Stress Perfusion Imaging Using Cardiovascular Magnetic Resonance: A Review

Christiansen, J.; Karamitsos, Theodoros D.; Myerson, Saul G.; Francis, Jane M; Neubauer, Stefan

doi:10.1016/j.hlc.2010.08.008

Cited by 10 publications

(6 citation statements)

References 70 publications

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“…In first-pass perfusion CMR, pharmacologic vasodilation (adenosine or dipyridamole) is used to induce hyperemia in myocardial areas subtended by normal coronary arteries, whereas no (or only minimal) change in blood flow is achieved in areas subtended by stenotic coronary arteries [12,13]. During the first pass of the gadolinium-based contrast such areas show lower peak enhancement with delayed uptake of the contrast and, thus, appear hypointense (dark) compared with adjacent normal myocardium [14].…”

Section: Myocardial Ischemiamentioning

confidence: 99%

Cardiovascular Magnetic Resonance in Heart Failure

Karamitsos

Neubauer

2011

Curr Cardiol Rep

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Imaging has a central role in the evaluation of patients with heart failure (HF). Cardiovascular magnetic resonance (CMR) is rapidly evolving as a versatile imaging modality that often provides additional information to echocardiography in patients with suspected or known HF. CMR is the only imaging modality that has the ability to assess, without exposure to ionizing radiation, cardiac function, structure (tissue characterization), perfusion, and viability. Moreover, magnetic resonance spectroscopy techniques can assess the pathophysiologic role of deranged cardiac energetics in HF. In this review we discuss the role of CMR in the evaluation of patients with HF giving particular emphasis to recent developments and the additional information that can be obtained with this imaging modality, over and above standard echocardiography.

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Section: Myocardial Ischemiamentioning

confidence: 99%

Cardiovascular Magnetic Resonance in Heart Failure

Karamitsos

Neubauer

2011

Curr Cardiol Rep

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Section: Current Techniques Of Myocardial Perfusion Imagingmentioning

confidence: 99%

“…The foundation of analysis and interpretation of stress perfusion MRI remains the visual qualitative approach by assessing delayed enhancement images, resulting in a sensitivity and specificity of 89% and 87%, respectively (29,30). Beyond the qualitative assessment of perfusion defects, (semi)quantitative measurement of myocardial perfusion with MRI has been widely used in research settings (29–33). The perfusion reserve index, defined as the ratio of the upslope of the time‐signal intensity curve at rest and stress and the upslope of the curve of the ventricular cavity, has been validated in animal studies and shows promising results in clinical trials (33–35).…”

Section: Current Techniques Of Myocardial Perfusion Imagingmentioning

confidence: 99%

Myocardial perfusion imaging by computed tomography: today and tomorrow

Marcus

Nikolaou

Theisen

et al. 2011

International Journal of Clinical Practice

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Summary Cardiac perfusion along with imaging of coronary artery stenosis is an important tool in assessing the degree of coronary artery disease (CAD) and decision‐making regarding further treatment. SPECT, PET, echocardiography and cardiac magnetic resonance imaging are clinically established techniques to evaluate myocardial perfusion and viability with a high diagnostic accuracy and relatively few unwanted side effects. However, none of these modalities Glose can reliably assess the extent and morphology of CAD, features which also have implications as well as for patient management. In contrast, cardiac CT has emerged over the last years as a reliable tool to visualise coronary atherosclerotic plaque and stenosis, nearly unaffected by heart rate and carrying a relatively low radiation exposure; however, without allowing an adequate assessment of myocardial perfusion. Given the great promise of a combined cardiac CT examination to assess morphology and function, much research has recently been focused on the development of CT‐based myocardial perfusion imaging techniques. In this article, we review recent developments in cardiac CT with respect to myocardial perfusion imaging, especially the two main techniques, first‐pass and dynamic CT acquisitions.

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“…Stress cardiovascular magnetic resonance (CMR) is a highly accurate, safe, and non-invasive method for diagnosis of coronary artery disease (CAD) and has been incorporated into guidelines for diagnosis of obstructive CAD [1][2][3][4][5][6]. Stress CMR is commonly performed using vasodilatory pharmacological stress agents such as adenosine or adenosine triphosphate (ATP) [7,8]. These adenosine-based compounds generate systemic vasodilatation and reflex sympatho excitation with a consequent decease in systolic blood pressure (SBP), increase in heart rate (HR), and modest increase in rate-pressure product [9,10].…”

Section: Introductionmentioning

confidence: 99%

Factors Determining Inadequate Stress Response to Adenosine Triphosphate in Perfusion Cardiovascular Magnetic Resonance

Cheng

Lam

et al. 2018

Cardiovasc Imaging Asia

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Adenosine triphosphate (ATP) is an established pharmacological agent for stress cardiovascular magnetic resonance (CMR) in the Asia Pacific region. Inadequate cardiac stress in a CMR study may lead to false-negative results. The aim of the present study is to identify the proportion of patients with inadequate stress using a 140 mcg/kg/min protocol and the factors for inadequate stress in ATP stress CMR. Materials and Methods: A retrospective analysis from January to December 2017 was performed. In total, 150 patients underwent ATP stress perfusion CMR at 1.5 tesla. All patients received ATP infusion of 140 mcg/kg/min for 4 min. Adequate stress was defined as two or more of the following criteria: 1) positive splenic switch off sign, 2) increased heart rate ≥10 bpm, and 3) drop in systolic blood pressure ≥10 mm Hg. Multivariable logistic regression analysis with forward and backward stepwise selection was used to identify predictors of inadequate response to ATP. Basic demographic variables with p-value ≤0.2 were examined for inclusion in the model. A p-value less than 0.05 was considered significant. Results: Fifty-six (37%) patients did not demonstrate adequate cardiac stress response. Non-responders to ATP more often had atrial fibrillation, higher indexed left ventricular end systolic volume, and lower ejection fraction. Multivariable logistic regression analysis showed that low body weight and male gender were consistent independent predictors of inadequate stress in all models. Conclusion: Inadequate stress occurred in 37% of subjects with ATP infusion of 140 mcg/kg/ min. Low body weight and male gender are independent predictors of inadequate response to ATP. Higher infusion rates of ATP should be considered in patients with inadequate stress.

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Stress Perfusion Imaging Using Cardiovascular Magnetic Resonance: A Review

Cited by 10 publications

References 70 publications

Cardiovascular Magnetic Resonance in Heart Failure

Cardiovascular Magnetic Resonance in Heart Failure

Myocardial perfusion imaging by computed tomography: today and tomorrow

Factors Determining Inadequate Stress Response to Adenosine Triphosphate in Perfusion Cardiovascular Magnetic Resonance

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