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Tang CX, Zhou Z, Zhang JY, Xu L, Lv B, Jiang Zhang L. Cardiovascular Imaging in China: Yesterday, Today, and Tomorrow. J Thorac Imaging 2022; 37:355-365. [PMID: 36162066 DOI: 10.1097/rti.0000000000000678] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The high prevalence and mortality of cardiovascular diseases in China's large population has increased the use of cardiovascular imaging for the assessment of conditions in recent years. In this study, we review the past 20 years of cardiovascular imaging in China, the increasingly important role played by cardiovascular computed tomography in coronary artery disease and pulmonary embolism assessment, magnetic resonance imaging's use for cardiomyopathy assessment, the development and application of artificial intelligence in cardiovascular imaging, and the future of Chinese cardiovascular imaging.
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Affiliation(s)
- Chun Xiang Tang
- Department of Radiology, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu Province
| | - Zhen Zhou
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University
| | - Jia Yin Zhang
- Department of Radiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lei Xu
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University
| | - Bin Lv
- Department of Radiology, Fuwai Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences
- State Key Laboratory and National Center for Cardiovascular Diseases, Beijing
| | - Long Jiang Zhang
- Department of Radiology, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu Province
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2
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Lu H, Zhao S, Tian D, Yang S, Ma J, Chen Y, Ge M, Zeng M, Jin H. Clinical Application of Non-Contrast-Enhanced Dixon Water-Fat Separation Compressed SENSE Whole-Heart Coronary MR Angiography at 3.0 T With and Without Nitroglycerin. J Magn Reson Imaging 2021; 55:579-591. [PMID: 34254384 DOI: 10.1002/jmri.27829] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 06/28/2021] [Accepted: 06/30/2021] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND 3.0 T non-contrast-enhanced nitroglycerin (NTG)-assisted whole-heart coronary magnetic resonance angiography (MRA) employing Dixon water-fat separation and compressed SENSE (CS-SENSE) acceleration is a promising method for diagnosing coronary artery disease (CAD). PURPOSE To evaluate the diagnostic performance of this technique for detecting clinically-relevant (≥50% diameter reducing) CAD and to evaluate the difference in NTG-induced coronary vasodilation between patients with and without clinically-relevant CAD. STUDY TYPE Prospective. POPULATION Sixty-six patients with suspected CAD. FIELD STRENGTH/SEQUENCE 3.0 T; CSSENSE, Dixon water-fat separation, three-dimensional segmented turbo field gradient-echo sequence for whole-heart coronary MRA. ASSESSMENT Overall image quality of coronary MRA was calculated on the basis of all visible coronary segments. The diagnostic performance of coronary MRA for detecting a ≥50% reduction in coronary artery diameter with and without NTG was compared using X-ray coronary angiography (CAG) as the reference. According to CAG, patients were divided into a non-clinically-relevant CAD group and clinically-relevant CAD group, and the difference in NTG-induced vasodilation between the groups was evaluated. STATISTICAL TESTS Unpaired/paired Student's t-test, Mann-Whitney U test, paired Wilcoxon signed-rank test, χ2 test, McNemar test. A two-tailed P value <0.05 was considered significant. RESULTS Overall image quality was increased significantly in the coronary MRA images after NTG. The diagnostic performance of the non-NTG vs. NTG-assisted coronary MRA was as follows on a per-patient basis: sensitivity 94.3% vs. 94.3%, specificity 64.5% vs. 83.9%, positive predictive value 75.0% vs. 86.8%, negative predictive value 90.9% vs. 92.9%, and accuracy 80.3% vs. 89.4%, respectively. NTG-induced vasodilation was significantly lower in the clinically-relevant CAD group than in the non-clinically-relevant CAD group (13.7 ± 8.1% vs. 24.1 ± 16.3%). DATA CONCLUSION Non-contrast Dixon water-fat separation CS-SENSE coronary MRA at 3.0 T can noninvasively detect clinically-relevant CAD and sublingual NTG improved performance. Combining pre- and post-NTG coronary MRA may provide a simple noninvasive and nonionizing test to evaluate coronary vasodilation function. LEVEL OF EVIDENCE 1 TECHNICAL EFFICACY STAGE: 2.
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Affiliation(s)
- Hongfei Lu
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Medical Imaging, Shanghai, China.,Department of Medical Imaging, Shanghai Medical School, Fudan University, Shanghai, China
| | - Shihai Zhao
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Medical Imaging, Shanghai, China.,Department of Medical Imaging, Shanghai Medical School, Fudan University, Shanghai, China
| | - Di Tian
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Medical Imaging, Shanghai, China.,Department of Medical Imaging, Shanghai Medical School, Fudan University, Shanghai, China
| | - Shan Yang
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Medical Imaging, Shanghai, China.,Department of Medical Imaging, Shanghai Medical School, Fudan University, Shanghai, China
| | - Jianying Ma
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yinyin Chen
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Medical Imaging, Shanghai, China.,Department of Medical Imaging, Shanghai Medical School, Fudan University, Shanghai, China
| | - Meiying Ge
- Department of Radiology, The Fifth People's Hospital of Shanghai, Fudan University, Shanghai, China
| | - Mengsu Zeng
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Medical Imaging, Shanghai, China.,Department of Medical Imaging, Shanghai Medical School, Fudan University, Shanghai, China
| | - Hang Jin
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Medical Imaging, Shanghai, China.,Department of Medical Imaging, Shanghai Medical School, Fudan University, Shanghai, China
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Kato Y, Ambale-Venkatesh B, Kassai Y, Kasuboski L, Schuijf J, Kapoor K, Caruthers S, Lima JAC. Non-contrast coronary magnetic resonance angiography: current frontiers and future horizons. MAGMA (NEW YORK, N.Y.) 2020; 33:591-612. [PMID: 32242282 PMCID: PMC7502041 DOI: 10.1007/s10334-020-00834-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 01/22/2020] [Accepted: 01/29/2020] [Indexed: 02/07/2023]
Abstract
Coronary magnetic resonance angiography (coronary MRA) is advantageous in its ability to assess coronary artery morphology and function without ionizing radiation or contrast media. However, technical limitations including reduced spatial resolution, long acquisition times, and low signal-to-noise ratios prevent it from clinical routine utilization. Nonetheless, each of these limitations can be specifically addressed by a combination of novel technologies including super-resolution imaging, compressed sensing, and deep-learning reconstruction. In this paper, we first review the current clinical use and motivations for non-contrast coronary MRA, discuss currently available coronary MRA techniques, and highlight current technical developments that hold unique potential to optimize coronary MRA image acquisition and post-processing. In the final section, we examine the various research-based coronary MRA methods and metrics that can be leveraged to assess coronary stenosis severity, physiological function, and atherosclerotic plaque characterization. We specifically discuss how such technologies may contribute to the clinical translation of coronary MRA into a robust modality for routine clinical use.
