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Huang Q, Tian Y, Mendes J, Ranjan R, Adluru G, DiBella E. Quantitative myocardial perfusion with a hybrid 2D simultaneous multi-slice sequence. Magn Reson Imaging 2023; 98:7-16. [PMID: 36563888 PMCID: PMC10474933 DOI: 10.1016/j.mri.2022.12.010] [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: 06/07/2022] [Accepted: 12/17/2022] [Indexed: 12/24/2022]
Abstract
PURPOSE To evaluate a novel 2D simultaneous multi-slice (SMS) myocardial perfusion acquisition and compare directly to a published quantitative 3D stack-of-stars (SoS) acquisition. METHODS A hybrid saturation recovery radial 2D SMS sequence following a single saturation was created for the quantification of myocardial blood flow (MBF). This sequence acquired three slices simultaneously and generated an arterial input function (AIF) using the first 24 rays. Validation was done in a novel way by alternating heartbeats between the hybrid 2D SMS and the 3D SoS acquisitions. Initial studies were done to study the effects of using only every other beat for the 2D SMS in two subjects, and for the 3D SoS in four subjects. The proposed alternating acquisitions were then performed in ten dog studies at rest, four dog studies at adenosine stress, and two human resting studies. Quantitative MBF analysis was performed for 2D SMS and 3D SoS separately, using a compartment model. RESULTS Acquiring every-other-beat data resulted in 6 ± 5% ("ideal") and 11 ± 8% ("practical") perfusion changes for both 2D SMS and 3D SoS methods. For alternating acquisitions, 2D SMS and 3D SoS quantitative perfusion values were comparable for both the twelve rest studies (2D SMS: 0.69 ± 0.16 vs 3D: 0.69 ± 0.15 ml/g/min, p = 0.55) and the four stress studies (2D SMS: 1.28 ± 0.22 vs 3D: 1.30 ± 0.24 ml/g/min, p = 0.61). CONCLUSION Every-other-beat acquisition changed estimated perfusion values relatively little for both sequences. The quantitative hybrid radial 2D SMS myocardial first-pass perfusion imaging sequence gave results similar to 3D perfusion when compared directly with an alternating beat acquisition.
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Affiliation(s)
- Qi Huang
- Utah Center for Advanced Imaging Research (UCAIR), Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT, USA; Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, USA.
| | - Ye Tian
- Ming Hsieh Department of Electrical and Computer Engineering, University of Southern California, Los Angeles, CA, USA
| | - Jason Mendes
- Utah Center for Advanced Imaging Research (UCAIR), Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT, USA
| | - Ravi Ranjan
- Division of Cardiovascular Medicine, University of Utah, Salt Lake City, UT, USA
| | - Ganesh Adluru
- Utah Center for Advanced Imaging Research (UCAIR), Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT, USA; Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, USA
| | - Edward DiBella
- Utah Center for Advanced Imaging Research (UCAIR), Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT, USA; Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, USA
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Kero T, Johansson E, Engström M, Eggers KM, Johansson L, Ahlström H, Lubberink M. Evaluation of quantitative CMR perfusion imaging by comparison with simultaneous 15O-water-PET. J Nucl Cardiol 2021; 28:1252-1266. [PMID: 31313066 PMCID: PMC8421320 DOI: 10.1007/s12350-019-01810-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 05/28/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND We assessed the quantitative accuracy of cardiac perfusion measurements using dynamic contrast-enhanced MRI with simultaneous 15O-water PET as reference with a fully integrated PET-MR scanner. METHODS 15 patients underwent simultaneous DCE MRI and 15O-water PET scans at rest and adenosine-stress on an integrated PET-MR scanner. Correlation and agreement between MRI- and PET-based global and regional MBF values were assessed using correlation and Bland-Altman analysis. RESULTS Three subjects were excluded due to technical problems. Global mean (± SD) MBF values at rest and stress were 0.97 ± 0.27 and 3.19 ± 0.70 mL/g/min for MRI and 1.02 ± 0.28 and 3.13 ± 1.16 mL/g/min for PET (P = 0.66 and P = 0.81). The correlations between global and regional MRI- and PET-based MBF values were strong (r = 0.86 and r = 0.75). The biases were negligible for both global and regional MBF comparisons (0.01 and 0.00 mL/min/g for both), but the limits of agreement were wide for both global and regional MBF, with larger variability for high MBF-values. CONCLUSION The correlation between simultaneous MBF measurements with DCE MRI and 15O-water PET measured in an integrated PET-MRI was strong but the agreement was only moderate indicating that MRI-based quantitative MBF measurements is not ready for clinical introduction.
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Affiliation(s)
- Tanja Kero
- Medical Imaging Centre, Uppsala University Hospital, 75185, Uppsala, Sweden.
- Department of Surgical Sciences/Radiology, Uppsala University, Uppsala, Sweden.
| | | | | | - Kai M Eggers
- Department of Cardiology, Uppsala University Hospital, Uppsala, Sweden
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | | | - Håkan Ahlström
- Medical Imaging Centre, Uppsala University Hospital, 75185, Uppsala, Sweden
- Department of Surgical Sciences/Radiology, Uppsala University, Uppsala, Sweden
- Antaros Medical, BioVenture Hub, Mölndal, Sweden
| | - Mark Lubberink
- Medical Physics, Uppsala University Hospital, Uppsala, Sweden
- Department of Surgical Sciences/Radiology, Uppsala University, Uppsala, Sweden
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3
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Brown LAE, Onciul SC, Broadbent DA, Johnson K, Fent GJ, Foley JRJ, Garg P, Chew PG, Knott K, Dall’Armellina E, Swoboda PP, Xue H, Greenwood JP, Moon JC, Kellman P, Plein S. Fully automated, inline quantification of myocardial blood flow with cardiovascular magnetic resonance: repeatability of measurements in healthy subjects. J Cardiovasc Magn Reson 2018; 20:48. [PMID: 29983119 PMCID: PMC6036695 DOI: 10.1186/s12968-018-0462-y] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Accepted: 05/23/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Non-invasive assessment of myocardial ischaemia is a cornerstone of the diagnosis of coronary artery disease. Measurement of myocardial blood flow (MBF) using positron emission tomography (PET) is the current reference standard for non-invasive quantification of myocardial ischaemia. Dynamic myocardial perfusion cardiovascular magnetic resonance (CMR) offers an alternative to PET and a recently developed method with automated inline perfusion mapping has shown good correlation of MBF values between CMR and PET. This study assessed the repeatability of myocardial perfusion mapping by CMR in healthy subjects. METHODS Forty-two healthy subjects were recruited and underwent adenosine stress and rest perfusion CMR on two visits. Scans were repeated with a minimum interval of 7 days. Intrastudy rest and stress MBF repeatability were assessed with a 15-min interval between acquisitions. Interstudy rest and stress MBF and myocardial perfusion reserve (MPR) were measured for global myocardium and regionally for coronary territories and slices. RESULTS There was no significant difference in intrastudy repeated global rest MBF (0.65 ± 0.13 ml/g/min vs 0.62 ± 0.12 ml/g/min, p = 0.24, repeatability coefficient (RC) =24%) or stress (2.89 ± 0.56 ml/g/min vs 2.83 ± 0.64 ml/g/min, p = 0.41, RC = 29%) MBF. No significant difference was seen in interstudy repeatability for global rest MBF (0.64 ± 0.13 ml/g/min vs 0.64 ± 0.15 ml/g/min, p = 0.80, RC = 32%), stress MBF (2.71 ± 0.61 ml/g/min vs 2.55 ± 0.57 ml/g/min, p = 0.12, RC = 33%) or MPR (4.24 ± 0.69 vs 3.73 ± 0.76, p = 0.25, RC = 36%). Regional repeatability was good for stress (RC = 30-37%) and rest MBF (RC = 32-36%) but poorer for MPR (RC = 35-43%). Within subject coefficient of variation was 8% for rest and 11% for stress within the same study, and 11% for rest and 12% for stress between studies. CONCLUSIONS Fully automated, inline, myocardial perfusion mapping by CMR shows good repeatability that is similar to the published PET literature. Both rest and stress MBF show better repeatability than MPR, particularly in regional analysis.
