| Myocardial oxygenation in coronary artery disease: insights from blood oxygen level-dependent magnetic resonance imaging at 3 tesla. | |
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MedLine Citation:
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PMID: 22624835 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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. |
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Authors:
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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:
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Type: Comparative Study; Journal Article; Research Support, Non-U.S. Gov't |
Journal Detail:
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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:
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Created Date: 2012-05-25 Completed Date: 2012-07-31 Revised Date: 2013-01-20 |
Medline Journal Info:
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Nlm Unique ID: 8301365 Medline TA: J Am Coll Cardiol Country: United States |
Other Details:
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Languages: eng Pagination: 1954-64 Citation Subset: AIM; IM |
Copyright Information:
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Copyright © 2012 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved. |
Affiliation:
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University of Oxford Centre for Clinical Magnetic Resonance Research, John Radcliffe Hospital, Oxford, United Kingdom. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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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:
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//British Heart Foundation; //Medical Research Council |
| Chemical | |
Reg. No./Substance:
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7782-44-7/Oxygen |
| Comments/Corrections | |
Comment In:
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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 ] |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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