridge, England; and School of Medicine &
Population Health and INSIGNEO, Institute for In Silico Medicine, University of
Sheffield, Sheffield, England (S.A.)
| | - Stephen P. Hoole
- From the Department of Radiology, Union Hospital, Tongji Medical
College, Huazhong University of Science and Technology, Wuhan, China (Q.F.);
Department of Radiology, Cambridge Biomedical Campus, University of Cambridge,
Box 219, Level 5, Cambridge CB2 0QQ, England (Q.F., J.R.W.M.);
Departments of Radiology (Q.F., J.R.W.M., S.A.) and Cardiology (S.P.H., G.A.),
Royal Papworth Hospital, Cambridge, England; and School of Medicine &
Population Health and INSIGNEO, Institute for In Silico Medicine, University of
Sheffield, Sheffield, England (S.A.)
| | - George Abraham
- From the Department of Radiology, Union Hospital, Tongji Medical
College, Huazhong University of Science and Technology, Wuhan, China (Q.F.);
Department of Radiology, Cambridge Biomedical Campus, University of Cambridge,
Box 219, Level 5, Cambridge CB2 0QQ, England (Q.F., J.R.W.M.);
Departments of Radiology (Q.F., J.R.W.M., S.A.) and Cardiology (S.P.H., G.A.),
Royal Papworth Hospital, Cambridge, England; and School of Medicine &
Population Health and INSIGNEO, Institute for In Silico Medicine, University of
Sheffield, Sheffield, England (S.A.)
| | - Jonathan R. Weir-McCall
- From the Department of Radiology, Union Hospital, Tongji Medical
College, Huazhong University of Science and Technology, Wuhan, China (Q.F.);
Department of Radiology, Cambridge Biomedical Campus, University of Cambridge,
Box 219, Level 5, Cambridge CB2 0QQ, England (Q.F., J.R.W.M.);
Departments of Radiology (Q.F., J.R.W.M., S.A.) and Cardiology (S.P.H., G.A.),
Royal Papworth Hospital, Cambridge, England; and School of Medicine &
Population Health and INSIGNEO, Institute for In Silico Medicine, University of
Sheffield, Sheffield, England (S.A.)
| |
Collapse
|
6
|
Patel AR, Kramer CM. Perfusion Imaging for the Heart. Magn Reson Imaging Clin N Am 2024; 32:125-134. [PMID: 38007275 DOI: 10.1016/j.mric.2023.09.005] [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] [Indexed: 11/27/2023]
Abstract
The use of myocardial perfusion imaging during a stress cardiac magnetic resonance (CMR) examination for the evaluation of coronary artery disease is now recommended by both US and European guidelines. Several studies have demonstrated high diagnostic accuracy for the detection of hemodynamically significant coronary artery disease. Stress perfusion CMR has been shown to be a noninvasive and cost-effective alternative to guide coronary revascularization.
Collapse
Affiliation(s)
- Amit R Patel
- Department of Medicine, From the Cardiovascular Division, University of Virginia Health, 1215 Lee Street, Box 800158, Charlottesville, VA 22908, USA; Department of Radiology and Medical Imaging, From the Cardiovascular Division, University of Virginia Health, 1215 Lee Street, Box 800158, Charlottesville, VA 22908, USA.
