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Noninvasive quantification of left-to-right shunt by phase contrast magnetic resonance imaging in secundum atrial septal defect: the effects of breath holding and comparison with invasive oximetry

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Abstract

To investigate the effect of breath-holding on left-to-right shunts in patients with a secundum atrial septal defect (ASD). Thirty-five consecutive patients with secundum ASDs underwent right heart catheterization and invasive oximetry. Phase-contrast magnetic resonance imaging (MRI) was performed for the main pulmonary artery and ascending aorta. All measurements were obtained during free breathing (FB) (quiet breathing; no breath-hold), expiratory breath-hold (EBH), and inspiratory breath-hold (IBH). Pulmonary circulation flow (Qp) and systemic circulation flow (Qs) were calculated by multiplying the heart rate by the stroke volume. Measurements during FB, EBH, and IBH were compared, and the differences compared to invasive oximetry were evaluated. There were significant differences among the measurements during FB, EBH, and IBH for Qp (FB, 7.70 ± 2.68; EBH, 7.18 ± 2.34; IBH, 6.88 ± 2.51 l/min); however, no significant difference was found for Qs (FB, 3.44 ± 0.74; EBH, 3.40 ± 0.83; IBH, 3.40 ± 0.86 l/min). There were significant differences among the measurements during FB, EBH, and IBH for Qp/Qs (FB, 2.38 ± 1.12; EBH, 2.24 ± 0.95; IBH, 2.14 ± 0.97). Qp/Qs during FB and EBH correlated better with Qp/Qs measured by invasive oximetry than did IBH. The limit of agreement was smaller for EBH than for FB and IBH. In patients with secundum ASDs, Qp/Qs significantly decreased with breath-holding. The accuracy of the Qp/Qs measurement by MRI compared with invasive oximetry during EBH was higher than during FB and IBH.

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Acknowledgements

This work was supported by the Japan Society for the Promotion of Science (JSPS), KAKENHI (15H06478).

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Authors and Affiliations

  1. Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan

    Yuzo Yamasaki, Takeshi Kamitani, Koji Sagiyama & Hiroshi Honda

  2. Department of Molecular Imaging & Diagnosis, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan

    Satoshi Kawanami

  3. Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan

    Ichiro Sakamoto & Ken-ichi Hiasa

  4. Department of Health Sciences, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan

    Hidetake Yabuuchi

  5. Department of Diagnostic Imaging and Nuclear Medicine, Tokyo Women’s Medical University, Tokyo, Japan

    Michinobu Nagao

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  1. Yuzo Yamasaki
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  2. Satoshi Kawanami
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  3. Takeshi Kamitani
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  4. Koji Sagiyama
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  5. Ichiro Sakamoto
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  6. Ken-ichi Hiasa
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  7. Hidetake Yabuuchi
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  8. Michinobu Nagao
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  9. Hiroshi Honda
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Corresponding author

Correspondence to Yuzo Yamasaki.

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Conflict of interest

S. Kawanami: Bayer Healthcare Japan, Modest, Research Grant; Philips Electronics Japan, Modest, Research Grant. Other authors: None.

Ethics approval

The study was approved by our institutional review board.

Informed consent

Written informed consent was obtained from each patient prior to imaging.

Appendix

Appendix

See Fig. 8.

Fig. 8
figure 8

Agreement between Qp values by MRI and that by invasive oximetry. FB free breath, EBH expiratory breath hold, IBH inspiratory breath hold, LOA limit of agreement

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Yamasaki, Y., Kawanami, S., Kamitani, T. et al. Noninvasive quantification of left-to-right shunt by phase contrast magnetic resonance imaging in secundum atrial septal defect: the effects of breath holding and comparison with invasive oximetry. Int J Cardiovasc Imaging 34, 931–937 (2018). https://doi.org/10.1007/s10554-018-1297-1

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  • DOI: https://doi.org/10.1007/s10554-018-1297-1

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