The Potential of Oxygenation-Sensitive CMR in Heart Failure

Hillier, Elizabeth; Friedrich, Matthias G.

doi:10.1007/s11897-021-00525-y

Cited by 10 publications

(9 citation statements)

References 103 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“… 13) Recently, the combined breathing maneuver has been utilized as a vasoactive stimulus in the accurate detection of reduced oxygenation in affected myocardium in patients with both ischemic and non-ischemic cardiomyopathy states. 14) 15) 16) 17) …”

Section: Introductionmentioning

confidence: 99%

Dynamic Cardiac Magnetic Resonance Fingerprinting During Vasoactive Breathing Maneuvers: First Results

Hopman

Hillier

Liu

et al. 2023

J Cardiovasc Imaging

Self Cite

View full text Add to dashboard Cite

BACKGROUND Cardiac magnetic resonance fingerprinting (cMRF) enables simultaneous mapping of myocardial T1 and T2 with very short acquisition times. Breathing maneuvers have been utilized as a vasoactive stress test to dynamically characterize myocardial tissue in vivo . We tested the feasibility of sequential, rapid cMRF acquisitions during breathing maneuvers to quantify myocardial T1 and T2 changes. METHODS We measured T1 and T2 values using conventional T1 and T2-mapping techniques (modified look locker inversion [MOLLI] and T2-prepared balanced-steady state free precession), and a 15 heartbeat (15-hb) and rapid 5-hb cMRF sequence in a phantom and in 9 healthy volunteers. The cMRF 5-hb sequence was also used to dynamically assess T1 and T2 changes over the course of a vasoactive combined breathing maneuver. RESULTS In healthy volunteers, the mean myocardial T1 of the different mapping methodologies were: MOLLI 1,224 ± 81 ms, cMRF 15-hb 1,359 ± 97 ms, and cMRF 5-hb 1,357 ± 76 ms. The mean myocardial T2 measured with the conventional mapping technique was 41.7 ± 6.7 ms, while for cMRF 15-hb 29.6 ± 5.8 ms and cMRF 5-hb 30.5 ± 5.8 ms. T2 was reduced with vasoconstriction (post-hyperventilation compared to a baseline resting state) (30.15 ± 1.53 ms vs. 27.99 ± 2.07 ms, p = 0.02), while T1 did not change with hyperventilation. During the vasodilatory breath-hold, no significant change of myocardial T1 and T2 was observed. CONCLUSIONS cMRF 5-hb enables simultaneous mapping of myocardial T1 and T2, and may be used to track dynamic changes of myocardial T1 and T2 during vasoactive combined breathing maneuvers.

show abstract

Section: Introductionmentioning

confidence: 99%

Dynamic Cardiac Magnetic Resonance Fingerprinting During Vasoactive Breathing Maneuvers: First Results

Hopman

Hillier

Liu

et al. 2023

J Cardiovasc Imaging

Self Cite

View full text Add to dashboard Cite

show abstract

“…In contrast, long breath-holds leading to an increase of CO 2 have been shown to increase myocardial perfusion and thereby myocardial oxygenation that can be quantified by a predictable increase in OS-CMR signal intensity. In coronary vascular dysfunction, this response is blunted [ 14 , 15 ]. Notably, previous results have demonstrated that preceding the long breath-hold with a period of hyperventilation leads to an increase in myocardial oxygenation that is at least as strong as that induced by intravenous adenosine [ 11 ].…”

Section: Introductionmentioning

confidence: 99%

The reproducibility of breathing maneuvers as a vasoactive stimulus in the heart: an oxygenation-sensitive resonance imaging study