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Affiliation(s)
- Yoko Kato
- Division of Cardiology, Johns Hopkins University School of Medicine, 600 N Wolfe St, Blalock 524, Baltimore, MD, 21287-0409, USA
| | | | | | | | | | - Karan Kapoor
- Division of Cardiology, Johns Hopkins University School of Medicine, 600 N Wolfe St, Blalock 524, Baltimore, MD, 21287-0409, USA
| | | | - Joao A C Lima
- Division of Cardiology, Johns Hopkins University School of Medicine, 600 N Wolfe St, Blalock 524, Baltimore, MD, 21287-0409, USA.
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4
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Zhao SH, Li CG, Chen YY, Yun H, Zeng MS, Jin H. Applying Nitroglycerin at Coronary MR Angiography at 1.5 T: Diagnostic Performance of Coronary Vasodilation in Patients with Coronary Artery Disease. Radiol Cardiothorac Imaging 2020; 2:e190018. [PMID: 33778548 DOI: 10.1148/ryct.2020190018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Revised: 10/09/2019] [Accepted: 10/31/2019] [Indexed: 01/10/2023]
Abstract
Purpose To evaluate the influence of applying nitroglycerin (NTG) on detecting significant coronary artery disease (CAD) and NTG-induced coronary vasodilation using coronary MR angiography in patients suspected of having CAD. Materials and Methods In this prospective study conducted from November 2017 to September 2018, 70 consecutive participants suspected of having CAD were recruited. Of those, 57 patients successfully underwent pre- and post-NTG coronary MR angiography, both of which were performed during the end-systolic phase of the cardiac cycle. Significant coronary stenosis was defined at x-ray coronary angiography as stenosis of 50% or more. Participants were divided into a significant CAD group (significant stenosis) and nonsignificant CAD group (no significant stenosis) based on x-ray coronary angiography. Paired and unpaired Student t, generalized linear mixed model, and McNemar tests were used. Results The diagnostic performance of coronary MR angiography was significantly improved after NTG (P < .001). Per-patient for coronary MR angiography, from before to after NTG, respectively, the sensitivity was 97.6% (95% confidence interval [CI]: 85.6%, 99.9%) to 97.6% (95% CI: 85.6%, 99.9%), specificity was 25.0% (95% CI: 8.3%, 52.5%) to 62.5% (95% CI: 35.9%, 83.7%), positive predictive value was 76.9% (95% CI: 62.8%, 87.0%) to 87.0% (95% CI: 73.0%, 94.6%), negative predictive value was 80.0% (95% CI: 29.9%, 98.9%) to 90.9% (95% CI: 57.1%, 99.5%), and accuracy was 77.2% (95% CI: 66.3%, 88.1%) to 87.7% (95% CI: 79.2%, 96.3%). The NTG-induced coronary vasodilation was significantly lower in the significant CAD group compared with the nonsignificant CAD group. Conclusion Administration of NTG significantly improved the diagnostic performance of coronary MR angiography for detecting significant CAD; however, NTG-induced coronary vasodilation was impaired in patients with significant CAD.© RSNA, 2020See also commentary by François in this issue.
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Affiliation(s)
- Shi-Hai Zhao
- Department of Radiology, Zhongshan Hospital, Fudan University and Shanghai Institute of Medical Imaging, No. 180 Fenglin Road, Shanghai 200032, China (S.H.Z., Y.Y.C., H.Y., M.S.Z., H.J.); Department of Medical Imaging, Shanghai Medical School, Fudan University, Shanghai, China (S.H.Z., Y.Y.C., H.Y., M.S.Z., H.J.); and Department of Cardiology, Zhongshan Hospital, Fudan University and Shanghai Institute of Cardiovascular Diseases, Shanghai, China (C.G.L.)
| | - Chen-Guang Li
- Department of Radiology, Zhongshan Hospital, Fudan University and Shanghai Institute of Medical Imaging, No. 180 Fenglin Road, Shanghai 200032, China (S.H.Z., Y.Y.C., H.Y., M.S.Z., H.J.); Department of Medical Imaging, Shanghai Medical School, Fudan University, Shanghai, China (S.H.Z., Y.Y.C., H.Y., M.S.Z., H.J.); and Department of Cardiology, Zhongshan Hospital, Fudan University and Shanghai Institute of Cardiovascular Diseases, Shanghai, China (C.G.L.)
