Myocardial oxygenation in coronary artery disease: Insights from blood oxygen level-dependent magnetic resonance imaging at 3 Tesla

Jayanth R. Arnold, Theodoros D. Karamitsos, Paul Bhamra-Ariza, Jane M. Francis, Nick Searle, Matthew D. Robson, Ruairidh K. Howells, Robin P. Choudhury, Ornella E. Rimoldi, Paolo G. Camici, Adrian P. Banning, Stefan Neubauer, Michael Jerosch-Herold, Joseph B. Selvanayagam

Research output: Contribution to journalArticle

Abstract

Objectives: The purpose of this study was to assess the diagnostic accuracy of blood oxygen-level dependent (BOLD) MRI in suspected coronary artery disease (CAD). Background: By exploiting the paramagnetic properties of deoxyhemoglobin, BOLD magnetic resonance imaging can detect myocardial ischemia. We applied BOLD imaging and first-pass perfusion techniques to: 1) examine the pathophysiological relationship between coronary stenosis, perfusion, ventricular scar, and myocardial oxygenation; and 2) evaluate the diagnostic performance of BOLD imaging in the clinical setting. Methods: BOLD and first-pass perfusion images were acquired at rest and stress (4 to 5 min intravenous adenosine, 140 μg/kg/min) and assessed quantitatively (using a BOLD signal intensity index [stress/resting signal intensity], and absolute quantification of perfusion by model-independent deconvolution). A BOLD signal intensity index threshold to identify ischemic myocardium was first determined in a derivation arm (25 CAD patients and 20 healthy volunteers). To determine diagnostic performance, this was then applied in a separate group comprising 60 patients with suspected CAD referred for diagnostic angiography. Results: Prospective evaluation of BOLD imaging yielded an accuracy of 84%, a sensitivity of 92%, and a specificity of 72% for detecting myocardial ischemia and 86%, 92%, and 72%, respectively, for identifying significant coronary stenosis. Segment-based analysis revealed evidence of dissociation between oxygenation and perfusion (r = -0.26), with a weaker correlation of quantitative coronary angiography with myocardial oxygenation (r = -0.20) than with perfusion (r = -0.40; p = 0.005 for difference). Hypertension increased the odds of an abnormal BOLD response, but diabetes mellitus, hypercholesterolemia, and the presence of ventricular scar were not associated with significant deoxygenation. Conclusions: BOLD imaging provides valuable insights into the pathophysiology of CAD; myocardial hypoperfusion is not necessarily commensurate with deoxygenation. In the clinical setting, BOLD imaging achieves favorable accuracy for identifying the anatomic and functional significance of CAD.

Original languageEnglish
Pages (from-to)1954-1964
Number of pages11
JournalJournal of the American College of Cardiology
Volume59
Issue number22
DOIs
Publication statusPublished - May 29 2012

Keywords

  • blood oxygen level-dependent
  • ischemia
  • myocardial blood flow

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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    Arnold, J. R., Karamitsos, T. D., Bhamra-Ariza, P., Francis, J. M., Searle, N., Robson, M. D., Howells, R. K., Choudhury, R. P., Rimoldi, O. E., Camici, P. G., Banning, A. P., Neubauer, S., Jerosch-Herold, M., & Selvanayagam, J. B. (2012). Myocardial oxygenation in coronary artery disease: Insights from blood oxygen level-dependent magnetic resonance imaging at 3 Tesla. Journal of the American College of Cardiology, 59(22), 1954-1964. https://doi.org/10.1016/j.jacc.2012.01.055