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Tingsgaard JK, Sørensen MH, Bojer AS, Anderson RH, Broadbent DA, Plein S, Gaede P, Madsen PL. Myocardial Blood Flow Determination From Contrast-Free Magnetic Resonance Imaging Quantification of Coronary Sinus Flow. J Magn Reson Imaging 2024; 59:1258-1266. [PMID: 37491887 DOI: 10.1002/jmri.28919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 07/09/2023] [Accepted: 07/10/2023] [Indexed: 07/27/2023] Open
Abstract
BACKGROUND Determination of myocardial blood flow (MBF) with MRI is usually performed with dynamic contrast enhanced imaging (MBFDCE ). MBF can also be determined from coronary sinus blood flow (MBFCS ), which has the advantage of being a noncontrast technique. However, comparative studies of MBFDCE and MBFCS in large cohorts are lacking. PURPOSE To compare MBFCS and MBFDCE in a large cohort. STUDY TYPE Prospective, sequence-comparison study. POPULATION 147 patients with type 2 diabetes mellitus (age: 56+/-12 years; 106 male; diabetes duration: 12.9+/-8.1 years), and 25 age-matched controls. FIELD STRENGTH/SEQUENCES 1.5 Tesla scanner. Saturation recovery sequence for MBFDCE vs. phase-contrast gradient-echo pulse sequence (free-breathing) for MBFCS . ASSESSMENT MBFDCE and MBFCS were determined at rest and during coronary dilatation achieved by administration of adenosine at 140 μg/kg/min. Myocardial perfusion reserve (MPR) was calculated as the stress/rest ratio of MBF values. Coronary sinus flow was determined twice in the same imaging session for repeatability assessment. STATISTICAL TESTS Agreement between MBFDCE and MBFCS was assessed with Bland and Altman's technique. Repeatability was determined from single-rater random intraclass and repeatability coefficients. RESULTS Rest and stress flows, including both MBFDCE and MBFCS values, ranged from 33 to 146 mL/min/100 g and 92 to 501 mL/min/100 g, respectively. Intraclass and repeatability coefficients for MBFCS were 0.95 (CI 0.90; 0.95) and 5 mL/min/100 g. In Bland-Altman analysis, mean bias at rest was -1.1 mL/min/100 g (CI -3.1; 0.9) with limits of agreement of -27 and 24.8 mL/min/100 g. Mean bias at stress was 6.3 mL/min/100 g (CI -1.1; 14.1) with limits of agreement of -86.9 and 99.9. Mean bias of MPR was 0.11 (CI: -0.02; 0.23) with limits of agreement of -1.43 and 1.64. CONCLUSION MBF may be determined from coronary sinus blood flow, with acceptable bias, but relatively large limits of agreement, against the reference of MBFDCE . LEVEL OF EVIDENCE 1 TECHNICAL EFFICACY STAGE: 2.
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Affiliation(s)
| | | | | | | | - David Andrew Broadbent
- Department of Medical Physics and Engineering, Leeds Teaching Hospitals, Leeds, UK
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Sven Plein
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Peter Gaede
- Department of Internal Medicine, Slagelse-Naestved Hospital, Denmark
| | - Per Lav Madsen
- Department of Cardiology, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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2
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Sjöberg P, Hedström E, Fricke K, Frieberg P, Weismann CG, Liuba P, Carlsson M, Töger J. Comparison of 2D and 4D Flow MRI in Neonates Without General Anesthesia. J Magn Reson Imaging 2023; 57:71-82. [PMID: 35726779 PMCID: PMC10084310 DOI: 10.1002/jmri.28303] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 06/01/2022] [Accepted: 06/02/2022] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Neonates with critical congenital heart disease require early intervention. Four-dimensional (4D) flow may facilitate surgical planning and improve outcome, but accuracy and precision in neonates are unknown. PURPOSE To 1) validate two-dimensional (2D) and 4D flow MRI in a phantom and investigate the effect of spatial and temporal resolution; 2) investigate accuracy and precision of 4D flow and internal consistency of 2D and 4D flow in neonates; and 3) compare scan time of 4D flow to multiple 2D flows. STUDY TYPE Phantom and prospective patients. POPULATION A total of 17 neonates with surgically corrected aortic coarctation (age 18 days [IQR 11-20]) and a three-dimensional printed neonatal aorta phantom. FIELD STRENGTH/SEQUENCE 1.5T, 2D flow and 4D flow. ASSESSMENT In the phantom, 2D and 4D flow volumes (ascending and descending aorta, and aortic arch vessels) with different resolutions were compared to high-resolution reference 2D flow. In neonates, 4D flow was compared to 2D flow volumes at each vessel. Internal consistency was computed as the flow volume in the ascending aorta minus the sum of flow volumes in the aortic arch vessels and descending aorta, divided by ascending aortic flow. STATISTICAL TESTS Bland-Altman plots, Pearson correlation coefficient (r), and Student's t-tests. RESULTS In the phantom, 2D flow differed by 0.01 ± 0.02 liter/min with 1.5 mm spatial resolution and -0.01 ± 0.02 liter/min with 0.8 mm resolution; 4D flow differed by -0.05 ± 0.02 liter/min with 2.4 mm spatial and 42 msec temporal resolution, -0.01 ± 0.02 liter/min with 1.5 mm, 42 msec resolution and -0.01 ± 0.02 liter/min with 1.5 mm, 21 msec resolution. In patients, 4D flow and 2D flow differed by -0.06 ± 0.08 liter/min. Internal consistency in patients was -11% ± 17% for 2D flow and 5% ± 13% for 4D flow. Scan time was 17.1 minutes [IQR 15.5-18.5] for 2D flow and 6.2 minutes [IQR 5.3-6.9] for 4D flow, P < 0.0001. DATA CONCLUSION Neonatal 4D flow MRI is time efficient and can be acquired with good internal consistency without contrast agents or general anesthesia, thus potentially expanding 4D flow use to the youngest and smallest patients. EVIDENCE LEVEL 1 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- Pia Sjöberg
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund
| | - Erik Hedström
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund.,Diagnostic Radiology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
| | - Katrin Fricke
- Pediatric Heart Center, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
| | - Petter Frieberg
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund
| | - Constance G Weismann
- Pediatric Heart Center, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
| | - Petru Liuba
- Pediatric Heart Center, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
| | - Marcus Carlsson
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund
| | - Johannes Töger
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund
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3
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Töger J, Andersen M, Haglund O, Kylkilahti TM, Lundgaard I, Markenroth Bloch K. Real‐time imaging of respiratory effects on cerebrospinal fluid flow in small diameter passageways. Magn Reson Med 2022; 88:770-786. [PMID: 35403247 PMCID: PMC9324219 DOI: 10.1002/mrm.29248] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 03/01/2022] [Accepted: 03/08/2022] [Indexed: 12/03/2022]
Abstract
Purpose Respiration‐related CSF flow through the cerebral aqueduct may be useful for elucidating physiology and pathophysiology of the glymphatic system, which has been proposed as a mechanism of brain waste clearance. Therefore, we aimed to (1) develop a real‐time (CSF) flow imaging method with high spatial and sufficient temporal resolution to capture respiratory effects, (2) validate the method in a phantom setup and numerical simulations, and (3) apply the method in vivo and quantify its repeatability and correlation with different respiratory conditions. Methods A golden‐angle radial flow sequence (reconstructed temporal resolution 168 ms, spatial resolution 0.6 mm) was implemented on a 7T MRI scanner and reconstructed using compressed sensing. A phantom setup mimicked simultaneous cardiac and respiratory flow oscillations. The effect of temporal resolution and vessel diameter was investigated numerically. Healthy volunteers (n = 10) were scanned at four different respiratory conditions, including repeat scans. Results Phantom data show that the developed sequence accurately quantifies respiratory oscillations (ratio real‐time/reference QR = 0.96 ± 0.02), but underestimates the rapid cardiac oscillations (ratio QC = 0.46 ± 0.14). Simulations suggest that QC can be improved by increasing temporal resolution. In vivo repeatability was moderate to very strong for cranial and caudal flow (intraclass correlation coefficient range: 0.55–0.99) and weak to strong for net flow (intraclass correlation coefficient range: 0.48–0.90). Net flow was influenced by respiratory condition (p < 0.01). Conclusions The presented real‐time flow MRI method can quantify respiratory‐related variations of CSF flow in the cerebral aqueduct, but it underestimates rapid cardiac oscillations. In vivo, the method showed good repeatability and a relationship between flow and respiration.
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Affiliation(s)
- Johannes Töger
- Department of Clinical Sciences Lund, Diagnostic Radiology Lund University, Skåne University Hospital Lund Sweden
| | - Mads Andersen
- Philips Healthcare Copenhagen Denmark
- Lund University, Lund University Bioimaging Center Lund Sweden
| | - Olle Haglund
- Department of Medical Radiation Physics Lund University Lund Sweden
| | - Tekla Maria Kylkilahti
- Department of Experimental Medical Science Lund University Lund Sweden
- Wallenberg Centre for Molecular Medicine Lund University Lund Sweden
| | - Iben Lundgaard
- Department of Experimental Medical Science Lund University Lund Sweden
- Wallenberg Centre for Molecular Medicine Lund University Lund Sweden
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Schulz A, Lloyd DFA, van Poppel MPM, Roberts TA, Steinweg JK, Pushparajah K, Hajnal JV, Razavi R. Structured analysis of the impact of fetal motion on phase-contrast MRI flow measurements with metric optimized gating. Sci Rep 2022; 12:5395. [PMID: 35354868 PMCID: PMC8967860 DOI: 10.1038/s41598-022-09327-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Accepted: 03/21/2022] [Indexed: 01/19/2023] Open
Abstract
The impact of fetal motion on phase contrast magnetic resonance imaging (PC-MRI) with metric optimized gating (MOG) remains unknown, despite being a known limitation to prenatal MRI. This study aims to describe the effect of motion on fetal flow-measurements using PC-MRI with MOG and to generate a scoring-system that could be used to predict motion-corrupted datasets at the time of acquisition. Ten adult volunteers underwent PC-MRI with MOG using a motion-device to simulate reproducible in-plane motion encountered in fetuses. PC-MRI data were acquired on ten fetuses. All ungated images were rated on their quality from 0 (no motion) to 2 (severe motion). There was no significant difference in measured flows with in-plane motion during the first and last third of sequence acquisition. Movement in the middle section of acquisition produced a significant difference while all referring ungated images were rated with a score of 2. Intra-Class-Correlation (ICC) for flow-measurements in adult and fetal datasets was lower for datasets with scores of 2. For fetal applications, the use of a simple three-point scoring system reliably identifies motion-corrupted sequences from unprocessed data at the time of acquisition, with a high score corresponding to significant underestimation of flow values and increased interobserver variability.