| | - Yin-Yin Chen
- Department of Radiology, Zhongshan Hospital, Fudan University and Shanghai Institute of Medical Imaging, No. 180 Fenglin Road, Shanghai 200032, China (S.H.Z., Y.Y.C., H.Y., M.S.Z., H.J.); Department of Medical Imaging, Shanghai Medical School, Fudan University, Shanghai, China (S.H.Z., Y.Y.C., H.Y., M.S.Z., H.J.); and Department of Cardiology, Zhongshan Hospital, Fudan University and Shanghai Institute of Cardiovascular Diseases, Shanghai, China (C.G.L.)
| | - Hong Yun
- Department of Radiology, Zhongshan Hospital, Fudan University and Shanghai Institute of Medical Imaging, No. 180 Fenglin Road, Shanghai 200032, China (S.H.Z., Y.Y.C., H.Y., M.S.Z., H.J.); Department of Medical Imaging, Shanghai Medical School, Fudan University, Shanghai, China (S.H.Z., Y.Y.C., H.Y., M.S.Z., H.J.); and Department of Cardiology, Zhongshan Hospital, Fudan University and Shanghai Institute of Cardiovascular Diseases, Shanghai, China (C.G.L.)
| | - Meng-Su Zeng
- Department of Radiology, Zhongshan Hospital, Fudan University and Shanghai Institute of Medical Imaging, No. 180 Fenglin Road, Shanghai 200032, China (S.H.Z., Y.Y.C., H.Y., M.S.Z., H.J.); Department of Medical Imaging, Shanghai Medical School, Fudan University, Shanghai, China (S.H.Z., Y.Y.C., H.Y., M.S.Z., H.J.); and Department of Cardiology, Zhongshan Hospital, Fudan University and Shanghai Institute of Cardiovascular Diseases, Shanghai, China (C.G.L.)
| | - Hang Jin
- Department of Radiology, Zhongshan Hospital, Fudan University and Shanghai Institute of Medical Imaging, No. 180 Fenglin Road, Shanghai 200032, China (S.H.Z., Y.Y.C., H.Y., M.S.Z., H.J.); Department of Medical Imaging, Shanghai Medical School, Fudan University, Shanghai, China (S.H.Z., Y.Y.C., H.Y., M.S.Z., H.J.); and Department of Cardiology, Zhongshan Hospital, Fudan University and Shanghai Institute of Cardiovascular Diseases, Shanghai, China (C.G.L.)
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5
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François CJ. Does the Use of Nitroglycerin at MR Angiography Help Diagnose Coronary Artery Disease? Radiol Cardiothorac Imaging 2020; 2:e200017. [PMID: 33779651 PMCID: PMC7977966 DOI: 10.1148/ryct.2020200017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 01/27/2020] [Indexed: 11/11/2022]
Affiliation(s)
- Christopher J. François
- From the Department of Radiology, Cardiovascular and Thoracic Imaging Sections, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, Madison, WI 53792
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6
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Lavin B, Phinikaridou A, Lorrio S, Zaragoza C, Botnar RM. Monitoring vascular permeability and remodeling after endothelial injury in a murine model using a magnetic resonance albumin-binding contrast agent. Circ Cardiovasc Imaging 2015; 8:CIRCIMAGING.114.002417. [PMID: 25873720 PMCID: PMC4405074 DOI: 10.1161/circimaging.114.002417] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Despite the beneficial effects of vascular interventions, these procedures may damage the endothelium leading to increased vascular permeability and remodeling. Re-endothelialization of the vessel wall, with functionally and structurally intact cells, is controlled by endothelial nitric oxide synthase (NOS3) and is crucial for attenuating adverse effects after injury. We investigated the applicability of the albumin-binding MR contrast agent, gadofosveset, to noninvasively monitor focal changes in vascular permeability and remodeling, after injury, in NOS3-knockout (NOS3(-/-)) and wild-type (WT) mice in vivo. METHODS AND RESULTS WT and NOS3(-/-) mice were imaged at 7, 15, and 30 days after aortic denudation or sham-surgery. T1 mapping (R1=1/T1, s(-1)) and delayed-enhanced MRI were used as measurements of vascular permeability (R1) and remodeling (vessel wall enhancement, mm(2)) after gadofosveset injection, respectively. Denudation resulted in higher vascular permeability and vessel wall enhancement 7 days after injury in both strains compared with sham-operated animals. However, impaired re-endothelialization and increased neovascularization in NOS3(-/-) mice resulted in significantly higher R1 at 15 and 30 days post injury compared with WT mice that showed re-endothelialization and lack of neovascularization (R1 [s(-1)]=15 days: NOS3 (-/-)4.02 [interquartile range, IQR, 3.77-4.41] versus WT2.39 [IQR, 2.35-2.92]; 30 days: NOS3 (-/-)4.23 [IQR, 3.94-4.68] versus WT2.64 [IQR, 2.33-2.80]). Similarly, vessel wall enhancement was higher in NOS3(-/-) but recovered in WT mice (area [mm(2)]=15 days: NOS3 (-/-)5.20 [IQR, 4.68-6.80] versus WT2.13 [IQR, 0.97-3.31]; 30 days: NOS3 (-/-)7.35 [IQR, 5.66-8.61] versus WT1.60 [IQR, 1.40-3.18]). Ex vivo histological studies corroborated the MRI findings. CONCLUSIONS We demonstrate that increased vascular permeability and remodeling, after injury, can be assessed noninvasively using an albumin-binding MR contrast agent and may be used as surrogate markers for evaluating the healing response of the vessel wall after injury.
