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Beaudry RI, Samuel TJ, Wang J, Tucker WJ, Haykowsky MJ, Nelson MD. Exercise cardiac magnetic resonance imaging: a feasibility study and meta-analysis. Am J Physiol Regul Integr Comp Physiol 2018; 315:R638-R645. [PMID: 29949409 DOI: 10.1152/ajpregu.00158.2018] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Cardiac stress testing improves detection and risk assessment of heart disease. Magnetic resonance imaging (MRI) is the clinical gold-standard for assessing cardiac morphology and function at rest; however, exercise MRI has not been widely adapted for cardiac assessment because of imaging and device limitations. Commercially available magnetic resonance ergometers, together with improved imaging sequences, have overcome many previous limitations, making cardiac stress MRI more feasible. Here, we aimed to demonstrate clinical feasibility and establish the normative, healthy response to supine exercise MRI. Eight young, healthy subjects underwent rest and exercise cinematic imaging to measure left ventricular volumes and ejection fraction. To establish the normative, healthy response to exercise MRI we performed a comprehensive literature review and meta-analysis of existing exercise cardiac MRI studies. Results were pooled using a random effects model to define the left ventricular ejection fraction, end-diastolic, end-systolic, and stroke volume responses. Our proof-of-concept data showed a marked increase in cardiac index with exercise, secondary to an increase in both heart rate and stroke volume. The change in stroke volume was driven by a reduction in end-systolic volume, with no change in end-diastolic volume. These findings were entirely consistent with 17 previous exercise MRI studies (226 individual records), despite differences in imaging approach, ergometer, or exercise type. Taken together, the data herein demonstrate that exercise cardiac MRI is clinically feasible, using commercially available exercise equipment and vendor-provided product sequences and establish the normative, healthy response to exercise MRI.
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Affiliation(s)
- Rhys I Beaudry
- Department of Kinesiology, University of Texas at Arlington , Arlington, Texas
| | - T Jake Samuel
- Department of Kinesiology, University of Texas at Arlington , Arlington, Texas
| | - Jing Wang
- College of Nursing and Health Innovation, University of Texas at Arlington , Arlington, Texas
| | - Wesley J Tucker
- Department of Kinesiology, University of Texas at Arlington , Arlington, Texas
| | - Mark J Haykowsky
- College of Nursing and Health Innovation, University of Texas at Arlington , Arlington, Texas
| | - Michael D Nelson
- Department of Kinesiology, University of Texas at Arlington , Arlington, Texas
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Nissen L, Winther S, Isaksen C, Ejlersen JA, Brix L, Urbonaviciene G, Frost L, Madsen LH, Knudsen LL, Schmidt SE, Holm NR, Maeng M, Nyegaard M, Bøtker HE, Bøttcher M. Danish study of Non-Invasive testing in Coronary Artery Disease (Dan-NICAD): study protocol for a randomised controlled trial. Trials 2016; 17:262. [PMID: 27225018 PMCID: PMC4880871 DOI: 10.1186/s13063-016-1388-z] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2015] [Accepted: 05/11/2016] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Coronary computed tomography angiography (CCTA) is an established method for ruling out coronary artery disease (CAD). Most patients referred for CCTA do not have CAD and only approximately 20-30 % of patients are subsequently referred to further testing by invasive coronary angiography (ICA) or non-invasive perfusion evaluation due to suspected obstructive CAD. In cases with severe calcifications, a discrepancy between CCTA and ICA often occurs, leading to the well-described, low-diagnostic specificity of CCTA. As ICA is cost consuming and involves a risk of complications, an optimized algorithm would be valuable and could decrease the number of ICAs that do not lead to revascularization. The primary objective of the Dan-NICAD study is to determine the diagnostic accuracy of cardiac magnetic resonance imaging (CMRI) and myocardial perfusion scintigraphy (MPS) as secondary tests after a primary CCTA where CAD could not be ruled out. The secondary objective includes an evaluation of the diagnostic precision of an acoustic technology that analyses the sound of coronary blood flow. It may potentially provide better stratification prior to CCTA than clinical risk stratification scores alone. METHODS/DESIGN Dan-NICAD is a multi-centre, randomised, cross-sectional trial, which will include approximately 2,000 patients without known CAD, who were referred to CCTA due to a history of symptoms suggestive of CAD and a low-risk to intermediate-risk profile, as evaluated by a cardiologist. Patient interview, sound recordings, and blood samples are obtained in connection with the CCTA. All patients with suspected obstructive CAD by CCTA are randomised to either stress CMRI or stress MPS, followed by ICA with fractional flow reserve (FFR) measurements. Obstructive CAD is defined as an FFR below 0.80 or as high-grade stenosis (>90 % diameter stenosis) by visual assessment. Diagnostic performance is evaluated as sensitivity, specificity, predictive values, likelihood ratios, and C statistics. Enrolment commenced in September 2014 and is expected to be complete in May 2016. DISCUSSION Dan-NICAD is designed to assess whether a secondary perfusion examination after CCTA could safely reduce the number of ICAs where revascularization is not required. The results are expected to add knowledge about the optimal algorithm for diagnosing CAD. TRIAL REGISTRATION Clinicaltrials.gov identifier, NCT02264717 . Registered on 26 September 2014.
