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Breathing maneuvers as a coronary vasodilator for myocardial perfusion imaging
Author(s) -
Teixeira Tiago,
Nadeshalingam Gobinath,
Fischer Kady,
Marcotte François,
Friedrich Matthias G.
Publication year - 2016
Publication title -
journal of magnetic resonance imaging
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.563
H-Index - 160
eISSN - 1522-2586
pISSN - 1053-1807
DOI - 10.1002/jmri.25224
Subject(s) - hyperventilation , medicine , perfusion , cardiology , breathing , nuclear medicine , vasodilation , anesthesia
Purpose A combined breathing maneuver of hyperventilation, followed by a long voluntary breathhold leads to coronary vasodilation. We investigated the impact of breathing maneuvers on MR first‐pass cardiac perfusion imaging and its potential clinical utility. Materials and Methods We studied 24 healthy volunteers (37 ± 12 years; 62.5% men) on a clinical 3 Tesla MRI system and performed first‐pass perfusion MR at rest, during a short breathhold (S‐HVBH) following 60 s of hyperventilation, and at the end of a long breathhold (L‐HVBH) following the hyperventilation, performed in random order. A blinded reader analyzed signal intensity upslope, upslope index, and time between 20 and 80% of maximal signal. Results All volunteers tolerated the breathing maneuvers well and completed the study protocol. The upslope of the signal‐intensity‐over‐time curve was increased during S‐HVBH (1.86 ± 0.70 units/s, P < 0.05) and at the end of L‐LVBH (1.77 ± 0.82 units/s), when compared with baseline results (1.34 ± 0.58 units/s). Corrected for the arterial input, the upslope was higher at the end of the L‐HVBH (0.095 ± 0.019 units/s versus 0.077 ± 0.016 units/s at rest, P < 0.01) as was the myocardial perfusion reserve index (1.25 ± 0.22 versus 1.09 ± 0.17; P < 0.001). In a multiple regression model, only gender, rate‐pressure product, and breathhold time were independently and significantly related to the upslope (R = 0.771; P < 0.001). Conclusion In conclusion, a voluntary long breathhold after hyperventilation leads to an increase of the myocardial perfusion reserve index. This may impact findings from current practice of first‐pass perfusion imaging. The clinical utility of breathing maneuvers as a vasodilatory stimulus for first‐pass perfusion imaging may warrant further research. J. MAGN. RESON. IMAGING 2016;44:947–955.