Dataset Information

Feasibility of cardiovascular magnetic resonance derived coronary wave intensity analysis.

ABSTRACT:

Background

Wave intensity analysis (WIA) of the coronary arteries allows description of the predominant mechanisms influencing coronary flow over the cardiac cycle. The data are traditionally derived from pressure and velocity changes measured invasively in the coronary artery. Cardiovascular magnetic resonance (CMR) allows measurement of coronary velocities using phase velocity mapping and derivation of central aortic pressure from aortic distension. We assessed the feasibility of WIA of the coronary arteries using CMR and compared this to invasive data.

Methods

CMR scans were undertaken in a serial cohort of patients who had undergone invasive WIA. Velocity maps were acquired in the proximal left anterior descending and proximal right coronary artery using a retrospectively-gated breath-hold spiral phase velocity mapping sequence with high temporal resolution (19 ms). A breath-hold segmented gradient echo sequence was used to acquire through-plane cross sectional area changes in the proximal ascending aorta which were used as a surrogate of an aortic pressure waveform after calibration with brachial blood pressure measured with a sphygmomanometer. CMR-derived aortic pressures and CMR-measured velocities were used to derive wave intensity. The CMR-derived wave intensities were compared to invasive data in 12 coronary arteries (8 left, 4 right). Waves were presented as absolute values and as a % of total wave intensity. Intra-study reproducibility of invasive and non-invasive WIA was assessed using Bland-Altman analysis and the intraclass correlation coefficient (ICC).

Results

The combination of the CMR-derived pressure and velocity data produced the expected pattern of forward and backward compression and expansion waves. The intra-study reproducibility of the CMR derived wave intensities as a % of the total wave intensity (mean?±?standard deviation of differences) was 0.0?±?6.8%, ICC?=?0.91. Intra-study reproducibility for the corresponding invasive data was 0.0?±?4.4%, ICC?=?0.96. The invasive and CMR studies showed reasonable correlation (r?=?0.73) with a mean difference of 0.0?±?11.5%.

Conclusion

This proof of concept study demonstrated that CMR may be used to perform coronary WIA non-invasively with reasonable reproducibility compared to invasive WIA. The technique potentially allows WIA to be performed in a wider range of patients and pathologies than those who can be studied invasively.

SUBMITTER: Raphael CE

PROVIDER: S-EPMC5154155 | biostudies-literature | 2016 Dec

REPOSITORIES: biostudies-literature

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Publications

Feasibility of cardiovascular magnetic resonance derived coronary wave intensity analysis.

Raphael Claire E CE Keegan Jennifer J Parker Kim H KH Simpson Robin R Collinson Julian J Vassiliou Vass V Wage Ricardo R Drivas Peter P Strain Stephen S Cooper Robert R de Silva Ranil R Stables Rod H RH Di Mario Carlo C Frenneaux Michael M Pennell Dudley J DJ Davies Justin E JE Hughes Alun D AD Firmin David D Prasad Sanjay K SK

Journal of cardiovascular magnetic resonance : official journal of the Society for Cardiovascular Magnetic Resonance 20161209 1

<h4>Background</h4>Wave intensity analysis (WIA) of the coronary arteries allows description of the predominant mechanisms influencing coronary flow over the cardiac cycle. The data are traditionally derived from pressure and velocity changes measured invasively in the coronary artery. Cardiovascular magnetic resonance (CMR) allows measurement of coronary velocities using phase velocity mapping and derivation of central aortic pressure from aortic distension. We assessed the feasibility of WIA o ...[more]

PMID: 27964736

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Project description:Background Phase-contrast cine cardiovascular magnetic resonance (CMR) of the coronary sinus has emerged as a non-invasive method for measuring coronary sinus blood flow and coronary flow reserve (CFR). However, its clinical utility has not yet been established. Here we performed a meta-analysis to clarify the clinical value of CMR-derived CFR in various cardiovascular diseases. Methods An electronic database search was performed of PubMed, Web of Science Core Collection, Cochrane Advanced Search, and EMBASE. We compared the CMR-derived CFR of various cardiovascular diseases (stable coronary artery disease [CAD], hypertrophic cardiomyopathy [HCM], dilated cardiomyopathy [DCM]) and control subjects. We assessed the prognostic value of CMR-derived CFR for predicting major adverse cardiac events (MACE) in patients with stable CAD. Results A total of 47 eligible studies were identified. The pooled CFR from our meta-analysis was 3.48 (95% confidence interval [CI], 2.98–3.98) in control subjects, 2.50 (95% CI, 2.38–2.61) in stable CAD, 2.01 (95% CI, 1.70–2.32) in cardiomyopathies (HCM and DCM). The meta-analysis showed that CFR was significantly reduced in stable CAD (mean difference [MD] = −1.48; 95% CI, −1.78 to −1.17; p < 0.001; I2 = 0%; p for heterogeneity = 0.33), HCM (MD = −1.20; 95% CI, −1.63 to −0.77; p < 0.001; I2 = 0%; p for heterogeneity = 0.49), and DCM (MD = −1.53; 95% CI, −1.93 to −1.13; p < 0.001; I2 = 0%; p for heterogeneity = 0.45). CMR-derived CFR was an independent predictor of MACE for patients with stable CAD (hazard ratio = 0.52 per unit increase; 95% CI, 0.37–0.73; p < 0.001; I2 = 84%, p for heterogeneity < 0.001). Conclusions CMR-derived CFR was significantly decreased in cardiovascular diseases, and a decreased CFR was associated with a higher occurrence of MACE in patients with stable CAD. These results suggest that CMR-derived CFR has potential for the pathological evaluation of stable CAD, cardiomyopathy, and risk stratification in CAD. Supplementary Information The online version contains supplementary material available at 10.1186/s12968-023-00912-5.

Dataset Information

Feasibility of cardiovascular magnetic resonance derived coronary wave intensity analysis.

Background

Methods

Results

Conclusion

Publications

Feasibility of cardiovascular magnetic resonance derived coronary wave intensity analysis.

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