1
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Ge Y. CMR in the dynamic assessment of MR. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2024; 40:1399-1400. [PMID: 38976109 DOI: 10.1007/s10554-024-03189-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/09/2024]
Affiliation(s)
- Yin Ge
- Division of Cardiology, Department of Medicine, St. Michael's Hospital, University of Toronto, 30 Bond Street, Toronto, ON, M5B 1W8, Canada.
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2
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Morales MA, Yoon S, Fahmy A, Ghanbari F, Nakamori S, Rodriguez J, Yue J, Street JA, Herzka DA, Manning WJ, Nezafat R. Highly accelerated free-breathing real-time myocardial tagging for exercise cardiovascular magnetic resonance. J Cardiovasc Magn Reson 2023; 25:56. [PMID: 37784153 PMCID: PMC10544487 DOI: 10.1186/s12968-023-00961-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 09/11/2023] [Indexed: 10/04/2023] Open
Abstract
BACKGROUND Exercise cardiovascular magnetic resonance (Ex-CMR) myocardial tagging would enable quantification of myocardial deformation after exercise. However, current electrocardiogram (ECG)-segmented sequences are limited for Ex-CMR. METHODS We developed a highly accelerated balanced steady-state free-precession real-time tagging technique for 3 T. A 12-fold acceleration was achieved using incoherent sixfold random Cartesian sampling, twofold truncated outer phase encoding, and a deep learning resolution enhancement model. The technique was tested in two prospective studies. In a rest study of 27 patients referred for clinical CMR and 19 healthy subjects, a set of ECG-segmented for comparison and two sets of real-time tagging images for repeatability assessment were collected in 2-chamber and short-axis views with spatiotemporal resolution 2.0 × 2.0 mm2 and 29 ms. In an Ex-CMR study of 26 patients with known or suspected cardiac disease and 23 healthy subjects, real-time images were collected before and after exercise. Deformation was quantified using measures of short-axis global circumferential strain (GCS). Two experienced CMR readers evaluated the image quality of all real-time data pooled from both studies using a 4-point Likert scale for tagline quality (1-excellent; 2-good; 3-moderate; 4-poor) and artifact level (1-none; 2-minimal; 3-moderate; 4-significant). Statistical evaluation included Pearson correlation coefficient (r), intraclass correlation coefficient (ICC), and coefficient of variation (CoV). RESULTS In the rest study, deformation was successfully quantified in 90% of cases. There was a good correlation (r = 0.71) between ECG-segmented and real-time measures of GCS, and repeatability was good to excellent (ICC = 0.86 [0.71, 0.94]) with a CoV of 4.7%. In the Ex-CMR study, deformation was successfully quantified in 96% of subjects pre-exercise and 84% of subjects post-exercise. Short-axis and 2-chamber tagline quality were 1.6 ± 0.7 and 1.9 ± 0.8 at rest and 1.9 ± 0.7 and 2.5 ± 0.8 after exercise, respectively. Short-axis and 2-chamber artifact level was 1.2 ± 0.5 and 1.4 ± 0.7 at rest and 1.3 ± 0.6 and 1.5 ± 0.8 post-exercise, respectively. CONCLUSION We developed a highly accelerated real-time tagging technique and demonstrated its potential for Ex-CMR quantification of myocardial deformation. Further studies are needed to assess the clinical utility of our technique.
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Affiliation(s)
- Manuel A Morales
- Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Ave., Boston, MA, 02215, USA
| | - Siyeop Yoon
- Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Ave., Boston, MA, 02215, USA
| | - Ahmed Fahmy
- Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Ave., Boston, MA, 02215, USA
| | - Fahime Ghanbari
- Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Ave., Boston, MA, 02215, USA
| | - Shiro Nakamori
- Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Ave., Boston, MA, 02215, USA
| | - Jennifer Rodriguez
- Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Ave., Boston, MA, 02215, USA
| | - Jennifer Yue
- Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Ave., Boston, MA, 02215, USA
| | - Jordan A Street
- Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Ave., Boston, MA, 02215, USA
| | | | - Warren J Manning
- Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Ave., Boston, MA, 02215, USA
- Department of Radiology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, USA
| | - Reza Nezafat
- Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Ave., Boston, MA, 02215, USA.
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3
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Vinco G, Dugo C, Rigolli M, Demattè C, Giovanelli C, Caruso F, Marinetti A, Chiampan A, Cicciò C, Quattrocchi CC, Molon G, Del Greco M. Stress Cardiovascular Magnetic Resonance Imaging for the Detection of Coronary Artery Disease. Rev Cardiovasc Med 2023; 24:254. [PMID: 39076403 PMCID: PMC11270085 DOI: 10.31083/j.rcm2409254] [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: 11/15/2022] [Revised: 03/10/2023] [Accepted: 05/16/2023] [Indexed: 07/31/2024] Open
Abstract
Stress cardiovascular magnetic resonance (CMR) imaging has received extensive validation for the assessment of ischemic heart disease. Without ionizing radiation exposure, it offers in-depth information regarding cardiac structure and function, presence and degree of myocardial ischemia and myocardial viability. When compared to other imaging modalities, it has demonstrated excellent sensitivity and specificity in detecting functionally relevant coronary artery stenosis, as well as strong prognostic value in clinical risk stratification. The current scientific data support a greater expansion of stress CMR. This review investigates the current stress CMR techniques and protocols, as well as its relevance in diagnosis and prognosis of coronary artery disease.
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Affiliation(s)
- Giulia Vinco
- Division of Cardiology, Santa Maria del Carmine Hospital, APSS, 38068
Rovereto, Italy
| | - Clementina Dugo
- Division of Cardiology, IRCCS Sacro Cuore Don Calabria Hospital, 37024
Negrar, Italy
| | - Marzia Rigolli
- Division of Cardiology, Department of Medicine, Azienda Ospedaliera
Universitaria Integrata Verona, 37126 Verona, Italy
| | - Cristina Demattè
- Division of Cardiology, Santa Maria del Carmine Hospital, APSS, 38068
Rovereto, Italy
| | - Cristiana Giovanelli
- Division of Cardiology, Santa Maria del Carmine Hospital, APSS, 38068
Rovereto, Italy
| | - Fabio Caruso
- Division of Radiology, Santa Maria del Carmine Hospital, APSS, 38068
Rovereto, Italy
| | - Alessandro Marinetti
- Division of Radiology, Santa Maria del Carmine Hospital, APSS, 38068
Rovereto, Italy
| | - Andrea Chiampan
- Division of Cardiology, IRCCS Sacro Cuore Don Calabria Hospital, 37024
Negrar, Italy
| | - Carmelo Cicciò
- Division of Radiology, IRCCS Sacro Cuore Don Calabria Hospital, 37024
Negrar, Italy
| | - Carlo Cosimo Quattrocchi
- Division of Radiology, Santa Maria del Carmine Hospital, APSS, 38068
Rovereto, Italy
- Center for Medical Sciences - CISMed, University of Trento, 38122 Trento,
Italy
| | - Giulio Molon
- Division of Cardiology, IRCCS Sacro Cuore Don Calabria Hospital, 37024
Negrar, Italy
| | - Maurizio Del Greco
- Division of Cardiology, Santa Maria del Carmine Hospital, APSS, 38068
Rovereto, Italy
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4
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Silva TQAC, Pezel T, Jerosch-Herold M, Coelho-Filho OR. The Role and Advantages of Cardiac Magnetic Resonance in the Diagnosis of Myocardial Ischemia. J Thorac Imaging 2023; 38:235-246. [PMID: 36917509 DOI: 10.1097/rti.0000000000000701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/15/2023]
Abstract
Ischemic heart disease continues to be the leading cause of death and disability worldwide. For the diagnosis of ischemic heart disease, some form of cardiac stress test involving exercise or pharmacological stimulation continues to play an important role, despite advances within modalities like computer tomography for the noninvasive detection and characterization of epicardial coronary lesions. Among noninvasive stress imaging tests, cardiac magnetic resonance (CMR) combines several capabilities that are highly relevant for the diagnosis of ischemic heart disease: assessment of wall motion abnormalities, myocardial perfusion imaging, and depiction of replacement and interstitial fibrosis markers by late gadolinium enhancement techniques and T1 mapping. On top of these qualities, CMR is also well tolerated and safe in most clinical scenarios, including in the presence of cardiovascular implantable devices, while in the presence of renal disease, gadolinium-based contrast should only be used according to guidelines. CMR also offers outstanding viability assessment and prognostication of cardiovascular events. The last 2019 European Society of Cardiology guidelines for chronic coronary syndromes has positioned stress CMR as a class I noninvasive imaging technique for the diagnosis of coronary artery disease in symptomatic patients. In the present review, we present the current state-of-the-art assessment of myocardial ischemia by stress perfusion CMR, highlighting its advantages and current shortcomings. We discuss the safety, clinical, and cost-effectiveness aspects of gadolinium-based CMR-perfusion imaging for ischemic heart disease assessment.
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Affiliation(s)
- Thiago Quinaglia A C Silva
- Discipline of Cardiology, Faculty of Medical Science-State University of Campinas-UNICAMP, Campinas, São Paulo, Brazil
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD
| | - Théo Pezel
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD
- Department of Cardiology, University of Paris, CHU Lariboisière, Inserm, UMRS 942, Paris, France
| | - Michael Jerosch-Herold
- Noninvasive Cardiovascular Imaging Program and Department of Radiology, Brigham and Women's Hospital, Boston, MA
| | - Otávio R Coelho-Filho
- Discipline of Cardiology, Faculty of Medical Science-State University of Campinas-UNICAMP, Campinas, São Paulo, Brazil
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5
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Hamilton-Craig C, Ugander M, Greenwood JP, Kozor R. Stress perfusion cardiovascular magnetic resonance imaging: a guide for the general cardiologist. Heart 2023; 109:428-433. [PMID: 36371659 DOI: 10.1136/heartjnl-2022-321630] [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: 07/15/2022] [Accepted: 08/10/2022] [Indexed: 11/04/2022] Open
Abstract
Stress cardiovascular magnetic resonance (CMR) is an emerging non-invasive imaging technique for the assessment of known or suspected ischaemic heart disease (IHD). Stress CMR provides information on myocardial perfusion, wall motion, ventricular dimensions and volumes, as well as late gadolinium enhancement (LGE) scar imaging in a single test without ionising radiation. Data from numerous multicentre randomised studies show high diagnostic and prognostic utility, its efficacy as a gatekeeper to invasive coronary angiography and use for guiding coronary revascularisation decisions. Stress CMR is cost-effective across multiple healthcare settings, yet its uptake and usage varies worldwide and is an underutilised technology. New developments include rapid acquisition protocols, automated quantification of perfusion and myocardial blood flow, and artificial intelligence-aided automated analysis and reporting. Stress CMR is becoming more accessible and standardised around the globe and is ready for 'prime time' use in the non-invasive assessment of patients with suspected IHD.
