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Androulakis E, Georgiopoulos G, Azzu A, Surkova E, Bakula A, Papagkikas P, Briasoulis A, De Silva R, Kellman P, Pennell DJ, Alpendurada F. Reduced response to regadenoson with increased weight: an artificial intelligence based quantitative myocardial perfusion study. J Cardiovasc Magn Reson 2024:101066. [PMID: 39067701 DOI: 10.1016/j.jocmr.2024.101066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 05/31/2024] [Accepted: 07/22/2024] [Indexed: 07/30/2024] Open
Abstract
BACKGROUND There is conflicting evidence regarding the response to a fixed dose of regadenoson in patients with high body weight. The aim of this study was to evaluate the effectiveness of regadenoson in patients with varying body weights using novel quantitative CMR perfusion parameters in addition to standard clinical markers. METHODS Consecutive patients with typical angina and/or risk factors for coronary artery disease (N=217) underwent regadenoson stress CMR perfusion imaging using a dual-sequence quantitative protocol with perfusion parameters generated from an artificial intelligence (AI) based algorithm. CMR was performed on 1.5T scanners using a standard 0.4mg injection of regadenoson. A cohort of consecutive patients undergoing adenosine stress perfusion (N=218) was used as a control group. RESULTS An inverse association of myocardial perfusion reserve and weight (mean decrease -0.05 per 10Kg increase, 95% CI -0.009/-0.0001, P=0.045) was noted in the regadenoson group but not in patients stressed with adenosine (P=0.77). Adjusted logistic regression analysis revealed a 10Kg increase resulted in 36% increased odds for inadequate stress response (OR= 1.36, 95% CI 1.10-1.69, P=0.005). Moreover, a significant interaction (OR=1.09, 95% CI 1.02-1.16, P=0.012) between stressor type (regadenoson vs adenosine) and weight was noted. This was also confirmed in the propensity matched subgroup (P=0.024) and was not attenuated after adjustment (P=0.041). BSA (P=0.006) but not BMI (P=0.055) was differentially associated with inadequate response conditional to the stressor used, and this association remained significant after adjustment for confounders (P=0.025). Patients in the highest quartile of weight (>93Kg) or BSA (>2.06m2) had substantially increased odds for inadequate response with regadenoson (OR=8.19, 95% CI 2.04-32.97, P=0.003 for increased weight and OR=7.75, 95% CI 1.93- 31.13, P=0.004 for increased BSA). Both weight and BSA had excellent discriminative ability for inadequate regadenoson response (ROC area under curve 0.84 and 0.83 respectively). CONCLUSIONS Using quantitative perfusion CMR in patients undergoing pharmacological stress with regadenoson, we found an inverse relationship between patient weight and both clinical response and myocardial perfusion parameters. A fixed-dose bolus approach may not be adequate to induce maximal hyperemia in patients with increased weight. Weight-adjusted stressors like adenosine may be considered instead in patients with body weight > 93Kg and BSA > 2.06m2.
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Affiliation(s)
- E Androulakis
- Royal Brompton and Harefield Hospitals, Guy's & St Thomas' NHS Foundation Trust; National Heart and Lung Institute, Imperial College London, UK
| | - G Georgiopoulos
- School of Biomedical Engineering and Imaging Sciences, Kings College London, London, UK
| | - A Azzu
- Royal Brompton and Harefield Hospitals, Guy's & St Thomas' NHS Foundation Trust; National Heart and Lung Institute, Imperial College London, UK
| | - E Surkova
- Royal Brompton and Harefield Hospitals, Guy's & St Thomas' NHS Foundation Trust; National Heart and Lung Institute, Imperial College London, UK
| | - A Bakula
- Royal Brompton and Harefield Hospitals, Guy's & St Thomas' NHS Foundation Trust; National Heart and Lung Institute, Imperial College London, UK
| | - P Papagkikas
- Royal Brompton and Harefield Hospitals, Guy's & St Thomas' NHS Foundation Trust; National Heart and Lung Institute, Imperial College London, UK
| | - A Briasoulis
- Department of Clinical Therapeutics, School of Medicine, Alexandra General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - R De Silva
- Royal Brompton and Harefield Hospitals, Guy's & St Thomas' NHS Foundation Trust; National Heart and Lung Institute, Imperial College London, UK
| | - P Kellman
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - D J Pennell
- Royal Brompton and Harefield Hospitals, Guy's & St Thomas' NHS Foundation Trust; National Heart and Lung Institute, Imperial College London, UK
| | - F Alpendurada
- Royal Brompton and Harefield Hospitals, Guy's & St Thomas' NHS Foundation Trust; National Heart and Lung Institute, Imperial College London, UK.
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Párraga R, Real C, Fernández-Jiménez R. Cardiovascular magnetic resonance in the working diagnosis of MINOCA: the sooner, the better? REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2024; 77:524-526. [PMID: 38316355 DOI: 10.1016/j.rec.2023.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 12/19/2023] [Indexed: 02/07/2024]
Affiliation(s)
- Rocío Párraga
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; Servicio de Cardiología, Hospital Universitario Clínico San Carlos, Madrid, Spain
| | - Carlos Real
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; Servicio de Cardiología, Hospital Universitario Clínico San Carlos, Madrid, Spain. https://twitter.com/@CHI_Lab_CNIC
| | - Rodrigo Fernández-Jiménez
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; Servicio de Cardiología, Hospital Universitario Clínico San Carlos, Madrid, Spain; Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares (CIBERCV), Spain.
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3
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Crawley R, Kunze KP, Milidonis X, Highton J, McElroy S, Frey SM, Hoefler D, Karamanli C, Wong NCK, Backhaus SJ, Alskaf E, Neji R, Scannell CM, Plein S, Chiribiri A. High-resolution free-breathing automated quantitative myocardial perfusion by cardiovascular magnetic resonance for the detection of functionally significant coronary artery disease. Eur Heart J Cardiovasc Imaging 2024; 25:914-925. [PMID: 38525948 PMCID: PMC11210990 DOI: 10.1093/ehjci/jeae084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 03/15/2024] [Accepted: 03/17/2024] [Indexed: 03/26/2024] Open
Abstract
AIMS Current assessment of myocardial ischaemia from stress perfusion cardiovascular magnetic resonance (SP-CMR) largely relies on visual interpretation. This study investigated the use of high-resolution free-breathing SP-CMR with automated quantitative mapping in the diagnosis of coronary artery disease (CAD). Diagnostic performance was evaluated against invasive coronary angiography (ICA) with fractional flow reserve (FFR) measurement. METHODS AND RESULTS Seven hundred and three patients were recruited for SP-CMR using the research sequence at 3 Tesla. Of those receiving ICA within 6 months, 80 patients had either FFR measurement or identification of a chronic total occlusion (CTO) with inducible perfusion defects seen on SP-CMR. Myocardial blood flow (MBF) maps were automatically generated in-line on the scanner following image acquisition at hyperaemic stress and rest, allowing myocardial perfusion reserve (MPR) calculation. Seventy-five coronary vessels assessed by FFR and 28 vessels with CTO were evaluated at both segmental and coronary territory level. Coronary territory stress MBF and MPR were reduced in FFR-positive (≤0.80) regions [median stress MBF: 1.74 (0.90-2.17) mL/min/g; MPR: 1.67 (1.10-1.89)] compared with FFR-negative regions [stress MBF: 2.50 (2.15-2.95) mL/min/g; MPR 2.35 (2.06-2.54) P < 0.001 for both]. Stress MBF ≤ 1.94 mL/min/g and MPR ≤ 1.97 accurately detected FFR-positive CAD on a per-vessel basis (area under the curve: 0.85 and 0.96, respectively; P < 0.001 for both). CONCLUSION A novel scanner-integrated high-resolution free-breathing SP-CMR sequence with automated in-line perfusion mapping is presented which accurately detects functionally significant CAD.