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Affiliation(s)
- Begoña Lavin
- From the Division of Imaging Sciences and Biomedical Engineering, King's College London, King's Health Partners, St. Thomas' Hospital, London, United Kingdom (B.L., A.P., S.L., R.M.B.); The British Heart Foundation Centre of Excellence, Cardiovascular Division (B.L., A.P., R.M.B.) and Wellcome Trust and EPSRC Medical Engineering Center (B.L., R.M.B.), King's College London, London, United Kingdom; Cardiovascular Research Unit, University Francisco de Vitoria/Hospital Ramón y Cajal, Ctra. Colmenar Viejo, km 9,100, Madrid 28034, Spain (C.Z.).
| | - Alkystis Phinikaridou
- From the Division of Imaging Sciences and Biomedical Engineering, King's College London, King's Health Partners, St. Thomas' Hospital, London, United Kingdom (B.L., A.P., S.L., R.M.B.); The British Heart Foundation Centre of Excellence, Cardiovascular Division (B.L., A.P., R.M.B.) and Wellcome Trust and EPSRC Medical Engineering Center (B.L., R.M.B.), King's College London, London, United Kingdom; Cardiovascular Research Unit, University Francisco de Vitoria/Hospital Ramón y Cajal, Ctra. Colmenar Viejo, km 9,100, Madrid 28034, Spain (C.Z.)
| | - Silvia Lorrio
- From the Division of Imaging Sciences and Biomedical Engineering, King's College London, King's Health Partners, St. Thomas' Hospital, London, United Kingdom (B.L., A.P., S.L., R.M.B.); The British Heart Foundation Centre of Excellence, Cardiovascular Division (B.L., A.P., R.M.B.) and Wellcome Trust and EPSRC Medical Engineering Center (B.L., R.M.B.), King's College London, London, United Kingdom; Cardiovascular Research Unit, University Francisco de Vitoria/Hospital Ramón y Cajal, Ctra. Colmenar Viejo, km 9,100, Madrid 28034, Spain (C.Z.)
| | - Carlos Zaragoza
- From the Division of Imaging Sciences and Biomedical Engineering, King's College London, King's Health Partners, St. Thomas' Hospital, London, United Kingdom (B.L., A.P., S.L., R.M.B.); The British Heart Foundation Centre of Excellence, Cardiovascular Division (B.L., A.P., R.M.B.) and Wellcome Trust and EPSRC Medical Engineering Center (B.L., R.M.B.), King's College London, London, United Kingdom; Cardiovascular Research Unit, University Francisco de Vitoria/Hospital Ramón y Cajal, Ctra. Colmenar Viejo, km 9,100, Madrid 28034, Spain (C.Z.)
| | - René M Botnar
- From the Division of Imaging Sciences and Biomedical Engineering, King's College London, King's Health Partners, St. Thomas' Hospital, London, United Kingdom (B.L., A.P., S.L., R.M.B.); The British Heart Foundation Centre of Excellence, Cardiovascular Division (B.L., A.P., R.M.B.) and Wellcome Trust and EPSRC Medical Engineering Center (B.L., R.M.B.), King's College London, London, United Kingdom; Cardiovascular Research Unit, University Francisco de Vitoria/Hospital Ramón y Cajal, Ctra. Colmenar Viejo, km 9,100, Madrid 28034, Spain (C.Z.)
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7
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Harmer JA, Keech AC, Veillard AS, Skilton MR, Marwick TH, Watts GF, Meredith IT, Celermajer DS. Cigarette smoking and albuminuria are associated with impaired arterial smooth muscle function in patients with type 2 diabetes mellitus: a FIELD substudy. Diabetes Res Clin Pract 2014; 106:328-36. [PMID: 25301035 DOI: 10.1016/j.diabres.2014.08.029] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2013] [Revised: 06/13/2014] [Accepted: 08/30/2014] [Indexed: 11/16/2022]
Abstract
AIM Impaired arterial function has been implicated in diabetes-related atherosclerosis, but its determinants in high-risk adults have not been well characterised. We investigated factors associated with impaired arterial function in adults with type 2 diabetes. METHODS Flow-mediated dilatation (a marker of endothelial function) and dilator response to glyceryl trinitrate (to assess smooth muscle function) of the brachial artery were assessed at baseline in 193 patients with type 2 diabetes from the Fenofibrate Intervention and Event Lowering in Diabetes (FIELD) study. Traditional risk factors were assessed and a multivariable model was constructed to identify factors independently associated with impaired arterial function. RESULTS Median age was 64 years (interquartile range, 58-69; 61% male) and duration of diabetes was 4 years (interquartile range, 2-9). Flow-mediated dilatation (3.06 ± 0.25%, mean ± SEM) was severely impaired but not significantly associated with other risk factors. Dilator responses to glyceryl trinitrate (10.56 ± 0.52%) were significantly and independently impaired in past and present cigarette smokers (P = 0.005) and in subjects with increased urinary albumin/creatinine ratio (P = 0.01). CONCLUSIONS In adults with type 2 diabetes and known or suspected atherosclerosis, arterial smooth muscle-dependent dilatation was shown to be significantly impaired in cigarette smokers and those with elevated urinary albumin levels.
