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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.
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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
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2
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Bogatu L, Turco S, Mischi M, Schmitt L, Woerlee P, Bezemer R, Bouwman AR, Korsten EHHM, Muehlsteff J. New Hemodynamic Parameters in Peri-Operative and Critical Care-Challenges in Translation. SENSORS (BASEL, SWITZERLAND) 2023; 23:2226. [PMID: 36850819 PMCID: PMC9961222 DOI: 10.3390/s23042226] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 02/03/2023] [Accepted: 02/06/2023] [Indexed: 06/18/2023]
Abstract
Hemodynamic monitoring technologies are evolving continuously-a large number of bedside monitoring options are becoming available in the clinic. Methods such as echocardiography, electrical bioimpedance, and calibrated/uncalibrated analysis of pulse contours are becoming increasingly common. This is leading to a decline in the use of highly invasive monitoring and allowing for safer, more accurate, and continuous measurements. The new devices mainly aim to monitor the well-known hemodynamic variables (e.g., novel pulse contour, bioreactance methods are aimed at measuring widely-used variables such as blood pressure, cardiac output). Even though hemodynamic monitoring is now safer and more accurate, a number of issues remain due to the limited amount of information available for diagnosis and treatment. Extensive work is being carried out in order to allow for more hemodynamic parameters to be measured in the clinic. In this review, we identify and discuss the main sensing strategies aimed at obtaining a more complete picture of the hemodynamic status of a patient, namely: (i) measurement of the circulatory system response to a defined stimulus; (ii) measurement of the microcirculation; (iii) technologies for assessing dynamic vascular mechanisms; and (iv) machine learning methods. By analyzing these four main research strategies, we aim to convey the key aspects, challenges, and clinical value of measuring novel hemodynamic parameters in critical care.
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Affiliation(s)
- Laura Bogatu
- Biomedical Diagnostics Lab (BM/d), Eindhoven University of Technology, 5612 AZ Eindhoven, The Netherlands
- Patient Care and Measurements, Philips Research, 5656 AE Eindhoven, The Netherlands
| | - Simona Turco
- Biomedical Diagnostics Lab (BM/d), Eindhoven University of Technology, 5612 AZ Eindhoven, The Netherlands
| | - Massimo Mischi
- Biomedical Diagnostics Lab (BM/d), Eindhoven University of Technology, 5612 AZ Eindhoven, The Netherlands
| | - Lars Schmitt
- Patient Care and Measurements, Philips Research, 5656 AE Eindhoven, The Netherlands
| | - Pierre Woerlee
- Biomedical Diagnostics Lab (BM/d), Eindhoven University of Technology, 5612 AZ Eindhoven, The Netherlands
| | - Rick Bezemer
- Patient Care and Measurements, Philips Research, 5656 AE Eindhoven, The Netherlands
| | - Arthur R. Bouwman
- Department of Anesthesiology, Intensive Care and Pain Medicine, Catharina Ziekenhuis, 5623 EJ Eindhoven, The Netherlands
| | - Erik H. H. M. Korsten
- Department of Anesthesiology, Intensive Care and Pain Medicine, Catharina Ziekenhuis, 5623 EJ Eindhoven, The Netherlands
| | - Jens Muehlsteff
- Patient Care and Measurements, Philips Research, 5656 AE Eindhoven, The Netherlands
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3
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Narang A, Blair JE, Patel MB, Mor-Avi V, Fedson SE, Uriel N, Lang RM, Patel AR. Myocardial perfusion reserve and global longitudinal strain as potential markers of coronary allograft vasculopathy in late-stage orthotopic heart transplantation. Int J Cardiovasc Imaging 2018; 34:1607-1617. [PMID: 29728952 PMCID: PMC6160357 DOI: 10.1007/s10554-018-1364-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Accepted: 04/29/2018] [Indexed: 12/30/2022]
Abstract
Coronary allograft vasculopathy (CAV) is a major cause of mortality in late-stage orthotopic heart transplantation (OHT) patients. Recent evidence has shown that myocardial perfusion reserve (MPR) derived from vasodilator cardiovascular magnetic resonance imaging (vCMR) and global longitudinal strain (GLS) from transthoracic echocardiography (TTE) are useful to detect CAV. However, previous studies have not comprehensively addressed whether these parameters are confounded by allograft rejection, myocardial scar/fibrosis, or allograft dysfunction. Our aim was to determine whether changes in late post-OHT MPR and GLS are due to CAV or other confounding factors. Twenty OHT patients (time from transplant to vCMR was 8.1 ± 4.1 years) and 30 controls (10 healthy volunteers and 20 with