Document Detail


Myocardial perfusion reserve in cardiovascular magnetic resonance: Correlation to coronary microvascular dysfunction.
MedLine Citation:
PMID:  17060099     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
The present study examined the association of myocardial perfusion reserve index (MPRI) in cardiovascular magnetic resonance (CMR) with coronary microvascular dysfunction (CMD) and serum levels of markers of inflammation or endothelial activation. Twelve patients with typical angina pectoris without coronary artery disease were enrolled in this study, and CMR perfusion was analyzed using a steady-state-free-precession sequence with 3 short axis slices per heartbeat during first pass of 0.025 mmol Gadolinium-DTPA/kg body weight. The upslope of myocardial signal intensity curves was used to calculate MPRI. CMD was assessed by intracoronary Doppler flow measurement and biplane angiography. Both MPRI and CMD were assessed during endothelium-independent stimulation with intravenous adenosine and during endothelium-dependent stimulation with intracoronary infusion of acetylcholine. Serum values of soluble CD40 ligand (sCD40L), interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-alpha), soluble intercellular adhesion molecule-1 (sICAM-1), and C-reactive protein (CRP) were measured. Impaired MPRI correlated significantly with a decrease in coronary blood flow reserve after both endothelium-dependent (p = 0.033) and endothelium-independent (p = 0.022) stimulation. Serum levels above the median of all normal ranged biomarkers sCD40L, TNF-alpha, IL-6, sICAM-1 and CRP were associated with an impaired MPRI for stimulation with adenosine as well as acetylcholine. In multivariable analyses, sCD40L (p < 0.001) and TNF-alpha (p = 0.011) were significantly associated with a decrease in MPRI on adenosine, as were TNF-alpha (p = 0.016) and sICAM-1 (p = 0.022) for a decrease in MPRI on acetylcholine. MPRI on adenosine significantly correlated with MPRI on acetylcholine (p < 0.001). Therefore, the present study demonstrates safety and feasibility of an intracoronary infusion of acetylcholine during CMR perfusion analysis, thus allowing direct assessment of endothelial dependent vasomotor function at the myocardial level by CMR. Furthermore, we show that an impaired myocardial perfusion reserved in CMR is associated with established biomarkers of early atherosclerosis and significantly correlated with CMD. CMR combined with adenosine could be proposed as a non-invasive tool to evaluate CMD.
Authors:
Jochen Wöhrle; Thorsten Nusser; Nico Merkle; Hans A Kestler; Olaf C Grebe; Nikolaus Marx; Martin Höher; Matthias Kochs; Vinzenz Hombach
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Journal of cardiovascular magnetic resonance : official journal of the Society for Cardiovascular Magnetic Resonance     Volume:  8     ISSN:  1097-6647     ISO Abbreviation:  J Cardiovasc Magn Reson     Publication Date:  2006  
Date Detail:
Created Date:  2006-10-24     Completed Date:  2007-02-08     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  9815616     Medline TA:  J Cardiovasc Magn Reson     Country:  United States    
Other Details:
Languages:  eng     Pagination:  781-7     Citation Subset:  IM    
Affiliation:
Department of Internal Medicine II, University of Ulm, Ulm, Germany. jochen.woehrle@uniklinik-ulm.de
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MeSH Terms
Descriptor/Qualifier:
Acetylcholine / diagnostic use
Adenosine / diagnostic use
Angina Pectoris / pathology
Blood Flow Velocity
C-Reactive Protein / analysis
CD40 Ligand / blood
Contrast Media
Coronary Angiography
Coronary Artery Disease / blood*,  pathology*,  physiopathology
Coronary Circulation*
Echocardiography
Feasibility Studies
Female
Gadolinium DTPA / diagnostic use
Humans
Intercellular Adhesion Molecule-1 / blood
Interleukin-6 / blood
Magnetic Resonance Imaging, Cine*
Male
Microcirculation
Middle Aged
Multivariate Analysis
Myocardium / pathology*
Tumor Necrosis Factor-alpha / blood
Vasodilator Agents / diagnostic use
Chemical
Reg. No./Substance:
0/Contrast Media; 0/Interleukin-6; 0/Tumor Necrosis Factor-alpha; 0/Vasodilator Agents; 126547-89-5/Intercellular Adhesion Molecule-1; 147205-72-9/CD40 Ligand; 51-84-3/Acetylcholine; 58-61-7/Adenosine; 80529-93-7/Gadolinium DTPA; 9007-41-4/C-Reactive Protein

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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