Assessment of global myocardial perfusion reserve using cardiovascular magnetic resonance of coronary sinus flow at 3 TeslaReport as inadecuate




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Journal of Cardiovascular Magnetic Resonance

, 16:24

First Online: 27 March 2014Received: 19 November 2013Accepted: 03 March 2014

Abstract

BackgroundDespite increasing clinical use, there is limited data regarding regadenoson in stress perfusion cardiovascular magnetic resonance CMR.
In particular, given its long half-life the optimal stress protocol remains unclear.
Although Myocardial Perfusion Reserve MPR may provide additive prognostic information, current techniques for its measurement are cumbersome and challenging for routine clinical practice.

The aims of this study were: 1 To determine the feasibility of MPR quantification during regadenoson stress CMR by measurement of Coronary Sinus CS flow; and 2 to investigate the role of aminophylline reversal during regadenoson stress-CMR.

Methods117 consecutive patients with possible myocardial ischemia were prospectively enrolled.
Perfusion imaging was performed at 1 minute and 15 minutes after administration of 0.4 mg regadenoson.
A subgroup of 41 patients was given aminophylline 100 mg after stress images were acquired.
CS flow was measured using phase-contrast imaging at baseline pre CS flow, and immediately after the stress peak CS flow and rest post CS flow perfusion images.

ResultsCS flow measurements were obtained in 92% of patients with no adverse events.
MPR was significantly underestimated when calculated as peak CS flow-post CS flow as compared to peak CS flow-pre CS flow 2.43 ± 0.20 vs.
3.28 ± 0.32, p = 0.03.
This difference was abolished when aminophylline was administered 3.35 ± 0.44 vs.
3.30 ± 0.52, p = 0.95.
Impaired MPR peak CS flow-pre CS flow <2 was associated with advanced age, diabetes, current smoking and higher Framingham risk score.

ConclusionsRegadenoson stress CMR with MPR measurement from CS flow can be successfully performed in most patients.
This measurement of MPR appears practical to perform in the clinical setting.
Residual hyperemia is still present even 15 minutes after regadenoson administration, at the time of resting-perfusion acquisition, and is completely reversed by aminophylline.
Our findings suggest routine aminophylline administration may be required when performing stress CMR with regadenoson.

KeywordsCardiovascular magnetic resonance Stress testing Perfusion Regadenoson AbbreviationsCADCoronary artery disease

CMRCardiovascular magnetic resonance

CSCoronary sinus

LGELate gadolinium enhancement

MPRMyocardial perfusion reserve

PETPositron emission tomography

SPECTSingle-photon emission computed tomography.

Electronic supplementary materialThe online version of this article doi:10.1186-1532-429X-16-24 contains supplementary material, which is available to authorized users.

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Author: Vineet K Dandekar - Michael A Bauml - Andrew W Ertel - Carolyn Dickens - Rosalia C Gonzalez - Afshin Farzaneh-Far

Source: https://link.springer.com/article/10.1186/1532-429X-16-24



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