| | - Christopher M Kramer
- Department of Medicine, From the Cardiovascular Division, University of Virginia Health, 1215 Lee Street, Box 800158, Charlottesville, VA 22908, USA; Department of Radiology and Medical Imaging, From the Cardiovascular Division, University of Virginia Health, 1215 Lee Street, Box 800158, Charlottesville, VA 22908, USA
| |
Collapse
|
7
|
Alajmi F, Kang M, Dundas J, Haenel A, Parker J, Blanke P, Coghlan F, Khoo JK, Bin Zaid AA, Singh A, Heydari B, Yeung D, Roston TM, Ong K, Leipsic J, Laksman Z. Novel Magnetic Resonance Imaging Tools for Hypertrophic Cardiomyopathy Risk Stratification. Life (Basel) 2024; 14:200. [PMID: 38398708 PMCID: PMC10889913 DOI: 10.3390/life14020200] [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: 12/21/2023] [Revised: 01/22/2024] [Accepted: 01/23/2024] [Indexed: 02/25/2024] Open
Abstract
Hypertrophic cardiomyopathy (HCM) is a common genetic disorder with a well described risk of sudden cardiac death; however, risk stratification has remained a challenge. Recently, novel parameters in cardiac magnetic resonance imaging (CMR) have shown promise in helping to improve upon current risk stratification paradigms. In this manuscript, we have reviewed novel CMR risk markers and their utility in HCM. The results of the review showed that T1, extracellular volume, CMR feature tracking, and other miscellaneous novel CMR variables have the potential to improve sudden death risk stratification and may have additional roles in diagnosis and prognosis. The strengths and weaknesses of these imaging techniques, and their potential utility and implementation in HCM risk stratification are discussed.
Collapse
Affiliation(s)
- Fahad Alajmi
- Center for Cardiovascular Innovation, Division of Cardiology, Department of Medicine, University of British Columbia, 2775 Laurel St, 9th Floor, Vancouver, BC V5Z 1M9, Canada; (M.K.); (A.H.); (J.P.); (P.B.); (F.C.); (J.K.K.); (A.A.B.Z.); (B.H.); (D.Y.); (T.M.R.); (K.O.)
| | - Mehima Kang
- Center for Cardiovascular Innovation, Division of Cardiology, Department of Medicine, University of British Columbia, 2775 Laurel St, 9th Floor, Vancouver, BC V5Z 1M9, Canada; (M.K.); (A.H.); (J.P.); (P.B.); (F.C.); (J.K.K.); (A.A.B.Z.); (B.H.); (D.Y.); (T.M.R.); (K.O.)
| | - James Dundas
- Department of Radiology, University of British Columbia, 2775 Laurel Street, 11th Floor, Vancouver, BC V5Z 1M9, Canada; (J.D.); (J.L.)
- Department of Cardiology, North Tees and Hartlepool NHS Foundation Trust, Hardwick Rd, Hardwick, Stockton-on-Tees TS19 8PE, UK
| | - Alexander Haenel
- Center for Cardiovascular Innovation, Division of Cardiology, Department of Medicine, University of British Columbia, 2775 Laurel St, 9th Floor, Vancouver, BC V5Z 1M9, Canada; (M.K.); (A.H.); (J.P.); (P.B.); (F.C.); (J.K.K.); (A.A.B.Z.); (B.H.); (D.Y.); (T.M.R.); (K.O.)
| | - Jeremy Parker
- Center for Cardiovascular Innovation, Division of Cardiology, Department of Medicine, University of British Columbia, 2775 Laurel St, 9th Floor, Vancouver, BC V5Z 1M9, Canada; (M.K.); (A.H.); (J.P.); (P.B.); (F.C.); (J.K.K.); (A.A.B.Z.); (B.H.); (D.Y.); (T.M.R.); (K.O.)
| | - Philipp Blanke
- Center for Cardiovascular Innovation, Division of Cardiology, Department of Medicine, University of British Columbia, 2775 Laurel St, 9th Floor, Vancouver, BC V5Z 1M9, Canada; (M.K.); (A.H.); (J.P.); (P.B.); (F.C.); (J.K.K.); (A.A.B.Z.); (B.H.); (D.Y.); (T.M.R.); (K.O.)
