Assessment of Myocardial Ischemia Using Stress Perfusion Cardiovascular Magnetic Resonance

Abstract

Coronary artery disease (CAD) is a major cause of mortality and morbidity throughout the world, and its prevalence is expected to increase worldwide. Myocardial ischemia is a strong predictor of future adverse outcomes in patients with suspected CAD. The detection of ischemia is an important part of the diagnostic strategy for patients with suspected CAD. Stress myocardial perfusion cardiovascular magnetic resonance (CMR) is a noninvasive diagnostic approach for the detection of myocardial ischemia. CMR offers several advantages over single-photon emission computed tomography, such as high spatial resolution and no radiation exposure. Stress perfusion CMR offers high diagnostic performance for the detection of CAD and prognostic value in patients with suspected CAD. In this review, we describe how to perform stress perfusion CMR and interpret its findings. We also discuss recent updates concerning the diagnostic and prognostic value of stress perfusion CMR in patients with suspected CAD.

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

“…This is probably attributable to our protocol of relatively low ATP infusion rate (140 mcg/kg/ min) for 4 min. From the literature, ATP can be infused intravenously at 160 mcg/kg/min for 5 min [10,[12][13][14][15][16][17][18][19][20]22]. Karamitsos et al [4] found that age and reduced EF were the predictors of inadequate response.…”

“…There are also fewer side effects and lower costs with ATP infusion [14,15,20]. ATP has been documented to demonstrate the SSO sign, which is not present with the use of other pharmacological agents such as regadenoson [12,22]. One disadvantage for ATP infusion is the relatively long infusion time needed to achieve a pharmacological stress response compared with adenosine [22].…”

“…In a per-patient analysis, the sensitivity and specificity of perfusion CMR for the detection of functionally significant CAD were 95% and 91%, respectively, with respective positive and negative predictive values of 97% and 84%. Stress perfusion CMR can detect functionally significant CAD with excellent diagnostic accuracy [12].…”

“…ATP infusion rates in some centers have been set at 160 mcg/ kg/min for 5 min [10,[12][13][14][15][16][17][18][19][20]. The purpose of this retrospective study is to identify the proportion of patients with inadequate stress using a lower dose 140 mcg/kg/min protocol and to determine the factors related to inadequate stress in ATP stress CMR.…”

Utilidad de la Resonancia Magnética Cardíaca con Estrés Farmacológico para valorar Isquemia Miocárdica

“…Si no se logra el efecto vasodilatador (incremento de la frecuencia cardiaca al menos 10 lpm y/o disminución de la presión arterial sistólica al menos 10mmHg), se aumenta la infusión a 170 ug/kg/min durante 2 minutos más 8. Recientemente se ha propuesto un nuevo signo viabilidad (2C, 3C, 4C y eje corto), con el mismo número de cortes realizados para la función ventricular 19. (Figura 2)Valoración de la función ventricular izquierda y derechaSe realiza un análisis cualitativo que incluye la evaluación dinámica de la motilidad global y segmentaria del ventrículo izquierdo (VI) y un análisis cuantitativo que incluye el cálculo de volumen telediastólico y telesistólico de los ventrículos, fracción de eyección de ambos ventrículos, volumen sistólico, gasto cardíaco, masa del VI y valores indexados al área de superficie corporal de todos, excepto de la fracción de eyección.…”