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Affiliation(s)
- Louise A. E. Brown
- Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Clarendon Way, Leeds, LS2 9JT UK
| | - Sebastian C. Onciul
- Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Clarendon Way, Leeds, LS2 9JT UK
| | - David A. Broadbent
- Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Clarendon Way, Leeds, LS2 9JT UK
- Medical Physics and Engineering, Leeds Teaching Hospitals NHS Trust, Leeds, LS1 3EX UK
| | - Kerryanne Johnson
- Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Clarendon Way, Leeds, LS2 9JT UK
| | - Graham J. Fent
- Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Clarendon Way, Leeds, LS2 9JT UK
| | - James R. J. Foley
- Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Clarendon Way, Leeds, LS2 9JT UK
| | - Pankaj Garg
- Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Clarendon Way, Leeds, LS2 9JT UK
| | - Pei G. Chew
- Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Clarendon Way, Leeds, LS2 9JT UK
| | - Kristopher Knott
- Barts Heart Centre, The Cardiovascular Magnetic Resonance Imaging Unit and The Inherited Cardiovascular Diseases Unit, St Bartholomew’s Hospital, West Smithfield, London, UK
| | - Erica Dall’Armellina
- Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Clarendon Way, Leeds, LS2 9JT UK
| | - Peter P. Swoboda
- Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Clarendon Way, Leeds, LS2 9JT UK
| | - Hui Xue
- National Heart, Lung, and Blood Institute, National Institutes of Health, DHHS, Bethesda, MD USA
| | - John P. Greenwood
- Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Clarendon Way, Leeds, LS2 9JT UK
| | - James C. Moon
- Barts Heart Centre, The Cardiovascular Magnetic Resonance Imaging Unit and The Inherited Cardiovascular Diseases Unit, St Bartholomew’s Hospital, West Smithfield, London, UK
| | - Peter Kellman
- National Heart, Lung, and Blood Institute, National Institutes of Health, DHHS, Bethesda, MD USA
| | - Sven Plein
- Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Clarendon Way, Leeds, LS2 9JT UK
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CMR First-Pass Perfusion for Suspected Inducible Myocardial Ischemia. JACC Cardiovasc Imaging 2017; 9:1338-1348. [PMID: 27832901 DOI: 10.1016/j.jcmg.2016.09.010] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Revised: 08/26/2016] [Accepted: 09/08/2016] [Indexed: 01/28/2023]
Abstract
Cardiovascular magnetic resonance (CMR) has evolved from a pioneering research tool to an established noninvasive imaging method for detecting inducible myocardial perfusion deficits. In this consensus document, experts of different imaging techniques summarize the existing body of evidence regarding CMR perfusion as a viable complement to other established noninvasive tools for the assessment of perfusion and discuss the advantages and pitfalls of the technique. A rapid, standardized CMR perfusion protocol is described, which is safe, clinically feasible, and cost-effective for centers with contemporary magnetic resonance equipment. CMR perfusion can be recommended as a routine diagnostic tool to identify inducible myocardial ischemia.
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Sampath S, Parimal AS, Feng D, Chang MML, Baumgartner R, Klimas M, Jacobsen K, Manigbas E, Gsell W, Evelhoch JL, Chin CL. Quantitative MRI biomarkers to characterize regional left ventricular perfusion and function in nonhuman primates during dobutamine-induced stress: A reproducibility and reliability study. J Magn Reson Imaging 2016; 45:556-569. [PMID: 27384520 DOI: 10.1002/jmri.25379] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Accepted: 06/22/2016] [Indexed: 01/07/2023] Open
Abstract
PURPOSE To identify reproducible and reliable noninvasive regional imaging biomarkers of cardiac function and perfusion at rest and under stress in healthy nonhuman primates (NHPs) that may be used in the future for the early characterization of preclinical heart failure models, to evaluate therapy, and for clinical translation. MATERIALS AND METHODS Seven naive cynomolgus macaques underwent test-retest 3T cardiac MRI tagging and dual-bolus perfusion experiments. Regional cardiac function biomarkers, such as peak circumferential strain (CS), average diastolic strain-rate (DSR), contractile reserve (CR), diastolic reserve, peak torsion, and torsion reserve were quantified. Further, regional myocardial blood flow (MBF), myocardial perfusion reserve (MPR), and myocardial perfusion reserve-to-contractile reserve (MPR/CR) were also derived. Inter- and intraobserver reproducibility and test-retest reliability analyses were conducted using the reliability and generalizability coefficients including correlation coefficient (CC) and intraclass correlation coefficient (ICC). RESULTS Overall, peak CS, DSR, and MBF are robust biomarkers at both rest and stress with moderate-good inter- and intraobserver reproducibility and test-retest reliability. At rest: intra-/interobserver reproducibility (CC): peak CS (0.81/0.81), DSR (0.81/0.81), MBF (0.72/0.57), peak torsion (0.79/0.79); test-retest reliability: (CC/ICC): peak CS (0.62/0.75), DSR (0.24/0.55), MBF (0.66/0.62), and peak torsion (0.79/0.78). Under stress: intra-/interobserver reproducibility (CC): peak CS (0.61/0.60), DSR (0.50/0.50), MBF (0.63/0.61), MPR (0.43/0.43), and peak torsion (0.38/0.38); test-retest reliability: (CC/ICC): peak CS (0.58/0.58), DSR (0.24/0.43), MBF (0.58/0.58), MPR (0.43/0.38), and peak torsion (0.38/0.38). CONCLUSION We demonstrated the feasibility of using cardiac MRI to characterize left ventricular functional and perfusion responses to stress in an NHP species, and specific robust biomarkers such as peak CS, DSR, MBF, diastolic reserve, and MPR have been identified for clinical translation and drug research. LEVEL OF EVIDENCE 1 J. Magn. Reson. Imaging 2017;45:556-569.
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Affiliation(s)
- Smita Sampath
- Translational Biomarkers, Merck Research Laboratories, MSD, Singapore
| | | | - Dai Feng
- Biometric Research, Biostatistics and Research Decision Sciences, Merck Research Laboratories, Merck & Co. Inc., Rahway, New Jersey, USA
| | | | - Richard Baumgartner
- Biometric Research, Biostatistics and Research Decision Sciences, Merck Research Laboratories, Merck & Co. Inc., Rahway, New Jersey, USA
| | - Michael Klimas
- Translational Biomarkers, Merck Research Laboratories, Merck & Co. Inc., West Point, Pennsylvania, USA
| | - Kirsten Jacobsen
- In Vivo Pharmacology, Merck Research Laboratories, MSD, Singapore
| | | | | | - Jeffrey L Evelhoch
- Translational Biomarkers, Merck Research Laboratories, Merck & Co. Inc., West Point, Pennsylvania, USA
| | - Chih-Liang Chin
- Translational Biomarkers, Merck Research Laboratories, MSD, Singapore
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6
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Selvanayagam JB, Rajendran S. Functional Assessment of Chronic Total Occlusions: Can CMR Imaging Add Value? JACC Cardiovasc Imaging 2016; 9:557-8. [PMID: 27085429 DOI: 10.1016/j.jcmg.2015.11.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Accepted: 11/05/2015] [Indexed: 11/18/2022]
Affiliation(s)
- Joseph B Selvanayagam
- Flinders University, Flinders Medical Centre, South Australian Health and Medical Research Institute, Adelaide, Australia.
| | - Sharmalar Rajendran
- University of Adelaide, Cardiology Unit, Queen Elizabeth Hospital/Lyell McEwin Hospital, Adelaide, Australia
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7
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Bucciarelli-Ducci C, Auger D, Di Mario C, Locca D, Petryka J, O'Hanlon R, Grasso A, Wright C, Symmonds K, Wage R, Asimacopoulos E, Del Furia F, Lyne JC, Gatehouse PD, Fox KM, Pennell DJ. CMR Guidance for Recanalization of Coronary Chronic Total Occlusion. JACC Cardiovasc Imaging 2016; 9:547-56. [PMID: 27085432 DOI: 10.1016/j.jcmg.2015.10.025] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Revised: 10/15/2015] [Accepted: 10/22/2015] [Indexed: 01/13/2023]
Abstract
OBJECTIVES This study explored whether cardiac magnetic resonance (CMR) could help select patients who could benefit from revascularization by identifying inducible myocardial ischemia and viability in the perfusion territory of the artery with chronic total occlusion (CTO). BACKGROUND The benefit of revascularization using percutaneous coronary intervention (PCI) in CTO is controversial. CMR offers incomparable left ventricular (LV) systolic function assessment in addition to potent ischemic burden quantification and reliable myocardial viability analysis. Whether CMR guided CTO revascularization would be helpful to such patients has not yet been explored fully. METHODS A prospective study of 50 consecutive CTO patients was conducted. Of 50 patients undergoing baseline stress CMR, 32 (64%) were selected for recanalization based on the presence of significant inducible perfusion deficit and myocardial viability within the CTO arterial territory. Patients were rescanned 3 months after successful CTO recanalization. RESULTS At baseline, myocardial perfusion reserve (MPR) in the CTO territory was significantly reduced compared with the remote region (1.8 ± 0.72 vs. 2.2 ± 0.7; p = 0.01). MPR in the CTO region improved significantly after PCI (to 2.3 ± 0.9; p = 0.02 vs. baseline) with complete or near-complete resolution of CTO related perfusion defect in 90% of patients. Remote territory MPR was unchanged after PCI (2.5 ± 1.2; p = NS vs. baseline). The LV ejection fraction increased from 63 ± 13% to 67 ± 12% (p < 0.0001) and end-systolic volume decreased from 65 ± 38 to 56 ± 38 ml (p < 0.001) 3 months after CTO PCI. Importantly, despite minimal post-procedural infarction due to distal embolization and side branch occlusion in 8 of 32 patients (25%), the total Seattle Angina Questionnaire score improved from a median of 54 (range 45 to 74) at baseline to 89 (range 77 to 98) after CTO recanalization (p < 0.0001). CONCLUSIONS In this small group of patients showing CMR evidence of significant myocardial inducible perfusion defect and viability, CTO recanalization reduces ischemic burden, favors reverse remodeling, and ameliorates quality of life.
