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Detecting Myocardial Ischemia at Rest With Cardiac Phase-Resolved Blood Oxygen Level-Dependent Cardiovascular Magnetic Resonance

Tsaftaris, Sotirios A. and Zhou, Xiangzhi and Tang, Richard and Li, Debiao and Dharmakumar, Rohan Detecting Myocardial Ischemia at Rest With Cardiac Phase-Resolved Blood Oxygen Level-Dependent Cardiovascular Magnetic Resonance. Circulation: Cardiovascular Imaging, 6 (2). pp. 311-319. ISSN 1941-9651 (2013)

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Background: Fast, noninvasive identification of ischemic territories at rest (prior to tissue-specific changes) and assessment of functional status can be valuable in the management of severe coronary artery disease. This study investigated the utility of cardiac phase-resolved Blood-Oxygen-Level-Dependent (CP-BOLD) CMR in detecting myocardial ischemia at rest secondary to severe coronary artery stenosis. Methods and Results: CP-BOLD, standard-cine, and T2-weighted images were acquired in canines (n=11) at baseline and within 20 minutes of ischemia induction (severe LAD stenosis) at rest. Following 3-hours of ischemia, LAD stenosis was removed and T2-weighted and late-gadolinium-enhancement (LGE) images were acquired. From standard-cine and CP-BOLD images, End-Systolic (ES) and End-Diastolic (ED) myocardium were segmented. Affected and remote sections of the myocardium were identified from post-reperfusion LGE images. S/D, quotient of mean ES and ED signal intensities (on CP-BOLD and standard-cine), was computed for affected and remote segments at baseline and ischemia. Ejection fraction (EF) and segmental wall-thickening (sWT) were derived from CP-BOLD images at baseline and ischemia. On CP-BOLD images: S/D was greater than 1 (remote and affected territories) at baseline; S/D was diminished only in affected territories during ischemia and the findings were statistically significant (ANOVA, post-hoc p<0.01). The dependence of S/D on ischemia was not observed in standard-cine images. Computer simulations confirmed the experimental findings. ROC analysis showed that S/D identifies affected regions with similar performance (AUC:0.87) as EF (AUC:0.89) and sWT (AUC:0.75). Conclusions: Preclinical studies and computer simulations showed that CP-BOLD CMR could be useful in detecting myocardial ischemia at rest. Patient studies are needed for clinical translation.

Item Type: Article
Identification Number: 10.1161/​CIRCIMAGING.112.976076
Uncontrolled Keywords: acute coronary syndrome; coronary artery disease; ischemia; BOLD; MRI
Subjects: Q Science > QA Mathematics > QA75 Electronic computers. Computer science
R Medicine > RC Internal medicine
Research Area: Computer Science and Applications
Depositing User: Ms T. Iannizzi
Date Deposited: 20 Nov 2013 11:04
Last Modified: 20 Nov 2013 11:04
URI: http://eprints.imtlucca.it/id/eprint/1916

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