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Affiliation(s)
- R Crawley
- School of Biomedical Engineering & Imaging Sciences, King’s College London, St Thomas’ Hospital, Westminster Bridge Road, London, SE1 7EH, UK
| | - K P Kunze
- School of Biomedical Engineering & Imaging Sciences, King’s College London, St Thomas’ Hospital, Westminster Bridge Road, London, SE1 7EH, UK
- Magnetic Resonance Research Collaborations, Siemens Healthcare Limited, Camberley, UK
| | - X Milidonis
- School of Biomedical Engineering & Imaging Sciences, King’s College London, St Thomas’ Hospital, Westminster Bridge Road, London, SE1 7EH, UK
- DeepCamera MRG, CYENS Centre of Excellence, Nicosia, Cyprus
| | - J Highton
- School of Biomedical Engineering & Imaging Sciences, King’s College London, St Thomas’ Hospital, Westminster Bridge Road, London, SE1 7EH, UK
- Aival, London, UK
| | - S McElroy
- School of Biomedical Engineering & Imaging Sciences, King’s College London, St Thomas’ Hospital, Westminster Bridge Road, London, SE1 7EH, UK
- Magnetic Resonance Research Collaborations, Siemens Healthcare Limited, Camberley, UK
| | - S M Frey
- Department of Cardiology, University Hospital Basel, Basel, Switzerland
| | - D Hoefler
- Department of Radiotherapy, University of Erlangen, Erlangen, Germany
| | - C Karamanli
- School of Biomedical Engineering & Imaging Sciences, King’s College London, St Thomas’ Hospital, Westminster Bridge Road, London, SE1 7EH, UK
| | - N C K Wong
- School of Biomedical Engineering & Imaging Sciences, King’s College London, St Thomas’ Hospital, Westminster Bridge Road, London, SE1 7EH, UK
| | - S J Backhaus
- Department of Cardiology, Campus Kerckhoff of the Justus-Liebig-University Giessen, Kerckhoff-Clinic, Bad Nauheim, Germany
| | - E Alskaf
- School of Biomedical Engineering & Imaging Sciences, King’s College London, St Thomas’ Hospital, Westminster Bridge Road, London, SE1 7EH, UK
| | - R Neji
- School of Biomedical Engineering & Imaging Sciences, King’s College London, St Thomas’ Hospital, Westminster Bridge Road, London, SE1 7EH, UK
| | - C M Scannell
- School of Biomedical Engineering & Imaging Sciences, King’s College London, St Thomas’ Hospital, Westminster Bridge Road, London, SE1 7EH, UK
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - S Plein
- School of Biomedical Engineering & Imaging Sciences, King’s College London, St Thomas’ Hospital, Westminster Bridge Road, London, SE1 7EH, UK
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - A Chiribiri
- School of Biomedical Engineering & Imaging Sciences, King’s College London, St Thomas’ Hospital, Westminster Bridge Road, London, SE1 7EH, UK
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Tassetti L, Sfriso E, Torlone F, Baggiano A, Mushtaq S, Cannata F, Del Torto A, Fazzari F, Fusini L, Junod D, Maragna R, Volpe A, Carrabba N, Conte E, Guglielmo M, La Mura L, Pergola V, Pedrinelli R, Indolfi C, Sinagra G, Perrone Filardi P, Guaricci AI, Pontone G. The Role of Multimodality Imaging (CT & MR) as a Guide to the Management of Chronic Coronary Syndromes. J Clin Med 2024; 13:3450. [PMID: 38929984 PMCID: PMC11205051 DOI: 10.3390/jcm13123450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2024] [Revised: 06/06/2024] [Accepted: 06/11/2024] [Indexed: 06/28/2024] Open
Abstract
Chronic coronary syndrome (CCS) is one of the leading cardiovascular causes of morbidity, mortality, and use of medical resources. After the introduction by international guidelines of the same level of recommendation to non-invasive imaging techniques in CCS evaluation, a large debate arose about the dilemma of choosing anatomical (with coronary computed tomography angiography (CCTA)) or functional imaging (with stress echocardiography (SE), cardiovascular magnetic resonance (CMR), or nuclear imaging techniques) as a first diagnostic evaluation. The determinant role of the atherosclerotic burden in defining cardiovascular risk and prognosis more than myocardial inducible ischemia has progressively increased the use of a first anatomical evaluation with CCTA in a wide range of pre-test probability in CCS patients. Functional testing holds importance, both because the role of revascularization in symptomatic patients with proven ischemia is well defined and because functional imaging, particularly with stress cardiac magnetic resonance (s-CMR), gives further prognostic information regarding LV function, detection of myocardial viability, and tissue characterization. Emerging techniques such as stress computed tomography perfusion (s-CTP) and fractional flow reserve derived from CT (FFRCT), combining anatomical and functional evaluation, appear capable of addressing the need for a single non-invasive examination, especially in patients with high risk or previous revascularization. Furthermore, CCTA in peri-procedural planning is promising to acquire greater importance in the non-invasive planning and guiding of complex coronary revascularization procedures, both by defining the correct strategy of interventional procedure and by improving patient selection. This review explores the different roles of non-invasive imaging techniques in managing CCS patients, also providing insights into preoperative planning for percutaneous or surgical myocardial revascularization.
