Diagnostic Accuracy of Stress Perfusion CMR for Risk Stratification in Patients With MR-Conditional Pacemakers

2021 ◽  
Author(s):  
Théo Pezel ◽  
Jérôme Lacotte ◽  
Solenn Toupin ◽  
Fiorella Salerno ◽  
Mina Ait Said ◽  
...  
Keyword(s):  
Risk Stratification ◽  
Diagnostic Accuracy ◽  
Stress Perfusion ◽  
Mr Conditional ◽  
Perfusion Cmr

scholarly journals Feasibility of adenosine stress cardiovascular magnetic resonance perfusion imaging in patients with MR-conditional transvenous permanent pacemakers and defibrillators

2022 ◽  
Vol 24 (1) ◽  
Author(s):  
Anna Giulia Pavon ◽  
Alessandra Pia Porretta ◽  
Dimitri Arangalage ◽  
Giulia Domenichini ◽  
Tobias Rutz ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Cardiovascular Magnetic Resonance ◽  
Image Quality ◽  
Diagnostic Value ◽  
Implantable Devices ◽  
Adenosine Stress ◽  
Stress Perfusion ◽  
Mr Conditional ◽  
Stress Cmr ◽  
Perfusion Cmr

Abstract Background The use of stress perfusion-cardiovascular magnetic resonance (CMR) imaging remains limited in patients with implantable devices. The primary goal of the study was to assess the safety, image quality, and the diagnostic value of stress perfusion-CMR in patients with MR-conditional transvenous permanent pacemakers (PPM) or implantable cardioverter-defibrillators (ICD). Methods Consecutive patients with a transvenous PPM or ICD referred for adenosine stress-CMR were enrolled in this single-center longitudinal study. The CMR protocol was performed using a 1.5 T system according to current guidelines while all devices were put in MR-mode. Quality of cine, late-gadolinium-enhancement (LGE), and stress perfusion sequences were assessed. An ischemia burden of ≥ 1.5 segments was considered significant. We assessed the safety, image quality and the occurrence of interference of the magnetic field with the implantable device. In case of ischemia, we also assessed the correlation with the presence of significant coronary lesions on coronary angiography. Results Among 3743 perfusion-CMR examinations, 66 patients had implantable devices (1.7%). Image quality proved diagnostic in 98% of cases. No device damage or malfunction was reported immediately and at 1 year. Fifty patients were continuously paced during CMR. Heart rate and systolic blood pressure remained unchanged during adenosine stress, while diastolic blood pressure decreased (p = 0.007). Six patients (9%) had an ischemia-positive stress CMR and significant coronary stenoses were confirmed by coronary angiography in all cases. Conclusion Stress perfusion-CMR is safe, allows reliable ischemia detection, and provides good diagnostic value.

scholarly journals Diagnostic Accuracy of Stress Perfusion CMR in Comparison With Quantitative Coronary Angiography

2014 ◽  
Vol 7 (1) ◽  
pp. 14-22 ◽  
Author(s):  
Federico E. Mordini ◽  
Tariq Haddad ◽  
Li-Yueh Hsu ◽  
Peter Kellman ◽  
Tracy B. Lowrey ◽  
...  
Keyword(s):  
Coronary Angiography ◽  
Diagnostic Accuracy ◽  
Quantitative Coronary Angiography ◽  
Stress Perfusion ◽  
Perfusion Cmr

scholarly journals Safety, feasibility and prognostic value of stress perfusion CMR in patients with pacemaker

2021 ◽  
Vol 22 (Supplement_2) ◽  
Author(s):  
T Pezel ◽  
J Lacotte ◽  
S Toupin ◽  
P Garot ◽  
T Hovasse ◽  
...  
Keyword(s):  
Prognostic Value ◽  
Cox Regression ◽  
Coronary Revascularization ◽  
Cardiovascular Death ◽  
Stress Perfusion ◽  
Major Adverse Cardiovascular Events ◽  
Inducible Ischemia ◽  
Mr Conditional ◽  
Stress Cmr ◽  
Perfusion Cmr