prior myocardial infarction to provide perspective with regards to the severity of any abnormalities seen in post-OHT patients) underwent vasodilator vCMR from which MPR index (MPRi), left ventricular ejection fraction (LVEF), and burden of late gadolinium enhancement (LGE) were quantified. TTE was used to measure GLS. The presence of CAV was determined from invasive coronary angiograms using thrombolysis in myocardial infarction (TIMI) frame counts and grading severity per guidelines. Previous endomyocardial biopsies were reviewed to assess association with episodes of rejection. We examined the correlations between MPRi and GLS with markers of CAV, allograft function, scar/fibrosis, and rejection. MPRi was abnormal in post-OHT patients compared to both healthy volunteers and MI controls. While there was no relationship between MPRi or GLS and LVEF, episodes of rejection, or LGE burden, both MPRi and GLS were associated with TIMI frame counts and presence and severity of CAV. Additionally, MPRi correlated with GLS (R = 0.68, P = 0.0002). In conclusion, MPRi and GLS are abnormal in late-stage OHT and associated with CAV, but not related to allograft rejection, myocardial scar/fibrosis, or allograft dysfunction. Non-invasive monitoring of MPRi and GLS may be a useful strategy to detect CAV.
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Affiliation(s)
- Akhil Narang
- Department of Medicine, University of Chicago Medicine, 5758 S. Maryland Avenue, MC9067, Chicago, IL, 60637, USA
| | - John E Blair
- Department of Medicine, University of Chicago Medicine, 5758 S. Maryland Avenue, MC9067, Chicago, IL, 60637, USA
| | - Mita B Patel
- Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Victor Mor-Avi
- Department of Medicine, University of Chicago Medicine, 5758 S. Maryland Avenue, MC9067, Chicago, IL, 60637, USA
| | - Savitri E Fedson
- Center for Medical Ethics and Health Policy, Baylor School of Medicine, Houston, TX, USA
| | - Nir Uriel
- Department of Medicine, University of Chicago Medicine, 5758 S. Maryland Avenue, MC9067, Chicago, IL, 60637, USA
| | - Roberto M Lang
- Department of Medicine, University of Chicago Medicine, 5758 S. Maryland Avenue, MC9067, Chicago, IL, 60637, USA
- Department of Radiology, University of Chicago, Chicago, IL, USA
| | - Amit R Patel
- Department of Medicine, University of Chicago Medicine, 5758 S. Maryland Avenue, MC9067, Chicago, IL, 60637, USA.
- Department of Radiology, University of Chicago, Chicago, IL, USA.
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Wang M, Zhang WB, Song JL, Luan Y, Jin CY. Effect of Breviscapine on Recovery of Viable Myocardium and Left Ventricular Remodeling in Chronic Total Occlusion Patients After Revascularization: Rationale and Design for a Randomized Controlled Trial. Med Sci Monit 2018; 24:4602-4609. [PMID: 29970875 PMCID: PMC6064194 DOI: 10.12659/msm.906438] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND How to speed the recovery of viable myocardium in chronic total occlusion (CTO) patients after revascularization is still an unsolved problem. Breviscapine is widely used in cardiovascular diseases. However, there has been no study focused on the effect of breviscapine on viable myocardium recovery and left ventricular remodeling after CTO revascularization. MATERIAL AND METHODS We propose to recruit 78 consecutive coronary artery disease (CAD) patients with CTO during a period of 12 months. They will be randomly assigned to receive either breviscapine (40 mg) or placebo in the following 12 months. Blood tests, electrocardiogram, and Major Adverse Cardiac Events (MACE) will be collected at baseline and the follow-up visits at 1, 3, 6, 9, and 12 months. Low-dose dobutamine MRI will be applied for the assessment of viable myocardium, microcirculation perfusion, and left ventricular remodeling, and the concentrations of angiogenic cytokine, vascular endothelial growth factor (VEGF), and basic fibroblast growth factor (bFGF) will be investigated at baseline and at 1- and 12-month follow-up. The recovery of viable myocardium after revascularization in CTO patients was the primary endpoint. Improvement of microcirculation perfusion, left ventricular remodeling, peripheral concentrations of VEGF and bFGF as well as MACE will be the secondary endpoints. RESULTS Breviscapine treatment obviously improve the recovery of viable myocardium, myocardial microcirculation perfusion, and left ventricular remodeling after revascularization in CTO patients, and reduce the occurrence of MACE. We also will determine if breviscapine increases the peripheral blood angiogenic cytokine concentrations of VEGF and bFGF. CONCLUSIONS This study will aim to demonstrate the effect of breviscapine on the recovery of viable myocardium and left ventricular remodeling in CTO patients after revascularization.
