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Liu XL, Wang GZ, Rui MP, Fan D, Zhang J, Zhu ZH, Perez R, Wang T, Yang LC, Lyu L, Zheng J, Wang G. Imaging characterization of myocardial function, fibrosis, and perfusion in a nonhuman primate model with heart failure-like features. Front Cardiovasc Med 2023; 10:1214249. [PMID: 37663419 PMCID: PMC10471131 DOI: 10.3389/fcvm.2023.1214249] [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: 04/29/2023] [Accepted: 07/25/2023] [Indexed: 09/05/2023] Open
Abstract
Introduction The availability of a human-like chronic heart failure (HF) animal model was critical for affiliating development of novel therapeutic drug treatments. With the close physiology relatedness to humans, the non-human primate (NHP) HF model would be valuable to better understand the pathophysiology and pharmacology of HF. The purpose of this work was to present preliminary cardiac image findings using echocardiography and cardiovascular magnetic resonance (CMR) in a HF-like cynomolgus macaque model. Methods The NHP diet-induced model developed cardiac phenotypes that exhibited diastolic dysfunction with reduced left ventricular ejection fraction (LVEF) or preserved LVEF. Twenty cynomolgus monkeys with cardiac dysfunction were selected by echocardiography and subsequently separated into two groups, LVEF < 65% (termed as HFrEF, n = 10) and LVEF ≥ 65% with diastolic dysfunction (termed as HFpEF, n = 10). Another group of ten healthy monkeys was used as the healthy control. All monkeys underwent a CMR study to measure global longitudinal strain (GLS), myocardial extracellular volume (ECV), and late gadolinium enhancement (LGE). In healthy controls and HFpEF group, quantitative perfusion imaging scans at rest and under dobutamine stress were performed and myocardial perfusion reserve (MPR) was subsequently obtained. Results No LGE was observed in any monkey. Monkeys with HF-like features were significantly older, compared to the healthy control group. There were significant differences among the three groups in ECV (20.79 ± 3.65% in healthy controls; 27.06 ± 3.37% in HFpEF group, and 31.11 ± 4.50% in HFrEFgroup, p < 0.001), as well as for stress perfusion (2.40 ± 0.34 ml/min/g in healthy controls vs. 1.28 ± 0.24 ml/min/g in HFpEF group, p < 0.01) and corresponding MPR (1.83 ± 0.3 vs. 1.35 ± 0.29, p < 0.01). After adjusting for age, ECV (p = 0.01) and MPR (p = 0.048) still showed significant differences among the three groups. Conclusion Our preliminary imaging findings demonstrated cardiac dysfunction, elevated ECV, and/or reduced MPR in this HF-like NHP model. This pilot study laid the foundation for further mechanistic research and the development of a drug testing platform for distinct HF pathophysiology.
