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Relationship of vasodilator-induced changes in myocardial oxygenation with the severity of coronary artery stenosis: A study using oxygenation-sensitive cardiovascularmagnetic resonance

Citation

Luu, JM and Friedrich, MG and Harker, J and Dwyer, N and Guensch, D and Mikami, Y and Faris, P and Hare, JL, Relationship of vasodilator-induced changes in myocardial oxygenation with the severity of coronary artery stenosis: A study using oxygenation-sensitive cardiovascularmagnetic resonance, European Heart Journal Cardiovascular Imaging, 15, (12) pp. 1358-1367. ISSN 2047-2404 (2014) [Refereed Article]

Copyright Statement

Published on behalf of the European Society of Cardiology. All rights reserved. Copyright The Author 2014.

DOI: doi:10.1093/ehjci/jeu138

Abstract

AIMS: To explore the impact of the functional severity of coronary artery stenosis on changes in myocardial oxygenation during pharmacological vasodilation, using oxygenation-sensitive cardiovascular magnetic resonance (OS-CMR) imaging and invasive fractional flow reserve (FFR). An FFR is considered a standard of reference for assessing haemodynamic relevance of coronary artery stenosis; yet, the relationship of FFR to changes in myocardial oxygenation during vasodilator stress and thus to an objective marker for ischaemia on the tissue level is not well understood.

METHODS AND RESULTS: We prospectively recruited 64 patients with suspected/known coronary artery disease undergoing invasive angiography. The FFR was performed in intermediate coronary artery stenosis. OS-CMR images were acquired using a T2*-sensitive sequence before and after adenosine-induced vasodilation, with myocardial segments matched to angiography. Very strict image quality criteria were defined to ensure the validity of results. The FFR was performed in 37 patients. Because of the strict image quality criteria, 41% of segments had to be excluded, leaving 29/64 patients for the blinded OS-CMR analysis. Coronary territories with an associated FFR of <0.80 showed a lack of increase in myocardial oxygenation [mean signal intensity (ΔSI) -0.49%; 95% confidence interval (CI) -3.78 to 2.78 vs. +7.30%; 95% CI 4.08 to 10.64; P < 0.001]. An FFR of <0.54 best predicted a complete lack of a vasodilator-induced oxygenation increase (sensitivity 71% and specificity 75%). An OS-CMR ΔSI <4.78% identified an FFR of <0.8 with a sensitivity of 86% and specificity of 92%.

CONCLUSION: An FFR of <0.80 is associated with a lack of an adenosine-inducible increase in oxygenation of the dependent coronary territory, while a complete lack of such an increase was best predicted by an FFR of <0.54. Further studies are warranted to identify clinically meaningful cut-off values for FFR measurements and to assess the utility of OS-CMR as an alternative clinical tool for assessing the functional relevance of coronary artery stenosis.

Item Details

Item Type:Refereed Article
Keywords:Cardiovascular magnetic resonance; Coronary artery disease; Fractional flow reserve; Ischaemia; Oxygenation-sensitive imaging
Research Division:Medical and Health Sciences
Research Group:Cardiorespiratory Medicine and Haematology
Research Field:Cardiology (incl. Cardiovascular Diseases)
Objective Division:Health
Objective Group:Clinical Health (Organs, Diseases and Abnormal Conditions)
Objective Field:Cardiovascular System and Diseases
Author:Dwyer, N (Dr Nathan Dwyer)
ID Code:120055
Year Published:2014
Web of Science® Times Cited:6
Deposited By:Health Sciences
Deposited On:2017-08-09
Last Modified:2017-11-07
Downloads:0

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