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Crawley R, Kunze KP, Milidonis X, Highton J, McElroy S, Frey SM, Hoefler D, Karamanli C, Wong NCK, Backhaus SJ, Alskaf E, Neji R, Scannell CM, Plein S, Chiribiri A. High-resolution free-breathing automated quantitative myocardial perfusion by cardiovascular magnetic resonance for the detection of functionally significant coronary artery disease. Eur Heart J Cardiovasc Imaging 2024; 25:914-925. [PMID: 38525948 PMCID: PMC11210990 DOI: 10.1093/ehjci/jeae084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 03/15/2024] [Accepted: 03/17/2024] [Indexed: 03/26/2024] Open
Abstract
AIMS Current assessment of myocardial ischaemia from stress perfusion cardiovascular magnetic resonance (SP-CMR) largely relies on visual interpretation. This study investigated the use of high-resolution free-breathing SP-CMR with automated quantitative mapping in the diagnosis of coronary artery disease (CAD). Diagnostic performance was evaluated against invasive coronary angiography (ICA) with fractional flow reserve (FFR) measurement. METHODS AND RESULTS Seven hundred and three patients were recruited for SP-CMR using the research sequence at 3 Tesla. Of those receiving ICA within 6 months, 80 patients had either FFR measurement or identification of a chronic total occlusion (CTO) with inducible perfusion defects seen on SP-CMR. Myocardial blood flow (MBF) maps were automatically generated in-line on the scanner following image acquisition at hyperaemic stress and rest, allowing myocardial perfusion reserve (MPR) calculation. Seventy-five coronary vessels assessed by FFR and 28 vessels with CTO were evaluated at both segmental and coronary territory level. Coronary territory stress MBF and MPR were reduced in FFR-positive (≤0.80) regions [median stress MBF: 1.74 (0.90-2.17) mL/min/g; MPR: 1.67 (1.10-1.89)] compared with FFR-negative regions [stress MBF: 2.50 (2.15-2.95) mL/min/g; MPR 2.35 (2.06-2.54) P < 0.001 for both]. Stress MBF ≤ 1.94 mL/min/g and MPR ≤ 1.97 accurately detected FFR-positive CAD on a per-vessel basis (area under the curve: 0.85 and 0.96, respectively; P < 0.001 for both). CONCLUSION A novel scanner-integrated high-resolution free-breathing SP-CMR sequence with automated in-line perfusion mapping is presented which accurately detects functionally significant CAD.
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Affiliation(s)
- R Crawley
- School of Biomedical Engineering & Imaging Sciences, King’s College London, St Thomas’ Hospital, Westminster Bridge Road, London, SE1 7EH, UK
| | - K P Kunze
- School of Biomedical Engineering & Imaging Sciences, King’s College London, St Thomas’ Hospital, Westminster Bridge Road, London, SE1 7EH, UK
- Magnetic Resonance Research Collaborations, Siemens Healthcare Limited, Camberley, UK
| | - X Milidonis
- School of Biomedical Engineering & Imaging Sciences, King’s College London, St Thomas’ Hospital, Westminster Bridge Road, London, SE1 7EH, UK
- DeepCamera MRG, CYENS Centre of Excellence, Nicosia, Cyprus
| | - J Highton
- School of Biomedical Engineering & Imaging Sciences, King’s College London, St Thomas’ Hospital, Westminster Bridge Road, London, SE1 7EH, UK
- Aival, London, UK
| | - S McElroy
- School of Biomedical Engineering & Imaging Sciences, King’s College London, St Thomas’ Hospital, Westminster Bridge Road, London, SE1 7EH, UK
- Magnetic Resonance Research Collaborations, Siemens Healthcare Limited, Camberley, UK
| | - S M Frey
- Department of Cardiology, University Hospital Basel, Basel, Switzerland
| | - D Hoefler
- Department of Radiotherapy, University of Erlangen, Erlangen, Germany
| | - C Karamanli
- School of Biomedical Engineering & Imaging Sciences, King’s College London, St Thomas’ Hospital, Westminster Bridge Road, London, SE1 7EH, UK
| | - N C K Wong
- School of Biomedical Engineering & Imaging Sciences, King’s College London, St Thomas’ Hospital, Westminster Bridge Road, London, SE1 7EH, UK
| | - S J Backhaus
- Department of Cardiology, Campus Kerckhoff of the Justus-Liebig-University Giessen, Kerckhoff-Clinic, Bad Nauheim, Germany
| | - E Alskaf
- School of Biomedical Engineering & Imaging Sciences, King’s College London, St Thomas’ Hospital, Westminster Bridge Road, London, SE1 7EH, UK
| | - R Neji
- School of Biomedical Engineering & Imaging Sciences, King’s College London, St Thomas’ Hospital, Westminster Bridge Road, London, SE1 7EH, UK
| | - C M Scannell
- School of Biomedical Engineering & Imaging Sciences, King’s College London, St Thomas’ Hospital, Westminster Bridge Road, London, SE1 7EH, UK
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - S Plein
- School of Biomedical Engineering & Imaging Sciences, King’s College London, St Thomas’ Hospital, Westminster Bridge Road, London, SE1 7EH, UK
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - A Chiribiri
- School of Biomedical Engineering & Imaging Sciences, King’s College London, St Thomas’ Hospital, Westminster Bridge Road, London, SE1 7EH, UK
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Al-Mallah MH, Al Rifai M, Saad JM. The role of splenic switch-off in assessing vasodilator response: When less is more. J Nucl Cardiol 2024:101896. [PMID: 38852901 DOI: 10.1016/j.nuclcard.2024.101896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2024] [Accepted: 05/31/2024] [Indexed: 06/11/2024]
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van de Burgt A, van Velden FHP, Kwakkenbos K, Smit F, de Geus-Oei LF, Dekkers IA. Dynamic rubidium-82 PET/CT as a novel tool for quantifying hemodynamic differences in renal blood flow using a one-tissue compartment model. Med Phys 2024; 51:4069-4080. [PMID: 38709908 DOI: 10.1002/mp.17080] [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: 10/30/2023] [Revised: 03/01/2024] [Accepted: 04/04/2024] [Indexed: 05/08/2024] Open
Abstract
PURPOSE Assessing renal perfusion in-vivo is challenging and quantitative information regarding renal hemodynamics is hardly incorporated in medical decision-making while abnormal renal hemodynamics might play a crucial role in the onset and progression of renal disease. Combining physiological stimuli with rubidium-82 positron emission tomography/computed tomography (82Rb PET/CT) offers opportunities to test the kidney perfusion under various conditions. The aim of this study is: (1) to investigate the application of a one-tissue compartment model for measuring renal hemodynamics with dynamic 82Rb PET/CT imaging, and (2) to evaluate whether dynamic PET/CT is sensitive to detect differences in renal hemodynamics in stress conditions compared to resting state. METHODS A one-tissue compartment model for the kidney was applied to cardiac 82Rb PET/CT scans that were obtained for ischemia detection as part of clinical care. Retrospective data, collected from 17 patients undergoing dynamic myocardial 82Rb PET/CT imaging in rest, were used to evaluate various CT-based volumes of interest (VOIs) of the kidney. Subsequently, retrospective data, collected from 10 patients (five impaired kidney functions and five controls) undergoing dynamic myocardial 82Rb PET/CT imaging, were used to evaluate image-derived input functions (IDIFs), PET-based VOIs of the kidney, extraction fractions, and whether dynamic 82Rb PET/CT can measure renal hemodynamics differences using the renal blood flow (RBF) values in rest and after exposure to adenosine pharmacological stress. RESULTS The delivery rate (K1) values showed no significant (p = 0.14) difference between the mean standard deviation (SD) K1 values using one CT-based VOI and the use of two, three, and four CT-based VOIs, respectively 2.01(0.32), 1.90(0.40), 1.93(0.39), and 1.94(0.40) mL/min/mL. The ratio between RBF in rest and RBF in pharmacological stress for the controls were overall significantly lower compared to the impaired kidney function group for both PET-based delineation methods (region growing and iso-contouring), with the smallest median interquartile range (IQR) of 0.40(0.28-0.66) and 0.96(0.62-1.15), respectively (p < 0.05). The K1 of the impaired kidney function group were close to 1.0 mL/min/mL. CONCLUSIONS This study demonstrated that obtaining renal K1 and RBF values using 82Rb PET/CT was feasible using a one-tissue compartment model. Applying iso-contouring as the PET-based VOI of the kidney and using AA as an IDIF is suggested for consideration in further studies. Dynamic 82Rb PET/CT imaging showed significant differences in renal hemodynamics in rest compared to when exposed to adenosine. This indicates that dynamic 82Rb PET/CT has potential to detect differences in renal hemodynamics in stress conditions compared to the resting state, and might be useful as a novel diagnostic tool for assessing renal perfusion.
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Affiliation(s)
- Alina van de Burgt
- Department of Nuclear Medicine, Alrijne hospital, Leiderdorp, The Netherlands
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Koen Kwakkenbos
- Department of Nuclear Medicine, Alrijne hospital, Leiderdorp, The Netherlands
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Frits Smit
- Department of Nuclear Medicine, Alrijne hospital, Leiderdorp, The Netherlands
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Lioe-Fee de Geus-Oei
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
- Biomedical Photonic Imaging Group, University of Twente, Enschede, The Netherlands
- Department of Radiation Science & Technology, Delft University of Technology, Delft, The Netherlands
| | - Ilona A Dekkers
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
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Brorson J, Gormsen LC, Madsen S, Tolbod LP, Jochumsen MR. Splenic switch-off in [ 15O]H 2O-positron emission tomography myocardial perfusion imaging using parametric blood flow images. J Nucl Cardiol 2024:101868. [PMID: 38685397 DOI: 10.1016/j.nuclcard.2024.101868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Revised: 03/29/2024] [Accepted: 04/22/2024] [Indexed: 05/02/2024]
Abstract
BACKGROUND Evaluation of sufficient adenosine response constitutes a significant challenge in myocardial perfusion imaging (MPI). Splenic switch-off in MPI studies denotes a visually (qualitatively) reduced splenic radiotracer signal during adenosine stress and is considered indicative of sufficient cardiac vasodilation. In this study, we examined semi-quantitative and quantitative approaches to splenic switch-off assessment using [15O]H2O-PET with either summed activity images or calculated parametric splenic blood flow images. METHODS Cohort 1: 90 clinical patients undergoing [15O]H2O MPI in whom adenosine response was considered clinically adequate were identified to characterize the corresponding splenic switch-off. Spleen stress/rest-ratio (SSR-ratio) was calculated as spleen stress signal intensity/spleen rest signal intensity on both summed activity and parametric blood flow images. Cohort 2: Twenty-five patients with repeat MPI due to suspected insufficient adenosine response were identified to observe if splenic switch-off on the initial MPI could predict the outcome of the repeat MPI. Cohort 3: Fifty-four patients who were considered adenosine responders on MPI and who had a coronary angiogram (CAG) follow-up within 3 months after MPI served as a separate validation group. RESULTS Splenic switch-off was present in most patients with a clinically sufficient adenosine response (Cohort 1), illustrated by both visual (74.4%-86.7%), semi-quantitative (summed activity images) (85.6%), and quantitative (parametric blood flow images) (92.2%) evaluation, which corresponds to the distribution in patients with sufficient adenosine response and follow-up CAG (Cohort 3). In patients suspected of insufficient adenosine response on the initial MPI (Cohort 2), the repeat MPI only yielded different myocardial blood flow (MBF) results if the initial SSR-ratio was >0.90 on splenic parametric blood flow images. CONCLUSION quantitative splenic switch-off assessment on parametric blood flow images was superior to the semi-quantitative splenic switch-off approach. Patients with a suspected insufficient initial adenosine response and SSR-ratio >0.90 can benefit from a repeat MPI. Thus, the integration of quantitative splenic switch-off using parametric blood flow images in the evaluation of adenosine response may support future clinical decision-making.
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Affiliation(s)
- Jonas Brorson
- Department of Nuclear Medicine and PET-Centre, Aarhus University Hospital, Denmark; Department of Biomedicine, Aarhus University, Denmark.
| | - Lars Christian Gormsen
- Department of Nuclear Medicine and PET-Centre, Aarhus University Hospital, Denmark; Department of Clinical Medicine, Aarhus University, Denmark
| | - Simon Madsen
- Department of Nuclear Medicine and PET-Centre, Aarhus University Hospital, Denmark; Department of Clinical Medicine, Aarhus University, Denmark
| | - Lars Poulsen Tolbod
- Department of Nuclear Medicine and PET-Centre, Aarhus University Hospital, Denmark; Department of Clinical Medicine, Aarhus University, Denmark
| | - Mads Ryø Jochumsen
- Department of Nuclear Medicine and PET-Centre, Aarhus University Hospital, Denmark; Department of Clinical Medicine, Aarhus University, Denmark
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Engblom H, Ostenfeld E, Carlsson M, Åkesson J, Aletras AH, Xue H, Kellman P, Arheden H. Diagnostic confidence with quantitative cardiovascular magnetic resonance perfusion mapping increases with increased coverage of the left ventricle. J Cardiovasc Magn Reson 2024; 26:101007. [PMID: 38316344 PMCID: PMC11211224 DOI: 10.1016/j.jocmr.2024.101007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 01/14/2024] [Accepted: 01/30/2024] [Indexed: 02/07/2024] Open
Abstract
BACKGROUND Quantitative cardiovascular magnetic resonance (CMR) first pass perfusion maps are conventionally acquired with 3 short-axis (SAX) views (basal, mid, and apical) in every heartbeat (3SAX/1RR). Thus, a significant part of the left ventricle (LV) myocardium, including the apex, is not covered. The aims of this study were 1) to investigate if perfusion maps acquired with 3 short-axis views sampled every other RR-interval (2RR) yield comparable quantitative measures of myocardial perfusion (MP) as 1RR and 2) to assess if acquiring 3 additional perfusion views (i.e., total of 6) every other RR-interval (2RR) increases diagnostic confidence. METHODS In 287 patients with suspected ischemic heart disease stress and rest MP were performed on clinical indication on a 1.5T MR scanner. Eighty-three patients were examined by acquiring 3 short-axis perfusion maps with 1RR sampling (3SAX/1RR); for which also 2RR maps were reconstructed. Additionally, in 103 patients 3 short-axis and 3 long-axis (LAX; 2-, 3, and 4-chamber view) perfusion maps were acquired using 2RR sampling (3SAX + 3LAX/2RR) and in 101 patients 6 short-axis perfusion maps using 2RR sampling (6SAX/2RR) were acquired. The diagnostic confidence for ruling in or out stress-induced ischemia was scored according to a Likert scale (certain ischemia [2 points], probably ischemia [1 point], uncertain [0 points], probably no ischemia [1 point], certain no ischemia [2 points]). RESULTS There was a strong correlation (R = 0.99) between 3SAX/1RR and 3SAX/2RR for global MP (mL/min/g). The diagnostic confidence score increased significantly when the number of perfusion views was increased from 3 to 6 (1.24 ± 0.68 vs 1.54 ± 0.64, p < 0.001 with similar increase for 3SAX+3LAX/2RR (1.29 ± 0.68 vs 1.55 ± 0.65, p < 0.001) and for 6SAX/2RR (1.19 ± 0.69 vs 1.53 ± 0.63, p < 0.001). CONCLUSION Quantitative perfusion mapping with 2RR sampling of data yields comparable perfusion values as 1RR sampling, allowing for the acquisition of additional views within the same perfusion scan. The diagnostic confidence for stress-induced ischemia increases when adding 3 additional views, short- or long axes, to the conventional 3 short-axis views. Thus, future development and clinical implementation of quantitative CMR perfusion should aim at increasing the LV coverage from the current standard using 3 short-axis views.
