Relationship of vasodilator-induced changes in myocardial oxygenation with the severity of coronary artery stenosis: a study using oxygenation-sensitive cardiovascular magnetic resonance
To explore the impact of the functional severity of coronary artery stenosis on changes in myocardial oxygenation during pharmacological vasodilation, using oxygenation-sensitive cardiovascular magnetic resonance (OS-CMR) imaging and invasive fractional flow reserve (FFR). An FFR is considered a sta...
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| Veröffentlicht in: | European heart journal cardiovascular imaging 2014-12, Vol.15 (12), p.1358-1367 |
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| creator | Luu, Judy M Friedrich, Matthias G Harker, Jodi Dwyer, Nathan Guensch, Dominik Mikami, Yoko Faris, Peter Hare, James L |
| description | To explore the impact of the functional severity of coronary artery stenosis on changes in myocardial oxygenation during pharmacological vasodilation, using oxygenation-sensitive cardiovascular magnetic resonance (OS-CMR) imaging and invasive fractional flow reserve (FFR). An FFR is considered a standard of reference for assessing haemodynamic relevance of coronary artery stenosis; yet, the relationship of FFR to changes in myocardial oxygenation during vasodilator stress and thus to an objective marker for ischaemia on the tissue level is not well understood.
We prospectively recruited 64 patients with suspected/known coronary artery disease undergoing invasive angiography. The FFR was performed in intermediate coronary artery stenosis. OS-CMR images were acquired using a T2*-sensitive sequence before and after adenosine-induced vasodilation, with myocardial segments matched to angiography. Very strict image quality criteria were defined to ensure the validity of results. The FFR was performed in 37 patients. Because of the strict image quality criteria, 41% of segments had to be excluded, leaving 29/64 patients for the blinded OS-CMR analysis. Coronary territories with an associated FFR of |
| doi_str_mv | 10.1093/ehjci/jeu138 |
| format | Article |
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We prospectively recruited 64 patients with suspected/known coronary artery disease undergoing invasive angiography. The FFR was performed in intermediate coronary artery stenosis. OS-CMR images were acquired using a T2*-sensitive sequence before and after adenosine-induced vasodilation, with myocardial segments matched to angiography. Very strict image quality criteria were defined to ensure the validity of results. The FFR was performed in 37 patients. Because of the strict image quality criteria, 41% of segments had to be excluded, leaving 29/64 patients for the blinded OS-CMR analysis. Coronary territories with an associated FFR of <0.80 showed a lack of increase in myocardial oxygenation [mean signal intensity (ΔSI) -0.49%; 95% confidence interval (CI) -3.78 to 2.78 vs. +7.30%; 95% CI 4.08 to 10.64; P < 0.001]. An FFR of <0.54 best predicted a complete lack of a vasodilator-induced oxygenation increase (sensitivity 71% and specificity 75%). An OS-CMR ΔSI <4.78% identified an FFR of <0.8 with a sensitivity of 86% and specificity of 92%.
An FFR of <0.80 is associated with a lack of an adenosine-inducible increase in oxygenation of the dependent coronary territory, while a complete lack of such an increase was best predicted by an FFR of <0.54. Further studies are warranted to identify clinically meaningful cut-off values for FFR measurements and to assess the utility of OS-CMR as an alternative clinical tool for assessing the functional relevance of coronary artery stenosis.]]></description><identifier>ISSN: 2047-2404</identifier><identifier>EISSN: 2047-2412</identifier><identifier>DOI: 10.1093/ehjci/jeu138</identifier><identifier>PMID: 25104812</identifier><language>eng</language><publisher>England</publisher><subject>Adenosine ; Aged ; Coronary Stenosis - diagnosis ; Coronary Stenosis - physiopathology ; Female ; Fractional Flow Reserve, Myocardial ; Humans ; Magnetic Resonance Imaging, Cine - methods ; Male ; Middle Aged ; Predictive Value of Tests ; Prospective Studies ; Reproducibility of Results ; Sensitivity and Specificity ; Vasodilator Agents</subject><ispartof>European heart journal cardiovascular imaging, 2014-12, Vol.15 (12), p.1358-1367</ispartof><rights>Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2014. For permissions please email: journals.permissions@oup.com.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c221t-adc87dd17f1cb44934821f43068957adefb713d91b495763e7ba7270b5b422623</citedby><cites>FETCH-LOGICAL-c221t-adc87dd17f1cb44934821f43068957adefb713d91b495763e7ba7270b5b422623</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27903,27904</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/25104812$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Luu, Judy M</creatorcontrib><creatorcontrib>Friedrich, Matthias G</creatorcontrib><creatorcontrib>Harker, Jodi</creatorcontrib><creatorcontrib>Dwyer, Nathan</creatorcontrib><creatorcontrib>Guensch, Dominik</creatorcontrib><creatorcontrib>Mikami, Yoko</creatorcontrib><creatorcontrib>Faris, Peter</creatorcontrib><creatorcontrib>Hare, James L</creatorcontrib><title>Relationship of vasodilator-induced changes in myocardial oxygenation with the severity of coronary artery stenosis: a study using oxygenation-sensitive cardiovascular magnetic resonance</title><title>European heart journal cardiovascular imaging</title><addtitle>Eur Heart J Cardiovasc Imaging</addtitle><description><![CDATA[To explore the impact of the functional severity of coronary artery stenosis on changes in myocardial oxygenation during pharmacological vasodilation, using oxygenation-sensitive cardiovascular magnetic resonance (OS-CMR) imaging and invasive fractional flow reserve (FFR). An FFR is considered a standard of reference for assessing haemodynamic relevance of coronary artery stenosis; yet, the relationship of FFR to changes in myocardial oxygenation during vasodilator stress and thus to an objective marker for ischaemia on the tissue level is not well understood.