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Affiliation(s)
- Christian Hamilton-Craig
- Faculty of Medicine and Centre for Advanced Imaging, The University of Queensland, Brisbane, Queensland, Australia .,School of Medicine, Griffith University, Sunshine Coast, Queensland, Australia
| | - Martin Ugander
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,Department of Clinical Physiology, Karolinska Institute, Stockholm, Stockholm, Sweden
| | - John P Greenwood
- Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK.,Biomedical Imaging Sciences, University of Leeds, Leeds, UK
| | - Rebecca Kozor
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
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6
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Sierra-Galan LM, Aggarwal NR, Stojanovska J, Raman SV, Han Y, Ferreira VM, Thomas K, Seiberlich N, Parwani P, Bucciarelli-Ducci C, Baldassarre LA, Mavrogeni S, Ordovas K, Schulz-Menger J, Bandettini WP. Women physicians in cardiovascular magnetic resonance: Past, present, and future. Front Cardiovasc Med 2023; 9:984326. [PMID: 36684587 PMCID: PMC9848434 DOI: 10.3389/fcvm.2022.984326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 12/12/2022] [Indexed: 01/06/2023] Open
Abstract
Women's engagement in medicine, and more specifically cardiovascular imaging and cardiovascular MRI (CMR), has undergone a slow evolution over the past several decades. As a result, an increasing number of women have joined the cardiovascular imaging community to contribute their expertise. This collaborative work summarizes the barriers that women in cardiovascular imaging have overcome over the past several years, the positive interventions that have been implemented to better support women in the field of CMR, and the challenges that still remain, with a special emphasis on women physicians.
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Affiliation(s)
- Lilia M. Sierra-Galan
- Cardiology Department of the Cardiovascular Division at the American British Cowdray Medical Center, Mexico City, Mexico
| | - Niti R. Aggarwal
- Department of Cardiovascular Disease, Mayo Clinic, Rochester, MN, United States
| | | | - Subha V. Raman
- Indiana University School of Medicine, Indianapolis, IN, United States
| | - Yuchi Han
- The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Vanessa M. Ferreira
- University of Oxford Centre for Clinical Magnetic Resonance Research, Oxford British Heart Foundation Centre of Research Excellence, The National Institute for Health Research Oxford Biomedical Research Centre at the Oxford University Hospitals NHS Foundation Trust, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Katharine Thomas
- University of Oxford Centre for Clinical Magnetic Resonance Research, Oxford British Heart Foundation Centre of Research Excellence, The National Institute for Health Research Oxford Biomedical Research Centre at the Oxford University Hospitals NHS Foundation Trust, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Nicole Seiberlich
- Department of Radiology, University of Michigan, Ann Arbor, MI, United States
| | - Purvi Parwani
- Division of Cardiology, Department of Medicine, Loma Linda University Health, Loma Linda, CA, United States
| | | | - Lauren A. Baldassarre
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT, United States
| | | | - Karen Ordovas
- Department of Radiology, University of Washington, Seattle, WA, United States
| | - Jeanette Schulz-Menger
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, ECRC Cardiology, Helios-Clinics Berlin-Buch, Clinic of Cardiology and Nephrology, DZHK Partnersite Berlin, Berlin, Germany
| | - W. Patricia Bandettini
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, United States
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7
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Morales MA, Assana S, Cai X, Chow K, Haji-Valizadeh H, Sai E, Tsao C, Matos J, Rodriguez J, Berg S, Whitehead N, Pierce P, Goddu B, Manning WJ, Nezafat R. An inline deep learning based free-breathing ECG-free cine for exercise cardiovascular magnetic resonance. J Cardiovasc Magn Reson 2022; 24:47. [PMID: 35948936 PMCID: PMC9367083 DOI: 10.1186/s12968-022-00879-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 07/21/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Exercise cardiovascular magnetic resonance (Ex-CMR) is a promising stress imaging test for coronary artery disease (CAD). However, Ex-CMR requires accelerated imaging techniques that result in significant aliasing artifacts. Our goal was to develop and evaluate a free-breathing and electrocardiogram (ECG)-free real-time cine with deep learning (DL)-based radial acceleration for Ex-CMR. METHODS A 3D (2D + time) convolutional neural network was implemented to suppress artifacts from aliased radial cine images. The network was trained using synthetic real-time radial cine images simulated using breath-hold, ECG-gated segmented Cartesian k-space data acquired at 3 T from 503 patients at rest. A prototype real-time radial sequence with acceleration rate = 12 was used to collect images with inline DL reconstruction. Performance was evaluated in 8 healthy subjects in whom only rest images were collected. Subsequently, 14 subjects (6 healthy and 8 patients with suspected CAD) were prospectively recruited for an Ex-CMR to evaluate image quality. At rest (n = 22), standard breath-hold ECG-gated Cartesian segmented cine and free-breathing ECG-free real-time radial cine images were acquired. During post-exercise stress (n = 14), only real-time radial cine images were acquired. Three readers evaluated residual artifact level in all collected images on a 4-point Likert scale (1-non-diagnostic, 2-severe, 3-moderate, 4-minimal). RESULTS The DL model substantially suppressed artifacts in real-time radial cine images acquired at rest and during post-exercise stress. In real-time images at rest, 89.4% of scores were moderate to minimal. The mean score was 3.3 ± 0.7, representing increased (P < 0.001) artifacts compared to standard cine (3.9 ± 0.3). In real-time images during post-exercise stress, 84.6% of scores were moderate to minimal, and the mean artifact level score was 3.1 ± 0.6. Comparison of left-ventricular (LV) measures derived from standard and real-time cine at rest showed differences in LV end-diastolic volume (3.0 mL [- 11.7, 17.8], P = 0.320) that were not significantly different from zero. Differences in measures of LV end-systolic volume (7.0 mL [- 1.3, 15.3], P < 0.001) and LV ejection fraction (- 5.0% [- 11.1, 1.0], P < 0.001) were significant. Total inline reconstruction time of real-time radial images was 16.6 ms per frame. CONCLUSIONS Our proof-of-concept study demonstrated the feasibility of inline real-time cine with DL-based radial acceleration for Ex-CMR.
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Affiliation(s)
- Manuel A Morales
- Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Ave., Boston, MA, 02215, USA
| | - Salah Assana
- Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Ave., Boston, MA, 02215, USA
| | - Xiaoying Cai
- Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Ave., Boston, MA, 02215, USA
- Siemens Medical Solutions USA, Inc, Chicago, IL, USA
| | - Kelvin Chow
- Siemens Medical Solutions USA, Inc, Chicago, IL, USA
| | - Hassan Haji-Valizadeh
- Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Ave., Boston, MA, 02215, USA
| | - Eiryu Sai
- Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Ave., Boston, MA, 02215, USA
| | - Connie Tsao
- Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Ave., Boston, MA, 02215, USA
| | - Jason Matos
- Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Ave., Boston, MA, 02215, USA
| | - Jennifer Rodriguez
- Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Ave., Boston, MA, 02215, USA
| | - Sophie Berg
- Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Ave., Boston, MA, 02215, USA
| | - Neal Whitehead
- Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Ave., Boston, MA, 02215, USA
| | - Patrick Pierce
- Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Ave., Boston, MA, 02215, USA
| | - Beth Goddu
- Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Ave., Boston, MA, 02215, USA
| | - Warren J Manning
- Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Ave., Boston, MA, 02215, USA
- Department of Radiology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - Reza Nezafat
- Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Ave., Boston, MA, 02215, USA.
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8
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Guo R, Qi H, Amyar A, Cai X, Kucukseymen S, Haji-Valizadeh H, Rodriguez J, Paskavitz A, Pierce P, Goddu B, Thompson RB, Nezafat R. Quantification of changes in myocardial T 1 * values with exercise cardiac MRI using a free-breathing non-electrocardiograph radial imaging. Magn Reson Med 2022; 88:1720-1733. [PMID: 35691942 DOI: 10.1002/mrm.29346] [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: 08/14/2021] [Revised: 05/09/2022] [Accepted: 05/16/2022] [Indexed: 11/11/2022]
Abstract
PURPOSE To develop and evaluate a free breathing non-electrocardiograph (ECG) myocardial T1 * mapping sequence using radial imaging to quantify the changes in myocardial T1 * between rest and exercise (T1 *reactivity ) in exercise cardiac MRI (Ex-CMR). METHODS A free-running T1 * sequence was developed using a saturation pulse followed by three Look-Locker inversion-recovery experiments. Each Look-Locker continuously acquired data as radial trajectory using a low flip-angle spoiled gradient-echo readout. Self-navigation was performed with a temporal resolution of ∼100 ms for retrospectively extracting respiratory motion. The mid-diastole phase for every cardiac cycle was retrospectively detected on the recorded electrocardiogram signal using an empirical model. Multiple measurements were performed to obtain mean value to reduce effects from the free-breathing acquisition. Finally, data acquired at both mid-diastole and end-expiration are picked and reconstructed by a low-rank plus sparsity constraint algorithm. The performance of this sequence was evaluated by simulations, phantoms, and in vivo studies at rest and after physiological exercise. RESULTS Numerical simulation demonstrated that changes in T1 * are related to the changes in T1 ; however, other factors such as breathing motion could influence T1 * measurements. Phantom T1 * values measured using free-running T1 * mapping sequence had good correlation with spin-echo T1 values and was insensitive to heart rate. In the Ex-CMR study, the measured T1 * reactivity was 10% immediately after exercise and declined over time. CONCLUSION The free-running T1 * mapping sequence allows free-breathing non-ECG quantification of changes in myocardial T1 * with physiological exercise. Although, absolute myocardial T1 * value is sensitive to various confounders such as B1 and B0 inhomogeneity, quantification of its change may be useful in revealing myocardial tissue properties with exercise.