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Affiliation(s)
- Henrik Engblom
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden.
| | - Ellen Ostenfeld
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
| | - Marcus Carlsson
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
| | - Julius Åkesson
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
| | - Anthony H Aletras
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden; Laboratory of Computing, Medical Informatics and Biomedical-Imaging Technologies, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Hui Xue
- National Heart-Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Peter Kellman
- National Heart-Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Håkan Arheden
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
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Zhuang B, Cui C, He J, Xu J, Wang X, Li L, Jia L, Wu W, Sun X, Li S, Zhou D, Yang W, Wang Y, Zhu L, Sirajuddin A, Zhao S, Lu M. Developing and evaluating a chronic ischemic cardiomyopathy in swine model by rest and stress CMR. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2024; 40:249-260. [PMID: 37971706 DOI: 10.1007/s10554-023-02999-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 10/28/2023] [Indexed: 11/19/2023]
Abstract
A large animal model of chronic coronary artery disease (CAD) is crucial for the understanding the underlying pathophysiological processes of chronic CAD and consequences for cardiac structure and function. The goal of this study was to develop a chronic model of CAD in a swine model and to evaluate the changes of myocardial structure, myocardial motility, and myocardial viability during coronary stenosis. A total of 30 swine (including 24 experimental animals and 6 controls) were enrolled. The chronic ischemia model was constructed by using Ameroid constrictor in experimental group. The 24 experimental animals were further divided into 4 groups (6 animals in each group) and were sacrificed at 1, 2, 3 and 4 weeks after operation for pathological examination, respectively. Cardiac magnetic resonance (CMR) was performed preoperatively and weekly postoperatively until sacrificed both in experimental and control group. CMR cine images, rest/adenosine triphosphate (ATP) stress myocardial contrast perfusion and LGE were performed and analyzed. The rest wall thickening (WT) score was calculated from rest cine images. The MPRI (myocardial perfusion reserve index) and MPR (myocardial perfusion reserve) were calculated based on rest and stress perfusion images. Pathology staining including triphenyltetrazolium chloride, HE and picrosirus red staining were performed after swine were sacrificed and collagen volume fraction (CVF) was calculated. The time to formation of ischemic, hibernating, and infarcted myocardium was recorded. In experimental group, from 1w to 4w after surgery, the rest WT score decreased gradually from 35.2 ± 2.0%, 32.0 ± 2.9% to 30.5 ± 3.0% and finally 29.06 ± 1.78%, p < 0.001. Left ventricular ejection fraction was gradually impaired after modeling (58.9 ± 12.6%, 56.3 ± 10.1%, 55.3 ± 9.0%, 53.8 ± 9.9%, respectively). And the MPR and MPRI also decreased stepwise with extent of surgery time (MPRI dropped from 2.1 ± 0.4, 2.0 ± 0.2 to 1.8 ± 0.3 and finally 1.7 ± 0.1, p = 0.004; MPR dropped from 2.3 ± 0.4, 2.1 ± 0.2 to 1.9 ± 0.4 and finally 1.8 ± 0.1, p < 0.001). Stronger associations between MPR, MPRI and CVF were paralleled lower wall thickening scores in fibrosis-affected areas. The ischemic myocardium was first appeared in the first week after surgery (involving ten segments), hibernated myocardium was first appeared in the second week after surgery (involving seventeen segments). LGE was first appeared in eight swine in the third weeks after surgery (16 segments). At 4w after surgery, average 9.6 g scar tissue was found among 6 swine. At the same time, histological analysis established the presence of fibrosis and ongoing apoptosis in the infarcted area. In conclusion, our study provided valuable insights into the pathophysiological processes of chronic CAD and its consequences for cardiac structure and function in a large animal model through combining myocardial motion and stress perfusion.
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Affiliation(s)
- Baiyan Zhuang
- Department of Radiology, Beijing Anzhen Hospital, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Capital Medical University, Beijing, 100029, People's Republic of China
- Department of Magnetic Resonance Imaging, Cardiovascular imaging and intervention Center, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Chen Cui
- Department of Magnetic Resonance Imaging, Cardiovascular imaging and intervention Center, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Jian He
- Department of Magnetic Resonance Imaging, Cardiovascular imaging and intervention Center, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Jing Xu
- Department of Magnetic Resonance Imaging, Cardiovascular imaging and intervention Center, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Xin Wang
- Department of Animal Experimental Center, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Li Li
- Department of Pathology, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Liujun Jia
- Department of Animal Experimental Center, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Weichun Wu
- Department of Echocardiography, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiaoxin Sun
- Key Laboratory of Cardiovascular Imaging (cultivation), Chinese Academy of Medical Sciences, Beijing, China
| | - Shuang Li
- Department of Magnetic Resonance Imaging, Cardiovascular imaging and intervention Center, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Di Zhou
- Department of Magnetic Resonance Imaging, Cardiovascular imaging and intervention Center, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Wenjing Yang
- Department of Magnetic Resonance Imaging, Cardiovascular imaging and intervention Center, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Yining Wang
- Department of Magnetic Resonance Imaging, Cardiovascular imaging and intervention Center, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Leyi Zhu
- Department of Magnetic Resonance Imaging, Cardiovascular imaging and intervention Center, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Arlene Sirajuddin
- National Heart, Lung and Blood Institute (NHLBI), National Institutes of Health (NIH), Bethesda, Maryland, USA
| | - Shihua Zhao
- Department of Magnetic Resonance Imaging, Cardiovascular imaging and intervention Center, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Minjie Lu
- Department of Magnetic Resonance Imaging, Cardiovascular imaging and intervention Center, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China.
- Key Laboratory of Cardiovascular Imaging (cultivation), Chinese Academy of Medical Sciences, Beijing, China.
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Inkinen SI, Hippeläinen E, Uusitalo V. Adenosine-induced splenic switch-off on [ 15O]H 2O PET perfusion for the assessment of vascular vasodilatation. EJNMMI Res 2023; 13:96. [PMID: 37943363 PMCID: PMC10635971 DOI: 10.1186/s13550-023-01045-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 10/18/2023] [Indexed: 11/10/2023] Open
Abstract
BACKGROUND Splenic switch-off (SSO) is a marker of adequate adenosine-induced vasodilatation on cardiac magnetic resonance perfusion imaging. We evaluate the feasibility of quantitative assessment of SSO in myocardial positron emission tomography (PET) perfusion imaging using [15O]H2O. METHODS Thirty patients underwent [15O]H2O PET perfusion with adenosine stress. Time-activity curves, as averaged standardized uptake values (SUVavg), were extracted from dynamic PET for spleen and liver. Maximum SUVavg, stress and rest spleen-to-liver ratio (SLR), and the splenic activity concentration ratio (SAR) were computed. Optimal cut-off values for SSO assessment were estimated from receiver operating characteristics (ROC) curve for maximum SUVavg and SLR. Also, differences between coronary artery disease, myocardial ischemia, beta-blockers, and diabetes were assessed. Data are presented as median [interquartile range]. RESULTS In concordance with the SSO phenomenon, both the spleen maximum SUVavg and SLR were lower in adenosine stress when compared to rest perfusion (8.1 [6.5, 9.2] versus 16.4 [13.4, 19.0], p < 0.001) and (0.81 [0.63, 1.08] versus 1.86 [1.73, 2.06], p < 0.001), respectively. During adenosine stress, the SSO effect was most prominent 40-160 s after radiotracer injection. Cut-off values of 12.6 and 1.57 for maximum SUVavg and SLR, respectively, were found based on ROC analysis. No differences in SAR, SLRRest, or SLRStress were observed in patients with coronary artery disease, myocardial ischemia, or diabetes. CONCLUSIONS SSO can be quantified from [15O]H2O PET perfusion and used as a marker for adequate adenosine-induced vasodilatation response. In contrary to other PET perfusion tracers, adenosine-induced SSO is time dependent with [15O]H2O.
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Affiliation(s)
- Satu Irene Inkinen
- HUS Diagnostic Center, Clinical Physiology and Nuclear Medicine, Helsinki University and Helsinki University Hospital, Helsinki, Finland.
| | - Eero Hippeläinen
- HUS Diagnostic Center, Clinical Physiology and Nuclear Medicine, Helsinki University and Helsinki University Hospital, Helsinki, Finland
- Department of Physics, University of Helsinki, Helsinki, Finland
| | - Valtteri Uusitalo
- HUS Diagnostic Center, Clinical Physiology and Nuclear Medicine, Helsinki University and Helsinki University Hospital, Helsinki, Finland
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Ganigara M, Sharma B, Doctor P, Nagiub M, Dzelebdzic S, Sebastian R, Fares M, Dillenbeck J, Greil G, Hussain T. Tolerability and efficacy of a reduced dose adenosine stress cardiac magnetic resonance protocol under general anesthesia in infants and children. Pediatr Radiol 2023; 53:2188-2196. [PMID: 37563320 DOI: 10.1007/s00247-023-05738-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 07/28/2023] [Accepted: 08/01/2023] [Indexed: 08/12/2023]
Abstract
BACKGROUND Intravenous adenosine induces pharmacological stress by causing vasodilatation and thus carries the risk of severe hypotension when combined with vasodilatory effects of anesthetic agents. OBJECTIVE This study describes our experience with a reduced dose adenosine cardiac magnetic resonance imaging (MRI) protocol in young children under general anesthesia (GA). MATERIALS AND METHODS This is a retrospective report of all patients from birth to 18 years who underwent adenosine stress cardiac MRI under GA between August 2018 and November 2022. Based on our anecdotal experience of severe adverse effects in patients receiving adenosine infusion under GA and in discussion with the pediatric anesthesia team, we developed a modified protocol starting at a dose of 110 mcg/kg/min with incremental escalation to a full dose of 140 mcg/kg/min to achieve desired hemodynamic effect. RESULTS Twenty-two children (mean age 6.5 years, mean weight 28 kg) satisfied the inclusion criteria. The diagnoses included Kawasaki disease (7), anomalous aortic origin of left coronary artery (3), anomalous aortic origin of right coronary artery (2), coronary fistula (3), repaired d-transposition of great arteries (2), repaired anomalous left coronary artery from pulmonary artery (2), repaired truncus arteriosus with left coronary artery occlusion (1), extracardiac-Fontan with left coronary artery myocardial bridge (1), and post heart transplantation (1). Nine patients needed dose escalation beyond 110 mcg/kg/min. Two patients had transient hypotension during testing (systemic blood pressure drop > 25 mmHg). No patient developed significant heart block or bronchospasm. Six patients (repeat study in one) demonstrated inducible perfusion defects (27%) on stress perfusion sequences-5 of whom had confirmed significant coronary abnormalities on angiography or direct surgical inspection. CONCLUSION A reduced/incremental dose adenosine stress cardiac MRI protocol under GA in children is safe and feasible. This avoids severe hypotension which is both unsafe and may result in inaccurate data.
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Affiliation(s)
- Madhusudan Ganigara
- Division of Pediatric Cardiology, Department of Pediatrics, The University of Chicago & Biological Sciences, 5841 S. Maryland Avenue, Chicago, IL, 60637, USA.
| | - Bharti Sharma
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Pezad Doctor
- Division of Pediatric Cardiology, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Mohamed Nagiub
- Division of Pediatric Cardiology, University of Virginia Technology, Roanoke, VA, USA
| | - Sanja Dzelebdzic
- Division of Pediatric Cardiology, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Roby Sebastian
- Division of Pediatric Anesthesia, Department of Anesthesia, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Munes Fares
- Division of Pediatric Cardiology, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Jeanne Dillenbeck
- Division of Pediatric Radiology, Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Gerald Greil
- Division of Pediatric Cardiology, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Tarique Hussain
- Division of Pediatric Cardiology, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA
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Wilson HC, Agarwal PP. Reduced adenosine dosing for stress cardiovascular MRI in children: adequate physiologic stress for patient, fewer adverse events, and less stress for the clinician? Pediatr Radiol 2023; 53:2197-2198. [PMID: 37606712 DOI: 10.1007/s00247-023-05748-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 08/10/2023] [Accepted: 08/11/2023] [Indexed: 08/23/2023]
Affiliation(s)
- Hunter C Wilson
- Department of Pediatrics, Division of Cardiology, Emory University School of Medicine, Children's Healthcare of Atlanta, 1405 Clifton Rd, Atlanta, GA, 30322, USA.
| | - Prachi P Agarwal
- Department of Radiology, Michigan Medicine, University of Michigan, 1500 E Medical Center Drive, Ann Arbor, MI, 48109, USA
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10
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Bennett J, van Dinther M, Voorter P, Backes W, Barnes J, Barkhof F, Captur G, Hughes AD, Sudre C, Treibel TA. Assessment of Microvascular Disease in Heart and Brain by MRI: Application in Heart Failure with Preserved Ejection Fraction and Cerebral Small Vessel Disease. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1596. [PMID: 37763715 PMCID: PMC10534635 DOI: 10.3390/medicina59091596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 08/18/2023] [Accepted: 08/29/2023] [Indexed: 09/29/2023]
Abstract
The objective of this review is to investigate the commonalities of microvascular (small vessel) disease in heart failure with preserved ejection fraction (HFpEF) and cerebral small vessel disease (CSVD). Furthermore, the review aims to evaluate the current magnetic resonance imaging (MRI) diagnostic techniques for both conditions. By comparing the two conditions, this review seeks to identify potential opportunities to improve the understanding of both HFpEF and CSVD.
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Affiliation(s)
- Jonathan Bennett
- Institute of Cardiovascular Science, University College London, London WC1E 6BT, UK
- Department of Cardiology, Barts Heart Centre, London EC1A 7BE, UK
| | - Maud van Dinther
- Department of Neurology, Maastricht University Medical Center, 6229 HX Maastricht, The Netherlands
- School for Cardiovascular Diseases, Faculty of Health, Medicine and Life Sciences, Maastricht University, 6211 LX Maastricht, The Netherlands
| | - Paulien Voorter
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, 6229 HX Maastricht, The Netherlands
- School for Mental Health & Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht University, 6200 MD Maastricht, The Netherlands
| | - Walter Backes
- School for Cardiovascular Diseases, Faculty of Health, Medicine and Life Sciences, Maastricht University, 6211 LX Maastricht, The Netherlands
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, 6229 HX Maastricht, The Netherlands
- School for Mental Health & Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht University, 6200 MD Maastricht, The Netherlands
| | - Josephine Barnes
- Dementia Research Centre, UCL Queens Square Institute of Neurology, University College London, London WC1E 6BT, UK
| | - Frederick Barkhof
- Department of Radiology & Nuclear Medicine, Amsterdam UMC, Vrije University, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands
- Queen Square Institute of Neurology, University College London, London WC1E 6BT, UK
- Centre for Medical Image Computing, University College London, London WC1E 6BT, UK
| | - Gabriella Captur
- Institute of Cardiovascular Science, University College London, London WC1E 6BT, UK
- Medical Research Council Unit for Lifelong Health and Ageing, Department of Population Science and Experimental Medicine, University College London, London WC1E 6BT, UK
- Centre for Inherited Heart Muscle Conditions, Cardiology Department, The Royal Free Hospital, London NW3 2QG, UK
| | - Alun D. Hughes
- Institute of Cardiovascular Science, University College London, London WC1E 6BT, UK
- Medical Research Council Unit for Lifelong Health and Ageing, Department of Population Science and Experimental Medicine, University College London, London WC1E 6BT, UK
| | - Carole Sudre
- Dementia Research Centre, UCL Queens Square Institute of Neurology, University College London, London WC1E 6BT, UK
- Centre for Medical Image Computing, University College London, London WC1E 6BT, UK
- Medical Research Council Unit for Lifelong Health and Ageing, Department of Population Science and Experimental Medicine, University College London, London WC1E 6BT, UK
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London WC2R 2LS, UK
| | - Thomas A. Treibel
- Institute of Cardiovascular Science, University College London, London WC1E 6BT, UK
- Department of Cardiology, Barts Heart Centre, London EC1A 7BE, UK
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11
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Saad JM, Ahmed AI, Han Y, El Nihum LI, Alahdab F, Nabi F, Al-Mallah MH. Splenic switch-off in regadenoson 82Rb-PET myocardial perfusion imaging: assessment of clinical utility. J Nucl Cardiol 2023; 30:1484-1496. [PMID: 36607537 DOI: 10.1007/s12350-022-03158-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 11/05/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND Splenic switch-off (SSO) is a phenomenon describing a decrease in splenic radiotracer uptake after vasodilatory stress. We aimed to assess the diagnostic utility of regadenoson-induced SSO. METHODS We included consecutive patients who had clinically indicated Regadenoson Rb-82 PET-MPI for suspected CAD. This derivation cohort (no perfusion defects and myocardial flow reserves (MFR) ≥ 2) was used to calculate the splenic response ratio (SRR). The validation cohort was defined as patients who underwent both PET-MPI studies and invasive coronary angiography (ICA). RESULTS The derivation cohort (n = 100, 57.4 ± 11.6 years, 77% female) showed a decrease in splenic uptake from rest to stress (79.9 ± 16.8 kBq⋅mL vs 69.1 ± 16.2 kBq⋅mL, P < .001). From the validation cohort (n = 315, 66.3 ± 10.4 years, 67% male), 28% (via SRR = 0.88) and 15% (visually) were classified as splenic non-responders. MFR was lower in non-responders (SRR; 1.55 ± 0.65 vs 1.76 ± 0.78, P = .02 and visually; 1.18 ± 0.33 vs 1.79 ± 0.77, P < .001). Based on ICA, non-responders were more likely to note obstructive epicardial disease with normal PET scans especially in patients with MFR < 1.5 (SRR; 61% vs 34% P = .05 and visually; 68% vs 33%, P = .01). CONCLUSION Lack of splenic response based on visual or quantitative assessment of SSO may be used to identify an inadequate vasodilatory response.
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Affiliation(s)
- Jean Michel Saad
- Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA
| | | | - Yushui Han
- Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA
| | | | - Fares Alahdab
- Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA
| | - Faisal Nabi
- Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA
| | - Mouaz H Al-Mallah
- Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA.