- Department of Radiology, University of British Columbia, 2775 Laurel Street, 11th Floor, Vancouver, BC V5Z 1M9, Canada; (J.D.); (J.L.)
| | - Fionn Coghlan
- Center for Cardiovascular Innovation, Division of Cardiology, Department of Medicine, University of British Columbia, 2775 Laurel St, 9th Floor, Vancouver, BC V5Z 1M9, Canada; (M.K.); (A.H.); (J.P.); (P.B.); (F.C.); (J.K.K.); (A.A.B.Z.); (B.H.); (D.Y.); (T.M.R.); (K.O.)
| | - John King Khoo
- Center for Cardiovascular Innovation, Division of Cardiology, Department of Medicine, University of British Columbia, 2775 Laurel St, 9th Floor, Vancouver, BC V5Z 1M9, Canada; (M.K.); (A.H.); (J.P.); (P.B.); (F.C.); (J.K.K.); (A.A.B.Z.); (B.H.); (D.Y.); (T.M.R.); (K.O.)
| | - Abdulaziz A. Bin Zaid
- Center for Cardiovascular Innovation, Division of Cardiology, Department of Medicine, University of British Columbia, 2775 Laurel St, 9th Floor, Vancouver, BC V5Z 1M9, Canada; (M.K.); (A.H.); (J.P.); (P.B.); (F.C.); (J.K.K.); (A.A.B.Z.); (B.H.); (D.Y.); (T.M.R.); (K.O.)
| | - Amrit Singh
- Department of Anesthesiology, Pharmacology and Therapeutics, The University of British Columbia, Medical Sciences, 2176 Health Sciences Mall Block C217, Vancouver, BC V6T 2A1, Canada;
| | - Bobby Heydari
- Center for Cardiovascular Innovation, Division of Cardiology, Department of Medicine, University of British Columbia, 2775 Laurel St, 9th Floor, Vancouver, BC V5Z 1M9, Canada; (M.K.); (A.H.); (J.P.); (P.B.); (F.C.); (J.K.K.); (A.A.B.Z.); (B.H.); (D.Y.); (T.M.R.); (K.O.)
| | - Darwin Yeung
- Center for Cardiovascular Innovation, Division of Cardiology, Department of Medicine, University of British Columbia, 2775 Laurel St, 9th Floor, Vancouver, BC V5Z 1M9, Canada; (M.K.); (A.H.); (J.P.); (P.B.); (F.C.); (J.K.K.); (A.A.B.Z.); (B.H.); (D.Y.); (T.M.R.); (K.O.)
| | - Thomas M. Roston
- Center for Cardiovascular Innovation, Division of Cardiology, Department of Medicine, University of British Columbia, 2775 Laurel St, 9th Floor, Vancouver, BC V5Z 1M9, Canada; (M.K.); (A.H.); (J.P.); (P.B.); (F.C.); (J.K.K.); (A.A.B.Z.); (B.H.); (D.Y.); (T.M.R.); (K.O.)
| | - Kevin Ong
- Center for Cardiovascular Innovation, Division of Cardiology, Department of Medicine, University of British Columbia, 2775 Laurel St, 9th Floor, Vancouver, BC V5Z 1M9, Canada; (M.K.); (A.H.); (J.P.); (P.B.); (F.C.); (J.K.K.); (A.A.B.Z.); (B.H.); (D.Y.); (T.M.R.); (K.O.)
| | - Jonathon Leipsic
- Department of Radiology, University of British Columbia, 2775 Laurel Street, 11th Floor, Vancouver, BC V5Z 1M9, Canada; (J.D.); (J.L.)
| | - Zachary Laksman
- Center for Cardiovascular Innovation, Division of Cardiology, Department of Medicine, University of British Columbia, 2775 Laurel St, 9th Floor, Vancouver, BC V5Z 1M9, Canada; (M.K.); (A.H.); (J.P.); (P.B.); (F.C.); (J.K.K.); (A.A.B.Z.); (B.H.); (D.Y.); (T.M.R.); (K.O.)