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Affiliation(s)
- Chiara Bucciarelli-Ducci
- Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, London, United Kingdom; National Heart and Lung Institute, Imperial College, London, United Kingdom; Bristol Heart Institute, Bristol NIHR Cardiovascular Biomedical Research Unit, University of Bristol, Bristol, United Kingdom
| | - Dominique Auger
- Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, London, United Kingdom
| | - Carlo Di Mario
- National Heart and Lung Institute, Imperial College, London, United Kingdom; Department of Cardiology, Royal Brompton Hospital, London, United Kingdom
| | - Didier Locca
- Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, London, United Kingdom
| | - Joanna Petryka
- Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, London, United Kingdom
| | - Rory O'Hanlon
- Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, London, United Kingdom
| | - Agata Grasso
- Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, London, United Kingdom
| | - Christine Wright
- Department of Cardiology, Royal Brompton Hospital, London, United Kingdom
| | - Karen Symmonds
- Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, London, United Kingdom
| | - Ricardo Wage
- Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, London, United Kingdom
| | - Eleni Asimacopoulos
- Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, London, United Kingdom
| | | | - Jonathan C Lyne
- Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, London, United Kingdom; Department of Cardiology, Royal Brompton Hospital, London, United Kingdom
| | - Peter D Gatehouse
- Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, London, United Kingdom; National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Kim M Fox
- National Heart and Lung Institute, Imperial College, London, United Kingdom; Department of Cardiology, Royal Brompton Hospital, London, United Kingdom
| | - Dudley J Pennell
- Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, London, United Kingdom; National Heart and Lung Institute, Imperial College, London, United Kingdom.
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8
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Likhite D, Suksaranjit P, Adluru G, Hu N, Weng C, Kholmovski E, McGann C, Wilson B, DiBella E. Interstudy repeatability of self-gated quantitative myocardial perfusion MRI. J Magn Reson Imaging 2015; 43:1369-78. [PMID: 26663511 DOI: 10.1002/jmri.25107] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2015] [Accepted: 11/14/2015] [Indexed: 01/04/2023] Open
Abstract
PURPOSE To evaluate the interstudy repeatability of multislice quantitative cardiovascular magnetic resonance myocardial blood flow (MBF), myocardial perfusion reserve (MPR), and extracellular volume (ECV). A unique saturation recovery self-gated acquisition was used for the perfusion scans. MATERIALS AND METHODS An ungated golden angle radial turboFLASH pulse sequence was used to scan 10 subjects on two separate days on a 3T scanner. A single saturation pulse was followed by a set of four slices. Rest and hyperemia scans were acquired during free breathing. The images were reconstructed using an iterative algorithm with spatiotemporal constraints. The ungated images were retrospectively binned (self-gated) into near-systole and near-diastole. Deformable registration was performed to adjust for respiratory and residual cardiac motion, and the data were fit with a Fermi model to estimate the interstudy repeatability of quantitative self-gated MBF and MPR. RESULTS The coefficient of variation (CoV) of the territorial MPR using the self-gated near-systole data was 18.6%. The self-gated near-diastole data gave less good CoV of MPR, equal to 46.2%. For MBFs, and using smaller (segmental) regions, the CoVs were 20.1% and 22.7% for the estimation of myocardial blood flow at stress and rest, respectively, using the self-gated near-systole data. The self-gated near-diastole data gave CoV = 48.6% and 44.9% for stress and rest. CONCLUSION The self-gated free-breathing technique for quantification of myocardial blood flow showed good repeatability for near-systole, with results comparable to published studies on interstudy repeatability of quantitative myocardial perfusion MRI using ECG-gating and breath-holds. Self-gated near-diastole data results were less repeatable. J. Magn. Reson. Imaging 2016;43:1369-1378.
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Affiliation(s)
- Devavrat Likhite
- Utah Center for Advanced Imaging Research, Department of Radiology, University of Utah, Salt Lake City, Utah, USA
| | - Promporn Suksaranjit
- Division of Cardiovascular Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Ganesh Adluru
- Utah Center for Advanced Imaging Research, Department of Radiology, University of Utah, Salt Lake City, Utah, USA
| | - Nan Hu
- Department of Internal Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Cindy Weng
- Department of Internal Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Eugene Kholmovski
- Utah Center for Advanced Imaging Research, Department of Radiology, University of Utah, Salt Lake City, Utah, USA
| | - Chris McGann
- Division of Cardiovascular Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Brent Wilson
- Division of Cardiovascular Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Edward DiBella
- Utah Center for Advanced Imaging Research, Department of Radiology, University of Utah, Salt Lake City, Utah, USA.,Department of Bioengineering, University of Utah, Salt Lake City, Utah, USA
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9
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Marinescu MA, Löffler AI, Ouellette M, Smith L, Kramer CM, Bourque JM. Coronary microvascular dysfunction, microvascular angina, and treatment strategies. JACC Cardiovasc Imaging 2015; 8:210-20. [PMID: 25677893 DOI: 10.1016/j.jcmg.2014.12.008] [Citation(s) in RCA: 198] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2014] [Revised: 12/16/2014] [Accepted: 12/22/2014] [Indexed: 02/07/2023]
Abstract
Angina without coronary artery disease (CAD) has substantial morbidity and is present in 10% to 30% of patients undergoing angiography. Coronary microvascular dysfunction (CMD) is present in 50% to 65% of these patients. The optimal treatment of this cohort is undefined. We performed a systematic review to evaluate treatment strategies for objectively-defined CMD in the absence of CAD. We included studies assessing therapy in human subjects with angina and coronary flow reserve or myocardial perfusion reserve <2.5 by positron emission tomography, cardiac magnetic resonance imaging, dilution methods, or intracoronary Doppler in the absence of coronary artery stenosis ≥50% or structural heart disease. Only 8 papers met the strict inclusion criteria. The papers were heterogeneous, using different treatments, endpoints, and definitions of CMD. The small sample sizes severely limit the power of these studies, with an average of 11 patients per analysis. Studies evaluating sildenafil, quinapril, estrogen, and transcutaneous electrical nerve stimulation application demonstrated benefits in their respective endpoints. No benefit was found with L-arginine, doxazosin, pravastatin, and diltiazem. Our systematic review highlights that there is little data to support therapies for CMD. We assess the data meeting rigorous inclusion criteria and review the related but excluded published data. We additionally describe the next steps needed to address this research gap, including a standardized definition of CMD, routine assessment of CMD in studies of chest pain without obstructive CAD, and specific therapy assessment in the population with confirmed CMD.
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Affiliation(s)
- Mark A Marinescu
- Department of Medicine, Cardiovascular Imaging Center, University of Virginia Health System, Charlottesville, Virginia
| | - Adrián I Löffler
- Department of Medicine, Cardiovascular Imaging Center, University of Virginia Health System, Charlottesville, Virginia
| | - Michelle Ouellette
- Department of Medicine, Cardiovascular Imaging Center, University of Virginia Health System, Charlottesville, Virginia
| | - Lavone Smith
- Department of Medicine, Cardiovascular Imaging Center, University of Virginia Health System, Charlottesville, Virginia
| | - Christopher M Kramer
- Department of Medicine, Cardiovascular Imaging Center, University of Virginia Health System, Charlottesville, Virginia; Department of Radiology and Medical Imaging, Cardiovascular Imaging Center, University of Virginia Health System, Charlottesville, Virginia
| | - Jamieson M Bourque
- Department of Medicine, Cardiovascular Imaging Center, University of Virginia Health System, Charlottesville, Virginia; Department of Radiology and Medical Imaging, Cardiovascular Imaging Center, University of Virginia Health System, Charlottesville, Virginia.
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10
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Bairey Merz CN, Handberg EM, Shufelt CL, Mehta PK, Minissian MB, Wei J, Thomson LEJ, Berman DS, Shaw LJ, Petersen JW, Brown GH, Anderson RD, Shuster JJ, Cook-Wiens G, Rogatko A, Pepine CJ. A randomized, placebo-controlled trial of late Na current inhibition (ranolazine) in coronary microvascular dysfunction (CMD): impact on angina and myocardial perfusion reserve. Eur Heart J 2015; 37:1504-13. [PMID: 26614823 PMCID: PMC4872284 DOI: 10.1093/eurheartj/ehv647] [Citation(s) in RCA: 128] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Accepted: 11/09/2015] [Indexed: 01/04/2023] Open
Abstract
Aims The mechanistic basis of the symptoms and signs of myocardial ischaemia in patients without obstructive coronary artery disease (CAD) and evidence of coronary microvascular dysfunction (CMD) is unclear. The aim of this study was to mechanistically test short-term late sodium current inhibition (ranolazine) in such subjects on angina, myocardial perfusion reserve index, and diastolic filling. Materials and results Randomized, double-blind, placebo-controlled, crossover, mechanistic trial in subjects with evidence of CMD [invasive coronary reactivity testing or non-invasive cardiac magnetic resonance imaging myocardial perfusion reserve index (MPRI)]. Short-term oral ranolazine 500–1000 mg twice daily for 2 weeks vs. placebo. Angina measured by Seattle Angina Questionnaire (SAQ) and SAQ-7 (co-primaries), diary angina (secondary), stress MPRI, diastolic filling, quality of life (QoL). Of 128 (96% women) subjects, no treatment differences in the outcomes were observed. Peak heart rate was lower during pharmacological stress during ranolazine (−3.55 b.p.m., P < 0.001). The change in SAQ-7 directly correlated with the change in MPRI (correlation 0.25, P = 0.005). The change in MPRI predicted the change in SAQ QoL, adjusted for body mass index (BMI), prior myocardial infarction, and site (P = 0.0032). Low coronary flow reserve (CFR <2.5) subjects improved MPRI (P < 0.0137), SAQ angina frequency (P = 0.027), and SAQ-7 (P = 0.041). Conclusions In this mechanistic trial among symptomatic subjects, no obstructive CAD, short-term late sodium current inhibition was not generally effective for SAQ angina. Angina and myocardial perfusion reserve changes were related, supporting the notion that strategies to improve ischaemia should be tested in these subjects. Trial registration clinicaltrials.gov Identifier: NCT01342029.
