Breath-Hold Dobutamine Magnetic Resonance Myocardial Tagging: Normal Left Ventricular Response

doi:10.1016/S0002-9149(97)00640-1

The American Journal of Cardiology

Volume 80, Issue 9, 1 November 1997, Pages 1203-1207

https://doi.org/10.1016/S0002-9149(97)00640-1 Get rights and content

Abstract

Analysis of the changes in myocardial deformation produced by adrenergic stress has been limited by the imaging techniques used. We used rapid magnetic resonance imaging (MRI) myocardial tagging to map the dose-dependent response to incremental dobutamine in the normal human left ventricle. Thirteen volunteers underwent breath-hold tagged cine MRI during dobutamine infusion. Images were acquired throughout systole to a peak dose of 20 μg/kg/min. End-systolic percent circumferential shortening (%S) was measured at 3 transmural locations and 4 circumferential locations at 3 long-axis positions. Mean circumferential shortening velocity (CSV) was also calculated at each location and dose. Mean %S reached a maximum of 26 ± 3% at 10 μg/kg/min compared with 21 ± 4% at baseline (p <0.003). Peak %S was reached by 10 μg/kg/min before a significant increase in heart rate or blood pressure and was unchanged at higher doses. In contrast, CSV increased linearly with dobutamine dose from 4.4 ± 0.9 mm/s at baseline to 9.8 ± 1.4 mm/s at 20 μg/kg/min (p <0.0001). Breath-hold tagged dobutamine MRI is safe and effective in detecting regional and transmural changes in function during incremental dobutamine. CSV increased continuously across the dobutamine dose range. At low dose (≤10 μg/kg/min) %S increased without any change in blood pressure or heart rate. Maintenance of peak %S beyond 10 μg/kg/min in the presence of decreasing systolic intervals resulted from a continued increase in CSV. Thus, CSV may be the preferred measure of contractile function during dobutamine stimulation in human myocardium.

Section snippets

Subjects:

Thirteen volunteers (10 men aged 27 to 53 years) without clinical or echocardiographic evidence of cardiac disease underwent dobutamine echocardiography and dobutamine MRI studies within 1 week of each other. All subjects gave informed consent and the protocol was approved by the institutional review board.

Dobutamine Echocardiography:

As a safety measure and to assure the normality of our volunteers, dobutamine echocardiography was performed before dobutamine MRI using dose increments of 5, 10, 15, 20, 30, and 40 μg/kg/min

Results

MRI tagged images suitable for quantitative analysis of circumferential segment shortening were obtained in all subjects with 20 μg/kg/min of dobutamine. Images at the 30- and 40–μg/kg/min infusion rate were technically inadequate for quantitation in 9 of 13 subjects, most often due to an inadequate electrocardiogram at the highest heart rates. Fig. 1A Fig. 1B Fig. 1C display the progressive increase in intramural myocardial tag-line deformation seen in an end-systolic, midventricular

Discussion

We found that at low dobutamine doses, CSV increased in the presence of a constant heart rate due to an increase in %S. Reductions (>10 μg/kg/min) in the systolic interval, associated with increasing heart rate, were the major cause of the continued increase in CSV since %S did not increase beyond the 10-μg/kg/min level.

At low doses (≤10 μg/kg/min) in the present study, the increase in heart rate and blood pressure were not significant, consistent with the findings of Carstensen et al.[21]