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Affiliation(s)
- Rui Guo
- Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - Haikun Qi
- School of Biomedical Engineering, ShanghaiTech University, Shanghai, China
| | - Amine Amyar
- Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - Xiaoying Cai
- Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA.,Siemens Medical Solutions USA, Inc., Boston, MA, USA
| | - Selcuk Kucukseymen
- Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - Hassan Haji-Valizadeh
- Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - Jennifer Rodriguez
- Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - Amanda Paskavitz
- Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - Patrick Pierce
- Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - Beth Goddu
- Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - Richard B Thompson
- Department of Biomedical Engineering, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Reza Nezafat
- Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
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9
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He B, Chen Y, Wang L, Yang Y, Xia C, Zheng J, Gao F. Compact MR-compatible ergometer and its application in cardiac MR under exercise stress: A preliminary study. Magn Reson Med 2022; 88:1927-1936. [PMID: 35649186 PMCID: PMC9545047 DOI: 10.1002/mrm.29311] [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] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 04/29/2022] [Accepted: 05/02/2022] [Indexed: 02/05/2023]
Abstract
Purpose To develop a compact MR‐compatible ergometer for exercise stress and to initially evaluate the reproducibility of myocardial native T1 and myocardial blood flow (MBF) measurements during exercise stress performed on this ergometer. Methods The compact ergometer consists of exercise, workload, and data processing components. The exercise stress can be achieved by pedaling on a pair of cylinders at a predefined frequency with adjustable resistances. Ten healthy subjects were recruited to perform cardiac MRI scans twice in a 3.0T MR scanner, at different days to assess reproducibility. Myocardial native T1 and MBF were acquired at rest and during a moderate exercise. The reproducibility of the two tests was determined by the intra‐group correlation coefficient (ICC) and coefficient of variation (CoV). Results The mean exercise intensity in this pilot study was 45 Watts (W), with an exercise duration of 5 min. Stress induced a significant increase in systolic blood pressure (from 113 ± 11 mmHg to 141 ± 12, P < 0.05) and maximal increase in heart rate by 74 ± 19%. The rate pressure product increased two‐fold (P < 0.001). Excellent reproducibility was demonstrated in native T1 during the exercise (CoV = 3.0%), whereas the reproducibility of MBF and myocardial perfusion reserve during the exercise was also good (CoV = 10.7% and 8.8%, respectively). Conclusion This pilot study demonstrated that it is possible to acquire reproducible measurements of myocardial native T1 and MBF during the exercise stress in healthy volunteers using our new compact ergometer. Click here for author‐reader discussions
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Affiliation(s)
- Bo He
- Department of Radiology, West China Hospital of Sichuan University, Chengdu, Sichuan, China.,Molecular Imaging Center, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Yushu Chen
- Department of Radiology, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Lei Wang
- Department of Radiology, West China Hospital of Sichuan University, Chengdu, Sichuan, China.,Molecular Imaging Center, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Yang Yang
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Chunchao Xia
- Department of Radiology, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Jie Zheng
- Mallinckrodt Institute of Radiology, Washington University in St Louis, St. Louis, Missouri, USA
| | - Fabao Gao
- Department of Radiology, West China Hospital of Sichuan University, Chengdu, Sichuan, China.,Molecular Imaging Center, West China Hospital of Sichuan University, Chengdu, Sichuan, China
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10
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Alenezi F, Covington TA, Mukherjee M, Mathai SC, Yu PB, Rajagopal S. Novel Approaches to Imaging the Pulmonary Vasculature and Right Heart. Circ Res 2022; 130:1445-1465. [PMID: 35482838 PMCID: PMC9060389 DOI: 10.1161/circresaha.121.319990] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
There is an increased appreciation for the importance of the right heart and pulmonary circulation in several disease states across the spectrum of pulmonary hypertension and left heart failure. However, assessment of the structure and function of the right heart and pulmonary circulation can be challenging, due to the complex geometry of the right ventricle, comorbid pulmonary airways and parenchymal disease, and the overlap of hemodynamic abnormalities with left heart failure. Several new and evolving imaging modalities interrogate the right heart and pulmonary circulation with greater diagnostic precision. Echocardiographic approaches such as speckle-tracking and 3-dimensional imaging provide detailed assessments of regional systolic and diastolic function and volumetric assessments. Magnetic resonance approaches can provide high-resolution views of cardiac structure/function, tissue characterization, and perfusion through the pulmonary vasculature. Molecular imaging with positron emission tomography allows an assessment of specific pathobiologically relevant targets in the right heart and pulmonary circulation. Machine learning analysis of high-resolution computed tomographic lung scans permits quantitative morphometry of the lung circulation without intravenous contrast. Inhaled magnetic resonance imaging probes, such as hyperpolarized 129Xe magnetic resonance imaging, report on pulmonary gas exchange and pulmonary capillary hemodynamics. These approaches provide important information on right ventricular structure and function along with perfusion through the pulmonary circulation. At this time, the majority of these developing technologies have yet to be clinically validated, with few studies demonstrating the utility of these imaging biomarkers for diagnosis or monitoring disease. These technologies hold promise for earlier diagnosis and noninvasive monitoring of right heart failure and pulmonary hypertension that will aid in preclinical studies, enhance patient selection and provide surrogate end points in clinical trials, and ultimately improve bedside care.
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Affiliation(s)
- Fawaz Alenezi
- Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, NC
| | | | | | - Steve C. Mathai
- Johns Hopkins Division of Pulmonary and Critical Care Medicine, Baltimore, MD
| | - Paul B. Yu
- Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA
| | - Sudarshan Rajagopal
- Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, NC
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11
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Stress Cardiac Magnetic Resonance Myocardial Perfusion Imaging: JACC Review Topic of the Week. J Am Coll Cardiol 2021; 78:1655-1668. [PMID: 34649703 DOI: 10.1016/j.jacc.2021.08.022] [Citation(s) in RCA: 61] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 08/08/2021] [Accepted: 08/18/2021] [Indexed: 11/22/2022]
Abstract
Stress cardiovascular magnetic resonance imaging (CMR) is a cost-effective, noninvasive test that accurately assesses myocardial ischemia, myocardial viability, and cardiac function without the need for ionizing radiation. There is a large body of literature, including randomized controlled trials, validating its diagnostic performance, risk stratification capabilities, and ability to guide appropriate use of coronary intervention. Specifically, stress CMR has shown higher diagnostic sensitivity than single-photon emission computed tomography imaging in detecting angiographically significant coronary artery disease. Stress CMR is particularly valuable for the evaluation of patients with moderate to high pretest probability of having stable ischemic heart disease and for patients known to have challenging imaging characteristics, including women, individuals with prior revascularization, and those with left ventricular dysfunction. This paper reviews the basics principles of stress CMR, the data supporting its clinical use, the added-value of myocardial blood flow quantification, and the assessment of myocardial function and viability routinely obtained during a stress CMR study.
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12
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Ordovas KG, Baldassarre LA, Bucciarelli-Ducci C, Carr J, Fernandes JL, Ferreira VM, Frank L, Mavrogeni S, Ntusi N, Ostenfeld E, Parwani P, Pepe A, Raman SV, Sakuma H, Schulz-Menger J, Sierra-Galan LM, Valente AM, Srichai MB. Cardiovascular magnetic resonance in women with cardiovascular disease: position statement from the Society for Cardiovascular Magnetic Resonance (SCMR). J Cardiovasc Magn Reson 2021; 23:52. [PMID: 33966639 PMCID: PMC8108343 DOI: 10.1186/s12968-021-00746-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 03/17/2021] [Indexed: 01/09/2023] Open
Abstract
This document is a position statement from the Society for Cardiovascular Magnetic Resonance (SCMR) on recommendations for clinical utilization of cardiovascular magnetic resonance (CMR) in women with cardiovascular disease. The document was prepared by the SCMR Consensus Group on CMR Imaging for Female Patients with Cardiovascular Disease and endorsed by the SCMR Publications Committee and SCMR Executive Committee. The goals of this document are to (1) guide the informed selection of cardiovascular imaging methods, (2) inform clinical decision-making, (3) educate stakeholders on the advantages of CMR in specific clinical scenarios, and (4) empower patients with clinical evidence to participate in their clinical care. The statements of clinical utility presented in the current document pertain to the following clinical scenarios: acute coronary syndrome, stable ischemic heart disease, peripartum cardiomyopathy, cancer therapy-related cardiac dysfunction, aortic syndrome and congenital heart disease in pregnancy, bicuspid aortic valve and aortopathies, systemic rheumatic diseases and collagen vascular disorders, and cardiomyopathy-causing mutations. The authors cite published evidence when available and provide expert consensus otherwise. Most of the evidence available pertains to translational studies involving subjects of both sexes. However, the authors have prioritized review of data obtained from female patients, and direct comparison of CMR between women and men. This position statement does not consider CMR accessibility or availability of local expertise, but instead highlights the optimal utilization of CMR in women with known or suspected cardiovascular disease. Finally, the ultimate goal of this position statement is to improve the health of female patients with cardiovascular disease by providing specific recommendations on the use of CMR.
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Affiliation(s)
| | | | - Chiara Bucciarelli-Ducci
- Bristol Heart Institute, Bristol, UK
- Bristol National Institute of Health Research (NIHR) Biomedical , Research Centre, Bristol, UK
- University Hospitals Bristol, Bristol, UK
- University of Bristol, Bristol, UK
| | - James Carr
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | - Vanessa M Ferreira
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, British Heart Foundation Centre of Research Excellence, Oxford NIHR Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Luba Frank
- Medical College of Wisconsin, Wisconsin, USA
| | - Sophie Mavrogeni
- Onassis Cardiac Surgery Center, Athens, Greece
- Kapodistrian University of Athens, Athens, Greece
| | - Ntobeko Ntusi
- University of Cape Town, Cape Town, South Africa
- Groote Schuur Hospital, Cape Town, South Africa
| | - Ellen Ostenfeld
- Department of Clinical Sciences Lund, Clinical Physiology, Skåne University Hospital Lund, Lund University, Lund, Sweden
| | - Purvi Parwani
- Division of Cardiology, Department of Medicine, Loma Linda University Health, Loma Linda, CA, USA
| | - Alessia Pepe
- Magnetic Resonance Imaging Unit, Fondazione G. Monasterio C.N.R., Pisa, Italy
| | - Subha V Raman
- Krannert Institute of Cardiology, Indiana University, Indianapolis, USA
| | - Hajime Sakuma
- Department of Radiology, Mie University School of Medicine, Mie, Japan
| | - Jeanette Schulz-Menger
- harite Hospital, University of Berlin, Berlin, Germany
- HELIOS-Clinics Berlin-Buch, Berlin, Germany
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13
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Cardiac Imaging in Athlete's Heart: The Role of the Radiologist. ACTA ACUST UNITED AC 2021; 57:medicina57050455. [PMID: 34066957 PMCID: PMC8148528 DOI: 10.3390/medicina57050455] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 04/28/2021] [Accepted: 04/30/2021] [Indexed: 02/07/2023]
Abstract
Athlete’s heart (AH) is the result of morphological and functional cardiac modifications due to long-lasting athletic training. Athletes can develop very marked structural myocardial changes, which may simulate or cover unknown cardiomyopathies. The differential diagnosis between AH and cardiomyopathy is necessary to prevent the risk of catastrophic events, such as sudden cardiac death, but it can be a challenging task. The improvement of the imaging modalities and the introduction of the new technologies in cardiac magnetic resonance (CMR) and cardiac computed tomography (CCT) can allow overcoming this challenge. Therefore, the radiologist, specialized in cardiac imaging, could have a pivotal role in the differential diagnosis between structural adaptative changes observed in the AH and pathological anomalies of cardiomyopathies. In this review, we summarize the main CMR and CCT techniques to evaluate the cardiac morphology, function, and tissue characterization, and we analyze the imaging features of the AH and the key differences with the main cardiomyopathies.