Abstract Funding Acknowledgements Type of funding sources: None. BACKGROUND Several studies have shown the excellent prognostic value of stress cardiovascular magnetic resonance (CMR). However, its prognostic value in patients with pacemaker (PM) remains unknown because most studies excluded PM patients. PURPOSE This study aimed to assess the prognostic value of vasodilator stress perfusion CMR in patients with PM. METHODS Consecutive patients with MR-conditional pacemakers referred for stress perfusion CMR at 1.5 T were followed for the occurrence of major adverse cardiovascular events (MACE), defined by cardiovascular death or nonfatal myocardial infarction. Cox regressions analyses were performed to determine the prognostic value of CMR-parameters. The quality of CMR was rated by two observers blinded to clinical details. Data on pacemaker and leads were collected pre- and post-CMR. RESULTS Of 224 patients who completed the stress CMR protocol, 2 patients had inconclusive stress CMR due to artefact and 203 patients (72.9% male, mean age 71.4 ± 8.7 years) completed the follow-up (median [interquartile range], 7.0 [5.2-7.3] years). Among those, 23 experienced a MACE (11.3%). Stress CMR was well tolerated with no major adverse events. All scans were completed successfully with no significant change in lead thresholds or pacing parameters. Overall, the image quality was rated good or excellent in 84.1% of segments. Using Kaplan-Meier analysis, inducible ischemia and late gadolinium enhancement (LGE) were significantly associated with the occurrence of MACE (hazard ratio, HR: 11.80 [95% CI, 4.63-30.30]; and HR: 6.74 [95% CI, 2.47-18.40], both p < 0.001; respectively). In multivariable Cox regression, inducible ischemia and LGE were independent predictors of a higher incidence of MACE (HR: 5.24 [95% CI, 2.61-14.40]; and HR: 2.98 [95% CI, 2.25-4.02]; both p < 0.001; respectively). In patients with ischemia, CMR-related coronary revascularization showed no benefit in reducing MACE (p = 0.25). CONCLUSION Stress CMR is safe, feasible and has a good discriminative prognostic value in consecutive patients with PM.

scholarly journals Prognostic value of vasodilator stress perfusion CMR in patients with known myocardial infarction

2021 ◽  
Vol 13 (1) ◽  
pp. 13-14
Author(s):  
T. Pezel ◽  
P. Garot ◽  
M. Kinnel ◽  
V. Landon ◽  
T. Hovasse ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Prognostic Value ◽  
Vasodilator Stress ◽  
Stress Perfusion ◽  
Perfusion Cmr

scholarly journals All-systolic non-ECG-gated stress perfusion CMR: improved visualization of subendocardial defects compared to conventional ECG-gated imaging

2015 ◽  
Vol 17 (S1) ◽  
Author(s):  
Behzad Sharif ◽  
Reza Arsanjani ◽  
Rohan Dharmakumar ◽  
Noel C Bairey Merz ◽  
Daniel S Berman ◽  
...  
Keyword(s):  
Stress Perfusion ◽  
Gated Imaging ◽  
Perfusion Cmr

scholarly journals 1020Stress-perfusion CMR at 3.0 Tesla: diagnostic accuracy and appropriateness of CMR-driven coronary angiography

2013 ◽  
Vol 14 (suppl_1) ◽  
pp. i30-i30
Author(s):  
S Muzzarelli ◽  
E Faragasso ◽  
G Pedrazzini ◽  
D Sürder ◽  
E Pasotti ◽  
...  
Keyword(s):  
Coronary Angiography ◽  
Diagnostic Accuracy ◽  
3.0 Tesla ◽  
Perfusion Cmr

scholarly journals Is positron emission tomography enough to rule out cardiac sarcoidosis? A case report

2021 ◽  
Vol 5 (9) ◽  
Author(s):  
Siyi Huang ◽  
Siri Kunchakarra ◽  
Ankit Rathod
Keyword(s):  
Cardiac Magnetic Resonance ◽  
Magnetic Resonance ◽  
Cardiac Sarcoidosis ◽  
Premature Ventricular Contraction ◽  
Lymph Node Biopsy ◽  
Stress Perfusion ◽  
Myocardial Uptake ◽  
Fdg Uptake ◽  
Positron Emission ◽  
Perfusion Cmr