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Affiliation(s)
- Xing-Li Liu
- Department of Radiology, The First People’s Hospital of Yunnan Province, Kunming, China
- Department of Radiology, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, China
| | - Guan-Zhong Wang
- Department of Pharmocolgy, Kunming Biomed International of TriApex Group, Kunming, China
| | - Mao-Ping Rui
- Department of Radiology, The First People’s Hospital of Yunnan Province, Kunming, China
- Department of Radiology, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, China
| | - Dong Fan
- Department of Radiology, The First People’s Hospital of Yunnan Province, Kunming, China
- Department of Radiology, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, China
| | - Jie Zhang
- Department of Pharmocolgy, Kunming Biomed International of TriApex Group, Kunming, China
| | - Zheng-Hua Zhu
- Department of Pharmocolgy, Kunming Biomed International of TriApex Group, Kunming, China
| | - Rosario Perez
- Department of Pharmocolgy, Kunming Biomed International of TriApex Group, Kunming, China
| | - Tony Wang
- Department of Pharmocolgy, Kunming Biomed International of TriApex Group, Kunming, China
| | - Li-Chuan Yang
- Department of Pharmocolgy, Kunming Biomed International of TriApex Group, Kunming, China
| | - Liang Lyu
- Department of Radiology, The First People’s Hospital of Yunnan Province, Kunming, China
- Department of Radiology, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, China
| | - Jie Zheng
- Mallinckrodt Institute of Radiology, Washington University in Saint Louis, St. Louis, MO, United States
| | - Gang Wang
- Department of Radiology, The First People’s Hospital of Yunnan Province, Kunming, China
- Department of Radiology, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, China
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Li R, Edalati M, Muccigrosso D, Lau JMC, Laforest R, Woodard PK, Zheng J. A simplified method to correct saturation of arterial input function for cardiac magnetic resonance first-pass perfusion imaging: validation with simultaneously acquired PET. J Cardiovasc Magn Reson 2023; 25:35. [PMID: 37344848 PMCID: PMC10286396 DOI: 10.1186/s12968-023-00945-w] [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: 11/30/2022] [Accepted: 06/06/2023] [Indexed: 06/23/2023] Open
Abstract
BACKGROUND First-pass perfusion imaging in magnetic resonance imaging (MRI) is an established method to measure myocardial blood flow (MBF). An obstacle for accurate quantification of MBF is the saturation of blood pool signal intensity used for arterial input function (AIF). The objective of this project was to validate a new simplified method for AIF estimation obtained from single-bolus and single sequence perfusion measurements. The reference MBF was measured simultaneously on 13N-ammonia positron emission tomography (PET). METHODS Sixteen patients with clinically confirmed myocardial ischemia were imaged in a clinical whole-body PET-MRI system. PET perfusion imaging was performed in a 10-min acquisition after the injection of 10 mCi of 13N-ammonia. The MRI perfusion acquisition started simultaneously with the start of the PET acquisition after the injection of a 0.075 mmol/kg gadolinium contrast agent. Cardiac stress imaging was initiated after the administration of regadenoson 20 s prior to PET-MRI scanning. The saturation part of the MRI AIF data was modeled as a gamma variate curve, which was then estimated for a true AIF by minimizing a cost function according to various boundary conditions. A standard AHA 16-segment model was used for comparative analysis of absolute MBF from PET and MRI. RESULTS Overall, there were 256 segments in 16 patients, mean resting perfusion for PET was 1.06 ± 0.34 ml/min/g and 1.04 ± 0.30 ml/min/g for MRI (P = 0.05), whereas mean stress perfusion for PET was 2.00 ± 0.74 ml/min/g and 2.12 ± 0.76 ml/min/g for MRI (P < 0.01). Linear regression analysis in MBF revealed strong correlation (r = 0.91, slope = 0.96, P < 0.001) between PET and MRI. Myocardial perfusion reserve, calculated from the ratio of stress MBF over resting MBF, also showed a strong correlation between MRI and PET measurements (r = 0.82, slope = 0.81, P < 0.001). CONCLUSION The results demonstrated the feasibility of the simplified AIF estimation method for the accurate quantification of MBF by MRI with single sequence and single contrast injection. The MRI MBF correlated strongly with PET MBF obtained simultaneously. This post-processing technique will allow easy transformation of clinical perfusion imaging data into quantitative information.
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Affiliation(s)
- Ran Li
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, 4525 Scott Ave, Room 3114, St. Louis, MO, USA
| | - Masoud Edalati
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, 4525 Scott Ave, Room 3114, St. Louis, MO, USA
| | - David Muccigrosso
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, 4525 Scott Ave, Room 3114, St. Louis, MO, USA
| | - Jeffrey M C Lau
- Department of Cardiology, National Heart Centre Singapore, Singapore, Singapore
| | - Richard Laforest
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, 4525 Scott Ave, Room 3114, St. Louis, MO, USA
| | - Pamela K Woodard
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, 4525 Scott Ave, Room 3114, St. Louis, MO, USA
| | - Jie Zheng
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, 4525 Scott Ave, Room 3114, St. Louis, MO, USA.
