Kady Fischer1, Dominik P Guensch2, Matthias G Friedrich3. 1. Philippa and Marvin Carsley CMR Centre at the Montreal Heart Institute, 5000 Belanger Street, Montreal, QC, Canada H1 T 1C8. 2. Philippa and Marvin Carsley CMR Centre at the Montreal Heart Institute, 5000 Belanger Street, Montreal, QC, Canada H1 T 1C8 Department Anesthesiology and Pain Therapy, Bern University Hospital, Bern, Switzerland. 3. Philippa and Marvin Carsley CMR Centre at the Montreal Heart Institute, 5000 Belanger Street, Montreal, QC, Canada H1 T 1C8 Departments of Cardiology and Radiology, Université de Montréal, Montreal, QC, Canada mgwfriedrich@gmail.com.
Abstract
AIMS: Testing for inducible myocardial ischaemia is one of the most important diagnostic procedures and has a strong impact on clinical decision-making. Current standard protocols are typically limited by the required infusion of vasodilatory substances. Recent data indicate that changes of myocardial oxygenation induced by hyperventilation and breath-holds can be monitored by oxygenation-sensitive (OS) cardiovascular magnetic resonance (CMR) and may be useful for assessing coronary vascular function. As tests using breathing manoeuvres may be safer, easier, and more comfortable than vasodilator stress agent infusion, we compared its impact on myocardial oxygenation with that of a standard adenosine infusion protocol. METHODS AND RESULTS: In 20 healthy volunteers, we assessed changes of myocardial oxygenation using OS-CMR at 3 T during adenosine infusion (140 µg/kg/min, i.v.) and during voluntary breathing manoeuvres: a maximal breath-hold following normal breathing and a maximal breath-hold following 60 s of hyperventilation. The study was successfully completed in 19 subjects. There was a significantly stronger myocardial response for hyperventilation (decrease of -10.6 ± 7.8%) and the following breath-hold (increase of 14.8 ± 6.6%) than adenosine (3.9 ± 6.5%), whereas a simple maximal voluntary breath-hold yielded a similar signal intensity increase (3.1 ± 3.9%). Subjective side effects occurred significantly more often with adenosine, especially in females. CONCLUSIONS: Hyperventilation combined with a subsequent long breath-hold and hyperventilation alone both have a greater impact on myocardial oxygenation changes than an intravenous administration of a standard dose of adenosine, as assessed by OS-CMR. Breathing manoeuvres may be more efficient, safer, and more comfortable than adenosine for the assessment of the coronary vasomotor response. Published on behalf of the European Society of Cardiology. All rights reserved.
AIMS: Testing for inducible myocardial ischaemia is one of the most important diagnostic procedures and has a strong impact on clinical decision-making. Current standard protocols are typically limited by the required infusion of vasodilatory substances. Recent data indicate that changes of myocardial oxygenation induced by hyperventilation and breath-holds can be monitored by oxygenation-sensitive (OS) cardiovascular magnetic resonance (CMR) and may be useful for assessing coronary vascular function. As tests using breathing manoeuvres may be safer, easier, and more comfortable than vasodilator stress agent infusion, we compared its impact on myocardial oxygenation with that of a standard adenosine infusion protocol. METHODS AND RESULTS: In 20 healthy volunteers, we assessed changes of myocardial oxygenation using OS-CMR at 3 T during adenosine infusion (140 µg/kg/min, i.v.) and during voluntary breathing manoeuvres: a maximal breath-hold following normal breathing and a maximal breath-hold following 60 s of hyperventilation. The study was successfully completed in 19 subjects. There was a significantly stronger myocardial response for hyperventilation (decrease of -10.6 ± 7.8%) and the following breath-hold (increase of 14.8 ± 6.6%) than adenosine (3.9 ± 6.5%), whereas a simple maximal voluntary breath-hold yielded a similar signal intensity increase (3.1 ± 3.9%). Subjective side effects occurred significantly more often with adenosine, especially in females. CONCLUSIONS: Hyperventilation combined with a subsequent long breath-hold and hyperventilation alone both have a greater impact on myocardial oxygenation changes than an intravenous administration of a standard dose of adenosine, as assessed by OS-CMR. Breathing manoeuvres may be more efficient, safer, and more comfortable than adenosine for the assessment of the coronary vasomotor response. Published on behalf of the European Society of Cardiology. All rights reserved.
Authors: Dominik P Guensch; Kady Fischer; Christof Jung; Samuel Hurni; Bernhard M Winkler; Bernd Jung; Andreas P Vogt; Balthasar Eberle Journal: PLoS One Date: 2019-01-16 Impact factor: 3.240
Authors: Dominik P Guensch; Matthias C Michel; Stefan P Huettenmoser; Bernd Jung; Patrik Gulac; Adrian Segiser; Sarah L Longnus; Kady Fischer Journal: Sci Rep Date: 2021-06-01 Impact factor: 4.379
Authors: Maaike van den Boomen; Mary Kate Manhard; Gert Jan H Snel; SoHyun Han; Kyrre E Emblem; Riemer H J A Slart; David E Sosnovik; Ciprian Catana; Bruce R Rosen; Niek H J Prakken; Christopher T Nguyen; Ronald J H Borra; Kawin Setsompop Journal: Radiology Date: 2020-01-21 Impact factor: 29.146
Authors: Susie Parnham; Jonathan M Gleadle; Sripal Bangalore; Suchi Grover; Rebecca Perry; Richard J Woodman; Carmine G De Pasquale; Joseph B Selvanayagam Journal: J Am Heart Assoc Date: 2015-08-10 Impact factor: 5.501