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12
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Ricci F, Khanji MY, Bisaccia G, Cipriani A, Di Cesare A, Ceriello L, Mantini C, Zimarino M, Fedorowski A, Gallina S, Petersen SE, Bucciarelli-Ducci C. Diagnostic and Prognostic Value of Stress Cardiovascular Magnetic Resonance Imaging in Patients With Known or Suspected Coronary Artery Disease: A Systematic Review and Meta-analysis. JAMA Cardiol 2023; 8:662-673. [PMID: 37285143 PMCID: PMC10248816 DOI: 10.1001/jamacardio.2023.1290] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 04/12/2023] [Indexed: 06/08/2023]
Abstract
Importance The clinical utility of stress cardiovascular magnetic resonance imaging (CMR) in stable chest pain is still debated, and the low-risk period for adverse cardiovascular (CV) events after a negative test result is unknown. Objective To provide contemporary quantitative data synthesis of the diagnostic accuracy and prognostic value of stress CMR in stable chest pain. Data Sources PubMed and Embase databases, the Cochrane Database of Systematic Reviews, PROSPERO, and the ClinicalTrials.gov registry were searched for potentially relevant articles from January 1, 2000, through December 31, 2021. Study Selection Selected studies evaluated CMR and reported estimates of diagnostic accuracy and/or raw data of adverse CV events for participants with either positive or negative stress CMR results. Prespecified combinations of keywords related to the diagnostic accuracy and prognostic value of stress CMR were used. A total of 3144 records were evaluated for title and abstract; of those, 235 articles were included in the full-text assessment of eligibility. After exclusions, 64 studies (74 470 total patients) published from October 29, 2002, through October 19, 2021, were included. Data Extraction and Synthesis This systematic review and meta-analysis adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Main Outcomes and Measures Diagnostic odds ratios (DORs), sensitivity, specificity, area under the receiver operating characteristic curve (AUROC), odds ratio (OR), and annualized event rate (AER) for all-cause death, CV death, and major adverse cardiovascular events (MACEs) defined as the composite of myocardial infarction and CV death. Results A total of 33 diagnostic studies pooling 7814 individuals and 31 prognostic studies pooling 67 080 individuals (mean [SD] follow-up, 3.5 [2.1] years; range, 0.9-8.8 years; 381 357 person-years) were identified. Stress CMR yielded a DOR of 26.4 (95% CI, 10.6-65.9), a sensitivity of 81% (95% CI, 68%-89%), a specificity of 86% (95% CI, 75%-93%), and an AUROC of 0.84 (95% CI, 0.77-0.89) for the detection of functionally obstructive coronary artery disease. In the subgroup analysis, stress CMR yielded higher diagnostic accuracy in the setting of suspected coronary artery disease (DOR, 53.4; 95% CI, 27.7-103.0) or when using 3-T imaging (DOR, 33.2; 95% CI, 19.9-55.4). The presence of stress-inducible ischemia was associated with higher all-cause mortality (OR, 1.97; 95% CI, 1.69-2.31), CV mortality (OR, 6.40; 95% CI, 4.48-9.14), and MACEs (OR, 5.33; 95% CI, 4.04-7.04). The presence of late gadolinium enhancement (LGE) was associated with higher all-cause mortality (OR, 2.22; 95% CI, 1.99-2.47), CV mortality (OR, 6.03; 95% CI, 2.76-13.13), and increased risk of MACEs (OR, 5.42; 95% CI, 3.42-8.60). After a negative test result, pooled AERs for CV death were less than 1.0%. Conclusion and Relevance In this study, stress CMR yielded high diagnostic accuracy and delivered robust prognostication, particularly when 3-T scanners were used. While inducible myocardial ischemia and LGE were associated with higher mortality and risk of MACEs, normal stress CMR results were associated with a lower risk of MACEs for at least 3.5 years.
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Affiliation(s)
- Fabrizio Ricci
- Department of Neuroscience, Imaging and Clinical Sciences, Gabriele d’Annunzio University of Chieti-Pescara, Chieti, Italy
- Department of Clinical Sciences, Lund University, Malmö, Sweden
- William Harvey Research Institute, Barts Biomedical Research Centre, National Institute for Health and Care Research, Queen Mary University London, Charterhouse Square, London, United Kingdom
| | - Mohammed Y. Khanji
- William Harvey Research Institute, Barts Biomedical Research Centre, National Institute for Health and Care Research, Queen Mary University London, Charterhouse Square, London, United Kingdom
- Newham University Hospital, Barts Health NHS Trust, London, United Kingdom
- Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS Trust, West Smithfield, London, United Kingdom
| | - Giandomenico Bisaccia
- Department of Neuroscience, Imaging and Clinical Sciences, Gabriele d’Annunzio University of Chieti-Pescara, Chieti, Italy
| | - Alberto Cipriani
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Annamaria Di Cesare
- Cardiology Unit, Rimini Hospital, Local Health Authority of Romagna, Rimini, Italy
| | - Laura Ceriello
- Department of Neuroscience, Imaging and Clinical Sciences, Gabriele d’Annunzio University of Chieti-Pescara, Chieti, Italy
| | - Cesare Mantini
- Department of Neuroscience, Imaging and Clinical Sciences, Gabriele d’Annunzio University of Chieti-Pescara, Chieti, Italy
| | - Marco Zimarino
- Department of Neuroscience, Imaging and Clinical Sciences, Gabriele d’Annunzio University of Chieti-Pescara, Chieti, Italy
| | - Artur Fedorowski
- Department of Clinical Sciences, Lund University, Malmö, Sweden
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
- Department of Medicine, Karolinska Institute, Stockholm, Sweden
| | - Sabina Gallina
- Department of Neuroscience, Imaging and Clinical Sciences, Gabriele d’Annunzio University of Chieti-Pescara, Chieti, Italy
| | - Steffen E. Petersen
- Newham University Hospital, Barts Health NHS Trust, London, United Kingdom
- Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS Trust, West Smithfield, London, United Kingdom
- The Alan Turing Institute, London, United Kingdom
- Health Data Research UK, London, United Kingdom
| | - Chiara Bucciarelli-Ducci
- Royal Brompton and Harefield Hospitals, Guys and St Thomas NHS Trust London, London, United Kingdom
- School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, Kings College London, London, United Kingdom
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13
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Zhuang B, Cui C, He J, Xu J, Yin G, Duan X, Yue G, Wang H, Wang X, Sirajuddin A, Zhao S, Lu M. Detection of Myocardial Ischemia Using Cardiovascular MRI Stress T1 Mapping: A Miniature-Swine Validation Study. Radiol Cardiothorac Imaging 2023; 5:e220092. [PMID: 37404782 PMCID: PMC10316297 DOI: 10.1148/ryct.220092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 03/30/2023] [Accepted: 04/18/2023] [Indexed: 07/06/2023]
Abstract
Purpose To assess the efficacy of cardiac MRI stress T1 mapping in detecting ischemic and infarcted myocardium in a miniature-swine model, using pathologic findings as the reference standard. Materials and Methods Ten adult male Chinese miniature swine, with coronary artery stenosis induced by an ameroid constrictor, and two healthy control swine were studied. Cardiac 3-T MRI rest and adenosine triphosphate stress T1 mapping and perfusion images, along with resting and late gadolinium enhancement images, were acquired at baseline and weekly up to 4 weeks after surgery or until humanely killed. A receiver operating characteristic analysis was used to analyze the performance of T1 mapping in the detection of myocardial ischemia. Results In the experimental group, both the infarcted myocardium (ΔT1 = 10 msec ± 2 [SD]; ΔT1 percentage = 0.7% ± 0.1) and ischemic myocardium (ΔT1 = 10 msec ± 2; ΔT1 percentage = 0.9% ± 0.2) exhibited reduced T1 reactivity compared with the remote myocardium (ΔT1 = 53 msec ± 7; ΔT1 percentage = 4.7% ± 0.6) and normal myocardium (ΔT1 = 56 msec ± 11; ΔT1 percentage = 4.9% ± 1.1). Receiver operating characteristic analysis demonstrated high diagnostic performance of ΔT1 in detecting ischemic myocardium, with an area under the curve (AUC) of 0.84 (P < .001). Rest T1 displayed high diagnostic performance in detecting infarcted myocardium (AUC = 0.95; P < .001). When rest T1 and ΔT1 were combined, the diagnostic performance for both ischemic and infarcted myocardium were improved (AUCs, 0.89 and 0.97, respectively; all P < .001). The collagen volume fraction correlated with ΔT1, ΔT1 percentage, and Δ extracellular volume percentage (r = -0.70, -0.70, and -0.50, respectively; P = .001, .001, and .03, respectively). Conclusion Using histopathologic validation in a swine model, noninvasive cardiac MRI stress T1 mapping demonstrated high performance in detecting ischemic and infarcted myocardium without the need for contrast agents.Keywords: Coronary Artery Disease, MRI, Myocardial Ischemia, Rest T1 Mapping, Stress T1 Mapping, Swine Model Supplemental material is available for this article. © RSNA, 2023See also commentary by Burrage and Ferreira in this issue.
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14
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Splenic switch-off to assess adequacy of adenosine stress for myocardial perfusion imaging studies. Clin Transl Imaging 2023. [DOI: 10.1007/s40336-023-00549-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023]
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15
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Adenosine triphosphate (ATP): a safe and effective vasodilator for stress perfusion cardiac magnetic resonance imaging. Clin Radiol 2023; 78:e71-e76. [PMID: 36351853 DOI: 10.1016/j.crad.2022.08.133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 06/16/2022] [Accepted: 08/17/2022] [Indexed: 11/08/2022]
Abstract
AIM To evaluate the efficiency and safety of adenosine triphosphate (ATP) as a stress agent in a cohort of patients undergoing stress perfusion cardiac magnetic resonance imaging (CMRI). MATERIALS AND METHODS This retrospective study was conducted between December 2019 and October 2021. The study recruited patients who underwent stress perfusion CMRI using ATP as a vasodilator. Adverse events, such as chest pain, flushing, dyspnoea, headache, and splenic switch-off (SSO) phenomenon, were evaluated in the patients who underwent stress perfusion CMRI. RESULTS The study included 107 patients (age range: 53 ± 11 years; male:female, 62%:38%). The haemodynamic response (heart rate increased by ≥ 10 beats/min) was quick and observed within 2 minutes of ATP infusion. Scanning was stopped in three patients because of atrioventricular block. CMRI images of seven out of 104 patients were excluded from the final analysis because of inferior quality. During ATP infusion, 37/107 patients (35%) experienced mild adverse events, such as chest pain, flushing, dyspnoea, headache, and atrioventricular block. Myocardial infarction and bronchospasms were not observed during ATP infusion. SSO, a marker of adequate stress, was observed in 91% (94/103) of the patients who underwent stress perfusion CMRI. CONCLUSIONS As a coronary vasodilator, ATP was safe for stress perfusion CMRI. In addition, the adverse events during ATP infusion were mild, which were relieved within 2 minutes of ATP injection cessation. SSO could serve as an indicator of stress success in ATP stress perfusion CMRI.
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16
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Zhou W, Sin J, Yan AT, Wang H, Lu J, Li Y, Kim P, Patel AR, Ng MY. Qualitative and Quantitative Stress Perfusion Cardiac Magnetic Resonance in Clinical Practice: A Comprehensive Review. Diagnostics (Basel) 2023; 13:diagnostics13030524. [PMID: 36766629 PMCID: PMC9914769 DOI: 10.3390/diagnostics13030524] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 01/11/2023] [Accepted: 01/28/2023] [Indexed: 02/05/2023] Open
Abstract
Stress cardiovascular magnetic resonance (CMR) imaging is a well-validated non-invasive stress test to diagnose significant coronary artery disease (CAD), with higher diagnostic accuracy than other common functional imaging modalities. One-stop assessment of myocardial ischemia, cardiac function, and myocardial viability qualitatively and quantitatively has been proven to be a cost-effective method in clinical practice for CAD evaluation. Beyond diagnosis, stress CMR also provides prognostic information and guides coronary revascularisation. In addition to CAD, there is a large body of literature demonstrating CMR's diagnostic performance and prognostic value in other common cardiovascular diseases (CVDs), especially coronary microvascular dysfunction (CMD). This review focuses on the clinical applications of stress CMR, including stress CMR scanning methods, practical interpretation of stress CMR images, and clinical utility of stress CMR in a setting of CVDs with possible myocardial ischemia.
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Affiliation(s)
- Wenli Zhou
- Department of Radiology, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, No. 600, Yishan Road, Shanghai 200233, China
| | - Jason Sin
- Department of Diagnostic Radiology, The University of Hong Kong, Hong Kong SAR, China
| | - Andrew T. Yan
- St. Michael’s Hospital, University of Toronto, Toronto, ON M5B 1W8, Canada
| | | | - Jing Lu
- Department of Radiology, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, No. 600, Yishan Road, Shanghai 200233, China
| | - Yuehua Li
- Department of Radiology, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, No. 600, Yishan Road, Shanghai 200233, China
| | - Paul Kim
- Department of Medicine, University of California San Diego, San Diego, CA 92093, USA
| | - Amit R. Patel
- Department of Cardiovascular Medicine, University of Virginia, Charlottesville, VA 22903, USA
| | - Ming-Yen Ng
- Department of Medical Imaging, HKU-Shenzhen Hospital, Shenzhen 518009, China
- Department of Diagnostic Radiology, School of Clinical Medicine, The University of Hong Kong, Hong Kong SAR, China
- Correspondence:
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17
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Pezel T, Lacotte J, Horvilleur J, Toupin S, Hovasse T, Unterseeh T, Sanguineti F, Said MA, Salerno F, Fiorina L, Manenti V, Zouaghi A, Faradji A, Nicol M, Ah-Sing T, Dillinger JG, Henry P, Garot P, Bousson V, Garot J. Safety, feasibility, and prognostic value of stress perfusion CMR in patients with MR-conditional pacemaker. Eur Heart J Cardiovasc Imaging 2023; 24:202-211. [PMID: 36214336 DOI: 10.1093/ehjci/jeac202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 09/02/2022] [Accepted: 09/12/2022] [Indexed: 01/25/2023] Open
Abstract
AIMS To assess the safety, feasibility, and prognostic value of stress cardiovascular magnetic resonance (CMR) in patients with pacemaker (PM). METHODS AND RESULTS Between 2008 and 2021, we conducted a bi-centre longitudinal study with all consecutive patients with MR-conditional PM referred for vasodilator stress CMR at 1.5 T in the Institut Cardiovasculaire Paris Sud and Lariboisiere University Hospital. They were followed for the occurrence of major adverse cardiovascular events (MACE) defined as cardiac death or non-fatal myocardial infarction. Cox regression analyses were performed to determine the prognostic value of CMR parameters. The quality of CMR was rated by two observers blinded to clinical details. Of 304 patients who completed the CMR protocol, 273 patients (70% male, mean age 71 ± 9 years) completed the follow-up (median [interquartile range], 7.1 [5.4-7.5] years). Among those, 32 experienced a MACE (11.7%). Stress CMR was well tolerated with no significant change in lead thresholds or pacing parameters. Overall, the image quality was rated good or excellent in 84.9% of segments. Ischaemia and late gadolinium enhancement (LGE) were significantly associated with the occurrence of MACE (hazard ratio, HR: 11.71 [95% CI: 4.60-28.2]; and HR: 5.62 [95% CI: 2.02-16.21], both P < 0.001). After adjustment for traditional risk factors, ischaemia and LGE were independent predictors of MACE (HR: 5.08 [95% CI: 2.58-14.0]; and HR: 2.28 [95% CI: 2.05-3.76]; both P < 0.001). CONCLUSION Stress CMR is safe, feasible and has a good discriminative prognostic value in consecutive patients with PM.