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Affiliation(s)
- Min Wang
- Department of Cardiology, Biomedical Research (Therapy) Center, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China (mainland)
| | - Wen-Bin Zhang
- Department of Cardiology, Biomedical Research (Therapy) Center, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China (mainland)
| | - Jia-le Song
- Department of Cardiology, Biomedical Research (Therapy) Center, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China (mainland)
| | - Yi Luan
- Department of Cardiology, Biomedical Research (Therapy) Center, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China (mainland)
| | - Chong-Ying Jin
- Department of Cardiology, Biomedical Research (Therapy) Center, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China (mainland)
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5
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Verkaik M, van Poelgeest EM, Kwekkeboom RFJ, Ter Wee PM, van den Brom CE, Vervloet MG, Eringa EC. Myocardial contrast echocardiography in mice: technical and physiological aspects. Am J Physiol Heart Circ Physiol 2017; 314:H381-H391. [PMID: 29101165 DOI: 10.1152/ajpheart.00242.2017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Myocardial contrast echocardiography (MCE) offers the opportunity to study myocardial perfusion defects in mice in detail. The value of MCE compared with single-photon emission computed tomography, positron emission tomography, and computed tomography consists of high spatial resolution, the possibility of quantification of blood volume, and relatively low costs. Nevertheless, a number of technical and physiological aspects should be considered to ensure reproducibility among research groups. The aim of this overview is to describe technical aspects of MCE and the physiological parameters that influence myocardial perfusion data obtained with this technique. First, technical aspects of MCE discussed in this technical review are logarithmic compression of ultrasound data by ultrasound systems, saturation of the contrast signal, and acquisition of images during different phases of the cardiac cycle. Second, physiological aspects of myocardial perfusion that are affected by the experimental design are discussed, including the anesthesia regimen, systemic cardiovascular effects of vasoactive agents used, and fluctuations in body temperature that alter myocardial perfusion. When these technical and physiological aspects of MCE are taken into account and adequately standardized, MCE is an easily accessible technique for mice that can be used to study the control of myocardial perfusion by a wide range of factors.
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Affiliation(s)
- Melissa Verkaik
- Department of Nephrology, Institute Cardiovascular Research VU, VU University Medical Centre , Amsterdam , The Netherlands.,Department of Physiology, Institute Cardiovascular Research VU, VU University Medical Centre , Amsterdam , The Netherlands
| | - Erik M van Poelgeest
- Department of Physiology, Institute Cardiovascular Research VU, VU University Medical Centre , Amsterdam , The Netherlands
| | - Rick F J Kwekkeboom
- Department of Physiology, Institute Cardiovascular Research VU, VU University Medical Centre , Amsterdam , The Netherlands
| | - Piet M Ter Wee
- Department of Nephrology, Institute Cardiovascular Research VU, VU University Medical Centre , Amsterdam , The Netherlands
| | - Charissa E van den Brom
- Department of Anaesthesiology, Institute Cardiovascular Research VU, VU University Medical Centre , Amsterdam , The Netherlands
| | - Marc G Vervloet
- Department of Nephrology, Institute Cardiovascular Research VU, VU University Medical Centre , Amsterdam , The Netherlands
| | - Etto C Eringa
- Department of Physiology, Institute Cardiovascular Research VU, VU University Medical Centre , Amsterdam , The Netherlands
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6
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Sareen N, Ananthasubramaniam K. Left main coronary artery disease: A review of the spectrum of noninvasive diagnostic modalities. J Nucl Cardiol 2016; 23:1411-1429. [PMID: 26487011 DOI: 10.1007/s12350-015-0152-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2015] [Accepted: 04/15/2015] [Indexed: 11/29/2022]
Abstract
Medically managed significant left main (LM) stem disease has been considered a determinant of increased cardiac mortality approaching 50% at 3-year follow-up. Despite the clinical significance of LM disease, studies comparing the various diagnostic modalities, especially noninvasive, are sparse. Clinicians, particularly imagers, should be aware of the strengths and weaknesses of existing modalities to diagnose LM disease as integrating many clues (history, symptoms, electrocardiogram, and stress hemodynamics are essential to suspect this diagnosis and proceed to the next step). Here we review the existing data on the current role of electrocardiography, nuclear myocardial perfusion imaging (single photon emission computed tomography and positron emission tomography), stress echocardiography, cardiac computed tomography, and cardiac magnetic resonance imaging in diagnostic evaluation of LM disease. Wherever applicable we have extended our discussion to multivessel coronary artery disease encompassing scenarios where LMS can present as LM equivalent with or without extensive multivessel coronary artery disease.
