Document Detail


Myocardial oxygenation in coronary artery disease: insights from blood oxygen level-dependent magnetic resonance imaging at 3 tesla.
MedLine Citation:
PMID:  22624835     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: The purpose of this study was to assess the diagnostic accuracy of blood oxygen-level dependent (BOLD) MRI in suspected coronary artery disease (CAD).
BACKGROUND: By exploiting the paramagnetic properties of deoxyhemoglobin, BOLD magnetic resonance imaging can detect myocardial ischemia. We applied BOLD imaging and first-pass perfusion techniques to: 1) examine the pathophysiological relationship between coronary stenosis, perfusion, ventricular scar, and myocardial oxygenation; and 2) evaluate the diagnostic performance of BOLD imaging in the clinical setting.
METHODS: BOLD and first-pass perfusion images were acquired at rest and stress (4 to 5 min intravenous adenosine, 140 μg/kg/min) and assessed quantitatively (using a BOLD signal intensity index [stress/resting signal intensity], and absolute quantification of perfusion by model-independent deconvolution). A BOLD signal intensity index threshold to identify ischemic myocardium was first determined in a derivation arm (25 CAD patients and 20 healthy volunteers). To determine diagnostic performance, this was then applied in a separate group comprising 60 patients with suspected CAD referred for diagnostic angiography.
RESULTS: Prospective evaluation of BOLD imaging yielded an accuracy of 84%, a sensitivity of 92%, and a specificity of 72% for detecting myocardial ischemia and 86%, 92%, and 72%, respectively, for identifying significant coronary stenosis. Segment-based analysis revealed evidence of dissociation between oxygenation and perfusion (r = -0.26), with a weaker correlation of quantitative coronary angiography with myocardial oxygenation (r = -0.20) than with perfusion (r = -0.40; p = 0.005 for difference). Hypertension increased the odds of an abnormal BOLD response, but diabetes mellitus, hypercholesterolemia, and the presence of ventricular scar were not associated with significant deoxygenation.
CONCLUSIONS: BOLD imaging provides valuable insights into the pathophysiology of CAD; myocardial hypoperfusion is not necessarily commensurate with deoxygenation. In the clinical setting, BOLD imaging achieves favorable accuracy for identifying the anatomic and functional significance of CAD.
Authors:
Jayanth R Arnold; Theodoros D Karamitsos; Paul Bhamra-Ariza; Jane M Francis; Nick Searle; Matthew D Robson; Ruairidh K Howells; Robin P Choudhury; Ornella E Rimoldi; Paolo G Camici; Adrian P Banning; Stefan Neubauer; Michael Jerosch-Herold; Joseph B Selvanayagam
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Journal of the American College of Cardiology     Volume:  59     ISSN:  1558-3597     ISO Abbreviation:  J. Am. Coll. Cardiol.     Publication Date:  2012 May 
Date Detail:
Created Date:  2012-05-25     Completed Date:  2012-07-31     Revised Date:  2014-06-10    
Medline Journal Info:
Nlm Unique ID:  8301365     Medline TA:  J Am Coll Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1954-64     Citation Subset:  AIM; IM    
Copyright Information:
Copyright © 2012 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
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MeSH Terms
Descriptor/Qualifier:
Coronary Angiography
Coronary Artery Disease / diagnosis,  metabolism*,  physiopathology
Coronary Circulation / physiology*
Electrocardiography
Equipment Design
Female
Follow-Up Studies
Humans
Magnetic Resonance Imaging, Cine / instrumentation*
Male
Middle Aged
Myocardium / metabolism*,  pathology
Oximetry
Oxygen / blood*
Oxygen Consumption / physiology*
Prognosis
Regional Blood Flow
Reproducibility of Results
Severity of Illness Index
Grant Support
ID/Acronym/Agency:
088291//Wellcome Trust; 090532//Wellcome Trust; G0700796//Medical Research Council; G0900883//Medical Research Council; //British Heart Foundation; //Medical Research Council
Chemical
Reg. No./Substance:
S88TT14065/Oxygen
Comments/Corrections
Comment In:
J Am Coll Cardiol. 2012 May 29;59(22):1965-7   [PMID:  22624836 ]
J Am Coll Cardiol. 2012 Oct 30;60(18):1842-3; author reply 1843   [PMID:  23099217 ]

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