MRI as a substitute for scintigraphic techniques in the assessment of inducible ischaemia

1996 ◽  
pp. 191-209
Author(s):  
Dudley J. Pennell
Keyword(s):  
Inducible Ischaemia

Exercise myocardial perfusion imaging to evaluate inducible ischaemia in children with Kawasaki disease

2011 ◽  
Vol 32 (2) ◽  
pp. 137-141 ◽  
Author(s):  
Raghava Kashyap ◽  
Bhagwant Rai Mittal ◽  
Anish Bhattacharya ◽  
Rohit Manojkumar ◽  
Surjit Singh
Keyword(s):  
Myocardial Perfusion Imaging ◽  
Kawasaki Disease ◽  
Myocardial Perfusion ◽  
Perfusion Imaging ◽  
Inducible Ischaemia

Stress echocardiography: diagnostic and prognostic values and specific clinical subsets

2016 ◽  
Author(s):  
Luc A. Pierard ◽  
Lauro Cortigiani
Keyword(s):  
Coronary Flow Reserve ◽  
Coronary Flow ◽  
Stress Echocardiography ◽  
Left Ventricular ◽  
Myocardial Imaging ◽  
Prognostic Information ◽  
Hypertensive Patients ◽  
Exercise Electrocardiography ◽  
Flow Reserve ◽  
Inducible Ischaemia

Stress echocardiography is a widely used method for assessing coronary artery disease, due to its high diagnostic and prognostic value. While inducible ischaemia predicts an unfavourable outcome, its absence is associated with a low risk of future cardiac events. The method provides superior diagnostic and prognostic information than standard exercise electrocardiography and perfusion myocardial imaging in specific clinical subsets, such as women, hypertensive patients, and patients with left bundle branch block. Stress echocardiography allows effective risk assessment also in the diabetic population. The evaluation of coronary flow reserve of the left anterior descending artery by transthoracic Doppler adds diagnostic and prognostic information to that of standard stress test. Stress echocardiography is indicated in the cases when exercise electrocardiography is unfeasible, uninterpretable or gives ambiguous result, and when ischaemia during the test is frequently a false-positive response, as in hypertensive patients, women, and patients with left ventricular hypertrophy. Viability detection represents another application of stress echocardiography. The documentation of a large amount of viable myocardium predicts improved ejection fraction, reverse remodelling, and improved outcome following revascularization in patients with ischaemic cardiomyopathy. Moreover, stress echocardiography can aid significantly in clinical decision-making in patients with valvular heart disease through dynamic assessment of primary or secondary mitral regurgitation, transvalvular gradients, and pulmonary artery systolic pressure, as well as before vascular surgery due to the excellent negative predictive value. Finally, stress echocardiography allows effective risk stratification in patients with hypertrophic cardiomyopathy through evaluation of inducible ischaemia, coronary flow reserve, and intraventricular gradient.

scholarly journals P1400 Improving ischemia diagnosis: 3D speckle-tracking stress echocardiography

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
M Pascual Izco ◽  
E Casas Rojo ◽  
A Kardos ◽  
G L Alonso Salinas ◽  
A Garcia Martin ◽  
...  
Keyword(s):  
Chest Pain ◽  
Speckle Tracking ◽  
Stress Echocardiography ◽  
Visual Analysis ◽  
Calcium Score ◽  
Peak Stress ◽  
Test Accuracy ◽  
High Calcium ◽  
Inducible Ischaemia ◽  
Area Strain