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Affiliation(s)
- Luigi Tassetti
- Perioperative Cardiology and Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (L.T.); (A.B.); (S.M.); (F.C.); (F.F.); (L.F.); (D.J.); (R.M.); (A.V.)
| | - Enrico Sfriso
- Radiology Unit, Department of Medical, Surgical and Health Sciences, University of Trieste, 34127 Trieste, Italy;
| | | | - Andrea Baggiano
- Perioperative Cardiology and Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (L.T.); (A.B.); (S.M.); (F.C.); (F.F.); (L.F.); (D.J.); (R.M.); (A.V.)
| | - Saima Mushtaq
- Perioperative Cardiology and Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (L.T.); (A.B.); (S.M.); (F.C.); (F.F.); (L.F.); (D.J.); (R.M.); (A.V.)
| | - Francesco Cannata
- Perioperative Cardiology and Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (L.T.); (A.B.); (S.M.); (F.C.); (F.F.); (L.F.); (D.J.); (R.M.); (A.V.)
| | - Alberico Del Torto
- Perioperative Cardiology and Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (L.T.); (A.B.); (S.M.); (F.C.); (F.F.); (L.F.); (D.J.); (R.M.); (A.V.)
| | - Fabio Fazzari
- Perioperative Cardiology and Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (L.T.); (A.B.); (S.M.); (F.C.); (F.F.); (L.F.); (D.J.); (R.M.); (A.V.)
| | - Laura Fusini
- Perioperative Cardiology and Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (L.T.); (A.B.); (S.M.); (F.C.); (F.F.); (L.F.); (D.J.); (R.M.); (A.V.)
| | - Daniele Junod
- Perioperative Cardiology and Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (L.T.); (A.B.); (S.M.); (F.C.); (F.F.); (L.F.); (D.J.); (R.M.); (A.V.)
| | - Riccardo Maragna
- Perioperative Cardiology and Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (L.T.); (A.B.); (S.M.); (F.C.); (F.F.); (L.F.); (D.J.); (R.M.); (A.V.)
| | - Alessandra Volpe
- Perioperative Cardiology and Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (L.T.); (A.B.); (S.M.); (F.C.); (F.F.); (L.F.); (D.J.); (R.M.); (A.V.)
| | - Nazario Carrabba
- Department of Cardiothoracovascular Medicine, Azienda Ospedaliero-Universitaria Careggi, 50134 Florence, Italy;
| | - Edoardo Conte
- Department of Clinical Cardiology and Cardiovascular Imaging, Galeazzi-Sant’Ambrogio Hospital IRCCS, 20157 Milan, Italy;
| | - Marco Guglielmo
- Department of Cardiology, Division of Heart and Lungs, Medical Center Utrecht, Utrecht University, 3584 Utrecht, The Netherlands;
| | - Lucia La Mura
- Department of Advanced Biomedical Sciences, University Federico II of Naples, 80131 Naples, Italy; (L.L.M.); (P.P.F.)
| | - Valeria Pergola
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, 35128 Padova, Italy;
| | - Roberto Pedrinelli
- Cardiac, Thoracic and Vascular Department, University of Pisa, 56124 Pisa, Italy;
| | - Ciro Indolfi
- Istituto di Cardiologia, Dipartimento di Scienze Mediche e Chirurgiche, Università degli Studi “Magna Graecia”, 88100 Catanzaro, Italy;
| | - Gianfranco Sinagra
- Cardiology Specialty School, University of Trieste, 34127 Trieste, Italy;
- Center for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI), 34149 Trieste, Italy
| | - Pasquale Perrone Filardi
- Department of Advanced Biomedical Sciences, University Federico II of Naples, 80131 Naples, Italy; (L.L.M.); (P.P.F.)
| | - Andrea Igoren Guaricci
- Cardiology Unit, Interdisciplinary Department of Medicine, University of Bari Aldo Moro, 70126 Bari, Italy;
| | - Gianluca Pontone
- Perioperative Cardiology and Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (L.T.); (A.B.); (S.M.); (F.C.); (F.F.); (L.F.); (D.J.); (R.M.); (A.V.)
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, 20122 Milan, Italy
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Crean AM. Scanning the Imaging Horizon for Hypertrophic Cardiomyopathy. Can J Cardiol 2024; 40:899-906. [PMID: 38467329 DOI: 10.1016/j.cjca.2024.02.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 02/27/2024] [Accepted: 02/27/2024] [Indexed: 03/13/2024] Open
Abstract
In this article some of the recent advances in the use of noninvasive imaging applied to patients with hypertrophic cardiomyopathy (HCM) are discussed. Echocardiography and cardiac computed tomography are briefly discussed with respect to their power to detect apical aneurysmal disease. Echocardiographic phenotype-genotype correlations and the use of echocardiography to characterize myocardial work are reviewed. Positron emission tomography is reviewed in the context of ischemia imaging and also in the context of the use of a new tracer that might allow for recognition of early activation of the fibrosis pathway. Next, the technical capabilities of cardiovascular magnetic resonance to measure myocardial perfusion, oxygenation, and disarray are discussed as they apply to HCM. The application of radiomics to improve prediction of sudden cardiac death is touched upon. Finally, a deep learning approach to the recognition of HCM vs phenocopies is presented as a potential future diagnostic aid in the not-too-distant future.
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Affiliation(s)
- Andrew M Crean
- Manchester Heart Center, University of Manchester, Manchester, United Kingdom; Division of Cardiology, Ottawa Heart Institute, Ottawa, Ontario, Canada.