| |
Collapse
|
8
|
Korosoglou G, Sagris M, André F, Steen H, Montenbruck M, Frey N, Kelle S. Systematic review and meta-analysis for the value of cardiac magnetic resonance strain to predict cardiac outcomes. Sci Rep 2024; 14:1094. [PMID: 38212323 PMCID: PMC10784294 DOI: 10.1038/s41598-023-50835-5] [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: 11/02/2023] [Accepted: 12/26/2023] [Indexed: 01/13/2024] Open
Abstract
Cardiac magnetic resonance (CMR) is the gold standard for the diagnostic classification and risk stratification in most patients with cardiac disorders. The aim of the present study was to investigate the ability of Strain-encoded MR (SENC) for the prediction of major adverse cardiovascular events (MACE). A systematic review and meta-analysis was performed according to the PRISMA Guidelines, including patients with or without cardiovascular disease and asymptomatic individuals. Myocardial strain by HARP were used as pulse sequences in 1.5 T scanners. Published literature in MEDLINE (PubMed) and Cochrane's databases were explored before February 2023 for studies assessing the clinical utility of myocardial strain by Harmonic Phase Magnetic Resonance Imaging (HARP), Strain-encoded MR (SENC) or fast-SENC. In total, 8 clinical trials (4 studies conducted in asymptomatic individuals and 4 in patients with suspected or known cardiac disease) were included in this systematic review, while 3 studies were used for our meta-analysis, based on individual patient level data. Kaplan-Meier analysis and Cox proportional hazard models were used, testing the ability of myocardial strain by HARP and SENC/fast-SENC for the prediction of MACE. Strain enabled risk stratification in asymptomatic individuals, predicting MACE and the development of incident heart failure. Of 1332 patients who underwent clinically indicated CMR, including SENC or fast-SENC acquisitions, 19 patients died, 28 experienced non-fatal infarctions, 52 underwent coronary revascularization and 86 were hospitalized due to heart failure during median 22.4 (17.2-28.5) months of follow-up. SENC/fast-SENC, predicted both all-cause mortality and MACE with high accuracy (HR = 3.0, 95% CI = 1.2-7.6, p = 0.02 and HR = 4.1, 95% CI = 3.0-5.5, respectively, p < 0.001). Using hierarchical Cox-proportional hazard regression models, SENC/fast-SENC exhibited incremental value to clinical data and conventional CMR parameters. Reduced myocardial strain predicts of all-cause mortality and cardiac outcomes in symptomatic patients with a wide range of ischemic or non-ischemic cardiac diseases, whereas in asymptomatic individuals, reduced strain was a precursor of incident heart failure.
Collapse
Affiliation(s)
- Grigorios Korosoglou
- Departments of Cardiology, Vascular Medicine and Pneumology, GRN Academic Teaching Hospital Weinheim, Roentgenstrasse 1, 69469, Weinheim, Germany.
- Cardiac Imaging Center Weinheim, Hector Foundations, Weinheim, Germany.
| | - Marios Sagris
- Hippokration General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Florian André
- Departments of Cardiology, Angiology and Pneumology, Heidelberg University, Heidelberg, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Heidelberg/Mannheim, Heidelberg, Germany
| | - Henning Steen
- Departments of Cardiology, Angiology and Pneumology, Heidelberg University, Heidelberg, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Heidelberg/Mannheim, Heidelberg, Germany
| | | | - Norbert Frey
- Departments of Cardiology, Angiology and Pneumology, Heidelberg University, Heidelberg, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Heidelberg/Mannheim, Heidelberg, Germany
| | - Sebastian Kelle
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| |
Collapse
|
9
|
Gräni C, Bigler MR, Kwong RY. Noninvasive Multimodality Imaging for the Assessment of Anomalous Coronary Artery. Curr Cardiol Rep 2023; 25:1233-1246. [PMID: 37851270 DOI: 10.1007/s11886-023-01948-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/19/2023] [Indexed: 10/19/2023]
Abstract
PURPOSE OF REVIEW Anomalous aortic origin of a coronary artery (AAOCA) is a rare congenital coronary anomaly with the potential to cause myocardial ischemia and adverse cardiac events. The presence of AAOCA anatomy itself does not necessarily implicate a need for revascularization. Therefore, the purpose of this review is to assess how noninvasive comprehensive anatomic- and physiologic evaluation may guide patient management. RECENT FINDINGS The assessment of AAOCA includes an accurate description of the anomalous origin/vessel course including anatomical high-risk features such as a slit-like ostium, proximal narrowing, elliptic vessel shape, acute take-off angle, intramural course, and possible concomitant coronary atherosclerosis and hemodynamics. Various cardiac imaging modalities offer unique advantages and capabilities in visualizing these anatomical and functional aspects of AAOCA. This review explored the role of noninvasive multimodality imaging in the characterization of AAOCA by highlighting the strengths, limitations, and potential applications of the current different cardiac imaging methods, with a focus on the pathophysiology of myocardial ischemia and stress testing protocols.