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Rickers C, Wegner P, Silberbach M, Madriago E, Gabbert DD, Kheradvar A, Voges I, Scheewe J, Attmann T, Jerosch-Herold M, Kramer HH. Myocardial Perfusion in Hypoplastic Left Heart Syndrome. Circ Cardiovasc Imaging 2021; 14:e012468. [PMID: 34610753 DOI: 10.1161/circimaging.121.012468] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The status of the systemic right ventricular coronary microcirculation in hypoplastic left heart syndrome (HLHS) is largely unknown. It is presumed that the systemic right ventricle's coronary microcirculation exhibits unique pathophysiological characteristics of HLHS in Fontan circulation. The present study sought to quantify myocardial blood flow by cardiac magnetic resonance imaging and evaluate the determinants of microvascular coronary dysfunction and myocardial ischemia in HLHS. METHODS One hundred nineteen HLHS patients (median age, 4.80 years) and 34 healthy volunteers (median age, 5.50 years) underwent follow-up cardiac magnetic resonance imaging ≈1.8 years after total cavopulmonary connection. Right ventricle volumes and function, myocardial perfusion, diffuse fibrosis, and late gadolinium enhancement were assessed in 4 anatomic HLHS subtypes. Myocardial blood flow (MBF) was quantified at rest and during adenosine-induced hyperemia. Coronary conductance was estimated from MBF at rest and catheter-based measurements of mean aortic pressure (n=99). RESULTS Hyperemic MBF in the systemic ventricle was lower in HLHS compared with controls (1.89±0.57 versus 2.70±0.84 mL/g per min; P<0.001), while MBF at rest normalized by the rate-pressure product, was similar (1.25±0.36 versus 1.19±0.33; P=0.446). Independent risk factors for a reduced hyperemic MBF were an HLHS subtype with mitral stenosis and aortic atresia (P=0.017), late gadolinium enhancement (P=0.042), right ventricular diastolic dysfunction (P=0.005), and increasing age at total cavopulmonary connection (P=0.022). The coronary conductance correlated negatively with systemic blood oxygen saturation (r, -0.29; P=0.02). The frequency of late gadolinium enhancement increased with age at total cavopulmonary connection (P=0.014). CONCLUSIONS The coronary microcirculation of the systemic ventricle in young HLHS patients shows significant differences compared with controls. These hypothesis-generating findings on HLHS-specific risk factors for microvascular dysfunction suggest a potential benefit from early relief of frank cyanosis by total cavopulmonary connection.
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Affiliation(s)
- Carsten Rickers
- University Heart Center, Adult Congenital Heart Disease Unit, University Hospital Hamburg-Eppendorf, Hamburg, Germany (C.R.)
| | - Philip Wegner
- Department of Congenital Heart Disease and Pediatric Cardiology (P.W., D.D.G., I.V., H.-H.K.) University Hospital Schleswig-Holstein, Kiel, Germany
| | - Michael Silberbach
- Department of Pediatric Cardiology, Doernbecher Children's Hospital, Oregon Health and Science University, Portland (M.S., E.M.)
| | - Erin Madriago
- Department of Pediatric Cardiology, Doernbecher Children's Hospital, Oregon Health and Science University, Portland (M.S., E.M.)
| | - Dominik Daniel Gabbert
- Department of Congenital Heart Disease and Pediatric Cardiology (P.W., D.D.G., I.V., H.-H.K.) University Hospital Schleswig-Holstein, Kiel, Germany
| | - Arash Kheradvar
- Edwards Lifesciences Center for Advanced Cardiovascular Technology, University of California Irvine (A.K.)