We prospectively recruited 64 patients with suspected/known coronary artery disease undergoing invasive angiography. The FFR was performed in intermediate coronary artery stenosis. OS-CMR images were acquired using a T2*-sensitive sequence before and after adenosine-induced vasodilation, with myocardial segments matched to angiography. Very strict image quality criteria were defined to ensure the validity of results. The FFR was performed in 37 patients. Because of the strict image quality criteria, 41% of segments had to be excluded, leaving 29/64 patients for the blinded OS-CMR analysis. Coronary territories with an associated FFR of <0.80 showed a lack of increase in myocardial oxygenation [mean signal intensity (ΔSI) -0.49%; 95% confidence interval (CI) -3.78 to 2.78 vs. +7.30%; 95% CI 4.08 to 10.64; P < 0.001]. An FFR of <0.54 best predicted a complete lack of a vasodilator-induced oxygenation increase (sensitivity 71% and specificity 75%). An OS-CMR ΔSI <4.78% identified an FFR of <0.8 with a sensitivity of 86% and specificity of 92%.
An FFR of <0.80 is associated with a lack of an adenosine-inducible increase in oxygenation of the dependent coronary territory, while a complete lack of such an increase was best predicted by an FFR of <0.54. Further studies are warranted to identify clinically meaningful cut-off values for FFR measurements and to assess the utility of OS-CMR as an alternative clinical tool for assessing the functional relevance of coronary artery stenosis.]]></description><subject>Adenosine</subject><subject>Aged</subject><subject>Coronary Stenosis - diagnosis</subject><subject>Coronary Stenosis - physiopathology</subject><subject>Female</subject><subject>Fractional Flow Reserve, Myocardial</subject><subject>Humans</subject><subject>Magnetic Resonance Imaging, Cine - methods</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Predictive Value of Tests</subject><subject>Prospective Studies</subject><subject>Reproducibility of Results</subject><subject>Sensitivity and Specificity</subject><subject>Vasodilator Agents</subject><issn>2047-2404</issn><issn>2047-2412</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2014</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpNkcFO3DAQhq2KqiDgxrnykUNTbMeJs9wqVGglJCRUzpFjTzZeJfbW42ybV-vTYXYpwpcZW5-_sfwTcsHZV85W5RUMG-OuNjDzsvlATgSTqhCSi6O3nsljco64YXlVspaCfyLHouJMNlyckH-PMOrkgsfBbWno6U5jsC6fhVg4b2cDlppB-zUgdZ5OSzA6WqdHGv4ua_D7y_SPSwNNA1CEHUSXlheVCTF4HReqY4JcMIEP6PCa6tzPdqEzOr9-LyoQPLrkdkD3Y0J-jplHHemk1x6SMzQCZqs3cEY-9npEOH-tp-Tp9vuvmx_F_cPdz5tv94URgqdCW9Moa7nquemkXJWyEbyXJaubVaW0hb5TvLQr3sm8r0tQnVZCsa7qpBC1KE_J5cG7jeH3DJjayaGBcdQewowtrzOtBG-qjH45oCYGxAh9u41uyl_Qcta-BNbuA2sPgWX886t57iawb_D_eMpnppqY6g</recordid><startdate>201412</startdate><enddate>201412</enddate><creator>Luu, Judy M</creator><creator>Friedrich, Matthias G</creator><creator>Harker, Jodi</creator><creator>Dwyer, Nathan</creator><creator>Guensch, Dominik</creator><creator>Mikami, Yoko</creator><creator>Faris, Peter</creator><creator>Hare, James L</creator><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>201412</creationdate><title>Relationship of vasodilator-induced changes in myocardial oxygenation with the severity of coronary artery stenosis: a study using oxygenation-sensitive cardiovascular magnetic resonance</title><author>Luu, Judy M ; Friedrich, Matthias G ; Harker, Jodi ; Dwyer, Nathan ; Guensch, Dominik ; Mikami, Yoko ; Faris, Peter ; Hare, James L</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c221t-adc87dd17f1cb44934821f43068957adefb713d91b495763e7ba7270b5b422623</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2014</creationdate><topic>Adenosine</topic><topic>Aged</topic><topic>Coronary Stenosis - diagnosis</topic><topic>Coronary Stenosis - physiopathology</topic><topic>Female</topic><topic>Fractional Flow Reserve, Myocardial</topic><topic>Humans</topic><topic>Magnetic Resonance Imaging, Cine - methods</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Predictive Value of Tests</topic><topic>Prospective Studies</topic><topic>Reproducibility of Results</topic><topic>Sensitivity and Specificity</topic><topic>Vasodilator Agents</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Luu, Judy