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Affiliation(s)
- Louise Nissen
- Department of Internal Medicine, Hospital Unit West, Gl.landevej 61, 7400, Herning, Denmark.
| | - Simon Winther
- Department of Internal Medicine, Hospital Unit West, Gl.landevej 61, 7400, Herning, Denmark
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Christin Isaksen
- Department of Radiology, Regional Hospital of Silkeborg, Silkeborg, Denmark
| | | | - Lau Brix
- Department of Radiology, Regional Hospital of Silkeborg, Silkeborg, Denmark
| | | | - Lars Frost
- Department of Cardiology, Regional Hospital of Silkeborg, Silkeborg, Denmark
| | - Lene Helleskov Madsen
- Department of Internal Medicine, Hospital Unit West, Gl.landevej 61, 7400, Herning, Denmark
| | - Lars Lyhne Knudsen
- Department of Internal Medicine, Hospital Unit West, Gl.landevej 61, 7400, Herning, Denmark
| | - Samuel Emil Schmidt
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | | | - Michael Maeng
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Mette Nyegaard
- Department of Biomedicine, Aarhus University, Aarhus, Denmark
| | - Hans Erik Bøtker
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Morten Bøttcher
- Department of Internal Medicine, Hospital Unit West, Gl.landevej 61, 7400, Herning, Denmark
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Basha TA, Roujol S, Kissinger KV, Goddu B, Berg S, Manning WJ, Nezafat R. Free-breathing cardiac MR stress perfusion with real-time slice tracking. Magn Reson Med 2014; 72:689-98. [PMID: 24123153 PMCID: PMC3979504 DOI: 10.1002/mrm.24977] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2013] [Revised: 09/09/2013] [Accepted: 09/11/2013] [Indexed: 12/30/2022]
Abstract
PURPOSE To develop a free-breathing cardiac MR perfusion sequence with slice tracking for use after physical exercise. METHODS We propose to use a leading navigator, placed immediately before each 2D slice acquisition, for tracking the respiratory motion and updating the slice location in real-time. The proposed sequence was used to acquire CMR perfusion datasets in 12 healthy adult subjects and 8 patients. Images were compared with the conventional perfusion (i.e., without slice tracking) results from the same subjects. The location and geometry of the myocardium were quantitatively analyzed, and the perfusion signal curves were calculated from both sequences to show the efficacy of the proposed sequence. RESULTS The proposed sequence was significantly better compared with the conventional perfusion sequence in terms of qualitative image scores. Changes in the myocardial location and geometry decreased by 50% in the slice tracking sequence. Furthermore, the proposed sequence had signal curves that are smoother and less noisy. CONCLUSION The proposed sequence significantly reduces the effect of the respiratory motion on the image acquisition in both rest and stress perfusion scans.
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Affiliation(s)
- Tamer A. Basha
- Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA
| | - Sébastien Roujol
- Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA
| | - Kraig V. Kissinger
- Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA
| | - Beth Goddu
- Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA
| | - Sophie Berg
- Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA
| | - Warren J. Manning
- Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA
- Department of Radiology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA
| | - Reza Nezafat
- Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA
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Caobelli F, Farina D, Pizzocaro C, Guerra UP. Will the new advantages provided by PET in myocardial perfusion imaging help nuclear cardiology survive the test of time against conventional radiological techniques? Eur J Nucl Med Mol Imaging 2012; 39:1970-2. [DOI: 10.1007/s00259-012-2214-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2012] [Accepted: 07/31/2012] [Indexed: 10/27/2022]
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