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14
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Emrich T, Halfmann M, Schoepf UJ, Kreitner KF. CMR for myocardial characterization in ischemic heart disease: state-of-the-art and future developments. Eur Radiol Exp 2021; 5:14. [PMID: 33763757 PMCID: PMC7990980 DOI: 10.1186/s41747-021-00208-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 01/22/2021] [Indexed: 01/25/2023] Open
Abstract
Ischemic heart disease and its sequelae are one of the major contributors to morbidity and mortality worldwide. Over the last decades, technological developments have strengthened the role of noninvasive imaging for detection, risk stratification, and management of patients with ischemic heart disease. Cardiac magnetic resonance (CMR) imaging incorporates both functional and morphological characterization of the heart to determine presence, acuteness, and severity of ischemic heart disease by evaluating myocardial wall motion and function, the presence and extent of myocardial edema, ischemia, and scarring. Currently established clinical protocols have already demonstrated their diagnostic and prognostic value. Nevertheless, there are emerging imaging technologies that provide additional information based on advanced quantification of imaging biomarkers and improved diagnostic accuracy, therefore potentially allowing reduction or avoidance of contrast and/or stressor agents. The aim of this review is to summarize the current state of the art of CMR imaging for ischemic heart disease and to provide insights into promising future developments.
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Affiliation(s)
- Tilman Emrich
- Department of Diagnostic and Interventional Radiology, University Medical Center, Mainz; Langenbeckstraße 1, 55131, Mainz, Germany. .,German Center for Cardiovascular Research (DZHK), Partner Site Rhine Main, Mainz, Langenbeckstraße 1, 55131, Mainz, Germany. .,Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Drive, Charleston, SC, 29425, USA.
| | - Moritz Halfmann
- Department of Diagnostic and Interventional Radiology, University Medical Center, Mainz; Langenbeckstraße 1, 55131, Mainz, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Rhine Main, Mainz, Langenbeckstraße 1, 55131, Mainz, Germany
| | - U Joseph Schoepf
- Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Drive, Charleston, SC, 29425, USA
| | - Karl-Friedrich Kreitner
- Department of Diagnostic and Interventional Radiology, University Medical Center, Mainz; Langenbeckstraße 1, 55131, Mainz, Germany
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15
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Le TT, Ang BWY, Bryant JA, Chin CY, Yeo KK, Wong PEH, Ho KW, Tan JWC, Lee PT, Chin CWL, Cook SA. Multiparametric exercise stress cardiovascular magnetic resonance in the diagnosis of coronary artery disease: the EMPIRE trial. J Cardiovasc Magn Reson 2021; 23:17. [PMID: 33658056 PMCID: PMC7931509 DOI: 10.1186/s12968-021-00705-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 01/06/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Stress cardiovascular magnetic resonance (CMR) offers assessment of ventricular function, myocardial perfusion and viability in a single examination to detect coronary artery disease (CAD). We developed an in-scanner exercise stress CMR (ExCMR) protocol using supine cycle ergometer and aimed to examine the diagnostic value of a multiparametric approach in patients with suspected CAD, compared with invasive fractional flow reserve (FFR) as the reference gold standard. METHODS In this single-centre prospective study, patients who had symptoms of angina and at least one cardiovascular disease risk factor underwent both ExCMR and invasive angiography with FFR. Rest-based left ventricular function (ejection fraction, regional wall motion abnormalities), tissue characteristics and exercise stress-derived (perfusion defects, inducible regional wall motion abnormalities and peak exercise cardiac index percentile-rank) CMR parameters were evaluated in the study. RESULTS In the 60 recruited patients with intermediate CAD risk, 50% had haemodynamically significant CAD based on FFR. Of all the CMR parameters assessed, the late gadolinium enhancement, stress-inducible regional wall motion abnormalities, perfusion defects and peak exercise cardiac index percentile-rank were independently associated with FFR-positive CAD. Indeed, this multiparametric approach offered the highest incremental diagnostic value compared to a clinical risk model (χ2 for the diagnosis of FFR-positive increased from 7.6 to 55.9; P < 0.001) and excellent performance [c-statistic area under the curve 0.97 (95% CI: 0.94-1.00)] in discriminating between FFR-normal and FFR-positive patients. CONCLUSION The study demonstrates the clinical potential of using in-scanner multiparametric ExCMR to accurately diagnose CAD. TRIAL REGISTRATION ClinicalTrials.gov, NCT03217227, Registered 11 July 2017-Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT03217227?id=NCT03217227&draw=2&rank=1&load=cart.
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Affiliation(s)
- Thu-Thao Le
- National Heart Research Institute Singapore, National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609, Singapore.
- Cardiovascular Sciences ACP, Duke-NUS Graduate Medical School, Singapore, Singapore.
| | - Briana W Y Ang
- National Heart Research Institute Singapore, National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609, Singapore
| | - Jennifer A Bryant
- National Heart Research Institute Singapore, National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609, Singapore
- Cardiovascular Sciences ACP, Duke-NUS Graduate Medical School, Singapore, Singapore
| | - Chee Yang Chin
- National Heart Research Institute Singapore, National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609, Singapore
- Cardiovascular Sciences ACP, Duke-NUS Graduate Medical School, Singapore, Singapore
- Department of Cardiology, National Heart Centre Singapore, Singapore, Singapore
| | - Khung Keong Yeo
- National Heart Research Institute Singapore, National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609, Singapore
- Cardiovascular Sciences ACP, Duke-NUS Graduate Medical School, Singapore, Singapore
- Department of Cardiology, National Heart Centre Singapore, Singapore, Singapore
| | - Philip E H Wong
- National Heart Research Institute Singapore, National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609, Singapore
- Cardiovascular Sciences ACP, Duke-NUS Graduate Medical School, Singapore, Singapore
- Department of Cardiology, National Heart Centre Singapore, Singapore, Singapore
| | - Kay Woon Ho
- National Heart Research Institute Singapore, National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609, Singapore
- Cardiovascular Sciences ACP, Duke-NUS Graduate Medical School, Singapore, Singapore
- Department of Cardiology, National Heart Centre Singapore, Singapore, Singapore
| | - Jack W C Tan
- National Heart Research Institute Singapore, National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609, Singapore
- Cardiovascular Sciences ACP, Duke-NUS Graduate Medical School, Singapore, Singapore
- Department of Cardiology, National Heart Centre Singapore, Singapore, Singapore
| | - Phong Teck Lee
- National Heart Research Institute Singapore, National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609, Singapore
- Cardiovascular Sciences ACP, Duke-NUS Graduate Medical School, Singapore, Singapore
- Department of Cardiology, National Heart Centre Singapore, Singapore, Singapore
| | - Calvin W L Chin
- National Heart Research Institute Singapore, National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609, Singapore
- Cardiovascular Sciences ACP, Duke-NUS Graduate Medical School, Singapore, Singapore
- Department of Cardiology, National Heart Centre Singapore, Singapore, Singapore
| | - Stuart A Cook
- National Heart Research Institute Singapore, National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609, Singapore
- Cardiovascular Sciences ACP, Duke-NUS Graduate Medical School, Singapore, Singapore
- Department of Cardiology, National Heart Centre Singapore, Singapore, Singapore
- National Heart and Lung Institute, Imperial College, London, UK
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16
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Trankle CR, Canada JM, Jordan JH, Truong U, Hundley WG. Exercise Cardiovascular Magnetic Resonance: A Review. J Magn Reson Imaging 2021; 55:720-754. [PMID: 33655592 DOI: 10.1002/jmri.27580] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 02/11/2021] [Accepted: 02/12/2021] [Indexed: 11/10/2022] Open
Abstract
While pharmacologic stress cardiovascular magnetic resonance imaging (MRI) is a robust noninvasive tool in the diagnosis and prognostication of epicardial coronary artery disease, clinical guidelines recommend exercise-based testing in those patients who can exercise. This review describes the development of exercise cardiovascular MRI protocols, summarizes the insights across various patient populations, and highlights future research initiatives. LEVEL OF EVIDENCE: 5 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- Cory R Trankle
- Division of Cardiology, Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Justin M Canada
- Division of Cardiology, Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Jennifer H Jordan
- Division of Cardiology, Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia, USA.,Department of Biomedical Engineering, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Uyen Truong
- Division of Pediatric Cardiology, Children's Hospital of Richmond, Virginia Commonwealth University, Richmond, Virginia, USA
| | - W Gregory Hundley
- Division of Cardiology, Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia, USA
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17
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Kirkham AA, Goonasekera MV, Mattiello BC, Grenier JG, Haykowsky MJ, Thompson RB. Reliability and reproducibility of cardiac MRI quantification of peak exercise function with long-axis views. PLoS One 2021; 16:e0245912. [PMID: 33539447 PMCID: PMC7861545 DOI: 10.1371/journal.pone.0245912] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 01/08/2021] [Indexed: 01/06/2023] Open
Abstract
The conventional approach to cardiac magnetic resonance (CMR) involving breath holds, electrocardiography-gating, and acquisition of a short-axis (SAX) image stack, introduces technical and logistical challenges for assessing exercise left ventricular (LV) function. Real-time, free-breathing CMR acquisition of long-axis (LAX) images overcomes these issues and also enables assessment of global longitudinal strain (GLS). We evaluated the reliability of a free-breathing LAX approach compared to the standard SAX approach and the reproducibility of free-breathing LAX. LV SAX (contiguous stack) and LAX (two-chamber and four-chamber) 3T CMR cine images were acquired four times within one scan in 32 women with cardiovascular risk factors (56±10 years, 28±4 kg/m2) as follows: 1) resting, gated-segmented, end-expiration breath-hold; 2) resting, real-time, free-breathing; 3) test-retest set of resting, real-time, free-breathing; 4) peak exercise (incremental-to-maximum, in-magnet, stepper test), real-time, free-breathing. A second scan was performed within one week in a subset (n = 5) to determine reproducibility of peak exercise measures. Reliability and agreement of the free-breathing LAX approach with the conventional SAX approach were assessed by intraclass correlation coefficient (ICC) and Bland-Altman plots, respectively. Normal control GLS reserve was also acquired in a separate set of 12 young, healthy control women (25±4 years, 22±2 kg/m2) for comparison. Comparisons of LV volumes and function among all techniques at rest had good-to-excellent reliability (ICC = 0.80-0.96), and excellent reliability between peak exercise free-breathing LAX and SAX evaluations (ICC = 0.92-0.96). Higher resting heart rates with free-breathing acquisitions compared to breath-hold (mean difference, limits of agreement: 5, 1-12 beats per minute) reduced reliability for cardiac output (ICC = 0.67-0.79). Reproducibility of the free-breathing LAX approach was good-to-excellent at rest and peak exercise (ICC = 0.74-0.99). GLS exercise reserve was impaired in older women at cardiovascular risk compared to young healthy women (-4.7±2.3% vs -7.4±2.1%, p = 0.001). Real-time, free-breathing CMR with LAX evaluation provides a reliable and reproducible method to assess rest and peak exercise cardiac function, including GLS.