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Affiliation(s)
- Alexander Schulz
- School of Biomedical Engineering and Imaging Sciences, King's College London, St. Thomas' Hospital, London, UK. .,Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, Berlin, 10117, Germany.
| | - David F A Lloyd
- School of Biomedical Engineering and Imaging Sciences, King's College London, St. Thomas' Hospital, London, UK.,Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Milou P M van Poppel
- School of Biomedical Engineering and Imaging Sciences, King's College London, St. Thomas' Hospital, London, UK
| | - Thomas A Roberts
- School of Biomedical Engineering and Imaging Sciences, King's College London, St. Thomas' Hospital, London, UK
| | - Johannes K Steinweg
- School of Biomedical Engineering and Imaging Sciences, King's College London, St. Thomas' Hospital, London, UK
| | - Kuberan Pushparajah
- School of Biomedical Engineering and Imaging Sciences, King's College London, St. Thomas' Hospital, London, UK.,Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Joseph V Hajnal
- School of Biomedical Engineering and Imaging Sciences, King's College London, St. Thomas' Hospital, London, UK
| | - Reza Razavi
- School of Biomedical Engineering and Imaging Sciences, King's College London, St. Thomas' Hospital, London, UK.,Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
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Gyllenhammar T, Carlsson M, Jögi J, Arheden H, Engblom H. Myocardial perfusion by CMR coronary sinus flow shows sex differences and lowered perfusion at stress in patients with suspected microvascular angina. Clin Physiol Funct Imaging 2022; 42:208-219. [PMID: 35279944 PMCID: PMC9310583 DOI: 10.1111/cpf.12750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 03/07/2022] [Indexed: 11/28/2022]
Abstract
Background Methods Results Conclusions
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Affiliation(s)
- Tom Gyllenhammar
- Department of Clinical Physiology Lund University, and Skåne University Hospital Sweden
| | - Marcus Carlsson
- Department of Clinical Physiology Lund University, and Skåne University Hospital Sweden
| | - Jonas Jögi
- Department of Clinical Physiology Lund University, and Skåne University Hospital Sweden
| | - Håkan Arheden
- Department of Clinical Physiology Lund University, and Skåne University Hospital Sweden
| | - Henrik Engblom
- Department of Clinical Physiology Lund University, and Skåne University Hospital Sweden
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Kato S, Fukui K, Kodama S, Azuma M, Nakayama N, Iwasawa T, Kimura K, Tamura K, Utsunomiya D. Cardiovascular magnetic resonance assessment of coronary flow reserve improves risk stratification in heart failure with preserved ejection fraction. J Cardiovasc Magn Reson 2021; 23:112. [PMID: 34657615 PMCID: PMC8522041 DOI: 10.1186/s12968-021-00807-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 08/17/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Coronary microvascular dysfunction (CMD) has been proposed as a novel mechanism for the pathophysiology of heart failure (HF) with preserved ejection fraction (HFpEF). Recent studies have suggested the potential utility of coronary flow reserve (CFR) as a marker of CMD in patients with HFpEF. Phase contrast (PC) cine cardiovascular magnetic resonance (CMR) of the coronary sinus has emerged as a non-invasive method to quantify CFR. We aimed to investigate the prognostic value of CMR-derived CFR in patients with HFpEF. METHODS Data from 163 HFpEF patients (73 ± 9 years; 86 [53%] female) were retrospectively analyzed. Coronary sinus blood flow was measured in all patients, and myocardial blood flow was calculated as coronary sinus blood flow divided by left ventricular mass. CFR was calculated as the myocardial blood flow during adenosine triphosphate infusion divided by that at rest. Adverse events were defined as all-cause death and hospitalization due to HF exacerbation. Event-free survival stratified according to CFR < 2.0 was estimated with Kaplan-Meier survival methods and Log-rank test. RESULTS During a median follow-up of 4.1 years, 26 patients (16%) experienced adverse events. CMR-derived CFR was significantly lower in HFpEF with adverse events compared with those without (1.93 ± 0.38 vs. 2.67 ± 0.52, p < 0.001). On a Kaplan Meier curve, the rates of adverse events were significantly higher in HFpEF patients with CFR < 2.0 compared with HFpEF with CFR ≥ 2.0 (p < 0.001). The area under the curve of CFR for predicting adverse events was significantly higher than that of LGE (0.881 vs. 0.768, p = 0.037) and GLS (0.881 vs. 0.747, p = 0.036). CONCLUSIONS CFR assessed using coronary sinus PC cine CMR may be useful as a non-invasive prognostic marker for HFpEF patients.
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Affiliation(s)
- Shingo Kato
- Department of Diagnostic Radiology, Yokohama City University Graduate School of Medicine, Yokohama, Japan.
- Department of Cardiology, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Japan.
| | - Kazuki Fukui
- Department of Cardiology, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Japan
| | - Sho Kodama
- Department of Cardiology, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Japan
| | - Mai Azuma
- Department of Cardiology, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Japan
| | - Naoki Nakayama
- Department of Cardiology, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Japan
| | - Tae Iwasawa
- Department of Radiology, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Japan
| | - Kazuo Kimura
- Department of Cardiology, Yokohama City University Medical Center, Yokohama, Japan
| | - Kouichi Tamura
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University, Yokohama, Japan
| | - Daisuke Utsunomiya
- Department of Diagnostic Radiology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
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7
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Kato S, Fukui K, Kodama S, Azuma M, Nakayama N, Iwasawa T, Kimura K, Tamura K, Utsunomiya D. Prognostic value of resting coronary sinus flow determined by phase-contrast cine cardiovascular magnetic resonance in patients with known or suspected coronary artery disease. J Cardiovasc Magn Reson 2021; 23:97. [PMID: 34407857 PMCID: PMC8375179 DOI: 10.1186/s12968-021-00790-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 06/29/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Phase-contrast cine cardiovascular magnetic resonance (CMR) of the coronary sinus has emerged as a non-invasive method to measure coronary sinus blood flow (CSBF) and coronary flow reserve (CFR). We aimed to compare the prognostic value of resting CSBF and CFR for predicting major adverse cardiac events (MACE) in patients with known or suspected coronary artery disease (CAD) who underwent vasodilator stress CMR. METHODS We studied 693 patients with known CAD and 519 patients with suspected CAD admitted to our hospital between 2009 and 2019. The CFR was calculated as the CSBF during adenosine triphosphate infusion divided by CSBF at rest. MACE was defined as composite of cardiovascular death, acute coronary syndrome, heart failure hospitalization, and sustained ventricular tachyarrhythmia. RESULTS During a median follow-up of 4.6 years, 92 patients (8%) experienced MACE. The resting CSBF was significantly higher in patients with MACE than in patients without MACE (114.7 ± 44.9 mL/min vs. 84.7 ± 30.9 mL/min, p < 0.001 for known CAD; 122.2 ± 33.3 mL/min vs. 86.6 ± 36.7 mL/min, p < 0.001 for suspected CAD). The resting CSBF remained a significant predictor for MACE after adjusting clinical and CMR variables (hazard ratio [HR] of resting CSBF higher than the median: 3.18, p = 0.0083 for known CAD; HR: 23.3, p < 0.001 for suspected CAD). The area under the curve for predicting MACE was 0.73 for resting CSBF, 0.72 for CFR (p = 0.78) in patients with known CAD, and 0.82 for resting CSBF, 0.83 (p = 0.58) for CFR in patients with suspected CAD. CONCLUSIONS The resting CSBF may be a useful non-invasive method for the risk stratification of patients with known or suspected CAD without any radiation exposure, contrast media, or pharmacological vasodilator agents.
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Affiliation(s)
- Shingo Kato
- Department of Diagnostic Radiology, Yokohama City Graduate School of Medicine, Yokohama, Kanagawa, Japan.
| | - Kazuki Fukui
- Department of Cardiology, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Kanagawa, Japan
- Department of Radiology, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Kanagawa, Japan
| | - Sho Kodama
- Department of Cardiology, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Kanagawa, Japan
- Department of Radiology, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Kanagawa, Japan
| | - Mai Azuma
- Department of Cardiology, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Kanagawa, Japan
- Department of Radiology, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Kanagawa, Japan
| | - Naoki Nakayama
- Department of Cardiology, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Kanagawa, Japan
- Department of Radiology, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Kanagawa, Japan
| | - Tae Iwasawa
- Department of Cardiology, Yokohama City University Medical Center, Yokohama, Kanagawa, Japan
| | - Kazuo Kimura
- Department of Cardiology, Yokohama City University Medical Center, Yokohama, Kanagawa, Japan
| | - Kouichi Tamura
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University, Yokohama, Kanagawa, Japan
| | - Daisuke Utsunomiya
- Department of Diagnostic Radiology, Yokohama City Graduate School of Medicine, Yokohama, Kanagawa, Japan
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Impaired coronary flow reserve evaluated by phase-contrast cine magnetic resonance imaging in patients with atrial fibrillations. Heart Vessels 2021; 36:775-781. [PMID: 33484290 DOI: 10.1007/s00380-020-01759-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 12/11/2020] [Indexed: 10/22/2022]
Abstract
Myocardial perfusion and perfusion reserve are diminished in patients with atrial fibrillation (AF). Phase-contrast (PC) cine magnetic resonance imaging (MRI) of the coronary sinus serves as a non-invasive means of quantifying coronary flow reserve (CFR) without any radioactive tracer. The present study aimed to evaluate the utility of PC cine MRI of the coronary sinus for assessing decreased CFR in patients with AF. We studied 362 patients with known or suspected coronary artery disease (CAD) [age 72 ± 9 years; 267 (74%) male; 90 (25%) had AF] and 20 age- and gender-matched control subjects [age 72 ± 9 years, 14 (70%) male]. Using a 1.5-T MR scanner and cardiac coils, blood flow of the coronary sinus (CBF) was quantified by PC cine MRI. CFR was calculated as CBF during adenosine triphosphate infusion divided by CBF at rest. CFR was significantly lower in patients with AF than in those without AF among all patients (n = 362) (2.45 ± 0.42 vs. 2.71 ± 0.58, p < 0.001), in patients with known CAD (n = 155) (2.40 ± 0.46 vs. 2.72 ± 0.58, p = 0.002), and in those with suspected CAD (n = 207) (2.49 ± 0.40 vs. 2.72 ± 0.59, p = 0.007). Significant differences in CFR were found between controls and patients without AF (3.12 ± 0.52 vs. 2.71 ± 0.58, p < 0.001). AF was independently associated with CFR in both known CAD patients [β = - 0.248, 95% confidence interval (CI): - 0.561 to - 0.119, p = 0.003) and suspected CAD patients (β = - 0.154, 95% CI - 0.353 to - 0.034, p = 0.018). The presence of AF was related to impaired CFR in both known and suspected CAD patients. PC cine MRI of the coronary sinus can be useful for detecting impaired CFR in patients with AF.
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Kato S, Fukui K, Kodama S, Azuma M, Iwasawa T, Kimura K, Tamura K, Utsunomiya D. Incremental prognostic value of coronary flow reserve determined by phase-contrast cine cardiovascular magnetic resonance of the coronary sinus in patients with diabetes mellitus. J Cardiovasc Magn Reson 2020; 22:73. [PMID: 33028350 PMCID: PMC7542951 DOI: 10.1186/s12968-020-00667-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 09/02/2020] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Although non-invasive assessment of coronary flow reserve (CFR) by cardiovascular magnetic resonance (CMR) provides prognostic information for patients with diabetes mellitus (DM), the incremental prognostic value of CMR-derived CFR remains unclear. PURPOSE To evaluate the incremental prognostic value of CMR-derived CFR for patients with DM who underwent stress CMR imaging. MATERIALS AND METHODS A total of 309 patients with type 2 DM [69 ± 9 years; 244 (78%) male] assessed between 2009 and 2019 were retrospectively reviewed. Coronary sinus blood flow (CSBF) was measured using phase contrast (PC) cine CMR. CFR was calculated as the CSBF during adenosine triphosphate infusion divided by that at rest. Major adverse cardiac events (MACE) were defined as death, acute coronary syndrome, hospitalization due to heart failure exacerbation, or sustained ventricular tachycardia. The incremental prognostic value of CFR over clinical and CMR variables was assessed by calculating the C-index and net reclassification improvement (NRI). RESULTS During a median follow-up of 3.8 years, 42 patients (14%) experienced MACE. The annualized event rate was significantly higher among patients with CFR < 2.0, regardless of the presence of late gadolinium enhancement (LGE) (1.4% vs. 9.8%, p = 0.011 in the LGE (-) group; 1.8% vs. 16.9%, p < 0.001 in the LGE (+) group). In addition, this trend was maintained in the subgroups stratified by presence or absence of ischemia (0.3% vs. 6.7%, p = 0.007 in the ischemia (-) group; 3.9% vs. 17.1%, p = 0.001 in the ischemia (+) group). Adding CFR to the risk model (age + gender + left ventricular ejection fraction + %LGE + %ischemia) resulted in a significant increase of the C-index from 0.838 to 0.870 (p = 0.038) and an NRI of 0.201 (0.004-0.368, p = 0.012). CONCLUSION PC cine CMR-derived CFR of the coronary sinus may be useful as a prognostic marker for DM patients, incremental to common clinical and CMR parameters. Due to the high prevalence of coronary microvascular dysfunction, the addition of CFR to conventional vasodilator stress CMR imaging may improve risk stratification for patients with DM.