| | - Inga Voges
- Department of Congenital Heart Disease and Pediatric Cardiology (P.W., D.D.G., I.V., H.-H.K.) University Hospital Schleswig-Holstein, Kiel, Germany
| | - Jens Scheewe
- Department of Cardiovascular Surgery (J.S., T.A.), University Hospital Schleswig-Holstein, Kiel, Germany
| | - Tim Attmann
- Department of Cardiovascular Surgery (J.S., T.A.), University Hospital Schleswig-Holstein, Kiel, Germany
| | - Michael Jerosch-Herold
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (M.J.-H.)
| | - Hans-Heiner Kramer
- Department of Congenital Heart Disease and Pediatric Cardiology (P.W., D.D.G., I.V., H.-H.K.) University Hospital Schleswig-Holstein, Kiel, Germany
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Auti OB, Bandekar K, Kamat N, Raj V. Cardiac magnetic resonance techniques: Our experience on wide bore 3 tesla magnetic resonance system. Indian J Radiol Imaging 2021; 27:404-412. [PMID: 29379234 PMCID: PMC5761166 DOI: 10.4103/ijri.ijri_503_16] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Cardiovascular magnetic resonance (CMR) has become a widely adapted imaging modality in the diagnosis and management of patients with cardiovascular diseases. It provides unparalleled data of cardiac function and myocardial morphology. Majority of CMR imaging is currently being performed on 1.5 Tesla (T) MR systems. Over the last many years, the cardiac imaging protocols have been standardized and optimized in the 1.5T systems. 3T MR systems are now being used more and more in small and large institutions in our country due to their proven advantages in the field of neuro, body, and musculoskeletal imaging. Cardiac imaging on 3T system can be a double-edged sword. On one hand, it may provide nondiagnostic images due to significant artifacts, and on the other hand, it may complete the examination in quick time and provide excellent quality images. It is therefore important for the user to be aware of the potential pitfalls of CMR in 3T systems and also the necessary steps to avoid them. In this study, we discuss various challenges and advantages of performing CMR in a 3T system. We also present potential technical solutions to improve the image quality.
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Affiliation(s)
- Onkar B Auti
- Department of Radio-diagnosis, Narayana Health City, Bengaluru, Karnataka, India.,Department of Radio-diagnosis, Jupiter Hospital, Thane, Maharashtra, India
| | - Kalashree Bandekar
- Department of Radio-diagnosis, Jupiter Hospital, Thane, Maharashtra, India
| | - Nikhil Kamat
- Department of Radio-diagnosis, Jupiter Hospital, Thane, Maharashtra, India
| | - Vimal Raj
- Department of Radio-diagnosis, Narayana Health City, Bengaluru, Karnataka, India
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Ladrova M, Martinek R, Nedoma J, Hanzlikova P, Nelson MD, Kahankova R, Brablik J, Kolarik J. Monitoring and Synchronization of Cardiac and Respiratory Traces in Magnetic Resonance Imaging: A Review. IEEE Rev Biomed Eng 2021; 15:200-221. [PMID: 33513108 DOI: 10.1109/rbme.2021.3055550] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Synchronization of human vital signs, namely the cardiac cycle and respiratory excursions, is necessary during magnetic resonance imaging of the cardiovascular system and the abdominal cavity to achieve optimal image quality with minimized artifacts. This review summarizes techniques currently available in clinical practice, as well as methods under development, outlines the benefits and disadvantages of each approach, and offers some unique solutions for consideration.
