59 research outputs found
Myocardial ischemia in the absence of epicardial coronary artery disease in Friedreich's ataxia
We present the first in vivo detection of microvascular abnormality in a patient with Friedreich's ataxia (FA) without epicardial coronary artery disease using cardiac magnetic resonance (CMR). The patient had exertional chest pain and dyspnea prompting referral for cardiac evaluation. These symptoms were reproduced during intravenous adenosine infusion, and simultaneous first-pass perfusion imaging showed a significant subendocardial defect; both symptoms and perfusion deficit were absent at rest. Epicardial coronaries were free of disease by invasive angiography; together, these findings support the notion of impaired myocardial perfusion reserve in FA
Use of the intravascular contrast agent NC100150 Injection in spin echo and gradient echo imaging of the heart
This
is
the
first
study of
the intravascular iron oxide particle contrast agent,
NC100150
Injection
(Nycomed
Imaging
AS,
Oslo,
Norway,
a
part
of
Nycomed
Amersham)
in magnetic
resonance
imaging
of
the
human
heart.
Eighteen healthy male volunteers
were studied
at both
0.5
and
1.5
T
before
and
after
the
administration
of
NC100150
Injection. Transaxial spin-echo images
were acquired at
both
field strengths, conventional gradient-echo cine images at
0.5
T,
and
breathhold Turbo-FLASH cine
images at
1.5
T.
Optimized
cine imaging sequences were
used
postcontrast, with
a
high
flip
angle
of
60-70”.
In
the
spin-echo images there was
a
significant reduction
in
the
blood
pool
flow
artifact at
the
level
of
the right
atrium
(0.5
T,
57%,
p
<
0.01;
1.5
41%.
p
=
0.01)
and
the
left
ventricle
(LV)
(0.5
T,
45%,
p
=
0.01;
1.5
T,
45%,
p
<
0.01).
In
the
conventional gradient-echo cines
at
0.5
T,
there
was
a significant
increase
in
the
LV
blood
pool
and
myocardial
signal
difference-to-noise
ratio
(SDNR)
in
the diastolic
(56%,
p
=
0.01)
and
systolic
(141%,
p
<
0.OOl)frames. There
was
also
a
significant
increase
in
the signal
intensity
(SI)
gradient
at
the
LV
blood
pool-myocardial border in
the
diastolic
and
systolicframes (both
p
<
0.001).
At
higher doses
of
NClOO150
Injection
(3
and
4
mg/kg),
a
rim
of
signal
void
around the
LV
blood
pool
was observed, perfectly
defining
the
LV
blood
pool-
myocardial
border.
In
the
Turbo-FLASH breathhold cines
at
1.5
T,
there was
a
significant
increase
in
the
LV
blood pool-myocardial
SDNR
in the diastolic
(221%,
p
<
0.001)
and
systolic
(916%,
p
<
0.001)
frames.
Again,
there was
also
a
significant increase
in
the
SI
gradient
at
the
LV
blood
pool-
myocardial border in
the
diastolic and
systolicframes
(both
p
=
0.003).
In
conclusion,
NC100150
Injection
was given safely
to
18
healthy subjects. Image quality
and
LV
blood
pool-myocardial definition
were
improved
after
the
administration
of
NClOOI50 Injection. These improvements enable better spin-echo anatomical
defiition,
better
definition
of
myocardial
wall
motion,
and
should
improve
the
capability
of
automated edge
detection algorithms
Model prediction of subendocardial perfusion of the coronary circulation in the presence of an epicardial coronary artery stenosis
The subendocardium is most vulnerable to ischemia, which is ameliorated by relaxation during diastole and increased coronary pressure. Recent clinical techniques permit the measuring of subendocardial perfusion and it is therefore important to gain insight into how measurements depend on perfusion conditions of the heart. Using data from microsphere experiments a layered model of the myocardial wall was developed. Myocardial perfusion distribution during hyperemia was predicted for different degrees of coronary stenosis and at different levels of Diastolic Time Fraction (DTF). At the reference DTF, perfusion was rather evenly distributed over the layers and the effect of the stenosis was homogenous. However, at shorter or longer DTF, the subendocardium was the first or last to suffer from shortage of perfusion. It is therefore concluded that the possible occurrence of subendocardial ischemia at exercise is underestimated when heart rate is increased and DTF is lower
Inter-observer variability of visual analysis of “stress”-only adenosine first-pass myocardial perfusion imaging in relation to clinical experience and reading criteria
To assess the inter-observer agreement of adenosine “stress”-only visual analysis of perfusion MR images in relation to experience and reading criteria. 106 adenosine perfusion MR examinations out of 350, 46 consecutive positive examinations and 60 randomly selected negative examinations were visually analysed by three individual readers (two residents and a technician) with different levels of experience. Readings (blinded for any information) were compared with the reading of an expert radiologist. After a month the examinations were presented again (randomly) without knowledge regarding the first readings. This time readings were performed with the systematical use of reading criteria. Agreement with the expert reading was good for the most experienced resident (k = 0.88). Kappa was 0.48 for the least experienced, and 0.57 for the technician. After the second systematical reading inter-observer agreement increased to 0.9, 0.68 and 0.77 respectively. Overall kappa increased from 0.59 to 0.71. The use of reading criteria significantly improved the performance of the least experienced reader (P = 0.01). Visual analysis of adenosine “stress”-only first-pass perfusion MR images has moderate to very good agreement. Performance is experience related, but the systematic use of reading criteria significantly increased performance for the least experienced observer
Noninvasive Assessment of Coronary Artery Disease in Women: What’s Next?