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Affiliation(s)
- C Noel Bairey Merz
- Barbra Streisand Women's Heart Center, Cedars-Sinai Heart Institute, Los Angeles, CA, USA
| | | | - Chrisandra L Shufelt
- Barbra Streisand Women's Heart Center, Cedars-Sinai Heart Institute, Los Angeles, CA, USA
| | - Puja K Mehta
- Barbra Streisand Women's Heart Center, Cedars-Sinai Heart Institute, Los Angeles, CA, USA
| | - Margo B Minissian
- Barbra Streisand Women's Heart Center, Cedars-Sinai Heart Institute, Los Angeles, CA, USA
| | - Janet Wei
- Barbra Streisand Women's Heart Center, Cedars-Sinai Heart Institute, Los Angeles, CA, USA
| | - Louise E J Thomson
- S. Mark Taper Foundation Imaging Center, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Daniel S Berman
- S. Mark Taper Foundation Imaging Center, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Leslee J Shaw
- Program in Cardiovascular Outcomes Research and Epidemiology, Emory University, Atlanta, GA, USA
| | - John W Petersen
- Division of Cardiology, University of Florida, Gainesville, FL, USA
| | - Garrett H Brown
- Division of Cardiology, University of Florida, Gainesville, FL, USA
| | - R David Anderson
- Division of Cardiology, University of Florida, Gainesville, FL, USA
| | - Jonathan J Shuster
- Health Outcomes and Policy, University of Florida Clinical and Translational Science Institute, University of Florida, Gainesville, FL, USA
| | - Galen Cook-Wiens
- Biostatistics and Bioinformatics Research Center, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - André Rogatko
- Biostatistics and Bioinformatics Research Center, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Carl J Pepine
- Division of Cardiology, University of Florida, Gainesville, FL, USA
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Lawson MA, Bell SP, Adkisson DW, Wang L, Ooi H, Sawyer DB, Kronenberg MW. High reproducibility of adenosine stress cardiac MR myocardial perfusion imaging in patients with non-ischaemic dilated cardiomyopathy. BMJ Open 2014; 4:e005984. [PMID: 25515841 PMCID: PMC4275661 DOI: 10.1136/bmjopen-2014-005984] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To evaluate the reproducibility of first-pass contrast-enhanced cardiac MR (CMR) myocardial perfusion imaging in patients with non-ischaemic dilated cardiomyopathy (NIDCM). DESIGN Prospective observational study. SETTING Single centre, tertiary care hospital. PARTICIPANTS 6 outpatient participants with NIDCM. OUTCOME Reproducibility of semiquantitative myocardial perfusion analysis by CMR. METHOD 6 patients with NIDCM were studied twice using first-pass of contrast transit through the left ventricular (LV) myocardium with a saturation-recovery gradient echo sequence at rest and during adenosine-induced hyperaemia. The anterior wall was divided into endocardial (Endo) and epicardial (Epi) segments. The Myocardial Perfusion Index (MPI) was calculated as the myocardial signal augmentation rate normalised to the LV cavity rate. The Myocardial Perfusion Reserve Index (MPRI) was calculated as hyperaemic/resting MPI. RESULTS Between study 1 and 2, median MPI was similar for resting Endo (0.076 vs 0.077), hyperaemic Endo (0.143 vs 0.143), resting Epi (0.073 vs 0.074), and hyperaemic Epi (0.135 vs 0.134). Median MPRI was similar for Endo (1.84 vs 1.87) and Epi (1.90 vs 2.00). Combining Endo and Epi MPI (N=12), there was excellent agreement between Study 1 and 2 for resting MPI (r=0.998, intraclass correlation coefficient (ICC) 0.998, coefficients of variation (CoV) 1.4%), hyperaemic MPI (r=0.979, ICC 0.963, CoV 3.3%) and MPRI (r=0.989, ICC 0.94, CoV 3.8%). CONCLUSIONS Resting and hyperaemic myocardial perfusion using a normalised upslope analysis during adenosine CMR is a highly reproducible technique in patients with NIDCM. TRIAL REGISTRATION NUMBER Clinical Trials.Gov ID NCT00574119.
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Affiliation(s)
- Mark A Lawson
- Division of Cardiovascular Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Susan P Bell
- Division of Cardiovascular Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Douglas W Adkisson
- Division of Cardiovascular Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Li Wang
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Henry Ooi
- Division of Cardiovascular Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
- Cardiology Section, Department of Veterans Affairs Tennessee Valley Healthcare System, Nashville, Tennessee, USA
| | - Douglas B Sawyer
- Division of Cardiovascular Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Marvin W Kronenberg
- Division of Cardiovascular Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
- Cardiology Section, Department of Veterans Affairs Tennessee Valley Healthcare System, Nashville, Tennessee, USA
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Current Diagnostic and Therapeutic Strategies in Microvascular Angina. CURRENT EMERGENCY AND HOSPITAL MEDICINE REPORTS 2014; 3:30-37. [PMID: 25685641 DOI: 10.1007/s40138-014-0059-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Microvascular angina is common among patients with signs and symptoms of acute coronary syndrome and is associated with an increased risk of cardiovascular and cerebrovascular events. Unfortunately, microvascular is often under-recognized in clinical settings. The diagnosis of microvascular angina relies on assessment of the functional status of the coronary microvasculature. Invasive strategies include acetylcholine provocation, intracoronary Doppler ultrasound, and intracoronary thermodilution; noninvasive strategies include cardiac positron emission tomography (PET), cardiac magnetic resonance, and Doppler echocardiography. Once the diagnosis of microvascular angina is established, treatment is focused on improving symptoms and reducing future risk of cardiovascular and cerebrovascular events. Pharmacologic options and lifestyle modifications for patients with microvascular angina are similar to those for patients with coronary artery disease.
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Schwab F, Ingrisch M, Marcus R, Bamberg F, Hildebrandt K, Adrion C, Gliemi C, Nikolaou K, Reiser M, Theisen D. Tracer kinetic modeling in myocardial perfusion quantification using MRI. Magn Reson Med 2014; 73:1206-15. [DOI: 10.1002/mrm.25212] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2013] [Revised: 02/04/2014] [Accepted: 02/18/2014] [Indexed: 12/21/2022]
Affiliation(s)
- Felix Schwab
- Josef Lissner Laboratory for Biomedical Imaging; Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital Munich; Munich Germany
- Munich Heart Alliance; Munich Germany
| | - Michael Ingrisch
- Josef Lissner Laboratory for Biomedical Imaging; Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital Munich; Munich Germany
| | - Roy Marcus
- Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital Munich; Munich Germany
| | - Fabian Bamberg
- Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital Munich; Munich Germany
- Munich Heart Alliance; Munich Germany
| | - Kristof Hildebrandt
- Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital Munich; Munich Germany
| | - Christine Adrion
- Chair of Biometry and Bioinformatics; Institute for Medical Information Sciences, Biometry and Epidemiology, Ludwig-Maximilians-University; Munich Germany
| | | | - Konstantin Nikolaou
- Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital Munich; Munich Germany
| | - Maximilian Reiser
- Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital Munich; Munich Germany
- Munich Heart Alliance; Munich Germany
| | - Daniel Theisen
- Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital Munich; Munich Germany
- Munich Heart Alliance; Munich Germany
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Bratis K, Nagel E. Variability in quantitative cardiac magnetic resonance perfusion analysis. J Thorac Dis 2013; 5:357-9. [PMID: 23825774 DOI: 10.3978/j.issn.2072-1439.2013.06.08] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2013] [Accepted: 06/06/2013] [Indexed: 11/14/2022]
Abstract
By taking advantage of its high spatial resolution, noninvasive and nontoxic nature first-pass perfusion cardiovascular magnetic resonance (CMR) has rendered an indispensable tool for the noninvasive detection of reversible myocardial ischemia. A potential advantage of perfusion CMR is its ability to quantitatively assess perfusion reserve within a myocardial segment, as expressed semi- quantitatively by myocardial perfusion reserve index (MPRI) and fully- quantitatively by absolute myocardial blood flow (MBF). In contrast to the high accuracy and reliability of CMR in evaluating cardiac function and volumes, perfusion CMR is adversely affected by multiple potential reasons during data acquisition as well as post-processing. Various image acquisition techniques, various contrast agents and doses as well as variable blood flow at rest as well as variable reactions to stress all influence the acquired data. Mechanisms underlying the variability in perfusion CMR post processing, as well as their clinical significance, are yet to be fully elucidated. The development of a universal, reproducible, accurate and easily applicable tool in CMR perfusion analysis remains a challenge and will substantially enforce the role of perfusion CMR in improving clinical care.