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Rijlaarsdam-Hermsen D, Lo-Kioeng-Shioe M, van Domburg RT, Deckers JW, Kuijpers D, van Dijkman PRM. Stress-Only Adenosine CMR Improves Diagnostic Yield in Stable Symptomatic Patients With Coronary Artery Calcium. JACC Cardiovasc Imaging 2020; 13:1152-1160. [PMID: 31954641 DOI: 10.1016/j.jcmg.2019.12.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 11/27/2019] [Accepted: 12/05/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVES This study assessed whether adenosine stress-only perfusion cardiac magnetic resonance (CMR) following a positive coronary artery calcium (CAC) score improved the diagnostic yield of invasive coronary angiography (CAG) in patients with stable chest pain. The study also established the association between positive CAC scores and stress-induced myocardial ischemia. BACKGROUND The diagnostic yield of catheterization among patients with suspected coronary artery disease (CAD) is low. Improved patient selection and diagnostic testing are necessary. The CAC score can minimize unnecessary diagnostic testing, and in low-risk patients, normal CMR results have a high negative predictive value. Less comprehensive protocols may be sufficient to guide further work-up. METHODS A total of 642 consecutive patients (mean age: 63 years; 50% women) with stable chest pain and CAC scores of >0 who were referred for CMR were enrolled. Patients with a perfusion defect were subsequently examined by CAG. Patients were followed up for 1 year. Outcome was obstructive CAD. RESULTS Obstructive CAD was present in 12% of patients. For CAD diagnosis, the sensitivity of adenosine CMR was 90.9% (95% confidence interval [CI]: 88.7 to 93.1), specificity was 98.7% (95% CI: 97.9 to 99.6), positive predictive value was 92.0% (95% CI: 89.8 to 94.1), and negative predictive value was 98.6% (95% CI: 97.6 to 99.5). A CAC score between 0.1 and 100 without typical angina was associated with obstructive CAD in only 3% of patients. Patients with nonanginal chest pain and a CAC score ≥400 had obstructive CAD (16%). CONCLUSIONS Stress-only adenosine CMR had high diagnostic accuracy and served as an efficient gatekeeper to CAG in stable patients with a CAC score >0. Patients with CAC scores between 0.1 and 100 could be deferred from further testing in the absence of clinical features that suggested high risk. However, in patients with CAC score ≥400, functional testing should be indicated, regardless of the type of chest pain.
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Affiliation(s)
- Dorine Rijlaarsdam-Hermsen
- Haaglanden Medical Center Bronovo, Department of Cardiology, The Hague, the Netherlands; Haaglanden Medical Center Bronovo, Department of Radiology, The Hague, the Netherlands; Erasmus Medical Center, Department of Cardiology, Rotterdam, the Netherlands
| | | | - Ron T van Domburg
- Erasmus Medical Center, Department of Cardiology, Rotterdam, the Netherlands
| | - Jaap W Deckers
- Erasmus Medical Center, Department of Cardiology, Rotterdam, the Netherlands.
| | - Dirkjan Kuijpers
- Haaglanden Medical Center Bronovo, Department of Radiology, The Hague, the Netherlands
| | - Paul R M van Dijkman
- Haaglanden Medical Center Bronovo, Department of Cardiology, The Hague, the Netherlands
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Richter H, Kircher PR, Joerger FB, Bruellmann E, Dennler M. Assessment of Myocardial Perfusion at Rest and During Stress Using Dynamic First-Pass Contrast-Enhanced Magnetic Resonance Imaging in Healthy Dogs. Front Vet Sci 2018; 5:211. [PMID: 30234137 PMCID: PMC6131641 DOI: 10.3389/fvets.2018.00211] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 08/14/2018] [Indexed: 01/24/2023] Open
Abstract
Objective: To assess the feasibility of myocardial perfusion analysis in healthy dogs using dynamic contrast-enhanced cardiac magnetic resonance (DCE-MR) imaging at rest and during simulated stress with two doses of adenosine. Animals: Ten healthy beagle dogs. Procedures: Dogs were anesthetized and positioned in dorsal recumbency in a 3.0 Tesla MR scanner. Electrocardiogram-triggered dynamic T1-weighted ultrafast gradient echo images of three slices in short-axis orientation of the heart were acquired during breath holds and the first pass of gadolinium contrast. Image acquisition was performed after 4 min infusion of 140 μg/kg/min and 280 μg/kg/min adenosine and, after a washout period, without adenosine, respectively. Images were processed by dividing each slice into 6 radial segments and perfusion analysis was performed from signal intensity-time data. Results: No differences in perfusion parameters were found between segments within any of the slices, but significant differences were found between slices for peak enhancement, accumulated enhancement, and the maximum upslope. In addition, significant differences were found within each slice between data at rest and during adenosine-induced stress for the relative and absolute maximum upslope, relative peak enhancement, time to peak, and accumulated enhancement although inter-individual variation was large and no difference was found between the two stress tests for some parameters. Conclusion and Clinical Relevance: Results of this study showed that rest and stress myocardial perfusion can be assessed using DCE-CMR in dogs using the methods described. Both, adenosine dose and slice appear to affect perfusion parameters in healthy dogs and individual response to adenosine was variable.