Abstract Background Cardiac sarcoidosis (CS) is associated with poor prognosis, yet the clinical diagnosis is often challenging. Advanced cardiac imaging including cardiac magnetic resonance (CMR) and positron emission tomographic (PET) have emerged as useful modalities to diagnose CS. Case summary A 66-year-old woman presented with palpitations. A 24-h Holter monitor detected a high premature ventricular contraction burden of 25.6%. She underwent two transthoracic echocardiograms; both showed normal results. Stress perfusion CMR did not show any evidence of ischaemic aetiology; however, myocardial lesions detected by late gadolinium enhancement (LGE) imaging raised suspicion for CS. While there was no myocardial uptake of fluorodeoxyglucose (FDG) in subsequent cardiac PET, high FDG uptake was seen in hilar lymph nodes. Lymph node biopsy confirmed the diagnosis of sarcoidosis. Discussion Cardiac magnetic resonance and PET imaging are designed to evaluate different aspects CS pathophysiology. The characteristic LGE in the absence of increased FDG uptake suggested inactive CS with residual myocardial scarring.

Adenosine Stress Perfusion CMR Accurately Identifies the Target Vessel for Revascularisation

2011 ◽  
Vol 20 ◽  
pp. S157
Author(s):  
J. Richardson ◽  
A. Bertaso ◽  
D. Wong ◽  
A. Nelson ◽  
H. Tayeb ◽  
...  
Keyword(s):  
Adenosine Stress ◽  
Stress Perfusion ◽  
Target Vessel ◽  
Adenosine Stress Perfusion ◽  
Perfusion Cmr

Abstract 2808: Combination of Adenosine Stress Perfusion and Late Enhancement Cardiac Magnetic Resonance Imaging in Patients with Suspected Coronary Artery Disease, Percutaneous Coronary Intervention and Coronary Bypass Graft -A Multi-Center Study

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Peter Bernhardt ◽  
Guenter Pilz ◽  
Jochen Spiess ◽  
Berthold Hoefling ◽  
Vinzenz Hombach ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Diagnostic Accuracy ◽  
Bypass Graft ◽  
Coronary Intervention ◽  
Suspected Coronary Artery Disease ◽  
Stress Perfusion ◽  
Vessel Stenosis ◽  
Percutaneous Coronary ◽  
Adenosine Stress Perfusion ◽  
Artery Disease

The combination of stress perfusion and late Gadolinium enhancement (LGE) cardiac magnetic resonance imaging (CMR) has been established for diagnosis of myocardial ischemia. However, little is known about this helpful clinical examination tool in patients who were treated by percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG). Aim of our study was to compare the diagnostic accuracy of stress perfusion and LGE in patients with suspected coronary artery disease (CAD), with PCI and with CABG in a multi-center trial. 477 patients with suspected CAD, 209 with PCI and 110 with CABG were included to the study and underwent adenosine stress perfusion and LGE 10 min. after a second bolus of contrast agent. CMR images were assessed visually using the 16-segments model. Myocardial ischemia was defined as resgional hypoenhancement in stress perfusion with absent LGE. All patients underwent coronary angiography. A significant stenosis was defined by QCA in case of ≥70% of coronary artery or bypass graft narrowing in vessels ≥2 mm diameter. A relevant vessel stenosis or occlusion was present in 173 (36%) patients with susptectd CAD, 69 (29%) PCI and 71 (65%) CABG patients. PCI was performed 314±231 and CABG 423±275 days before CMR examination. Sensitivity, specificity and overall accuracy per patient are given in table 1 CMR is feasible and suitable for detecting relevant vessel stenosis in patients who previously were treated by PCI or CABG. Diagnostic accuracy is reduced in patients with CABG. This could be due to different flow and perfusion kinetic. Furthermore, presented evaluation method may be inadequate, since collaterals and different perfusion territories are not taken into consideration. CMR yields similar diagnostic accuracy in patients with suspected CAD and those who previously were treated by PCI.

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