Real-time cine and myocardial perfusion with treadmill exercise stress cardiovascular magnetic resonance in patients referred for stress SPECT.
Real-time cine and myocardial perfusion with treadmill exercise stress cardiovascular magnetic resonance in patients referred for stress SPECT.
复制标题
DOI：
10.1186/1532-429x-12-41
复制
发表时间：
2010-07-12
期刊：
影响因子：
--
通讯作者：
Simonetti OP
中科院分区：
文献类型：
--
作者：
Raman SV;Dickerson JA;Jekic M;Foster EL;Pennell ML;McCarthy B;Simonetti OP
迄今为止，应力心血管磁共振（CMR）依赖于药物，因此缺乏生理信息，只有运动应激。43例年龄25 ~ 81岁的患者接受了结合Tc 99 m SPECT和CMR的平板运动负荷试验。在静息Tc 99 mSPECT成像后，患者接受静息电影CMR。然后，患者使用部分改良的跑步机进行室内运动应激。12-全程进行导联心电图监测。在峰值应力时，注射Tc 99 m，患者迅速返回到磁体中的先前位置，进行运动后电影和灌注成像。将患者扫描床从磁体中拉出，以进行恢复监测。患者被送回磁体中进行恢复电影和静息灌注，随后进行延迟钆后成像。CMR后，患者前往邻近的SPECT实验室完成应力核成像。对每种模式的图像进行审查，而对另一种模式的结果不知情。患者完成布鲁斯方案的平均时间为9.3 ± 2.4分钟。运动结束后，负荷电影CMR在68 ± 14秒内完成，负荷灌注CMR在88 ± 8秒内完成。SPECT和CMR之间的一致性为中等（κ = 0.58）。在8例接受冠状动脉造影的患者中，CMR和SPECT的准确性分别为7/8和5/8（p = 0.625）。6个月随访表明，29/29例CMR阴性患者和33/34例SPECT阴性患者无心血管事件。运动负荷CMR包括室壁运动和灌注在疑似缺血性心脏病患者中是可行的。基于该试点研究的有希望的结果，需要进行更大规模的临床试验，以比较该应力成像系统与其他应力成像模式的有效性研究。
To date, stress cardiovascular magnetic resonance (CMR) has relied on pharmacologic agents, and therefore lacked the physiologic information available only with exercise stress. 43 patients age 25 to 81 years underwent a treadmill stress test incorporating both Tc99m SPECT and CMR. After rest Tc99m SPECT imaging, patients underwent resting cine CMR. Patients then underwent in-room exercise stress using a partially modified treadmill. 12-lead ECG monitoring was performed throughout. At peak stress, Tc99m was injected and patients rapidly returned to their prior position in the magnet for post-exercise cine and perfusion imaging. The patient table was pulled out of the magnet for recovery monitoring. The patient was sent back into the magnet for recovery cine and resting perfusion followed by delayed post-gadolinium imaging. Post-CMR, patients went to the adjacent SPECT lab to complete stress nuclear imaging. Each modality's images were reviewed blinded to the other's results. Patients completed on average 9.3 ± 2.4 min of the Bruce protocol. Stress cine CMR was completed in 68 ± 14 sec following termination of exercise, and stress perfusion CMR was completed in 88 ± 8 sec. Agreement between SPECT and CMR was moderate (κ = 0.58). Accuracy in eight patients who underwent coronary angiography was 7/8 for CMR and 5/8 for SPECT (p = 0.625). Follow-up at 6 months indicated freedom from cardiovascular events in 29/29 CMR-negative and 33/34 SPECT-negative patients. Exercise stress CMR including wall motion and perfusion is feasible in patients with suspected ischemic heart disease. Larger clinical trials are warranted based on the promising results of this pilot study to allow comparative effectiveness studies of this stress imaging system vs. other stress imaging modalities.