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Rapid rest/stress regadenoson ungated perfusion CMR for detection of coronary artery disease in patients with atrial fibrillation

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Abstract

Cardiovascular magnetic resonance (CMR) perfusion has been established as a useful imaging modality for the detection of coronary artery disease (CAD). However, there are several limitations when applying standard, ECG-gated stress/rest perfusion CMR to patients with atrial fibrillation (AF). In this study we investigate an approach with no ECG gating and a rapid rest/stress perfusion protocol to determine its accuracy for detection of CAD in patients with AF. 26 patients with AF underwent a rapid rest/regadenoson stress CMR perfusion imaging protocol, and all patients had X-ray coronary angiography. An ungated radial myocardial perfusion sequence was used. Imaging protocol included: rest perfusion image acquisition, followed nearly immediately by administration of regadenoson to induce hyperemia, 60 s wait, and stress image acquisition. CMR perfusion images were interpreted by three blinded readers as normal or abnormal. Diagnostic accuracy was evaluated by comparison to X-ray angiography. 21 of the CMR rest/stress perfusion scans were negative, and 5 were positive by angiography criteria. Majority results of the ungated datasets from all of the readers showed a sensitivity, specificity and accuracy of 80, 100 and 96%, respectively, for detection of CAD. An ungated, rapid rest/stress regadenoson perfusion CMR protocol appears to be useful for the diagnosis of obstructive CAD in patients with AF.

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Abbreviations

CMR:

Cardiovascular magnetic resonance

CAD:

Coronary artery disease

AF:

Atrial fibrillation

SPECT:

Single positron emission computed tomography

MRI:

Magnetic resonance imaging

LGE:

Late gadolinium enhancement

FFR:

Fractional flow reserve

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Acknowledgements

We would like to thank Ashlee Rooks, who coordinated the study, the three readers for the study, and the MRI technologists who performed the image acquisition. We would also like to thank each of the patients who participated.

Author contributions

EB, IH, GA, and LC made significant contributions to the data acquisition, analysis and interpretation, made significant contributions to drafting the manuscript, and read and approved the final manuscript. PS and DL made significant contributions to data acquisition, and read and approved the final manuscript. AS and LJ made significant contributions to the image interpretation design and read and approved the final manuscript. CM made significant contributions to the conception and design of the study, analysis and interpretation, and read and approved the final manuscript. BW and ED made significant contributions to the conception and design of the study, data acquisition, analysis and interpretation, and critically reviewed and approved the final manuscript. All authors agreed to be accountable for the accuracy and integrity of the work.

Funding

We would like to acknowledge funding sources Astellas Pharma and the National Heart, Lung, and Blood Institute of the National Institutes of Health R01HL113224. The content is solely the responsibility of the authors and does not necessarily represent the official views of the funding entities.

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Authors and Affiliations

  1. Division of Cardiovascular Medicine, University of Utah, 50 N Medical Dr, Salt Lake City, UT, 84132, USA

    Erik T. Bieging, I. Haider, L. Chang, P. Suksaranjit & B. D. Wilson

  2. Department of Radiology and Imaging Sciences, Utah Center for Advanced Imaging Research, University of Utah, 729 Arapeen Drive, Salt Lake City, UT, 84108, USA

    G. Adluru, D. Likhite, A. Shaaban, L. Jensen & E. DiBella

  3. Department of Cardiology, Swedish Medical Center, 550 17th Ave, Seattle, WA, 98122, USA

    C. J. McGann

Authors
  1. Erik T. Bieging
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  2. I. Haider
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  3. G. Adluru
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  4. L. Chang
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  5. P. Suksaranjit
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  6. D. Likhite
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  7. A. Shaaban
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  8. L. Jensen
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  9. B. D. Wilson
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  10. C. J. McGann
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  11. E. DiBella
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Corresponding author

Correspondence to Erik T. Bieging.

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Conflict of interest

The authors declare that they have no competing interests.

Ethical approval

The University of Utah Institutional Review Board approved the study. Written consent for participation was obtained from all participants.

Consent for publication

Written consent for publication was obtained from all study participants.

Availability of data and material

The datasets analyzed during the current study are available from the corresponding author on reasonable request.

Additional information

Trial Registrations ClinicalTrials.gov Identifier: NCT01710254, Date of registration: October 2, 2012.

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Bieging, E.T., Haider, I., Adluru, G. et al. Rapid rest/stress regadenoson ungated perfusion CMR for detection of coronary artery disease in patients with atrial fibrillation. Int J Cardiovasc Imaging 33, 1781–1788 (2017). https://doi.org/10.1007/s10554-017-1168-1

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  • DOI: https://doi.org/10.1007/s10554-017-1168-1

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