Myocardial Oxygenation in Coronary Artery Disease: Insights From Blood Oxygen Level–Dependent Magnetic Resonance Imaging at 3 Tesla

 
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2012 (EN)
Myocardial Oxygenation in Coronary Artery Disease: Insights From Blood Oxygen Level–Dependent Magnetic Resonance Imaging at 3 Tesla

Rimoldi, Ornella E.
Searle, Nick
Selvanayagam, Joseph B.
Jerosch-Herold, Michael
Howells, Ruairidh K.
Neubauer, Stefan
Camici, Paolo G.
Arnold, Jayanth R.
Karamitsos, Theodoros
Francis, Jane M.
Robson, Matthew D.
Bhamra-Ariza, Paul
Banning, Adrian P.
Choudhury, Robin P.

OBJECTIVES: The purpose of this study was to assess the diagnostic accuracy of blood oxygen-level dependent (BOLD) MRI in suspected coronary artery disease (CAD). BACKGROUND: By exploiting the paramagnetic properties of deoxyhemoglobin, BOLD magnetic resonance imaging can detect myocardial ischemia. We applied BOLD imaging and first-pass perfusion techniques to: 1) examine the pathophysiological relationship between coronary stenosis, perfusion, ventricular scar, and myocardial oxygenation; and 2) evaluate the diagnostic performance of BOLD imaging in the clinical setting. METHODS: BOLD and first-pass perfusion images were acquired at rest and stress (4 to 5 min intravenous adenosine, 140 μg/kg/min) and assessed quantitatively (using a BOLD signal intensity index [stress/resting signal intensity], and absolute quantification of perfusion by model-independent deconvolution). A BOLD signal intensity index threshold to identify ischemic myocardium was first determined in a derivation arm (25 CAD patients and 20 healthy volunteers). To determine diagnostic performance, this was then applied in a separate group comprising 60 patients with suspected CAD referred for diagnostic angiography. RESULTS: Prospective evaluation of BOLD imaging yielded an accuracy of 84%, a sensitivity of 92%, and a specificity of 72% for detecting myocardial ischemia and 86%, 92%, and 72%, respectively, for identifying significant coronary stenosis. Segment-based analysis revealed evidence of dissociation between oxygenation and perfusion (r = -0.26), with a weaker correlation of quantitative coronary angiography with myocardial oxygenation (r = -0.20) than with perfusion (r = -0.40; p = 0.005 for difference). Hypertension increased the odds of an abnormal BOLD response, but diabetes mellitus, hypercholesterolemia, and the presence of ventricular scar were not associated with significant deoxygenation. CONCLUSIONS: BOLD imaging provides valuable insights into the pathophysiology of CAD; myocardial hypoperfusion is not necessarily commensurate with deoxygenation. In the clinical setting, BOLD imaging achieves favorable accuracy for identifying the anatomic and functional significance of CAD. Copyright © 2012 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Article / Άρθρο
info:eu-repo/semantics/article

Αριστοτέλειο Πανεπιστήμιο Θεσσαλονίκης (EL)
Aristotle University of Thessaloniki (EN)

English

2012
2016-10-11T08:32:57Z


Αριστοτέλειο Πανεπιστήμιο Θεσσαλονίκης, Σχολή Επιστημών Υγείας, Τμήμα Ιατρικής

urn:ISSN:07351097
Journal of the American College of Cardiology, vol.59 no.22 [2012] p.1954-1964

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