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Affiliation(s)
- Shingo Kato
- Department of Diagnostic Radiology, Yokohama City University Graduate School of Medicine, Yokohama, Japan.
- Department of Cardiology, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Japan.
| | - Kazuki Fukui
- Department of Cardiology, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Japan
| | - Sho Kodama
- Department of Cardiology, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Japan
| | - Mai Azuma
- Department of Cardiology, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Japan
| | - Tae Iwasawa
- Department Radiology, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Japan
| | - Kazuo Kimura
- Department of Cardiology, Yokohama City University Medical Center, Yokohama, Japan
| | - Kouichi Tamura
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University, Yokohama, Japan
| | - Daisuke Utsunomiya
- Department of Diagnostic Radiology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
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Al-Mashat M, Jögi J, Carlsson M, Borgquist R, Ostenfeld E, Magnusson M, Bachus E, Rådegran G, Arheden H, Kanski M. Increased pulmonary blood volume variation in patients with heart failure compared to healthy controls: a noninvasive, quantitative measure of heart failure. J Appl Physiol (1985) 2020; 128:324-337. [PMID: 31873068 DOI: 10.1152/japplphysiol.00507.2019] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Variation of the blood content of the pulmonary vascular bed during a heartbeat can be quantified by pulmonary blood volume variation (PBVV) using magnetic resonance imaging (MRI). The aim was to evaluate whether PBVV differs in patients with heart failure compared with healthy controls and investigate the mechanisms behind the PBVV. Forty-six patients and 10 controls underwent MRI. PBVV was calculated from blood flow measurements in the main pulmonary artery and a pulmonary vein, defined as the maximum difference in cumulative PBV over one heartbeat. PBVV was indexed to stroke volume (SV) in the main pulmonary artery (PBVVSV). Patients displayed higher PBVVSV than controls (58 ± 14 vs. 43 ± 7%, P < 0.001). The change in PBVVSV could be explained by left ventricular (LV) longitudinal contribution to SV (R2 = 0.15, P = 0.02) and the phase shift between in- and outflow (R2 = 0.31, P < 0.001) in patients. Both variables contributed to the multiple regression analysis model and predicted PBVVSV (R2 = 0.38); however, the phase shift alone explained ~30% of the variation in PBVVSV. No correlation was found between PBVVSV and large vessel area. In conclusion, PBVVSV was higher in patients compared with controls. Approximately 40% of the variation of PBVVSV in patients can be explained by the LV longitudinal contribution to SV and the phase shift between pulmonary in- and outflow, where the phase shift alone accounts for ~30%. The remaining variation (60-70%) most likely occurs on a small vessel level. Future studies are needed to show the clinical added value of PBVVSV compared with right-heart catheterization.NEW & NOTEWORTHY This study shows that the pulmonary blood volume variation indexed to the stroke volume is higher in patients with heart failure compared with controls. The mechanisms behind this are lack of systolic suction from the left ventricular atrioventricular plane descent and increased phase shift between the in- and outflow to the pulmonary circulation (~40%), where the phase shift alone accounts for ~30%. The remaining variation (60-70%) is suggested to occur on a small vessel level.
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Affiliation(s)
- Mariam Al-Mashat
- Lund University, Department of Clinical Sciences Lund, Clinical Physiology, Skane University Hospital, Lund, Sweden
| | - Jonas Jögi
- Lund University, Department of Clinical Sciences Lund, Clinical Physiology, Skane University Hospital, Lund, Sweden
| | - Marcus Carlsson
- Lund University, Department of Clinical Sciences Lund, Clinical Physiology, Skane University Hospital, Lund, Sweden
| | - Rasmus Borgquist
- Lund University, Clinical Sciences, Cardiology, Arrhythmia Section, Skane University Hospital
| | - Ellen Ostenfeld
- Lund University, Department of Clinical Sciences Lund, Clinical Physiology, Skane University Hospital, Lund, Sweden
| | - Martin Magnusson
- Department of Clinical Sciences, Malmö, Lund University, Sweden.,Wallenberg Centre for Molecular Medicine, Lund University, Sweden.,Department of Cardiology, Malmö, Skane University Hospital, Sweden
| | - Erasmus Bachus
- Department of Clinical Sciences, Malmö, Lund University, Sweden
| | - Göran Rådegran
- Lund University, Department of Clinical Science Lund, Cardiology, and the Hemodynamic Lab, VO Heart and Lung Medicine, Skane University Hospital, Lund, Sweden
| | - Håkan Arheden
- Lund University, Department of Clinical Sciences Lund, Clinical Physiology, Skane University Hospital, Lund, Sweden
| | - Mikael Kanski
- Lund University, Department of Clinical Sciences Lund, Clinical Physiology, Skane University Hospital, Lund, Sweden
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Ryd D, Sun L, Steding-Ehrenborg K, Bidhult S, Kording F, Ruprecht C, Macgowan CK, Seed M, Aletras AH, Arheden H, Hedström E. Quantification of blood flow in the fetus with cardiovascular magnetic resonance imaging using Doppler ultrasound gating: validation against metric optimized gating. J Cardiovasc Magn Reson 2019; 21:74. [PMID: 31783877 PMCID: PMC6883707 DOI: 10.1186/s12968-019-0586-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 10/25/2019] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Fetal cardiovascular magnetic resonance (CMR) imaging is used clinically and for research, but has been previously limited due to lack of direct gating methods. A CMR-compatible Doppler ultrasound (DUS) gating device has resolved this. However, the DUS-gating method is not validated against the current reference method for fetal phase-contrast blood flow measurements, metric optimized gating (MOG). Further, we investigated how different methods for vessel delineation affect flow volumes and observer variability in fetal flow acquisitions. AIMS To 1) validate DUS gating versus MOG for quantifying fetal blood flow; 2) assess repeatability of DUS gating; 3) assess impact of region of interest (ROI) size on flow volume; and 4) compare time-resolved and static delineations for flow volume and observer variability. METHODS Phase-contrast CMR was acquired in the fetal descending aorta (DAo) and umbilical vein by DUS gating and MOG in 22 women with singleton pregnancy in gestational week 360 (265-400) with repeated scans in six fetuses. Impact of ROI size on measured flow was assessed for ROI:s 50-150% of the vessel diameter. Four observers from two centers provided time-resolved and static delineations. Bland-Altman analysis was used to determine agreement between both observers and methods. RESULTS DAo flow was 726 (348-1130) ml/min and umbilical vein flow 366 (150-782) ml/min by DUS gating. Bias±SD for DUS-gating versus MOG were - 45 ± 122 ml/min (-6 ± 15%) for DAo and 19 ± 136 ml/min (2 ± 24%) for umbilical vein flow. Repeated flow measurements in the same fetus showed similar volumes (median CoV = 11% (DAo) and 23% (umbilical vein)). Region of interest 50-150% of vessel diameter yielded flow 35-120%. Bias±SD for time-resolved versus static DUS-gated flow was 33 ± 39 ml/min (4 ± 6%) for DAo and 11 ± 84 ml/min (2 ± 15%) for umbilical vein flow. CONCLUSIONS Quantification of blood flow in the fetal DAo and umbilical vein using DUS-gated phase-contrast CMR is feasible and agrees with the current reference method. Repeatability was generally high for CMR fetal blood flow assessment. An ROI similar to the vessel area or slightly larger is recommended. A static ROI is sufficient for fetal flow quantification using currently available CMR sequences.
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Affiliation(s)
- Daniel Ryd
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skane University Hospital, Lund, Sweden
| | - Liqun Sun
- Department of Pediatrics, University of Toronto and Hospital for Sick Children, Toronto, ON Canada
| | - Katarina Steding-Ehrenborg
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skane University Hospital, Lund, Sweden
- Department of Health Sciences, Physiotherapy, Lund University, Lund, Sweden
| | - Sebastian Bidhult
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skane University Hospital, Lund, Sweden
- Department of Biomedical Engineering, Faculty of Engineering, Lund University, Lund, Sweden
| | - Fabian Kording
- Department of Diagnostic and Interventional Radiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christian Ruprecht
- Department of Diagnostic and Interventional Radiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christopher K. Macgowan
- Department of Medical Biophysics, University of Toronto and Hospital for Sick Children, Toronto, ON Canada
| | - Michael Seed
- Department of Pediatrics, University of Toronto and Hospital for Sick Children, Toronto, ON Canada
- Department of Diagnostic Imaging, University of Toronto and Hospital for Sick Children, Toronto, ON Canada
| | - Anthony H. Aletras
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skane University Hospital, Lund, Sweden
- School of Medicine, Laboratory of Computing, Medical Informatics and Biomedical, Imaging Technologies, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Håkan Arheden
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skane University Hospital, Lund, Sweden
| | - Erik Hedström
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skane University Hospital, Lund, Sweden
- Diagnostic Radiology, Department of Clinical Sciences Lund, Lund University, Skane University Hospital, Lund, Sweden
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12
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Seemann F, Heiberg E, Carlsson M, Gonzales RA, Baldassarre LA, Qiu M, Peters DC. Valvular imaging in the era of feature-tracking: A slice-following cardiac MR sequence to measure mitral flow. J Magn Reson Imaging 2019; 51:1412-1421. [PMID: 31654470 PMCID: PMC7217167 DOI: 10.1002/jmri.26971] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 09/26/2019] [Indexed: 12/19/2022] Open
Abstract
Background In mitral valve dysfunction, noninvasive measurement of transmitral blood flow is an important clinical examination. Flow imaging of the mitral valve, however, is challenging, since it moves in and out of the image plane during the cardiac cycle. Purpose To more accurately measure mitral flow, a slice‐following MRI phase contrast sequence is proposed. This study aimed to implement such a sequence, validate its slice‐following functionality in a phantom and healthy subjects, and test its feasibility in patients with mitral valve dysfunction. Study Type Prospective. Phantom and Subjects The slice‐following functionality was validated in a cone‐shaped phantom by measuring the depicted slice radius. Sixteen healthy subjects and 10 mitral valve dysfunction patients were enrolled at two sites. Field Strength/Sequence 1.5T and 3T gradient echo cine phase contrast. Assessment A single breath‐hold retrospectively gated sequence using offline feature‐tracking of the mitral valve was developed. Valve displacements were measured and imported to the scanner, allowing the slice position to change dynamically based on the cardiac phase. Mitral valve imaging was performed with slice‐following and static imaging planes. Validation was performed by comparing mitral stroke volume with planimetric and aortic stroke volume. Statistical Tests Measurements were compared using linear regression, Pearson's R, parametric paired t‐tests, Bland–Altman analysis, and intraclass correlation coefficient (ICC). Results Phantom experiments confirmed accurate slice displacements. Slice‐following was feasible in all subjects, yielding physiologically accurate mitral flow patterns. In healthy subjects, mitral and aortic stroke volumes agreed, with ICC = 0.72 and 0.90 for static and slice‐following planes; with bias ±1 SDs 23.2 ± 13.2 mls and 8.4 ± 10.8 mls, respectively. Agreement with planimetry was stronger, with ICC = 0.84 and 0.96; bias ±1 SDs 13.7 ± 13.7 mls and –2.0 ± 8.8 mls for static and slice‐following planes, respectively. Data Conclusion Slice‐following outperformed the conventional sequence and improved the accuracy of transmitral flow, which is important for assessment of diastolic function and mitral regurgitation. Level of Evidence: 2 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2020;51:1412–1421.