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Affiliation(s)
- Théo Pezel
- Université de Paris Cité, Department of Cardiology, Hôpital Lariboisière - APHP, Inserm UMRS 942, 75010 Paris, France.,Institut Cardiovasculaire Paris Sud, Department of Cardiovascular Magnetic Resonance, Hôpital Privé Jacques CARTIER, Ramsay Santé, 91300 Massy, France.,Université de Paris Cité, Department of Medical Imaging, Hôpital Lariboisière - APHP, 75010 Paris, France
| | - Jérôme Lacotte
- Institut Cardiovasculaire Paris Sud, Department of Invasive Cardiology and Electrophysiology, Hôpital Privé Jacques CARTIER, Ramsay Santé, 91300 Massy, France
| | - Jérôme Horvilleur
- Institut Cardiovasculaire Paris Sud, Department of Invasive Cardiology and Electrophysiology, Hôpital Privé Jacques CARTIER, Ramsay Santé, 91300 Massy, France
| | - Solenn Toupin
- Siemens Healthcare France, 93200 Saint-Denis, France
| | - Thomas Hovasse
- Institut Cardiovasculaire Paris Sud, Department of Cardiovascular Magnetic Resonance, Hôpital Privé Jacques CARTIER, Ramsay Santé, 91300 Massy, France
| | - Thierry Unterseeh
- Institut Cardiovasculaire Paris Sud, Department of Cardiovascular Magnetic Resonance, Hôpital Privé Jacques CARTIER, Ramsay Santé, 91300 Massy, France
| | - Francesca Sanguineti
- Institut Cardiovasculaire Paris Sud, Department of Cardiovascular Magnetic Resonance, Hôpital Privé Jacques CARTIER, Ramsay Santé, 91300 Massy, France
| | - Mina Ait Said
- Institut Cardiovasculaire Paris Sud, Department of Invasive Cardiology and Electrophysiology, Hôpital Privé Jacques CARTIER, Ramsay Santé, 91300 Massy, France
| | - Fiorella Salerno
- Institut Cardiovasculaire Paris Sud, Department of Invasive Cardiology and Electrophysiology, Hôpital Privé Jacques CARTIER, Ramsay Santé, 91300 Massy, France
| | - Laurent Fiorina
- Institut Cardiovasculaire Paris Sud, Department of Invasive Cardiology and Electrophysiology, Hôpital Privé Jacques CARTIER, Ramsay Santé, 91300 Massy, France
| | - Vladimir Manenti
- Institut Cardiovasculaire Paris Sud, Department of Invasive Cardiology and Electrophysiology, Hôpital Privé Jacques CARTIER, Ramsay Santé, 91300 Massy, France
| | - Amir Zouaghi
- Université de Paris Cité, Department of Cardiology, Hôpital Lariboisière - APHP, Inserm UMRS 942, 75010 Paris, France.,Université de Paris, Service de Cardiologie, Department of Cardiology and Electrophysiology, Hôpital Lariboisière - APHP, Inserm UMRS 942, 75010 Paris, France
| | - Alyssa Faradji
- Université de Paris Cité, Department of Medical Imaging, Hôpital Lariboisière - APHP, 75010 Paris, France
| | - Martin Nicol
- Université de Paris Cité, Department of Cardiology, Hôpital Lariboisière - APHP, Inserm UMRS 942, 75010 Paris, France.,Université de Paris Cité, Department of Medical Imaging, Hôpital Lariboisière - APHP, 75010 Paris, France
| | - Tania Ah-Sing
- Université de Paris Cité, Department of Medical Imaging, Hôpital Lariboisière - APHP, 75010 Paris, France
| | - Jean-Guillaume Dillinger
- Université de Paris Cité, Department of Cardiology, Hôpital Lariboisière - APHP, Inserm UMRS 942, 75010 Paris, France
| | - Patrick Henry
- Université de Paris Cité, Department of Cardiology, Hôpital Lariboisière - APHP, Inserm UMRS 942, 75010 Paris, France
| | - Philippe Garot
- Institut Cardiovasculaire Paris Sud, Department of Cardiovascular Magnetic Resonance, Hôpital Privé Jacques CARTIER, Ramsay Santé, 91300 Massy, France
| | - Valérie Bousson
- Université de Paris Cité, Department of Medical Imaging, Hôpital Lariboisière - APHP, 75010 Paris, France
| | - Jérôme Garot
- Institut Cardiovasculaire Paris Sud, Department of Cardiovascular Magnetic Resonance, Hôpital Privé Jacques CARTIER, Ramsay Santé, 91300 Massy, France
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Bazmpani MA, Nikolaidou C, Papanastasiou CA, Ziakas A, Karamitsos TD. Cardiovascular Magnetic Resonance Parametric Mapping Techniques for the Assessment of Chronic Coronary Syndromes. J Cardiovasc Dev Dis 2022; 9:jcdd9120443. [PMID: 36547440 PMCID: PMC9782163 DOI: 10.3390/jcdd9120443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 11/29/2022] [Accepted: 12/06/2022] [Indexed: 12/13/2022] Open
Abstract
The term chronic coronary syndromes encompasses a variety of clinical presentations of coronary artery disease (CAD), ranging from stable angina due to epicardial coronary artery disease to microvascular coronary dysfunction. Cardiac magnetic resonance (CMR) imaging has an established role in the diagnosis, prognostication and treatment planning of patients with CAD. Recent advances in parametric mapping CMR techniques have added value in the assessment of patients with chronic coronary syndromes, even without the need for gadolinium contrast administration. Furthermore, quantitative perfusion CMR techniques have enabled the non-invasive assessment of myocardial blood flow and myocardial perfusion reserve and can reliably identify multivessel coronary artery disease and microvascular dysfunction. This review summarizes the clinical applications and the prognostic value of the novel CMR parametric mapping techniques in the setting of chronic coronary syndromes and discusses their strengths, pitfalls and future directions.
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Affiliation(s)
- Maria Anna Bazmpani
- Department of First Cardiology, Aristotle University of Thessaloniki School of Medicine, AHEPA University Hospital, 54636 Thessaloniki, Greece
| | | | - Christos A. Papanastasiou
- Department of First Cardiology, Aristotle University of Thessaloniki School of Medicine, AHEPA University Hospital, 54636 Thessaloniki, Greece
| | - Antonios Ziakas
- Department of First Cardiology, Aristotle University of Thessaloniki School of Medicine, AHEPA University Hospital, 54636 Thessaloniki, Greece
| | - Theodoros D. Karamitsos
- Department of First Cardiology, Aristotle University of Thessaloniki School of Medicine, AHEPA University Hospital, 54636 Thessaloniki, Greece
- Correspondence: ; Tel.: +30-2310994832; Fax: +30-2310994673
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Lassen ML, Wissenberg M, Byrne C, Sheykhzade M, Hurry PK, Schmedes AV, Kjær A, Hasbak P. Image-derived and physiological markers to predict adequate adenosine-induced hyperemic response in Rubidium-82 myocardial perfusion imaging. J Nucl Cardiol 2022; 29:3207-3217. [PMID: 35149976 PMCID: PMC9834126 DOI: 10.1007/s12350-022-02906-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 12/22/2021] [Indexed: 01/22/2023]
Abstract
AIMS This study aimed to investigate the potential of different markers to identify adequate stressing in subjects with and without caffeine intake prior to Rubidium-82 myocardial imaging. METHODS AND RESULTS This study comprised 40 healthy subjects who underwent four serial Rubidium-82 rest/adenosine stress MPI; two with 0mg caffeine consumption (baseline MPIs) and two with controlled consumption of caffeine (arm 1: 100 and 300mg, or arm 2: 200 and 400mg). We report the sensitivity and specificity of seven markers ability to predict adequate adenosine-induced hyperemic response: (1) the splenic response ratio (SRR); (2) splenic stress-to-rest intensity ratios (SIR); (3) changes in heart rate (ΔHR); (4) percentwise change in heart rate (Δ%HR); (5) changes in the rate pressure product (ΔRPP); (6) changes in the systolic blood pressure (ΔSBP); and (7) changes in the cardiovascular resistance (ΔCVR). Adequate stressing was determined as stress myocardial blood flow > 3ml/g/min and a corresponding myocardial flow reserve >68% of the individual maximum myocardial flow reserve obtained in the baseline MPIs. RESULTS 129 MPI sessions (obtained in 39 subjects) were considered for this study. The following sensitivities were obtained: SSR = 72.7%, SIR = 63.6%, ΔHR = 45.5%, Δ%HR = 77.3%, ΔRPP = 54.5%, ΔSBP = 47.7%, and ΔCVR =40.9%, while the specificities were SSR = 80.9%, SIR = 85.0%, ΔHR = 90.4%, Δ%HR = 81.6%, ΔRPP=81.1%, ΔSBP = 86.4%, and ΔCVR =90.4%. CONCLUSION The image-derived and physiological markers all provide acceptable sensitivities and specificities when patients follow the caffeine pausation before MPI. However, their use warrants great care when caffeine consumption cannot be ruled out.
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Affiliation(s)
- Martin Lyngby Lassen
- Department of Clinical Physiology, Nuclear Medicine & PET and Cluster for Molecular Imaging, of Biomedical Sciences, Section 4011, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen, Denmark.
| | - Mads Wissenberg
- Department of Cardiology, Copenhagen University Hospital, Gentofte, Denmark
| | - Christina Byrne
- Department of Clinical Physiology, Nuclear Medicine & PET and Cluster for Molecular Imaging, of Biomedical Sciences, Section 4011, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Majid Sheykhzade
- Department of Drug Design and Pharmacology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Preetee Kapisha Hurry
- Department of Clinical Physiology, Nuclear Medicine & PET and Cluster for Molecular Imaging, of Biomedical Sciences, Section 4011, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | | | - Andreas Kjær
- Department of Clinical Physiology, Nuclear Medicine & PET and Cluster for Molecular Imaging, of Biomedical Sciences, Section 4011, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Philip Hasbak
- Department of Clinical Physiology, Nuclear Medicine & PET and Cluster for Molecular Imaging, of Biomedical Sciences, Section 4011, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen, Denmark
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20
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Higuchi S, Ota H. Editorial for “Assessment of Splenic Switch‐Off With Arterial Spin Labeling in Adenosine Perfusion Cardiac
MRI
”. J Magn Reson Imaging 2022. [DOI: 10.1002/jmri.28465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Revised: 09/23/2022] [Accepted: 09/23/2022] [Indexed: 11/06/2022] Open
Affiliation(s)
- Satoshi Higuchi
- Department of Diagnostic Radiology Tohoku University Hospital Sendai Japan
| | - Hideki Ota
- Department of Diagnostic Radiology Tohoku University Hospital Sendai Japan
- Department of Advanced MRI Collaboration Research Tohoku University Graduate School of Medicine Sendai Japan
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21
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Reinartz S, Fischbach K. [Ischemic heart disease : More than just chronic CAD]. RADIOLOGIE (HEIDELBERG, GERMANY) 2022; 62:960-970. [PMID: 36301318 DOI: 10.1007/s00117-022-01078-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/14/2022] [Indexed: 06/16/2023]
Abstract
CLINICAL/METHODOLOGICAL ISSUE Myocardial ischemia as a reduction in perfusion with therefore oxygen deficiency of vital cardiomyocytes. Thus primary and secondary prophylaxis of myocardial infarction and it's complications. STANDARD RADIOLOGICAL METHODS Adenosine-regadenoson stress magnetic resonance imaging (AR-stress MRI), computed tomography coronary angiography (CTCA). METHODOLOGICAL INNOVATIONS Non-invasive stress testing using AR-stress MRI to exclude relevant obstructive coronary artery disease (CAD). PERFORMANCE Meta-analysis: The diagnosis of obstructive CAD at the coronary artery level has a pooled sensitivity of 87.7% and a specificity of 88.6%. Diagnostic accuracy is better than single photon emission computed tomography (SPECT; AUC 0.89 vs. 0.74). ACHIEVEMENTS AR-stress MRI can be used to assess myocardial ischemia in the setting of obstructive CAD. Current clinical guidelines for myocardial revascularization have strengthened the use of stress MRI in patients with intermediate risk of CAD and stable symptoms. Cardiac MR imaging using late gadolinium enhancement (LGE) is considered gold standard for myocardial viability assessment in vivo. Both viability and ischemia are considered prognostic factors for major adverse cardiac events. PRACTICAL RECOMMENDATIONS AR-stress MRI is used to diagnose myocardial ischemia in combination with viability imaging (LGE). Dobutamine-atropine (DoA) stress MRI is an alternative in the setting of contraindications for AR or specific clinical questions.
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Affiliation(s)
- Sebastian Reinartz
- Institut für diagnostische und interventionelle Radiologie, Universitätsklinikum Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Deutschland.
| | - Katharina Fischbach
- Klinik für Radiologie und Nuklearmedizin, Otto von Guericke Universität Magdeburg, Magdeburg, Deutschland
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22
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Barrishi A, Graby J, Khavandi A, Dastidar A, Rodrigues JCL. Assessing splenic switch-off in Adenosine stress CMR for patients with atrial fibrillation: a propensity-matched study. Br J Radiol 2022; 95:20220422. [PMID: 36000672 PMCID: PMC9793484 DOI: 10.1259/bjr.20220422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVES Splenic switch-off (SSO) is a validated indicator of adequate vasodilator stress unique to adenosine stress cardiac MR (CMR). Patients in atrial fibrillation (AF) may have a reduced adenosine response due to lower hyperaemic coronary flow reserve and may achieve SSO less frequently versus sinus rhythm (SR). METHODS 1100 stress CMR studies were identified from a clinical CMR database (2016-2021). 70 patients in AF were propensity score matched to a SR group for age, sex, and body mass index. The adenosine dose administered, symptoms, heart-rate change and scan result were recorded. SSO was evaluated subjectively and semi-quantitatively via changes in splenic and myocardial signal intensity (SI) from rest to stress. RESULTS SSO occurred significantly less frequently in AF than SR (34/70 [49%] vs 53/70 [76%], p = 0.003). Semi-quantitative assessment supported this, with a smaller splenic SI difference between stress and rest in AF vs SR (median splenic stress:rest peak SI ratio 0.92 [IQR:0.61-1.11] vs 0.56 [IQR:0.45-0.75], p < 0.001). A heart-rate increase >10 bpm predicted visual SSO in SR but not AF. Fewer patients in AF than SR had inducible ischaemia (9/70 [13%] vs 17/69 [25%], p = 0.058). This difference was not driven by inducible ischaemia rates in patients who did not achieve SSO (6/36 [17%] AF vs 4/17 [24%] SR, p = 0.403). CONCLUSIONS SSO occurs significantly less frequently with AF. This may risk the under diagnosis of inducible ischaemia and requires further assessment. ADVANCES IN KNOWLEDGE SSO, a validated marker of adequate stress in CMR, occurs significantly less frequently in the presence of AF, risking a suboptimal functional assessment of coronary disease.
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Affiliation(s)
| | | | - Ali Khavandi
- Department of Cardiology, Royal United Hospital, Combe Park, Bath, UK
| | - Amardeep Dastidar
- Department of Cardiology, North Bristol NHS Trust, Southmead Rd, Bristol, UK
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23
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Aramendía-Vidaurreta V, Solis-Barquero SM, Ezponda A, Vidorreta M, Echeverria-Chasco R, Pascual M, Bastarrika G, Fernández-Seara MA. Assessment of Splenic Switch-Off With Arterial Spin Labeling in Adenosine Perfusion Cardiac MRI. J Magn Reson Imaging 2022. [PMID: 36218288 DOI: 10.1002/jmri.28460] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 09/21/2022] [Accepted: 09/22/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND In patients with suspected coronary artery disease (CAD), myocardial perfusion is assessed under rest and pharmacological stress to identify ischemia. Splenic switch-off, defined as the stress to rest splenic perfusion attenuation in response to adenosine, has been proposed as an indicator of stress adequacy. Its occurrence has been previously assessed in first-pass perfusion images, but the use of noncontrast techniques would be highly beneficial. PURPOSE To explore the ability of pseudo-continuous arterial spin labeling (PCASL) to identify splenic switch-off in patients with suspected CAD. STUDY TYPE Prospective. POPULATION Five healthy volunteers (age 24.8 ± 3.8 years) and 32 patients (age 66.4 ± 8.2 years) with suspected CAD. FIELD STRENGTH/SEQUENCE A 1.5-T/PCASL (spin-echo) and first-pass imaging (gradient-echo). ASSESSMENT In healthy subjects, multi-delay PCASL data (500-2000 msec) were acquired to quantify splenic blood flow (SBF) and determine the adequate postlabeling delay (PLD) for single-delay acquisitions (PLD > arterial transit time). In patients, single-delay PCASL (1200 msec) and first-pass perfusion images were acquired under rest and adenosine conditions. PCASL data were used to compute SBF maps and SBF stress-to-rest ratios. Three observers classified patients into "switch-off" and "failed switch-off" groups by visually comparing rest-stress perfusion data acquired with PCASL and first-pass, independently. First-pass categories were used as reference to evaluate the accuracy of quantitative classification. STATISTICAL TESTS Wilcoxon signed-rank, Pearson correlation, kappa, percentage agreement, Generalized Linear Mixed Model, Mann-Whitney, Pearson Chi-squared, receiver operating characteristic, area-under-the-curve (AUC) and confusion matrix. SIGNIFICANCE P value < 0.05. RESULTS A total of 27 patients (84.4%) experienced splenic switch-off according to first-pass categories. Comparison of PCASL-derived SBF maps during stress and rest allowed assessment of splenic switch-off, reflected in a reduction of SBF values during stress. SBF stress-to-rest ratios showed a 97% accuracy (sensitivity = 80%, specificity = 100%, AUC = 85.2%). DATA CONCLUSION This study could demonstrate the feasibility of PCASL to identify splenic switch-off during adenosine perfusion MRI, both by qualitative and quantitative assessments. EVIDENCE LEVEL 2 TECHNICAL EFFICACY: 2.
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Affiliation(s)
- Verónica Aramendía-Vidaurreta
- Department of Radiology, Clínica Universidad de Navarra, Pamplona, Navarra, Spain.,Idisna, Instituto de Investigación Sanitaria de Navarra, Spain
| | - Sergio M Solis-Barquero
- Department of Radiology, Clínica Universidad de Navarra, Pamplona, Navarra, Spain.,Idisna, Instituto de Investigación Sanitaria de Navarra, Spain
| | - Ana Ezponda
- Department of Radiology, Clínica Universidad de Navarra, Pamplona, Navarra, Spain.,Idisna, Instituto de Investigación Sanitaria de Navarra, Spain
| | | | - Rebeca Echeverria-Chasco
- Department of Radiology, Clínica Universidad de Navarra, Pamplona, Navarra, Spain.,Idisna, Instituto de Investigación Sanitaria de Navarra, Spain
| | - Marina Pascual
- Department of Cardiology, Clínica Universidad de Navarra, Pamplona, Navarra, Spain
| | - Gorka Bastarrika
- Department of Radiology, Clínica Universidad de Navarra, Pamplona, Navarra, Spain.,Idisna, Instituto de Investigación Sanitaria de Navarra, Spain
| | - María A Fernández-Seara
- Department of Radiology, Clínica Universidad de Navarra, Pamplona, Navarra, Spain.,Idisna, Instituto de Investigación Sanitaria de Navarra, Spain
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24
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Miller L, Airapetov S, Pillai A, Kalahasty G, Ellenbogen KA, Gregory Hundley W, Trankle CR. Hemodynamic response and safety of vasodilator stress cardiovascular magnetic resonance in patients with permanent pacemakers or implantable cardioverter-defibrillators. J Cardiovasc Electrophysiol 2022; 33:2127-2135. [PMID: 35842792 PMCID: PMC9561044 DOI: 10.1111/jce.15630] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 05/20/2022] [Accepted: 06/13/2022] [Indexed: 01/01/2023]
Abstract
INTRODUCTION Vasodilator stress cardiovascular magnetic resonance (CMR) is a powerful diagnostic modality, but data toward its use in patients with permanent pacemakers (PPMs) or implantable cardioverter-defibrillators (ICDs) is limited. METHODS AND RESULTS Patients with ICDs (>1% pacing) or PPMs who underwent regadenoson single photon emission computed tomography (SPECT) and all patients with ICDs or PPMs who underwent stress CMR were retrospectively identified. SPECT tests were analyzed for hemodynamic responses and new pacing requirements; CMR studies were examined for safety, device characteristics and programming, hemodynamic responses, and image quality. Changes from baseline were evaluated with the Related-Samples Wilcoxon Signed Rank Test. Of 67 patients (median age 65 [IQR 58-72] years, 31 [46%] female, 31 [46%] Black), 47 underwent SPECT and 20 CMR. With regadenoson SPECT, 89% of patients experienced tachycardic responses above resting heart rates (+19 [13-32] beats per minute, p < .01). During stress CMR, 10 (50%) devices were asynchronously paced approximately 10 beats per minute above resting rates, and the remaining were temporarily deactivated. Those with asynchronous pacing had no changes in heart rates, whereas patients with deactivated devices had near uniform heart rate accelerations. Image quality was diagnostic in the majority of stress CMR sequences, with nonconditional ICDs contributing 40 of 57 (70%) of nondiagnostic segments. CONCLUSION This data supports the safety of vasodilator stress CMR with promising diagnostic quality images in patients with CMR conditional ICDs and PPMs. Despite a near uniform tachycardic response to regadenoson in the SPECT environment, high rates of asynchronous pacing during vasodilator stress CMR did not result in competitive pacing or adverse arrhythmic events. Further studies are needed to validate these findings and confirm the diagnostic and prognostic performance of stress CMR in these individuals.