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Affiliation(s)
- K Bratis
- Division of Imaging Sciences and Biomedical Engineering, King's College London. British Heart Foundation Centre of Excellence, National Institute for Health Research Biomedical Research Centre and Wellcome Trust and Engineering and Physical Sciences Research Council Medical Engineering Centre at Guy's and St Thomas' NHS Foundation Trust, London, UK
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Ikuye K, Buckert D, Schaaf L, Walcher T, Rottbauer W, Bernhardt P. Inter-observer agreement and diagnostic accuracy of myocardial perfusion reserve quantification by cardiovascular magnetic resonance at 3 Tesla in comparison to quantitative coronary angiography. J Cardiovasc Magn Reson 2013; 15:25. [PMID: 23537061 PMCID: PMC3707831 DOI: 10.1186/1532-429x-15-25] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2012] [Accepted: 02/28/2013] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Quantification of cardiovascular magnetic resonance (CMR) myocardial perfusion reserve (MPR) at 1.5 Tesla has been shown to correlate to invasive evaluation of coronary artery disease (CAD) and to yield good inter-observer agreement. However, little is known about quantitative adenosine-perfusion CMR at 3 Tesla and no data about inter-observer agreement is available. Aim of our study was to evaluate inter-observer agreement and to assess the diagnostic accuracy in comparison to quantitative coronary angiography (QCA). METHODS Fifty-three patients referred for coronary x-ray angiography were previously examined in a 3 Tesla whole-body scanner. Adenosine and rest perfusion CMR were acquired for the quantification of MPR in all segments. Two blinded and independent readers analyzed all images. QCA was performed in case of coronary stenosis. QCA data was used to assess diagnostic accuracy of the MPR measurements. RESULTS Inter-observer agreement was high for all myocardial perfusion territories (ρ = 0.92 for LAD, ρ = 0.93 for CX and RCA perfused segments). Compared to QCA receiver-operating characteristics yielded an area under the curve of 0.78 and 0.73 for RCA, 0.66 and 0.69 for LAD, and 0.52 and 0.53 for LCX perfused territories. CONCLUSIONS Inter-observer agreement of MPR quantification at 3 Tesla CMR is very high for all myocardial segments. Diagnostic accuracy in comparison to QCA yields good values for the RCA and LAD perfused territories, but moderate values for the posterior LCX perfused myocardial segments.
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Affiliation(s)
- Katharina Ikuye
- Department of Internal Medicine II, University of Ulm, Albert-Einstein-Allee 23, Ulm 89081, Germany
| | - Dominik Buckert
- Department of Internal Medicine II, University of Ulm, Albert-Einstein-Allee 23, Ulm 89081, Germany
| | - Lisa Schaaf
- Department of Internal Medicine II, University of Ulm, Albert-Einstein-Allee 23, Ulm 89081, Germany
| | - Thomas Walcher
- Department of Internal Medicine II, University of Ulm, Albert-Einstein-Allee 23, Ulm 89081, Germany
| | - Wolfgang Rottbauer
- Department of Internal Medicine II, University of Ulm, Albert-Einstein-Allee 23, Ulm 89081, Germany
| | - Peter Bernhardt
- Department of Internal Medicine II, University of Ulm, Albert-Einstein-Allee 23, Ulm 89081, Germany
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16
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Handayani A, Sijens PE, Lubbers DD, Triadyaksa P, Oudkerk M, van Ooijen PMA. Influence of the Choice of Software Package on the Outcome of Semiquantitative MR Myocardial Perfusion Analysis. Radiology 2013; 266:759-65. [DOI: 10.1148/radiol.12120626] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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17
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Broadbent DA, Biglands JD, Larghat A, Sourbron SP, Radjenovic A, Greenwood JP, Plein S, Buckley DL. Myocardial blood flow at rest and stress measured with dynamic contrast-enhanced MRI: comparison of a distributed parameter model with a Fermi function model. Magn Reson Med 2013; 70:1591-7. [PMID: 23417985 DOI: 10.1002/mrm.24611] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2012] [Revised: 11/30/2012] [Accepted: 12/02/2012] [Indexed: 12/20/2022]
Abstract
PURPOSE To assess the feasibility of simultaneously measuring blood flow (Fb ), Gd-DTPA extraction fraction (E), and distribution volume (vd ) in healthy myocardium at rest and under adenosine stress using dynamic contrast-enhanced MRI. METHODS Sixteen volunteers were examined at 1.5 T and 11 returned for a repeat study. The data were analyzed using a distributed parameter (DP) 2-region model to arrive at estimates of Fb , E, blood volume, and interstitial volume. For comparison, estimates of Fb were also obtained using a Fermi function model. RESULTS DP model fits were successful in 49 of the 54 data sets. Estimates obtained using DP and Fermi models did not differ for either rest Fb or myocardial perfusion reserve though DP estimates of stress Fb were lower than Fermi estimates. The repeatability of the DP parameters Fb , E, and vd was better than or equal to the repeatability of Fermi-Fb . E at rest and under stress was estimated to be 66% and 57%, respectively. CONCLUSION The results suggest that characteristics of the microvasculature of healthy myocardium can be reliably determined using dynamic contrast-enhanced MRI at rest and under stress and that delivery of Gd-DTPA to the myocardium is not flow-limited.
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Affiliation(s)
- David A Broadbent
- Division of Medical Physics, Leeds Institute of Genetics Health and Therapeutics, Faculty of Medicine and Health, University of Leeds, Leeds, UK; Department of Medical Physics and Engineering, Leeds Teaching Hospitals NHS Trust, Leeds, UK; Multidisciplinary Cardiovascular Research Centre, University of Leeds, Leeds, UK
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18
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Larghat AM, Maredia N, Biglands J, Greenwood JP, Ball SG, Jerosch-Herold M, Radjenovic A, Plein S. Reproducibility of first-pass cardiovascular magnetic resonance myocardial perfusion. J Magn Reson Imaging 2013; 37:865-74. [PMID: 23335425 DOI: 10.1002/jmri.23889] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2012] [Accepted: 09/14/2012] [Indexed: 11/11/2022] Open
Abstract
PURPOSE To assess the reproducibility of semiquantitative and quantitative analysis of first-pass myocardial perfusion cardiovascular magnetic resonance (CMR) in healthy volunteers. MATERIALS AND METHODS Eleven volunteers underwent myocardial perfusion CMR during adenosine stress and rest on 2 separate days. Perfusion data were acquired in a single mid-ventricular section in two cardiac phases to permit cardiac phase reproducibility comparisons. Semiquantitative analysis was performed to derive normalized upslopes of myocardial signal intensity profiles (myocardial perfusion index, MPI). The quantitative analysis estimated absolute myocardial blood flow (MBF) using Fermi-constrained deconvolution. The perfusion reserve index was calculated by dividing stress by rest data. Two observers performed all the measurements independently. One observer repeated all first scan measurements 4 weeks later. RESULTS The reproducibility of perfusion CMR was highest for semiquantitative analysis with an intraobserver coefficient of variability (CoV) of 3%-7% and interobserver CoV of 4%-10%. Semiquantitative interstudy comparison was less reproducible (CoV of 13%-27%). Quantitative intraobserver CoV of 10%-18%, interobserver CoV of 8%-15% and interstudy CoV of 20%-41%. Reproducibility of systolic and diastolic phases and the endocardial and epicardial myocardial layer showed similar reproducibility on both semiquantitative and quantitative analysis. CONCLUSION The reproducibility of CMR myocardial perfusion estimates is good, but varies between intraobserver, interobserver, and interstudy comparisons. In this study semiquantitative analysis was more reproducible than quantitative analysis.
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Affiliation(s)
- Abdulghani M Larghat
- Multidisciplinary Cardiovascular Research Centre & Leeds Institute of Genetics, Health and Therapeutics, University of Leeds, Leeds, UK
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Goykhman P, Mehta PK, Agarwal M, Shufelt C, Slomka PJ, Yang Y, Xu Y, Shaw LJ, Berman DS, Merz NB, Thomson LEJ. Reproducibility of myocardial perfusion reserve - variations in measurements from post processing using commercially available software. Cardiovasc Diagn Ther 2012; 2:268-77. [PMID: 24282727 PMCID: PMC3839165 DOI: 10.3978/j.issn.2223-3652.2012.10.02] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2012] [Accepted: 10/11/2012] [Indexed: 01/20/2023]
Abstract
PURPOSE Adenosine stress first pass cardiac magnetic resonance imaging (CMRI) is a rapidly evolving tool in the diagnosis of ischemic heart disease (IHD). The rest and stress first pass myocardial perfusion data may be interpreted using commercially available software for calculation of time intensity curves in order to generate a numeric value of the segmental or whole heart myocardial perfusion reserve index (MPRI). The objective of this study was to determine the inter- and intra-observer reliability of the data generated by standard commercially available software. METHODS Data from 20 adenosine stress CMRI (1.5 T) studies were analyzed using commercially available CAAS MRV 3.3 software (Pie Medical Imaging B.V., Netherlands) for calculation of the MPRI. The stress CMRI was performed using a standardized protocol in 20 women including 10 women with angina and the absence of obstructive CAD and 10 healthy volunteers. MPRI calculation was made in a standardized manner on separate occasions by two independent observers. A single observer repeated the calculation of MPRI three months later, without reference to the prior data. Basal, mid, and apical segments, for the whole myocardium, sub-endocardium, and sub-epicardium were analyzed. Intra-class correlation coefficients (ICC), repeatability coefficients (RC), and coefficients of variation (CoV) were determined. RESULTS The MPRI results by repeated software measurements were highly correlated, with potentially important variations in measurement observed. The myocardial inter-observer ICC was 0.80 (95% CI, 0.57, 0.92) with a CoV of 7.5%, and intra-observer ICC was 0.89 (95% CI, 0.77, 0.95) with a CoV of 3.6%. The mid-ventricular level MPRI was most reproducible, with intra-observer ICC at 0.91 (95% CI, 0.77, 0.97); intra-observer measurement was more reproducible than inter-observer measurement. CONCLUSIONS There is variation in measurement of MPRI observed in post processing of perfusion data when using a standardized approach and commercially available software. This has implications in the interpretation of data obtained for clinical and research purposes.