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Affiliation(s)
- Nishtha Sareen
- Department of Cardiology, St. Joseph Mercy Oakland Hospital, Pontiac, MI, USA
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7
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Sharif B, Dharmakumar R, LaBounty T, Arsanjani R, Shufelt C, Thomson L, Merz CNB, Berman DS, Li D. Towards elimination of the dark-rim artifact in first-pass myocardial perfusion MRI: removing Gibbs ringing effects using optimized radial imaging. Magn Reson Med 2014; 72:124-36. [PMID: 24030840 PMCID: PMC4176898 DOI: 10.1002/mrm.24913] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2013] [Revised: 07/11/2013] [Accepted: 07/15/2013] [Indexed: 11/11/2022]
Abstract
PURPOSE Subendocardial dark-rim artifacts (DRAs) remain a major concern in first-pass perfusion (FPP) myocardial MRI and may lower the diagnostic accuracy for detection of ischemia. A major source of DRAs is the "Gibbs ringing" effect. We propose an optimized radial acquisition strategy aimed at eliminating ringing-induced DRAs in FPP. THEORY AND METHODS By studying the underlying point spread function (PSF), we show that optimized radial sampling with a simple reconstruction method can eliminate the oscillations in the PSF that cause ringing artifacts. We conducted realistic MRI phantom experiments and in vivo studies (n = 12 healthy humans) to evaluate the artifact behavior of the proposed imaging scheme in comparison to a conventional Cartesian imaging protocol. RESULTS Simulations and phantom experiments verified our theoretical expectations. The in vivo studies showed that optimized radial imaging is capable of significantly reducing DRAs in the early myocardial enhancement phase (during which the ringing effect is most prominent and may obscure perfusion defects) while providing similar resolution and image quality compared with conventional Cartesian imaging. CONCLUSION The developed technical framework and results demonstrate that, in comparison to conventional Cartesian techniques, optimized radial imaging with the proposed optimizations significantly reduces the prevalence and spatial extent of DRAs in FPP imaging.
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Affiliation(s)
- Behzad Sharif
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Rohan Dharmakumar
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Troy LaBounty
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Departments of Medicine and Radiology, University of Michigan, Ann Arbor, MI, USA
| | - Reza Arsanjani
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Chrisandra Shufelt
- Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Barbra Streisand Women's Heart Center, Cedars-Sinai Heart Institute, Los Angeles, CA, USA
| | - Louise Thomson
- Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - C. Noel Bairey Merz
- Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Barbra Streisand Women's Heart Center, Cedars-Sinai Heart Institute, Los Angeles, CA, USA
| | - Daniel S. Berman
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Debiao Li
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Department of Bioengineering, University of California Los Angeles, Los Angeles, CA, USA
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Salerno M, Kramer CM. Advances in parametric mapping with CMR imaging. JACC Cardiovasc Imaging 2014; 6:806-22. [PMID: 23845576 DOI: 10.1016/j.jcmg.2013.05.005] [Citation(s) in RCA: 141] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2013] [Revised: 05/10/2013] [Accepted: 05/15/2013] [Indexed: 01/03/2023]
Abstract
Cardiac magnetic resonance imaging (CMR) is well established and considered the gold standard for assessing myocardial volumes and function, and for quantifying myocardial fibrosis in both ischemic and nonischemic heart disease. Recent developments in CMR imaging techniques are enabling clinically-feasible rapid parametric mapping of myocardial perfusion and magnetic relaxation properties (T1, T2, and T2* relaxation times) that are further expanding the range of unique tissue parameters that can be assessed using CMR. To generate a parametric map of perfusion or relaxation times, multiple images of the same region of the myocardium are acquired with different sensitivity to the parameter of interest, and the signal intensities of these images are fit to a model which describes the underlying physiology or relaxation parameters. The parametric map is an image of the fitted perfusion parameters or relaxation times. Parametric mapping requires acquisition of multiple