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Abraham GR, Berry C, Fu Q, Hoole SP, Weir-McCall JR. Differences in quantitative myocardial perfusion mapping by CMR at 1.5 T and 3 T. AMERICAN HEART JOURNAL PLUS : CARDIOLOGY RESEARCH AND PRACTICE 2024; 41:100388. [PMID: 38680205 PMCID: PMC11045872 DOI: 10.1016/j.ahjo.2024.100388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 03/13/2024] [Accepted: 03/15/2024] [Indexed: 05/01/2024]
Affiliation(s)
- George R. Abraham
- Royal Papworth Hospital NHS Foundation Trust, Papworth Road, Cambridge Biomedical Campus, Cambridge CB2 0AY, United Kingdom of Great Britain and Northern Ireland
- University of Cambridge, The Old Schools, Trinity Lane, Cambridge CB2 1TN, United Kingdom of Great Britain and Northern Ireland
| | - Colin Berry
- NHS Greater Glasgow and Clyde Health Board, Gartnavel Royal Hospital Campus, 1055 Great Western Road, Glasgow G12 0XH, United Kingdom of Great Britain and Northern Ireland
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, BHF Glasgow Cardiovascular Research Centre (GCRC), 126 University Place, Glasgow G12 8TA, United Kingdom of Great Britain and Northern Ireland
| | - Qing Fu
- Royal Papworth Hospital NHS Foundation Trust, Papworth Road, Cambridge Biomedical Campus, Cambridge CB2 0AY, United Kingdom of Great Britain and Northern Ireland
- University of Cambridge, The Old Schools, Trinity Lane, Cambridge CB2 1TN, United Kingdom of Great Britain and Northern Ireland
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Stephen P. Hoole
- Royal Papworth Hospital NHS Foundation Trust, Papworth Road, Cambridge Biomedical Campus, Cambridge CB2 0AY, United Kingdom of Great Britain and Northern Ireland
- University of Cambridge, The Old Schools, Trinity Lane, Cambridge CB2 1TN, United Kingdom of Great Britain and Northern Ireland
| | - Jonathan R. Weir-McCall
- Royal Papworth Hospital NHS Foundation Trust, Papworth Road, Cambridge Biomedical Campus, Cambridge CB2 0AY, United Kingdom of Great Britain and Northern Ireland
- University of Cambridge, The Old Schools, Trinity Lane, Cambridge CB2 1TN, United Kingdom of Great Britain and Northern Ireland
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7
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Moutzoukis G, Lorenz MK, Schroeder T, Schulte-Steinberg B, Chow K, Kellman P, Bekeredjian R, Schmid N, Mahrholdt H, Seitz A. Systematic underestimation of myocardial perfusion reserve by regadenoson stress perfusion CMR-when haste makes waste. Clin Res Cardiol 2024:10.1007/s00392-024-02405-6. [PMID: 38466348 DOI: 10.1007/s00392-024-02405-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 02/14/2024] [Indexed: 03/13/2024]
Affiliation(s)
- Georgios Moutzoukis
- Department of Cardiology and Angiology, Robert Bosch Medical Center, Auerbachstrasse 110, 70376, Stuttgart, Germany
| | - Marie K Lorenz
- Department of Cardiology and Angiology, Robert Bosch Medical Center, Auerbachstrasse 110, 70376, Stuttgart, Germany
| | - Thomas Schroeder
- Department of Medical Informatics, Bosch Health Campus, Stuttgart, Germany
| | - Benedict Schulte-Steinberg
- Department of Cardiology and Angiology, Robert Bosch Medical Center, Auerbachstrasse 110, 70376, Stuttgart, Germany
| | - Kelvin Chow
- Cardiovascular MR R&D, Siemens Medical Solutions USA, Inc., Chicago, IL, USA
| | - Peter Kellman
- National Heart, Lung, and Blood Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, MD, USA
| | - Raffi Bekeredjian
- Department of Cardiology and Angiology, Robert Bosch Medical Center, Auerbachstrasse 110, 70376, Stuttgart, Germany
| | - Nico Schmid
- Department of Medical Informatics, Bosch Health Campus, Stuttgart, Germany
| | - Heiko Mahrholdt
- Department of Cardiology and Angiology, Robert Bosch Medical Center, Auerbachstrasse 110, 70376, Stuttgart, Germany.
| | - Andreas Seitz
- Department of Cardiology and Angiology, Robert Bosch Medical Center, Auerbachstrasse 110, 70376, Stuttgart, Germany
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8
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Arai AE. Why Should We Quantify Stress Myocardial Perfusion CMR? JACC Cardiovasc Imaging 2024; 17:266-268. [PMID: 37855801 DOI: 10.1016/j.jcmg.2023.08.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 08/28/2023] [Accepted: 08/29/2023] [Indexed: 10/20/2023]
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9
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Ricci F, Khanji MY, Bisaccia G, Cipriani A, Di Cesare A, Ceriello L, Mantini C, Zimarino M, Fedorowski A, Gallina S, Petersen SE, Bucciarelli-Ducci C. Diagnostic and Prognostic Value of Stress Cardiovascular Magnetic Resonance Imaging in Patients With Known or Suspected Coronary Artery Disease: A Systematic Review and Meta-analysis. JAMA Cardiol 2023; 8:662-673. [PMID: 37285143 PMCID: PMC10248816 DOI: 10.1001/jamacardio.2023.1290] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 04/12/2023] [Indexed: 06/08/2023]
Abstract
Importance The clinical utility of stress cardiovascular magnetic resonance imaging (CMR) in stable chest pain is still debated, and the low-risk period for adverse cardiovascular (CV) events after a negative test result is unknown. Objective To provide contemporary quantitative data synthesis of the diagnostic accuracy and prognostic value of stress CMR in stable chest pain. Data Sources PubMed and Embase databases, the Cochrane Database of Systematic Reviews, PROSPERO, and the ClinicalTrials.gov registry were searched for potentially relevant articles from January 1, 2000, through December 31, 2021. Study Selection Selected studies evaluated CMR and reported estimates of diagnostic accuracy and/or raw data of adverse CV events for participants with either positive or negative stress CMR results. Prespecified combinations of keywords related to the diagnostic accuracy and prognostic value of stress CMR were used. A total of 3144 records were evaluated for title and abstract; of those, 235 articles were included in the full-text assessment of eligibility. After exclusions, 64 studies (74 470 total patients) published from October 29, 2002, through October 19, 2021, were included. Data Extraction and Synthesis This systematic review and meta-analysis adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Main Outcomes and Measures Diagnostic odds ratios (DORs), sensitivity, specificity, area under the receiver operating characteristic curve (AUROC), odds ratio (OR), and annualized event rate (AER) for all-cause death, CV death, and major adverse cardiovascular events (MACEs) defined as the composite of myocardial infarction and CV death. Results A total of 33 diagnostic studies pooling 7814 individuals and 31 prognostic studies pooling 67 080 individuals (mean [SD] follow-up, 3.5 [2.1] years; range, 0.9-8.8 years; 381 357 person-years) were identified. Stress CMR yielded a DOR of 26.4 (95% CI, 10.6-65.9), a sensitivity of 81% (95% CI, 68%-89%), a specificity of 86% (95% CI, 75%-93%), and an AUROC of 0.84 (95% CI, 0.77-0.89) for the detection of functionally obstructive coronary artery disease. In the subgroup analysis, stress CMR yielded higher diagnostic accuracy in the setting of suspected coronary artery disease (DOR, 53.4; 95% CI, 27.7-103.0) or when using 3-T imaging (DOR, 33.2; 95% CI, 19.9-55.4). The presence of stress-inducible ischemia was associated with higher all-cause mortality (OR, 1.97; 95% CI, 1.69-2.31), CV mortality (OR, 6.40; 95% CI, 4.48-9.14), and MACEs (OR, 5.33; 95% CI, 4.04-7.04). The presence of late gadolinium enhancement (LGE) was associated with higher all-cause mortality (OR, 2.22; 95% CI, 1.99-2.47), CV mortality (OR, 6.03; 95% CI, 2.76-13.13), and increased risk of MACEs (OR, 5.42; 95% CI, 3.42-8.60). After a negative test result, pooled AERs for CV death were less than 1.0%. Conclusion and Relevance In this study, stress CMR yielded high diagnostic accuracy and delivered robust prognostication, particularly when 3-T scanners were used. While inducible myocardial ischemia and LGE were associated with higher mortality and risk of MACEs, normal stress CMR results were associated with a lower risk of MACEs for at least 3.5 years.
