Department of Cardiology, University of Heidelberg, Heidelberg, Germany; DZHK (German Centre for Cardiovascular Research), partner site Heidelberg, Heidelberg, Germany.
Department of Cardiology, University of Heidelberg, Heidelberg, Germany; DZHK (German Centre for Cardiovascular Research), partner site Heidelberg, Heidelberg, Germany.
JACC Cardiovasc Imaging. 2021 Oct;14(10):1932-1944. doi: 10.1016/j.jcmg.2021.02.022. Epub 2021 Apr 14.
The purpose of this study was to evaluate the diagnostic accuracy of a fast, needle-free test for myocardial ischemia using fast Strain-ENCoded (fSENC) cardiovascular MR (CMR) after a hyperventilation/breath-hold maneuver (HVBH).
Myocardial stress testing is one of the most frequent diagnostic tests performed. Recent data indicate that CMR first-pass perfusion outperforms other modalities. Its use, however, is limited by the need for both, a vasodilatory stress and the intravenous application of gadolinium. Both are associated with added cost, safety concerns, and patient inconvenience. The combination of 2 novel CMR approaches, fSENC, an ultrafast technique to visualize myocardial strain, and HVBH, a physiological vasodilator, may overcome these limitations.
Patients referred for CMR stress testing underwent an extended protocol to evaluate 3 different tests: 1) adenosine-perfusion; 2) adenosine-strain; and 3) HVBH-strain. Diagnostic accuracy was assessed using quantitative coronary angiography as reference.
A total of 122 patients (age 66 ± 11years; 80% men) suspected of obstructive coronary artery disease were enrolled. All participants completed the protocol without significant adverse events. Adenosine-strain and HVBH-strain provided significantly better diagnostic accuracy than adenosine-perfusion, both on a patient level (adenosine-strain: sensitivity 82%, specificity 83%; HVBH-strain: sensitivity 81%, specificity 86% vs. adenosine-perfusion: sensitivity 67%, specificity 92%; p < 0.05) and territory level (adenosine-strain: sensitivity 67%, specificity 93%; HVBH-strain: sensitivity 63%, specificity 95% vs. adenosine-perfusion: sensitivity 49%, specificity 96%; p < 0.05). However, these differences in diagnostic accuracy disappear by excluding patients with history of coronary artery bypass graft or previous myocardial infarction. The response of longitudinal strain differs significantly between ischemic and nonischemic segments to adenosine (ΔLS = 0.6 ± 5.4%, ΔLS = -0.9 ± 2.7%; p < 0.05) and HVBH (ΔLS = 1.3% ± 3.8%, ΔLS = -0.3 ± 1.8%; p = 0.002). Test duration of HVBH-strain (t = 64 ± 2 s) was significantly shorter compared with adenosine-strain (t = 184 ± 59 s; p < 0.0001) and adenosine-perfusion (t = adenosine-perfusion: 172 ± 59 s; p < 0.0001).
HVBH-strain has a high diagnostic accuracy in detecting significant coronary artery stenosis. It is not only significantly faster than any other method but also neither requires contrast agents nor pharmacological stressors.
本研究旨在评估一种快速、无针心肌缺血检测方法的诊断准确性，该方法使用快速应变编码（fSENC）心血管磁共振（CMR）在过度通气/屏气（HVBH）后进行。
心肌应激测试是最常见的诊断测试之一。最近的数据表明，CMR 首过灌注优于其他方式。然而，其使用受到以下限制：需要血管扩张应激和静脉应用钆对比剂。两者都与额外的成本、安全性问题和患者不便有关。两种新型 CMR 方法（fSENC，一种用于可视化心肌应变的超快技术和 HVBH，一种生理血管扩张剂）的结合可能会克服这些限制。
因怀疑患有阻塞性冠状动脉疾病而接受 CMR 应激测试的患者接受了扩展方案，以评估 3 种不同的测试：1）腺苷灌注；2）腺苷应变；和 3）HVBH 应变。使用定量冠状动脉造影作为参考来评估诊断准确性。
共有 122 名（年龄 66±11 岁；80%为男性）疑似阻塞性冠状动脉疾病的患者入组。所有参与者均顺利完成了该方案，没有发生严重不良事件。腺苷应变和 HVBH 应变的诊断准确性均明显优于腺苷灌注，无论是在患者水平（腺苷应变：敏感性 82%，特异性 83%；HVBH 应变：敏感性 81%，特异性 86%，而腺苷灌注：敏感性 67%，特异性 92%；p<0.05）还是区域水平（腺苷应变：敏感性 67%，特异性 93%；HVBH 应变：敏感性 63%，特异性 95%，而腺苷灌注：敏感性 49%，特异性 96%；p<0.05）。然而，排除有冠状动脉旁路移植术或既往心肌梗死病史的患者后，这些诊断准确性的差异就消失了。在腺苷（ΔLS=0.6±5.4%，ΔLS=-0.9±2.7%；p<0.05）和 HVBH（ΔLS=1.3%±3.8%，ΔLS=-0.3±1.8%；p=0.002）刺激下，缺血和非缺血节段的纵向应变反应差异有统计学意义。HVBH 应变的测试持续时间（t=64±2s）明显短于腺苷应变（t=184±59s；p<0.0001）和腺苷灌注（t=腺苷灌注：172±59s；p<0.0001）。
HVBH 应变在检测显著冠状动脉狭窄方面具有较高的诊断准确性。它不仅明显快于任何其他方法，而且既不需要造影剂也不需要药物应激剂。
