Influence of Left Ventricular Hypertrophy and Geometry on Diagnostic Accuracy of Wall Motion and Perfusion Magnetic Resonance During Dobutamine Stress

Gebker, Rolf; Mirelis, Jesus G; Jahnke, Cosima; Hucko, Thomas; Manka, Robert; Hamdan, Ashraf; Schnackenburg, Bernhard; Fleck, Eckart; Paetsch, Ingo

doi:10.1161/circimaging.109.923672

Cited by 23 publications

(17 citation statements)

References 30 publications

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“…Hereby, increase in regional hypoenhancement during adenosine or dypiridamole stress (≥25% increase in hypoenhancement transmurality compared to baseline scans) in at least one myocardial segment, which persists for ≥5 consecutive image frames, is considered as indicative of inducible ischemia (Korosoglou et al, 2010b). Several studies also demonstrated the value of myocardial perfusion assessment during high dose dobutamine stress CMR for the detection of CAD, particularly in patients with left ventricular hypertrophy and concentric remodeling (Gebker et al, 2008, 2010). Recently, fully quantitative stress perfusion CMR was shown to exhibit higher precision for the detection of obstructive CAD (≥70% stenosis) compared to semi-quantitative and visual assessment (Mordini et al, 2014).…”

Section: Cardiac Magnetic Resonance Imagingmentioning

confidence: 99%

Cardiac magnetic resonance and computed tomography angiography for clinical imaging of stable coronary artery disease. Diagnostic classification and risk stratification

et al. 2014

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Despite advances in the pharmacologic and interventional treatment of coronary artery disease (CAD), atherosclerosis remains the leading cause of death in Western societies. X-ray coronary angiography has been the modality of choice for diagnosing the presence and extent of CAD. However, this technique is invasive and provides limited information on the composition of atherosclerotic plaque. Coronary computed tomography angiography (CCTA) and cardiac magnetic resonance (CMR) have emerged as promising non-invasive techniques for the clinical imaging of CAD. Hereby, CCTA allows for visualization of coronary calcification, lumen narrowing and atherosclerotic plaque composition. In this regard, data from the CONFIRM Registry recently demonstrated that both atherosclerotic plaque burden and lumen narrowing exhibit incremental value for the prediction of future cardiac events. However, due to technical limitations with CCTA, resulting in false positive or negative results in the presence of severe calcification or motion artifacts, this technique cannot entirely replace invasive angiography at the present time. CMR on the other hand, provides accurate assessment of the myocardial function due to its high spatial and temporal resolution and intrinsic blood-to-tissue contrast. Hereby, regional wall motion and perfusion abnormalities, during dobutamine or vasodilator stress, precede the development of ST-segment depression and anginal symptoms enabling the detection of functionally significant CAD. While CT generally offers better spatial resolution, the versatility of CMR can provide information on myocardial function, perfusion, and viability, all without ionizing radiation for the patients. Technical developments with these 2 non-invasive imaging tools and their current implementation in the clinical imaging of CAD will be presented and discussed herein.

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Section: Cardiac Magnetic Resonance Imagingmentioning

confidence: 99%

Cardiac magnetic resonance and computed tomography angiography for clinical imaging of stable coronary artery disease. Diagnostic classification and risk stratification

et al. 2014

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“…Potential influences of the LV geometry, in particular hypertrophy, have to be taken into account [2,24,31]. Adenosine stress perfusion magnetic resonance imaging is often used to detect hypoperfused areas and myocardial ischemia.…”

Section: How To Diagnose the Cardiac Phenotype Of Diabetic Cardiomyopmentioning

confidence: 99%

Diabetic cardiomyopathy—fact or fiction?

