scholarly journals Fick versus flow: a real-time invasive cardiovascular magnetic resonance (iCMR) reproducibility study

2021 ◽  
Vol 23 (1) ◽  
Author(s):  
Yousef Arar ◽  
Tarique Hussain ◽  
Riad Abou Zahr ◽  
Vasu Gooty ◽  
Joshua S. Greer ◽  
...  
Keyword(s):  
Blood Flow ◽  
Cardiovascular Magnetic Resonance ◽  
Magnetic Resonance ◽  
Real Time ◽  
Correlation Coefficients ◽  
Flow Quantification ◽  
Heart Catheterization ◽  
Saturation Pulse ◽  
Fick Principle ◽  
Reproducibility Study

Abstract Background Cardiac catheterization and cardiovascular magnetic resonance (CMR) imaging have distinct diagnostic roles in the congenital heart disease (CHD) population. Invasive CMR (iCMR) allows for a more thorough assessment of cardiac hemodynamics at the same time under the same conditions. It is assumed but not proven that iCMR gives an incremental value by providing more accurate flow quantification. Methods Subjects with CHD underwent real-time 1.5 T iCMR using a passive catheter tracking technique with partial saturation pulse of 40° to visualize the gadolinium-filled balloon, CMR-conditional guidewire, and cardiac structures simultaneously to aid in completion of right (RHC) and left heart catheterization (LHC). Repeat iCMR and catheterization measurements were performed to compare reliability by the Pearson (PCC) and concordance correlation coefficients (CCC). Results Thirty CHD (20 single ventricle and 10 bi-ventricular) subjects with a median age and weight of 8.3 years (2–33) and 27.7 kg (9.2–80), respectively,  successfully underwent iCMR RHC and LHC. No catheter related complications were encountered. Time taken for first pass RHC and LHC/aortic pull back was 5.1, and 2.9 min, respectively. Total success rate to obtain required data points to complete Fick principle calculations for all patients was 321/328 (98%). One patient with multiple shunts was an outlier and excluded from further analysis. The PCC for catheter-derived pulmonary blood flow (Qp) (0.89, p < 0.001) is slightly lower than iCMR-derived Qp (0.96, p < 0.001), whereas catheter-derived systemic blood flow (Qs) (0.62, p = < 0.001) was considerably lower than iCMR-derived Qs (0.94, p < 0.001). CCC agreement for Qp at baseline (C1-CCC = 0.65, 95% CI 0.41–0.81) and retested conditions (C2-CCC = 0.78, 95% CI 0.58–0.89) were better than for Qs at baseline (C1-CCC = 0.22, 95% CI − 0.15–0.53) and retested conditions (C2-CCC = 0.52, 95% CI 0.17–0.76). Conclusion This study further validates hemodynamic measurements obtained via iCMR. iCMR-derived flows have considerably higher test–retest reliability for Qs. iCMR evaluations allow for more reproducible hemodynamic assessments in the CHD population.

scholarly journals Impaired Exercise Tolerance in Repaired Tetralogy of Fallot Is Associated With Impaired Biventricular Contractile Reserve: An Exercise-Stress Real-Time Cardiovascular Magnetic Resonance Study

2021 ◽  
Author(s):  
Michael Steinmetz ◽  
Thomas Stümpfig ◽  
Matthias Seehase ◽  
Andreas Schuster ◽  
Johannes Kowallick ◽  
...  
Keyword(s):  
Blood Flow ◽  
Cardiovascular Magnetic Resonance ◽  
Magnetic Resonance ◽  
Real Time ◽  
Exercise Capacity ◽  
Body Surface ◽  
Pulmonary Blood Flow ◽  
Pulmonary Valve ◽  
Lv Function ◽  
End Diastolic Volume

