Advances in Myocardial Perfusion MR Imaging: Physiological Implications, the Importance of Quantitative Analysis, and Impact on Patient Care in Coronary Artery Disease

Sakuma, Hajime; Ishida, Masaki

doi:10.2463/mrms.rev.2021-0033

Cited by 11 publications

(5 citation statements)

References 92 publications

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“…Результаты нашего исследования подтверждают недавно опубликованные данные о возможности выявления дефектов перфузии в субэндокардиальной зоне благодаря пространственному разрешению МРТ, которые могут быть обусловлены коронарной микрососудистой дисфункцией [17]. В исследовании, посвящённом диагностике микрососудистой стенокардии методом стресс-МРТ в сравнении с инвазивным измерением резерва кровотока, количественный и полуколичественный анализы превосходят визуальную оценку в диагностике микрососудистой стенокардии [18].…”

Section: Fig 4 Perfusion Stress Cmr With Adenosine Triphosphate LV Sh...unclassified

Perfusion Cardiac Magnetic Resonance With Adenosine Triphosphate in the Diagnosis of Myocardial Ischemia

Стукалова¹,

Pivovarova²,

Соболева³

et al. 2023

Rejr

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2 -ФГАОУ ВО «Первый Московский государственный медицинский университет им. И.М. Сеченова» МЗ РФ (Сеченовский Университет). г. Москва, Россия.ель. Показать диагностические возможности стресс-МРТ сердца в выявлении стрессиндуцированной ишемии миокарда, а также оценить переносимость аденозинтрифосфата (АТФ) при проведении перфузионной магнитно-резонансной томографии (МРТ) сердца. Материалы и методы. Перфузионная стресс-МРТ сердца с фармакологической нагрузкой выполнялась у 40 пациентов с вероятной или диагностированной ишемической болезнью сердца. В качестве фармакологической нагрузки была использована АТФ в дозе 160 мкг/кг/мин при введении в течение 3-5 мин. За стресс-индуцированный дефект перфузии миокарда принимали зону гипоинтенсивного сигнала при первом прохождении контрастного препарата на протяжении не менее 3 последовательных изображений.Результаты. Тяжелых побочных реакций на введение АТФ зарегистрировано не было. Шанс выявления дефекта перфузии в зоне, соответствующей бассейну пораженных коронарных артерий (КА), был выше более чем в 2 раза (ОШ = 2.62 (1.06-6.66), р=0,038) по сравнению с зонами, кровоснабжающимися неизмененными КА. У 7 пациентов субэндокардиальные дефекты перфузии были обнаружены при малоизмененных коронарных артериях и имели циркулярный диффузный характер.Заключение. Использование аденозинтрифосфата в качестве фармакологической нагрузки удовлетворительно переносится при проведении перфузионной МРТ сердца. Благодаря возможности выявления дефектов перфузии миокарда в субэндокардиальной зоне становится возможным выявление преходящей ишемии миокарда не только в результате стенозирующего атеросклероза, но и обусловленной, вероятно, коронарной микрососудистой дисфункцией.Ключевые слова: перфузионная МРТ сердца, стресс-МРТ сердца, аденозинтрифосфат, ишемия миокарда, перфузия миокарда.

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Section: Fig 4 Perfusion Stress Cmr With Adenosine Triphosphate LV Sh...unclassified

Perfusion Cardiac Magnetic Resonance With Adenosine Triphosphate in the Diagnosis of Myocardial Ischemia

Стукалова¹,

Pivovarova²,

Соболева³

et al. 2023

Rejr

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“…Quantitative stress CMR perfusion mapping has the advantage of avoiding risks related to the current gold-standard modalities invasive coronary angiography and positron emission tomography (25, 26). The MINOCA patients in the current study were well-characterized.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

Reduced stress perfusion in myocardial infarction with nonobstructive coronary arteries