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Affiliation(s)
- Fabrizio Ricci
- Department of Neuroscience, Imaging and Clinical Sciences, Gabriele d’Annunzio University of Chieti-Pescara, Chieti, Italy
- Department of Clinical Sciences, Lund University, Malmö, Sweden
- William Harvey Research Institute, Barts Biomedical Research Centre, National Institute for Health and Care Research, Queen Mary University London, Charterhouse Square, London, United Kingdom
| | - Mohammed Y. Khanji
- William Harvey Research Institute, Barts Biomedical Research Centre, National Institute for Health and Care Research, Queen Mary University London, Charterhouse Square, London, United Kingdom
- Newham University Hospital, Barts Health NHS Trust, London, United Kingdom
- Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS Trust, West Smithfield, London, United Kingdom
| | - Giandomenico Bisaccia
- Department of Neuroscience, Imaging and Clinical Sciences, Gabriele d’Annunzio University of Chieti-Pescara, Chieti, Italy
| | - Alberto Cipriani
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Annamaria Di Cesare
- Cardiology Unit, Rimini Hospital, Local Health Authority of Romagna, Rimini, Italy
| | - Laura Ceriello
- Department of Neuroscience, Imaging and Clinical Sciences, Gabriele d’Annunzio University of Chieti-Pescara, Chieti, Italy
| | - Cesare Mantini
- Department of Neuroscience, Imaging and Clinical Sciences, Gabriele d’Annunzio University of Chieti-Pescara, Chieti, Italy
| | - Marco Zimarino
- Department of Neuroscience, Imaging and Clinical Sciences, Gabriele d’Annunzio University of Chieti-Pescara, Chieti, Italy
| | - Artur Fedorowski
- Department of Clinical Sciences, Lund University, Malmö, Sweden
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
- Department of Medicine, Karolinska Institute, Stockholm, Sweden
| | - Sabina Gallina
- Department of Neuroscience, Imaging and Clinical Sciences, Gabriele d’Annunzio University of Chieti-Pescara, Chieti, Italy
| | - Steffen E. Petersen
- Newham University Hospital, Barts Health NHS Trust, London, United Kingdom
- Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS Trust, West Smithfield, London, United Kingdom
- The Alan Turing Institute, London, United Kingdom
- Health Data Research UK, London, United Kingdom
| | - Chiara Bucciarelli-Ducci
- Royal Brompton and Harefield Hospitals, Guys and St Thomas NHS Trust London, London, United Kingdom
- School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, Kings College London, London, United Kingdom
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10
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Adenosine triphosphate (ATP): a safe and effective vasodilator for stress perfusion cardiac magnetic resonance imaging. Clin Radiol 2023; 78:e71-e76. [PMID: 36351853 DOI: 10.1016/j.crad.2022.08.133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 06/16/2022] [Accepted: 08/17/2022] [Indexed: 11/08/2022]
Abstract
AIM To evaluate the efficiency and safety of adenosine triphosphate (ATP) as a stress agent in a cohort of patients undergoing stress perfusion cardiac magnetic resonance imaging (CMRI). MATERIALS AND METHODS This retrospective study was conducted between December 2019 and October 2021. The study recruited patients who underwent stress perfusion CMRI using ATP as a vasodilator. Adverse events, such as chest pain, flushing, dyspnoea, headache, and splenic switch-off (SSO) phenomenon, were evaluated in the patients who underwent stress perfusion CMRI. RESULTS The study included 107 patients (age range: 53 ± 11 years; male:female, 62%:38%). The haemodynamic response (heart rate increased by ≥ 10 beats/min) was quick and observed within 2 minutes of ATP infusion. Scanning was stopped in three patients because of atrioventricular block. CMRI images of seven out of 104 patients were excluded from the final analysis because of inferior quality. During ATP infusion, 37/107 patients (35%) experienced mild adverse events, such as chest pain, flushing, dyspnoea, headache, and atrioventricular block. Myocardial infarction and bronchospasms were not observed during ATP infusion. SSO, a marker of adequate stress, was observed in 91% (94/103) of the patients who underwent stress perfusion CMRI. CONCLUSIONS As a coronary vasodilator, ATP was safe for stress perfusion CMRI. In addition, the adverse events during ATP infusion were mild, which were relieved within 2 minutes of ATP injection cessation. SSO could serve as an indicator of stress success in ATP stress perfusion CMRI.
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11
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Lassen ML, Wissenberg M, Byrne C, Sheykhzade M, Hurry PK, Schmedes AV, Kjær A, Hasbak P. Image-derived and physiological markers to predict adequate adenosine-induced hyperemic response in Rubidium-82 myocardial perfusion imaging. J Nucl Cardiol 2022; 29:3207-3217. [PMID: 35149976 PMCID: PMC9834126 DOI: 10.1007/s12350-022-02906-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 12/22/2021] [Indexed: 01/22/2023]
Abstract
AIMS This study aimed to investigate the potential of different markers to identify adequate stressing in subjects with and without caffeine intake prior to Rubidium-82 myocardial imaging. METHODS AND RESULTS This study comprised 40 healthy subjects who underwent four serial Rubidium-82 rest/adenosine stress MPI; two with 0mg caffeine consumption (baseline MPIs) and two with controlled consumption of caffeine (arm 1: 100 and 300mg, or arm 2: 200 and 400mg). We report the sensitivity and specificity of seven markers ability to predict adequate adenosine-induced hyperemic response: (1) the splenic response ratio (SRR); (2) splenic stress-to-rest intensity ratios (SIR); (3) changes in heart rate (ΔHR); (4) percentwise change in heart rate (Δ%HR); (5) changes in the rate pressure product (ΔRPP); (6) changes in the systolic blood pressure (ΔSBP); and (7) changes in the cardiovascular resistance (ΔCVR). Adequate stressing was determined as stress myocardial blood flow > 3ml/g/min and a corresponding myocardial flow reserve >68% of the individual maximum myocardial flow reserve obtained in the baseline MPIs. RESULTS 129 MPI sessions (obtained in 39 subjects) were considered for this study. The following sensitivities were obtained: SSR = 72.7%, SIR = 63.6%, ΔHR = 45.5%, Δ%HR = 77.3%, ΔRPP = 54.5%, ΔSBP = 47.7%, and ΔCVR =40.9%, while the specificities were SSR = 80.9%, SIR = 85.0%, ΔHR = 90.4%, Δ%HR = 81.6%, ΔRPP=81.1%, ΔSBP = 86.4%, and ΔCVR =90.4%. CONCLUSION The image-derived and physiological markers all provide acceptable sensitivities and specificities when patients follow the caffeine pausation before MPI. However, their use warrants great care when caffeine consumption cannot be ruled out.