images typically within a breath-hold and thus requires specialized rapid acquisition techniques. Quantitative perfusion imaging techniques can more accurately determine the extent of myocardial ischemia in coronary artery disease and provide the opportunity to evaluate microvascular disease with CMR. T1 mapping techniques performed both with and without contrast are enabling quantification of diffuse myocardial fibrosis and myocardial infiltration. Myocardial edema and inflammation can be evaluated using T2 mapping techniques. T2* mapping provides an assessment of myocardial iron-overload and myocardial hemorrhage. There is a growing body of evidence for the clinical utility of quantitative assessment of perfusion and relaxation times, although current techniques still have some important limitations. This article will review the current imaging technologies for parametric mapping, emerging applications, current limitations, and potential of CMR parametric mapping of the myocardium. The specific focus will be the assessment and quantification of myocardial perfusion and magnetic relaxation times.
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Affiliation(s)
- Michael Salerno
- Cardiovascular Division, Department of Medicine, University of Virginia Health System, Charlottesville, VA 22908, USA
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Bratis K, Mahmoud I, Chiribiri A, Nagel E. Quantitative myocardial perfusion imaging by cardiovascular magnetic resonance and positron emission tomography. J Nucl Cardiol 2013; 20:860-70; quiz 857-9, 871-3. [PMID: 23868071 PMCID: PMC7611156 DOI: 10.1007/s12350-013-9762-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2013] [Accepted: 07/01/2013] [Indexed: 12/19/2022]
Abstract
Recent studies have demonstrated that a detailed knowledge of the extent of angiographic coronary artery disease (CAD) is not a prerequisite for clinical decision making, and the clinical management of patients with CAD is more and more focused towards the identification of myocardial ischemia and the quantification of ischemic burden. In this view, non-invasive assessment of ischemia and in particular stress imaging techniques are emerging as preferred and non-invasive options. A quantitative assessment of regional myocardial perfusion can provide an objective estimate of the severity of myocardial injury and may help clinicians to discriminate regions of the heart that are at increased risk for myocardial infarction. Positron emission tomography (PET) has established itself as the reference standard for myocardial blood flow (MBF) and myocardial perfusion reserve (MPR) quantification. Cardiac magnetic resonance (CMR) is increasingly used to measure MBF and MPR by means of first-pass signals, with a well-defined diagnostic performance and prognostic value. The aim of this article is to review the currently available evidence on the use of both PET and CMR for quantification of MPR, with particular attention to the studies that directly compared these two diagnostic methods.
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Affiliation(s)
- K Bratis
- Division of Imaging Sciences and Biomedical Engineering, King's College London, 4th Floor, Lambeth Wing, St. Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, United Kingdom,
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10
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Lanza GA, Camici PG, Galiuto L, Niccoli G, Pizzi C, Di Monaco A, Sestito A, Novo S, Piscione F, Tritto I, Ambrosio G, Bugiardini R, Crea F, Marzilli M. Methods to investigate coronary microvascular function in clinical practice. J Cardiovasc Med (Hagerstown) 2013; 14:1-18. [DOI: 10.2459/jcm.0b013e328351680f] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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11
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Bhave NM, Freed BH, Yodwut C, Kolanczyk D, Dill K, Lang RM, Mor-Avi V, Patel AR. Considerations when measuring myocardial perfusion reserve by cardiovascular magnetic resonance using regadenoson. J Cardiovasc Magn Reson 2012; 14:89. [PMID: 23272658 PMCID: PMC3552720 DOI: 10.1186/1532-429x-14-89] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2012] [Accepted: 12/18/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Adenosine cardiovascular magnetic resonance (CMR) can accurately quantify myocardial perfusion reserve. While regadenoson is increasingly employed due to ease of use, imaging protocols have not been standardized. We sought to determine the optimal regadenoson CMR protocol for quantifying