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Affiliation(s)
- Amy A. Kirkham
- Department of Biomedical Engineering, University of Alberta, Edmonton, Alberta, Canada
| | | | - Brenna C. Mattiello
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, Alberta, Canada
| | - Justin G. Grenier
- Department of Biomedical Engineering, University of Alberta, Edmonton, Alberta, Canada
| | - Mark J. Haykowsky
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Richard B. Thompson
- Department of Biomedical Engineering, University of Alberta, Edmonton, Alberta, Canada
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18
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Eck BL, Flamm SD, Kwon DH, Tang WHW, Vasquez CP, Seiberlich N. Cardiac magnetic resonance fingerprinting: Trends in technical development and potential clinical applications. PROGRESS IN NUCLEAR MAGNETIC RESONANCE SPECTROSCOPY 2021; 122:11-22. [PMID: 33632415 PMCID: PMC8366914 DOI: 10.1016/j.pnmrs.2020.10.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Revised: 10/23/2020] [Accepted: 10/29/2020] [Indexed: 05/02/2023]
Abstract
Quantitative cardiac magnetic resonance has emerged in recent years as an approach for evaluating a range of cardiovascular conditions, with T1 and T2 mapping at the forefront of these developments. Cardiac Magnetic Resonance Fingerprinting (cMRF) provides a rapid and robust framework for simultaneous quantification of myocardial T1 and T2 in addition to other tissue properties. Since the advent of cMRF, a number of technical developments and clinical validation studies have been reported. This review provides an overview of cMRF, recent technical developments, healthy subject and patient studies, anticipated technical improvements, and potential clinical applications. Recent technical developments include slice profile and pulse efficiency corrections, improvements in image reconstruction, simultaneous multislice imaging, 3D whole-ventricle imaging, motion-resolved imaging, fat-water separation, and machine learning for rapid dictionary generation. Future technical developments in cMRF, such as B0 and B1 field mapping, acceleration of acquisition and reconstruction, imaging of patients with implanted devices, and quantification of additional tissue properties are also described. Potential clinical applications include characterization of infiltrative, inflammatory, and ischemic cardiomyopathies, tissue characterization in the left atrium and right ventricle, post-cardiac transplantation assessment, reduction of contrast material, pre-procedural planning for electrophysiology interventions, and imaging of patients with implanted devices.
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Affiliation(s)
- Brendan L Eck
- Imaging Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
| | - Scott D Flamm
- Heart and Vascular Institute and Imaging Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
| | - Deborah H Kwon
- Heart and Vascular Institute and Imaging Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
| | - W H Wilson Tang
- Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
| | - Claudia Prieto Vasquez
- School of Biomedical Engineering and Imaging Sciences, King's College London, Westminster Bridge Road, London, UK.
| | - Nicole Seiberlich
- Department of Radiology, University of Michigan, 1150 West Medical Center Drive, Ann Arbor, MI 48109, USA.
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19
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Exercise cardiovascular magnetic resonance: feasibility and development of biventricular function and great vessel flow assessment, during continuous exercise accelerated by Compressed SENSE: preliminary results in healthy volunteers. Int J Cardiovasc Imaging 2020; 37:685-698. [PMID: 33011851 PMCID: PMC7900338 DOI: 10.1007/s10554-020-02044-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 09/25/2020] [Indexed: 12/27/2022]
Abstract
Purpose Exercise cardiovascular magnetic resonance (Ex-CMR) typically requires complex post-processing or transient exercise cessation, decreasing clinical utility. We aimed to demonstrate the feasibility of assessing biventricular volumes and great vessel flow during continuous in-scanner Ex-CMR, using vendor provided Compressed SENSE (C-SENSE) sequences and commercial analysis software (Cvi42). Methods 12 healthy volunteers (8-male, age: 35 ± 9 years) underwent continuous supine cycle ergometer (Lode-BV) Ex-CMR (1.5T Philips, Ingenia). Free-breathing, respiratory navigated C-SENSE short-axis cines and aortic/pulmonary phase contrast magnetic resonance (PCMR) sequences were validated against clinical sequences at rest and used during low and moderate intensity Ex-CMR. Optimal PCMR C-SENSE acceleration, C-SENSE-3 (CS3) vs C-SENSE-6 (CS6), was further investigated by image quality scoring. Intra-and inter-operator reproducibility of biventricular and flow indices was performed. Results All CS3 PCMR image quality scores were superior (p < 0.05) to CS6 sequences, except pulmonary PCMR at moderate exercise. Resting stroke volumes from clinical PCMR sequences correlated stronger with CS3 than CS6 sequences. Resting biventricular volumes from CS3 and clinical sequences correlated very strongly (r > 0.93). During Ex-CMR, biventricular end-diastolic volumes (EDV) remained unchanged, except right-ventricular EDV decreasing at moderate exercise. Biventricular ejection-fractions increased at each stage. Exercise biventricular cine and PCMR stroke volumes correlated very strongly (r ≥ 0.9), demonstrating internal validity. Intra-observer reproducibility was excellent, co-efficient of variance (COV) < 10%. Inter-observer reproducibility was excellent, except for resting right-ventricular, and exercise bi-ventricular end-systolic volumes which were good (COV 10–20%). Conclusion Biventricular function, aortic and pulmonary flow assessment during continuous Ex-CMR using CS3 sequences is feasible, reproducible and analysable using commercially available software.
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20
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Craven TP, Tsao CW, La Gerche A, Simonetti OP, Greenwood JP. Exercise cardiovascular magnetic resonance: development, current utility and future applications. J Cardiovasc Magn Reson 2020; 22:65. [PMID: 32907587 PMCID: PMC7488086 DOI: 10.1186/s12968-020-00652-w] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 07/01/2020] [Indexed: 12/23/2022] Open
Abstract
Stress cardiac imaging is the current first line investigation for coronary artery disease diagnosis and decision making and an adjunctive tool in a range of non-ischaemic cardiovascular diseases. Exercise cardiovascular magnetic resonance (Ex-CMR) has developed over the past 25 years to combine the superior image qualities of CMR with the preferred method of exercise stress. Presently, numerous exercise methods exist, from performing stress on an adjacent CMR compatible treadmill to in-scanner exercise, most commonly on a supine cycle ergometer. Cardiac conditions studied by Ex-CMR are broad, commonly investigating ischaemic heart disease and congenital heart disease but extending to pulmonary hypertension and diabetic heart disease. This review presents an in-depth assessment of the various Ex-CMR stress methods and the varied pulse sequence approaches, including those specially designed for Ex-CMR. Current and future developments in image acquisition are highlighted, and will likely lead to a much greater clinical use of Ex-CMR across a range of cardiovascular conditions.
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Affiliation(s)
- Thomas P Craven
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK.
| | - Connie W Tsao
- Cardiovascular Division, Beth Israel Deaconess Medical Center, 330 Brookline Ave, RW-453, Boston, MA, 02215, USA
| | - Andre La Gerche
- Clinical Research Domain, Baker Heart and Diabetes Institute, Melbourne, Australia
- National Centre for Sports Cardiology, St Vincent's Hospital, Fitzroy, Australia
| | | | - John P Greenwood
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
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21
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Chew PG, Swoboda PP, Ferguson C, Garg P, Cook AL, Ibeggazene S, Brown LAE, Craven TP, Foley JR, Fent GJ, Saunderson CE, Higgins DM, Plein S, Birch KM, Greenwood JP. Feasibility and reproducibility of a cardiovascular magnetic resonance free-breathing, multi-shot, navigated image acquisition technique for ventricular volume quantification during continuous exercise. Quant Imaging Med Surg 2020; 10:1837-1851. [PMID: 32879861 DOI: 10.21037/qims-20-117] [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] [Indexed: 01/09/2023]
Abstract
Background Cardiovascular magnetic resonance (CMR) image acquisition techniques during exercise typically requires either transient cessation of exercise or complex post-processing, potentially compromising clinical utility. We evaluated the feasibility and reproducibility of a navigated image acquisition method for ventricular volumes assessment during continuous physical exercise. Methods Ten healthy volunteers underwent supine cycle ergometer (Lode) exercise CMR on two separate occasions using a free-breathing, multi-shot, navigated, balanced steady-state free precession cine pulse sequence. Images were acquired at 3-stages, baseline and during steady-state exercise at 55% and 75% maximal heart rate (HRmax), based on a prior supine cardiopulmonary exercise test. Intra-and inter-observer variability and inter-scan reproducibility were derived. Clinical feasibility was tested in a separate cohort of patients with severe mitral regurgitation (n=6). Results End-diastolic volume (EDV) of both LV and RV decreased during exercise at 55% and 75% HRmax, although a reduction in RVEDV index was only observed at 75% HRmax. Ejection fractions (EF) for both ventricles were significantly higher at 75% HRmax compared to their respective baselines (LVEF 68%±3% vs. 58%±5%, P=0.001; RVEF 66%±4% vs. 58%±7%, P=0.02). Intra-observer and inter-observer reproducibility of LV parameters was excellent at all 3-stages. Although measurements of RVESV were more variable during exercise, the reproducibility of both RVEF and RV cardiac index was excellent (CV <10%). Inter-scan LV and RV ejection fraction were highly reproducible at all 3 stages, although inter-scan reproducibility of indexed RVESV was only moderate. The protocol was well tolerated by all patients. Conclusions Exercise CMR using a free-breathing, multi-shot, navigated cine imaging method allows simultaneous assessment of left and right ventricular volumes during continuous exercise. Intra- and inter-observer reproducibility were excellent. Inter-scan LV and RV ejection fraction were also highly reproducible.