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Affiliation(s)
- Felicia Seemann
- Department of Clinical Sciences Lund, Clinical Physiology, Lund University, Skåne University Hospital, Lund, Sweden.,Department of Biomedical Engineering, Faculty of Engineering, Lund University, Lund, Sweden.,Department of Radiology & Biomedical Imaging, Yale School of Medicine, Yale University, New Haven, Connecticut, USA
| | - Einar Heiberg
- Department of Clinical Sciences Lund, Clinical Physiology, Lund University, Skåne University Hospital, Lund, Sweden.,Department of Biomedical Engineering, Faculty of Engineering, Lund University, Lund, Sweden.,Wallenberg Center for Molecular Medicine, Lund University, Lund, Sweden
| | - Marcus Carlsson
- Department of Clinical Sciences Lund, Clinical Physiology, Lund University, Skåne University Hospital, Lund, Sweden
| | - Ricardo A Gonzales
- Department of Clinical Sciences Lund, Clinical Physiology, Lund University, Skåne University Hospital, Lund, Sweden.,Department of Radiology & Biomedical Imaging, Yale School of Medicine, Yale University, New Haven, Connecticut, USA.,Department of Electrical Engineering, Universidad de Ingenieria y Tecnologia, Lima, Peru
| | - Lauren A Baldassarre
- Department of Radiology & Biomedical Imaging, Yale School of Medicine, Yale University, New Haven, Connecticut, USA.,Department of Cardiology, Yale School of Medicine, Yale University, New Haven, Connecticut, USA
| | - Maolin Qiu
- Department of Radiology & Biomedical Imaging, Yale School of Medicine, Yale University, New Haven, Connecticut, USA
| | - Dana C Peters
- Department of Radiology & Biomedical Imaging, Yale School of Medicine, Yale University, New Haven, Connecticut, USA
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Bidhult S, Töger J, Heiberg E, Carlsson M, Arheden H, Aletras AH, Hedström E. Independent validation of metric optimized gating for fetal cardiovascular phase-contrast flow imaging. Magn Reson Med 2019; 81:495-503. [PMID: 30159933 PMCID: PMC6282515 DOI: 10.1002/mrm.27392] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 05/11/2018] [Accepted: 05/14/2018] [Indexed: 11/24/2022]
Abstract
PURPOSE To validate metric optimized gating phase-contrast MR (MOG PC-MR) flow measurements for a range of fetal flow velocities in phantom experiments. 2) To investigate intra- and interobserver variability for fetal flow measurements at an imaging center other than the original site. METHODS MOG PC-MR was compared to timer/beaker measurements in a pulsatile flow phantom using a heart rate (∼145 bpm), nozzle diameter (∼6 mm), and flow range (∼130-700 mL/min) similar to fetal imaging. Fifteen healthy fetuses were included for intra- and interobserver variability in the fetal descending aorta and umbilical vein. RESULTS Phantom MOG PC-MR flow bias and variability was 2% ± 23%. Accuracy of MOG PC-MR was degraded for flow profiles with low velocity-to-noise ratio. Intra- and interobserver coefficients of variation were 6% and 19%, respectively, for fetal descending aorta; and 10% and 17%, respectively, for the umbilical vein. CONCLUSION Phantom validation showed good agreement between MOG and conventionally gated PC-MR, except for cases with low velocity-to-noise ratio, which resulted in MOG misgating and underestimated peak velocities and warranted optimization of sequence parameters to individual fetal vessels. Inter- and intraobserver variability for fetal MOG PC-MR imaging were comparable to previously reported values.
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Affiliation(s)
- Sebastian Bidhult
- Lund University, Skane University HospitalDepartment of Clinical Sciences Lund, Clinical PhysiologyLundSweden
- Lund UniversityDepartment of Biomedical Engineering, Faculty of EngineeringLundSweden
| | - Johannes Töger
- Lund University, Skane University HospitalDepartment of Clinical Sciences Lund, Clinical PhysiologyLundSweden
| | - Einar Heiberg
- Lund University, Skane University HospitalDepartment of Clinical Sciences Lund, Clinical PhysiologyLundSweden
- Lund UniversityDepartment of Biomedical Engineering, Faculty of EngineeringLundSweden
| | - Marcus Carlsson
- Lund University, Skane University HospitalDepartment of Clinical Sciences Lund, Clinical PhysiologyLundSweden
| | - Håkan Arheden
- Lund University, Skane University HospitalDepartment of Clinical Sciences Lund, Clinical PhysiologyLundSweden
| | - Anthony H. Aletras
- Lund University, Skane University HospitalDepartment of Clinical Sciences Lund, Clinical PhysiologyLundSweden
- Laboratory of Computing, Medical Informatics and Biomedical–Imaging Technologies, School of MedicineAristotle University of ThessalonikiGreece
| | - Erik Hedström
- Lund University, Skane University HospitalDepartment of Clinical Sciences Lund, Clinical PhysiologyLundSweden
- Lund University, Skane University HospitalDepartment of Clinical Sciences Lund, Diagnostic RadiologyLundSweden
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14
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Gyllenhammar T, Kanski M, Engblom H, Wuttge DM, Carlsson M, Hesselstrand R, Arheden H. Decreased global myocardial perfusion at adenosine stress as a potential new biomarker for microvascular disease in systemic sclerosis: a magnetic resonance study. BMC Cardiovasc Disord 2018; 18:16. [PMID: 29382301 PMCID: PMC5791343 DOI: 10.1186/s12872-018-0756-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Accepted: 01/23/2018] [Indexed: 01/26/2023] Open
Abstract
Background Patients with systemic sclerosis (SSc) have high cardiovascular mortality even though there is no or little increase in prevalence of epicardial coronary stenosis. First-pass perfusion on cardiovascular magnetic resonance (CMR) have detected perfusion defects indicative of microvascular disease, but the quantitative extent of hypoperfusion is not known. Therefore, we aimed to determine if patients with SSc have lower global myocardial perfusion (MP) at rest or during adenosine stress, compared to healthy controls, quantified with CMR. Methods Nineteen SSc patients (17 females, 61 ± 10 years) and 22 controls (10 females, 62 ± 11 years) underwent CMR. Twelve patients had limited cutaneous SSc and 7 patients had diffuse cutaneous SSc. One patient had pulmonary arterial hypertension (PAH). MP was quantified using coronary sinus flow (CSF) measurements at rest and during adenosine stress, divided by left ventricular mass (LVM). Results There was no difference in MP at rest between patients and controls (1.1 ± 0.5 vs. 1.1 ± 0.3 ml/min/g, P = 0.85) whereas SSc patients showed statistically significantly lower MP during adenosine stress (3.1 ± 0.9 vs. 4.2 ± 1.3 ml/min/g, P = 0.008). Three out of the 19 SSc patients showed fibrosis in the right ventricle insertion points despite absence of PAH. None had signs of myocardial infarction. Conclusions Patients with SSc have decreased MP during adenosine stress compared to healthy controls. Thus hypoperfusion at stress may be a sensitive marker of cardiac disease in SSc patients possibly signifying microvascular myocardial disease.
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Affiliation(s)
- Tom Gyllenhammar
- Skane University Hospital, Department of Clinical Physiology, Lund University, Lund, Sweden
| | - Mikael Kanski
- Skane University Hospital, Department of Clinical Physiology, Lund University, Lund, Sweden
| | - Henrik Engblom
- Skane University Hospital, Department of Clinical Physiology, Lund University, Lund, Sweden
| | - Dirk M Wuttge
- Skane University Hospital, Department of Rheumatology, Lund University, Lund, Sweden
| | - Marcus Carlsson
- Skane University Hospital, Department of Clinical Physiology, Lund University, Lund, Sweden
| | - Roger Hesselstrand
- Skane University Hospital, Department of Rheumatology, Lund University, Lund, Sweden
| | - Håkan Arheden
- Skane University Hospital, Department of Clinical Physiology, Lund University, Lund, Sweden.
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15
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Hassan M, Wagdy K, Kharabish A, Selwanos PP, Nabil A, Elguindy A, ElFaramawy A, Elmahdy MF, Mahmoud H, Yacoub MH. Validation of Noninvasive Measurement of Cardiac Output Using Inert Gas Rebreathing in a Cohort of Patients With Heart Failure and Reduced Ejection Fraction. Circ Heart Fail 2017; 10:CIRCHEARTFAILURE.116.003592. [PMID: 28283502 DOI: 10.1161/circheartfailure.116.003592] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Accepted: 02/03/2017] [Indexed: 01/25/2023]
Abstract
BACKGROUND Cardiac output (CO) is a key indicator of cardiac function in patients with heart failure. No completely accurate method is available for measuring CO in all patients. The objective of this study was to validate CO measurement using the inert gas rebreathing (IGR) method against other noninvasive and invasive methods of CO quantification in a cohort of patients with heart failure and reduced ejection fraction. METHODS AND RESULTS The study included 97 patients with heart failure and reduced ejection fraction (age 42±15.5 years; 64 patients (65.9%) had idiopathic dilated cardiomyopathy and 21 patients (21.6%) had ischemic heart disease). Median left ventricle ejection fraction was 24% (10%-36%). Patients with atrial fibrillation were excluded. CO was measured using 4 methods (IGR, cardiac magnetic resonance imaging, cardiac catheterization, and echocardiography) and indexed to body surface area (cardiac index [CI]). All studies were performed within 48 hours. Median CI measured by IGR was 1.75, by cardiac magnetic resonance imaging was 1.82, by cardiac catheterization was 1.65, and by echo was 1.7 L·min-1·m-2. There were significant modest linear correlations between IGR-derived CI and cardiac magnetic resonance imaging-derived CI (r=0.7; P<0.001), as well as cardiac catheterization-derived CI (r=0.6; P<0.001). Using Bland-Altman analysis, the agreement between the IGR method and the other methods was as good as the agreement between any 2 other methods with each other. CONCLUSIONS The IGR method is a simple, accurate, and reproducible noninvasive method for quantification of CO in patients with advanced heart failure. The prognostic value of this simple measurement needs to be studied prospectively.
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Affiliation(s)
- Mohamed Hassan
- From the Cardiology Department (M.H., A.E., M.F.E.) and Radiology Department (A.K.), Cairo University, Egypt; Cardiology Department (M.H., K.W., P.P.S., A.E., H.M.), Radiology Department (A.K.), Biomedical Engineering Department (A.N.), and Cardiothoracic Department (M.H.Y.), Aswan Heart Centre, Egypt; and Imperial College, London, United Kingdom (M.H.Y.)
| | - Kerolos Wagdy
- From the Cardiology Department (M.H., A.E., M.F.E.) and Radiology Department (A.K.), Cairo University, Egypt; Cardiology Department (M.H., K.W., P.P.S., A.E., H.M.), Radiology Department (A.K.), Biomedical Engineering Department (A.N.), and Cardiothoracic Department (M.H.Y.), Aswan Heart Centre, Egypt; and Imperial College, London, United Kingdom (M.H.Y.)
| | - Ahmed Kharabish
- From the Cardiology Department (M.H., A.E., M.F.E.) and Radiology Department (A.K.), Cairo University, Egypt; Cardiology Department (M.H., K.W., P.P.S., A.E., H.M.), Radiology Department (A.K.), Biomedical Engineering Department (A.N.), and Cardiothoracic Department (M.H.Y.), Aswan Heart Centre, Egypt; and Imperial College, London, United Kingdom (M.H.Y.)
| | - Peter Philip Selwanos
- From the Cardiology Department (M.H., A.E., M.F.E.) and Radiology Department (A.K.), Cairo University, Egypt; Cardiology Department (M.H., K.W., P.P.S., A.E., H.M.), Radiology Department (A.K.), Biomedical Engineering Department (A.N.), and Cardiothoracic Department (M.H.Y.), Aswan Heart Centre, Egypt; and Imperial College, London, United Kingdom (M.H.Y.)
