CMR First-Pass Perfusion for Suspected Inducible Myocardial Ischemia

Hendel, Robert C.; Friedrich, Matthias G.; Schulz‐Menger, Jeanette; Zemmrich, Claudia; Bengel, Frank M.; Berman, Daniel S.; Camici, Paolo G.; Flamm, Scott D.; Guludec, Dominique Le; Kim, Woojin; Lombardi, Massimo; Mahmarian, John J.; Sechtem, Udo; Nagel, Eike

doi:10.1016/j.jcmg.2016.09.010

Cited by 59 publications

(47 citation statements)

References 59 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…More sophisticated tools for aetiological workup include CMR which is most accurate for determining LA and LV volumes and mass, 270 detects scar and myocardial ischaemia due to epicardial coronary disease or microvascular dysfunction, 65 and stress perfusion imaging to reveal diffuse subendocardial defects. Regional and diffuse myocardial oedema (T2‐imaging) and infiltration or fibrosis are quantified using late gadolinium enhancement [LGE; for extracellular volume fraction (ECV)] or T1‐mapping 137 , 267 , 271–274 (online supplementary Appendix ).…”

Section: Calculating and Interpreting The Hfa–peff Scorementioning

confidence: 99%

“…These findings can immediately translate into management strategies, such as anti-ischaemic therapy, improved blood pressure control, removal of bradycardic agents (such as beta-blockers often prescribed for hypertension), and control of exercise-induced cardiac arrhythmias. More sophisticated tools for aetiological workup include CMR which is most accurate for determining LA and LV volumes and mass, 270 detects scar and myocardial ischaemia due to epicardial coronary disease or microvascular dysfunction, 65 and stress perfusion imaging to reveal diffuse subendocardial defects. Regional and diffuse myocardial oedema (T2-imaging) and infiltration or fibrosis are quantified using late gadolinium enhancement [LGE; for extracellular volume fraction (ECV)] or T1-mapping 137,267,[271][272][273][274] (online supplementary Appendix S1).…”

Section: Step 4(f 2 ): Final Aetiologymentioning

confidence: 99%

See 1 more Smart Citation

How to diagnose heart failure with preserved ejection fraction: the HFA–PEFF diagnostic algorithm: a consensus recommendation from the Heart Failure Association (HFA) of the European Society of Cardiology (ESC)

Pieske

Tschöpe

Boer

et al. 2020

European J of Heart Fail

Self Cite

418

643

View full text Add to dashboard Cite

Making a firm diagnosis of chronic heart failure with preserved ejection fraction (HFpEF) remains a challenge. We recommend a new stepwise diagnostic process, the ‘HFA–PEFF diagnostic algorithm’. Step 1 (P=Pre‐test assessment) is typically performed in the ambulatory setting and includes assessment for heart failure symptoms and signs, typical clinical demographics (obesity, hypertension, diabetes mellitus, elderly, atrial fibrillation), and diagnostic laboratory tests, electrocardiogram, and echocardiography. In the absence of overt non‐cardiac causes of breathlessness, HFpEF can be suspected if there is a normal left ventricular (LV) ejection fraction, no significant heart valve disease or cardiac ischaemia, and at least one typical risk factor. Elevated natriuretic peptides support, but normal levels do not exclude a diagnosis of HFpEF. The second step (E: Echocardiography and Natriuretic Peptide Score) requires comprehensive echocardiography and is typically performed by a cardiologist. Measures include mitral annular early diastolic velocity (e′), LV filling pressure estimated using E/e′, left atrial volume index, LV mass index, LV relative wall thickness, tricuspid regurgitation velocity, LV global longitudinal systolic strain, and serum natriuretic peptide levels. Major (2 points) and Minor (1 point) criteria were defined from these measures. A score ≥5 points implies definite HFpEF; ≤1 point makes HFpEF unlikely. An intermediate score (2–4 points) implies diagnostic uncertainty, in which case Step 3 (F1: Functional testing) is recommended with echocardiographic or invasive haemodynamic exercise stress tests. Step 4 (F2: Final aetiology) is recommended to establish a possible specific cause of HFpEF or alternative explanations. Further research is needed for a better classification of HFpEF.

show abstract

Section: Calculating and Interpreting The Hfa–peff Scorementioning

confidence: 99%

Section: Step 4(f 2 ): Final Aetiologymentioning

confidence: 99%

How to diagnose heart failure with preserved ejection fraction: the HFA–PEFF diagnostic algorithm: a consensus recommendation from the Heart Failure Association (HFA) of the European Society of Cardiology (ESC)

Pieske

Tschöpe

Boer

et al. 2020

European J of Heart Fail

Self Cite

418

643

View full text Add to dashboard Cite

show abstract

“…To increase the sensitivity and specificity of detecting perfusion defects, imaging under pharmacologically induced stress is performed, followed by an optional measurement under rest condition [2]. In a clinical setting, stress is typically induced by administration of adenosine [3] or dobutamine [4].…”

