Accelerated cardiac MR stress perfusion with radial sampling after physical exercise with an MR‐compatible supine bicycle ergometer

Pflugi, Silvio; Roujol, Sébastien; Akçakaya, Mehmet; Kawaji, Keigo; Foppa, Murilo; Heydari, Bobby; Goddu, Beth; Kissinger, Kraig V.; Berg, Sophie; Manning, Warren J.; Kozerke, Sebastian; Nezafat, Reza

doi:10.1002/mrm.25405

Cited by 21 publications

(24 citation statements)

References 57 publications

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“…Multiple measurements over a broader physiological range of cardiac work rates would be of major benefit for characterizing myocardial energy homeostasis. Indeed, successful implementation of more strenuous exercise regimens in clinical cardiac 1 H-MRI protocols has recently been reported (La Gerche et al, 2013 ; Pflugi et al, 2015 ; Roberts et al, 2015 ; Barber et al, 2016 ), with maximal heart rates during supine in-magnet bicycle exercise exceeding 160 beats min −1 (La Gerche et al, 2013 ). However, 31 P-MRS suffers from low sensitivity and poor measurement repeatability compared to 1 H-MRI, compromising a quantitative evaluation of potentially subtle changes in myocardial energy homeostasis.…”

Section: Introductionmentioning

confidence: 99%

Human Cardiac 31P-MR Spectroscopy at 3 Tesla Cannot Detect Failing Myocardial Energy Homeostasis during Exercise

et al. 2017

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Phosphorus-31 magnetic resonance spectroscopy (31P-MRS) is a unique non-invasive imaging modality for probing in vivo high-energy phosphate metabolism in the human heart. We investigated whether current 31P-MRS methodology would allow for clinical applications to detect exercise-induced changes in (patho-)physiological myocardial energy metabolism. Hereto, measurement variability and repeatability of three commonly used localized 31P-MRS methods [3D image-selected in vivo spectroscopy (ISIS) and 1D ISIS with 1D chemical shift imaging (CSI) oriented either perpendicular or parallel to the surface coil] to quantify the myocardial phosphocreatine (PCr) to adenosine triphosphate (ATP) ratio in healthy humans (n = 8) at rest were determined on a clinical 3 Tesla MR system. Numerical simulations of myocardial energy homeostasis in response to increased cardiac work rates were performed using a biophysical model of myocardial oxidative metabolism. Hypertrophic cardiomyopathy was modeled by either inefficient sarcomere ATP utilization or decreased mitochondrial ATP synthesis. The effect of creatine depletion on myocardial energy homeostasis was explored for both conditions. The mean in vivo myocardial PCr/ATP ratio measured with 3D ISIS was 1.57 ± 0.17 with a large repeatability coefficient of 40.4%. For 1D CSI in a 1D ISIS-selected slice perpendicular to the surface coil, the PCr/ATP ratio was 2.78 ± 0.50 (repeatability 42.5%). With 1D CSI in a 1D ISIS-selected slice parallel to the surface coil, the PCr/ATP ratio was 1.70 ± 0.56 (repeatability 43.7%). The model predicted a PCr/ATP ratio reduction of only 10% at the maximal cardiac work rate in normal myocardium. Hypertrophic cardiomyopathy led to lower PCr/ATP ratios for high cardiac work rates, which was exacerbated by creatine depletion. Simulations illustrated that when conducting cardiac 31P-MRS exercise stress testing with large measurement error margins, results obtained under pathophysiologic conditions may still lie well within the 95% confidence interval of normal myocardial PCr/ATP dynamics. Current measurement precision of localized 31P-MRS for quantification of the myocardial PCr/ATP ratio precludes the detection of the changes predicted by computational modeling. This hampers clinical employment of 31P-MRS for diagnostic testing and risk stratification, and warrants developments in cardiac 31P-MRS exercise stress testing methodology.

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Section: Introductionmentioning

confidence: 99%

Human Cardiac 31P-MR Spectroscopy at 3 Tesla Cannot Detect Failing Myocardial Energy Homeostasis during Exercise

et al. 2017

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“…Informed consent was gained from all patients undergoing contrast‐enhanced MRI for clinical referrals, with permission granted by the organization's ethics committee for performing these scans at rest. To simulate potential increased breathing motion during stress imaging (for example, as for hyperpnoea associated with adenosine or post physical exercise ), an attempt was made to intensify the volunteers' breathing motion. Therefore, the volunteers were asked to use a “slow and deep” breathing motion throughout the acquisition process, and this instruction was repeated for both the MFP and FPP scans.…”

Section: Methodsmentioning

confidence: 99%

Improved dynamic parallel imaging coil calibration method robust to respiratory motion with application to first‐pass contrast‐enhanced myocardial perfusion imaging

Fair

Gatehouse

Drivas

et al. 2015

Magnetic Resonance in Med

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“…The most useful technique for the assessment of stable CAD is stress CMR. Although there have been reports of exercise stress, 41 , 42 stress CMR is traditionally performed using pharmacological stress. Both vasodilator (typically using adenosine or regadenoson) and dobutamine stress have been used.…”

Section: Cmrmentioning

confidence: 99%

Efficacy of noninvasive cardiac imaging tests in diagnosis and management of stable coronary artery disease

Mordi¹,

Badar²,

Irving³

et al. 2017

VHRM

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The aim of this review was to discuss the current literature regarding the utility of noninvasive imaging in diagnosis and management of stable coronary artery disease (CAD) including recent data from large randomized trials assessing diagnosis and prognosis. Current guidelines recommend revascularization in patients with refractory angina and in those with potential prognostic benefit. Appropriate risk stratification through noninvasive assessment is important in ensuring patients are not exposed to unnecessary invasive coronary angiograms. The past 20 years have seen an unprecedented expansion in noninvasive imaging modalities for the assessment of stable CAD, with cardiovascular magnetic resonance and computed tomography complementing established techniques such as myocardial perfusion imaging, echocardiography and exercise electrocardiogram. In this review, we examine the current state-of-the-art in noninvasive imaging to provide an up-to-date analysis of current investigation and management options.

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Accelerated cardiac MR stress perfusion with radial sampling after physical exercise with an MR‐compatible supine bicycle ergometer

Cited by 21 publications

References 57 publications

Human Cardiac 31P-MR Spectroscopy at 3 Tesla Cannot Detect Failing Myocardial Energy Homeostasis during Exercise

Human Cardiac 31P-MR Spectroscopy at 3 Tesla Cannot Detect Failing Myocardial Energy Homeostasis during Exercise

Improved dynamic parallel imaging coil calibration method robust to respiratory motion with application to first‐pass contrast‐enhanced myocardial perfusion imaging

Efficacy of noninvasive cardiac imaging tests in diagnosis and management of stable coronary artery disease

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