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Affiliation(s)
- Lauren Miller
- School of MedicineVirginia Commonwealth UniversityRichmondVirginiaUSA
| | - Sergei Airapetov
- Division of Cardiology, VCU Pauley Heart CenterVirginia Commonwealth UniversityRichmondVirginiaUSA
| | - Ajay Pillai
- Division of Cardiology, VCU Pauley Heart CenterVirginia Commonwealth UniversityRichmondVirginiaUSA
| | - Gautham Kalahasty
- Division of Cardiology, VCU Pauley Heart CenterVirginia Commonwealth UniversityRichmondVirginiaUSA
| | - Kenneth A. Ellenbogen
- Division of Cardiology, VCU Pauley Heart CenterVirginia Commonwealth UniversityRichmondVirginiaUSA
| | - W. Gregory Hundley
- Division of Cardiology, VCU Pauley Heart CenterVirginia Commonwealth UniversityRichmondVirginiaUSA
| | - Cory R. Trankle
- Division of Cardiology, VCU Pauley Heart CenterVirginia Commonwealth UniversityRichmondVirginiaUSA
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25
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Semi-Quantitative Versus Visual Analysis of Adenosine Perfusion Magnetic Resonance Imaging in Intermediate-Grade Coronary Artery Stenosis Using Fractional Flow Reserve as the Reference: A Pilot Study. J Belg Soc Radiol 2022; 106:59. [PMID: 35814277 PMCID: PMC9231575 DOI: 10.5334/jbsr.2675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Accepted: 06/08/2022] [Indexed: 11/20/2022] Open
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26
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Bakula A, Patriki D, von Felten E, Benetos G, Sustar A, Benz DC, Wiedemann-Buser M, Treyer V, Pazhenkottil AP, Gräni C, Gebhard C, Kaufmann PA, Buechel RR, Fuchs TA. Splenic switch-off as a novel marker for adenosine response in nitrogen-13 ammonia PET myocardial perfusion imaging: Cross-validation against CMR using a hybrid PET/MR device. J Nucl Cardiol 2022; 29:1205-1214. [PMID: 33354759 PMCID: PMC9163112 DOI: 10.1007/s12350-020-02448-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 11/09/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND No methodology is available to distinguish truly reduced myocardial flow reserve (MFR) in positron emission tomography myocardial perfusion imaging (PET MPI) from seemingly impaired MFR due to inadequate adenosine response. The adenosine-induced splenic switch-off (SSO) sign has been proposed as a potential marker for adequate adenosine response in cardiac magnetic resonance (CMR). We assessed the feasibility of detecting SSO in nitrogen-13 ammonia PET MPI using SSO in CMR as the standard of reference. METHODS AND RESULTS Fifty patients underwent simultaneous CMR and PET MPI on a hybrid PET/MR device with co-injection of a gadolinium-based contrast agent and nitrogen-13 ammonia during rest and adenosine-induced stress. In CMR, SSO was assessed visually (positive vs negative SSO) and quantitatively by calculating the ratio of the peak signal intensity of the spleen during stress over rest (SIR). In PET MPI, the splenic signal activity ratio (SAR) was calculated as the maximal standard uptake value of the spleen during stress over rest. The median SIR was significantly lower in patients with positive versus negative SSO in CMR (0.57 [IQR 0.49 to 0.62] vs 0.89 [IQR 0.76 to 0.98]; P < .001). Similarly, median SAR in PET MPI was significantly lower in patients with positive versus negative SSO (0.40 [IQR 0.32 to 0.45] vs 0.80 [IQR 0.47 to 0.98]; P < .001). CONCLUSION Similarly to CMR, SSO can be detected in nitrogen-13 ammonia PET MPI. This might help distinguish adenosine non-responders from patients with truly impaired MFR due to microvascular dysfunction or multivessel coronary artery disease.
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Affiliation(s)
- Adam Bakula
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
| | - Dimitri Patriki
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
| | - Elia von Felten
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
| | - Georgios Benetos
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
| | - Aleksandra Sustar
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
| | - Dominik C Benz
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
| | - Muriel Wiedemann-Buser
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
| | - Valerie Treyer
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
| | - Aju P Pazhenkottil
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
| | - Christoph Gräni
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
| | - Catherine Gebhard
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
| | - Philipp A Kaufmann
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
| | - Ronny R Buechel
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
| | - Tobias A Fuchs
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland.
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Moody WE, Arumugam P. Assessment of stress adequacy with adenosine: Does the answer lie in the spleen? J Nucl Cardiol 2022; 29:1215-1218. [PMID: 33420661 DOI: 10.1007/s12350-020-02485-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Accepted: 12/07/2020] [Indexed: 10/22/2022]
Affiliation(s)
- William E Moody
- Department of Cardiology, Centre for Clinical Cardiovascular Science, Nuffield House, Queen Elizabeth Hospital Birmingham, University Hospital Birmingham NHS Foundation Trust, Edgbaston, B15 2TH, UK
| | - Parthiban Arumugam
- Department of Nuclear Medicine, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Oxford Road, Manchester, M13 9WL, UK.
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28
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Sakuma H, Ishida M. Advances in Myocardial Perfusion MR Imaging: Physiological Implications, the Importance of Quantitative Analysis, and Impact on Patient Care in Coronary Artery Disease. Magn Reson Med Sci 2022; 21:195-211. [PMID: 34108304 PMCID: PMC9199984 DOI: 10.2463/mrms.rev.2021-0033] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 04/27/2021] [Indexed: 11/09/2022] Open
Abstract
Stress myocardial perfusion imaging (MPI) is the preferred test in patients with intermediate-to-high clinical likelihood of coronary artery disease (CAD) and can be used as a gatekeeper to avoid unnecessary revascularization. Cardiac magnetic resonance (CMR) has a number of favorable characteristics, including: (1) high spatial resolution that can delineate subendocardial ischemia; (2) comprehensive assessment of morphology, global and regional cardiac functions, tissue characterization, and coronary artery stenosis; and (3) no radiation exposure to patients. According to meta-analysis studies, the diagnostic accuracy of perfusion CMR is comparable to positron emission tomography (PET) and perfusion CT, and is better than single-photon emission CT (SPECT) when fractional flow reserve (FFR) is used as a reference standard. In addition, stress CMR has an excellent prognostic value. One meta-analysis study demonstrated the annual event rate of cardiovascular death or non-fatal myocardial infarction was 4.9% and 0.8%, respectively, in patients with positive and negative stress CMR. Quantitative assessment of perfusion CMR not only allows the objective evaluation of regional ischemia but also provides insights into the pathophysiology of microvascular disease and diffuse subclinical atherosclerosis. For accurate quantification of myocardial perfusion, saturation correction of arterial input function is important. There are two major approaches for saturation correction, one is a dual-bolus method and the other is a dual-sequence method. Absolute quantitative mapping with myocardial perfusion CMR has good accuracy in detecting coronary microvascular dysfunction. Flow measurement in the coronary sinus (CS) with phase contrast cine CMR is an alternative approach to quantify global coronary flow reserve (CFR). The measurement of global CFR by quantitative analysis of perfusion CMR or flow measurement in the CS permits assessment of microvascular disease and diffuse subclinical atherosclerosis, which may provide improved prediction of future event risk in patients with suspected or known CAD. Multi-institutional studies to validate the diagnostic and prognostic values of quantitative perfusion CMR approaches are required.
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Affiliation(s)
- Hajime Sakuma
- Department of Radiology, Mie University Graduate School of Medicine, Tsu, Mie, Japan
| | - Masaki Ishida
- Department of Radiology, Mie University Graduate School of Medicine, Tsu, Mie, Japan
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29
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Sharrack N, Chiribiri A, Schwitter J, Plein S. How to do quantitative myocardial perfusion cardiovascular magnetic resonance. Eur Heart J Cardiovasc Imaging 2022; 23:315-318. [PMID: 34587625 PMCID: PMC8863076 DOI: 10.1093/ehjci/jeab193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 09/10/2021] [Indexed: 11/12/2022] Open
Affiliation(s)
- Noor Sharrack
- Multidisciplinary Cardiovascular Research Centre and Biomedical Imaging Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds LS2 9JT, UK
| | - Amedeo Chiribiri
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London SE1 7EH, UK
| | - Juerg Schwitter
- Division of Cardiology, Cardiovascular Department, University Hospital Lausanne, Rue de Bugnon 46, CH-1011 Lausanne, Switzerland
- Cardiac MR Center, University Hospital Lausanne, Rue de Bugnon 46, CH-1011 Lausanne, Switzerland
- University of Lausanne, UniL, Faculty of Biology and Medicine, Rue du Bugnon 21, Lausanne, Switzerland
| | - Sven Plein
- Multidisciplinary Cardiovascular Research Centre and Biomedical Imaging Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds LS2 9JT, UK
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London SE1 7EH, UK
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Pavon AG, Porretta AP, Arangalage D, Domenichini G, Rutz T, Hugelshofer S, Pruvot E, Monney P, Pascale P, Schwitter J. Feasibility of adenosine stress cardiovascular magnetic resonance perfusion imaging in patients with MR-conditional transvenous permanent pacemakers and defibrillators. J Cardiovasc Magn Reson 2022; 24:9. [PMID: 35022037 PMCID: PMC8756706 DOI: 10.1186/s12968-021-00842-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 12/21/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The use of stress perfusion-cardiovascular magnetic resonance (CMR) imaging remains limited in patients with implantable devices. The primary goal of the study was to assess the safety, image quality, and the diagnostic value of stress perfusion-CMR in patients with MR-conditional transvenous permanent pacemakers (PPM) or implantable cardioverter-defibrillators (ICD). METHODS Consecutive patients with a transvenous PPM or ICD referred for adenosine stress-CMR were enrolled in this single-center longitudinal study. The CMR protocol was performed using a 1.5 T system according to current guidelines while all devices were put in MR-mode. Quality of cine, late-gadolinium-enhancement (LGE), and stress perfusion sequences were assessed. An ischemia burden of ≥ 1.5 segments was considered significant. We assessed the safety, image quality and the occurrence of interference of the magnetic field with the implantable device. In case of ischemia, we also assessed the correlation with the presence of significant coronary lesions on coronary angiography. RESULTS Among 3743 perfusion-CMR examinations, 66 patients had implantable devices (1.7%). Image quality proved diagnostic in 98% of cases. No device damage or malfunction was reported immediately and at 1 year. Fifty patients were continuously paced during CMR. Heart rate and systolic blood pressure remained unchanged during adenosine stress, while diastolic blood pressure decreased (p = 0.007). Six patients (9%) had an ischemia-positive stress CMR and significant coronary stenoses were confirmed by coronary angiography in all cases. CONCLUSION Stress perfusion-CMR is safe, allows reliable ischemia detection, and provides good diagnostic value.
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Affiliation(s)
- Anna Giulia Pavon
- Division of Cardiology, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Via Tesserete, 48, 6900 Lugano, Switzerland
| | - Alessandra Pia Porretta
- Cardiovascular Department, Division of Cardiology, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Dimitri Arangalage
- Cardiovascular Department, Division of Cardiology, Lausanne University Hospital (CHUV), Lausanne, Switzerland
- Cardiology Department, AP-HP, Bichat Hospital and Université de Paris, Paris, France
| | - Giulia Domenichini
- Cardiovascular Department, Division of Cardiology, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Tobias Rutz
- Cardiovascular Department, Division of Cardiology, Lausanne University Hospital (CHUV), Lausanne, Switzerland
- Cardiac Magnetic Resonance Center of the CHUV (CRMC), Lausanne University Hospital, Lausanne, Switzerland
- Faculty of Biology and Medicine, University of Lausanne (UniL), Lausanne, Switzerland
| | - Sarah Hugelshofer
- Cardiovascular Department, Division of Cardiology, Lausanne University Hospital (CHUV), Lausanne, Switzerland
- Cardiac Magnetic Resonance Center of the CHUV (CRMC), Lausanne University Hospital, Lausanne, Switzerland
| | - Etienne Pruvot
- Cardiovascular Department, Division of Cardiology, Lausanne University Hospital (CHUV), Lausanne, Switzerland
- Faculty of Biology and Medicine, University of Lausanne (UniL), Lausanne, Switzerland
| | - Pierre Monney
- Cardiovascular Department, Division of Cardiology, Lausanne University Hospital (CHUV), Lausanne, Switzerland
- Cardiac Magnetic Resonance Center of the CHUV (CRMC), Lausanne University Hospital, Lausanne, Switzerland
- Faculty of Biology and Medicine, University of Lausanne (UniL), Lausanne, Switzerland
| | - Patrizio Pascale
- Cardiovascular Department, Division of Cardiology, Lausanne University Hospital (CHUV), Lausanne, Switzerland
- Faculty of Biology and Medicine, University of Lausanne (UniL), Lausanne, Switzerland
| | - Juerg Schwitter
- Cardiovascular Department, Division of Cardiology, Lausanne University Hospital (CHUV), Lausanne, Switzerland
- Cardiac Magnetic Resonance Center of the CHUV (CRMC), Lausanne University Hospital, Lausanne, Switzerland
- Faculty of Biology and Medicine, University of Lausanne (UniL), Lausanne, Switzerland
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Abstract
Ischemic cardiomyopathy (ICM) is one of the most common causes of congestive heart failure. In patients with ICM, tissue characterization with cardiac magnetic resonance imaging (CMR) allows for evaluation of myocardial abnormalities in acute and chronic settings. Myocardial edema, microvascular obstruction (MVO), intracardiac thrombus, intramyocardial hemorrhage, and late gadolinium enhancement of the myocardium are easily depicted using standard CMR sequences. In the acute setting, tissue characterization is mainly focused on assessment of ventricular thrombus and MVO, which are associated with poor prognosis. Conversely, in chronic ICM, it is important to depict late gadolinium enhancement and myocardial ischemia using stress perfusion sequences. Overall, with CMR's ability to accurately characterize myocardial tissue in acute and chronic ICM, it represents a valuable diagnostic and prognostic imaging method for treatment planning. In particular, tissue characterization abnormalities in the acute setting can provide information regarding the patients that may develop major adverse cardiac event and show the presence of ventricular thrombus; in the chronic setting, evaluation of viable myocardium can be fundamental for planning myocardial revascularization. In this review, the main findings on tissue characterization are illustrated in acute and chronic settings using qualitative and quantitative tissue characterization.
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Kotecha T, Monteagudo JM, Martinez-Naharro A, Chacko L, Brown J, Knight D, Knott KD, Hawkins P, Moon JC, Plein S, Xue H, Kellman P, Lockie T, Patel N, Rakhit R, Fontana M. Quantitative cardiovascular magnetic resonance myocardial perfusion mapping to assess hyperaemic response to adenosine stress. Eur Heart J Cardiovasc Imaging 2021; 22:273-281. [PMID: 33188683 DOI: 10.1093/ehjci/jeaa252] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Indexed: 11/13/2022] Open
Abstract
AIMS Assessment of hyperaemia during adenosine stress cardiovascular magnetic resonance (CMR) remains a clinical challenge with lack of a gold-standard non-invasive clinical marker to confirm hyperaemic response. This study aimed to validate maximum stress myocardial blood flow (SMBF) measured using quantitative perfusion mapping for assessment of hyperaemic response and compare this to current clinical markers of adenosine stress. METHODS AND RESULTS Two hundred and eighteen subjects underwent adenosine stress CMR. A derivation cohort (22 volunteers) was used to identify a SMBF threshold value for hyperaemia. This was tested in a validation cohort (37 patients with suspected coronary artery disease) who underwent invasive coronary physiology assessment on the same day as CMR. A clinical cohort (159 patients) was used to compare SMBF to other physiological markers of hyperaemia [splenic switch-off (SSO), heart rate response (HRR), and blood pressure (BP) fall]. A minimum SMBF threshold of 1.43 mL/g/min was derived from volunteer scans. All patients in the coronary physiology cohort demonstrated regional maximum SMBF (SMBFmax) >1.43 mL/g/min and invasive evidence of hyperaemia. Of the clinical cohort, 93% had hyperaemia defined by perfusion mapping compared to 71% using SSO and 81% using HRR. There was no difference in SMBFmax in those with or without SSO (2.58 ± 0.89 vs. 2.54 ± 1.04 mL/g/min, P = 0.84) but those with HRR had significantly higher SMBFmax (2.66 1.86 mL/g/min, P < 0.001). HRR >15 bpm was superior to SSO in predicting adequate increase in SMBF (AUC 0.87 vs. 0.62, P < 0.001). CONCLUSION Adenosine-induced increase in myocardial blood flow is accurate for confirmation of hyperaemia during stress CMR studies and is superior to traditional, clinically used markers of adequate stress such as SSO and BP response.