| | - Ahmed Nabil
- From the Cardiology Department (M.H., A.E., M.F.E.) and Radiology Department (A.K.), Cairo University, Egypt; Cardiology Department (M.H., K.W., P.P.S., A.E., H.M.), Radiology Department (A.K.), Biomedical Engineering Department (A.N.), and Cardiothoracic Department (M.H.Y.), Aswan Heart Centre, Egypt; and Imperial College, London, United Kingdom (M.H.Y.)
| | - Ahmed Elguindy
- From the Cardiology Department (M.H., A.E., M.F.E.) and Radiology Department (A.K.), Cairo University, Egypt; Cardiology Department (M.H., K.W., P.P.S., A.E., H.M.), Radiology Department (A.K.), Biomedical Engineering Department (A.N.), and Cardiothoracic Department (M.H.Y.), Aswan Heart Centre, Egypt; and Imperial College, London, United Kingdom (M.H.Y.)
| | - Amr ElFaramawy
- From the Cardiology Department (M.H., A.E., M.F.E.) and Radiology Department (A.K.), Cairo University, Egypt; Cardiology Department (M.H., K.W., P.P.S., A.E., H.M.), Radiology Department (A.K.), Biomedical Engineering Department (A.N.), and Cardiothoracic Department (M.H.Y.), Aswan Heart Centre, Egypt; and Imperial College, London, United Kingdom (M.H.Y.)
| | - Mahmoud F Elmahdy
- From the Cardiology Department (M.H., A.E., M.F.E.) and Radiology Department (A.K.), Cairo University, Egypt; Cardiology Department (M.H., K.W., P.P.S., A.E., H.M.), Radiology Department (A.K.), Biomedical Engineering Department (A.N.), and Cardiothoracic Department (M.H.Y.), Aswan Heart Centre, Egypt; and Imperial College, London, United Kingdom (M.H.Y.)
| | - Hani Mahmoud
- From the Cardiology Department (M.H., A.E., M.F.E.) and Radiology Department (A.K.), Cairo University, Egypt; Cardiology Department (M.H., K.W., P.P.S., A.E., H.M.), Radiology Department (A.K.), Biomedical Engineering Department (A.N.), and Cardiothoracic Department (M.H.Y.), Aswan Heart Centre, Egypt; and Imperial College, London, United Kingdom (M.H.Y.)
| | - Magdi H Yacoub
- From the Cardiology Department (M.H., A.E., M.F.E.) and Radiology Department (A.K.), Cairo University, Egypt; Cardiology Department (M.H., K.W., P.P.S., A.E., H.M.), Radiology Department (A.K.), Biomedical Engineering Department (A.N.), and Cardiothoracic Department (M.H.Y.), Aswan Heart Centre, Egypt; and Imperial College, London, United Kingdom (M.H.Y.).
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16
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Kato S, Fukui K, Kirigaya H, Gyotoku D, Iinuma N, Kusakawa Y, Iguchi K, Nakachi T, Iwasawa T, Kimura K. Inhibition of DPP-4 by alogliptin improves coronary flow reserve and left ventricular systolic function evaluated by phase contrast cine magnetic resonance imaging in patients with type 2 diabetes and coronary artery disease. Int J Cardiol 2016; 223:770-775. [DOI: 10.1016/j.ijcard.2016.08.306] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Accepted: 08/19/2016] [Indexed: 10/21/2022]
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17
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Kirigaya H, Kato S, Gyotoku D, Yamada N, Iinuma N, Kusakawa Y, Iguchi K, Miki Y, Nakachi T, Fukui K, Iwasawa T, Kimura K. Higher CHADS2 score is associated with impaired coronary flow reserve: A study using phase contrast cine magnetic resonance imaging. Int J Cardiol 2016; 221:800-5. [PMID: 27428324 DOI: 10.1016/j.ijcard.2016.07.116] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Accepted: 07/08/2016] [Indexed: 12/30/2022]
Abstract
BACKGROUND The presence of coronary microvascular dysfunction (CMD) is an important prognostic marker for coronary artery disease (CAD) patients. The purpose of this study was to investigate whether the CHADS2 score is associated with CMD evaluated by magnetic resonance imaging (MRI). MATERIALS AND METHODS One hundred forty three patients with known or suspected CAD (mean age 70.3±9.5years) were enrolled. All patients did not have any significant coronary stenosis on X-ray coronary angiography (CAG) at the time of MRI acquisition. By using a 1.5T MRI scanner, breath-hold phase contrast cine MRI images of coronary sinus (CS) were obtained to assess the blood flow of CS both at rest and during adenosine triphosphate (ATP) infusion. Coronary flow reserve (CFR) was calculated as CS blood flow during ATP infusion divided by CS blood flow at rest. CMD was defined as CFR<2.5 according to a previous study. Patients were allocated to four groups based on the CHADS2 score (group1: CHADS2 score=0, group2: CHADS2 score=1; group3: CHADS2 score=2, and group4: CHADS2 score≥3). RESULTS Mean CFR was 2.81±0.95 (77.6±32.7mL/min at rest; 208.2±86.5mL/min during ATP infusion, p<0.001). Patients with higher CHAD2 score had lower CFR. In the multiple logistic regression analysis, CHADS2 score was independently associated with CFR (odds ratio=0.61, 95% confidence interval: 0.37-0.99, p=0.049). CONCLUSIONS Higher CHADS2 score was significantly associated with lower CFR evaluated by phase contrast cine MRI.
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Affiliation(s)
- Hidekuni Kirigaya
- Department of Cardiology, Kanagawa Cardiovascular and Respiratory Center, Japan
| | - Shingo Kato
- Department of Cardiology, Kanagawa Cardiovascular and Respiratory Center, Japan.
| | - Daiki Gyotoku
- Department of Cardiology, Kanagawa Cardiovascular and Respiratory Center, Japan
| | - Nao Yamada
- Department of Cardiology, Kanagawa Cardiovascular and Respiratory Center, Japan
| | - Naoki Iinuma
- Department of Cardiology, Kanagawa Cardiovascular and Respiratory Center, Japan
| | - Yuka Kusakawa
- Department of Cardiology, Kanagawa Cardiovascular and Respiratory Center, Japan
| | - Kohei Iguchi
- Department of Cardiology, Kanagawa Cardiovascular and Respiratory Center, Japan
| | - Yuko Miki
- Department of Cardiology, Kanagawa Cardiovascular and Respiratory Center, Japan
| | - Tatsuya Nakachi
- Department of Cardiology, Kanagawa Cardiovascular and Respiratory Center, Japan
| | - Kazuki Fukui
- Department of Cardiology, Kanagawa Cardiovascular and Respiratory Center, Japan
| | - Tae Iwasawa
- Department of Radiology, Kanagawa Cardiovascular and Respiratory Center, Japan
| | - Kazuo Kimura
- Division of Cardiology, Yokohama City University Medical Center, Japan
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Kato S, Saito N, Kirigaya H, Gyotoku D, Iinuma N, Kusakawa Y, Iguchi K, Nakachi T, Fukui K, Futaki M, Iwasawa T, Kimura K, Umemura S. Impairment of Coronary Flow Reserve Evaluated by Phase Contrast Cine-Magnetic Resonance Imaging in Patients With Heart Failure With Preserved Ejection Fraction. J Am Heart Assoc 2016; 5:e002649. [PMID: 26908404 PMCID: PMC4802441 DOI: 10.1161/jaha.115.002649] [Citation(s) in RCA: 94] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Accepted: 01/12/2016] [Indexed: 11/25/2022]
Abstract
BACKGROUND Phase contrast (PC) cine-magnetic resonance imaging (MRI) of the coronary sinus allows for noninvasive evaluation of coronary flow reserve (CFR), which is an index of left ventricular microvascular function. The objective of this study was to investigate coronary flow reserve in patients with heart failure with preserved ejection fraction (HFpEF). METHODS AND RESULTS We studied 25 patients with HFpEF (mean and SD of age: 73±7 years), 13 with hypertensive left ventricular hypertrophy (LVH) (67±10 years), and 18 controls (65±15 years). Breath-hold PC cine-MRI images of the coronary sinus were obtained to assess blood flow at rest and during ATP infusion. CFR was calculated as coronary sinus blood flow during ATP infusion divided by coronary sinus blood flow at rest. Impairment of CFR was defined as CFR <2.5 according to a previous study. The majority (76%) of HFpEF patients had decreased CFR. CFR was significantly decreased in HFpEF patients in comparison to hypertensive LVH patients and control subjects (CFR: 2.21±0.55 in HFpEF vs 3.05±0.74 in hypertensive LVH, 3.83±0.73 in controls; P<0.001 by 1-way ANOVA). According to multivariable linear regression analysis, CFR independently and significantly correlated with serum brain natriuretic peptide level (β=-68.0; 95% CI, -116.2 to -19.7; P=0.007). CONCLUSIONS CFR was significantly lower in patients with HFpEF than in hypertensive LVH patients and controls. These results indicated that impairment of CFR might be a pathophysiological factor for HFpEF and might be related to HFpEF disease severity.
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Affiliation(s)
- Shingo Kato
- Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center, Boston, MA
| | - Naka Saito
- Department of Cardiology, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Kanagawa, Japan
| | - Hidekuni Kirigaya
- Department of Cardiology, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Kanagawa, Japan
| | - Daiki Gyotoku
- Department of Cardiology, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Kanagawa, Japan
| | - Naoki Iinuma
- Department of Cardiology, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Kanagawa, Japan
| | - Yuka Kusakawa
- Department of Cardiology, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Kanagawa, Japan
| | - Kohei Iguchi
- Department of Cardiology, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Kanagawa, Japan
| | - Tatsuya Nakachi
- Department of Cardiology, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Kanagawa, Japan
| | - Kazuki Fukui
- Department of Cardiology, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Kanagawa, Japan
| | - Masaaki Futaki
- Department of Radiology, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Kanagawa, Japan
| | - Tae Iwasawa
- Department of Radiology, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Kanagawa, Japan
| | - Kazuo Kimura
- Department of Cardiology, Yokohama City Medical Center, Yokohama, Kanagawa, Japan
| | - Satoshi Umemura
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University Hospital, Yokohama, Kanagawa, Japan
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Gyllenhammar T, Fernlund E, Jablonowski R, Jogi J, Engblom H, Liuba P, Arheden H, Carlsson M. Young patients with hypertrophic cardiomyopathy, but not subjects at risk, show decreased myocardial perfusion reserve quantified with CMR. Eur Heart J Cardiovasc Imaging 2014; 15:1350-7. [DOI: 10.1093/ehjci/jeu137] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Carlsson M, Jögi J, Markenroth Bloch K, Hedén B, Ekelund U, Ståhlberg F, Arheden H. Submaximal adenosine‐induced coronary hyperaemia with 12 h caffeine abstinence: implications for clinical adenosine perfusion imaging tests. Clin Physiol Funct Imaging 2014; 35:49-56. [DOI: 10.1111/cpf.12125] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2013] [Accepted: 12/11/2013] [Indexed: 12/01/2022]
Affiliation(s)
- Marcus Carlsson
- Department of Clinical Physiology and Nuclear Medicine Lund University Hospital Lund University Lund Sweden
| | - Jonas Jögi
- Department of Clinical Physiology and Nuclear Medicine Lund University Hospital Lund University Lund Sweden
| | - Karin Markenroth Bloch
- Philips Healthcare Lund Sweden
- Department of Medical Radiation Physics Lund University Lund Sweden
| | - Bo Hedén
- Department of Clinical Physiology and Nuclear Medicine Lund University Hospital Lund University Lund Sweden
| | - Ulf Ekelund
- Department of Emergency Medicine Lund University Hospital Lund University Lund Sweden
| | - Freddy Ståhlberg
- Department of Medical Radiation Physics Lund University Lund Sweden
- Department of Diagnostic Radiology Lund University Hospital Lund University Lund Sweden
| | - Håkan Arheden
- Department of Clinical Physiology and Nuclear Medicine Lund University Hospital Lund University Lund Sweden
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21
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Kato S, Fukui K, Kawaguchi J, Ishii N, Koga M, Kusakawa Y, Kusama I, Nakachi T, Nakagawa T, Terauchi Y, Uchino K, Kimura K, Umemura S. Relationship between coronary flow reserve evaluated by phase-contrast cine cardiovascular magnetic resonance and serum eicosapentaenoic acid. J Cardiovasc Magn Reson 2013; 15:106. [PMID: 24359564 PMCID: PMC3878179 DOI: 10.1186/1532-429x-15-106] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2013] [Accepted: 12/11/2013] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Long-term intake of long-chain n-3 polyunsaturated fatty acids (n-3 PUFAs), especially eicosapentaenoic acid (EPA) is associated with a low risk for cardiovascular disease. Phase-contrast cine cardiovascular magnetic resonance (PC cine CMR) can assess coronary flow reserve (CFR). The present study investigates the relationship between CFR evaluated by PC cine CMR and the serum EPA. METHODS We studied 127 patients (male, 116 (91%); mean age, 72.2 ± 7.4 years) with known or suspected coronary artery disease (CAD). X-ray coronary angiography revealed no significant coronary arterial stenoses (defined as luminal diameter reduction ≥ 50% on quantitative coronary angiogram (QCA) analysis) in all study participants. Breath-hold PC cine CMR images of the coronary sinus (CS) were acquired to assess blood flow of the CS both at rest and during adenosine triphosphate (ATP) infusion. We calculated CFR as CS blood flow during ATP infusion divided by that at rest. Patients were allocated to groups according to whether they had high (n = 64, EPA ≥ 75.8 μg/mL) or low (n = 63, EPA < 75.8 μg/mL) median serum EPA. RESULTS CFR was significantly lower in the low, than in the high EPA group (2.54 ± 1.00 vs. 2.91 ± 0.98, p = 0.038). Serum EPA positively correlated with CFR (R = 0.35, p < 0.001). We defined preserved CFR as > 2.5, which is the previously reported lower limit of normal flow reserve without obstructive CAD. Multivariate analysis revealed that EPA is an independent predictor of CFR > 2.5 (odds ratio, 1.01; 95% confidence interval, 1.00 - 1.02, p = 0.008). CONCLUSIONS The serum EPA is significantly correlated with CFR in CAD patients without significant coronary artery stenosis.