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Affiliation(s)
- Martin Lyngby Lassen
- Department of Clinical Physiology, Nuclear Medicine & PET and Cluster for Molecular Imaging, of Biomedical Sciences, Section 4011, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen, Denmark.
| | - Mads Wissenberg
- Department of Cardiology, Copenhagen University Hospital, Gentofte, Denmark
| | - Christina Byrne
- Department of Clinical Physiology, Nuclear Medicine & PET and Cluster for Molecular Imaging, of Biomedical Sciences, Section 4011, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Majid Sheykhzade
- Department of Drug Design and Pharmacology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Preetee Kapisha Hurry
- Department of Clinical Physiology, Nuclear Medicine & PET and Cluster for Molecular Imaging, of Biomedical Sciences, Section 4011, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | | | - Andreas Kjær
- Department of Clinical Physiology, Nuclear Medicine & PET and Cluster for Molecular Imaging, of Biomedical Sciences, Section 4011, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Philip Hasbak
- Department of Clinical Physiology, Nuclear Medicine & PET and Cluster for Molecular Imaging, of Biomedical Sciences, Section 4011, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen, Denmark
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12
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Edvardsen T, Donal E, Muraru D, Gimelli A, Fontes-Carvalho R, Maurer G, Petersen SE, Cosyns B. The year 2021 in the European Heart Journal—Cardiovascular Imaging: Part I. Eur Heart J Cardiovasc Imaging 2022; 23:1576-1583. [DOI: 10.1093/ehjci/jeac210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 09/28/2022] [Indexed: 11/13/2022] Open
Abstract
Abstract
The European Heart Journal—Cardiovascular Imaging was introduced in 2012 and has during these 10 years become one of the leading multimodality cardiovascular imaging journals. The journal is currently ranked as Number 19 among all cardiovascular journals. It has an impressive impact factor of 9.130 and our journal is well established as one of the top cardiovascular journals. The most important studies published in our Journal in 2021 will be highlighted in two reports. Part I of the review will focus on studies about myocardial function and risk prediction, myocardial ischaemia, and emerging techniques in cardiovascular imaging, while Part II will focus on valvular heart disease, heart failure, cardiomyopathies, and congenital heart disease.
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Affiliation(s)
- Thor Edvardsen
- Department of Cardiology, Oslo University Hospital, Rikshospitalet , Sognsvannsveien 20, Postbox 4950 Nydalen, NO-0424 Oslo , Norway
- Institute for Clinical Medicine, University of Oslo , Sognsvannsveien 20, NO-0424 Oslo , Norway
| | - Erwan Donal
- Department of Cardiology and CIC-IT1414, CHU Rennes, Inserm, LTSI-UMR 1099, University Rennes-1, Rennes F-35000 , France
| | - Denisa Muraru
- Department of Cardiology, Istituto Auxologico Italiano, IRCCS , Piazzale Brescia 20, 20149 Milan , Italy
- Department of Medicine and Surgery, University of Milano-Bicocca , Via Cadore 48, 20900 Monza , Italy
| | - Alessia Gimelli
- Imaging Department, Fondazione Toscana G. Monasterio , Via Giuseppe Moruzzi, 1, 56124 Pisa PI , Italy
| | - Ricardo Fontes-Carvalho
- Cardiology Department, Centro Hospitalar de Vila Nova de Gaia/Espinho, R. Dr. Francisco Sá Carneiro 4400-129 , 4430-999 Vila Nova de Gaia , Portugal
- Cardiovascular R&D Centre - UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto , Alameda Prof. Hernâni Monteiro 4200-319 Porto , Portugal
| | - Gerald Maurer
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna , Wahringer Gurtel 18-20, 1090 Vienna , Austria
| | - Steffen E Petersen
- Barts Heart Centre, Barts Health NHS Trust , West Smithfield, London EC1A 7BE , UK
- William Harvey Research Institute, Queen Mary University of London , Charterhouse Square, London EC1M 6BQ , UK
| | - Bernard Cosyns
- Department of Cardiology, CHVZ (Centrum voor Hart en Vaatziekten), ICMI (In Vivo Cellular and Molecular Imaging) Laboratory, Universitair ziekenhuis Brussel , 1090 Jette, Brussels , Belgium
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13
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Chowdhary A, Thirunavukarasu S, Jex N, Coles L, Bowers C, Sengupta A, Swoboda P, Witte K, Cubbon R, Xue H, Kellman P, Greenwood J, Plein S, Levelt E. Coronary microvascular function and visceral adiposity in patients with normal body weight and type 2 diabetes. Obesity (Silver Spring) 2022; 30:1079-1090. [PMID: 35357083 PMCID: PMC9314597 DOI: 10.1002/oby.23413] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 02/10/2022] [Accepted: 02/12/2022] [Indexed: 11/24/2022]
Abstract
OBJECTIVE This study sought to assess whether diabetes affects coronary microvascular function in individuals with normal body weight. METHODS Seventy-five participants (30 patients with type 2 diabetes [T2D] who were overweight [O-T2D], 15 patients with T2D who were lean [LnT2D], 15 healthy volunteers who were lean [LnHV], and 15 healthy volunteers who were overweight [O-HV]) without established cardiovascular disease were recruited. Participants underwent magnetic resonance imaging for assessment of subcutaneous, epicardial, and visceral adipose tissue areas, adenosine stress myocardial blood flow (MBF), and cardiac structure and function. RESULTS Stress MBF was reduced only in the O-T2D group (mean [SD], LnHV = 2.07 [0.47] mL/g/min, O-HV = 2.08 [0.42] mL/g/min, LnT2D = 2.16 [0.36] mL/g/min, O-T2D = 1.60 [0.28] mL/g/min; p ≤ 0.0001). Accumulation of visceral fat was evident in the LnT2D group at similar levels to the O-HV group (LnHV = 127 [53] cm2 , O-HV = 181 [60] cm2 , LnT2D = 182 [99] cm2 , O-T2D = 288 [72] cm2 ; p < 0.0001). Only the O-T2D group showed reductions in left ventricular ejection fraction (LnHV = 63% [4%], O-HV = 63% [4%], LnT2D = 60% [5%], O-T2D = 58% [6%]; p = 0.0008) and global longitudinal strain (LnHV = -15.1% [3.1%], O-HV= -15.2% [3.7%], LnT2D = -13.4% [2.7%], O-T2D = -11.1% [2.8%]; p = 0.002) compared with both control groups. CONCLUSIONS Patients with T2D and normal body weight do not show alterations in global stress MBF, but they do show significant increases in visceral adiposity. Patients with T2D who were overweight and had no prior cardiovascular disease showed an increase in visceral adiposity and significant reductions in stress MBF.
