Gadolinium-Free Cardiovascular Magnetic Resonance Stress T1 Mapping in Patients With Chronic Kidney Disease

Shah, Ranjit; Raman, K. Sree; Walls, Angela; Woodman, Richard; Faull, Randall J.; Gleadle, Jonathan; Selvanayagam, Joseph B.

doi:10.1016/j.jcmg.2019.04.016

Cited by 8 publications

(17 citation statements)

References 2 publications

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“…3 c). The LV native T1 for the healthy controls were within previously published ranges [ 23 ]. In PAH patients, the native T1 values in the inferior RV wall was comparable to both the LV septal (1303 (1107–1612) vs 1332 (1169–1492)ms, p = 0.71) and LV lateral wall (1303 (1107–1612) vs 1301 (1102–1500)ms, p = 0.85) of PAH patients.…”

Section: Resultssupporting

confidence: 57%

Right ventricular myocardial deoxygenation in patients with pulmonary artery hypertension

Raman

Shah

Stokes

et al. 2021

Journal of Cardiovascular Magnetic Resonance

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Background In pulmonary arterial hypertension (PAH), progressive right ventricular (RV) dysfunction is believed to be largely secondary to RV ischaemia. A recent pilot study has demonstrated the feasibility of Oxygen-sensitive (OS) cardiovascular magnetic resonance (CMR) to detect in-vivo RV myocardial oxygenation. The aims of the present study therefore, were to assess the prevalence of RV myocardial ischaemia and relationship with RV myocardial interstitial changes in PAH patients with non-obstructive coronaries, and corelate with functional and haemodynamic parameters. Methods We prospectively recruited 42 patients with right heart catheter (RHC) proven PAH and 11 healthy age matched controls. The CMR examination involved standard functional imaging, OS-CMR imaging and native T1 mapping. An ΔOS-CMR signal intensity (SI) index (stress/rest signal intensity) was acquired at RV anterior, RV free-wall and RV inferior segments. T1 maps were acquired using Shortened Modified Look-Locker Inversion recovery (ShMOLLI) at the inferior RV segment. Results The inferior RV ΔOS-CMR SI index was significantly lower in PAH patients compared with healthy controls (9.5 (– 7.4–42.8) vs 12.5 (9–24.6)%, p = 0.02). The inferior RV ΔOS-CMR SI had a significant correlation to RV inferior wall thickness (r = – 0.7, p < 0.001) and RHC mean pulmonary artery pressure (mPAP) (r = – 0.4, p = 0.02). Compared to healthy controls, patients with PAH had higher native T1 in the inferior RV wall: 1303 (1107–1612) vs 1232 (1159–1288)ms, p = 0.049. In addition, there was a significant difference in the inferior RV T1 values between the idiopathic PAH and systemic sclerosis associated PAH patients: 1242 (1107–1612) vs 1386 (1219–1552)ms, p = 0.007. Conclusion Blunted OS-CMR SI suggests the presence of in-vivo microvascular RV dysfunction in PAH patients. The native T1 in the inferior RV segments is significantly increased in the PAH patients, particularly among the systemic sclerosis associated PAH group.

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Section: Resultssupporting

confidence: 57%

Right ventricular myocardial deoxygenation in patients with pulmonary artery hypertension

Raman

Shah

Stokes

et al. 2021

Journal of Cardiovascular Magnetic Resonance

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“…Shah et al applied stress T1 mapping to a cohort of 20 CKD patients, some of whom also had CAD. 75 Native stress T1 mapping was able to differentiate between remote, ischemic, and infarcted myocardium, with ΔT1 values of 4.7 ± 4.5%, 1.0 ± 4.1%, and −1.1 ± 6.1%, respectively. Notably, these studies did not have invasive reference measures of IMR or FFR for validation.…”

Section: While Both Diabetic Patients and Healthy Controls Demonstratedmentioning

confidence: 90%

“…Moreover, the use of gadolinium‐based contrast agents is not desirable in CKD patients, 74 making traditional perfusion MR imaging techniques more challenging. Shah et al applied stress T1 mapping to a cohort of 20 CKD patients, some of whom also had CAD 75 . Native stress T1 mapping was able to differentiate between remote, ischemic, and infarcted myocardium, with ΔT1 values of 4.7 ± 4.5%, 1.0 ± 4.1%, and −1.1 ± 6.1%, respectively.…”