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Highly accelerated free-breathing real-time myocardial tagging for exercise cardiovascular magnetic resonance
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Exercise cardiovascular magnetic resonance (Ex-CMR) myocardial tagging would enable quantification of myocardial deformation after exercise. However, current electrocardiogram (ECG)-segmented sequences are limited for Ex-CMR.
We developed a highly accelerated balanced steady-state free-precession real-time tagging technique for 3 T. A 12-fold acceleration was achieved using incoherent sixfold random Cartesian sampling, twofold truncated outer phase encoding, and a deep learning resolution enhancement model. The technique was tested in two prospective studies. In a rest study of 27 patients referred for clinical CMR and 19 healthy subjects, a set of ECG-segmented for comparison and two sets of real-time tagging images for repeatability assessment were collected in 2-chamber and short-axis views with spatiotemporal resolution 2.0 × 2.0 mm² and 29 ms. In an Ex-CMR study of 26 patients with known or suspected cardiac disease and 23 healthy subjects, real-time images were collected before and after exercise. Deformation was quantified using measures of short-axis global circumferential strain (GCS). Two experienced CMR readers evaluated the image quality of all real-time data pooled from both studies using a 4-point Likert scale for tagline quality (1-excellent; 2-good; 3-moderate; 4-poor) and artifact level (1-none; 2-minimal; 3-moderate; 4-significant). Statistical evaluation included Pearson correlation coefficient (r), intraclass correlation coefficient (ICC), and coefficient of variation (CoV).
In the rest study, deformation was successfully quantified in 90% of cases. There was a good correlation (r = 0.71) between ECG-segmented and real-time measures of GCS, and repeatability was good to excellent (ICC = 0.86 [0.71, 0.94]) with a CoV of 4.7%. In the Ex-CMR study, deformation was successfully quantified in 96% of subjects pre-exercise and 84% of subjects post-exercise. Short-axis and 2-chamber tagline quality were 1.6 ± 0.7 and 1.9 ± 0.8 at rest and 1.9 ± 0.7 and 2.5 ± 0.8 after exercise, respectively. Short-axis and 2-chamber artifact level was 1.2 ± 0.5 and 1.4 ± 0.7 at rest and 1.3 ± 0.6 and 1.5 ± 0.8 post-exercise, respectively.
We developed a highly accelerated real-time tagging technique and demonstrated its potential for Ex-CMR quantification of myocardial deformation. Further studies are needed to assess the clinical utility of our technique.
Straining for perfection
2011, Journal of the American College of Cardiology
Myocardial tagging by Cardiovascular Magnetic Resonance: evolution of techniques–pulse sequences, analysis algorithms, and applications
2011, Journal of Cardiovascular Magnetic Resonance
Cardiovascular magnetic resonance (CMR) tagging has been established as an essential technique for measuring regional myocardial function. It allows quantification of local intramyocardial motion measures, e.g. strain and strain rate. The invention of CMR tagging came in the late eighties, where the technique allowed for the first time for visualizing transmural myocardial movement without having to implant physical markers. This new idea opened the door for a series of developments and improvements that continue up to the present time. Different tagging techniques are currently available that are more extensive, improved, and sophisticated than they were twenty years ago. Each of these techniques has different versions for improved resolution, signal-to-noise ratio (SNR), scan time, anatomical coverage, three-dimensional capability, and image quality. The tagging techniques covered in this article can be broadly divided into two main categories: 1) Basic techniques, which include magnetization saturation, spatial modulation of magnetization (SPAMM), delay alternating with nutations for tailored excitation (DANTE), and complementary SPAMM (CSPAMM); and 2) Advanced techniques, which include harmonic phase (HARP), displacement encoding with stimulated echoes (DENSE), and strain encoding (SENC). Although most of these techniques were developed by separate groups and evolved from different backgrounds, they are in fact closely related to each other, and they can be interpreted from more than one perspective. Some of these techniques even followed parallel paths of developments, as illustrated in the article. As each technique has its own advantages, some efforts have been made to combine different techniques together for improved image quality or composite information acquisition. In this review, different developments in pulse sequences and related image processing techniques are described along with the necessities that led to their invention, which makes this article easy to read and the covered techniques easy to follow. Major studies that applied CMR tagging for studying myocardial mechanics are also summarized. Finally, the current article includes a plethora of ideas and techniques with over 300 references that motivate the reader to think about the future of CMR tagging.
Steadily straining toward clinical utility: Real-time quantitative CMR of myocardial deformation during stress
2010, JACC: Cardiovascular Imaging
Strain-encoded CMR for the detection of inducible ischemia during intermediate stress
2010, JACC: Cardiovascular Imaging
Citation Excerpt :
On the other hand, strain remained constant in nonischemic segments (SReserve ∼1) and decreased stepwise during intermediate and peak stress in ischemic segments. Conversely, using magnetic resonance tagging, circumferential strain was previously shown to slightly increase (by 10% to 20%) during low-dose inotropic stimulation in normal segments (13). This mismatch may be attributed to differences in methodology used for the acquisition of SENC images, where in contrast to conventional tagging, the gradient is applied in the slice-selection direction, orthogonal to the imaging plane and not in the phase- or frequency-encoding direction (14).
This study sought to evaluate the diagnostic accuracy of strain-encoded cardiac magnetic resonance (SENC) for the detection of inducible ischemia during intermediate stress.
High-dose dobutamine stress cardiac magnetic resonance (DS-CMR) is a well-established modality for the noninvasive detection of coronary artery disease (CAD). However, the assessment of cine scans relies on the visual interpretation of wall motion, which is subjective, and modalities that can objectively and quantitatively assess the time course of myocardial strain response during stress are lacking.
Stress-induced ischemia was assessed by wall motion analysis and by SENC in 80 patients with suspected or known CAD and in 18 healthy volunteers who underwent DS-CMR in a clinical 1.5-T scanner. Quantitative coronary angiography was used as the standard reference for the presence of CAD (≥50% diameter stenosis).
On a patient level, 46 of 80 patients (58%) had CAD, including 20 with single-vessel, 18 with 2-vessel, and 8 with 3-vessel disease. During peak stress, SENC correctly detected ischemia in 45 versus 38 of 46 patients with CAD (7 additional correct findings for SENC), yielding significantly higher sensitivity than cine (98% vs. 83%, p < 0.05). No patients were correctly diagnosed by cine and missed by SENC. During intermediate stress, SENC showed diagnostic value similar to that provided by cine imaging only during peak dobutamine stress (sensitivity of 76% vs. 83%, specificity of 88% vs. 91%, and accuracy of 81% vs. 86%; p = NS for all). Quantification analysis demonstrated that strain rate response is a highly sensitive marker for the detection of inducible ischemia (area under the curve = 0.96; SE = 0.01; 95% confidence interval: 0.93 to 0.99) that precedes the development of inducible wall motion abnormalities and already significantly decreases with moderate 40% to 60% coronary lesions.
Using SENC, CAD can be detected during intermediate stress with similar accuracy to that provided by cine only during peak stress. By this approach, patient safety may be improved during diagnostic procedures within lower time spent (Strain-Encoded Cardiac Magnetic Resonance Imaging for Dobutamine Stress Testing; NCT00758654
MRI of left ventricular function
2007, Journal of Nuclear Cardiology
Cardiac magnetic resonance imaging (CMR) is widely recognized as the most accurate noninvasive imaging modality for the assessment of left ventricular (LV) function. By use of state-of-the-art magnetic resonance imaging (MRI) scanners, electrocardiography (ECG)–gated cine images depicting LV function with high contrast and excellent spatial and temporal resolution are readily acquired in breath-holds of 5 to 10 heartbeats. For patients in whom breath-holding and ECG gating are difficult, real-time cine imaging without ECG gating and breath-holding can be performed. LV function can be qualitatively assessed from cine images, or alternatively, parameters such as LV volumes, ejection fraction, and mass may be quantified via computer-based analysis software. In addition, techniques such as myocardial tagging and newer variants can be used to qualitatively or quantitatively assess regional intramyocardial strain, twist, and torsion. Many of the CMR methods have undergone clinical evaluation in the settings of high-dose dobutamine stress testing and determination of myocardial viability. These methods are also very accurate for prognosis in coronary heart disease patients and may be quite useful for the detection of contractile dyssynchrony. When used together with other CMR techniques such as first-pass perfusion imaging or late gadolinium enhancement, CMR of LV function provides a wealth of information in a single imaging study.