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Affiliation(s)
- Shingo Kato
- Department of Cardiology, Kanagawa Cardiovascular and Respiratory Center, 6-16-1 Tomiokahigashi, Kanazawa-ku, Yokohama, Kanagawa 236-0051, Japan
| | - Kazuki Fukui
- Department of Cardiology, Kanagawa Cardiovascular and Respiratory Center, 6-16-1 Tomiokahigashi, Kanazawa-ku, Yokohama, Kanagawa 236-0051, Japan
| | - Junko Kawaguchi
- Department of Endocrinology and Metabolism, Yokohama City University Hospital, Yokohama, Japan
| | - Nao Ishii
- Department of Cardiology, Kanagawa Cardiovascular and Respiratory Center, 6-16-1 Tomiokahigashi, Kanazawa-ku, Yokohama, Kanagawa 236-0051, Japan
| | - Masashi Koga
- Department of Cardiology, Kanagawa Cardiovascular and Respiratory Center, 6-16-1 Tomiokahigashi, Kanazawa-ku, Yokohama, Kanagawa 236-0051, Japan
| | - Yuka Kusakawa
- Department of Cardiology, Kanagawa Cardiovascular and Respiratory Center, 6-16-1 Tomiokahigashi, Kanazawa-ku, Yokohama, Kanagawa 236-0051, Japan
| | - Ikuyoshi Kusama
- Department of Cardiology, Kanagawa Cardiovascular and Respiratory Center, 6-16-1 Tomiokahigashi, Kanazawa-ku, Yokohama, Kanagawa 236-0051, Japan
| | - Tatsuya Nakachi
- Department of Cardiology, Kanagawa Cardiovascular and Respiratory Center, 6-16-1 Tomiokahigashi, Kanazawa-ku, Yokohama, Kanagawa 236-0051, Japan
| | - Takeshi Nakagawa
- Department of Cardiology, Kanagawa Cardiovascular and Respiratory Center, 6-16-1 Tomiokahigashi, Kanazawa-ku, Yokohama, Kanagawa 236-0051, Japan
| | - Yasuo Terauchi
- Department of Endocrinology and Metabolism, Yokohama City University Hospital, Yokohama, Japan
| | - Kazuaki Uchino
- Department of Cardiology, Yokohama City University Hospital, Yokohama, Japan
| | - Kazuo Kimura
- Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan
| | - Satoshi Umemura
- Department of Cardiology, Yokohama City University Hospital, Yokohama, Japan
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Carlsson M, Andersson R, Bloch KM, Steding-Ehrenborg K, Mosén H, Stahlberg F, Ekmehag B, Arheden H. Cardiac output and cardiac index measured with cardiovascular magnetic resonance in healthy subjects, elite athletes and patients with congestive heart failure. J Cardiovasc Magn Reson 2012; 14:51. [PMID: 22839436 PMCID: PMC3419124 DOI: 10.1186/1532-429x-14-51] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2012] [Accepted: 07/04/2012] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Cardiovascular Magnetic Resonance (CMR) enables non-invasive quantification of cardiac output (CO) and thereby cardiac index (CI, CO indexed to body surface area). The aim of this study was to establish if CI decreases with age and compare the values to CI for athletes and for patients with congestive heart failure (CHF). METHODS CI was measured in 144 healthy volunteers (39 ± 16 years, range 21-81 years, 68 females), in 60 athletes (29 ± 6 years, 30 females) and in 157 CHF patients with ejection fraction (EF) below 40% (60 ± 13 years, 33 females). CI was calculated using aortic flow by velocity-encoded CMR and is presented as mean ± SD. Flow was validated in vitro using a flow phantom and in 25 subjects with aorta and pulmonary flow measurements. RESULTS There was a slight decrease of CI with age in healthy subjects (8 ml/min/m² per year, r² = 0.07, p = 0.001). CI in males (3.2 ± 0.5 l/min/m²) and females (3.1 ± 0.4 l/min/m²) did not differ (p = 0.64). The mean ± SD of CI in healthy subjects in the age range of 20-29 was 3.3 ± 0.4 l/min/m², in 30-39 years 3.3 ± 0.5 l/min/m², in 40-49 years 3.1 ± 0.5 l/min/m², 50-59 years 3.0 ± 0.4 l/min/m² and >60 years 3.0 ± 0.4 l/min/m². There was no difference in CI between athletes and age-controlled healthy subjects but HR was lower and indexed SV higher in athletes. CI in CHF patients (2.3 ± 0.6 l/min/m²) was lower compared to the healthy population (p < 0.001). There was a weak correlation between CI and EF in CHF patients (r² = 0.07, p < 0.001) but CI did not differ between patients with NYHA-classes I-II compared to III-IV (n = 97, p = 0.16) or patients with or without hospitalization in the previous year (n = 100, p = 0.72). In vitro phantom validation showed low bias (-0.8 ± 19.8 ml/s) and in vivo validation in 25 subjects also showed low bias (0.26 ± 0.61 l/min, QP/QS 1.04 ± 0.09) between pulmonary and aortic flow. CONCLUSIONS CI decreases in healthy subjects with age but does not differ between males and females. We found no difference in CI between athletes and healthy subjects at rest but CI was lower in patients with congestive heart failure. The presented values can be used as reference values for flow velocity mapping CMR.
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Affiliation(s)
- Marcus Carlsson
- Department of Clinical Physiology and Nuclear Medicine, BFC, Skåne University Hospital, Lund University, Lund, SE-22185, Sweden
| | - Ruslana Andersson
- Department of Clinical Physiology and Nuclear Medicine, BFC, Skåne University Hospital, Lund University, Lund, SE-22185, Sweden
| | - Karin Markenroth Bloch
- Philips Healthcare, Lund, Sweden
- Department of Radiation Physics, Lund University, Lund, Sweden
| | - Katarina Steding-Ehrenborg
- Department of Clinical Physiology and Nuclear Medicine, BFC, Skåne University Hospital, Lund University, Lund, SE-22185, Sweden
| | - Henrik Mosén
- Department of Clinical Physiology and Nuclear Medicine, BFC, Skåne University Hospital, Lund University, Lund, SE-22185, Sweden
| | | | - Bjorn Ekmehag
- Norrtalje Hospital, TioHundra AB, Norrtalje, Sweden and Lund University, Lund, Sweden
| | - Hakan Arheden
- Department of Clinical Physiology and Nuclear Medicine, BFC, Skåne University Hospital, Lund University, Lund, SE-22185, Sweden
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Beaudin AE, Brugniaux JV, Vöhringer M, Flewitt J, Green JD, Friedrich MG, Poulin MJ. Cerebral and myocardial blood flow responses to hypercapnia and hypoxia in humans. Am J Physiol Heart Circ Physiol 2011; 301:H1678-86. [DOI: 10.1152/ajpheart.00281.2011] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
In humans, cerebrovascular responses to alterations in arterial Pco2 and Po2 are well documented. However, few studies have investigated human coronary vascular responses to alterations in blood gases. This study investigated the extent to which the cerebral and coronary vasculatures differ in their responses to euoxic hypercapnia and isocapnic hypoxia in healthy volunteers. Participants ( n = 15) were tested at rest on two occasions. On the first visit, middle cerebral artery blood velocity ( V̄P) was assessed using transcranial Doppler ultrasound. On the second visit, coronary sinus blood flow (CSBF) was measured using cardiac MRI. For comparison with V̄P, CSBF was normalized to the rate pressure product [an index of myocardial oxygen consumption; normalized (n)CSBF]. Both testing sessions began with 5 min of euoxic [end-tidal Po2 (PetO2) = 88 Torr] isocapnia [end-tidal Pco2 (PetCO2) = +1 Torr above resting values]. PetO2 was next held at 88 Torr, and PetCO2 was increased to 40 and 45 Torr in 5-min increments. Participants were then returned to euoxic isocapnia for 5 min, after which PetO2 was decreased from 88 to 60, 52 and 45 Torr in 5-min decrements. Changes in V̄P and nCSBF were normalized to isocapnic euoxic conditions and indexed against PetCO2 and arterial oxyhemoglobin saturation. The V̄P gain for euoxic hypercapnia (%/Torr) was significantly higher than nCSBF ( P = 0.030). Conversely, the V̄P gain for isocapnic hypoxia (%/%desaturation) was not different from nCSBF ( P = 0.518). These findings demonstrate, compared with coronary circulation, that the cerebral circulation is more sensitive to hypercapnia but similarly sensitive to hypoxia.