Abstract Background 2D stress echocardiography (SE) is based in the visual analysis of wall motion abnormalities and it requires a trained operator. This operator-dependence has promoted the search for a semiautomatic method to reduce SE limitations and improve test accuracy. The aim of this study was to evaluate the value of 3D speckle tracking (3DSTE) in SE in patients with chest pain. Methods 44 consecutive patients with chest pain and pathological findings on CCTA (>50% stenosis or high calcium score (>400 HU) with undetermined severity) were included. These patients underwent SE with acquisition of 3DSTE at rest and at peak stress. Results Mean age was 63.9 ± 9.9 years. 90% were men. The images of the 44 patients were processed with automatic tracking and manual corrections. 11 patients developed inducible ischaemia during SE. Patients with ischaemic response showed significant reductions in 3D area strain (AS) compared to resting values. The 33 patients without inducible ischaemia showed, however, a significant increase in this parameter. Results are shown in table 1. Conclusion 3D area strain SE could help to identify patients with inducible ischemia. However, further studies are need to confirm these data. Ischemia + (n = 11) Ischemia - (n = 33) P 2D LVEF rest 57.2; 5.5 61.4; 6.0 0.04 2D LVEF peak stress 56.9; 11.7 70.0; 9.0 <0.01 3D LVEF at rest 54.3; 6.9 64.3; 9.7 0.17 3D LVEF peak stress 51.9; 22.5 66.0; 8.6 0.17 AS rest 38.3; 5.1 40.4; 5.7 0.29 AS peak stress 37.2; 11.3 43.6; 7.2 0.03 LVEF: left ventricle ejection fracion; AS: area strain.

Transcatheter occlusion of an anomalous origin of left coronary artery from pulmonary artery in an adult as an alternative to surgery

2020 ◽  
pp. 1-4
Author(s):  
Pramod Sagar ◽  
Kothandam Sivakumar
Keyword(s):  
Coronary Artery ◽  
Pulmonary Artery ◽  
Complete Resolution ◽  
Left Coronary Artery ◽  
Adult Survivors ◽  
Anomalous Origin ◽  
Transcatheter Occlusion ◽  
Surgical Ligation ◽  
Coronary Ligation ◽  
Inducible Ischaemia

Abstract Anomalous origin of the left coronary artery from the pulmonary artery causes heart failure and death in infancy. In rare adult survivors with well-developed collaterals, surgical left coronary ligation to arrest steal is often combined with bypass grafting. Transcatheter left coronary artery closure in a symptomatic adult as an alternative to surgical ligation resulted in complete resolution of inducible ischaemia on myocardial perfusion imaging.

Long-term prognostic value of ischaemia and cardiovascular magnetic resonance-related revascularization for stable coronary disease, irrespective of patient’s sex: a large retrospective study

2021 ◽  
Author(s):  
Théo Pezel ◽  
Philippe Garot ◽  
Marine Kinnel ◽  
Thomas Hovasse ◽  
Stéphane Champagne ◽  
...  
Keyword(s):  
Cardiovascular Magnetic Resonance ◽  
Magnetic Resonance ◽  
Prognostic Value ◽  
Cox Regression ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Major Adverse Cardiovascular Events ◽  
Ventricular Ejection Fraction ◽  
Inducible Ischaemia

Abstract Aims To assess the sex-specific, long-term prognostic value of myocardial ischaemia induced by stress cardiovascular magnetic resonance (CMR) and early CMR-related revascularization in consecutive patients from a large registry. Methods and results Between 2008 and 2010, all consecutive patients referred for stress CMR were followed for the occurrence of major adverse cardiovascular events (MACE), defined by cardiovascular mortality or recurrent non-fatal myocardial infarction (MI). Early CMR-related revascularization was defined as any revascularization within 90 days after CMR. Among 3664 patients (56.9% male, mean age 69.9 ± 11.8 years), 472 (12.9%) had MACE (163 women and 309 men) after a median follow-up of 8.8 (IQR 6.9-9.5) years. Inducible ischaemia and late gadolinium enhancement (LGE) by CMR were associated with MACE in women and men (all P < 0.001). In multivariable Cox regression, inducible ischaemia, LGE, and CMR-related revascularization were independent predictors of MACE both in women [heart rate (HR) 4.79, 95% confidence interval (CI) 2.17–9.10; HR 1.82, 95% CI 1.22–2.71; HR 0.71, 95% CI 0.54–0.92, respectively; all P < 0.001] and men (HR 3.88, 95% CI 2.33–5.98; HR 1.48, 95% CI 1.16–1.89; HR 0.78, 95% CI 0.65–0.97, respectively; all P < 0.001). The addition of CMR-parameters led to improved model discrimination for MACE (C-statistic 0.61 vs. 0.71; NRI = 0.212; IDI = 0.032) for both women and men. CMR-related revascularization was associated with a lower incidence of MACE in patients with left ventricular ejection fraction (LVEF)<50%. Conclusion Inducible ischaemia and early CMR-related revascularization were good long-term predictors of MACE irrespective of sex. CMR-related revascularization was associated with a lower MACE incidence in the sole sub-set of patients with LVEF < 50%.