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^☆: This study was supported by an American Heart Association Pennsylvania Affiliate Fellowship Grant and the Allegheny-Singer Research Institute, Pittsburgh, Pennsylvania.

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flaBreath-Hold Dobutamine Magnetic Resonance Myocardial Tagging: Normal Left Ventricular Response☆

Abstract

Section snippets

Subjects:

Dobutamine Echocardiography:

Results

Discussion

J Am Cardiol

J Am Coll Cardiol

J Am Coll Cardiol

J Am Coll Cardiol

J Am Coll Cardiol

J Am Coll Cardiol

J Am Coll Cardiol

J Am Coll Cardiol

J Am Coll Cardiol

Echocardiographic detection of coronary artery disease during dobutamine infusion

Circulation

Accuracy of dobutamine stress echocardiography in detecting coronary artery disease

J Am Coll Cardiol

Quantitation of global and regional left ventricular function by cine magnetic resonance imaging during dobutamine stress in normal human subjects

Eur Heart J

Assessment of magnetic resonance velocity mapping of global ventricular function during dobutamine infusion in coronary artery disease

Br Heart J

Magnetic resonance imaging during dobutamine stress for detection and localization of coronary artery disease

Circulation

fla
Breath-Hold Dobutamine Magnetic Resonance Myocardial Tagging: Normal Left Ventricular Response☆