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Affiliation(s)
- Jason A Harmer
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia; Department of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia; NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia.
| | - Anthony C Keech
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia; Department of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia; NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
| | | | - Michael R Skilton
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia; Department of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | | | - Gerald F Watts
- Department of Medicine, University of Western Australia, Perth, WA, Australia
| | - Ian T Meredith
- Department of Medicine, Monash University, Melbourne, VIC, Australia
| | - David S Celermajer
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia; Department of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
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8
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Garcia-Garcia HM, Jang IK, Serruys PW, Kovacic JC, Narula J, Fayad ZA. Imaging plaques to predict and better manage patients with acute coronary events. Circ Res 2014; 114:1904-17. [PMID: 24902974 DOI: 10.1161/circresaha.114.302745] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Culprit lesions of patients, who have had an acute coronary syndrome commonly, are ruptured coronary plaques with superimposed thrombus. The precursor of such lesions is an inflamed thin-capped fibroatheroma. These plaques can be imaged by means of invasive techniques, such as intravascular ultrasound (and derived techniques), optical coherence tomography, and near-infrared spectroscopy. Often these patients exhibit similar (multiple) plaques beyond the culprit lesion. These remote plaques can be assessed noninvasively by computed tomographic angiography and MRI and also using invasive imaging. The detection of these remote plaques is not only feasible but also in natural history studies have been associated with clinical coronary events. Different systemic pharmacological treatments have been studied (mostly statins) with modest success and, therefore, newer approaches are being tested. Local treatment for such lesions is in its infancy and larger, prospective, and randomized trials are needed. This review will describe the pathological and imaging findings in culprit lesions of patients with acute coronary syndrome and the assessment of remote plaques. In addition, the pharmacological and local treatment options will be reviewed.
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Affiliation(s)
- Hector M Garcia-Garcia
- From the Department of Cardiology, Thoraxcenter, Erasmus University Medical Centre, Rotterdam, The Netherlands (H.M.G.-G., P.W.S.); Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston (I.-K.J.); and Department of Cardiology, Zena and Michael A. Wiener Cardiovascular Institute and Cardiovascular Research Center (J.C.K., J.N., Z.A.F.) and Department of Radiology, Translational and Molecular Imaging Institute (Z.A.F.), Icahn School of Medicine at Mount Sinai, New York, NY
| | - Ik-Kyung Jang
- From the Department of Cardiology, Thoraxcenter, Erasmus University Medical Centre, Rotterdam, The Netherlands (H.M.G.-G., P.W.S.); Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston (I.-K.J.); and Department of Cardiology, Zena and Michael A. Wiener Cardiovascular Institute and Cardiovascular Research Center (J.C.K., J.N., Z.A.F.) and Department of Radiology, Translational and Molecular Imaging Institute (Z.A.F.), Icahn School of Medicine at Mount Sinai, New York, NY
| | - Patrick W Serruys
- From the Department of Cardiology, Thoraxcenter, Erasmus University Medical Centre, Rotterdam, The Netherlands (H.M.G.-G., P.W.S.); Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston (I.-K.J.); and Department of Cardiology, Zena and Michael A. Wiener Cardiovascular Institute and Cardiovascular Research Center (J.C.K., J.N., Z.A.F.) and Department of Radiology, Translational and Molecular Imaging Institute (Z.A.F.), Icahn School of Medicine at Mount Sinai, New York, NY
| | - Jason C Kovacic
- From the Department of Cardiology, Thoraxcenter, Erasmus University Medical Centre, Rotterdam, The Netherlands (H.M.G.-G., P.W.S.); Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston (I.-K.J.); and Department of Cardiology, Zena and Michael A. Wiener Cardiovascular Institute and Cardiovascular Research Center (J.C.K., J.N., Z.A.F.) and Department of Radiology, Translational and Molecular Imaging Institute (Z.A.F.), Icahn School of Medicine at Mount Sinai, New York, NY
| | - Jagat Narula
- From the Department of Cardiology, Thoraxcenter, Erasmus University Medical Centre, Rotterdam, The Netherlands (H.M.G.-G., P.W.S.); Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston (I.-K.J.); and Department of Cardiology, Zena and Michael A. Wiener Cardiovascular Institute and Cardiovascular Research Center (J.C.K., J.N., Z.A.F.) and Department of Radiology, Translational and Molecular Imaging Institute (Z.A.F.), Icahn School of Medicine at Mount Sinai, New York, NY
| | - Zahi A Fayad
- From the Department of Cardiology, Thoraxcenter, Erasmus University Medical Centre, Rotterdam, The Netherlands (H.M.G.-G., P.W.S.); Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston (I.-K.J.); and Department of Cardiology, Zena and Michael A. Wiener Cardiovascular Institute and Cardiovascular Research Center (J.C.K., J.N., Z.A.F.) and Department of Radiology, Translational and Molecular Imaging Institute (Z.A.F.), Icahn School of Medicine at Mount Sinai, New York, NY.
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9
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Makowski MR, Henningsson M, Spuentrup E, Kim WY, Maintz D, Manning WJ, Botnar RM. Characterization of coronary atherosclerosis by magnetic resonance imaging. Circulation 2013; 128:1244-55. [PMID: 24019445 DOI: 10.1161/circulationaha.113.002681] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Marcus R Makowski
- Division of Imaging Sciences and Biomedical Engineering (M.R.M., M.H., R.M.B.), BHF Center of Research Excellence (M.R.M., M.H., R.M.B.), Wellcome Trust and EPSRC Medical Engineering Center (M.H., R.M.B.), and NIHR Biomedical Research Center (M.H., R.M.B.), King's College London, London, UK; Department of Radiology, Charité, Berlin, Germany (M.R.M.); Department of Radiology and Nuclear Medicine, Hospital Saarbrucken, Saarbrucken, Germany (E.S.); Department of Cardiology, Aarhus University Hospital, Skejby Sygehus, Denmark (W.Y.K.); Department of Radiology, University of Cologne, Cologne, Germany (D.M.); and Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA (W.J.M.)