Collapse
Affiliation(s)
- Christoph Gräni
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Marius R Bigler
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Raymond Y Kwong
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA.
| |
Collapse
|
10
|
Gröschel J, Trauzeddel RF, Blaszczyk E, Schulz-Menger J. [Role of cardiovascular magnetic resonance in cardiovascular diagnostics]. Dtsch Med Wochenschr 2022; 147:528-537. [PMID: 35468634 DOI: 10.1055/a-1554-8382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Cardiovascular magnetic resonance (CMR) has become an accepted method for noninvasive imaging in cardiology. As part of a multimodality concept, this method can contribute valuable diagnostic aspects, often even as a first-choice method in a variety of diseases. Currently the availability is still limited, but the increasing time efficiency, technical stability and the growing competence will lead to more guideline-compliant use. The increase of CMR inclusion into guidelines of various societies is mainly based on the unique selling point of CMR, which is noninvasive myocardial tissue differentiation. In addition to efficient ischemia diagnosis, the ability to differentiate active from chronic inflammatory processes as well as the identification of reversible and irreversible damage are some aspects CMR can offer. New developments are sequences which allow for a parametric assessment of myocardial tissue based on T1- and T2-relaxation times. This is especially useful if the exact pathophysiology is unclear, as it is often the case in left ventricular hypertrophy for example. Next to the noninvasive myocardial tissue characterization CMR allows for quantitative hemodynamic assessment of the heart and the related pathologies. Flows as well as gradients can be quantified based on 2D-flow-sequences. New 4D-sequences are aiming to further characterize blood flow in the heart and the great vessels beyond flow volume and gradients. As with any diagnostic method a qualified application is crucial. In recent years, the technique itself has become much more stable and consensus recommendations of the Society for Cardiovascular Magnetic Resonance are available for the main indications, both for the MRI scan procedure and for the evaluation. Appropriate qualifications and certification opportunities are offered both nationally and internationally.
Collapse
|
11
|
Baggiano A, Italiano G, Guglielmo M, Fusini L, Guaricci AI, Maragna R, Giacari CM, Mushtaq S, Conte E, Annoni AD, Formenti A, Mancini ME, Andreini D, Rabbat M, Pepi M, Pontone G. Changing Paradigms in the Diagnosis of Ischemic Heart Disease by Multimodality Imaging. J Clin Med 2022; 11:jcm11030477. [PMID: 35159929 PMCID: PMC8836710 DOI: 10.3390/jcm11030477] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Revised: 11/24/2021] [Accepted: 01/13/2022] [Indexed: 02/01/2023] Open
Abstract
Coronary artery disease (CAD) represents the most common cardiovascular disease, with high morbidity and mortality. Historically patients with chest pain of suspected coronary origin have been assessed with functional tests, capable to detect haemodynamic consequences of coronary obstructions through depiction of electrocardiographic changes, myocardial perfusion defects or regional wall motion abnormalities under stress condition. Stress echocardiography (SE), single-photon emission computed tomography (SPECT), positron emission tomography (PET) and cardiovascular magnetic resonance (CMR) represent the functional techniques currently available, and technical developments contributed to increased diagnostic performance of these techniques. More recently, cardiac computed tomography angiography (cCTA) has been developed as a non-invasive anatomical test for a direct visualisation of coronary vessels and detailed description of atherosclerotic burden. Cardiovascular imaging techniques have dramatically enhanced our knowledge regarding physiological aspects and myocardial implications of CAD. Recently, after the publication of important trials, international guidelines recognised these changes, updating indications and level of recommendations. This review aims to summarise current standards with main novelties and specific limitations, and a diagnostic algorithm for up-to-date clinical management is also proposed.