Background: Correction of tetralogy of Fallot (cTOF) often results in pulmonary valve pathology and right ventricular (RV) dysfunction. Reduced exercise capacity in cTOF patients cannot be explained by these findings alone. We aimed to explore why cTOF patients exhibit impaired exercise capacity with the aid of a comprehensive cardiopulmonary exercise testing (CPET) and real-time cardiovascular magnetic resonance exercise testing (CMR-ET) protocol. Methods: Three cTOF patients and 35 matched healthy controls underwent CPET and CMR-ET in a prospective case-control study. Real-time steady-state free precession cine and phase-contrast sequences were obtained during incremental supine in-scanner cycling at 50, 70, and 90 W. RV and left ventricle (LV) volumes and pulmonary blood flow (Qp) were calculated. Differences of CPET and CMR-ET between cTOF versus controls and correlations between CPET and CMR-ET parameters in cTOF were evaluated statistically for all CMR exercise levels using Mann-Whitney U and Spearman rank-order correlation tests. Results: CPET capacity was significantly lower in cTOF than in controls. cTOF patients exhibited not only significantly reduced Qp and RV function but also lower LV function on CMR-ET. Higher CPET values in cTOF correlated with higher Qp (Qp 90 W versus carbon dioxide ventilatory equivalent %: R =−0.519, P <0.05), higher LV–end-diastolic volume indexed to body surface area (LV–end-diastolic volume indexed to body surface area at 50 W versus oxygen uptake in % at maximum exercise on CPET R =0.452, P <0.05), and change in LV ejection fraction (EF; LV-EF at 90 W versus Watt %: r =−0.463, P <0.05). No correlation was found with regard to RV-EF. Significant RV-LV interaction was observed during CMR-ET (RV-EF versus LV-EF at 50 W and 70 W: r =0.66, P <0.02 and r =0.52, P <0.05, respectively). Conclusions: Impaired exercise capacity in cTOF resulted from a reduction in not only RV, but also LV function. cTOF with good exercise capacity on CPET demonstrated higher LV reserve and pulmonary blood flow during incremental CMR-ET. Apart from RV parameters, CMR-ET–derived LV function could be a valuable tool to stratify cTOF patients for pulmonary valve replacement.

Hybrid MPI-MRI System for Dual-Modal In Situ Cardiovascular Assessments of Real-Time 3D Blood Flow Quantification—A Pre-Clinical In Vivo Feasibility Investigation

2020 ◽  
Vol 39 (12) ◽  
pp. 4335-4345
Author(s):  
Jochen Franke ◽  
Nicoleta Baxan ◽  
Heinrich Lehr ◽  
Ulrich Heinen ◽  
Sebastian Reinartz ◽  
...  
Keyword(s):  
Blood Flow ◽  
Real Time ◽  
Flow Quantification ◽  
Blood Flow Quantification

scholarly journals Use of quantitative cardiovascular magnetic resonance myocardial perfusion mapping for characterization of ischemia in patients with left internal mammary coronary artery bypass grafts

2021 ◽  
Vol 23 (1) ◽  
Author(s):  
Andreas Seraphim ◽  
Kristopher D. Knott ◽  
Anne-Marie Beirne ◽  
Joao B. Augusto ◽  
Katia Menacho ◽  
...  
Keyword(s):  
Blood Flow ◽  
Cardiovascular Magnetic Resonance ◽  
Coronary Artery ◽  
Magnetic Resonance ◽  
Myocardial Perfusion ◽  
Myocardial Blood Flow ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Internal Mammary ◽  
Perfusion Defects

Abstract Background Quantitative myocardial perfusion mapping using cardiovascular magnetic resonance (CMR) is validated for myocardial blood flow (MBF) estimation in native vessel coronary artery disease (CAD). Following coronary artery bypass graft (CABG) surgery, perfusion defects are often detected in territories supplied by the left internal mammary artery (LIMA) graft, but their interpretation and subsequent clinical management is variable. Methods We assessed myocardial perfusion using quantitative CMR perfusion mapping in 38 patients with prior CABG surgery, all with angiographically-proven patent LIMA grafts to the left anterior descending coronary artery (LAD) and no prior infarction in the LAD territory. Factors potentially determining MBF in the LIMA–LAD myocardial territory, including the impact of delayed contrast arrival through the LIMA graft were evaluated. Results Perfusion defects were reported on blinded visual analysis in the LIMA–LAD territory in 27 (71%) cases, despite LIMA graft patency and no LAD infarction. Native LAD chronic total occlusion (CTO) was a strong independent predictor of stress MBF (B = − 0.41, p = 0.014) and myocardial perfusion reserve (MPR) (B = − 0.56, p = 0.005), and was associated with reduced stress MBF in the basal (1.47 vs 2.07 ml/g/min; p = 0.002) but not the apical myocardial segments (1.52 vs 1.87 ml/g/min; p = 0.057). Extending the maximum arterial time delay incorporated in the quantitative perfusion algorithm, resulted only in a small increase (3.4%) of estimated stress MBF. Conclusions Perfusion defects are frequently detected in LIMA–LAD subtended territories post CABG despite LIMA patency. Although delayed contrast arrival through LIMA grafts causes a small underestimation of MBF, perfusion defects are likely to reflect true reductions in myocardial blood flow, largely due to proximal native LAD disease.