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Phinikaridou A, Andia ME, Passacquale G, Ferro A, Botnar RM. Noninvasive MRI monitoring of the effect of interventions on endothelial permeability in murine atherosclerosis using an albumin-binding contrast agent. J Am Heart Assoc 2013; 2:e000402. [PMID: 24072533 PMCID: PMC3835253 DOI: 10.1161/jaha.113.000402] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Background Endothelial dysfunction promotes atherosclerosis. We investigated whether in vivo magnetic resonance imaging (MRI) using an albumin‐binding contrast agent, gadofosveset, could monitor the efficacy of minocycline and ebselen in reducing endothelial permeability and atherosclerotic burden in the brachiocephalic artery of high‐fat diet (HFD)–fed ApoE−/− mice. Methods and Results ApoE−/− mice were scanned 12 weeks after commencement of either a normal diet (controls) or an HFD. HFD‐fed ApoE−/− mice were either untreated or treated with minocycline or ebselen for 12 weeks. Delayed‐enhancement MRI and T1 mapping of the brachiocephalic artery, 30 minutes after injection of gadofosveset, showed increased vessel wall enhancement and relaxation rate (R1, s−1) in untreated HFD‐fed ApoE−/− mice (R1=3.8±0.52 s−1) compared with controls (R1=2.15±0.34 s−1, P<0.001). Conversely, minocycline‐treated (R1=2.7±0.17 s−1, P<0.001) and ebselen‐treated (R1=2.7±0.23 s−1, P<0.001) ApoE−/− mice showed less vessel wall enhancement compared with untreated HFD‐fed ApoE−/− mice. Mass spectroscopy showed a lower gadolinium concentration in the brachiocephalic artery of treated (minocycline=28.5±3 μmol/L, ebselen=32.4±4 μmol/L) compared with untreated HFD‐fed ApoE−/− mice (191±4.8 μmol/L) (P<0.02). Both interventions resulted in a lower plaque burden as measured by delayed‐enhancement MRI (minocycline=0.14±0.02 mm2, ebselen=0.20±0.09 mm2, untreated=0.44±0.01 mm2; P<0.001) and histology (minocycline=0.13±0.05 mm2, ebselen=0.18±0.02 mm2, untreated=0.32±0.04 mm2; P<0.002). Endothelium cells displayed fewer structural changes and smaller gap junction width in treated compared with untreated animals as seen by electron microscopy (minocycline=42.3±8.4 nm, ebselen=56.5±17 nm, untreated=2400±39 nm; P<0.001). Tissue flow cytometry of the brachiocephalic artery showed lower monocyte/macrophage content in both ebselen‐ and minocycline‐treated mice (8.06±3.2% and 7.62±1.73%, respectively) compared with untreated animals (20.1±2.2%) (P=0.03), with significant attenuation of the proinflammatory Ly6Chigh subtype (untreated mice, 42.64±6.1% of total monocytes; ebselen, 14.07±9.5% of total monocytes; minocycline, 26.42±0.6% of total monocytes). Conclusions We demonstrate that contrast‐enhanced MRI with an albumin‐binding contrast agent can be used to noninvasively monitor the effect of interventions on endothelial permeability and plaque burden. Blood albumin leakage could be a surrogate marker for the in vivo evaluation of interventions that aim at restoring endothelial integrity.
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Affiliation(s)
- Alkystis Phinikaridou
- Division of Imaging Science and Biomedical Engineering, King's College London, London, United Kingdom
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Jin H, Zeng MS, Ge MY, Yun H, Yang S. 3D coronary MR angiography at 1.5 T: Volume-targeted versus whole-heart acquisition. J Magn Reson Imaging 2013; 38:594-602. [PMID: 23371834 DOI: 10.1002/jmri.24015] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2012] [Accepted: 12/05/2012] [Indexed: 11/08/2022] Open
Affiliation(s)
- Hang Jin
- Department of Radiology; Zhongshan Hospital, Fudan University and Shanghai Medical Imaging Institute; Shanghai; China
| | - Meng-Su Zeng
- Department of Radiology; Zhongshan Hospital, Fudan University and Shanghai Medical Imaging Institute; Shanghai; China
| | - Mei-Ying Ge
- Department of Radiology; the 5th People's Hospital of Shanghai, Fudan University; Shanghai; China
| | - Hong Yun
- Department of Radiology; Zhongshan Hospital, Fudan University and Shanghai Medical Imaging Institute; Shanghai; China
| | - Shan Yang
- Department of Radiology; Zhongshan Hospital, Fudan University and Shanghai Medical Imaging Institute; Shanghai; China
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Phinikaridou A, Andia ME, Shah AM, Botnar RM. Advances in molecular imaging of atherosclerosis and myocardial infarction: shedding new light on in vivo cardiovascular biology. Am J Physiol Heart Circ Physiol 2012; 303:H1397-410. [PMID: 23064836 DOI: 10.1152/ajpheart.00583.2012] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Molecular imaging of the cardiovascular system heavily relies on the development of new imaging probes and technologies to facilitate visualization of biological processes underlying or preceding disease. Molecular imaging is a highly active research discipline that has seen tremendous growth over the past decade. It has broadened our understanding of oncologic, neurologic, and cardiovascular diseases by providing new insights into the in vivo biology of disease progression and therapeutic interventions. As it allows for the longitudinal evaluation of biological processes, it is ideally suited for monitoring treatment response. In this review, we will concentrate on the major accomplishments and advances in the field of molecular imaging of atherosclerosis and myocardial infarction with a special focus on magnetic resonance imaging.
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Affiliation(s)
- Alkystis Phinikaridou
- Division of Imaging Science and Biomedical Engineering, King's College London, United Kingdom.
