Feasibility of cardiovascular magnetic resonance to detect oxygenation deficits in patients with multi-vessel coronary artery disease triggered by breathing maneuvers
Abstract Background Hyperventilation with a subsequent breath-hold has been successfully used as a non-pharmacological vasoactive stimulus to induce changes in myocardial oxygenation. The purpose of this pilot study was to assess if this maneuver is feasible in patients with multi-vessel coronary ar...
| Main Authors: | , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2018-05-01
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| Series: | Journal of Cardiovascular Magnetic Resonance |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s12968-018-0446-y |
| _version_ | 1797203781421629440 |
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| author | Kady Fischer Kyohei Yamaji Silvia Luescher Yasushi Ueki Bernd Jung Hendrik von Tengg-Kobligk Stephan Windecker Matthias G. Friedrich Balthasar Eberle Dominik P. Guensch |
| author_facet | Kady Fischer Kyohei Yamaji Silvia Luescher Yasushi Ueki Bernd Jung Hendrik von Tengg-Kobligk Stephan Windecker Matthias G. Friedrich Balthasar Eberle Dominik P. Guensch |
| author_sort | Kady Fischer |
| collection | DOAJ |
| description | Abstract Background Hyperventilation with a subsequent breath-hold has been successfully used as a non-pharmacological vasoactive stimulus to induce changes in myocardial oxygenation. The purpose of this pilot study was to assess if this maneuver is feasible in patients with multi-vessel coronary artery disease (CAD), and if it is effective at detecting coronary artery stenosis > 50% determined by quantitative coronary angiography (QCA). Methods Twenty-six patients with coronary artery stenosis (QCA > 50% diameter stenosis) underwent a contrast-free cardiovascular magnetic resonance (CMR) exam in the time interval between their primary coronary angiography and a subsequent percutaneous coronary intervention (PCI, n = 24) or coronary artery bypass (CABG, n = 2) revascularization procedure. The CMR exam involved standard function imaging, myocardial strain analysis, T2 mapping, native T1 mapping and oxygenation-sensitive CMR (OS-CMR) imaging. During OS-CMR, participants performed a paced hyperventilation for 60s followed by a breath-hold to induce a vasoactive stimulus. Ten healthy subjects underwent the CMR protocol as the control group. Results All CAD patients completed the breathing maneuvers with an average breath-hold duration of 48 ± 23 s following hyperventilation and without any complications or adverse effects. In comparison to healthy subjects, CAD patients had a significantly attenuated global myocardial oxygenation response to both hyperventilation (− 9.6 ± 6.8% vs. -3.1 ± 6.5%, p = 0.012) and apnea (11.3 ± 6.1% vs. 2.1 ± 4.4%, p < 0.001). The breath-hold maneuver unmasked regional oxygenation differences in territories subtended by a stenotic coronary artery in comparison to remote territory within the same patient (0.5 ± 3.8 vs. 3.8 ± 5.3%, p = 0.011). Conclusion Breathing maneuvers in conjunction with OS-CMR are clinically feasible in CAD patients. Furthermore, OS-CMR demonstrates myocardial oxygenation abnormalities in regional myocardium related to CAD without the use of pharmacologic vasodilators or contrast agents. A larger trial appears warranted for a better understanding of its diagnostic utility. Trial registration Clinical Trials Identifier: NCT02233634, registered 8 September 2014. |
| first_indexed | 2024-04-24T08:24:47Z |
| format | Article |
| id | doaj.art-6fb3aed0f6bd431f85b42b3f446062cf |
| institution | Directory Open Access Journal |
| issn | 1532-429X |
| language | English |
| last_indexed | 2024-04-24T08:24:47Z |
| publishDate | 2018-05-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Journal of Cardiovascular Magnetic Resonance |
| spelling | doaj.art-6fb3aed0f6bd431f85b42b3f446062cf2024-04-16T23:15:53ZengElsevierJournal of Cardiovascular Magnetic Resonance1532-429X2018-05-0120111110.1186/s12968-018-0446-yFeasibility of cardiovascular magnetic resonance to detect oxygenation deficits in patients with multi-vessel coronary artery disease triggered by breathing maneuversKady Fischer0Kyohei Yamaji1Silvia Luescher2Yasushi Ueki3Bernd Jung4Hendrik von Tengg-Kobligk5Stephan Windecker6Matthias G. Friedrich7Balthasar Eberle8Dominik P. Guensch9Department of Anaesthesiology and Pain Medicine, Bern University Hospital, Inselspital, University of BernDepartment of Cardiology, Bern University Hospital, Inselspital, University of BernDepartment of Anaesthesiology and Pain Medicine, Bern University Hospital, Inselspital, University of BernDepartment of Cardiology, Bern University Hospital, Inselspital, University of BernInstitute for Diagnostic, Interventional and Paediatric Radiology, Bern University