Section: Introductionmentioning

confidence: 99%

Hyperpolarized 13C urea myocardial first-pass perfusion imaging using velocity-selective excitation

Füetterer

Busch

Peereboom

et al. 2016

Journal of Cardiovascular Magnetic Resonance

View full text Add to dashboard Cite

BackgroundA velocity-selective binomial excitation scheme for myocardial first-pass perfusion measurements with hyperpolarized 13C substrates, which preserves bolus magnetization inside the blood pool, is presented. The proposed method is evaluated against gadolinium-enhanced 1H measurements in-vivo.MethodsThe proposed excitation with an echo-planar imaging readout was implemented on a clinical CMR system. Dynamic myocardial stress perfusion images were acquired in six healthy pigs after bolus injection of hyperpolarized 13C urea with the velocity-selective vs. conventional excitation, as well as standard 1H gadolinium-enhanced images. Signal-to-noise, contrast-to-noise (CNR) and homogeneity of semi-quantitative perfusion measures were compared between methods based on first-pass signal-intensity time curves extracted from a mid-ventricular slice. Diagnostic feasibility is demonstrated in a case of septal infarction.ResultsVelocity-selective excitation provides over three-fold reduction in blood pool signal with a two-fold increase in myocardial CNR. Extracted first-pass perfusion curves reveal a significantly reduced variability of semi-quantitative first-pass perfusion measures (12–20%) for velocity-selective excitation compared to conventional excitation (28–93%), comparable to that of reference 1H gadolinium data (9–15%). Overall image quality appears comparable between the velocity-selective hyperpolarized and gadolinium-enhanced imaging.ConclusionThe feasibility of hyperpolarized 13C first-pass perfusion CMR has been demonstrated in swine. Comparison with reference 1H gadolinium data revealed sufficient data quality and indicates the potential of hyperpolarized perfusion imaging for human applications.Electronic supplementary materialThe online version of this article (doi:10.1186/s12968-017-0364-4) contains supplementary material, which is available to authorized users.

show abstract

“…Relatively recently, perfusion -CMR has become a top imaging modality for the assessment of myocardial perfusion. 3 Myocardial perfusion CMR technique with adenosine-or regadenosone -induced hyperemia is a highly accurate and standardized method to detect significant CAD. 1,[3][4][5][6][7][8] This CMR technique is based on tracking the first pass of an intravenous bolus of gadolinium -based contrast agent (GBCA) as it circulates through the myocardium during pharmacologically obtained maximal vasodilation (stress perfusion).…”

mentioning

confidence: 99%

“…3 Myocardial perfusion CMR technique with adenosine-or regadenosone -induced hyperemia is a highly accurate and standardized method to detect significant CAD. 1,[3][4][5][6][7][8] This CMR technique is based on tracking the first pass of an intravenous bolus of gadolinium -based contrast agent (GBCA) as it circulates through the myocardium during pharmacologically obtained maximal vasodilation (stress perfusion). In the presence of a hemodynamically significant coronary lesion, myocardial hypoperfusion is observed as a subendocardial, or less frequently, as transmural, Introduction According to the 2019 European Society of Cardiology (ESC) guidelines, stable chest pain is one of the 6 most frequently encountered clinical scenarios of chronic coronary syndromes (CCS).…”

mentioning

confidence: 99%

Perfusion cardiovascular magnetic resonance as the first-line technique in patients with stable chest pain

Gawor¹,

Nagel

2020

Kardiol Pol

Self Cite

View full text Add to dashboard Cite

Perfusion imaging with cardiovascular magnetic resonance is a noninvasive test free of ionizing radiation recommended by the latest European Society of Cardiology guidelines as one of the functional tests for coronary artery disease (CAD) detection. It has been demonstrated in numerous studies that perfusion imaging with cardiovascular magnetic resonance is highly accurate, provide strong prognostic data, and reduce the number of unnecessary invasive angiographies in patients with stable chest pain. Implementation of this method as the first-line technique in patients with stable chest pain provides an important refinement of the current concept for the assessment of CAD and in a unique way extends the diagnostic workup beyond simply ruling in or out myocardial ischemia.

show abstract

CMR First-Pass Perfusion for Suspected Inducible Myocardial Ischemia

Cited by 59 publications

References 59 publications

How to diagnose heart failure with preserved ejection fraction: the HFA–PEFF diagnostic algorithm: a consensus recommendation from the Heart Failure Association (HFA) of the European Society of Cardiology (ESC)

How to diagnose heart failure with preserved ejection fraction: the HFA–PEFF diagnostic algorithm: a consensus recommendation from the Heart Failure Association (HFA) of the European Society of Cardiology (ESC)

Hyperpolarized 13C urea myocardial first-pass perfusion imaging using velocity-selective excitation

Perfusion cardiovascular magnetic resonance as the first-line technique in patients with stable chest pain

Contact Info

Product

Resources

About