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Affiliation(s)
| | - Julien V. Brugniaux
- Departments of 1Physiology and Pharmacology and
- Hotchkiss Brain Institute, and
| | | | | | - Jordin D. Green
- Stephenson Cardiac MR Centre,
- Libin Cardiovascular Institute of Alberta,
- Siemens Healthcare, Calgary, Canada
| | | | - Marc J. Poulin
- Departments of 1Physiology and Pharmacology and
- Clinical Neurosciences,
- Libin Cardiovascular Institute of Alberta,
- Hotchkiss Brain Institute, and
- Faculties of 6Medicine and
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Hedström E, Bloch KM, Bergvall E, Ståhlberg F, Arheden H. Effects of gadolinium contrast agent on aortic blood flow and myocardial strain measurements by phase-contrast cardiovascular magnetic resonance. J Cardiovasc Magn Reson 2010; 12:70. [PMID: 21106081 PMCID: PMC3002915 DOI: 10.1186/1532-429x-12-70] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2010] [Accepted: 11/24/2010] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Quantitative blood flow and aspects of regional myocardial function such as myocardial displacement and strain can be measured using phase-contrast cardiovascular magnetic resonance (PC-CMR). Since a gadolinium-based contrast agent is often used to measure myocardial infarct size, we sought to determine whether the contrast agent affects measurements of aortic flow and myocardial displacement and strain. Phase-contrast data pre and post contrast agent was acquired during free breathing using 1.5T PC-CMR. RESULTS For aortic flow and regional myocardial function 12 and 17 patients were analysed, respectively. The difference pre and post contrast agent was 0.03±0.16 l/min for cardiac output, and 0.1±0.5 mm for myocardial displacement. Linear regression for myocardial displacement (MD) after and before contrast agent (CA) showed MDpostCA=0.95MDpreCA+0.05 (r=0.95, p<0.001). For regional myocardial function, the contrast-to-noise ratios for left ventricular myocardial wall versus left ventricular lumen were pre and post contrast agent administration 7.4±3.3 and 4.4±8.9, respectively (p<0.001). The contrast-to-noise ratios for left ventricular myocardial wall versus surrounding tissue were pre and post contrast agent administration -16.9±22 and -0.2±6.3, respectively (p<0.0001). CONCLUSIONS Quantitative measurements of aortic flow yield equal results both in the absence and presence of gadolinium contrast agent. The total examination time may thereby be reduced when assessing both viability and quantitative flow using PC-CMR, by assessing aortic flow post contrast agent administration. Phase-contrast information for myocardial displacement is also assessable both in the absence and presence of contrast agent. However, delineation of the myocardium may be difficult or impossible post contrast agent due to the lower image contrast. Acquisition of myocardial displacement should therefore be performed pre contrast agent using current PC-CMR sequences.
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Affiliation(s)
- Erik Hedström
- Department of Clinical Physiology, Lund University, Lund, Sweden
| | - Karin Markenroth Bloch
- Philips Medical Systems, Best, the Netherlands
- Department of Imaging and Function, Skåne University Hospital, Lund, Sweden
| | - Erik Bergvall
- Department of Clinical Physiology, Lund University, Lund, Sweden
| | - Freddy Ståhlberg
- Department of Medical Radiation Physics, Lund University, Lund, Sweden
- Department of Radiology, Lund University, Lund, Sweden
| | - Håkan Arheden
- Department of Clinical Physiology, Lund University, Lund, Sweden
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Accurate measurement of pulsatile flow velocity in a small tube phantom: comparison of phase-contrast cine magnetic resonance imaging and intraluminal Doppler guidewire. Jpn J Radiol 2010; 28:571-7. [DOI: 10.1007/s11604-010-0472-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2010] [Accepted: 06/01/2010] [Indexed: 10/18/2022]
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Brandts A, Roes SD, Doornbos J, Weiss RG, de Roos A, Stuber M, Westenberg JJM. Right coronary artery flow velocity and volume assessment with spiral K-space sampled breathhold velocity-encoded MRI at 3 tesla: accuracy and reproducibility. J Magn Reson Imaging 2010; 31:1215-23. [PMID: 20432359 DOI: 10.1002/jmri.22144] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
PURPOSE To evaluate accuracy and reproducibility of flow velocity and volume measurements in a phantom and in human coronary arteries using breathhold velocity-encoded (VE) MRI with spiral k-space sampling at 3 Tesla. MATERIALS AND METHODS Flow velocity assessment was performed using VE MRI with spiral k-space sampling. Accuracy of VE MRI was tested in vitro at five constant flow rates. Reproducibility was investigated in 19 healthy subjects (mean age 25.4 +/- 1.2 years, 11 men) by repeated acquisition in the right coronary artery (RCA). RESULTS MRI-measured flow rates correlated strongly with volumetric collection (Pearson correlation r = 0.99; P < 0.01). Due to limited sample resolution, VE MRI overestimated the flow rate by 47% on average when nonconstricted region-of-interest segmentation was used. Using constricted region-of-interest segmentation with lumen size equal to ground-truth luminal size, less than 13% error in flow rate was found. In vivo RCA flow velocity assessment was successful in 82% of the applied studies. High interscan, intra- and inter-observer agreement was found for almost all indices describing coronary flow velocity. Reproducibility for repeated acquisitions varied by less than 16% for peak velocity values and by less than 24% for flow volumes. CONCLUSION 3T breathhold VE MRI with spiral k-space sampling enables accurate and reproducible assessment of RCA flow velocity.
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Affiliation(s)
- Anne Brandts
- Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands.
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27
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Assessment of left ventricular diastolic function by MR: why, how and when. Insights Imaging 2010; 1:183-192. [PMID: 22347914 PMCID: PMC3259379 DOI: 10.1007/s13244-010-0026-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2010] [Accepted: 05/11/2010] [Indexed: 01/19/2023] Open
Abstract
Cardiovascular magnetic resonance (CMR), a valuable non-invasive technique for the evaluation of the cardiovascular system, has already been accepted as the "gold standard" for the assessment of systolic function. The assessment of diastolic function is important not only for diagnosis purposes, but also in terms of prognosis. ECG-triggering phase-contrast (PC) CMR allows the routine assessment of diastolic function by measuring the transmitral and pulmonary venous flow with high accuracy and reproducibility, using morphological and quantitative parameters similar to those obtained by transthoracic echocardiography, which are so familiar to general cardiologists. Therefore, the increasing role of CMR in the assessment of the cardiovascular system requires a greater awareness and knowledge of this condition by radiologists. The aim of this study is to review the main mechanisms and common causes of left ventricle diastolic dysfunction, provide a practical approach for the assessment of LV diastolic function and illustrate the different degrees of diastolic dysfunction.
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Totman JJ, Marciani L, Foley S, Campbell E, Hoad CL, Macdonald IA, Spiller RC, Gowland PA. Characterization of the time course of the superior mesenteric, abdominal aorta, internal carotid and vertebral arteries blood flow response to the oral glucose challenge test using magnetic resonance imaging. Physiol Meas 2009; 30:1117-36. [PMID: 19759401 DOI: 10.1088/0967-3334/30/10/011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Blood flow to the splanchnic circulation increases postprandially which may cause a reduction in systemic and cerebral perfusion leading to postprandial syncope in the elderly who lack adequate cardiovascular reserve. We used multi-station 2D phase contrast cine magnetic resonance imaging (PC-MRI) with the aim of characterizing the time course of the haemodynamic response to an oral glucose challenge test (OGCT) in the large arteries perfusing the splanchnic, systemic and cerebral circulations (superior mesenteric artery SMA, abdominal aorta AA, internal carotid arteries, ICA and vertebral arteries VA). In this study nine fasted healthy volunteers were studied. Separate cine PC-MRI scans were acquired in the neck and in the abdomen every 88 s, these two measurements being interleaved for ten baseline scans at each station with the scanner automatically moving the subject between the two stations. After ingestion of the OGCT, a further 30 cine PC-MRI scans were acquired at each station. Using this technique we were able to characterize with frequent sampling of volumetric blood flow the time course of blood flow response to the OGCT of the SMA, AA and both VA and ICA. We found a substantial variation between individuals in the amplitude and the time to the peak of the SMA blood flow response to the OGCT which correlated positively with body mass index. MRI provides a robust, non-invasive method of studying normal physiology that could be valuable in studies of diseases such as postprandial hypotension.
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Affiliation(s)
- J J Totman
- Brain and Body Centre, University of Nottingham, Nottingham NG7 2RD, UK
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29
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Bloch KM, Carlsson M, Arheden H, Ståhlberg F. Quantifying coronary sinus flow and global LV perfusion at 3T. BMC Med Imaging 2009; 9:9. [PMID: 19519892 PMCID: PMC2702273 DOI: 10.1186/1471-2342-9-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2008] [Accepted: 06/11/2009] [Indexed: 11/30/2022] Open
Abstract
Background Despite the large availability of 3T MR scanners and the potential of high field imaging, this technical platform has yet to prove its usefulness in the cardiac MR setting, where 1.5T remains the established standard. Global perfusion of the left ventricle, as well as the coronary flow reserve (CFR), can provide relevant diagnostic information, and MR measurements of these parameters may benefit from increased field strength. Quantitative flow measurements in the coronary sinus (CS) provide one method to investigate these parameters. However, the ability of newly developed faster MR sequences to measure coronary flow during a breath-hold at 3T has not been evaluated. Methods The aim of this work was to measure CS flow using segmented phase contrast MR (PC MR) on a clinical 3T MR scanner. Parallel imaging was employed to reduce the total acquisition time. Global LV perfusion was calculated by dividing CS flow with left ventricular (LV) mass. The repeatability of the method was investigated by measuring the flow three times in each of the twelve volunteers. Phantom experiments were performed to investigate potential error sources. Results The average CS flow was determined to 88 ± 33 ml/min and the deduced LV perfusion was 0.60 ± 0.22 ml/min·g, in agreement with published values. The repeatability (1-error) of the three repeated measurements in each subject was on average 84%. Conclusion This work demonstrates that the combination of high field strength (3T), parallel imaging and segmented gradient echo sequences allow for quantification of the CS flow and global perfusion within a breath-hold.
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Petzina R, Ugander M, Gustafsson L, Engblom H, Hetzer R, Arheden H, Ingemansson R, Malmsjö M. Topical negative pressure therapy of a sternotomy wound increases sternal fluid content but does not affect internal thoracic artery blood flow: Assessment using magnetic resonance imaging. J Thorac Cardiovasc Surg 2008; 135:1007-13. [DOI: 10.1016/j.jtcvs.2007.09.070] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2007] [Revised: 08/09/2007] [Accepted: 09/12/2007] [Indexed: 11/26/2022]
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Coronary artery flow measurement using navigator echo gated phase contrast magnetic resonance velocity mapping at 3.0 T. J Biomech 2007; 41:595-602. [PMID: 18036532 DOI: 10.1016/j.jbiomech.2007.10.010] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2007] [Revised: 10/11/2007] [Accepted: 10/13/2007] [Indexed: 11/21/2022]
Abstract
A validation study and early results for non-invasive, in vivo measurement of coronary artery blood flow using phase contrast magnetic resonance imaging (PC-MRI) at 3.0T is presented. Accuracy of coronary artery blood flow measurements by phase contrast MRI is limited by heart and respiratory motion as well as the small size of the coronary arteries. In this study, a navigator echo gated, cine phase velocity mapping technique is described to obtain time-resolved velocity and flow waveforms of small diameter vessels at 3.0T. Phantom experiments using steady, laminar flow are presented to validate the technique and show flow rates measured by 3.0T phase contrast MRI to be accurate within 15% of true flow rates. Subsequently, in vivo scans on healthy volunteers yield velocity measurements for blood flow in the right, left anterior descending, and left circumflex arteries. Measurements of average, cross-sectional velocity were obtainable in 224/243 (92%) of the cardiac phases. Time-averaged, cross-sectional velocity of the blood flow was 6.8+/-4.3cm/s in the LAD, 8.0+/-3.8cm/s in the LCX, and 6.0+/-1.6cm/s in the RCA.
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Schwizer W, Steingoetter A, Fox M. Magnetic resonance imaging for the assessment of gastrointestinal function. Scand J Gastroenterol 2006; 41:1245-60. [PMID: 17060117 DOI: 10.1080/00365520600827188] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- Werner Schwizer
- Clinic of Gastroenterology and Hepatology, University Hospital Zurich, Switzerland.
