eprintid: 1916
rev_number: 6
eprint_status: archive
userid: 6
dir: disk0/00/00/19/16
datestamp: 2013-11-20 11:04:43
lastmod: 2013-11-20 11:04:43
status_changed: 2013-11-20 11:04:43
type: article
metadata_visibility: show
creators_name: Tsaftaris, Sotirios A.
creators_name: Zhou, Xiangzhi 
creators_name: Tang, Richard
creators_name: Li, Debiao
creators_name: Dharmakumar, Rohan
creators_id: sotirios.tsaftaris@imtlucca.it
creators_id: 
creators_id: 
creators_id: 
creators_id: 
title: Detecting Myocardial Ischemia at Rest With Cardiac Phase-Resolved Blood Oxygen Level-Dependent Cardiovascular Magnetic Resonance
ispublished: pub
subjects: QA75
subjects: RC
divisions: CSA
full_text_status: none
keywords: acute coronary syndrome; coronary artery disease; ischemia; BOLD; MRI

abstract: 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. 
date: 2013
date_type: published
publication: Circulation: Cardiovascular Imaging
volume: 6
number: 2
publisher: American Heart Association
pagerange: 311-319
id_number: 10.1161/​CIRCIMAGING.112.976076
refereed: TRUE
issn: 1941-9651
official_url: http://dx.doi.org/10.1161/​CIRCIMAGING.112.976076
citation:   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)