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Affiliation(s)
- Pavel Goykhman
- Women’s Heart Center, Cedars-Sinai Heart Institute, Los Angeles, CA, USA
| | - Puja K. Mehta
- Women’s Heart Center, Cedars-Sinai Heart Institute, Los Angeles, CA, USA
| | - Megha Agarwal
- Women’s Heart Center, Cedars-Sinai Heart Institute, Los Angeles, CA, USA
| | - Chrisandra Shufelt
- Women’s Heart Center, Cedars-Sinai Heart Institute, Los Angeles, CA, USA
| | - Piotr J. Slomka
- S. Mark Taper Foundation Imaging Center, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Yuching Yang
- Women’s Heart Center, Cedars-Sinai Heart Institute, Los Angeles, CA, USA
| | - Yuan Xu
- S. Mark Taper Foundation Imaging Center, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Leslee J. Shaw
- Program in Cardiovascular Outcomes Research and Epidemiology, Emory University, Atlanta, GA, USA
| | - Daniel S. Berman
- S. Mark Taper Foundation Imaging Center, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Noel Bairey Merz
- Women’s Heart Center, Cedars-Sinai Heart Institute, Los Angeles, CA, USA
| | - Louise E. J. Thomson
- S. Mark Taper Foundation Imaging Center, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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Morton G, Jogiya R, Plein S, Schuster A, Chiribiri A, Nagel E. Quantitative cardiovascular magnetic resonance perfusion imaging: inter-study reproducibility. Eur Heart J Cardiovasc Imaging 2012; 13:954-60. [PMID: 22634739 DOI: 10.1093/ehjci/jes103] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
AIMS To evaluate the inter-study reproducibility of quantitative cardiovascular magnetic resonance (CMR) myocardial perfusion imaging and the influence of diurnal variation on perfusion. Data on these are limited, despite being crucially important for performing serial examinations both in clinical practice and in trials. METHODS AND RESULTS Sixteen healthy volunteers underwent high-resolution 3 T perfusion imaging three times during a single day to evaluate inter-study reproducibility and the effects of diurnal variation. Absolute perfusion was determined in each coronary artery territory and globally by Fermi constrained deconvolution of myocardial signal intensity curves. Left ventricular (LV) volumes and function were also calculated. Eleven full data sets were suitable for quantitative perfusion analysis. Global rest and stress perfusion and myocardial perfusion reserve (MPR) were 0.6 ± 0.1 and 2.5 ± 0.5 mL/min/g and 4.3 ± 0.9, respectively, for the first scan and were 0.5 ± 0.2 and 2.1 ± 0.5 mL/min/g and 4.2 ± 1.2 for the second (P= 0.1, 0.19, and 0.37, respectively). Inter-study reproducibility was moderate. The coefficient of variation (CV) was 16.0, 26.8, and 23.9% for global rest and stress perfusion and MPR, respectively. The corresponding territorial CVs were 27.5, 35.2, and 33.5%. The reproducibility of LV volumes and function was excellent (CV 4, 7.7, and 4.6% for end-diastolic volume, end-systolic volume, and ejection fraction, respectively). There were no significant detectable diurnal variations in perfusion or LV volumes and function (P≥ 0.05 for all). CONCLUSION The inter-study reproducibility of quantitative myocardial perfusion is reasonable and best for global rest perfusion. No significant diurnal variation in perfusion was observed.
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Affiliation(s)
- Geraint Morton
- Division of Imaging Sciences, The Rayne Institute, King’s College London, 4th Floor Lambeth Wing, St Thomas’ Hospital, London SE1 7EH, UK.
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DiBella EVR, Fluckiger JU, Chen L, Kim TH, Pack NA, Matthews B, Adluru G, Priester T, Kuppahally S, Jiji R, McGann C, Litwin SE. The effect of obesity on regadenoson-induced myocardial hyperemia: a quantitative magnetic resonance imaging study. Int J Cardiovasc Imaging 2011; 28:1435-44. [PMID: 21968545 PMCID: PMC3463785 DOI: 10.1007/s10554-011-9949-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2011] [Accepted: 09/17/2011] [Indexed: 10/27/2022]
Abstract
The A2(A) receptor agonist, regadenoson, is increasingly used as a vasodilator during nuclear myocardial perfusion imaging. Regadenoson is administered as a single, fixed dose. Given the frequency of obesity in patients with symptoms of heart disease, it is important to know whether the fixed dose of regadenoson produces maximal coronary hyperemia in subjects of widely varying body size. Thirty subjects (12 female, 18 male, mean BMI 30.3 ± 6.5, range 19.6-46.6) were imaged on a 3T magnetic resonance scanner. Imaging with a saturation recovery radial turboFLASH sequence was done first at rest, then during adenosine infusion (140 μg/kg/min) and 30 min later with regadenoson (0.4 mg/5 ml bolus). A 5 cc/s injection of Gd-BOPTA was used for each perfusion sequence, with doses of 0.02, 0.03 and 0.03 mmol/kg, respectively. Analysis of the upslope of myocardial time-intensity curves and quantitative processing to obtain myocardial perfusion reserve (MPR) values were performed for each vasodilator. The tissue upslopes for adenosine and regadenoson matched closely (y = 1.1x + 0.03, r = 0.9). Mean MPR was 2.3 ± 0.6 for adenosine and 2.4 ± 0.9 for regadenoson (p = 0.14). There was good agreement between MPR measured with adenosine and regadenoson (y = 1.1x - 0.06, r = 0.7). The MPR values measured with both agents tended to be lower as BMI increased. There were no complications during administration of either agent. Regadenoson produced fewer side effects. Fixed dose regadenoson and weight adjusted adenosine produce similar measures of MPR in patients with a wide range of body sizes. Regadenoson is a potentially useful vasodilator for stress MRI studies.
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Affiliation(s)
- Edward V R DiBella
- UCAIR, Department of Radiology, University of Utah, Salt Lake City, UT, USA
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Exercise training increases myocardial perfusion in residual viable myocardium within infarct zone. J Magn Reson Imaging 2011; 34:60-8. [DOI: 10.1002/jmri.22597] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2010] [Accepted: 03/07/2011] [Indexed: 11/07/2022] Open
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Mehta PK, Goykhman P, Thomson LEJ, Shufelt C, Wei J, Yang Y, Gill E, Minissian M, Shaw LJ, Slomka PJ, Slivka M, Berman DS, Bairey Merz CN. Ranolazine improves angina in women with evidence of myocardial ischemia but no obstructive coronary artery disease. JACC Cardiovasc Imaging 2011; 4:514-22. [PMID: 21565740 PMCID: PMC6364688 DOI: 10.1016/j.jcmg.2011.03.007] [Citation(s) in RCA: 138] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2010] [Revised: 03/02/2011] [Accepted: 03/04/2011] [Indexed: 10/18/2022]
Abstract
OBJECTIVES We conducted a pilot study for a large definitive clinical trial evaluating the impact of ranolazine in women with angina, evidence of myocardial ischemia, and no obstructive coronary artery disease (CAD). BACKGROUND Women with angina, evidence of myocardial ischemia, but no obstructive CAD frequently have microvascular coronary dysfunction. The impact of ranolazine in this patient group is unknown. METHODS A pilot randomized, double-blind, placebo-controlled, crossover trial was conducted in 20 women with angina, no obstructive CAD, and ≥ 10% ischemic myocardium on adenosine stress cardiac magnetic resonance (CMR) imaging. Participants were assigned to ranolazine or placebo for 4 weeks separated by a 2-week washout. The Seattle Angina Questionnaire and CMR were evaluated after each treatment. Invasive coronary flow reserve (CFR) was available in patients who underwent clinically indicated coronary reactivity testing. CMR data analysis included the percentage of ischemic myocardium and quantitative myocardial perfusion reserve index (MPRI). RESULTS The mean age of subjects was 57 ± 11 years. Compared with placebo, patients on ranolazine had significantly higher (better) Seattle Angina Questionnaire scores, including physical functioning (p = 0.046), angina stability (p = 0.008), and quality of life (p = 0.021). There was a trend toward a higher (better) CMR mid-ventricular MPRI (2.4 [2.0 minimum, 2.8 maximum] vs. 2.1 [1.7 minimum, 2.5 maximum], p = 0.074) on ranolazine. Among women with coronary reactivity testing (n = 13), those with CFR ≤ 3.0 had a significantly improved MPRI on ranolazine versus placebo compared to women with CFR > 3.0 (Δ in MPRI 0.48 vs. -0.82, p = 0.04). CONCLUSIONS In women with angina, evidence of ischemia, and no obstructive CAD, this pilot randomized, controlled trial revealed that ranolazine improves angina. Myocardial ischemia may also improve, particularly among women with low CFR. These data document approach feasibility and provide outcome variability estimates for planning a definitive large clinical trial to evaluate the role of ranolazine in women with microvascular coronary dysfunction. (Microvascular Coronary Disease In Women: Impact Of Ranolazine; NCT00570089).