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Affiliation(s)
- Henning Richter
- Clinic for Diagnostic Imaging, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - Patrick R Kircher
- Clinic for Diagnostic Imaging, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - Fabiola B Joerger
- Division of Anesthesiology, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | | | - Matthias Dennler
- Clinic for Diagnostic Imaging, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
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Jaarsma C, Nagel E, Schalla S. A Critical Review of Different Imaging Methods for the Assessment of Myocardial Ischemia. CURRENT CARDIOVASCULAR IMAGING REPORTS 2013. [DOI: 10.1007/s12410-012-9185-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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9
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Jaarsma C, Leiner T, Bekkers SC, Crijns HJ, Wildberger JE, Nagel E, Nelemans PJ, Schalla S. Diagnostic performance of noninvasive myocardial perfusion imaging using single-photon emission computed tomography, cardiac magnetic resonance, and positron emission tomography imaging for the detection of obstructive coronary artery disease: a meta-analysis. J Am Coll Cardiol 2012; 59:1719-28. [PMID: 22554604 DOI: 10.1016/j.jacc.2011.12.040] [Citation(s) in RCA: 328] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2011] [Revised: 12/06/2011] [Accepted: 12/20/2011] [Indexed: 12/17/2022]
Abstract
OBJECTIVES This study aimed to determine the diagnostic accuracy of the 3 most commonly used noninvasive myocardial perfusion imaging modalities, single-photon emission computed tomography (SPECT), cardiac magnetic resonance (CMR), and positron emission tomography (PET) perfusion imaging for the diagnosis of obstructive coronary artery disease (CAD). Additionally, the effect of test and study characteristics was explored. BACKGROUND Accurate detection of obstructive CAD is important for effective therapy. Noninvasive myocardial perfusion imaging is increasingly being applied to gauge the severity of CAD. METHODS Studies published between 1990 and 2010 identified by PubMed search and citation tracking were examined. A study was included if a perfusion imaging modality was used as a diagnostic test for the detection of obstructive CAD and coronary angiography as the reference standard (≥50% diameter stenosis). RESULTS Of the 3,635 citations, 166 articles (n = 17,901) met the inclusion criteria: 114 SPECT, 37 CMR, and 15 PET articles. There were not enough publications on other perfusion techniques such as perfusion echocardiography and computed tomography to include these modalities into the study. The patient-based analysis per imaging modality demonstrated a pooled sensitivity of 88% (95% confidence interval [CI]: 88% to 89%), 89% (95% CI: 88% to 91%), and 84% (95% CI: 81% to 87%) for SPECT, CMR, and PET, respectively; with a pooled specificity of 61% (95% CI: 59% to 62%), 76% (95% CI: 73% to 78%), and 81% (95% CI: 74% to 87%). This resulted in a pooled diagnostic odds ratio (DOR) of 15.31 (95% CI: 12.66 to 18.52; I(2) 63.6%), 26.42 (95% CI: 17.69 to 39.47; I(2) 58.3%), and 36.47 (95% CI: 21.48 to 61.92; I(2) 0%). Most of the evaluated test and study characteristics did not affect the ranking of diagnostic performances. CONCLUSIONS SPECT, CMR, and PET all yielded a high sensitivity, while a broad range of specificity was observed. SPECT is widely available and most extensively validated; PET achieved the highest diagnostic performance; CMR may provide an alternative without ionizing radiation and a similar diagnostic accuracy as PET. We suggest that referring physicians consider these findings in the context of local expertise and infrastructure.