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Affiliation(s)
- Tushar Kotecha
- Institute of Cardiovascular Science, University College London, London, UK.,Department of Cardiology, Royal Free Hospital, Pond Street, London, UK
| | | | - Ana Martinez-Naharro
- Department of Cardiology, Royal Free Hospital, Pond Street, London, UK.,Division of Medicine, University College London, London, UK
| | - Liza Chacko
- Department of Cardiology, Royal Free Hospital, Pond Street, London, UK.,Division of Medicine, University College London, London, UK
| | - James Brown
- Institute of Cardiovascular Science, University College London, London, UK.,Department of Cardiology, Royal Free Hospital, Pond Street, London, UK
| | - Daniel Knight
- Institute of Cardiovascular Science, University College London, London, UK.,Department of Cardiology, Royal Free Hospital, Pond Street, London, UK
| | - Kristopher D Knott
- Institute of Cardiovascular Science, University College London, London, UK.,Department of Cardiovascular Magnetic Resonance, Barts Heart Centre, London, UK
| | - Philip Hawkins
- Department of Cardiology, Royal Free Hospital, Pond Street, London, UK.,Division of Medicine, University College London, London, UK
| | - James C Moon
- Institute of Cardiovascular Science, University College London, London, UK.,Department of Cardiovascular Magnetic Resonance, Barts Heart Centre, London, UK
| | - Sven Plein
- Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Hui Xue
- Medical Signal and Imaging Processing Program, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Peter Kellman
- Medical Signal and Imaging Processing Program, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Tim Lockie
- Department of Cardiology, Royal Free Hospital, Pond Street, London, UK
| | - Niket Patel
- Institute of Cardiovascular Science, University College London, London, UK.,Department of Cardiology, Royal Free Hospital, Pond Street, London, UK
| | - Roby Rakhit
- Institute of Cardiovascular Science, University College London, London, UK.,Department of Cardiology, Royal Free Hospital, Pond Street, London, UK
| | - Marianna Fontana
- Department of Cardiology, Royal Free Hospital, Pond Street, London, UK.,Division of Medicine, University College London, London, UK
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Farzaneh-Far A, Wong J. Stressed enough? Hyperaemic thresholds during quantitative cardiovascular magnetic resonance perfusion mapping. Eur Heart J Cardiovasc Imaging 2021; 22:282-284. [PMID: 33338199 DOI: 10.1093/ehjci/jeaa268] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Indexed: 11/13/2022] Open
Affiliation(s)
- Afshin Farzaneh-Far
- Division of Cardiology, Department of Medicine, University of Illinois at Chicago, 840 South Wood St. M/C 715, Suite 920 S, Chicago, IL 60612, USA.,Division of Cardiology, Department of Medicine, Duke University, Durham, NC, USA
| | - Joyce Wong
- Department of Cardiology, Harefield Hospital, Royal Brompton and Harefield NHS Foundation Trust, Harefield, UK
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Duran SR, Huffaker T, Dixon B, Gooty V, Abou Zahr R, Arar Y, Greer JS, Butts RJ, Hussain MT. Feasibility and safety of quantitative adenosine stress perfusion cardiac magnetic resonance imaging in pediatric heart transplant patients with and without coronary allograft vasculopathy. Pediatr Radiol 2021; 51:1311-1321. [PMID: 33791838 DOI: 10.1007/s00247-021-04977-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 11/11/2020] [Accepted: 01/21/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Pediatric heart transplant patients require cardiac catheterization to monitor for coronary allograft vasculopathy. Cardiac catheterization has no safe and consistent method for measuring microvascular disease. Stress perfusion cardiac magnetic resonance imaging (MRI) assessing microvascular disease has been performed in adults. OBJECTIVE To investigate the feasibility and safety of performing cardiac MRI with quantitative adenosine stress perfusion testing in pediatric heart transplant patients with and without coronary allograft vasculopathy. MATERIALS AND METHODS All pediatric heart transplant patients with coronary vasculopathy at our institution were asked to participate. Age- and gender-matched pediatric heart transplant patients without vasculopathy were recruited for comparison. Patients underwent cardiac MRI with adenosine stress perfusion testing. RESULTS Sixteen pediatric heart transplant patients, ages 6-22 years, underwent testing. Nine patients had vasculopathy by angiography. No heart block or other complications occurred during the study. The myocardial perfusion reserve for patients with vasculopathy showed no significant difference with comparison patients (median: 1.43 vs. 1.48; P=0.49). Values for both groups were lower than expected values based on previous adult studies. The patients were also analyzed for time after transplant and the number of rejection episodes. Patients within 6 years of transplantation had a nonsignificant trend toward a higher myocardial perfusion reserve (median: 1.57) versus patients with older transplants (median: 1.47; P=0.46). Intra- and interobserver reproducibility were 97% and 92%, respectively. CONCLUSION Myocardial perfusion reserve is a safe and feasible method for estimating myocardial perfusion in pediatric heart transplant patients. There is no reliable way to monitor microvascular disease in pediatric patients. This method shows potential and deserves investigation in a larger cohort.
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Affiliation(s)
- Silvestre R Duran
- Department of Pediatrics, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390, USA. .,Division of Pediatric Cardiology, Children's Medical Center Dallas, Dallas, TX, USA. .,Division of Pediatric Cardiology, University Hospitals Rainbow Babies & Children's Hospital, Cleveland, OH, USA.
| | - Tyler Huffaker
- Department of Pediatrics, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390, USA
| | - Bryant Dixon
- Department of Pediatrics, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390, USA
| | - Vasu Gooty
- Department of Pediatrics, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390, USA.,Division of Pediatric Cardiology, Children's Medical Center Dallas, Dallas, TX, USA
| | - Riad Abou Zahr
- Department of Pediatrics, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390, USA.,Division of Pediatric Cardiology, Children's Medical Center Dallas, Dallas, TX, USA
| | - Yousef Arar
- Department of Pediatrics, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390, USA.,Division of Pediatric Cardiology, Children's Medical Center Dallas, Dallas, TX, USA
| | - Joshua S Greer
- Department of Pediatrics, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390, USA
| | - Ryan J Butts
- Department of Pediatrics, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390, USA.,Division of Pediatric Cardiology, Children's Medical Center Dallas, Dallas, TX, USA
| | - Mohammad T Hussain
- Department of Pediatrics, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390, USA.,Division of Pediatric Cardiology, Children's Medical Center Dallas, Dallas, TX, USA
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Brown LAE, Saunderson CED, Das A, Craven T, Levelt E, Knott KD, Dall’Armellina E, Xue H, Moon JC, Greenwood JP, Kellman P, Swoboda PP, Plein S. A comparison of standard and high dose adenosine protocols in routine vasodilator stress cardiovascular magnetic resonance: dosage affects hyperaemic myocardial blood flow in patients with severe left ventricular systolic impairment. J Cardiovasc Magn Reson 2021; 23:37. [PMID: 33731141 PMCID: PMC7971951 DOI: 10.1186/s12968-021-00714-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 01/26/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Adenosine stress perfusion cardiovascular magnetic resonance (CMR) is commonly used in the assessment of patients with suspected ischaemia. Accepted protocols recommend administration of adenosine at a dose of 140 µg/kg/min increased up to 210 µg/kg/min if required. Conventionally, adequate stress has been assessed using change in heart rate, however, recent studies have suggested that these peripheral measurements may not reflect hyperaemia and can be blunted, in particular, in patients with heart failure. This study looked to compare stress myocardial blood flow (MBF) and haemodynamic response with different dosing regimens of adenosine during stress perfusion CMR in patients and healthy controls. METHODS 20 healthy adult subjects were recruited as controls to compare 3 adenosine perfusion protocols: standard dose (140 µg/kg/min for 4 min), high dose (210 µg/kg/min for 4 min) and long dose (140 µg/kg/min for 8 min). 60 patients with either known or suspected coronary artery disease (CAD) or with heart failure and different degrees of left ventricular (LV) dysfunction underwent adenosine stress with standard and high dose adenosine within the same scan. All studies were carried out on a 3 T CMR scanner. Quantitative global myocardial perfusion and haemodynamic response were compared between doses. RESULTS In healthy controls, no significant difference was seen in stress MBF between the 3 protocols. In patients with known or suspected CAD, and those with heart failure and mild systolic impairment (LV ejection fraction (LVEF) ≥ 40%) no significant difference was seen in stress MBF between standard and high dose adenosine. In those with LVEF < 40%, there was a significantly higher stress MBF following high dose adenosine compared to standard dose (1.33 ± 0.46 vs 1.10 ± 0.47 ml/g/min, p = 0.004). Non-responders to standard dose adenosine (defined by an increase in heart rate (HR) < 10 bpm) had a significantly higher stress HR following high dose (75 ± 12 vs 70 ± 14 bpm, p = 0.034), but showed no significant difference in stress MBF. CONCLUSIONS Increasing adenosine dose from 140 to 210 µg/kg/min leads to increased stress MBF in patients with significantly impaired LV systolic function. Adenosine dose in clinical perfusion assessment may need to be increased in these patients.
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Affiliation(s)
- Louise A. E. Brown
- Multidisciplinary Cardiovascular Research Centre (MCRC) & Biomedical Imaging Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Clarendon Way, Leeds, LS2 9JT UK
| | - Christopher E. D. Saunderson
- Multidisciplinary Cardiovascular Research Centre (MCRC) & Biomedical Imaging Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Clarendon Way, Leeds, LS2 9JT UK
| | - Arka Das
- Multidisciplinary Cardiovascular Research Centre (MCRC) & Biomedical Imaging Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Clarendon Way, Leeds, LS2 9JT UK
| | - Thomas Craven
- Multidisciplinary Cardiovascular Research Centre (MCRC) & Biomedical Imaging Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Clarendon Way, Leeds, LS2 9JT UK
| | - Eylem Levelt
- Multidisciplinary Cardiovascular Research Centre (MCRC) & Biomedical Imaging Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Clarendon Way, Leeds, LS2 9JT UK
| | - Kristopher D. Knott
- The Cardiovascular Magnetic Resonance Imaging Unit and The Inherited Cardiovascular Diseases Unit, Barts Heart Centre, St Bartholomew’s Hospital, West Smithfield, London, UK
- National Heart, Lung, and Blood Institute, National Institutes of Health, DHHS, Bethesda, MD USA
| | - Erica Dall’Armellina
- Multidisciplinary Cardiovascular Research Centre (MCRC) & Biomedical Imaging Science Department, 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
| | - James C. Moon
- The Cardiovascular Magnetic Resonance Imaging Unit and The Inherited Cardiovascular Diseases Unit, Barts Heart Centre, St Bartholomew’s Hospital, West Smithfield, London, UK
- National Heart, Lung, and Blood Institute, National Institutes of Health, DHHS, Bethesda, MD USA
| | - John P. Greenwood
- Multidisciplinary Cardiovascular Research Centre (MCRC) & Biomedical Imaging Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Clarendon Way, Leeds, LS2 9JT UK
| | - Peter Kellman
- Multidisciplinary Cardiovascular Research Centre (MCRC) & Biomedical Imaging Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Clarendon Way, Leeds, LS2 9JT UK
- The Cardiovascular Magnetic Resonance Imaging Unit and The Inherited Cardiovascular Diseases Unit, Barts Heart Centre, St Bartholomew’s Hospital, West Smithfield, London, UK
- National Heart, Lung, and Blood Institute, National Institutes of Health, DHHS, Bethesda, MD USA
| | - Peter P. Swoboda
- Multidisciplinary Cardiovascular Research Centre (MCRC) & Biomedical Imaging Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Clarendon Way, Leeds, LS2 9JT UK
| | - Sven Plein
- Multidisciplinary Cardiovascular Research Centre (MCRC) & Biomedical Imaging Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Clarendon Way, Leeds, LS2 9JT UK
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Patriki D, von Felten E, Bakula A, Giannopoulos AA, Kamani CH, Schwyzer M, Messerli M, Benz DC, Gebhard C, Gräni C, Pazhenkottil AP, Kaufmann PA, Fuchs TA, Buechel RR. Splenic switch-off as a predictor for coronary adenosine response: validation against 13N-ammonia during co-injection myocardial perfusion imaging on a hybrid PET/CMR scanner. J Cardiovasc Magn Reson 2021; 23:3. [PMID: 33407586 PMCID: PMC7789581 DOI: 10.1186/s12968-020-00696-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 12/09/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Inadequate coronary adenosine response is a potential cause for false negative ischemia testing. Recently, the splenic switch-off (SSO) sign has been identified as a promising tool to ascertain the efficacy of adenosine during vasodilator stress cardiovascular magnetic resonance imaging (CMR). We assessed the value of SSO to predict adenosine response, defined as an increase in myocardial blood flow (MBF) during quantitative stress myocardial perfusion 13 N-ammonia positron emission tomography (PET). METHODS We prospectively enrolled 64 patients who underwent simultaneous CMR and PET myocardial perfusion imaging on a hybrid PET/CMR scanner with co-injection of gadolinium based contrast agent (GBCA) and 13N-ammonia during rest and adenosine-induced stress. A myocardial flow reserve (MFR) of > 1.5 or ischemia as assessed by PET were defined as markers for adequate coronary adenosine response. The presence or absence of SSO was visually assessed. The stress-to-rest intensity ratio (SIR) was calculated as the ratio of stress over rest peak signal intensity for splenic tissue. Additionally, the spleen-to-myocardium ratio, defined as the relative change of spleen to myocardial signal, was calculated for stress (SMRstress) and rest. RESULTS Sixty-one (95%) patients were coronary adenosine responders, but SSO was absent in 18 (28%) patients. SIR and SMRstress were significantly lower in patients with SSO (SIR: 0.56 ± 0.13 vs. 0.93 ± 0.23; p < 0.001 and SMRstress: 1.09 ± 0.47 vs. 1.68 ± 0.62; p < 0.001). Mean hyperemic and rest MBF were 2.12 ± 0.68 ml/min/g and 0.78 ± 0.26 ml/min/g, respectively. MFR was significantly higher in patients with vs. patients without presence of SSO (3.07 ± 1.03 vs. 2.48 ± 0.96; p = 0.038), but there was only a weak inverse correlation between SMRstress and MFR (R = -0.378; p = 0.02) as well as between SIR and MFR (R = -0.356; p = 0.004). CONCLUSIONS The presence of SSO implies adequate coronary adenosine-induced MBF response. Its absence, however, is not a reliable indicator for failed adenosine-induced coronary vasodilatation.
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Affiliation(s)
- Dimitri Patriki
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich and University Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
| | - Elia von Felten
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich and University Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
| | - Adam Bakula
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich and University Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
| | - Andreas A Giannopoulos
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich and University Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
| | - Christel H Kamani
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich and University Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
| | - Moritz Schwyzer
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich and University Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
| | - Michael Messerli
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich and University Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
| | - Dominik C Benz
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich and University Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
| | - Catherine Gebhard
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich and University Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
| | - Christoph Gräni
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich and University Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
| | - Aju P Pazhenkottil
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich and University Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
| | - Philipp A Kaufmann
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich and University Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
| | - Tobias A Fuchs
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich and University Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
| | - Ronny R Buechel
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich and University Zurich, Ramistrasse 100, 8091, Zurich, Switzerland.