scholarly journals Real-time cardiovascular magnetic resonance subxiphoid pericardial access and pericardiocentesis using off-the-shelf devices in swine

2013 ◽  
Vol 15 (1) ◽  
pp. 61 ◽  
Author(s):  
Majdi Halabi ◽  
Anthony Z Faranesh ◽  
William H Schenke ◽  
Victor J Wright ◽  
Michael S Hansen ◽  
...  
Keyword(s):  
Cardiovascular Magnetic Resonance ◽  
Magnetic Resonance ◽  
Real Time

scholarly journals Stationary tissue background correction increases the precision of clinical evaluation of intra-cardiac shunts by cardiovascular magnetic resonance

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Jannike Nickander ◽  
Magnus Lundin ◽  
Goran Abdula ◽  
Jonas Jenner ◽  
Eva Maret ◽  
...  
Keyword(s):  
Cardiovascular Magnetic Resonance ◽  
Magnetic Resonance ◽  
Background Correction ◽  
Flow Quantification ◽  
Clinical Population ◽  
Normal Range ◽  
Number Of Patients ◽  
Stationary Tissue ◽  
Linear Correction ◽  
Background Phase

AbstractWe aimed to evaluate the clinical utility of stationary tissue background phase correction for affecting precision in the measurement of Qp/Qs by cardiovascular magnetic resonance (CMR). We enrolled consecutive patients (n = 91) referred for CMR at 1.5T without suspicion of cardiac shunt, and patients (n = 10) with verified cardiac shunts in this retrospective study. All patients underwent phase contrast flow quantification in the ascending aorta and pulmonary trunk. Flow was quantified using two semi-automatic software platforms (SyngoVia VA30, Vendor 1; Segment 2.0R4534, Vendor 2). Measurements were performed both uncorrected and corrected for linear (Vendor 1 and Vendor 2) or quadratic (Vendor 2) background phase. The proportion of patients outside the normal range of Qp/Qs was compared using the McNemar’s test. Compared to uncorrected measurements, there were fewer patients with a Qp/Qs outside the normal range following linear correction using Vendor 1 (10% vs 18%, p < 0.001), and Vendor 2 (10% vs 18%, p < 0.001), and following quadratic correction using Vendor 2 (7% vs 18%, p < 0.001). No patient with known shunt was reclassified as normal following stationary background correction. Therefore, we conclude that stationary tissue background correction reduces the number of patients with a Qp/Qs ratio outside the normal range in a consecutive clinical population, while simultaneously not reclassifying any patient with known cardiac shunts as having a normal Qp/Qs. Stationary tissue background correction may be used in clinical patients to increase diagnostic precision.

Cardiovascular Magnetic Resonance Measurement of Coronary Arterial Blood Flow at Rest and After Submaximal Exercise

2006 ◽  
Vol 30 (3) ◽  
pp. 421-425 ◽  
Author(s):  
Erica Dall'Armellina ◽  
Miranda B. Baugh ◽  
Timothy M. Morgan ◽  
Craig A. Hamilton ◽  
Ping Tan ◽  
...  
Keyword(s):  
Blood Flow ◽  
Cardiovascular Magnetic Resonance ◽  
Magnetic Resonance ◽  
Submaximal Exercise ◽  
Arterial Blood Flow ◽  
Resonance Measurement ◽  
Arterial Blood
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