M</creatorcontrib><creatorcontrib>Friedrich, Matthias G</creatorcontrib><creatorcontrib>Harker, Jodi</creatorcontrib><creatorcontrib>Dwyer, Nathan</creatorcontrib><creatorcontrib>Guensch, Dominik</creatorcontrib><creatorcontrib>Mikami, Yoko</creatorcontrib><creatorcontrib>Faris, Peter</creatorcontrib><creatorcontrib>Hare, James L</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>European heart journal cardiovascular imaging</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Luu, Judy M</au><au>Friedrich, Matthias G</au><au>Harker, Jodi</au><au>Dwyer, Nathan</au><au>Guensch, Dominik</au><au>Mikami, Yoko</au><au>Faris, Peter</au><au>Hare, James L</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Relationship of vasodilator-induced changes in myocardial oxygenation with the severity of coronary artery stenosis: a study using oxygenation-sensitive cardiovascular magnetic resonance</atitle><jtitle>European heart journal cardiovascular imaging</jtitle><addtitle>Eur Heart J Cardiovasc Imaging</addtitle><date>2014-12</date><risdate>2014</risdate><volume>15</volume><issue>12</issue><spage>1358</spage><epage>1367</epage><pages>1358-1367</pages><issn>2047-2404</issn><eissn>2047-2412</eissn><abstract><![CDATA[To explore the impact of the functional severity of coronary artery stenosis on changes in myocardial oxygenation during pharmacological vasodilation, using oxygenation-sensitive cardiovascular magnetic resonance (OS-CMR) imaging and invasive fractional flow reserve (FFR). An FFR is considered a standard of reference for assessing haemodynamic relevance of coronary artery stenosis; yet, the relationship of FFR to changes in myocardial oxygenation during vasodilator stress and thus to an objective marker for ischaemia on the tissue level is not well understood.
We prospectively recruited 64 patients with suspected/known coronary artery disease undergoing invasive angiography. The FFR was performed in intermediate coronary artery stenosis. OS-CMR images were acquired using a T2*-sensitive sequence before and after adenosine-induced vasodilation, with myocardial segments matched to angiography. Very strict image quality criteria were defined to ensure the validity of results. The FFR was performed in 37 patients. Because of the strict image quality criteria, 41% of segments had to be excluded, leaving 29/64 patients for the blinded OS-CMR analysis. Coronary territories with an associated FFR of <0.80 showed a lack of increase in myocardial oxygenation [mean signal intensity (ΔSI) -0.49%; 95% confidence interval (CI) -3.78 to 2.78 vs. +7.30%; 95% CI 4.08 to 10.64; P < 0.001]. An FFR of <0.54 best predicted a complete lack of a vasodilator-induced oxygenation increase (sensitivity 71% and specificity 75%). An OS-CMR ΔSI <4.78% identified an FFR of <0.8 with a sensitivity of 86% and specificity of 92%.
An FFR of <0.80 is associated with a lack of an adenosine-inducible increase in oxygenation of the dependent coronary territory, while a complete lack of such an increase was best predicted by an FFR of <0.54. Further studies are warranted to identify clinically meaningful cut-off values for FFR measurements and to assess the utility of OS-CMR as an alternative clinical tool for assessing the functional relevance of coronary artery stenosis.]]></abstract><cop>England</cop><pmid>25104812</pmid><doi>10.1093/ehjci/jeu138</doi><tpages>10</tpages></addata></record> |
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| source | MEDLINE; Oxford University Press Journals All Titles (1996-Current); Alma/SFX Local Collection |
| subjects | Adenosine Aged Coronary Stenosis - diagnosis Coronary Stenosis - physiopathology Female Fractional Flow Reserve, Myocardial Humans Magnetic Resonance Imaging, Cine - methods Male Middle Aged Predictive Value of Tests Prospective Studies Reproducibility of Results Sensitivity and Specificity Vasodilator Agents |
| title | Relationship of vasodilator-induced changes in myocardial oxygenation with the severity of coronary artery stenosis: a study using oxygenation-sensitive cardiovascular magnetic resonance |
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