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Phinikaridou A, Andia ME, Protti A, Indermuehle A, Shah A, Smith A, Warley A, Botnar RM. Noninvasive magnetic resonance imaging evaluation of endothelial permeability in murine atherosclerosis using an albumin-binding contrast agent. Circulation 2012; 126:707-19. [PMID: 22753191 DOI: 10.1161/circulationaha.112.092098] [Citation(s) in RCA: 91] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Endothelial dysfunction promotes atherosclerosis and precedes acute cardiovascular events. We investigated whether in vivo magnetic resonance imaging with the use of an albumin-binding contrast agent, gadofosveset, could detect endothelial damage associated with atherosclerosis in apolipoprotein E-deficient (ApoE(-/-)) mice. Furthermore, we tested whether magnetic resonance imaging could noninvasively assess endothelial function by measuring the endothelial-dependent vasodilation in response to acetylcholine. METHODS AND RESULTS ApoE(-/-) mice were imaged at 4, 8, and 12 weeks after commencement of a high-fat diet. Statin-treated ApoE(-/-) mice were scanned after 12 weeks of a high-fat diet. Wild-type mice were imaged before and 48 hours after injection of Russell's viper venom, an endothelial toxin. Delayed enhancement magnetic resonance imaging and T1 mapping of the brachiocephalic artery, 30 minutes after injection of gadofosveset, showed increased vessel wall enhancement and relaxation rate (R(1)) with progression of atherosclerosis in ApoE(-/-)(R(1) [s(-1)]: R(4 weeks) 2.42±0.35, R(8 weeks) 3.45±0.54, R(12 weeks) 3.83±0.52) and Russell's viper venom-injected wild-type mice (R(1)=4.57±0.86). Conversely, wild-type (R(1)=2.15±0.34) and statin-treated ApoE(-/-) (R(1)=3.0±0.65) mice showed less enhancement. Uptake of gadofosveset correlated with Evans blue staining, morphological changes of endothelial cells, and widening of the cell-cell junctions, suggesting that uptake occurs in regions of increased vascular permeability. Endothelial-dependent vasomotor responses showed vasoconstriction of the arteries of the ApoE(-/-) (-22.22±7.95%) and Russell's viper venom-injected (-10.37±17.60%) mice compared with wild-type mice (32.45±12.35%). Statin treatment improved endothelium morphology and function (-8.12±8.22%). CONCLUSIONS We demonstrate the noninvasive assessment of endothelial permeability and function with the use of an albumin-binding magnetic resonance contrast agent. Blood albumin leakage could be a surrogate marker for the in vivo evaluation of interventions that aim to restore the endothelium.
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Affiliation(s)
- Alkystis Phinikaridou
- King's College London, Division of Imaging Sciences and Biomedical Engineering, The Rayne Institute, 4th Floor, Lambeth Wing, St Thomas' Hospital, London SE1 7EH, United Kingdom.
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Jin H, Zeng MS, Yun H, Ge MY, Ma JY, Yang S. Noninvasive test of nitrate-induced coronary vasomotion by 1.5-T whole-heart 3D magnetic resonance angiography using a T2-prepared SSFP sequence. Int J Cardiovasc Imaging 2011; 28:1707-16. [PMID: 22187200 DOI: 10.1007/s10554-011-9999-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2011] [Accepted: 12/07/2011] [Indexed: 12/31/2022]
Abstract
This study was aimed to investigate the use of 1.5-T whole-heart 3D coronary MRA employing a T2-prepared SSFP sequence for assessing epicardial coronary artery vasodilation following exogenous nitrates. Navigator-gated whole-heart 3D coronary MRA was performed before and after sublingual nitroglycerin (NTG) in 22 volunteers and a T2-prepared SSFP sequence was used for imaging of coronary arteries without MR contrast agent. Coronary cross-sectional area was measured on pre- and post-NTG images of equivalent coronary segments in the major coronary arteries and whole-heart coronary vasodilation was analyzed quantitatively. Measurements were obtained by two independent investigators. Coronary vasodilation could be observed directly on multiplanar reformatted and three-dimensional volume-rendered MR images. On quantitative analysis, NTG administration results in the whole-heart coronary vasodilation by an average of 37.3 ± 12.7%. There was moderate yet significant correlation between the NTG-induced vasodilation and age (r = -0.52, P = 0.02). The mean absolute cross-sectional area of the coronary arteries was significantly higher after sublingual NTG in all the major coronary arteries. The coronary area measurements had an interobserver variability of 8 ± 3% and an intraobserver variability of 4 ± 2%. Non-contrast-enhanced 1.5-T SSFP whole-heart coronary MRA can noninvasively measure endothelium-independent coronary vasodilation over the entire heart with high feasibility and is a promising noninvasive method to explore whole-heart coronary smooth muscle cell function following exogenous nitrates in clinical practice.
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Affiliation(s)
- Hang Jin
- Department of Radiology, Zhongshan Hospital, Fudan University and Shanghai Medical Imaging Institute, 180#, Feng Lin Road, Shanghai 200032, China.
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Nguyen PK, Terashima M, Fair JM, Varady A, Taylor-Piliae RE, Iribarren C, Go AS, Haskell WL, Hlatky MA, Fortmann SP, McConnell MV. Physical Activity in Older Subjects Is Associated With Increased Coronary Vasodilation. JACC Cardiovasc Imaging 2011; 4:622-9. [DOI: 10.1016/j.jcmg.2011.05.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2011] [Revised: 04/14/2011] [Accepted: 04/21/2011] [Indexed: 12/15/2022]
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Nguyen PK, Nag D, Wu JC. Sex differences in the diagnostic evaluation of coronary artery disease. J Nucl Cardiol 2011; 18:144-52. [PMID: 21136229 PMCID: PMC3657505 DOI: 10.1007/s12350-010-9315-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Patricia K Nguyen
- Division of Cardiology, Department of Medicine, Stanford University, Stanford, CA, USA.