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Affiliation(s)
- Caroline Jaarsma
- Department of Cardiology, Maastricht University Medical Center, Maastricht, the Netherlands
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10
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Coolen BF, Moonen RPM, Paulis LEM, Geelen T, Nicolay K, Strijkers GJ. Mouse myocardial first-pass perfusion MR imaging. Magn Reson Med 2010; 64:1658-63. [DOI: 10.1002/mrm.22588] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Browne LP, Kearney D, Taylor MD, Chung T, Slesnick TC, Nutting AC, Krishnamurthy R. ALCAPA: the role of myocardial viability studies in determining prognosis. Pediatr Radiol 2010; 40:163-7. [PMID: 19795113 DOI: 10.1007/s00247-009-1412-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2009] [Revised: 08/21/2009] [Accepted: 09/01/2009] [Indexed: 10/20/2022]
Abstract
BACKGROUND ALCAPA is optimally treated by coronary artery reimplantation early in neonatal life. Delayed diagnosis, however, is not infrequent, because symptoms often do not manifest until about 3 months of age, coinciding with the physiological nadir in pulmonary vascular resistance. With delayed diagnosis, there is potential for coronary steal and irreversible myocardial injury, which worsens outcome. OBJECTIVE To assess the utility of MRI in determining prognosis in children with surgically corrected ALCAPA. MATERIALS AND METHODS A retrospective chart review was performed in two children with ALCAPA who underwent coronary reimplantation and postoperative cardiac MRI. Both children subsequently underwent cardiac transplantation. The imaging findings and pathological findings at explant are presented. RESULTS In both children, there was severe, globally depressed left ventricular systolic function and abnormal delayed enhancement in a predominantly subendocardial distribution. Pathological examination of the cardiac explants showed extensive fibrotic tissue, which correlated with areas of abnormal delayed enhancement on MRI. CONCLUSION Severe reduction in systolic function and presence of delayed enhancement indicate extensive myocardial injury and pathologically correlate with irreversible fibrotic changes, which may help identify a subgroup of children who will not recover ventricular function and ultimately require heart transplantation.
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Affiliation(s)
- Lorna P Browne
- Department of Diagnostic Imaging, Texas Children's Hospital, 6621 Fannin St., Houston, TX 77030, USA.
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The gold standard for noninvasive imaging in coronary heart disease: magnetic resonance imaging. Curr Opin Cardiol 2009; 24:567-79. [DOI: 10.1097/hco.0b013e3283315553] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Vogel-Claussen J, Fishman EK, Bluemke DA. Novel cardiovascular MRI and CT methods for evaluation of ischemic heart disease. Expert Rev Cardiovasc Ther 2007; 5:791-802. [PMID: 17605656 DOI: 10.1586/14779072.5.4.791] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
New developments in cardiac MRI and multidetector CT (MDCT) have generated tremendous excitement for both physicians and the general public. Their roles in the diagnostic algorithm of patients with suspected coronary artery disease are rapidly evolving. In addition to cardiac catheterization, nuclear imaging techniques and cardiac echocardiography, MDCT and MRI will play increasing roles in the diagnosis of ischemic heart disease. In this review we outline imaging techniques and illustrate the various applications of cardiac MRI and MDCT in the assessment of myocardial ischemia.
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Affiliation(s)
- Jens Vogel-Claussen
- Johns Hopkins University School of Medicine, Russell H. Morgan Department of Radiology and Radiological Science, Baltimore, MD, USA.