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Affiliation(s)
- Puja K. Mehta
- Women’s Heart Center, Cedars-Sinai Heart Institute, Los Angeles, California
| | - Pavel Goykhman
- Women’s Heart Center, Cedars-Sinai Heart Institute, Los Angeles, California
| | - Louise E. J. Thomson
- S. Mark Taper Foundation Imaging Center, Cedars-Sinai Medical Center, Los Angeles, California
| | - Chrisandra Shufelt
- Women’s Heart Center, Cedars-Sinai Heart Institute, Los Angeles, California
| | - Janet Wei
- Women’s Heart Center, Cedars-Sinai Heart Institute, Los Angeles, California
| | - YuChing Yang
- Women’s Heart Center, Cedars-Sinai Heart Institute, Los Angeles, California
| | - Edward Gill
- S. Mark Taper Foundation Imaging Center, Cedars-Sinai Medical Center, Los Angeles, California
| | - Margo Minissian
- Women’s Heart Center, Cedars-Sinai Heart Institute, Los Angeles, California
| | - Leslee J. Shaw
- Program in Cardiovascular Outcomes Research and Epidemiology, Emory University, Atlanta, Georgia
| | - Piotr J. Slomka
- S. Mark Taper Foundation Imaging Center, Cedars-Sinai Medical Center, Los Angeles, California
| | - Melissa Slivka
- Women’s Heart Center, Cedars-Sinai Heart Institute, Los Angeles, California
| | - Daniel S. Berman
- S. Mark Taper Foundation Imaging Center, Cedars-Sinai Medical Center, Los Angeles, California
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Chih S, Macdonald PS, Feneley MP, Law M, Graham RM, McCrohon JA. Reproducibility of adenosine stress cardiovascular magnetic resonance in multi-vessel symptomatic coronary artery disease. J Cardiovasc Magn Reson 2010; 12:42. [PMID: 20663155 PMCID: PMC2914773 DOI: 10.1186/1532-429x-12-42] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2010] [Accepted: 07/21/2010] [Indexed: 02/06/2023] Open
Abstract
PURPOSE First-pass perfusion cardiovascular magnetic resonance (CMR) is increasingly being utilized in both clinical practice and research. However, the reproducibility of this technique remains incompletely evaluated, particularly in patients with severe coronary artery disease (CAD). The purpose of this study was to determine the inter-study reproducibility of adenosine stress CMR in patients with symptomatic multi-vessel CAD and those at low risk for CAD. METHODS Twenty patients (10 with CAD, 10 low risk CAD) underwent two CMR scans 8 +/- 2 days apart. Basal, mid and apical left ventricular short axis slices were acquired using gadolinium 0.05 mmol/kg at peak stress (adenosine, 140 micro/kg/min, 4 min) and rest. Myocardial perfusion was evaluated qualitatively by assessing the number of ischemic segments, and semi-quantitatively by determining the myocardial perfusion reserve index (MPRi) using a normalized upslope method. Inter-study and observer reproducibility were assessed--the latter being defined by the coefficient of variation (CoV), which was calculated from the standard deviation of the differences of the measurements, divided by the mean. Additionally, the percentage of myocardial segments with perfect agreement and inter- and intra-observer MPRi correlation between studies, were also determined. RESULTS The CoV for the number of ischemic segments was 31% with a mean difference of -0.15 +/- 0.88 segments and 91% perfect agreement between studies. MPRi was lower in patients with CAD (1.13 +/- 0.21) compared to those with low risk CAD (1.59 +/- 0.58), p = 0.02. The reproducibility of MPRi was 19% with no significant difference between patients with CAD and those with low risk CAD (p = 0.850). Observer reproducibility for MPRi was high: inter-observer CoV 9%, r = 0.93 and intra-observer CoV 5%, r = 0.94. For trials using perfusion CMR as an endpoint, an estimated sample size of 12 subjects would be required to detect a two-segment change in the number of ischemic segments (power 0.9, alpha 0.05). CONCLUSIONS Adenosine stress CMR, by qualitative and semi-quantitative normalized upslope analyses are reproducible techniques in both patients with multi-vessel CAD and those without known CAD. The robust inter-study reproducibility of perfusion CMR supports its clinical and research application.
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Affiliation(s)
- Sharon Chih
- Victor Chang Cardiac Research Institute, Lower Packer Building, Liverpool Street, Sydney, Australia
- Department of Cardiology, St Vincent's Hospital, Victoria Street, Sydney, Australia
| | - Peter S Macdonald
- Victor Chang Cardiac Research Institute, Lower Packer Building, Liverpool Street, Sydney, Australia
- Department of Cardiology, St Vincent's Hospital, Victoria Street, Sydney, Australia
- University of New South Wales, Sydney, Australia
| | - Michael P Feneley
- Victor Chang Cardiac Research Institute, Lower Packer Building, Liverpool Street, Sydney, Australia
- Department of Cardiology, St Vincent's Hospital, Victoria Street, Sydney, Australia
- University of New South Wales, Sydney, Australia
| | - Matthew Law
- University of New South Wales, Sydney, Australia
| | - Robert M Graham
- Victor Chang Cardiac Research Institute, Lower Packer Building, Liverpool Street, Sydney, Australia
- Department of Cardiology, St Vincent's Hospital, Victoria Street, Sydney, Australia
- University of New South Wales, Sydney, Australia
| | - Jane A McCrohon
- Department of Cardiology, St Vincent's Hospital, Victoria Street, Sydney, Australia
- University of New South Wales, Sydney, Australia
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Lee DC, Johnson NP. Quantification of absolute myocardial blood flow by magnetic resonance perfusion imaging. JACC Cardiovasc Imaging 2009; 2:761-70. [PMID: 19520349 DOI: 10.1016/j.jcmg.2009.04.003] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2008] [Revised: 03/24/2009] [Accepted: 04/13/2009] [Indexed: 12/01/2022]
Abstract
By serially imaging the myocardium during the initial transit of gadolinium contrast, magnetic resonance perfusion imaging can accurately assess relative reductions in regional myocardial blood flow and identify hemodynamically significant coronary artery disease. Models can be used to quantify myocardial blood flow (in milliliters/minute/gram) on the basis of dynamic signal changes within the myocardium and left ventricular cavity. Although the mathematical modeling involved in this type of analysis adds complexity, the benefits of absolute blood flow quantification might improve clinical diagnosis and have important implications for cardiovascular research.
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Affiliation(s)
- Daniel C Lee
- Feinberg Cardiovascular Research Institute, Department of Medicine and Division of Cardiology, Bluhm Cardiovascular Institute, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA.
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Cheng ASH, Selvanayagam JB, Jerosch-Herold M, van Gaal WJ, Karamitsos TD, Neubauer S, Banning AP. Percutaneous treatment of chronic total coronary occlusions improves regional hyperemic myocardial blood flow and contractility: insights from quantitative cardiovascular magnetic resonance imaging. JACC Cardiovasc Interv 2009; 1:44-53. [PMID: 19393143 DOI: 10.1016/j.jcin.2007.11.003] [Citation(s) in RCA: 96] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2007] [Revised: 11/14/2007] [Accepted: 11/21/2007] [Indexed: 11/30/2022]
Abstract
OBJECTIVES We sought to investigate temporal changes in contractility and hyperemic and resting myocardial blood flow (MBF) in dependent and remote myocardium after percutaneous coronary intervention (PCI) of chronic total occlusions (CTOs) by using cardiovascular magnetic resonance (CMR) imaging. BACKGROUND Data about the physiological consequences of revascularization of CTOs are limited. The use of CMR allows investigation of the regional effects of revascularization on MBF and left ventricular contractility. METHODS We prospectively recruited 3 patient groups: 17 patients scheduled for CTO PCI, 17 scheduled for PCI of a stenosed but nonoccluded coronary artery (non-CTO), and 6 patients with CTO who were not scheduled for revascularization. All patients undergoing PCI underwent CMR imaging <24 h before PCI, with repeat CMR imaging 24 h and 6 months after PCI. Each CMR scan consisted of cine, perfusion, and delayed enhancement imaging. Regional hyperemic and resting MBF, wall thickening, and transmural extent of infarction were calculated. RESULTS In both intervention groups, hyperemic MBF in treated segments increased 24 h after PCI compared with baseline: CTO group, 2.1 +/- 0.2 ml/min/g versus 1.4 +/- 0.2 ml/min/g (p < 0.01); non-CTO group, 2.5 +/- 0.2 ml/min/g versus 1.6 +/- 0.2 ml/min/g (p < 0.01). This improvement persisted 6 months after PCI (p < 0.01 for both groups). Contractility in treated segments was improved at 24 h and 6 months after CTO PCI but only at 6 months after non-CTO PCI. In both intervention groups, treated segments no longer had reduced MBF or contractility compared with remote segments. In patients with untreated CTO segments, MBF and wall thickening did not improve at follow-up. CONCLUSIONS Successful CTO PCI increases hyperemic MBF as early as 24 h after the procedure, with a greater and earlier improvement in regional contractility than after non-CTO PCI, despite a greater likelihood of irreversible injury in CTO segments.