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Affiliation(s)
- Pei G Chew
- Multidisciplinary Cardiovascular Research Centre & Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Peter P Swoboda
- Multidisciplinary Cardiovascular Research Centre & Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Carrie Ferguson
- School of Biomedical Sciences, University of Leeds, Leeds, UK
| | - Pankaj Garg
- Multidisciplinary Cardiovascular Research Centre & Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Abigail L Cook
- School of Biomedical Sciences, University of Leeds, Leeds, UK
| | - Said Ibeggazene
- School of Biomedical Sciences, University of Leeds, Leeds, UK
| | - Louise A E Brown
- Multidisciplinary Cardiovascular Research Centre & Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Thomas P Craven
- Multidisciplinary Cardiovascular Research Centre & Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - James R Foley
- Multidisciplinary Cardiovascular Research Centre & Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Graham J Fent
- Multidisciplinary Cardiovascular Research Centre & Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Christopher E Saunderson
- Multidisciplinary Cardiovascular Research Centre & Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | | | - Sven Plein
- Multidisciplinary Cardiovascular Research Centre & Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Karen M Birch
- School of Biomedical Sciences, University of Leeds, Leeds, UK
| | - John P Greenwood
- Multidisciplinary Cardiovascular Research Centre & Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
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22
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Arena R, Canada JM, Popovic D, Trankle CR, Del Buono MG, Lucas A, Abbate A. Cardiopulmonary exercise testing - refining the clinical perspective by combining assessments. Expert Rev Cardiovasc Ther 2020; 18:563-576. [PMID: 32749934 DOI: 10.1080/14779072.2020.1806057] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
INTRODUCTION Cardiorespiratory fitness (CRF) is now established as a vital sign. Cardiopulmonary exercise testing (CPX) is the gold-standard approach to assessing CRF. AREAS COVERED A body of literature spanning several decades clearly supports the clinical utility of CPX in those who are apparently health and at risk for chronic disease as well as numerous patient populations. While CPX, in and of itself, is a valid and reliable clinical assessment, combining findings with other available assessments may provide a more comprehensive perspective that enhances clinical decision making and outcomes. The current review will accomplish the following: (1) define key CPX measures based upon current evidence; and (2) describe the current evidence addressing the relationships between CPX and echocardiography, serum biomarkers, and cardiovascular magnetic resonance. EXPERT OPINION Cardiopulmonary exercise testing provides prognostic and diagnostic information in apparently healthy individuals, those at risk for one or more chronic conditions, as well as numerous patient populations. Moreover, if the goal of an intervention is to improve one or more systems integral to the physiologic response to exercise, CPX should be considered as a central assessment to gauge therapeutic efficacy. To further refine the information obtained from CPX, combining other assessments has demonstrated promise.
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Affiliation(s)
- Ross Arena
- Department of Physical Therapy, College of Applied Science, University of Illinois , Chicago, IL, USA
| | - Justin M Canada
- VCU Pauley Heart Center, Virginia Commonwealth University , Richmond, VA, USA.,Department of Kinesiology & Health Sciences, Virginia Commonwealth University , Richmond, Virginia, USA
| | - Dejana Popovic
- Division of Cardiology, Faculty of Medicine, University of Belgrade , Belgrade, Serbia.,Department of Physiology, Faculty of Pharmacy, University of Belgrade , Belgrade, Serbia
| | - Cory R Trankle
- VCU Pauley Heart Center, Virginia Commonwealth University , Richmond, VA, USA
| | | | - Alexander Lucas
- Department of Health Behavior and Policy and Department of Internal Medicine, Division of Cardiology, VCU Pauley Heart Center, Virginia Commonwealth University , Richmond, VA, USA
| | - Antonio Abbate
- VCU Pauley Heart Center, Virginia Commonwealth University , Richmond, VA, USA
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23
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Macdonald JA, Beshish AG, Corrado PA, Barton GP, Goss KN, Eldridge MW, François CJ, Wieben O. Feasibility of Cardiovascular Four-dimensional Flow MRI during Exercise in Healthy Participants. Radiol Cardiothorac Imaging 2020; 2:e190033. [PMID: 32734274 DOI: 10.1148/ryct.2020190033] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 11/04/2019] [Accepted: 12/23/2019] [Indexed: 11/11/2022]
Abstract
Purpose To explore the feasibility of using four-dimensional (4D) flow MRI to quantify blood flow and kinetic energy (KE) in the heart during strenuous exercise. Materials and Methods For this prospective study, cardiac 4D flow MRI was performed in 11 healthy young adult participants (eight men, three women; mean age, 26 years ± 1 [standard deviation]) at rest and during exercise with an MRI-compatible exercise stepper between March 2016 and July 2017. Flow was measured in the ascending aorta (AAo) and main pulmonary artery (MPA). KE was quantified in the left and right ventricle. Significant changes in flow and KE during exercise were identified by using t tests. Repeatability was assessed with inter- and intraobserver comparisons and an analysis of internal flow consistency. Results Nine participants successfully completed both rest and exercise imaging. Internal flow consistency analysis in systemic and pulmonary circulation showed average relative differences of 10% at rest and 16% during exercise. For flow measurements in the AAo and MPA, relative differences between observers never exceeded 6% in any vessel and showed excellent correlation, even during exercise. Relative differences were increased for KE, typically on the order of 30%, with poor interobserver correlation between measurements. Conclusion Four-dimensional flow MRI can quantify increases in flow in the AAo and MPA during strenuous exercise and is highly repeatable. KE had reduced repeatability because of suboptimal segmentation methods and requires further development before clinical implementation. Supplemental material is available for this article. © RSNA, 2020See also the commentary by Markl and Lee in this issue.
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Affiliation(s)
- Jacob A Macdonald
- Departments of Medical Physics (J.A.M., P.A.C., O.W.), Pediatrics (A.G.B., G.P.B., K.N.G., M.W.E.), Medicine (K.N.G.), Biomedical Engineering (M.W.E., O.W.), and Radiology (C.J.F., O.W.), University of Wisconsin, 1111 Highland Ave, Room 1005, Madison, WI 53705
| | - Arij G Beshish
- Departments of Medical Physics (J.A.M., P.A.C., O.W.), Pediatrics (A.G.B., G.P.B., K.N.G., M.W.E.), Medicine (K.N.G.), Biomedical Engineering (M.W.E., O.W.), and Radiology (C.J.F., O.W.), University of Wisconsin, 1111 Highland Ave, Room 1005, Madison, WI 53705
| | - Philip A Corrado
- Departments of Medical Physics (J.A.M., P.A.C., O.W.), Pediatrics (A.G.B., G.P.B., K.N.G., M.W.E.), Medicine (K.N.G.), Biomedical Engineering (M.W.E., O.W.), and Radiology (C.J.F., O.W.), University of Wisconsin, 1111 Highland Ave, Room 1005, Madison, WI 53705
| | - Gregory P Barton
- Departments of Medical Physics (J.A.M., P.A.C., O.W.), Pediatrics (A.G.B., G.P.B., K.N.G., M.W.E.), Medicine (K.N.G.), Biomedical Engineering (M.W.E., O.W.), and Radiology (C.J.F., O.W.), University of Wisconsin, 1111 Highland Ave, Room 1005, Madison, WI 53705
| | - Kara N Goss
- Departments of Medical Physics (J.A.M., P.A.C., O.W.), Pediatrics (A.G.B., G.P.B., K.N.G., M.W.E.), Medicine (K.N.G.), Biomedical Engineering (M.W.E., O.W.), and Radiology (C.J.F., O.W.), University of Wisconsin, 1111 Highland Ave, Room 1005, Madison, WI 53705
| | - Marlowe W Eldridge
- Departments of Medical Physics (J.A.M., P.A.C., O.W.), Pediatrics (A.G.B., G.P.B., K.N.G., M.W.E.), Medicine (K.N.G.), Biomedical Engineering (M.W.E., O.W.), and Radiology (C.J.F., O.W.), University of Wisconsin, 1111 Highland Ave, Room 1005, Madison, WI 53705
| | - Christopher J François
- Departments of Medical Physics (J.A.M., P.A.C., O.W.), Pediatrics (A.G.B., G.P.B., K.N.G., M.W.E.), Medicine (K.N.G.), Biomedical Engineering (M.W.E., O.W.), and Radiology (C.J.F., O.W.), University of Wisconsin, 1111 Highland Ave, Room 1005, Madison, WI 53705
| | - Oliver Wieben
- Departments of Medical Physics (J.A.M., P.A.C., O.W.), Pediatrics (A.G.B., G.P.B., K.N.G., M.W.E.), Medicine (K.N.G.), Biomedical Engineering (M.W.E., O.W.), and Radiology (C.J.F., O.W.), University of Wisconsin, 1111 Highland Ave, Room 1005, Madison, WI 53705
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Ugander M. Exercise CMR T1 Mapping for Myocardial Ischemia Testing: No Gad, No Drugs, No Problem? JACC Cardiovasc Imaging 2019; 13:681-683. [PMID: 31422149 DOI: 10.1016/j.jcmg.2019.06.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 06/06/2019] [Indexed: 11/25/2022]
Affiliation(s)
- Martin Ugander
- University of Sydney, Northern Clinical School, Sydney Medical School, Sydney, Australia; Department of Clinical Physiology, Karolinska University Hospital, and Karolinska Institutet, Stockholm, Sweden.
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25
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Shusterman V, Hodgson-Zingman D, Thedens D, Zhu X, Hoffman S, Sieren JC, Morgan GM, Faranesh A, London B. High-energy external defibrillation and transcutaneous pacing during MRI: feasibility and safety. J Cardiovasc Magn Reson 2019; 21:47. [PMID: 31378203 PMCID: PMC6681494 DOI: 10.1186/s12968-019-0558-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 07/01/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Rapid application of external defibrillation, a crucial first-line therapy for ventricular fibrillation and cardiac arrest, is currently unavailable in the setting of magnetic resonance imaging (MRI), raising concerns about patient safety during MRI tests and MRI-guided procedures, particularly in patients with cardiovascular diseases. The objective of this study was to examine the feasibility and safety of defibrillation/pacing for the entire range of clinically useful shock energies inside the MRI bore and during scans, using defibrillation/pacing outside the magnet as a control. METHODS Experiments were conducted using a commercial defibrillator (LIFEPAK 20, Physio-Control, Redmond, Washington, USA) with a custom high-voltage, twisted-pair cable with two mounted resonant floating radiofrequency traps to reduce emission from the defibrillator and the MRI scanner. A total of 18 high-energy (200-360 J) defibrillation experiments were conducted in six swine on a 1.5 T MRI scanner outside the magnet bore, inside the bore, and during scanning, using adult and pediatric defibrillation pads. Defibrillation was followed by cardiac pacing (with capture) in a subset of two animals. Monitored signals included: high-fidelity temperature (0.01 °C, 10 samples/sec) under the pads and 12-lead electrocardiogram (ECG) using an MRI-compatible ECG system. RESULTS Defibrillation/pacing was successful in all experiments. Temperature was higher during defibrillation inside the bore and during scanning compared with outside the bore, but the differences were small (ΔT: 0.5 and 0.7 °C, p = 0.01 and 0.04, respectively). During scans, temperature after defibrillation tended to be higher for pediatric vs. adult pads (p = 0.08). MR-image quality (signal-to-noise ratio) decreased by ~ 10% when the defibrillator was turned on. CONCLUSIONS Our study demonstrates the feasibility and safety of in-bore defibrillation for the full range of defibrillation energies used in clinical practice, as well as of transcutaneous cardiac pacing inside the MRI bore. Methods for Improving MR-image quality in the presence of a working defibrillator require further study.