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Saeed M. Editorial for: “Splenic Switch‐Off for Determining the Optimal Dosage for Adenosine Stress Cardiovascular MR in Terms of Stress Effectiveness and Patient Safety”. J Magn Reson Imaging 2020; 52:1743-1744. [DOI: 10.1002/jmri.27252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Accepted: 05/26/2020] [Indexed: 11/09/2022] Open
Affiliation(s)
- Maythem Saeed
- Department of Radiology and Biomedical Imaging, School of Medicine University of California San Francisco San Francisco California USA
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Zhou W, Lee JCY, Leung ST, Lai A, Lee TF, Chiang JB, Cheng YW, Chan HL, Yiu KH, Goh VKM, Pennell DJ, Ng MY. Long-Term Prognosis of Patients With Coronary Microvascular Disease Using Stress Perfusion Cardiac Magnetic Resonance. JACC Cardiovasc Imaging 2020; 14:602-611. [PMID: 33248966 DOI: 10.1016/j.jcmg.2020.09.034] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 07/20/2020] [Accepted: 09/03/2020] [Indexed: 12/28/2022]
Abstract
OBJECTIVES This study investigated the prognosis of coronary microvascular disease (CMD) as determined by stress perfusion cardiac magnetic resonance (CMR) in patients with ischemic symptoms but without significant coronary artery disease (CAD). BACKGROUND Patients with CMD have poorer prognosis with various cardiac diseases. The myocardial perfusion reserve index (MPRI) derived from noninvasive stress perfusion CMR has been established to diagnose microvascular angina with a threshold MPRI <1.4. The prognosis of CMD as determined by MPRI is unknown. METHODS Chest pain patients without epicardial CAD or myocardial disease from January 2009 to December 2017 were retrospectively included from 3 imaging centers in Hong Kong (HK). Stress perfusion CMR examinations were performed using either adenosine or adenosine triphosphate. Adequate stress was assessed by achieving splenic switch-off sign. Measurement of MPRI was performed in all stress perfusion CMR scans. Patients were followed for major adverse cardiovascular events defined as all-cause death, acute coronary syndrome (ACS), epicardial CAD development, heart failure hospitalization and non-fatal stroke. RESULTS A total of 218 patients were studied (mean age 59 ± 12 years; 49.5% male) and the average MPRI of that cohort was 1.56 ± 0.33. Females and a history of hyperlipidemia were predictors of lower MPRI. Major adverse cardiovascular events (MACE) occurred in 15.6% of patients during a median follow-up of 5.5 years (interquartile range: 4.6 to 6.8 years). The optimal cutoff value of MPRI in predicting MACE was found with a threshold MPRI ≤1.47. Patients with MPRI ≤1.47 had three-fold increased risk of MACE compared with those with MPRI >1.47 (hazard ratio [HR]: 3.14; 95% confidence interval [CI]: 1.58 to 6.25; p = 0.001). Multivariate Cox regression after adjusting for age and hypertension demonstrated that MPRI was an independent predictor of MACE (HR: 0.10; 95% CI: 0.03 to 0.34; p < 0.001). CONCLUSIONS Stress perfusion CMR-derived MPRI is an independent imaging marker that predicts MACE in patients with ischemic symptom and no overt CAD over the medium term.
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Affiliation(s)
- Wenli Zhou
- Department of Diagnostic Radiology, The University of Hong Kong, Hong Kong
| | | | - Siu Ting Leung
- Department of Radiology, Pamela Youde Nethersole Eastern Hospital, Hong Kong
| | - Alta Lai
- Department of Radiology, Pamela Youde Nethersole Eastern Hospital, Hong Kong
| | - Tang-Fei Lee
- Department of Radiology, Pamela Youde Nethersole Eastern Hospital, Hong Kong
| | | | - Yuet Wong Cheng
- Division of Cardiology, Department of Medicine, Queen Elizabeth Hospital, Hong Kong
| | - Hiu-Lam Chan
- Division of Cardiology, Department of Medicine, Pamela Youde Nethersole Eastern Hospital, Hong Kong
| | - Kai-Hang Yiu
- Division of Cardiology, Department of Medicine, The University of Hong Kong, Hong Kong
| | - Victor King-Man Goh
- Hong Kong Sanatorium and Hospital, Hong Kong; School of Public Health, The Chinese University of Hong Kong, Hong Kong
| | - Dudley John Pennell
- Cardiovascular Magnetic Resonance Unit, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom; National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Ming-Yen Ng
- Department of Diagnostic Radiology, The University of Hong Kong, Hong Kong; Department of Medical Imaging, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China.
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de Knegt MC, Rossi A, Petersen SE, Wragg A, Khurram R, Westwood M, Saberwal B, Mathur A, Nieman K, Bamberg F, Jensen MT, Pugliese F. Stress myocardial perfusion with qualitative magnetic resonance and quantitative dynamic computed tomography: comparison of diagnostic performance and incremental value over coronary computed tomography angiography. Eur Heart J Cardiovasc Imaging 2020:jeaa270. [PMID: 33029616 DOI: 10.1093/ehjci/jeaa270] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 09/23/2020] [Indexed: 12/16/2022] Open
Abstract
AIMS Assessment of haemodynamically significant coronary artery disease (CAD) using cardiovascular magnetic resonance (CMR) imaging perfusion or dynamic stress myocardial perfusion imaging by computed tomography (CT perfusion) may aid patient selection for invasive coronary angiography (ICA). We evaluated the diagnostic performance and incremental value of qualitative CMR perfusion and quantitative CT perfusion complementary to cardiac computed tomography angiography (CCTA) for the diagnosis of haemodynamically significant CAD using fractional flow reserve (FFR) and quantitative coronary angiography (QCA) as reference standard. METHODS AND RESULTS CCTA, qualitative visual CMR perfusion, visual CT perfusion, and quantitative relative myocardial blood flow (CT-MBF) were performed in patients with stable angina pectoris. FFR was measured in coronary vessels with stenosis visually estimated between 30% and 90% diameter reduction on ICA. Haemodynamically significant CAD was defined as FFR <0.80, or QCA ≥80% in those cases where FFR could not be performed. A total of 218 vessels from 93 patients were assessed. An optimal cut-off of 0.72 for relative CT-MBF was determined. The diagnostic performances (area under the receiver-operating characteristics curves, 95% CI) of visual CMR perfusion (0.84, 0.77-0.90) and relative CT-MBF (0.86, 0.81-0.92) were comparable and outperformed visual CT perfusion (0.64, 0.57-0.71). In combination with CCTA ≥50%, CCTA + visual CMR perfusion (0.91, 0.86-0.96), CCTA + relative CT-MBF (0.92, 0.88-0.96), and CCTA + visual CT perfusion (0.82, 0.75-0.90) improved discrimination compared with CCTA alone (all P < 0.05). CONCLUSION Visual CMR perfusion and relative CT-MBF outperformed visual CT perfusion and provided incremental discrimination compared with CCTA alone for the diagnosis of haemodynamically significant CAD.
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Affiliation(s)
- Martina C de Knegt
- Centre for Advanced Cardiovascular Imaging, William Harvey Research Institute, Barts NIHR Biomedical Research Centre, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield, London EC1A 7BE, UK
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Alexia Rossi
- Centre for Advanced Cardiovascular Imaging, William Harvey Research Institute, Barts NIHR Biomedical Research Centre, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield, London EC1A 7BE, UK
| | - Steffen E Petersen
- Centre for Advanced Cardiovascular Imaging, William Harvey Research Institute, Barts NIHR Biomedical Research Centre, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield, London EC1A 7BE, UK
| | - Andrew Wragg
- Centre for Advanced Cardiovascular Imaging, William Harvey Research Institute, Barts NIHR Biomedical Research Centre, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield, London EC1A 7BE, UK
| | - Ruhaid Khurram
- Centre for Advanced Cardiovascular Imaging, William Harvey Research Institute, Barts NIHR Biomedical Research Centre, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK
| | - Mark Westwood
- Centre for Advanced Cardiovascular Imaging, William Harvey Research Institute, Barts NIHR Biomedical Research Centre, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield, London EC1A 7BE, UK
| | - Bunny Saberwal
- Centre for Advanced Cardiovascular Imaging, William Harvey Research Institute, Barts NIHR Biomedical Research Centre, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield, London EC1A 7BE, UK
| | - Anthony Mathur
- Centre for Advanced Cardiovascular Imaging, William Harvey Research Institute, Barts NIHR Biomedical Research Centre, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield, London EC1A 7BE, UK
| | - Koen Nieman
- Department of Radiology and Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford University, 300 Pasteur Drive, Stanford, CA 94305, USA
| | - Fabian Bamberg
- Department of Diagnostic and Interventional Radiology, Medical Center, University of Freiburg, Hugstetter Straße 55, 79106 Freiburg, Germany
| | - Magnus T Jensen
- Centre for Advanced Cardiovascular Imaging, William Harvey Research Institute, Barts NIHR Biomedical Research Centre, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield, London EC1A 7BE, UK
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
- Department of Cardiology, Copenhagen University Hospital Herlev-Gentofte, Kildegaardsvej 28, 2900 Hellerup, Denmark
| | - Francesca Pugliese
- Centre for Advanced Cardiovascular Imaging, William Harvey Research Institute, Barts NIHR Biomedical Research Centre, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield, London EC1A 7BE, UK
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Buffa V, Di Renzi P. CMR in the diagnosis of ischemic heart disease. Radiol Med 2020; 125:1114-1123. [PMID: 32936388 DOI: 10.1007/s11547-020-01278-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 09/03/2020] [Indexed: 12/11/2022]
Abstract
Cardiovascular magnetic resonance has always been more often used in the last 10 years in evaluation of heart disease. Role in diagnosis of ischemia and in evaluation of myocardial infarction is well established by many scientific papers and included in current guidelines. High accuracy in evaluation of stress-induced ischemia, tissue characterization and functional parameters are the pillars the make the method widely used. In this paper are described role and techniques in diagnosis of ischemia, myocardial infarction and its sequelae.
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Affiliation(s)
- Vitaliano Buffa
- Department of Radiology, Azienda Ospedaliera San Camillo Forlanini, Rome, Italy.
| | - Paolo Di Renzi
- Department of Radiology, Ospedale San Giovanni Calibita FBF, Rome, Italy
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Gezmiş E, Peebles C, Flett A, Abbas A, Harden S, Shambrook J. Comparison of MOLLI and ShMOLLI in Terms of T1 Reactivity and the Relationship between T1 Reactivity and Conventional Signs of Response during Adenosine Stress Perfusion CMR. Balkan Med J 2020; 37:260-268. [PMID: 32319279 PMCID: PMC7424177 DOI: 10.4274/balkanmedj.galenos.2020.2019.12.161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Background: One of the most important techniques of cardiac magnetic resonance in assessment of coronary heart diseases is adenosine stress myocardial first-pass perfusion imaging. Using this imaging method, there should be an adequate response to the drug adenosine to make an accurate evaluation. The conventional signs of drug response are not always observed and are often subjective. Methods based on splenic perfusion might possess limitations as well. Therefore, T1 mapping presents as a novel, quantitative and reliable method. There are several studies analyzing this newly discovered property of different T1 mapping sequences. However most of these studies are enrolling only one of the techniques. Aims: To compare modified look-locker inversion recovery and shortened modified look-locker inversion recovery sequences in terms of T1 reactivity and to determine the relationship between T1 reactivity and conventional stress adequacy assessment methods in adenosine stress perfusion cardiac magnetic resonance. Study Design: A cross-sectional study using STARD reporting guideline. Methods: Thirty-four consecutive patients, who were referred for adenosine stress perfusion cardiac magnetic resonance with suspect of myocardial ischemia, were prospectively enrolled into the study. Four patients were disqualified, and thirty patients were included in the final analysis. Using both modified look-locker inversion recovery and shortened modified look-locker inversion recovery, midventricular short axis slices of T1 maps were acquired at rest and during peak adenosine stress before gadolinium administration. Then, they were divided into six segments according to the 17-segment model proposed by the American Heart Association, and separate measurements were made from each segment. Mean rest and mean stress T1 values of remote, ischemic, and infarcted myocardium were calculated individually per subject. During adenosine administration, patients’ heart rates and blood pressures are measured and recorded every one minute. Adenosine stress perfusion images were examined for the presence of splenic switch-off. Results: There was a significant difference between rest and stress T1 values of remote myocardium in both modified look-locker inversion recovery and shortened modified look-locker inversion recovery (p<0.001). In both modified look-locker inversion recovery and shortened modified look-locker inversion recovery there was no significant correlation between T1 reactivity and heart rates response (modified look-locker inversion recovery p=0.30, shortened modified look-locker inversion recovery p=0.10), blood pressures response (modified look-locker inversion recovery p=0.062, shortened modified look-locker inversion recovery p=0.078), splenic perfusion (modified look-locker inversion recovery p=0.35, shortened modified look-locker inversion recovery p=0.053). There was no statistically significant difference between modified look-locker inversion recovery and shortened modified look-locker inversion recovery regarding T1 reactivity of remote (p=0.330), ischemic (p=0.068), and infarcted (p=0.116) myocardium. Conclusion: T1 reactivity is independent of the other stress response signs and modified look-locker inversion recovery and shortened modified look-locker inversion recovery do not differ in terms of T1 reactivity.
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Affiliation(s)
- Esin Gezmiş
- Department of Radiology, Başkent University Hospital İzmir Practice and Research Center, İzmir, Turkey
| | - Charles Peebles
- Department of Cardiothoracic Radiology, Southampton University Hospital, Southampton, United Kingdom
| | - Andrew Flett
- Department of Cardiology, Southampton University Hospital, Southampton, United Kingdom
| | - Ausami Abbas
- Department of Cardiothoracic Radiology, Southampton University Hospital, Southampton, United Kingdom
| | - Stephen Harden
- Department of Cardiothoracic Radiology, Southampton University Hospital, Southampton, United Kingdom
| | - James Shambrook
- Department of Cardiothoracic Radiology, Southampton University Hospital, Southampton, United Kingdom
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Stimulation of the hepatic arterial buffer response using exogenous adenosine: hepatic rest/stress perfusion imaging. Eur Radiol 2020; 30:5852-5861. [DOI: 10.1007/s00330-020-06984-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 04/06/2020] [Accepted: 05/26/2020] [Indexed: 11/25/2022]
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Females have higher myocardial perfusion, blood volume and extracellular volume compared to males - an adenosine stress cardiovascular magnetic resonance study. Sci Rep 2020; 10:10380. [PMID: 32587326 PMCID: PMC7316834 DOI: 10.1038/s41598-020-67196-y] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 06/02/2020] [Indexed: 01/12/2023] Open
Abstract
Knowledge on sex differences in myocardial perfusion, blood volume (MBV), and extracellular volume (ECV) in healthy individuals is scarce and conflicting. Therefore, this was investigated quantitatively by cardiovascular magnetic resonance (CMR). Healthy volunteers (n = 41, 51% female) underwent CMR at 1.5 T. Quantitative MBV [%] and perfusion [ml/min/g] maps were acquired during adenosine stress and at rest following an intravenous contrast bolus (0.05 mmol/kg, gadobutrol). Native T1 maps were acquired before and during adenosine stress, and after contrast (0.2 mmol/kg) at rest and during adenosine stress, rendering rest and stress ECV maps. Compared to males, females had higher perfusion, ECV, and MBV at stress, and perfusion and ECV at rest (p < 0.01 for all). Multivariate linear regression revealed that sex and MBV were associated with perfusion (sex beta −0.31, p = 0.03; MBV beta −0.37, p = 0.01, model R2 = 0.29, p < 0.01) while sex and hematocrit were associated with ECV (sex beta −0.33, p = 0.03; hematocrit beta −0.48, p < 0.01, model R2 = 0.54, p < 0.001). Myocardial perfusion, MBV, and ECV are higher in female healthy volunteers compared to males. Sex is an independent contributor to perfusion and ECV, beyond other physiological factors that differ between the sexes. These findings provide mechanistic insight into sex differences in myocardial physiology.
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Giusca S, Wolf D, Hofmann N, Hagstotz S, Forschner M, Schueler M, Nunninger P, Kelle S, Korosoglou G. Splenic Switch-Off for Determining the Optimal Dosage for Adenosine Stress Cardiac MR in Terms of Stress Effectiveness and Patient Safety. J Magn Reson Imaging 2020; 52:1732-1742. [PMID: 32557923 DOI: 10.1002/jmri.27248] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 05/18/2020] [Accepted: 05/20/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Adenosine stress MRI is well established for the evaluation of known and suspected coronary artery disease. However, a proportion of patients might be "under-stressed" using the standard adenosine dose. PURPOSE To compare three different adenosine dosages for stress MRI in terms of stress adequacy based on splenic switch-off (SSO) and limiting side effects. STUDY TYPE Prospective. POPULATION In all, 100 patients were randomized in group 1 (33 pts), group 2 (34 pts), and group 3 (33 pts), receiving dosages of 140 μg/kg/min, 175 μg/kg/min, or 210 μg/kg/min, respectively. SSO was evaluated visually and quantitatively. SEQUENCE Stress perfusion was performed using a 1.5T scanner in three short axes using a standard single-shot, saturation recovery gradient-echo sequence. ASSESSMENT Three blinded experienced operators evaluated SSO on stress and rest perfusion acquisitions in the three groups. The signal intensity of the spleen and myocardium and the presence of inducible ischemia and late gadolinium enhancement were assessed. STATISTICAL ANALYSIS T-test, analysis of variance (ANOVA), chi-squared test, and Pearson's correlation coefficient. RESULTS SSO was present more frequently in patients receiving 175 μg/kg/min and 210 μg/kg/min (31/33 [94%] and 27/29 [93%], respectively) compared to those receiving the standard dose (19/33 [58%], P < 0.05). A positive stress result was noted in 3/33 (9%) patients receiving 140 μg/kg/min vs. 9/33 (27%) patients receiving 175 μg/kg/min and 10/31 (33%) patients receiving 210 μg/kg/min (P < 0.05 for all, P < 0.05 for group 1 vs. groups 2, 3). The relative decrease of splenic signal intensity at hyperemia vs. baseline was significantly lower in group 1 compared to groups 2 and 3 (-33% vs. -54%, -56%, respectively; P < 0.05). No adverse events during scanning were noted in groups 1 and 2, whereas in group 3 four examinations were stopped due to severe dyspnea (n = 2) and AV-blockage (n = 2). DATA CONCLUSION A dosage of 175 μg/kg/min adenosine results in a higher proportion of SSO, which may be an indirect marker of adequate coronary vasodilatation and simultaneously offers similar safety compared to the standard 140 μg/kg/min dosage. LEVEL OF EVIDENCE 1 TECHNICAL EFFICACY STAGE: 2 J. MAGN. RESON. IMAGING 2020;52:1732-1742.