Hospital, Inselspital, University of BernInstitute for Diagnostic, Interventional and Paediatric Radiology, Bern University Hospital, Inselspital, University of BernDepartment of Cardiology, Bern University Hospital, Inselspital, University of BernResearch Institute of the McGill University Health CentreDepartment of Anaesthesiology and Pain Medicine, Bern University Hospital, Inselspital, University of BernDepartment of Anaesthesiology and Pain Medicine, Bern University Hospital, Inselspital, University of BernAbstract Background Hyperventilation with a subsequent breath-hold has been successfully used as a non-pharmacological vasoactive stimulus to induce changes in myocardial oxygenation. The purpose of this pilot study was to assess if this maneuver is feasible in patients with multi-vessel coronary artery disease (CAD), and if it is effective at detecting coronary artery stenosis > 50% determined by quantitative coronary angiography (QCA). Methods Twenty-six patients with coronary artery stenosis (QCA > 50% diameter stenosis) underwent a contrast-free cardiovascular magnetic resonance (CMR) exam in the time interval between their primary coronary angiography and a subsequent percutaneous coronary intervention (PCI, n = 24) or coronary artery bypass (CABG, n = 2) revascularization procedure. The CMR exam involved standard function imaging, myocardial strain analysis, T2 mapping, native T1 mapping and oxygenation-sensitive CMR (OS-CMR) imaging. During OS-CMR, participants performed a paced hyperventilation for 60s followed by a breath-hold to induce a vasoactive stimulus. Ten healthy subjects underwent the CMR protocol as the control group. Results All CAD patients completed the breathing maneuvers with an average breath-hold duration of 48 ± 23 s following hyperventilation and without any complications or adverse effects. In comparison to healthy subjects, CAD patients had a significantly attenuated global myocardial oxygenation response to both hyperventilation (− 9.6 ± 6.8% vs. -3.1 ± 6.5%, p = 0.012) and apnea (11.3 ± 6.1% vs. 2.1 ± 4.4%, p < 0.001). The breath-hold maneuver unmasked regional oxygenation differences in territories subtended by a stenotic coronary artery in comparison to remote territory within the same patient (0.5 ± 3.8 vs. 3.8 ± 5.3%, p = 0.011). Conclusion Breathing maneuvers in conjunction with OS-CMR are clinically feasible in CAD patients. Furthermore, OS-CMR demonstrates myocardial oxygenation abnormalities in regional myocardium related to CAD without the use of pharmacologic vasodilators or contrast agents. A larger trial appears warranted for a better understanding of its diagnostic utility. Trial registration Clinical Trials Identifier: NCT02233634, registered 8 September 2014.http://link.springer.com/article/10.1186/s12968-018-0446-yCoronary artery diseaseOxygenation-sensitive cardiovascular magnetic resonanceBOLDBreathing maneuversHypocapniaHypercapnia |
| spellingShingle | Kady Fischer Kyohei Yamaji Silvia Luescher Yasushi Ueki Bernd Jung Hendrik von Tengg-Kobligk Stephan Windecker Matthias G. Friedrich Balthasar Eberle Dominik P. Guensch Feasibility of cardiovascular magnetic resonance to detect oxygenation deficits in patients with multi-vessel coronary artery disease triggered by breathing maneuvers Journal of Cardiovascular Magnetic Resonance Coronary artery disease Oxygenation-sensitive cardiovascular magnetic resonance BOLD Breathing maneuvers Hypocapnia Hypercapnia |
| title | Feasibility of cardiovascular magnetic resonance to detect oxygenation deficits in patients with multi-vessel coronary artery disease triggered by breathing maneuvers |
| title_full | Feasibility of cardiovascular magnetic resonance to detect oxygenation deficits in patients with multi-vessel coronary artery disease triggered by breathing maneuvers |
| title_fullStr | Feasibility of cardiovascular magnetic resonance to detect oxygenation deficits in patients with multi-vessel coronary artery disease triggered by breathing maneuvers |
| title_full_unstemmed | Feasibility of cardiovascular magnetic resonance to detect oxygenation deficits in patients with multi-vessel coronary artery disease triggered by breathing maneuvers |
| title_short | Feasibility of cardiovascular magnetic resonance to detect oxygenation deficits in patients with multi-vessel coronary artery disease triggered by breathing maneuvers |
| title_sort | feasibility of cardiovascular magnetic resonance to detect oxygenation deficits in patients with multi vessel coronary artery disease triggered by breathing maneuvers |
| topic | Coronary artery disease Oxygenation-sensitive cardiovascular magnetic resonance BOLD Breathing maneuvers Hypocapnia Hypercapnia |
| url | http://link.springer.com/article/10.1186/s12968-018-0446-y |
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