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Affiliation(s)
- Vladimir Shusterman
- PinMed, Inc., Pittsburgh, PA USA
- Department of Internal Medicine, The University of Iowa, Iowa City, IA USA
| | | | - Daniel Thedens
- Department of Radiology, The University of Iowa, Iowa City, IA USA
| | - Xiaodong Zhu
- Department of Internal Medicine, The University of Iowa, Iowa City, IA USA
- Department of Biological Sciences, The University of Pittsburgh, Pittsburgh, PA USA
| | | | | | - Gina M. Morgan
- Department of Internal Medicine, The University of Iowa, Iowa City, IA USA
| | | | - Barry London
- Department of Internal Medicine, The University of Iowa, Iowa City, IA USA
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Abstract
Distinguishing between adaptive and maladaptive cardiovascular response to exercise is crucial to prevent the unnecessary termination of an athlete's career and to minimize the risk of sudden death. This is a challenging task essentially due to the substantial phenotypic overlap between electrical and structural changes seen in the physiological athletic heart remodeling and pathological changes seen in inherited or acquired cardiomyopathies. Stress testing is an ideal tool to discriminate normal from abnormal cardiovascular response by unmasking subtle pathologic responses otherwise undetectable at rest. Treadmill or bicycle electrocardiography, transthoracic echocardiography, and cardiopulmonary exercise testing are common clinical investigations used in sports cardiology, specifically among participants presenting with resting electrocardiographic abnormalities, frequent premature ventricular beats, or non-sustained ventricular arrhythmias. In this setting, as well as in cases of left ventricular hypertrophy or asymptomatic left ventricular dysfunction, stress imaging and myocardial tissue characterization by cardiovascular magnetic resonance show promise. In this review, we aimed to reappraise current diagnostic schemes, screening strategies and novel approaches that may be used to distinguish adaptive remodeling patterns to physical exercise from early phenotypes of inherited or acquired pathological conditions commanding prompt intervention.
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27
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LaFountain RA, Raman SV, Simonetti OP. Letter to the Editor: Exercise MRI in healthy individuals—will the outlier please stand up? Am J Physiol Regul Integr Comp Physiol 2019; 316:R298-R399. [DOI: 10.1152/ajpregu.00368.2018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
| | - Subha V. Raman
- Department of Internal Medicine, Division of Cardiovascular Medicine, The Ohio State University, Columbus, Ohio
| | - Orlando P. Simonetti
- Department of Internal Medicine, Division of Cardiovascular Medicine, The Ohio State University, Columbus, Ohio
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28
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Beaudry RI, Haykowsky MJ, Nelson MD. Reply to “Letter to the Editor: Exercise MRI in healthy individuals—will the outlier please stand up?”. Am J Physiol Regul Integr Comp Physiol 2019; 316:R300. [DOI: 10.1152/ajpregu.00400.2018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Rhys I. Beaudry
- Department of Kinesiology, University of Texas, Arlington, Texas
| | | | - Michael D. Nelson
- Department of Kinesiology, University of Texas, Arlington, Texas
- Department of Bioengineering, University of Texas, Arlington, Texas
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Habert P, Bentatou Z, Aldebert P, Finas M, Bartoli A, Bal L, Lalande A, Rapacchi S, Guye M, Kober F, Bernard M, Jacquier A. Exercise stress CMR reveals reduced aortic distensibility and impaired right-ventricular adaptation to exercise in patients with repaired tetralogy of Fallot. PLoS One 2018; 13:e0208749. [PMID: 30596647 PMCID: PMC6312273 DOI: 10.1371/journal.pone.0208749] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Accepted: 11/21/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The aim of our study was to evaluate the feasibility of exercise cardiac magnetic resonance (CMR) in patients with repaired tetralogy of Fallot (RTOF) and to assess right and left ventricular adaptation and aortic wall response to exercise in comparison with volunteers. METHODS 11 RTOF and 11 volunteers underwent prospective CMR at rest and during exercise. A supine bicycle ergometer was employed to reach twice the resting heart rate during continuous exercise, blood pressure and heart rate were recorded. Bi-ventricular parameters and aortic stiffness were assessed using accelerated cine sequences and flow-encoding CMR. A t-test was used to compare values between groups. A Mann Whitney test was used to compare values within groups. RESULTS In RTOF both ventricles showed an impaired contractile reserve (RVEF rest 36.2±8.3%, +1.3±3.9% increase after exercise; LVEF rest 53.8±6.1%, +5.7±6.4% increase after exercise) compared to volunteers (RVEF rest 50.5±5.0%, +10.4±7.1% increase after exercise, p = 0.039; LVEF rest 61.9±3.1%, +12.2±4.7% increase after exercise, p = 0.014). RTOF showed a reduced distensibility of the ascending aorta during exercise compared to volunteers (RTOF: 3.4±1.9 10-3.mmHg-1 vs volunteers: 5.1±1.4 10-3.mmHg-1; p = 0.027). Ascending aorta distensibility was correlated to cardiac work in the volunteers but not in RTOF. CONCLUSION RTOF showed an impaired contractile reserve for both ventricles. The exercise unmasked a reduced distensibility of the ascending aorta in RTOF, which may be an early sign of increased aortic rigidity.
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Affiliation(s)
- Paul Habert
- Aix-Marseille Univ, CNRS, CRMBM, Marseille, France
- Department of Radiology and Cardiovascular Imaging, La Timone Hospital, Marseille, France
- * E-mail:
| | | | - Philippe Aldebert
- Aix-Marseille Univ, CNRS, CRMBM, Marseille, France
- Department of Cardiology and Department of Infectious Diseases, La Timone Hospital, Marseille, France
| | | | - Axel Bartoli
- Department of Radiology and Cardiovascular Imaging, La Timone Hospital, Marseille, France
| | - Laurence Bal
- Aix-Marseille Univ, CNRS, CRMBM, Marseille, France
- Department of Vascular Surgery and Vascular Medicine, La Timone Hospital, Marseille, France
| | - Alain Lalande
- LE2I, UMR 6306 CNRS, University of Burgundy, Dijon, France
- MRI Department, University Hospital of Dijon, Dijon, France
| | | | - Maxime Guye
- Aix-Marseille Univ, CNRS, CRMBM, Marseille, France
| | - Frank Kober
- Aix-Marseille Univ, CNRS, CRMBM, Marseille, France
| | | | - Alexis Jacquier
- Aix-Marseille Univ, CNRS, CRMBM, Marseille, France
- Department of Radiology and Cardiovascular Imaging, La Timone Hospital, Marseille, France
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Beaudry RI, Samuel TJ, Wang J, Tucker WJ, Haykowsky MJ, Nelson MD. Exercise cardiac magnetic resonance imaging: a feasibility study and meta-analysis. Am J Physiol Regul Integr Comp Physiol 2018; 315:R638-R645. [PMID: 29949409 DOI: 10.1152/ajpregu.00158.2018] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Cardiac stress testing improves detection and risk assessment of heart disease. Magnetic resonance imaging (MRI) is the clinical gold-standard for assessing cardiac morphology and function at rest; however, exercise MRI has not been widely adapted for cardiac assessment because of imaging and device limitations. Commercially available magnetic resonance ergometers, together with improved imaging sequences, have overcome many previous limitations, making cardiac stress MRI more feasible. Here, we aimed to demonstrate clinical feasibility and establish the normative, healthy response to supine exercise MRI. Eight young, healthy subjects underwent rest and exercise cinematic imaging to measure left ventricular volumes and ejection fraction. To establish the normative, healthy response to exercise MRI we performed a comprehensive literature review and meta-analysis of existing exercise cardiac MRI studies. Results were pooled using a random effects model to define the left ventricular ejection fraction, end-diastolic, end-systolic, and stroke volume responses. Our proof-of-concept data showed a marked increase in cardiac index with exercise, secondary to an increase in both heart rate and stroke volume. The change in stroke volume was driven by a reduction in end-systolic volume, with no change in end-diastolic volume. These findings were entirely consistent with 17 previous exercise MRI studies (226 individual records), despite differences in imaging approach, ergometer, or exercise type. Taken together, the data herein demonstrate that exercise cardiac MRI is clinically feasible, using commercially available exercise equipment and vendor-provided product sequences and establish the normative, healthy response to exercise MRI.
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Affiliation(s)
- Rhys I Beaudry
- Department of Kinesiology, University of Texas at Arlington , Arlington, Texas
| | - T Jake Samuel
- Department of Kinesiology, University of Texas at Arlington , Arlington, Texas
| | - Jing Wang
- College of Nursing and Health Innovation, University of Texas at Arlington , Arlington, Texas
| | - Wesley J Tucker
- Department of Kinesiology, University of Texas at Arlington , Arlington, Texas
| | - Mark J Haykowsky
- College of Nursing and Health Innovation, University of Texas at Arlington , Arlington, Texas
| | - Michael D Nelson
- Department of Kinesiology, University of Texas at Arlington , Arlington, Texas
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Optimizing Risk Stratification and Noninvasive Diagnosis of Ischemic Heart Disease in Women. Can J Cardiol 2018; 34:400-412. [DOI: 10.1016/j.cjca.2018.01.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Revised: 01/09/2018] [Accepted: 01/17/2018] [Indexed: 01/17/2023] Open
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Niss O, Taylor MD. Applications of cardiac magnetic resonance imaging in sickle cell disease. Blood Cells Mol Dis 2017; 67:126-134. [PMID: 28818577 DOI: 10.1016/j.bcmd.2017.08.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Accepted: 08/07/2017] [Indexed: 02/06/2023]
Abstract
Cardiac magnetic resonance imaging (CMR) has evolved from an effective research tool to a non-invasive clinical modality with versatile applications. The accuracy of volume measurements and functional assessment and the ability to identify unique myocardial tissue characteristics non-invasively are the primary advantages of CMR. The use of CMR in sickle cell disease (SCD) has been limited clinically to myocardial iron assessment. The use of other CMR applications to characterize the cardiac pathology in SCD is slowly emerging but remains limited to research level. In this review, we discuss some of the applications of CMR in studying cardiovascular diseases and its potential uses in SCD for research and clinical purposes.
