scholarly journals Prognostic Value of Vasodilator Stress Cardiac Magnetic Resonance Imaging

2019 ◽  
Vol 4 (3) ◽  
pp. 256 ◽  
Author(s):  
John F. Heitner ◽  
Raymond J. Kim ◽  
Han W. Kim ◽  
Igor Klem ◽  
Dipan J. Shah ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Cardiac Magnetic Resonance ◽  
Magnetic Resonance ◽  
Cardiac Magnetic Resonance Imaging ◽  
Prognostic Value ◽  
Vasodilator Stress ◽  
Resonance Imaging ◽  
Stress Cardiac Magnetic Resonance

Abstract 15075: Exercise Stress Testing and Stress Cardiac Magnetic Resonance Imaging for Detection of Inducible Ischemia in a Large Cohort of Children With Anomalous Aortic Origin of a Coronary Artery

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Amna Qasim ◽  
Tam Doan ◽  
Tam Dan Pham ◽  
Dana Reaves-O’Neal ◽  
Silvana M Molossi
Keyword(s):  
Magnetic Resonance Imaging ◽  
Cardiac Magnetic Resonance ◽  
Coronary Artery ◽  
Magnetic Resonance ◽  
Cardiac Magnetic Resonance Imaging ◽  
Exercise Stress ◽  
Resonance Imaging ◽  
Inducible Ischemia ◽  
St Depression ◽  
Stress Cardiac Magnetic Resonance

Introduction: The current AATS and AHA/ACC guidelines recommend maximal exercise stress test (mEST) to identify ischemia and direct decision-making in patients (pts) with anomalous aortic origin of a coronary artery (AAOCA). Stress cardiac magnetic resonance imaging (sCMR) has reliably identified myocardial perfusion abnormalities. Hypothesis: We hypothesize that EST and sCMR do not agree in the detection of inducible ischemia in AAOCA. Methods: AAOCA pts <21 years old were prospectively enrolled and evaluated following a standardized approach from 12/2012-12/2019. mEST was performed in pts ≥6 years old, except those who presented with cardiac arrest or physical limitations. Demographic data, coronary anomaly type, EST (symptoms, ST changes, arrhythmias, metabolic parameters) and sCMR data were collected. A mEST was defined as max HR ≥85%ile with a subgroup defined as respiratory exchange ratio (RER) >1.05. Abnormal mEST included: significant ST changes (≥1 mm horizontal or downsloping ST-depression, ≥2 mm upsloping ST depression, ST elevation), high-grade arrhythmia, abnormal peak VO2 (<85% predicted). Continuous and categorical variables were compared using Wilcoxon-Rank sum and Fisher’s exact/χ2 respectively. McNemar’s test was used to determine the agreement between EST and sCMR. Results: Of 147 pts with AAOCA and both EST and sCMR, 140 achieved max HR ≥85%ile on EST. Table 1 compares demographics and EST parameters in pts with inducible ischemia on sCMR (+sCMR) vs without (-sCMR). Significant ST changes were seen in 2/26 (7.7%) pts with +sCMR compared to 8/114 (7%) pts with -sCMR. An abnormal mEST did not agree with sCMR in identifying inducible ischemia (McNemar p < 0.001) in all AAOCA patients who achieved max HR, nor in the sub-group with RER >1.05 (n = 88). Conclusions: mEST does not agree with sCMR in identifying inducible ischemia in patients with AAOCA. Our data suggest that mEST should not be used alone for the detection of inducible ischemia.

Stress Cardiac Magnetic Resonance Imaging

2018 ◽  
pp. 335-343
Author(s):  
Yeonyee E. Yoon ◽  
L. Samuel Wann
Keyword(s):  
Magnetic Resonance Imaging ◽  
Cardiac Magnetic Resonance ◽  
Magnetic Resonance ◽  
Myocardial Perfusion ◽  
Cardiac Magnetic Resonance Imaging ◽  
Wall Motion ◽  
Scar Tissue ◽  
Resonance Imaging ◽  
Stress Cardiac Magnetic Resonance ◽  
Myocardial Thickening

The chapter Stress Cardiac Magnetic Resonance Imaging reviews how cardiovascular magnetic resonance imaging (CMR) has become a gold standard for evaluating stress induced wall motion abnormalities based on regional endocardial excursion and myocardial thickening. The high spatial and temporal resolution of CMR without limitations imposed by body habitus and acoustic windows allows outstanding visualization of myocardial function. CMR can also be combined with vasodilator stress to perform dynamic first-pass myocardial perfusion imaging. The addition of late gadolinium enhancement allows the accurate of nonviable scar tissue in combination with wall motion and myocardial perfusion assessment. Case studies highlight the opportunity provided by stress CMR.

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