Crawley Richard J, Kunze Karl-Philipp, Kaushal Anmol, Milidonis Xenios, Highton Jack, Domenech-Ximenos Blanca, Kotadia Irum D, Karamanli Can, Wong Nathan C K, Murphy Robbie, Alskaf Ebraham, Neji Radhouene, O'Neill Mark, Williams Steven E, Scannell Cian M, Plein Sven, Chiribiri Amedeo
School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom; Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom.
School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom; Magnetic Resonance Research Collaborations, Siemens Healthcare Limited, Camberley, United Kingdom.
J Cardiovasc Magn Reson. 2025 Jun 6;27(2):101917. doi: 10.1016/j.jocmr.2025.101917.
Stress perfusion cardiovascular magnetic resonance (CMR) in the presence of atrial fibrillation (AF) has long been challenging due to electrocardiogram (ECG) mis-triggering. However, non-invasive ischemia imaging is important due to an increased risk of myocardial infarction in patients with AF, which has been attributed to underlying microvascular dysfunction. Myocardial blood flow (MBF) in patients with AF is poorly understood, and few studies have attempted to quantify this through non-invasive imaging.
Patients were recruited for stress perfusion CMR using a research sequence at 3-Tesla. Image acquisition occurred during both vasodilator-induced hyperemia and at rest. Stress and rest MBF maps were automatically generated. Analysis of perfusion maps included assessment of myocardial perfusion reserve (MPR) and endocardial-to-epicardial MBF ratios.
Around 442 patients were analyzed; 63 of whom had a history of AF and were in AF during the scan. Both MBF during hyperemia (stress MBF) and MPR were reduced in patients with AF compared to those in sinus rhythm (median stress MBF 1.85 [1.52-2.24] vs. 2.35 [1.98-2.77] mL/min/g, p<0.001; median MPR 1.95 [1.62-2.19] vs. 2.37 [2.05-2.80], p<0.001). No significant difference was seen between the two groups at rest (p=0.451). When considering co-factors affecting MBF, multivariate linear regression analysis identified the presence of AF as a significant independent contributor to stress MBF and MPR values. Both endocardial and epicardial stress MBF and MPR were reduced in AF compared with sinus rhythm (both p<0.001) and endocardial/epicardial ratios were similar between the groups.
Automated quantitative MBF assessment can be performed in patients with AF. At hyperemia, MBF is reduced in AF compared to sinus rhythm.
由于心电图（ECG）触发错误，长期以来，在心房颤动（AF）患者中进行应力灌注心血管磁共振成像（CMR）一直具有挑战性。然而，由于AF患者心肌梗死风险增加，无创性缺血成像很重要，这归因于潜在的微血管功能障碍。AF患者的心肌血流量（MBF）了解甚少，很少有研究试图通过无创成像对其进行量化。
使用3特斯拉的研究序列招募患者进行应力灌注CMR检查。在血管扩张剂诱导的充血期和静息期进行图像采集。自动生成应力和静息MBF图。灌注图分析包括评估心肌灌注储备（MPR）和心内膜与心外膜MBF比值。
共分析了约442例患者；其中63例有AF病史且在扫描期间处于AF状态。与窦性心律患者相比，AF患者充血期的MBF（应力MBF）和MPR均降低（应力MBF中位数1.85[1.52 - 2.24]对2.35[1.98 - 2.77]mL/min/g，p<0.001；MPR中位数1.95[1.62 - 2.19]对2.37[2.05 - 2.80]，p<0.001）。两组在静息期无显著差异（p = 0.451）。在考虑影响MBF的协变量时，多变量线性回归分析确定AF的存在是应力MBF和MPR值的重要独立影响因素。与窦性心律相比，AF患者的心内膜和心外膜应力MBF及MPR均降低（均p<0.001），且两组的心内膜/心外膜比值相似。
AF患者可进行自动定量MBF评估。在充血期时，与窦性心律相比，AF患者的MBF降低。