Collapse
Affiliation(s)
- Andrea Baggiano
- Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (A.B.); (G.I.); (M.G.); (L.F.); (R.M.); (C.M.G.); (S.M.); (E.C.); (A.D.A.); (A.F.); (M.E.M.); (D.A.); (M.P.)
- Cardiovascular Section, Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
| | - Gianpiero Italiano
- Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (A.B.); (G.I.); (M.G.); (L.F.); (R.M.); (C.M.G.); (S.M.); (E.C.); (A.D.A.); (A.F.); (M.E.M.); (D.A.); (M.P.)
| | - Marco Guglielmo
- Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (A.B.); (G.I.); (M.G.); (L.F.); (R.M.); (C.M.G.); (S.M.); (E.C.); (A.D.A.); (A.F.); (M.E.M.); (D.A.); (M.P.)
| | - Laura Fusini
- Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (A.B.); (G.I.); (M.G.); (L.F.); (R.M.); (C.M.G.); (S.M.); (E.C.); (A.D.A.); (A.F.); (M.E.M.); (D.A.); (M.P.)
| | - Andrea Igoren Guaricci
- Department of Emergency and Organ Transplantation, Institute of Cardiovascular Disease, University Hospital Policlinico of Bari, 70124 Bari, Italy;
| | - Riccardo Maragna
- Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (A.B.); (G.I.); (M.G.); (L.F.); (R.M.); (C.M.G.); (S.M.); (E.C.); (A.D.A.); (A.F.); (M.E.M.); (D.A.); (M.P.)
| | - Carlo Maria Giacari
- Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (A.B.); (G.I.); (M.G.); (L.F.); (R.M.); (C.M.G.); (S.M.); (E.C.); (A.D.A.); (A.F.); (M.E.M.); (D.A.); (M.P.)
| | - Saima Mushtaq
- Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (A.B.); (G.I.); (M.G.); (L.F.); (R.M.); (C.M.G.); (S.M.); (E.C.); (A.D.A.); (A.F.); (M.E.M.); (D.A.); (M.P.)
| | - Edoardo Conte
- Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (A.B.); (G.I.); (M.G.); (L.F.); (R.M.); (C.M.G.); (S.M.); (E.C.); (A.D.A.); (A.F.); (M.E.M.); (D.A.); (M.P.)
- Department of Biomedical Sciences for Health, University of Milan, 20133 Milan, Italy
| | - Andrea Daniele Annoni
- Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (A.B.); (G.I.); (M.G.); (L.F.); (R.M.); (C.M.G.); (S.M.); (E.C.); (A.D.A.); (A.F.); (M.E.M.); (D.A.); (M.P.)
| | - Alberto Formenti
- Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (A.B.); (G.I.); (M.G.); (L.F.); (R.M.); (C.M.G.); (S.M.); (E.C.); (A.D.A.); (A.F.); (M.E.M.); (D.A.); (M.P.)
| | - Maria Elisabetta Mancini
- Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (A.B.); (G.I.); (M.G.); (L.F.); (R.M.); (C.M.G.); (S.M.); (E.C.); (A.D.A.); (A.F.); (M.E.M.); (D.A.); (M.P.)
| | - Daniele Andreini
- Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (A.B.); (G.I.); (M.G.); (L.F.); (R.M.); (C.M.G.); (S.M.); (E.C.); (A.D.A.); (A.F.); (M.E.M.); (D.A.); (M.P.)
- Cardiovascular Section, Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
| | - Mark Rabbat
- Division of Cardiology, Department of Medicine and Radiology, Loyola University of Chicago, Chicago, IL 60660, USA;
- Division of Cardiology, Department of Medicine, Edward Hines Jr. VA Hospital, Hines, IL 60141, USA
| | - Mauro Pepi
- Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (A.B.); (G.I.); (M.G.); (L.F.); (R.M.); (C.M.G.); (S.M.); (E.C.); (A.D.A.); (A.F.); (M.E.M.); (D.A.); (M.P.)
| | - Gianluca Pontone
- Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (A.B.); (G.I.); (M.G.); (L.F.); (R.M.); (C.M.G.); (S.M.); (E.C.); (A.D.A.); (A.F.); (M.E.M.); (D.A.); (M.P.)