Section: T1 Stress Mapping: Demonstrated Clinical Utility In Cmdmentioning

confidence: 99%

Pathophysiology, classification, and MRI parallels in microvascular disease of the heart and brain

et al. 2020

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Small vessel disease of the brain and the heart has far-reaching clinical implications, with healthcare costs totaling billions each year. 1-3 Though a lack of consensus in the classification of small vessel disease exists, the pathophysiologic features implicate damage to small end arteries, arterioles, venules, and capillaries, resulting in chronic end-organ hypoperfusion. 4 In the brain, hypoperfusion can contribute to cognitive decline, gait disturbance, dementia, and stroke; in the heart, hypoperfusion can result in angina, coronary syndromes, and debilitating heart failure. 4 Cardiac and cerebral small vessel diseases likely represent variations of the same systemic, pathologic process. Despite similarities in pathogenesis, divergent diagnostic and therapeutic approaches currently exist. In the current paper, we will discuss the parallels between cardiac and cerebral small vessel diseases and highlight the diagnostic magnetic

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“…These changes in MBV may be interrogated by stress T1-mapping, based on the principle that native T1 values are sensitive to tissue free water content and may thus detect changes in MBV during vasodilatory stress [ 10 ]. Previous studies have shown that adenosine stress T1-mapping on CMR can distinguish between normal, ischemic, infarcted, and remote myocardium, without the need for gadolinium-based contrast agents (GBCAs) [ 9 , [11] , [12] , [13] ].…”

Section: Introductionmentioning

confidence: 99%

Cardiovascular magnetic resonance stress and rest T1-mapping using regadenoson for detection of ischemic heart disease compared to healthy controls

Burrage

Shanmuganathan

Masi

et al. 2021

International Journal of Cardiology

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Background Adenosine stress T1-mapping on cardiovascular magnetic resonance (CMR) can differentiate between normal, ischemic, infarcted, and remote myocardial tissue classes without the need for contrast agents. Regadenoson, a selective coronary vasodilator, is often used in stress perfusion imaging when adenosine is contra-indicated, and has advantages in ease of administration, safety profile, and clinical workflow. We aimed to characterize the regadenoson stress T1-mapping response in healthy individuals, and to investigate its ability to differentiate between myocardial tissue classes in patients with coronary artery disease (CAD). Methods Eleven healthy controls and 25 patients with CAD underwent regadenoson stress perfusion CMR, as well as rest and stress ShMOLLI T1-mapping. Native T1 values and stress T1 reactivity were derived for normal myocardium in healthy controls and for different myocardial tissue classes in patients with CAD. Results Healthy controls had normal myocardial native T1 values at rest (931 ± 22 ms) with significant global regadenoson stress T1 reactivity (δT1 = 8.2 ± 0.8% relative to baseline; p < 0.0001). Infarcted myocardium had significantly higher resting T1 (1215 ± 115 ms) than ischemic, remote, and normal myocardium (all p < 0.0001) with an abolished stress T1 response (δT1 = −0.8% [IQR: −1.9–0.5]). Ischemic myocardium had elevated resting T1 compared to normal (964 ± 57 ms; p < 0.01) with an abolished stress T1 response (δT1 = 0.5 ± 1.6%). Remote myocardium in patients had comparable resting T1 to normal (949 ms [IQR: 915–973]; p = 0.06) with blunted stress reactivity (δT1 = 4.3% [IQR: 3.1–6.3]; p < 0.0001). Conclusions Healthy controls demonstrate significant stress T1 reactivity during regadenoson stress. Regadenoson stress and rest T1-mapping is a viable alternative to adenosine and exercise for the assessment of CAD and can distinguish between normal, ischemic, infarcted, and remote myocardium.

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Gadolinium-Free Cardiovascular Magnetic Resonance Stress T1 Mapping in Patients With Chronic Kidney Disease

Cited by 8 publications

References 2 publications

Right ventricular myocardial deoxygenation in patients with pulmonary artery hypertension

Right ventricular myocardial deoxygenation in patients with pulmonary artery hypertension

Pathophysiology, classification, and MRI parallels in microvascular disease of the heart and brain

Cardiovascular magnetic resonance stress and rest T1-mapping using regadenoson for detection of ischemic heart disease compared to healthy controls

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