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Terashima M, Nguyen PK, Rubin GD, Meyer CH, Shimakawa A, Nishimura DG, Ehara S, Iribarren C, Courtney BK, Go AS, Hlatky MA, Fortmann SP, McConnell MV. Right coronary wall CMR in the older asymptomatic advance cohort: positive remodeling and associations with type 2 diabetes and coronary calcium. J Cardiovasc Magn Reson 2010; 12:75. [PMID: 21192815 PMCID: PMC3022803 DOI: 10.1186/1532-429x-12-75] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2010] [Accepted: 12/30/2010] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Coronary wall cardiovascular magnetic resonance (CMR) is a promising noninvasive approach to assess subclinical atherosclerosis, but data are limited in subjects over 60 years old, who are at increased risk. The purpose of the study was to evaluate coronary wall CMR in an asymptomatic older cohort. RESULTS Cross-sectional images of the proximal right coronary artery (RCA) were acquired using spiral black-blood coronary CMR (0.7 mm resolution) in 223 older, community-based patients without a history of cardiovascular disease (age 60-72 years old, 38% female). Coronary measurements (total vessel area, lumen area, wall area, and wall thickness) had small intra- and inter-observer variabilities (r = 0.93~0.99, all p < 0.0001), though one-third of these older subjects had suboptimal image quality. Increased coronary wall thickness correlated with increased coronary vessel area (p < 0.0001), consistent with positive remodeling. On multivariate analysis, type 2 diabetes was the only risk factor associated with increased coronary wall area and thickness (p = 0.03 and p = 0.007, respectively). Coronary wall CMR measures were also associated with coronary calcification (p = 0.01-0.03). CONCLUSIONS Right coronary wall CMR in asymptomatic older subjects showed increased coronary atherosclerosis in subjects with type 2 diabetes as well as coronary calcification. Coronary wall CMR may contribute to the noninvasive assessment of subclinical coronary atherosclerosis in older, at-risk patient groups.
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Affiliation(s)
- Masahiro Terashima
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Patricia K Nguyen
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Geoffrey D Rubin
- Department of Radiology, Stanford University School of Medicine, Stanford, CA, USA
| | - Craig H Meyer
- Department of Biomedical Engineering, University of Virginia, Charlottesville, VA, USA
| | - Ann Shimakawa
- Applied Science Laboratory-West, GE Healthcare, Menlo Park, CA, USA
| | - Dwight G Nishimura
- Magnetic Resonance Systems Research Laboratory, Department of Electrical Engineering, Stanford University School of Medicine, Stanford, CA, USA
| | - Shoichi Ehara
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Carlos Iribarren
- Division of Research, Kaiser Permanente of Northern California, Oakland, CA, USA
| | - Brian K Courtney
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Alan S Go
- Division of Research, Kaiser Permanente of Northern California, Oakland, CA, USA
- Departments of Epidemiology, Biostatistics, and Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Mark A Hlatky
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA
- Department of Health Research and Policy, Stanford University School of Medicine, Stanford, CA, USA
| | - Stephen P Fortmann
- Stanford Prevention Research Center, Stanford University School of Medicine, Stanford, CA, USA
| | - Michael V McConnell
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA
- Magnetic Resonance Systems Research Laboratory, Department of Electrical Engineering, Stanford University School of Medicine, Stanford, CA, USA
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Influence of applying nitroglycerin in whole-heart free-breathing 3D coronary MR angiography. AJR Am J Roentgenol 2010; 194:927-32. [PMID: 20308493 DOI: 10.2214/ajr.09.3330] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVE The purpose of our study was to assess the impact of sublingual nitroglycerin (NTG) spray on free-breathing 3D whole-heart coronary MR angiography (MRA). SUBJECTS AND METHODS We compared the timing parameters; measured the lumen diameter of the major coronary arteries; calculated coronary vasodilation, apparent signal-to-noise ratio (SNR), and apparent contrast-to-noise ratio (CNR); and evaluated the image quality on pre- and post-NTG coronary MRA in 15 volunteers. Statistical analysis was performed with p value less than 0.05 considered significant. RESULTS The mean trigger delay and optimal acquisition window were shortened significantly and the mean scanning time was prolonged statistically after NTG administration. There was no significant alteration in terms of apparent SNR and apparent CNR. The lumen diameters were significantly larger in coronary MRA post-NTG than in that of pre-NTG, with an average 25.35% +/- 6.51% (SD) increase, and the left circumflex coronary artery (LCX) had slightly lower vasodilation in comparison with the right coronary artery. Image quality scores of 53 (39.3%, 53/135) segments were increased and 15 segments (11.1%, 15/135) decreased after NTG administration, and the remaining 67 segments (49.6%, 67/135) were unchanged. CONCLUSION In general, sublingual NTG is useful for improving visualization of the coronary artery lumen and alleviating the impact of artifact. However, several alterations and disadvantages should be taken into consideration in view of the disturbed assessment of vasodilatory response in the LCX and the impaired quality in a minority of segments after NTG administration. Further studies are needed to evaluate the effect of beta-blockade on eliminating the disadvantages of sublingual NTG.
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Affiliation(s)
- Dudley J. Pennell
- From the Cardiovascular MR Unit, Royal Brompton Hospital, London, UK and Imperial College, London, UK
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Current awareness in NMR in biomedicine. NMR IN BIOMEDICINE 2009; 22:242-249. [PMID: 19320059 DOI: 10.1002/nbm.1331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
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