Hillier,

Covone,

Friedrich

2023

Journal of Cardiovascular Magnetic Resonance

Self Cite

View full text Add to dashboard Cite

Background Endothelial dysfunction and impaired oxygenation of the heart is a hallmark of several diseases, including coronary artery disease, hypertension, diabetes, and sleep apnea. Recent studies indicate that oxygenation-sensitive cardiovascular magnetic resonance (OS-CMR) imaging combined with breathing maneuvers may allow for assessing coronary vascular responsiveness as a marker for coronary vascular function in various clinical settings. However, despite the use of OS-CMR in evaluating tissue oxygenation, the reproducibility of these standardized, combined breathing maneuvers as a vasoactive stimulus has yet to be systematically assessed or validated. In this study, we aimed to assess the reproducibility of vasoactive breathing maneuvers to assess vascular function in a population of healthy volunteers. Methods Eighteen healthy volunteers were recruited for the study. Inclusion criteria were an age over 18 years and absence of any evidence or knowledge of cardiovascular, neurological, or pulmonary disease. MRI was performed on a clinical 3 T MRI system (MAGNETOM Skyra, Siemens Healthineers, Erlangen, Germany). The OS-CMR acquisition was performed as previously described (1 min hyperventilation followed by a maximal, voluntary breath-hold). Standard statistical tests were performed as appropriate. Results Data from 18 healthy subjects was analyzed. The healthy volunteers had a mean age of 42 ± 15 years and a mean BMI of 25.4 ± 2.8 kg/m2, with an average heart rate of 72 ± 11 beats per minute, and ten of whom (56%) were female. There were no significant differences between global myocardial oxygenation (%$$\Delta$$ Δ SI) after hyperventilation (HV1: − 7.82 $$\pm$$ ± 5.2; HV2: − 7.89 $$\pm$$ ± 6.4, p = 0.9) or breath-hold (BH1: 5.34 $$\pm$$ ± 3.1; BH2: 6.0 $$\pm$$ ± 3.3, p = 0.5) between the repeated breathing maneuvers. The Bland–Altman analysis showed good agreement (bias: 0.074, SD of bias: 2.93). Conclusion We conclude that in healthy individuals, the myocardial oxygenation response to a standardized breathing maneuver with hyperventilation and a voluntary breath-hold is consistent and highly reproducible. These results corroborate previous evidence for breathing-enhanced OS-CMR as a robust test for coronary vascular function.

show abstract

“…Oxygenation-sensitive MRI with vasoactive breathing maneuvers offers a unique, noninvasive, needlefree methodology to quasisimultaneously investigate microvascular (endothelial) dysfunction in both the heart and brain of patients with HF. 20 It has been utilized in studies of macrovascular coronary artery disease 21 and microvascular dysfunction, in obstructive sleep apnea, 22 women with ischemia and no obstructive coronary artery disease, 23 postcardiac transplantation, 24 and in heart failure with preserved ejection fraction. 25 This study aims to assess the myocardial and cerebral oxygenation status in patients with HF and to correlate these findings to the cardiac and cognitive functional status.…”

mentioning

confidence: 99%

Microvascular Dysfunction as a Possible Link Between Heart Failure and Cognitive Dysfunction

Hillier,

Covone,

Fischer

et al. 2023

Circ: Heart Failure

Self Cite

View full text Add to dashboard Cite

Background: Microvascular function in the brain and heart may play an important role in the course of patients with heart failure (HF), but its relationship with ventricular and cognitive function is not well understood. We hypothesized that microvascular function in HF is closely related to both, cardiac and cognitive function. Methods: In healthy controls and symptomatic patients with HF (New York Heart Association functional class II or III), we used oxygenation-sensitive magnetic resonance imaging during a standardized breathing maneuver to determine the cerebral oxygenation reserve and the myocardial oxygenation reserve (MORE) as markers for microvascular function. A stepwise multivariable linear regression was performed to determine the variables that best predict changes in cerebral oxygenation reserve and MORE. We also measured cognitive function using the Montreal Cognitive Assessment test. Results: Twenty patients with HF (age 64.4±8.3 years; 50% female sex), and 21 healthy controls (age 55.0±5.1 years; 62% female sex) were included in the analysis. In patients with HF, cerebral oxygenation reserve and MORE were lower than in healthy controls (MORE, −0.1±3.3 versus 5.0±4.2, cerebral oxygenation reserve: 0.43±0.47 versus 1.21±0.60, respectively) as were Montreal Cognitive Assessment score results (HF, 23.9±3.7; healthy, 27.8±1.5; P =0.002). The Montreal Cognitive Assessment score in patients was correlated with cardiac output ( r =0.55, P =0.011) and MORE ( r =0.46, P =0.040). In addition to the presence of HF, significant predictors of cerebral and myocardial oxygenation reserve were cardiac output and end-diastolic volume, respectively. Conclusions: Our results indicate that heart failure is an independent predictor of coronary and cerebral microvascular dysfunction as defined by a reduced response to a vasodilatory breathing maneuver. This impaired response was associated with reduced cognitive function.

show abstract

The Potential of Oxygenation-Sensitive CMR in Heart Failure

Cited by 10 publications

References 103 publications

Dynamic Cardiac Magnetic Resonance Fingerprinting During Vasoactive Breathing Maneuvers: First Results

Dynamic Cardiac Magnetic Resonance Fingerprinting During Vasoactive Breathing Maneuvers: First Results

The reproducibility of breathing maneuvers as a vasoactive stimulus in the heart: an oxygenation-sensitive resonance imaging study

Microvascular Dysfunction as a Possible Link Between Heart Failure and Cognitive Dysfunction

Contact Info

Product

Resources

About