- Correspondence: ; Tel.: +39-02-5800-2574; Fax: +39-02-5800-2231
| |
Collapse
|
12
|
Schloss B, Bekiroglu I, O'Connor C, Lee S, Rice J, Kim SS, Tobias JD. Hemodynamic and Respiratory Effects of Regadenoson During Radiologic Imaging in Infants and Children. Cardiol Res 2022; 12:329-334. [PMID: 34970361 PMCID: PMC8683102 DOI: 10.14740/cr1323] [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] [Received: 09/15/2021] [Accepted: 11/29/2021] [Indexed: 11/11/2022] Open
Abstract
Background Myocardial perfusion imaging using radionuclides is a well-validated, noninvasive method to aid in the diagnosis of patients with suspected or known myocardial ischemia. To increase the sensitivity of the technique, pharmacologic agents which induce coronary vasodilatation are administered. Regadenoson is a novel selective A2A receptor agonist that has similar efficacy to adenosine for cardiac magnetic resonance imaging (MRI) with a more favorable adverse effect profile and is the most widely used pharmacologic stress agent. While widely used in adults, there is limited experience with it in pediatrics, particularly young children. Methods The current study retrospectively reviews our experience with stress cardiac MRI using regadenoson in children requiring general anesthesia. The study cohort included eight patients, all male, ranging in age from 2 to 6.2 years (mean age of 4.2 years) and in weight from 10 to 30.5 kg (mean weight of 18.5 kg). All patients received general anesthesia with endotracheal intubation and a volatile anesthetic agent. Results Heart rate 1 min prior to regadenoson was 99 ± 19.2 (mean ± standard deviation (SD)) beats per minute. Peak heart rate was achieved at an average of 4 min post regadenoson administration with a mean heart rate of 122 ± 15 beats per minute. The average of the mean arterial pressure 1 min prior to regadenoson was 53.4 ± 5.2 mm Hg. Mean arterial pressure nadir was noted at 6 min post regadenoson with a value of 44.1 ± 6.3 mm Hg. Blood pressure support with phenylephrine was required in four of the eight (50%) of patients. No adverse respiratory events were noted. Only one of the eight (13%) patients had a perfusion defect but had preserved ventricular function and recovered without incident. Conclusions Use of regadenoson in pediatric patients requiring general anesthesia is safe and feasible.
Collapse
Affiliation(s)
- Brian Schloss
- Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA.,Department of Anesthesiology & Pain Medicine, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Ismail Bekiroglu
- Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA
| | - Colin O'Connor
- Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA
| | - Simon Lee
- Division of Pediatric Cardiology, Department of Pediatrics, Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus, OH, USA
| | - Julie Rice
- Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA
| | - Stephani S Kim
- Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA.,Department of Anesthesiology & Pain Medicine, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Joseph D Tobias
- Department of Anesthesiology & Pain Medicine, The Ohio State University College of Medicine, Columbus, OH, USA.,Division of Pediatric Cardiology, Department of Pediatrics, Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus, OH, USA
| |
Collapse
|
13
|
Garot J, Pezel T. What if a patient has CAD? Go to CMR! Arch Cardiovasc Dis 2021; 114:765-767. [PMID: 34776368 DOI: 10.1016/j.acvd.2021.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Accepted: 10/19/2021] [Indexed: 10/19/2022]
Affiliation(s)
- Jérôme Garot
- Institut Cardiovasculaire Paris Sud, Cardiovascular Magnetic Resonance Laboratory, Hôpital Privé Jacques Cartier, Ramsay Santé, 6, Avenue du Noyer Lambert, 91300 Massy, France.
| | - Théo Pezel
- Department of Cardiology, Lariboisière Hospital, AP-HP, Inserm UMRS 942, University of Paris, Paris, France
| |
Collapse
|