myocardial perfusion reserve index (MPRi) - more specifically, whether regadenoson stress imaging should be performed before or after rest imaging. METHODS Twenty healthy subjects underwent CMR perfusion imaging during resting conditions, during regadenoson-induced hyperemia (0.4 mg), and after 15 min of recovery. In 10/20 subjects, recovery was facilitated with aminophylline (125 mg). Myocardial time-intensity curves were used to obtain left ventricular cavity-normalized myocardial up-slopes. MPRi was calculated in two different ways: as the up-slope ratio of stress to rest (MPRi-rest), and the up-slope ratio of stress to recovery (MPRi-recov). RESULTS In all 20 subjects, MPRi-rest was 1.78 ± 0.60. Recovery up-slope did not return to resting levels, regardless of aminophylline use. Among patients not receiving aminophylline, MPRi-recov was 36 ± 16% lower than MPRi-rest (1.13 ± 0.38 vs. 1.82 ± 0.73, P = 0.001). In the 10 patients whose recovery was facilitated with aminophylline, MPRi-recov was 20 ± 24% lower than MPRi-rest (1.40 ± 0.35 vs. 1.73 ± 0.43, P = 0.04), indicating incomplete reversal. In 3 subjects not receiving aminophylline and 4 subjects receiving aminophylline, up-slope at recovery was greater than at stress, suggesting delayed maximal hyperemia. CONCLUSIONS MPRi measurements from regadenoson CMR are underestimated if recovery perfusion is used as a substitute for resting perfusion, even when recovery is facilitated with aminophylline. True resting images should be used to allow accurate MPRi quantification. The delayed maximal hyperemia observed in some subjects deserves further study. TRIAL REGISTRATION ClinicalTrials.gov NCT00871260.
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Affiliation(s)
- Nicole M Bhave
- Departments of Medicine and Radiology, University of Chicago, Cardiac Imaging Center, 5841 S. Maryland Ave., MC5084, Chicago, IL, 60637, USA
| | - Benjamin H Freed
- Departments of Medicine and Radiology, University of Chicago, Cardiac Imaging Center, 5841 S. Maryland Ave., MC5084, Chicago, IL, 60637, USA
| | - Chattanong Yodwut
- Departments of Medicine and Radiology, University of Chicago, Cardiac Imaging Center, 5841 S. Maryland Ave., MC5084, Chicago, IL, 60637, USA
| | - Denise Kolanczyk
- Departments of Medicine and Radiology, University of Chicago, Cardiac Imaging Center, 5841 S. Maryland Ave., MC5084, Chicago, IL, 60637, USA
| | - Karin Dill
- Departments of Medicine and Radiology, University of Chicago, Cardiac Imaging Center, 5841 S. Maryland Ave., MC5084, Chicago, IL, 60637, USA
| | - Roberto M Lang
- Departments of Medicine and Radiology, University of Chicago, Cardiac Imaging Center, 5841 S. Maryland Ave., MC5084, Chicago, IL, 60637, USA
| | - Victor Mor-Avi
- Departments of Medicine and Radiology, University of Chicago, Cardiac Imaging Center, 5841 S. Maryland Ave., MC5084, Chicago, IL, 60637, USA
| | - Amit R Patel
- Departments of Medicine and Radiology, University of Chicago, Cardiac Imaging Center, 5841 S. Maryland Ave., MC5084, Chicago, IL, 60637, USA
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12
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Vandsburger MH, Epstein FH. Emerging MRI methods in translational cardiovascular research. J Cardiovasc Transl Res 2011; 4:477-92. [PMID: 21452060 DOI: 10.1007/s12265-011-9275-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2011] [Accepted: 03/15/2011] [Indexed: 12/11/2022]
Abstract
Cardiac magnetic resonance imaging (CMR) has become a reference standard modality for imaging of left ventricular (LV) structure and function and, using late gadolinium enhancement, for imaging myocardial infarction. Emerging CMR techniques enable a more comprehensive examination of the heart, making CMR an excellent tool for use in translational cardiovascular research. Specifically, emerging CMR methods have been developed to measure the extent of myocardial edema, changes in ventricular mechanics, changes in tissue composition as a result of fibrosis, and changes in myocardial perfusion as a function of both disease and infarct healing. New CMR techniques also enable the tracking of labeled cells, molecular imaging of biomarkers of disease, and changes in calcium flux in cardiomyocytes. In addition, MRI can quantify blood flow velocity and wall shear stress in large blood vessels. Almost all of these techniques can be applied in both pre-clinical and clinical settings, enabling both the techniques themselves and the knowledge gained using such techniques in pre-clinical research to be translated from the lab bench to the patient bedside.
