Breathing maneuvers as a coronary vasodilator for myocardial perfusion imaging

Teixeira, Tiago; Nadeshalingam, Gobinath; Fischer, Kady; Marcotte, François; Friedrich, Matthias G.

doi:10.1002/jmri.25224

Cited by 6 publications

(7 citation statements)

References 39 publications

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“…The primary aim of this retrospective pooled analysis was to investigate differences in the heart rate responses to a short period of hyperventilation between controls and patients with cardiovascular disease. Data was collected from studies that were conducted between 2010 and 2018 at the Bern University Hospital in Switzerland, the Stephenson Cardiac Imaging Centre, the Montreal Heart Institute, and the McGill University Health Centre in Canada 19–21,45–47 (NCT03050346, NCT02233634 of original studies). Hemodynamic responses to HR was not the defined end-point in any of the original studies.…”

Section: Methodsmentioning

confidence: 99%

“…Recently, cardiovascular magnetic resonance (CMR) studies by our groups and collaborators have used hyperventilation as a tool to investigate myocardial oxygenation and heart disease 19–21 . CMR, while considered the gold standard modality for many cardiac function and tissue parameters, is not suitable as an initial diagnostic or screening test because of the associated cost.…”

Section: Introductionmentioning

confidence: 99%

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Hyperventilation-induced heart rate response as a potential marker for cardiovascular disease

Hawkins

Guensch

Friedrich

et al. 2019

Sci Rep

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An increase of heart rate to physical or mental stress reflects the ability of the autonomous nervous system and the heart to respond adequately. Hyperventilation is a user-controlled breathing maneuver that has a significant impact on coronary function and hemodynamics. Thus, we aimed to investigate if the heart rate response to hyperventilation (HRRHV) can provide clinically useful information. A pooled analysis of the HRRHV after 60 s of hyperventilation was conducted in 282 participants including healthy controls; patients with heart failure (HF); coronary artery disease (CAD); a combination of both; or patients suspected of CAD but with a normal angiogram. Hyperventilation significantly increased heart rate in all groups, although healthy controls aged 55 years and older (15 ± 9 bpm) had a larger HRRHV than each of the disease groups (HF: 6 ± 6, CAD: 8 ± 8, CAD+/HF+: 6 ± 4, and CAD−/HF−: 8 ± 6 bpm, p < 0.001). No significant differences were found between disease groups. The HRRHV may serve as an easily measurable additional marker of cardiovascular health. Future studies should test its diagnostic potential as a simple, inexpensive pre-screening test to improve patient selection for other diagnostic exams.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Hyperventilation-induced heart rate response as a potential marker for cardiovascular disease

Hawkins

Guensch

Friedrich

et al. 2019

Sci Rep

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“…This was paralleled by marked regional differences of myocardial oxygenation during the HVBH maneuver between hypoperfused and remote myocardium. Furthermore, this was matched by a healthy volunteer study which showed the same breathing maneuver could induce a change in myocardial blood flow, as assessed by first pass perfusion CMR[ 13 ].…”

Section: Discussionmentioning

confidence: 99%

“…As a potential disadvantage, changes of the saturation of incoming blood and of the cardiac workload during the maneuvers could be confounders. Of note, breathing patterns may also affect other current myocardial perfusion techniques[ 13 ], for example with varying durations of breath-holds during CMR or CT scans or hyperventilation in anxious patients during cardiology tests.…”

Section: Discussionmentioning

confidence: 99%

“…Alterations of blood gases by breathing maneuvers or inhalation of gas mixtures were identified as an alternative to pharmacologic vasodilation in functional MRI studies of the brain and more recently the heart[ 7 – 9 ]. In particular, a combination of hyperventilation and breath-holds with OS-CMR yielded promising results in monitoring changes of myocardial oxygenation induced by vasoactive maneuvers[ 10 – 12 ], and could induce significant changes in myocardial perfusion as detected by first pass perfusion CMR[ 13 ]. Yet, its clinical potential to identify an abnormal regional response of the coronary vasculature in the presence of severe coronary artery stenosis has not been explored.…”

Section: Introductionmentioning

confidence: 99%

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Breathing Maneuvers as a Vasoactive Stimulus for Detecting Inducible Myocardial Ischemia – An Experimental Cardiovascular Magnetic Resonance Study

et al. 2016

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BackgroundBreathing maneuvers can elicit a similar vascular response as vasodilatory agents like adenosine; yet, their potential diagnostic utility in the presence of coronary artery stenosis is unknown. The objective of the study is to investigate if breathing maneuvers can non-invasively detect inducible ischemia in an experimental animal model when the myocardium is imaged with oxygenation-sensitive cardiovascular magnetic resonance (OS-CMR).Methods and FindingsIn 11 anesthetised swine with experimentally induced significant stenosis (fractional flow reserve <0.75) of the left anterior descending coronary artery (LAD) and 9 control animals, OS-CMR at 3T was performed during two different breathing maneuvers, a long breath-hold; and a combined maneuver of 60s of hyperventilation followed by a long breath-hold. The resulting change of myocardial oxygenation was compared to the invasive measurements of coronary blood flow, blood gases, and oxygen extraction. In control animals, all breathing maneuvers could significantly alter coronary blood flow as hyperventilation decreased coronary blood flow by 34±23%. A long breath-hold alone led to an increase of 97±88%, while the increase was 346±327% (p<0.001), when the long breath-hold was performed after hyperventilation. In stenosis animals, the coronary blood flow response was attenuated after both hyperventilation and the following breath-hold. This was matched by the observed oxygenation response as breath-holds following hyperventilation consistently yielded a significant difference in the signal of the MRI images between the perfusion territory of the stenosis LAD and remote myocardium. There was no difference between the coronary territories during the other breathing maneuvers or in the control group at any point.ConclusionIn an experimental animal model, the response to a combined breathing maneuver of hyperventilation with subsequent breath-holding is blunted in myocardium subject to significant coronary artery stenosis. This maneuver may allow for detecting severe coronary artery stenosis and have a significant clinical potential as a non-pharmacological method for diagnostic testing in patients with suspected coronary artery disease.

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The Potential of Oxygenation-Sensitive CMR in Heart Failure

Hillier

Friedrich

2021

Curr Heart Fail Rep

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Breathing maneuvers as a coronary vasodilator for myocardial perfusion imaging

Cited by 6 publications

References 39 publications

Hyperventilation-induced heart rate response as a potential marker for cardiovascular disease

Hyperventilation-induced heart rate response as a potential marker for cardiovascular disease

Breathing Maneuvers as a Vasoactive Stimulus for Detecting Inducible Myocardial Ischemia – An Experimental Cardiovascular Magnetic Resonance Study

The Potential of Oxygenation-Sensitive CMR in Heart Failure

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