Significant progress in research has been made in the areas of sex-specific aspects of cardiovascular disease. Despite these advances, coronary artery disease (CAD) is the leading cause of death of women in the Western world. Over the past decade, the focused research on women at risk for ischemic heart disease has helped to clarify our understanding of some of the sex-specific factors, which are important in detecting CAD. In women, the detection and evaluation of physiologically significant CAD is challenging, especially given that traditional tests designed to detect focal areas of coronary artery stenosis are less sensitive and specific in female patients who have a lower prevalence of obstructive coronary disease, greater burden of symptoms, and a high atherosclerotic burden. In this article, we review the available evidence on the role of contemporary cardiovascular imaging techniques in evaluating ischemic heart disease in women
Angiographic correlations of patients with small vessel disease diagnosed by adenosine-stress cardiac magnetic resonance imaging
Cardiac magnetic resonance imaging (CMR) with adenosine-stress myocardial perfusion is gaining importance for the detection and quantification of coronary artery disease (CAD). However, there is little knowledge about patients with CMR-detected ischemia, but having no relevant stenosis as seen on coronary angiography (CA). The aims of our study were to characterize these patients by CMR and CA and evaluate correlations and potential reasons for the ischemic findings. 73 patients with an indication for CA were first scanned on a 1.5T whole-body CMR-scanner including adenosine-stress first-pass perfusion. The images were analyzed by two independent investigators for myocardial perfusion which was classified as subendocardial ischemia (n = 22), no perfusion deficit (n = 27, control 1), or more than subendocardial ischemia (n = 24, control 2). All patients underwent CA, and a highly significant correlation between the classification of CMR perfusion deficit and the degree of coronary luminal narrowing was found. For quantification of coronary blood flow, corrected Thrombolysis in Myocardial Infarction (TIMI) frame count (TFC) was evaluated for the left anterior descending (LAD), circumflex (LCX) and right coronary artery (RCA). The main result was that corrected TFC in all coronaries was significantly increased in study patients compared to both control 1 and to control 2 patients. Study patients had hypertension or diabetes more often than control 1 patients. In conclusion, patients with CMR detected subendocardial ischemia have prolonged coronary blood flow. In connection with normal resting flow values in CAD, this supports the hypothesis of underlying coronary microvascular impairment. CMR stress perfusion differentiates non-invasively between this entity and relevant CAD
Frequency and severity of myocardial perfusion abnormalities using Tc-99m MIBI SPECT in cardiac syndrome X
BACKGROUND: Cardiac syndrome X is defined by a typical angina pectoris with normal or near normal (stenosis <40%) coronary angiogram with or without electrocardiogram (ECG) change or atypical angina pectoris with normal or near normal coronary angiogram plus a positive none-invasive test (exercise tolerance test or myocardial perfusion scan) with or without ECG change. Studies with myocardial perfusion imaging on this syndrome have indicated some abnormal perfusion scan. We evaluated the role of myocardial perfusion imaging (MPI) and also the severity and extent of perfusion abnormality using Tc-99m MIBI Single Photon Emission Computed Tomography (SPECT) in these patients. METHODS: The study group consisted of 36 patients with cardiac syndrome X. The semiquantitative perfusion analysis was performed using exercise Tc-99m MIBI SPECT. The MPI results were analyzed by the number, location and severity of perfusion defects. RESULTS: Abnormal perfusion defects were detected in 13 (36.10%) cases, while the remaining 23 (63.90%) had normal cardiac imaging. Five of 13 (38.4%) abnormal studies showed multiple perfusion defects. The defects were localized in the apex in 3, apical segments in 4, midventricular segments in 12 and basal segments in 6 cases. Fourteen (56%) of all abnormal segments revealed mild, 7(28%) moderate and 4 (16%) severe reduction of tracer uptake. No fixed defects were identified. The vessel territories were approximately the same in all subjects. The Exercise treadmill test (ETT) was positive in 25(69%) and negative in 11(30%) patients. There was no consistent pattern as related to the extent of MPI defects or exercise test results. CONCLUSION: Our study suggests that multiple perfusion abnormalities with different levels of severity are common in cardiac syndrome X, with more than 30 % of these patients having at least one abnormal perfusion segment. Our findings suggest that in these patients microvascular angina is probably more common than is generally believed
The Association of Systemic Microvascular Changes with Lung Function and Lung Density: A Cross-Sectional Study
10.1371/journal.pone.0050224PLoS ONE712
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