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Affiliation(s)
- Moriel H Vandsburger
- Department of Biological Regulation, Weizmann Institute of Science, 76100, Rehovot, Israel.
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West AM, Kramer CM. Cardiovascular magnetic resonance imaging of myocardial infarction, viability, and cardiomyopathies. Curr Probl Cardiol 2010; 35:176-220. [PMID: 20197150 DOI: 10.1016/j.cpcardiol.2009.12.002] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Cardiovascular magnetic resonance provides the opportunity for a truly comprehensive evaluation of patients with a history of myocardial infarction, with regard to characterizing the extent of disease, effect on left ventricular function, and degree of viable myocardium. The use of contrast-enhanced cardiac magnetic resonance (CMR) imaging for first-pass perfusion and late gadolinium enhancement is a powerful technique for delineating areas of myocardial ischemia and infarction. Using a combination of T2-weighted and contrast-enhanced CMR images, information about the acuity of an infarct can be obtained. There is extensive published data using contrast-enhanced CMR to predict myocardial functional recovery with revascularization in patients with ischemic cardiomyopathies. In addition, CMR imaging in patients with cardiomyopathies can distinguish between ischemic and nonischemic etiologies, with the ability to further characterize the underlying pathology of nonischemic cardiomyopathies.
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Affiliation(s)
- Amy M West
- University of Virginia Health System, Departments of Medicine and Radiology, Charlottesville, VA 22908, USA
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Recent advances and future trends in multimodality cardiac imaging. Heart Lung Circ 2010; 19:193-209. [PMID: 20138581 DOI: 10.1016/j.hlc.2009.11.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2009] [Accepted: 11/24/2009] [Indexed: 01/07/2023]
Abstract
The cardiovascular imaging field has experienced marked growth and technical advancement in the past several decades. In the future, multimodality imaging will provide enhanced characterisation of disease states. Myocardial perfusion imaging will become more quantitative, permitting measurement of absolute blood flow and coronary flow reserves during stress states. A greater use of positron emission tomography (PET) can be expected for both assessing blood flow quantitatively and molecular imaging of atherosclerotic plaques and myocardial disease states. SPECT and PET imaging of myocardial metabolism and cardiac neuronal imaging have already shown great promise for identifying high-risk patients with coronary heart disease and nonischaemic cardiomyopathy. Further progress will occur in computed tomography imaging of the heart and coronary arteries and cardiac magnetic resonance imaging including quantitative estimates of coronary blood flow, coronary and peripheral vessel plaque characterisation, and detection of myocardial cellular dysfunction. Fusion imaging, in which two disparate image data sets are merged into one functional image, will become commonplace. Major breakthroughs in CV imaging will depend on discoveries in basic research, further refinement of instrumentation and software for image processing and analysis, and outcomes research demonstrating the worth of imaging technologies in reducing cardiovascular death and morbidity.
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Galiuto L, Natale L, Leccisotti L, Locorotondo G, Giordano A, Bonomo L, Crea F. Non-invasive imaging of microvascular damage. J Nucl Cardiol 2009; 16:811-31. [PMID: 19705211 DOI: 10.1007/s12350-009-9134-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2009] [Accepted: 07/06/2009] [Indexed: 01/29/2023]
Affiliation(s)
- L Galiuto
- Institute of Cardiology, Catholic University of the Sacred Heart, Policlinico A. Gemelli, Largo A. Gemelli, 8, 00168, Rome, Italy.
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West AM, Kramer CM. Comprehensive cardiac magnetic resonance imaging. THE JOURNAL OF INVASIVE CARDIOLOGY 2009; 21:339-345. [PMID: 19571346 PMCID: PMC2964663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Affiliation(s)
- Amy M. West
- Division of Cardiovascular Medicine, University of Virginia, Charlottesville, Virginia
| | - Christopher M. Kramer
- Division of Cardiovascular Medicine, University of Virginia, Charlottesville, Virginia
- Cardiovascular Imaging Center, University of Virginia, Charlottesville, Virginia
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