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Affiliation(s)
- Adrian S H Cheng
- University of Oxford Centre for Clinical Magnetic Resonance Research, University of Oxford, Oxford, United Kingdom
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Utz W, Greiser A, Niendorf T, Dietz R, Schulz-Menger J. Single- or dual-bolus approach for the assessment of myocardial perfusion reserve in quantitative MR perfusion imaging. Magn Reson Med 2008; 59:1373-7. [PMID: 18506802 DOI: 10.1002/mrm.21611] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
A dual-bolus protocol can overcome limitations due to T1-induced MR signal attenuation and hence enables more accurate quantification of myocardial blood flow (MBF) by contrast enhanced MR perfusion imaging. The study explores potential benefits of the dual-bolus technique for the assessment of myocardial perfusion reserve (MPR) over a standard single-bolus protocol. Nineteen patients without obstructive coronary artery disease as assessed by cardiac catheterization underwent a stress-rest MR perfusion study using a dual-bolus protocol. Gd-DTPA dosages of 0.005 and 0.05 mmol/kg of bodyweight were delivered as pre- and main-bolus. For comparison arterial input curves where extracted from left ventricular cavity passage including both, pre-bolus and main-bolus data. Global and segmental MPR were determined from semiquantitative and from full quantitative measures of MBF. As a result good agreement between dual- and single-bolus technique was found with relative differences of maximally 10% in global MPR estimates. For the dual bolus approach a significant relative decrease of 30% (P<0.001) was found for the coefficient of segmental MPR variation, which may allow a more reliable detection of hypoperfused segments in clinical studies.
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Affiliation(s)
- Wolfgang Utz
- Franz Volhard Klinik, Charite Campus Buch, HELIOS Klinikum-Berlin at the Max Delbrück Center for Molecular Medicine, Berlin, Germany.
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Abstract
Extensive research has documented that rapid imaging during the first pass of a magnetic resonance imaging (MRI) contrast agent provides good sensitivity to detect myocardial blood flow deficits caused by coronary disease, cardiomyopathies, or microvascular dysfunction in patients without obstructive lesions in the coronary arteries. The autoregulatory mechanisms of the coronary circulation serve the purpose of maintaining sufficient blood flow at baseline in the presence of flow-obstructing coronary lesions. Stress testing is most commonly used in this setting to determine the hemodynamic effect of coronary lesions in the epicardial arteries when the small-vessel resistance has been minimized by vasodilation. The protocols for perfusion MRI combined with vasodilation have been successfully tested in large patient studies. Besides the absence of any ionizing radiation, MRI offers the advantages of relatively high spatial resolution to detect perfusion defects limited to the inner layer of the heart muscle. Furthermore, MRI can be used for noninvasive quantitative measurements of myocardial blood flow that compare well with invasive measurements with labeled microspheres. Additional useful markers, such as the dynamic distribution volume, the delay in the arrival of the contrast agent in a myocardial region relative to the enhancement in the arterial input, and the capillary permeability-surface area product, may, in the future, further enhance the capabilities to characterize with MRI coronary atherosclerosis, coronary vascular dysfunction, and adaptive mechanisms in the coronary circulation, such as arteriogenesis, that reduce ischemia.
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Köstler H, Ritter C, Lipp M, Beer M, Hahn D, Sandstede J. Comparison of different contrast agents and doses for quantitative MR myocardial perfusion imaging. J Magn Reson Imaging 2008; 28:382-9. [PMID: 18666144 DOI: 10.1002/jmri.21443] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To investigate three different contrast agents at different injection volumes for repetitive quantitative multislice myocardial perfusion imaging using the prebolus technique. MATERIALS AND METHODS Two consecutive prebolus perfusion measurements were performed on a 1.5 T scanner using identical injection volumes for the first and second examination to test the reproducibility for possible rest and stress examination in normal volunteers. Either 1-8 mL, 1-12 mL Gd-DTPA, 1-4 mL, 1-6 mL, 1-9 mL Gd-BOPTA, or 1-4 mL, 1-6 mL gadobutrol were applied. RESULTS In cases where injection volumes were sufficiently small, there was no indication of significant differences in quantitative perfusion values with respect to the different contrast agents. Increasing the bolus volume improved the contrast-to-noise ratio (CNR) but led to saturation effects and underestimation of the true perfusion. The highest CNR was measured for gadobutrol (6 mL, p < 0.0005 compared to 8 mL Gd-DTPA). The smallest difference of perfusion values between the first and the second prebolus examination was found for Gd-BOPTA (p < or = 0.006 compared Gd-DTPA). CONCLUSION Prebolus examinations for quantitative myocardial perfusion imaging are possible with all three contrast agents for sufficient small injection volumes. Gd-BOPTA was found to be advantageous for a combined quantitative rest and stress examination.
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Affiliation(s)
- Herbert Köstler
- Institut für Röntgendiagnostik der Universität Würzburg, Würzburg, Germany.
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Variability of Myocardial Blood Flow Measurements by Magnetic Resonance Imaging in the Multi-Ethnic Study of Atherosclerosis. Invest Radiol 2008; 43:155-61. [DOI: 10.1097/rli.0b013e31815abebd] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Webb CM, Elkington AG, Kraidly MM, Keenan N, Pennell DJ, Collins P. Effects of oral testosterone treatment on myocardial perfusion and vascular function in men with low plasma testosterone and coronary heart disease. Am J Cardiol 2008; 101:618-24. [PMID: 18308009 PMCID: PMC2258313 DOI: 10.1016/j.amjcard.2007.09.114] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2007] [Revised: 09/30/2007] [Accepted: 09/30/2007] [Indexed: 11/20/2022]
Abstract
Intracoronary testosterone infusions induce coronary vasodilatation and increase coronary blood flow. Longer term testosterone supplementation favorably affected signs of myocardial ischemia in men with low plasma testosterone and coronary heart disease. However, the effects on myocardial perfusion are unknown. Effects of longer term testosterone treatment on myocardial perfusion and vascular function were investigated in men with CHD and low plasma testosterone. Twenty-two men (mean age 57 ± 9 [SD] years) were randomly assigned to oral testosterone undecanoate (TU; 80 mg twice daily) or placebo in a crossover study design. After each 8-week period, subjects underwent at rest and adenosine-stress first-pass myocardial perfusion cardiovascular magnetic resonance, pulse-wave analysis, and endothelial function measurements using radial artery tonometry, blood sampling, anthropomorphic measurements, and quality-of-life assessment. Although no difference was found in global myocardial perfusion after TU compared with placebo, myocardium supplied by unobstructed coronary arteries showed increased perfusion (1.83 ± 0.9 vs 1.52 ± 0.65; p = 0.037). TU decreased basal radial and aortic augmentation indexes (p = 0.03 and p = 0.02, respectively), indicating decreased arterial stiffness, but there was no effect on endothelial function. TU significantly decreased high-density lipoprotein cholesterol and increased hip circumference, but had no effect on hemostatic factors, quality of life, and angina symptoms. In conclusion, oral TU had selective and modest enhancing effects on perfusion in myocardium supplied by unobstructed coronary arteries, in line with previous intracoronary findings. The TU-related decrease in basal arterial stiffness may partly explain previously shown effects of exogenous testosterone on signs of exercise-induced myocardial ischemia.
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Utz W, Niendorf T, Wassmuth R, Messroghli D, Dietz R, Schulz-Menger J. Contrast–dose relation in first-pass myocardial MR perfusion imaging. J Magn Reson Imaging 2007; 25:1131-5. [PMID: 17520736 DOI: 10.1002/jmri.20910] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
PURPOSE To determine the regime of linear contrast enhancement in human first-pass perfusion cardiovascular magnetic resonance (CMR) imaging to improve accuracy in myocardial perfusion quantification. MATERIALS AND METHODS A total of 10 healthy subjects were studied on a clinical 1.5T MR scanner. Seven doses of Gd-DTPA ranging from 0.00125 to 0.1 mmol/kg of body weight (b.w.) were administered as equal volumes by rapid bolus injection (6 mL/second). Resting periods of 15 minutes were introduced after delivery of Gd doses >0.01 mmol/kg b.w. For each subject, two series of rest perfusion scans were performed using two different multislice saturation-recovery perfusion sequences. Maximum contrast enhancement and maximum upslope were obtained in the blood pool of the left ventricular (LV) cavity and in the myocardium. The range of linear contrast-dose relation was determined by linear regression analysis. RESULTS MR signal intensity increased linearly for contrast agent concentrations up to 0.01 mmol/kg b.w. in the LV blood pool and up to 0.05 mmol/kg b.w. in the myocardium. For Gd concentrations exceeding these thresholds the signal intensity response was not linear with respect to the contrast agent dose. CONCLUSION Quantitative evaluation of cardiac MR perfusion data needs to account for signal saturation in both the LV blood pool and the myocardium.
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Affiliation(s)
- Wolfgang Utz
- Franz Volhard Klinik, Charite Campus Buch, Helios Klinikum-Berlin at the Max Delbrück Center for Molecular Medicine, Wiltbergstrasse 50, 13125 Berlin, Germany.
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