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Affiliation(s)
- Amrit Chowdhary
- Multidisciplinary Cardiovascular Research Centre and Biomedical Imaging Science DepartmentLeeds Institute of Cardiovascular and Metabolic MedicineUniversity of LeedsLeedsUK
| | - Sharmaine Thirunavukarasu
- Multidisciplinary Cardiovascular Research Centre and Biomedical Imaging Science DepartmentLeeds Institute of Cardiovascular and Metabolic MedicineUniversity of LeedsLeedsUK
| | - Nicholas Jex
- Multidisciplinary Cardiovascular Research Centre and Biomedical Imaging Science DepartmentLeeds Institute of Cardiovascular and Metabolic MedicineUniversity of LeedsLeedsUK
| | - Lauren Coles
- Multidisciplinary Cardiovascular Research Centre and Biomedical Imaging Science DepartmentLeeds Institute of Cardiovascular and Metabolic MedicineUniversity of LeedsLeedsUK
| | - Charles Bowers
- Multidisciplinary Cardiovascular Research Centre and Biomedical Imaging Science DepartmentLeeds Institute of Cardiovascular and Metabolic MedicineUniversity of LeedsLeedsUK
| | - Anshuman Sengupta
- Multidisciplinary Cardiovascular Research Centre and Biomedical Imaging Science DepartmentLeeds Institute of Cardiovascular and Metabolic MedicineUniversity of LeedsLeedsUK
| | - Peter Swoboda
- Multidisciplinary Cardiovascular Research Centre and Biomedical Imaging Science DepartmentLeeds Institute of Cardiovascular and Metabolic MedicineUniversity of LeedsLeedsUK
| | - Klaus Witte
- Discovery and Translational Science DepartmentLeeds Institute of Cardiovascular and Metabolic MedicineUniversity of LeedsLeedsUK
| | - Richard Cubbon
- Discovery and Translational Science DepartmentLeeds Institute of Cardiovascular and Metabolic MedicineUniversity of LeedsLeedsUK
| | - Hui Xue
- National Heart, Lung, and Blood InstituteNational Institutes of HealthDepartment of Health and Human ServicesBethesdaMarylandUSA
| | - Peter Kellman
- National Heart, Lung, and Blood InstituteNational Institutes of HealthDepartment of Health and Human ServicesBethesdaMarylandUSA
| | - John Greenwood
- Multidisciplinary Cardiovascular Research Centre and Biomedical Imaging Science DepartmentLeeds Institute of Cardiovascular and Metabolic MedicineUniversity of LeedsLeedsUK
| | - Sven Plein
- Multidisciplinary Cardiovascular Research Centre and Biomedical Imaging Science DepartmentLeeds Institute of Cardiovascular and Metabolic MedicineUniversity of LeedsLeedsUK
| | - Eylem Levelt
- Multidisciplinary Cardiovascular Research Centre and Biomedical Imaging Science DepartmentLeeds Institute of Cardiovascular and Metabolic MedicineUniversity of LeedsLeedsUK
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14
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Sakuma H, Ishida M. Advances in Myocardial Perfusion MR Imaging: Physiological Implications, the Importance of Quantitative Analysis, and Impact on Patient Care in Coronary Artery Disease. Magn Reson Med Sci 2022; 21:195-211. [PMID: 34108304 PMCID: PMC9199984 DOI: 10.2463/mrms.rev.2021-0033] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 04/27/2021] [Indexed: 11/09/2022] Open
Abstract
Stress myocardial perfusion imaging (MPI) is the preferred test in patients with intermediate-to-high clinical likelihood of coronary artery disease (CAD) and can be used as a gatekeeper to avoid unnecessary revascularization. Cardiac magnetic resonance (CMR) has a number of favorable characteristics, including: (1) high spatial resolution that can delineate subendocardial ischemia; (2) comprehensive assessment of morphology, global and regional cardiac functions, tissue characterization, and coronary artery stenosis; and (3) no radiation exposure to patients. According to meta-analysis studies, the diagnostic accuracy of perfusion CMR is comparable to positron emission tomography (PET) and perfusion CT, and is better than single-photon emission CT (SPECT) when fractional flow reserve (FFR) is used as a reference standard. In addition, stress CMR has an excellent prognostic value. One meta-analysis study demonstrated the annual event rate of cardiovascular death or non-fatal myocardial infarction was 4.9% and 0.8%, respectively, in patients with positive and negative stress CMR. Quantitative assessment of perfusion CMR not only allows the objective evaluation of regional ischemia but also provides insights into the pathophysiology of microvascular disease and diffuse subclinical atherosclerosis. For accurate quantification of myocardial perfusion, saturation correction of arterial input function is important. There are two major approaches for saturation correction, one is a dual-bolus method and the other is a dual-sequence method. Absolute quantitative mapping with myocardial perfusion CMR has good accuracy in detecting coronary microvascular dysfunction. Flow measurement in the coronary sinus (CS) with phase contrast cine CMR is an alternative approach to quantify global coronary flow reserve (CFR). The measurement of global CFR by quantitative analysis of perfusion CMR or flow measurement in the CS permits assessment of microvascular disease and diffuse subclinical atherosclerosis, which may provide improved prediction of future event risk in patients with suspected or known CAD. Multi-institutional studies to validate the diagnostic and prognostic values of quantitative perfusion CMR approaches are required.
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Affiliation(s)
- Hajime Sakuma
- Department of Radiology, Mie University Graduate School of Medicine, Tsu, Mie, Japan
| | - Masaki Ishida
- Department of Radiology, Mie University Graduate School of Medicine, Tsu, Mie, Japan
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15
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Baggiano A, Italiano G, Guglielmo M, Fusini L, Guaricci AI, Maragna R, Giacari CM, Mushtaq S, Conte E, Annoni AD, Formenti A, Mancini ME, Andreini D, Rabbat M, Pepi M, Pontone G. Changing Paradigms in the Diagnosis of Ischemic Heart Disease by Multimodality Imaging. J Clin Med 2022; 11:jcm11030477. [PMID: 35159929 PMCID: PMC8836710 DOI: 10.3390/jcm11030477] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Revised: 11/24/2021] [Accepted: 01/13/2022] [Indexed: 02/01/2023] Open
Abstract
Coronary artery disease (CAD) represents the most common cardiovascular disease, with high morbidity and mortality. Historically patients with chest pain of suspected coronary origin have been assessed with functional tests, capable to detect haemodynamic consequences of coronary obstructions through depiction of electrocardiographic changes, myocardial perfusion defects or regional wall motion abnormalities under stress condition. Stress echocardiography (SE), single-photon emission computed tomography (SPECT), positron emission tomography (PET) and cardiovascular magnetic resonance (CMR) represent the functional techniques currently available, and technical developments contributed to increased diagnostic performance of these techniques. More recently, cardiac computed tomography angiography (cCTA) has been developed as a non-invasive anatomical test for a direct visualisation of coronary vessels and detailed description of atherosclerotic burden. Cardiovascular imaging techniques have dramatically enhanced our knowledge regarding physiological aspects and myocardial implications of CAD. Recently, after the publication of important trials, international guidelines recognised these changes, updating indications and level of recommendations. This review aims to summarise current standards with main novelties and specific limitations, and a diagnostic algorithm for up-to-date clinical management is also proposed.