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Affiliation(s)
- Sorin Giusca
- Department of Cardiology Angiology and Pneumology, GRN Hospital Weinheim, Weinheim, Germany
| | - David Wolf
- Department of Cardiology Angiology and Pneumology, GRN Hospital Weinheim, Weinheim, Germany
| | - Nina Hofmann
- Department of Cardiology Angiology and Pneumology, GRN Hospital Weinheim, Weinheim, Germany
| | - Saskia Hagstotz
- Department of Cardiology Angiology and Pneumology, GRN Hospital Weinheim, Weinheim, Germany
| | | | - Melanie Schueler
- Department of Cardiology Angiology and Pneumology, GRN Hospital Weinheim, Weinheim, Germany
| | | | - Sebastian Kelle
- Department of Internal Medicine/Cardiology, German Heart Center Berlin, Berlin, Germany.,Department of Internal Medicine/Cardiology, Charité Campus Virchow Clinic, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Grigorios Korosoglou
- Department of Cardiology Angiology and Pneumology, GRN Hospital Weinheim, Weinheim, Germany
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Westwood M, Knott KD. Stress CMR and Combination Testing in the World of Multimodality Imaging. JACC Cardiovasc Imaging 2020; 13:1161-1162. [DOI: 10.1016/j.jcmg.2020.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 02/10/2020] [Indexed: 11/29/2022]
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Knott KD, Seraphim A, Augusto JB, Xue H, Chacko L, Aung N, Petersen SE, Cooper JA, Manisty C, Bhuva AN, Kotecha T, Bourantas CV, Davies RH, Brown LA, Plein S, Fontana M, Kellman P, Moon JC. The Prognostic Significance of Quantitative Myocardial Perfusion: An Artificial Intelligence-Based Approach Using Perfusion Mapping. Circulation 2020; 141:1282-1291. [PMID: 32078380 PMCID: PMC7176346 DOI: 10.1161/circulationaha.119.044666] [Citation(s) in RCA: 66] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 01/23/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND Myocardial perfusion reflects the macro- and microvascular coronary circulation. Recent quantitation developments using cardiovascular magnetic resonance perfusion permit automated measurement clinically. We explored the prognostic significance of stress myocardial blood flow (MBF) and myocardial perfusion reserve (MPR, the ratio of stress to rest MBF). METHODS A 2-center study of patients with both suspected and known coronary artery disease referred clinically for perfusion assessment. Image analysis was performed automatically using a novel artificial intelligence approach deriving global and regional stress and rest MBF and MPR. Cox proportional hazard models adjusting for comorbidities and cardiovascular magnetic resonance parameters sought associations of stress MBF and MPR with death and major adverse cardiovascular events (MACE), including myocardial infarction, stroke, heart failure hospitalization, late (>90 day) revascularization, and death. RESULTS A total of 1049 patients were included with a median follow-up of 605 (interquartile range, 464-814) days. There were 42 (4.0%) deaths and 188 MACE in 174 (16.6%) patients. Stress MBF and MPR were independently associated with both death and MACE. For each 1 mL·g-1·min-1 decrease in stress MBF, the adjusted hazard ratios for death and MACE were 1.93 (95% CI, 1.08-3.48, P=0.028) and 2.14 (95% CI, 1.58-2.90, P<0.0001), respectively, even after adjusting for age and comorbidity. For each 1 U decrease in MPR, the adjusted hazard ratios for death and MACE were 2.45 (95% CI, 1.42-4.24, P=0.001) and 1.74 (95% CI, 1.36-2.22, P<0.0001), respectively. In patients without regional perfusion defects on clinical read and no known macrovascular coronary artery disease (n=783), MPR remained independently associated with death and MACE, with stress MBF remaining associated with MACE only. CONCLUSIONS In patients with known or suspected coronary artery disease, reduced MBF and MPR measured automatically inline using artificial intelligence quantification of cardiovascular magnetic resonance perfusion mapping provides a strong, independent predictor of adverse cardiovascular outcomes.
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Affiliation(s)
- Kristopher D. Knott
- Institute of Cardiovascular Science, University College London, United Kingdom (K.D.K., A.S., J.B.A., L.C., C.M., A.N.B., T.K., C.V.B., R.H.D., M.F., J.C.M.)
- Barts Heart Centre, St Bartholomew’s Hospital, London, United Kingdom (K.D.K., A.S., J.B.A., N.A., S.E.P., C.M., A.N.B., C.V.B., R.H.D., J.C.M.)
| | - Andreas Seraphim
- Institute of Cardiovascular Science, University College London, United Kingdom (K.D.K., A.S., J.B.A., L.C., C.M., A.N.B., T.K., C.V.B., R.H.D., M.F., J.C.M.)
- Barts Heart Centre, St Bartholomew’s Hospital, London, United Kingdom (K.D.K., A.S., J.B.A., N.A., S.E.P., C.M., A.N.B., C.V.B., R.H.D., J.C.M.)
| | - Joao B. Augusto
- Institute of Cardiovascular Science, University College London, United Kingdom (K.D.K., A.S., J.B.A., L.C., C.M., A.N.B., T.K., C.V.B., R.H.D., M.F., J.C.M.)
- Barts Heart Centre, St Bartholomew’s Hospital, London, United Kingdom (K.D.K., A.S., J.B.A., N.A., S.E.P., C.M., A.N.B., C.V.B., R.H.D., J.C.M.)
| | - Hui Xue
- National Heart, Lung, and Blood Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, MD (H.X., P.K.)
| | - Liza Chacko
- Institute of Cardiovascular Science, University College London, United Kingdom (K.D.K., A.S., J.B.A., L.C., C.M., A.N.B., T.K., C.V.B., R.H.D., M.F., J.C.M.)
- Royal Free Hospital, London, United Kingdom (L.C., T.K., M.F.)
| | - Nay Aung
- Barts Heart Centre, St Bartholomew’s Hospital, London, United Kingdom (K.D.K., A.S., J.B.A., N.A., S.E.P., C.M., A.N.B., C.V.B., R.H.D., J.C.M.)
- William Harvey Research Institute, Queen Mary University of London, United Kingdom (N.A., S.E.P., J.A.C.)
| | - Steffen E. Petersen
- Barts Heart Centre, St Bartholomew’s Hospital, London, United Kingdom (K.D.K., A.S., J.B.A., N.A., S.E.P., C.M., A.N.B., C.V.B., R.H.D., J.C.M.)
- William Harvey Research Institute, Queen Mary University of London, United Kingdom (N.A., S.E.P., J.A.C.)
| | - Jackie A. Cooper
- William Harvey Research Institute, Queen Mary University of London, United Kingdom (N.A., S.E.P., J.A.C.)
| | - Charlotte Manisty
- Institute of Cardiovascular Science, University College London, United Kingdom (K.D.K., A.S., J.B.A., L.C., C.M., A.N.B., T.K., C.V.B., R.H.D., M.F., J.C.M.)
- Barts Heart Centre, St Bartholomew’s Hospital, London, United Kingdom (K.D.K., A.S., J.B.A., N.A., S.E.P., C.M., A.N.B., C.V.B., R.H.D., J.C.M.)
| | - Anish N. Bhuva
- Institute of Cardiovascular Science, University College London, United Kingdom (K.D.K., A.S., J.B.A., L.C., C.M., A.N.B., T.K., C.V.B., R.H.D., M.F., J.C.M.)
- Barts Heart Centre, St Bartholomew’s Hospital, London, United Kingdom (K.D.K., A.S., J.B.A., N.A., S.E.P., C.M., A.N.B., C.V.B., R.H.D., J.C.M.)
| | - Tushar Kotecha
- Institute of Cardiovascular Science, University College London, United Kingdom (K.D.K., A.S., J.B.A., L.C., C.M., A.N.B., T.K., C.V.B., R.H.D., M.F., J.C.M.)
- Royal Free Hospital, London, United Kingdom (L.C., T.K., M.F.)
| | - Christos V. Bourantas
- Institute of Cardiovascular Science, University College London, United Kingdom (K.D.K., A.S., J.B.A., L.C., C.M., A.N.B., T.K., C.V.B., R.H.D., M.F., J.C.M.)
- Barts Heart Centre, St Bartholomew’s Hospital, London, United Kingdom (K.D.K., A.S., J.B.A., N.A., S.E.P., C.M., A.N.B., C.V.B., R.H.D., J.C.M.)
| | - Rhodri H. Davies
- Institute of Cardiovascular Science, University College London, United Kingdom (K.D.K., A.S., J.B.A., L.C., C.M., A.N.B., T.K., C.V.B., R.H.D., M.F., J.C.M.)
- Barts Heart Centre, St Bartholomew’s Hospital, London, United Kingdom (K.D.K., A.S., J.B.A., N.A., S.E.P., C.M., A.N.B., C.V.B., R.H.D., J.C.M.)
| | - Louise A.E. Brown
- Department of Biomedical Imaging Science, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, United Kingdom (L.A.E.B., S.P.)
| | - Sven Plein
- Department of Biomedical Imaging Science, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, United Kingdom (L.A.E.B., S.P.)
| | - Marianna Fontana
- Institute of Cardiovascular Science, University College London, United Kingdom (K.D.K., A.S., J.B.A., L.C., C.M., A.N.B., T.K., C.V.B., R.H.D., M.F., J.C.M.)
- Royal Free Hospital, London, United Kingdom (L.C., T.K., M.F.)
| | - Peter Kellman
- National Heart, Lung, and Blood Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, MD (H.X., P.K.)
| | - James C. Moon
- Institute of Cardiovascular Science, University College London, United Kingdom (K.D.K., A.S., J.B.A., L.C., C.M., A.N.B., T.K., C.V.B., R.H.D., M.F., J.C.M.)
- Barts Heart Centre, St Bartholomew’s Hospital, London, United Kingdom (K.D.K., A.S., J.B.A., N.A., S.E.P., C.M., A.N.B., C.V.B., R.H.D., J.C.M.)
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Schulz-Menger J, Bluemke DA, Bremerich J, Flamm SD, Fogel MA, Friedrich MG, Kim RJ, von Knobelsdorff-Brenkenhoff F, Kramer CM, Pennell DJ, Plein S, Nagel E. Standardized image interpretation and post-processing in cardiovascular magnetic resonance - 2020 update : Society for Cardiovascular Magnetic Resonance (SCMR): Board of Trustees Task Force on Standardized Post-Processing. J Cardiovasc Magn Reson 2020; 22:19. [PMID: 32160925 PMCID: PMC7066763 DOI: 10.1186/s12968-020-00610-6] [Citation(s) in RCA: 445] [Impact Index Per Article: 111.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 02/17/2020] [Indexed: 01/04/2023] Open
Abstract
With mounting data on its accuracy and prognostic value, cardiovascular magnetic resonance (CMR) is becoming an increasingly important diagnostic tool with growing utility in clinical routine. Given its versatility and wide range of quantitative parameters, however, agreement on specific standards for the interpretation and post-processing of CMR studies is required to ensure consistent quality and reproducibility of CMR reports. This document addresses this need by providing consensus recommendations developed by the Task Force for Post-Processing of the Society for Cardiovascular Magnetic Resonance (SCMR). The aim of the Task Force is to recommend requirements and standards for image interpretation and post-processing enabling qualitative and quantitative evaluation of CMR images. Furthermore, pitfalls of CMR image analysis are discussed where appropriate. It is an update of the original recommendations published 2013.
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Affiliation(s)
- Jeanette Schulz-Menger
- Department of Cardiology and Nephrology, Working Group on Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center, a joint cooperation between the Charité Medical Faculty and the Max-Delbrueck Center for Molecular Medicine, and HELIOS Klinikum Berlin Buch, Schwanebecker Chaussee 50, 13125, Berlin, Germany.
| | - David A Bluemke
- University of Wisconsin School of Medicine and Public Health, Madison, USA
| | - Jens Bremerich
- Department of Radiology of the University Hospital Basel, Basel, Switzerland
| | - Scott D Flamm
- Imaging, and Heart and Vascular Institutes, Cleveland Clinic, Cleveland, OH, USA
| | - Mark A Fogel
- Department of Radiology, Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - Matthias G Friedrich
- Departments of Medicine and Diagnostic Radiology, McGill University, Montreal, QC, Canada
| | - Raymond J Kim
- Duke Cardiovascular Magnetic Resonance Center, and Departments of Medicine and Radiology, Duke University Medical Center, Durham, NC, USA
| | | | - Christopher M Kramer
- Departments of Medicine and Radiology and the Cardiovascular Imaging Center, University of Virginia Health System, Charlottesville, VA, USA
| | | | - Sven Plein
- Leeds Institute for Genetics Health and Therapeutics & Leeds Multidisciplinary Cardiovascular Research Centre, University of Leeds, Leeds, UK
| | - Eike Nagel
- Institute for Experimental and Translational Cardiovascular Imaging, DZHK (German Centre for Cardiovascular Research) Centre for Cardiovascular Imaging, partner site RheinMain, University Hospital Frankfurt, Frankfurt am Main, Germany
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Xue H, Brown LA, Nielles-Vallespin S, Plein S, Kellman P. Automatic in-line quantitative myocardial perfusion mapping: Processing algorithm and implementation. Magn Reson Med 2020; 83:712-730. [PMID: 31441550 PMCID: PMC8400845 DOI: 10.1002/mrm.27954] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 06/27/2019] [Accepted: 07/27/2019] [Indexed: 02/03/2023]
Abstract
PURPOSE Quantitative myocardial perfusion mapping has advantages over qualitative assessment, including the ability to detect global flow reduction. However, it is not clinically available and remains a research tool. Building upon the previously described imaging sequence, this study presents algorithm and implementation of an automated solution for inline perfusion flow mapping with step by step performance characterization. METHODS Proposed workflow consists of motion correction (MOCO), arterial input function blood detection, intensity to gadolinium concentration conversion, and pixel-wise mapping. A distributed kinetics model, blood-tissue exchange model, is implemented, computing pixel-wise maps of myocardial blood flow (mL/min/g), permeability-surface-area product (mL/min/g), blood volume (mL/g), and interstitial volume (mL/g). RESULTS Thirty healthy subjects (11 men; 26.4 ± 10.4 years) were recruited and underwent adenosine stress perfusion cardiovascular MR. Mean MOCO quality score was 3.6 ± 0.4 for stress and 3.7 ± 0.4 for rest. Myocardial Dice similarity coefficients after MOCO were significantly improved (P < 1e-6), 0.87 ± 0.05 for stress and 0.86 ± 0.06 for rest. Arterial input function peak gadolinium concentration was 4.4 ± 1.3 mmol/L at stress and 5.2 ± 1.5 mmol/L at rest. Mean myocardial blood flow at stress and rest were 2.82 ± 0.47 mL/min/g and 0.68 ± 0.16 mL/min/g, respectively. The permeability-surface-area product was 1.32 ± 0.26 mL/min/g at stress and 1.09 ± 0.21 mL/min/g at rest (P < 1e-3). Blood volume was 12.0 ± 0.8 mL/100 g at stress and 9.7 ± 1.0 mL/100 g at rest (P < 1e-9), indicating good adenosine vasodilation response. Interstitial volume was 20.8 ± 2.5 mL/100 g at stress and 20.3 ± 2.9 mL/100 g at rest (P = 0.50). CONCLUSIONS An inline perfusion flow mapping workflow is proposed and demonstrated on normal volunteers. Initial evaluation demonstrates this fully automated solution for the respiratory MOCO, arterial input function left ventricle mask detection, and pixel-wise mapping, from free-breathing myocardial perfusion imaging.
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Affiliation(s)
- Hui Xue
- National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Louise A.E. Brown
- Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United Kingdom
| | | | - Sven Plein
- Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United Kingdom
| | - Peter Kellman
- National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland
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Akincioglu C, Malhotra S. Low yield of routine stress testing in patients awaiting liver transplantation. J Nucl Cardiol 2020; 27:266-268. [PMID: 30168030 DOI: 10.1007/s12350-018-1409-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 08/08/2018] [Indexed: 12/15/2022]
Affiliation(s)
- Cigdem Akincioglu
- Division of Nuclear Medicine, Department of Medical Imaging, University of Western Ontario, London, ON, Canada
| | - Saurabh Malhotra
- Division of Cardiovascular Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, USA.
- Clinical and Translational Research Center, 875 Ellicott Street, Suite 7030, Buffalo, NY, 14203, USA.
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Rischpler C, Totzeck M. Are you stressed? J Nucl Cardiol 2019; 26:1898-1900. [PMID: 29948893 DOI: 10.1007/s12350-018-1332-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Accepted: 05/22/2018] [Indexed: 11/26/2022]
Affiliation(s)
- C Rischpler
- Department of Nuclear Medicine, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.
| | - M Totzeck
- Department of Cardiology and Vascular Medicine, University Hospital Essen, West German Heart and Vascular Center, University of Duisburg, Essen, Germany
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