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Kupatt C, Hinkel R, von Brühl ML, Pohl T, Horstkotte J, Raake P, El Aouni C, Thein E, Dimmeler S, Feron O, Boekstegers P. Endothelial Nitric Oxide Synthase Overexpression Provides a Functionally Relevant Angiogenic Switch in Hibernating Pig Myocardium. J Am Coll Cardiol 2007; 49:1575-84. [PMID: 17418299 DOI: 10.1016/j.jacc.2006.11.047] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2006] [Revised: 10/19/2006] [Accepted: 11/27/2006] [Indexed: 10/23/2022]
Abstract
OBJECTIVES We investigated whether retroinfusion of liposomal endothelial nitric oxide synthase (eNOS) S1177D complementary deoxyribonucleic acid (cDNA) would affect neovascularization and function of the ischemic myocardium. BACKGROUND Recently, we demonstrated the feasibility of liposomal eNOS cDNA transfection via retroinfusion in a model of acute myocardial ischemia/reperfusion. In the present study, we used this approach to target a phosphomimetic eNOS construct (eNOS S1177D) into chronic ischemic myocardium in a pig model of hibernation. METHODS Pigs (n = 6/group) were subjected to percutaneous implantation of a reduction stent graft into the left anterior descending artery (LAD), inducing total occlusion within 28 days. At day 28, retroinfusion of saline solution containing liposomal green fluorescent protein or eNOS S1177D cDNA (1.5 mg/animal, 2 x 10 min) was performed. Furthermore, L-nitroarginine-methylester (L-NAME) was applied orally from day 28, where indicated. At day 28 and day 49, fluorescent microspheres were injected into the left atrium for perfusion analysis. Regional functional reserve (at atrial pacing 140/min) was assessed at day 49 by subendocardial segment shortening (SES) (sonomicrometry, percent of ramus circumflexus region). RESULTS The eNOS S1177D overexpression increased endothelial cell proliferation as well as capillary and collateral growth at day 49. Concomitantly, eNOS S1177D overexpression enhanced regional myocardial perfusion from 62 +/- 4% (control) to 77 +/- 3% of circumflex coronary artery-perfused myocardium, unless L-NAME was co-applied (69 +/- 5%). Similarly, eNOS S1177D cDNA improved functional reserve of the LAD (33 +/- 5% vs. 7 +/- 3% of circumflex coronary artery-perfused myocardium), except for L-NAME coapplication (13 +/- 6%). CONCLUSIONS Retroinfusion of eNOS S1177D cDNA induces neovascularization via endothelial cell proliferation and collateral growth. The resulting gain of perfusion enables an improved functional reserve of the hibernating myocardium.
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Affiliation(s)
- Christian Kupatt
- Internal Medicine I, Klinikum Grosshadern, Ludwig-Maximilians-University of Munich, Munich, Germany.
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Krombach GA, Niendorf T, Günther RW, Mahnken AH. Characterization of myocardial viability using MR and CT imaging. Eur Radiol 2007; 17:1433-44. [PMID: 17206427 DOI: 10.1007/s00330-006-0531-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2006] [Revised: 10/22/2006] [Accepted: 11/07/2006] [Indexed: 02/04/2023]
Abstract
Cardiovascular magnetic resonance (MR) imaging is of proven clinical value for the noninvasive characterization of myocardial viability. Computed tomography (CT) is also being exploited for this indication. Examples of each of these imaging strategies for the assessment of myocardial viability will be provided in this review. Key MRI concepts and practical considerations such as customized MR imaging techniques and tailored imaging protocols dedicated to viability assessment are outlined with the primary focus on recent developments. Clinical applications of MR-based viability assessment are reviewed, ranging from rapid functional cine imaging to tissue characterization using T2-weighted imaging and T1-weighted late-contrast-enhanced imaging. Next, the merits and limitations of state-of-the-art CT imaging are surveyed, and their implications for viability assessment are considered. The final emphasis is on current trends and future directions in noninvasive viability assessment using MRI and CT.
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Affiliation(s)
- Gabriele A Krombach
- Department of Diagnostic Radiology, RWTH Aachen University Hospital, Pauwelstrasse 30, 52057 Aachen, Germany.
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