scholarly journals Vasodilatation stress cardiovascular magnetic resonance: feasibility and safety in a monocentric prospective study

2021 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
T Pezel ◽  
P Garot ◽  
T Hovasse ◽  
S Toupin ◽  
T Unterseeh ◽  
...  
Keyword(s):  
Cardiovascular Magnetic Resonance ◽  
Magnetic Resonance ◽  
Demographic Data ◽  
Obstructive Coronary Artery Disease ◽  
Vasodilator Stress ◽  
Stress Perfusion ◽  
Funding Sources ◽  
Artery Disease ◽  
Stress Cmr ◽  
Inducible Ischaemia

Abstract Funding Acknowledgements Type of funding sources: None. BACKGROUND Cardiovascular magnetic resonance imaging (CMR) has emerged as an accurate technique that can assess ventricular function, stress myocardial perfusion, and viability, without radiation. Recent studies have shown that stress CMR would be the best test to predict obstructive coronary artery disease (CAD) with a good safety. PURPOSE The aim of our study was to assess the feasibility and incidence of immediate complications of stress CMR in a tertiary Cardiovascular Center with CMR Laboratory dedicated. METHODS Prospective registry of vasodilator stress CMR in a French center with CMR expertise included all consecutive patients referred for vasodilator stress perfusion CMR to detect an obstructive CAD between 2008 and 2020. Stress CMR was performed at 1.5 T using dipyridamole. The clinical and demographic data, quality of test, CMR findings, haemodynamic data, and complications were prospectively recorded. RESULTS Stress CMR was performed in 35,157 patients (98.2% of requested). The study could not be performed due to claustrophobia in 0.3%. Quality was optimal in 93.1%, suboptimal in 6.4%, and poor in 0.5% of studies. Images were diagnostic in 97.9% of patients. No patient died or had acute myocardial infarction during the test. Moreover, 56 patients (0.16%) had severe immediate complications, and one anaphylactic shock post-gadolinium. The only factor significantly associated with higher incidence of serious complications was the detection of inducible ischaemia (p < 0.001). Incidence of non-severe complications was low (1.5%), severe controlled chest pain being the most frequent. Minor symptoms occurred frequently (35.5%). CONCLUSION Performance of stress CMR is safe with very high image rate of satisfactory quality to perform the diagnosis in a referral population. Inducible ischaemia was the only factor identified which was associated with serious complications. Abstract Table. Final results after stress CMR

Cardiovascular magnetic resonance

2010 ◽  
pp. 197-217 ◽  
Author(s):  
Theodoros D. Karamitsos ◽  
Stefan Neubauer
Keyword(s):  
Coronary Artery Disease ◽  
Cardiovascular Magnetic Resonance ◽  
Clinical Practice ◽  
Chest Pain ◽  
Magnetic Resonance ◽  
Ease Of Use ◽  
Cardiac Anatomy ◽  
Clinical Questions ◽  
Artery Disease ◽  
Inducible Ischaemia

Over the past decade, cardiovascular magnetic resonance (CMR) has undergone significant advancement in terms of imaging capabilities, ease of use, and speed of acquisition. A study of cardiac anatomy, function, and viability can now be completed in less than 30min with superb image quality and excellent reproducibility. This has led to widespread adoption of CMR in clinical practice. New CMR specialists and dedicated CMR units are rapidly emerging. The interventional cardiologist can now use CMR to find answers to many common clinical questions (e.g. inducible ischaemia, viability, coronary artery disease versus non-coronary causes of chest pain, etc.). Moreover, with the development of combined CMR-interventional units, interventional cardiologists are becoming an integral component of this evolving technology.

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