PMID- 26684978 OWN - NLM STAT- MEDLINE DCOM- 20161017 LR - 20220129 IS - 1876-7591 (Electronic) IS - 1936-878X (Print) IS - 1876-7591 (Linking) VI - 9 IP - 1 DP - 2016 Jan TI - Adenosine Stress and Rest T1 Mapping Can Differentiate Between Ischemic, Infarcted, Remote, and Normal Myocardium Without the Need for Gadolinium Contrast Agents. PG - 27-36 LID - S1936-878X(15)00770-6 [pii] LID - 10.1016/j.jcmg.2015.08.018 [doi] AB - OBJECTIVES: The aim of this study was to evaluate the potential of T1 mapping at rest and during adenosine stress as a novel method for ischemia detection without the use of gadolinium contrast. BACKGROUND: In chronic coronary artery disease (CAD), accurate detection of ischemia is important because targeted revascularization improves clinical outcomes. Myocardial blood volume (MBV) may be a more comprehensive marker of ischemia than myocardial blood flow. T1 mapping using cardiac magnetic resonance (CMR) is highly sensitive to changes in myocardial water content, including MBV. We propose that T1 mapping at rest and during adenosine vasodilatory stress can detect MBV changes in normal and diseased myocardium in CAD. METHODS: Twenty normal controls (10 at 1.5-T; 10 at 3.0-T) and 10 CAD patients (1.5-T) underwent conventional CMR to assess for left ventricular function (cine), infarction (late gadolinium enhancement [LGE]) and ischemia (myocardial perfusion reserve index [MPRI] on first-pass perfusion imaging during adenosine stress). These were compared to novel pre-contrast stress/rest T1 mapping using the Shortened Modified Look-Locker Inversion recovery technique, which is heart rate independent. T1 values were derived for normal myocardium in controls and for infarcted, ischemic, and remote myocardium in CAD patients. RESULTS: Normal myocardium in controls (normal wall motion, MPRI, no LGE) showed normal resting T1 (954 +/- 19 ms at 1.5-T; 1,189 +/- 34 ms at 3.0-T) and significant positive T1 reactivity during adenosine stress compared to baseline (6.2 +/- 0.5% at 1.5-T; 6.3 +/- 1.1% at 3.0-T; all p < 0.0001). Infarcted myocardium showed the highest resting T1 of all tissue classes (1,442 +/- 84 ms), without significant T1 reactivity (0.2 +/- 1.5%). Ischemic myocardium showed elevated resting T1 compared to normal (987 +/- 17 ms; p < 0.001) without significant T1 reactivity (0.2 +/- 0.8%). Remote myocardium, although having comparable resting T1 to normal (955 +/- 17 ms; p = 0.92), showed blunted T1 reactivity (3.9 +/- 0.6%; p < 0.001). CONCLUSIONS: T1 mapping at rest and during adenosine stress can differentiate between normal, infarcted, ischemic, and remote myocardium with distinctive T1 profiles. Stress/rest T1 mapping holds promise for ischemia detection without the need for gadolinium contrast. CI - Copyright (c) 2016 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved. FAU - Liu, Alexander AU - Liu A AD - Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom. FAU - Wijesurendra, Rohan S AU - Wijesurendra RS AD - Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom. FAU - Francis, Jane M AU - Francis JM AD - Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom. FAU - Robson, Matthew D AU - Robson MD AD - Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom. FAU - Neubauer, Stefan AU - Neubauer S AD - Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom. FAU - Piechnik, Stefan K AU - Piechnik SK AD - Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom. FAU - Ferreira, Vanessa M AU - Ferreira VM AD - Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom. Electronic address: vanessa.ferreira@cardiov.ox.ac.uk. LA - eng GR - FS/15/11/31233/BHF_/British Heart Foundation/United Kingdom GR - G0900883/MRC_/Medical Research Council/United Kingdom PT - Comparative Study PT - Evaluation Study PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20151209 PL - United States TA - JACC Cardiovasc Imaging JT - JACC. Cardiovascular imaging JID - 101467978 RN - 0 (Contrast Media) RN - 0 (Organometallic Compounds) RN - 0 (Vasodilator Agents) RN - 6HG8UB2MUY (Meglumine) RN - K72T3FS567 (Adenosine) RN - L0ND3981AG (gadoterate meglumine) SB - IM CIN - JACC Cardiovasc Imaging. 2016 Jan;9(1):37-9. PMID: 26684977 MH - Adenosine/*administration & dosage MH - Adult MH - Aged MH - Case-Control Studies MH - Contrast Media/administration & dosage MH - *Coronary Circulation MH - Diagnosis, Differential MH - Female MH - Humans MH - *Magnetic Resonance Imaging, Cine MH - Male MH - Meglumine/administration & dosage MH - Middle Aged MH - Myocardial Infarction/*diagnosis/pathology/physiopathology MH - Myocardial Ischemia/*diagnosis/pathology/physiopathology MH - Myocardial Perfusion Imaging/*methods MH - Myocardium/*pathology MH - Organometallic Compounds/administration & dosage MH - Predictive Value of Tests MH - Vasodilator Agents/*administration & dosage MH - Ventricular Function, Left MH - Young Adult PMC - PMC4708879 OTO - NOTNLM OT - ShMOLLI OT - T1 mapping OT - adenosine stress OT - cardiac magnetic resonance OT - ischemia EDAT- 2015/12/20 06:00 MHDA- 2016/10/19 06:00 PMCR- 2016/01/01 CRDT- 2015/12/20 06:00 PHST- 2015/03/03 00:00 [received] PHST- 2015/08/25 00:00 [revised] PHST- 2015/08/27 00:00 [accepted] PHST- 2015/12/20 06:00 [entrez] PHST- 2015/12/20 06:00 [pubmed] PHST- 2016/10/19 06:00 [medline] PHST- 2016/01/01 00:00 [pmc-release] AID - S1936-878X(15)00770-6 [pii] AID - 10.1016/j.jcmg.2015.08.018 [doi] PST - ppublish SO - JACC Cardiovasc Imaging. 2016 Jan;9(1):27-36. doi: 10.1016/j.jcmg.2015.08.018. Epub 2015 Dec 9.