Johansson

Tornvall

Sörensson

et al. 2022

Preprint

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Background: Myocardial infarction with nonobstructive coronary arteries (MINOCA) constitutes a working diagnosis. Early cardiovascular magnetic resonance imaging (CMR) is recommended, however cannot provide a diagnosis in 25% of MINOCA cases. A pathophysiological mechanism may be coronary microvascular dysfunction (CMD). Quantitative stress CMR perfusion mapping allows for quantification of myocardial perfusion, which may detect CMD in the absence of obstructive coronary artery disease. However, it is unknown if CMD is present post-convalescence in suspected MINOCA patients. Purpose: To evaluate the presence of CMD after convalescence in patients with suspected MINOCA. Methods: Patients from the multicenter Stockholm Myocardial Infarction with Normal Coronaries (SMINC) 2 study with a normal CMR scan 2-4 days after hospitalization, and healthy age- and sex-matched volunteers underwent stress CMR during long-term follow-up. Cardiovascular risk factors, medication and symptoms of myocardial ischemia measured by the Seattle Angina Questionnaire 7, were registered. Results: In total, 15 patients with suspected MINOCA (59±7 years old, 60% female), and 15 healthy age- and sex-matched volunteers, underwent CMR. Patients with suspected MINOCA had lower global stress perfusion (2.83±1.8 vs 3.53±0.7 ml/min/g, p=0.02). There was neither differences in other CMR parameters such as global rest perfusion and myocardial perfusion reserve, hemodynamic parameters nor cardiovascular risk factors except for higher statin use in the MINOCA patient group compared to volunteers. Conclusions: Global stress perfusion is lower in MINOCA patients with a normal initial CMR scan during follow-up, compared to age- and sex-matched volunteers, suggesting CMD as a possible pathophysiological mechanism in MINOCA.

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“…More than 490,000 invasive coronary angiography (ICA) operations were performed in Japan, according to a 2019 JROAD report. However, the number of percutaneous coronary interventions was only 271,000 (9). This demonstrates that many invasive examinations are unnecessary, many patients do not have severe obstructive coronary disease.…”

Section: Introductionmentioning

confidence: 99%

Research Progress of Imaging Methods for Detection of Microvascular Angina Pectoris in Diabetic Patients

Feng

et al. 2021

Front. Cardiovasc. Med.

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Diabetes is a complex metabolic disease characterized by hyperglycemia. Its complications are various, often involving the heart, brain, kidney, and other essential organs. At present, the number of diabetic patients in the world is growing day by day. The cardiovascular disease caused by diabetes has dramatically affected the quality of life of diabetic patients. It is the leading cause of death of diabetic patients. Diabetic patients often suffer from microvascular angina pectoris without obstructive coronary artery disease. Still, there are typical ECG ischemia and angina pectoris, that is, chest pain and dyspnea under exercise. Unlike obstructive coronary diseases, nitrate does not affect chest pain caused by coronary microvascular angina in most cases. With the increasing emphasis on diabetic microvascular angina, the need for accurate diagnosis of the disease is also increasing. We can use SPECT, PET, CMR, MCE, and other methods to evaluate coronary microvascular function. SPECT is commonly used in clinical practice, and PET is considered the gold standard for non-invasive detection of myocardial blood flow. This article mainly introduces the research progress of these imaging methods in detecting microvascular angina in diabetic patients.

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Advances in Myocardial Perfusion MR Imaging: Physiological Implications, the Importance of Quantitative Analysis, and Impact on Patient Care in Coronary Artery Disease

Cited by 11 publications

References 92 publications

Perfusion Cardiac Magnetic Resonance With Adenosine Triphosphate in the Diagnosis of Myocardial Ischemia

Perfusion Cardiac Magnetic Resonance With Adenosine Triphosphate in the Diagnosis of Myocardial Ischemia

Reduced stress perfusion in myocardial infarction with nonobstructive coronary arteries

Research Progress of Imaging Methods for Detection of Microvascular Angina Pectoris in Diabetic Patients

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