Maisch

Alter

Pankuweit

2011

Herz

141

139

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Epidemiologic as well as clinical studies confirm the close link between diabetes mellitus and heart failure. Diabetic cardiomyopathy (DCM) is still a poorly understood "entity", however, with several contributing pathogenetic factors which lead in different stages of diabetes to characteristic clinical phenotypes. Hyperglycemia with a shift from glucose metabolism to increased beta-oxidation and consecutive free fatty acid damage (lipotoxicity) to the myocardium, insulin resistance, renin-angiotensin-aldosterone system (RAAS) activation, altered calcium homeostasis and structural changes from the natural collagen network to a stiffer matrix due to advanced glycation endproduct (AGE) formation, hypertrophy and fibrosis contribute to the respective clinical phenotypes of DCM. We propose the following classification of cardiomyopathy in diabetic patients: a) Diastolic heart failure with normal ejection fraction (HFNEF) in diabetic patients often associated with hypertrophy without relevant hypertension. Relevant coronary artery disease (CAD), valvular disease and uncontrolled hypertension are not present. This is referred to as stage 1 DCM. b) Systolic and diastolic heart failure with dilatation and reduced ejection (HFREF) in diabetic patients excluding relevant CAD, valvular disease and uncontrolled hypertension as stage 2 DCM. c) Systolic and/or diastolic heart failure in diabetic patients with small vessel disease (microvascular disease) and/or microbial infection and/or inflammation and/or hypertension but without CAD as stage 3 DCM. d) If heart failure may also be attributed to infarction or ischemia and remodeling in addition to stage 3 DCM the term should be heart failure in diabetes or stage 4 DCM. These clinical phenotypes of diabetic cardiomyopathy can be separated by biomarkers, non-invasive (echocardiography, cardiac magnetic resonance imaging) and invasive imaging methods (levocardiography, coronary angiography) and further analysed by endomyocardial biopsy for concomitant viral infection. The role of specific diabetic drivers to the clinical phenotypes, to macro- and microangiopathy as well as accompanying risk factors or confounders, e.g. hypertension, autoimmune factors or inflammation with or without viral persistence, need to be identified in each individual patient separately. Thus hyperglycemia, hyperinsulinemia and insulin resistance as well as lipotoxicity by free fatty acids (FFAs) are the factors responsible for diabetic cardiomyopathy. In stage 1 and 2 DCM diabetic cardiomyopathy is clearly a fact. However, precise determination of to what degree the various underlying pathogenetic processes are responsible for the overall heart failure phenotype remains a fiction.

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“…The imaging methodology has been described before [8]. In brief, cardiac standard geometries (three short axis views and a four-, two-and threechamber view) were acquired at rest and during each dobutamine stress level according to standard procedure [9].…”

Section: Mr Imagingmentioning

confidence: 99%

“…During maximum dobutamine-atropine stress additional perfusion imaging using identical geometry as the cine short axis views was performed using an intravenous bolus of 0.1 mmol/kg Gd-DTPA (Magnevist Ò , Bayer, Berlin, Germany), injection rate 4 ml/s, followed by a saline flush of 20 ml at the same rate. A single dose of Gd-DTPA was used for perfusion imaging in order to optimize for visual analysis [8]. A second injection of 0.1 mmol/kg Gd-DTPA was applied immediately after DSMR-perfusion without data acquisition to complete double dose for delayed enhancement imaging.…”

Section: Mr Imagingmentioning

confidence: 99%

Value of additional myocardial perfusion imaging during dobutamine stress magnetic resonance for the assessment of intermediate coronary artery disease

Gebker

Frick

Jahnke

et al. 2010

Int J Cardiovasc Imaging

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This study was performed to assess the role of additional myocardial perfusion imaging during high dose dobutamine/atropine stress magnetic resonance (DSMR-wall motion) for the evaluation of patients with intermediate (50-70%) coronary artery stenosis. Routine DSMR-wall motion was combined with perfusion imaging (DSMR-perfusion) in 174 consecutive patients with chest pain syndromes who were scheduled for a clinically indicated coronary angiography. When defining CAD as the presence of a ≥ 50% stenosis, the addition of perfusion imaging improved sensitivity (90 vs. 79%, P < 0.001) with a non-significant reduction in specificity (85 vs. 90%, P = 0.13) and an improvement in overall diagnostic accuracy (88 vs. 84%, P = 0.008). Adding perfusion imaging improved sensitivity in patients with intermediate stenosis (87 vs. 72%, P = 0.03), but not in patients with severe (≥70%) stenosis (93 vs. 84%, P = 0.06). In patients with severe stenosis specificity of DSMR-perfusion versus DSMR-wall motion decreased (61 vs 70%, P = 0.001) resulting in a lower overall accuracy (71 vs 74%, P = 0.03). Using a cutoff of ≥50% for the definition of CAD, sensitivity of DSMR-perfusion compared to DSMR-wall motion was significantly higher in patients with single vessel (88 vs. 77%, P = 0.03) and multi vessel disease (93 vs. 79%, P = 0.03), whereas no significant differences were found using a cutoff of ≥70% stenosis for the definition of CAD. The addition of perfusion imaging during DSMR-wall motion improved the sensitivity in patients with intermediate coronary artery stenosis. Overall diagnostic accuracy increased only when defining CAD as ≥50% stenosis. In patients with ≥70% stenosis DSMR-wall motion alone had higher accuracy due to more false-positive cases with DSMR-perfusion.

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Influence of Left Ventricular Hypertrophy and Geometry on Diagnostic Accuracy of Wall Motion and Perfusion Magnetic Resonance During Dobutamine Stress

Cited by 23 publications

References 30 publications

Cardiac magnetic resonance and computed tomography angiography for clinical imaging of stable coronary artery disease. Diagnostic classification and risk stratification

Cardiac magnetic resonance and computed tomography angiography for clinical imaging of stable coronary artery disease. Diagnostic classification and risk stratification

Diabetic cardiomyopathy—fact or fiction?

Value of additional myocardial perfusion imaging during dobutamine stress magnetic resonance for the assessment of intermediate coronary artery disease

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