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Affiliation(s)
- Omar Niss
- Divisions of Hematology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
| | - Michael D Taylor
- Division of Cardiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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Abstract
Coronary artery disease (CAD) continues to be a leading cause of morbidity and mortality worldwide. Although invasive coronary angiography has previously been the gold standard in establishing the diagnosis of CAD, there is a growing shift to more appropriately use the cardiac catheterization laboratory to perform interventional procedures once a diagnosis of CAD has been established by noninvasive imaging modalities rather than using it primarily as a diagnostic facility to confirm or refute CAD. With ongoing technological advancements, noninvasive imaging plays a pre-eminent role in not only diagnosing CAD but also informing the choice of appropriate therapies, establishing prognosis, all while containing costs and providing value-based care. Multiple imaging modalities are available to evaluate patients suspected of having coronary ischemia, such as stress electrocardiography, stress echocardiography, single-photon emission computed tomography myocardial perfusion imaging, positron emission tomography, coronary computed tomography (CT) angiography, and magnetic resonance imaging. These imaging modalities can variably provide functional and anatomical delineation of coronary stenoses and help guide appropriate therapy. This review will discuss their advantages and limitations and their usage in the diagnostic pathway for patients with CAD. We also discuss newer technologies such as CT fractional flow reserve, CT angiography with perfusion, whole-heart coronary magnetic resonance angiography with perfusion, which can provide both anatomical as well as functional information in the same test, thus obviating the need for multiple diagnostic tests to obtain a comprehensive assessment of both, plaque burden and downstream ischemia. Recognizing that clinicians have a multitude of tests to choose from, we provide an underpinning of the principles of ischemia detection by these various modalities, focusing on anatomy vs physiology, the database justifying their use, their prognostic capabilities and lastly, their appropriate and judicious use in this era of patient-centered, cost-effective imaging.
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Hedgire SS, Osborne M, Verdini DJ, Ghoshhajra BB. Updates on Stress Imaging Testing and Myocardial Viability With Advanced Imaging Modalities. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2017; 19:26. [PMID: 28316034 DOI: 10.1007/s11936-017-0525-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OPINION STATEMENT Non-invasive stress testing plays a key role in diagnosis and risk stratification in patients with coronary artery disease. Technical advances in CT, MRI, and PET have lead to increased utility of these modalities in myocardial perfusion imaging. The aim of the review is to provide a succinct update on CT, PET, and MRI for myocardial stress perfusion imaging.
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Affiliation(s)
- Sandeep S Hedgire
- Department of Radiology, Division of Cardiovascular Imaging, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA
| | - Michael Osborne
- Cardiac MR PET-CT Program, Division of Cardiology and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02144, USA
| | - Daniel J Verdini
- Department of Radiology, Division of Cardiovascular Imaging, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA
| | - Brian B Ghoshhajra
- Department of Radiology, Division of Cardiovascular Imaging, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA.
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Rodríguez Palomares JF, Maceira González AM, Saura D, López Fernández T, Pérez de Isla L, Barba Cosials J. Selection of the Best of 2016 in Cardiac Imaging: Advances in Stress Cardiac Magnetic Resonance. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2017; 70:214-215. [PMID: 28254140 DOI: 10.1016/j.rec.2016.12.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Accepted: 10/17/2016] [Indexed: 06/06/2023]
Affiliation(s)
- José F Rodríguez Palomares
- Servicio de Cardiología, Hospital Universitari Vall d'Hebron, Institut de Recerca-VHIR, Universitat Autónoma de Barcelona, Barcelona, Spain.
| | | | - Daniel Saura
- Hospital Clínico Universitario Virgen de la Arrixaca, IMIB-Arrixaca, Murcia, Spain
| | | | - Leopoldo Pérez de Isla
- Servicio de Cardiología, Hospital Clínico San Carlos, Departamento de Medicina, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - Joaquín Barba Cosials
- Departamento de Cardiología y Cirugía Cardiaca, Clínica Universidad de Navarra, Pamplona, Navarra, Spain
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Selección de lo mejor del año 2016 en imagen cardiaca: Novedades en cardiorresonancia magnética de estrés. Rev Esp Cardiol (Engl Ed) 2017. [DOI: 10.1016/j.recesp.2016.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Le TT, Huang W, Bryant JA, Cook SA, Chin CWL. Stress cardiovascular magnetic resonance imaging: current and future perspectives. Expert Rev Cardiovasc Ther 2017; 15:181-189. [DOI: 10.1080/14779072.2017.1296356] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- Thu-Thao Le
- Department of cardiovascular medicine, National Heart Centre Singapore, Singapore, Singapore
| | - Weiting Huang
- Department of cardiovascular medicine, National Heart Centre Singapore, Singapore, Singapore
| | - Jennifer Ann Bryant
- Department of cardiovascular medicine, National Heart Centre Singapore, Singapore, Singapore
| | - Stuart Alexander Cook
- Department of cardiovascular medicine, National Heart Centre Singapore, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Calvin Woon-Loong Chin
- Department of cardiovascular medicine, National Heart Centre Singapore, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
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Le TT, Bryant JA, Ting AE, Ho PY, Su B, Teo RCC, Gan JSJ, Chung YC, O'Regan DP, Cook SA, Chin CWL. Assessing exercise cardiac reserve using real-time cardiovascular magnetic resonance. J Cardiovasc Magn Reson 2017. [PMID: 28110638 DOI: 10.1186/s12968-0170322-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2023] Open
Abstract
BACKGROUND Exercise cardiovascular magnetic resonance (ExCMR) has great potential for clinical use but its development has been limited by a lack of compatible equipment and robust real-time imaging techniques. We developed an exCMR protocol using an in-scanner cycle ergometer and assessed its performance in differentiating athletes from non-athletes. METHODS Free-breathing real-time CMR (1.5T Aera, Siemens) was performed in 11 athletes (5 males; median age 29 [IQR: 28-39] years) and 16 age- and sex-matched healthy volunteers (7 males; median age 26 [interquartile range (IQR): 25-33] years). All participants underwent an in-scanner exercise protocol on a CMR compatible cycle ergometer (Lode BV, the Netherlands), with an initial workload of 25W followed by 25W-increment every minute. In 20 individuals, exercise capacity was also evaluated by cardiopulmonary exercise test (CPET). Scan-rescan reproducibility was assessed in 10 individuals, at least 7 days apart. RESULTS The exCMR protocol demonstrated excellent scan-rescan (cardiac index (CI): 0.2 ± 0.5L/min/m2) and inter-observer (ventricular volumes: 1.2 ± 5.3mL) reproducibility. CI derived from exCMR and CPET had excellent correlation (r = 0.83, p < 0.001) and agreement (1.7 ± 1.8L/min/m2). Despite similar values at rest (P = 0.87), athletes had increased exercise CI compared to healthy individuals (at peak exercise: 12.2 [IQR: 10.2-13.5] L/min/m2 versus 8.9 [IQR: 7.5-10.1] L/min/m2, respectively; P < 0.001). Peak exercise CI, where image acquisition lasted 13-17 s, outperformed that at rest (c-statistics = 0.95 [95% confidence interval: 0.87-1.00] versus 0.48 [95% confidence interval: 0.23-0.72], respectively; P < 0.0001 for comparison) in differentiating athletes from healthy volunteers; and had similar performance as VO2max (c-statistics = 0.84 [95% confidence interval = 0.62-1.00]; P = 0.29 for comparison). CONCLUSIONS We have developed a novel in-scanner exCMR protocol using real-time CMR that is highly reproducible. It may now be developed for clinical use for physiological studies of the heart and circulation.
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Affiliation(s)
- Thu-Thao Le
- National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609, Singapore.
| | - Jennifer Ann Bryant
- National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609, Singapore
| | - Alicia Er Ting
- National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609, Singapore
| | - Pei Yi Ho
- National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609, Singapore
| | - Boyang Su
- National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609, Singapore
| | | | | | | | | | - Stuart A Cook
- National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609, Singapore
- Duke-NUS Medical School, Singapore, Singapore
- National Heart and Lung Institute, Imperial College, London, UK
| | - Calvin Woon-Loong Chin
- National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609, Singapore
- Duke-NUS Medical School, Singapore, Singapore
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Le TT, Bryant JA, Ting AE, Ho PY, Su B, Teo RCC, Gan JSJ, Chung YC, O’Regan DP, Cook SA, Chin CWL. Assessing exercise cardiac reserve using real-time cardiovascular magnetic resonance. J Cardiovasc Magn Reson 2017; 19:7. [PMID: 28110638 PMCID: PMC5256575 DOI: 10.1186/s12968-017-0322-1] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Accepted: 01/06/2017] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Exercise cardiovascular magnetic resonance (ExCMR) has great potential for clinical use but its development has been limited by a lack of compatible equipment and robust real-time imaging techniques. We developed an exCMR protocol using an in-scanner cycle ergometer and assessed its performance in differentiating athletes from non-athletes. METHODS Free-breathing real-time CMR (1.5T Aera, Siemens) was performed in 11 athletes (5 males; median age 29 [IQR: 28-39] years) and 16 age- and sex-matched healthy volunteers (7 males; median age 26 [interquartile range (IQR): 25-33] years). All participants underwent an in-scanner exercise protocol on a CMR compatible cycle ergometer (Lode BV, the Netherlands), with an initial workload of 25W followed by 25W-increment every minute. In 20 individuals, exercise capacity was also evaluated by cardiopulmonary exercise test (CPET). Scan-rescan reproducibility was assessed in 10 individuals, at least 7 days apart. RESULTS The exCMR protocol demonstrated excellent scan-rescan (cardiac index (CI): 0.2 ± 0.5L/min/m2) and inter-observer (ventricular volumes: 1.2 ± 5.3mL) reproducibility. CI derived from exCMR and CPET had excellent correlation (r = 0.83, p < 0.001) and agreement (1.7 ± 1.8L/min/m2). Despite similar values at rest (P = 0.87), athletes had increased exercise CI compared to healthy individuals (at peak exercise: 12.2 [IQR: 10.2-13.5] L/min/m2 versus 8.9 [IQR: 7.5-10.1] L/min/m2, respectively; P < 0.001). Peak exercise CI, where image acquisition lasted 13-17 s, outperformed that at rest (c-statistics = 0.95 [95% confidence interval: 0.87-1.00] versus 0.48 [95% confidence interval: 0.23-0.72], respectively; P < 0.0001 for comparison) in differentiating athletes from healthy volunteers; and had similar performance as VO2max (c-statistics = 0.84 [95% confidence interval = 0.62-1.00]; P = 0.29 for comparison). CONCLUSIONS We have developed a novel in-scanner exCMR protocol using real-time CMR that is highly reproducible. It may now be developed for clinical use for physiological studies of the heart and circulation.
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Affiliation(s)
- Thu-Thao Le
- National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609 Singapore
| | - Jennifer Ann Bryant
- National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609 Singapore
| | - Alicia Er Ting
- National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609 Singapore
| | - Pei Yi Ho
- National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609 Singapore
| | - Boyang Su
- National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609 Singapore
| | | | | | | | | | - Stuart A. Cook
- National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609 Singapore
- Duke-NUS Medical School, Singapore, Singapore
- National Heart and Lung Institute, Imperial College, London, UK
| | - Calvin Woon-Loong Chin
- National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609 Singapore
- Duke-NUS Medical School, Singapore, Singapore
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Affiliation(s)
- Eike Nagel
- Institute for Experimental and Translational Cardiovascular Imaging, Goethe University Frankfurt and German Centre for Cardiovascular Research (DZHK, partner site Rhine-Main), Frankfurt, Germany
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