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Kellenberger CJ, Macgowan CK, Roman KS, Al-Habshan F, Benson LN, Redington AN, Yoo SJ. Hemodynamic evaluation of the peripheral pulmonary circulation by cine phase-contrast magnetic resonance imaging. J Magn Reson Imaging 2005; 22:780-7. [PMID: 16270288 DOI: 10.1002/jmri.20447] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
PURPOSE To describe the normal flow patterns in peripheral pulmonary vessels with phase-contrast (PC) magnetic resonance imaging (MRI). MATERIALS AND METHODS Twelve healthy adults (age = 33 +/- 7 years) underwent cine PC MRI of the segmental and central pulmonary arteries and veins by means of a breath-held segmented k-space technique. Flow patterns were analyzed on time-velocity curves and compared between the peripheral and central vessels. RESULTS The pulsatile flow patterns in the segmental arteries and veins were similar among individuals. When compared with the central pulmonary arteries, the segmental arteries had a delay in the systolic and diastolic flow velocity waves, and an increased magnitude of the diastolic peaks, in relation to the systolic peaks. A prominent notch was present during the deceleration phase of the systolic flow velocity wave in 79% of the segmental arteries investigated. The segmental veins showed a typical pulmonary venous flow pattern, as seen in the central veins, with similar systolic-to-diastolic peak velocity ratios. CONCLUSION Noninvasive evaluation of blood flow in intraparenchymal pulmonary vessels is feasible with PC MRI. This first description of normal flow patterns in segmental pulmonary arteries and veins can serve as basis for further investigation in the setting of altered pulmonary blood flows.
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Affiliation(s)
- Christian J Kellenberger
- Department of Diagnostic Imaging, Hospital for Sick Children, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada
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Gatehouse PD, Keegan J, Crowe LA, Masood S, Mohiaddin RH, Kreitner KF, Firmin DN. Applications of phase-contrast flow and velocity imaging in cardiovascular MRI. Eur Radiol 2005; 15:2172-84. [PMID: 16003509 DOI: 10.1007/s00330-005-2829-3] [Citation(s) in RCA: 190] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2005] [Accepted: 05/31/2005] [Indexed: 10/25/2022]
Abstract
A review of cardiovascular clinical and research applications of MRI phase-contrast velocity imaging, also known as velocity mapping or flow imaging. Phase-contrast basic principles, advantages, limitations, common pitfalls and artefacts are described. It can measure many different aspects of the complicated blood flow in the heart and vessels: volume flow (cardiac output, shunt, valve regurgitation), peak blood velocity (for stenosis), patterns and timings of velocity waveforms and flow distributions within heart chambers (abnormal ventricular function) and vessels (pulse-wave velocity, vessel wall disease). The review includes phase-contrast applications in cardiac function, heart valves, congenital heart diseases, major blood vessels, coronary arteries and myocardial wall velocity.
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Affiliation(s)
- Peter D Gatehouse
- Royal Brompton Hospital and National Heart and Lung Institute, Imperial College, London, UK.
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Watzinger N, Lund GK, Saeed M, Reddy GP, Araoz PA, Yang M, Schwartz AB, Bedigian M, Higgins CB. Myocardial blood flow in patients with dilated cardiomyopathy: Quantitative assessment with velocity-encoded cine magnetic resonance imaging of the coronary sinus. J Magn Reson Imaging 2005; 21:347-53. [PMID: 15778950 DOI: 10.1002/jmri.20274] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE To quantify global myocardial perfusion using magnetic resonance imaging (MRI) in patients with heart failure due to idiopathic dilated cardiomyopathy (IDC) and to compare myocardial perfusion and microvascular reactivity with healthy subjects. MATERIALS AND METHODS A total of 19 subjects (healthy volunteers (N = 12) and IDC patients (N = 7)) were studied using cine MRI to measure left ventricular (LV) mass and a velocity-encoded cine MRI technique to measure coronary sinus flow at rest and after dipyridamole-induced hyperemia. Absolute values of total myocardial blood flow (MBF) were calculated from coronary sinus flow and LV mass. RESULTS At baseline, MBF was not significantly different in patients with IDC (0.48 +/- 0.07 mL/minute/g) and healthy subjects (0.55 +/- 0.19 mL/minute/g, P= 0.41). After dipyridamole administration, MBF in IDC patients increased to a level significantly less than that in normal volunteers (1.05 +/- 0.35 mL/minute/g vs. 1.99 +/- 1.05 mL/minute/g, P < 0.05). Consequently, MBF reserve was impaired in patients with IDC (2.19 +/- 0.77) compared to that in healthy subjects (3.51 +/- 1.29, P < 0.05). A moderate correlation was found between MBF reserve and LV ejection fraction (r = 0.48, P < 0.05). CONCLUSION MBF reserve is reduced in patients with IDC, indicating that coronary microcirculatory flow is impaired. This integrated MRI approach allows quantitative measurement of global MBF in humans and may have the potential to study the effects of pharmacological interventions on myocardial perfusion.
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Affiliation(s)
- Norbert Watzinger
- Department of Radiology, University of California, San Francisco, California 94143-0628, USA
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Lund GK, Watzinger N, Saeed M, Reddy GP, Yang M, Araoz PA, Curatola D, Bedigian M, Higgins CB. Chronic heart failure: global left ventricular perfusion and coronary flow reserve with velocity-encoded cine MR imaging: initial results. Radiology 2003; 227:209-15. [PMID: 12668746 DOI: 10.1148/radiol.2271012156] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To quantify and compare global left ventricular (LV) perfusion and coronary flow reserve (CFR) in patients with chronic heart failure and in healthy volunteers by measuring coronary sinus flow with velocity-encoded cine (VEC) magnetic resonance (MR) imaging. MATERIALS AND METHODS MR measurements were performed in 10 consecutive patients with chronic heart failure due to coronary artery disease and in 10 volunteers. Global LV perfusion was quantified by measuring coronary sinus flow in an oblique imaging plane perpendicular to the coronary sinus with non-breath-hold VEC MR imaging. LV mass was measured by means of cine imaging that encompassed the heart. LV perfusion was calculated from coronary sinus flow and mass. CFR was measured from LV perfusion at rest and that after infusion of dipyridamole. Analysis of covariance was used to determine differences between groups. Differences within groups were analyzed by means of the Student t test for paired data. Regression analysis was used to determine correlation between CFR and LV ejection fraction. RESULTS At rest, LV perfusion was not significantly different in patients with chronic heart failure (0.46 mL/min/g +/- 0.19) and volunteers (0.52 mL/min/g +/- 0.21, P =.54). After administration of dipyridamole, LV perfusion was less than half in patients with chronic heart failure compared with that in volunteers (1.07 mL/min/g +/- 0.64 vs 2.19 mL/min/g +/- 0.98) (P =.03). CFR was severely reduced in patients with chronic heart failure compared with that in volunteers (2.3 +/- 0.9 vs 4.2 +/- 1.5, P =.01). A moderate but significant correlation was found between CFR and LV ejection fraction (r = 0.54, P =.02) CONCLUSION Combined cine and VEC MR imaging revealed that patients with chronic heart failure have normal LV perfusion at rest but severely depressed LV perfusion after vasodilation. Impaired CFR may contribute to progressive decline in LV function in patients with chronic heart failure.
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Affiliation(s)
- Gunnar K Lund
- Department of Radiology, University of California, San Francisco, 505 Parnassus Ave, Rm L-308, San Francisco, CA 94143-0628, USA
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Bedaux WLF, Hofman MBM, de Cock CC, Stoel MG, Visser CA, van Rossum AC. Magnetic resonance imaging versus Doppler guide wire in the assessment of coronary flow reserve in patients with coronary artery disease. Coron Artery Dis 2002; 13:365-72. [PMID: 12488645 DOI: 10.1097/00019501-200211000-00003] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Coronary flow velocity reserve (CFVR), defined as the ratio of maximal hyperaemic to baseline flow velocity, has been validated as a marker of physiological significance of a coronary lesion. Clinically, this parameter is measured invasively during X-ray angiography using the Doppler guide wire. With magnetic resonance (MR) imaging it is possible to quantify CFVR non-invasively. DESIGN The purpose of the study was to compare CFVR, acquired with MR imaging and the Doppler guide wire in patients with coronary artery disease. METHODS Twenty-two patients suffering from one- or two-vessel coronary artery disease as derived from diagnostic X-ray coronary angiography were included. Coronary flow velocity reserve was measured at baseline and during maximal hyperaemia, obtained by intravenous administration of adenosine using MR phase contrast velocity quantification. Within 2 weeks CFVR was measured invasively with a Doppler guide wire. RESULTS In 26 coronary arteries CFVR was acquired with both techniques. Mean CFVR in the stenosed and healthy reference arteries was 1.5 +/- 0.7 and 2.7 +/- 1.0 (P < 0.01) respectively for MR measurements and 1.9 +/- 0.7 and 3.1 +/- 0.6 (P < 0.01) respectively for Doppler measurements. Bland-Altman analysis revealed a non-significant mean difference between the two techniques of 0.4 +/- 1.2. CONCLUSION In a selected group of stable patients with coronary artery disease MR flow velocity quantification provides non-invasive data equivalent to the invasive Doppler guide wire data. Variability in both the MR and Doppler ultrasound measurement resulted in a significant scatter of data without systematic difference.
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Affiliation(s)
- Willemijn L F Bedaux
- Department of Cardiology, VU University Medical Center, Amsterdam, The Netherlands.
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Current awareness in NMR in biomedicine. NMR IN BIOMEDICINE 2002; 15:251-262. [PMID: 11968141 DOI: 10.1002/nbm.748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
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Holmqvist C, Ståhlberg F, Hanséus K, Hochbergs P, Sandström S, Larsson EM, Laurin S. Collateral flow in coarctation of the aorta with magnetic resonance velocity mapping: correlation to morphological imaging of collateral vessels. J Magn Reson Imaging 2002; 15:39-46. [PMID: 11793455 DOI: 10.1002/jmri.10036] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To correlate quantification of collateral flow in aortic coarctation with the morphological visualization of the collateral vessels and to compare different approaches to measurement of collateral flow. MATERIALS AND METHODS Thirteen children with coarctation were examined with T1-weighted spin-echo (T1-W SE) imaging and 3D contrast-enhanced magnetic resonance angiography (MRA). MR velocity mapping was performed at four levels in the descending aorta. RESULTS The flow immediately above and below the coarctation did not differ significantly. Measuring within the coarctation resulted in flow overestimation. The increase of flow from proximal to distal aorta was 12 +/- 21% in patients with no or uncertain collaterals and 69 +/- 55% in patients with pronounced collaterals. Spin-echo images and MRA were comparable in visualizing collateral vessels. The visual estimation of collaterals correlated reasonably well with flow quantification MR velocity mapping. CONCLUSION Collateral flow assessment with MR velocity mapping is an accurate technique for evaluating the hemodynamic importance of a coarctation and is recommended if abundant collaterals are not visualized with spin echo or MRA.
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Affiliation(s)
- Catarina Holmqvist
- Diagnostic Center of Medical Imaging and Physiology, Lund University Hospital, Lund, Sweden.
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Poskitt KJ, Marotta T, Haw C, Cochrane D, Steinbok P. MR Quantification of Flow in Children with Vascular Malformations. Interv Neuroradiol 2001; 7:201-12. [PMID: 20663349 DOI: 10.1177/159101990100700304] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2001] [Accepted: 07/15/2001] [Indexed: 11/17/2022] Open
Abstract
SUMMARY The evaluation of treatments such as embolization, stereotactic radiation, and even surgery would be enhanced by an objective method of measuring flow in feeding arteries or draining veins. We developed a non-invasive method of measuring vascular flow using cardiac gated phase contrast MR angiography (MR Q flow). The purpose of this work was to employ the same technique in a series of patients with vascular malformations of the head and neck. We selected a series of vascular malformations with simple arterial and venous architecture and significantly smaller vessel diameters than that encountered with Vein of Calen Malformations. Our aim was to determine the reproducibility of the derived flow values by using multiple velocity encoded sequences (VENC) and compare the values derived from the arterial feeders to the venous outflow data. There are inherent technical difficulties with assessing flow through multiple arterial feeders or draining veins, so the technique is most easily applied to AVMs with simple, easily defined feeding arteries or draining veins. Nonetheless, this technique is relatively straightforward to learn, rapid, cost-effective and may provide an objective means to assess therapeutic maneuvers when applied to head and neck vascular malformations.
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Affiliation(s)
- K J Poskitt
- Department of Radiology, Children's Hospital, Vancouver, Canada
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