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Affiliation(s)
- Andrea Baggiano
- Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (A.B.); (G.I.); (M.G.); (L.F.); (R.M.); (C.M.G.); (S.M.); (E.C.); (A.D.A.); (A.F.); (M.E.M.); (D.A.); (M.P.)
- Cardiovascular Section, Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
| | - Gianpiero Italiano
- Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (A.B.); (G.I.); (M.G.); (L.F.); (R.M.); (C.M.G.); (S.M.); (E.C.); (A.D.A.); (A.F.); (M.E.M.); (D.A.); (M.P.)
| | - Marco Guglielmo
- Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (A.B.); (G.I.); (M.G.); (L.F.); (R.M.); (C.M.G.); (S.M.); (E.C.); (A.D.A.); (A.F.); (M.E.M.); (D.A.); (M.P.)
| | - Laura Fusini
- Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (A.B.); (G.I.); (M.G.); (L.F.); (R.M.); (C.M.G.); (S.M.); (E.C.); (A.D.A.); (A.F.); (M.E.M.); (D.A.); (M.P.)
| | - Andrea Igoren Guaricci
- Department of Emergency and Organ Transplantation, Institute of Cardiovascular Disease, University Hospital Policlinico of Bari, 70124 Bari, Italy;
| | - Riccardo Maragna
- Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (A.B.); (G.I.); (M.G.); (L.F.); (R.M.); (C.M.G.); (S.M.); (E.C.); (A.D.A.); (A.F.); (M.E.M.); (D.A.); (M.P.)
| | - Carlo Maria Giacari
- Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (A.B.); (G.I.); (M.G.); (L.F.); (R.M.); (C.M.G.); (S.M.); (E.C.); (A.D.A.); (A.F.); (M.E.M.); (D.A.); (M.P.)
| | - Saima Mushtaq
- Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (A.B.); (G.I.); (M.G.); (L.F.); (R.M.); (C.M.G.); (S.M.); (E.C.); (A.D.A.); (A.F.); (M.E.M.); (D.A.); (M.P.)
| | - Edoardo Conte
- Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (A.B.); (G.I.); (M.G.); (L.F.); (R.M.); (C.M.G.); (S.M.); (E.C.); (A.D.A.); (A.F.); (M.E.M.); (D.A.); (M.P.)
- Department of Biomedical Sciences for Health, University of Milan, 20133 Milan, Italy
| | - Andrea Daniele Annoni
- Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (A.B.); (G.I.); (M.G.); (L.F.); (R.M.); (C.M.G.); (S.M.); (E.C.); (A.D.A.); (A.F.); (M.E.M.); (D.A.); (M.P.)
| | - Alberto Formenti
- Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (A.B.); (G.I.); (M.G.); (L.F.); (R.M.); (C.M.G.); (S.M.); (E.C.); (A.D.A.); (A.F.); (M.E.M.); (D.A.); (M.P.)
| | - Maria Elisabetta Mancini
- Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (A.B.); (G.I.); (M.G.); (L.F.); (R.M.); (C.M.G.); (S.M.); (E.C.); (A.D.A.); (A.F.); (M.E.M.); (D.A.); (M.P.)
| | - Daniele Andreini
- Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (A.B.); (G.I.); (M.G.); (L.F.); (R.M.); (C.M.G.); (S.M.); (E.C.); (A.D.A.); (A.F.); (M.E.M.); (D.A.); (M.P.)
- Cardiovascular Section, Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
| | - Mark Rabbat
- Division of Cardiology, Department of Medicine and Radiology, Loyola University of Chicago, Chicago, IL 60660, USA;
- Division of Cardiology, Department of Medicine, Edward Hines Jr. VA Hospital, Hines, IL 60141, USA
| | - Mauro Pepi
- Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (A.B.); (G.I.); (M.G.); (L.F.); (R.M.); (C.M.G.); (S.M.); (E.C.); (A.D.A.); (A.F.); (M.E.M.); (D.A.); (M.P.)
| | - Gianluca Pontone
- Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (A.B.); (G.I.); (M.G.); (L.F.); (R.M.); (C.M.G.); (S.M.); (E.C.); (A.D.A.); (A.F.); (M.E.M.); (D.A.); (M.P.)
- Correspondence: ; Tel.: +39-02-5800-2574; Fax: +39-02-5800-2231
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Baessato F, Guglielmo M, Muscogiuri G, Baggiano A, Fusini L, Scafuri S, Babbaro M, Mollace R, Collevecchio A, Guaricci AI, Pontone G. Stress CMR in Known or Suspected CAD: Diagnostic and Prognostic Role. BIOMED RESEARCH INTERNATIONAL 2021; 2021:6678029. [PMID: 33511208 PMCID: PMC7822671 DOI: 10.1155/2021/6678029] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 12/23/2020] [Accepted: 01/04/2021] [Indexed: 12/12/2022]
Abstract
The recently published 2019 guidelines on chronic coronary syndromes (CCS) focus on the need for noninvasive imaging modalities to accurately establish the diagnosis of coronary artery disease (CAD) and assess the risk of clinical scenario occurrence. Appropriate patient management should rely on controlling symptoms, improving prognosis, and guiding each therapeutic strategy as well as monitoring disease progress. Among the noninvasive imaging modalities, cardiovascular magnetic resonance (CMR) has gained broad acceptance in past years due to its unique features in providing a complete assessment of CAD through data on cardiac anatomy and function and myocardial viability, with high spatial and temporal resolution and without ionizing radiation. In detail, evaluation of the presence and extent of myocardial ischemia through stress CMR (S-CMR) has shown a high rule-in power in detecting functionally significant coronary artery stenosis in patients suspected of CCS. Moreover, S-CMR technique may add significant prognostic value, as demonstrated by different studies which have progressively evidenced the valuable power of this multiparametric imaging modality in predicting adverse cardiac events. The latest scientific progress supports a greater expansion of S-CMR with improvement of quantitative myocardial perfusion analysis, myocardial strain, and native mapping within the same examination. Although further study is warranted, these techniques, which are currently mostly restricted to the research field, are likely to become increasingly prevalent in the clinical setting with the scope of increasing accuracy in the selection of patients to be sent to invasive revascularization. This review investigates the diagnostic and prognostic role of S-CMR in the context of CAD, by analysing a strong, long-standing, scientific evidence together with an appraisal of new advanced techniques which may potentially enrich CAD management in the next future.
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Affiliation(s)
- Francesca Baessato
- Department of Cardiology, San Maurizio Regional Hospital, Bolzano, Italy
| | - Marco Guglielmo
- Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Giuseppe Muscogiuri
- Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Andrea Baggiano
- Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Laura Fusini
- Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Stefano Scafuri
- Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Mario Babbaro
- Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Rocco Mollace
- Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Ada Collevecchio
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Andrea I. Guaricci
- Institute of Cardiovascular Disease, Department of Emergency and Organ Transplantation, University Hospital Policlinico of Bari, Bari, Italy
| | - Gianluca Pontone
- Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, Milan, Italy
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