Hyperventilation-breath-hold maneuver to detect ischemia by strain-encoded CMR: a pilot study to evaluate a needle-free stress protocol. (8th February 2021)

• Record Type: Journal Article
• Authors: Kajzar, I; Ochs, MM; Salatzki, J; Ochs, AT; Riffel, J; Osman, N; Katus, HA; Friedrich, MG
• Is Part Of: European heart journal. Volume 22(2021)Supplement 1
• Publication Date: 2021-02-08
• Subjects: Cardiovascular system -- Imaging -- Periodicals; Heart -- Imaging -- Periodicals; 616.10754
• DOI: 10.1093/ehjci/jeaa356.294
• Languages: English
• ISSNs: 2047-2404

Abstract

Abstract: Funding Acknowledgements: Type of funding sources: None. Background: Safety concerns for gadolinium-containing contrast agents and pharmacological stressors, together with tremendous costs and inconsistent reimbursement modalities are still limiting a widespread application of CMR stress testing despite proven benefits. Like the effect of adenosine, hyperventilation-breath-hold-maneuver (HVBH) has demonstrated to induce myocardial vasodilation and might serve as a stressor to induce coronary steal with consecutive hypokinesia. Purpose: To evaluate the diagnostic accuracy of a needle-free, ultrafast stress test to detect myocardial ischemia by strain-encoded CMR (fSENC) after HVBH. Methods: Patients referred for CMR stress testing underwent an extended protocol in order to evaluate three different stress forms: (1) Adenosine first-pass perfusion (Ad-FPP), (2) Adenosine-fSENC (Ad-fSENC) and (3) HVBH-fSENC. Diagnostic accuracy was assessed using quantitative coronary angiography as reference. Results: One-hundred-twenty-two predominantly male patients (age 66 ± 11years; 80% men) suspected for obstructive CAD were enrolled. Ad-fSENC and HVBH-fSENC provided significantly better diagnostic accuracy than Ad-FPP, both on a patient-level (Ad-fSENC: sensitivity 82%[65-93], specificity 83%[73-90], p < 0.05; HVBH-fSENC: sensitivity 81%[64-93], specificity 86%[77-93], p < 0.05) and territory-level (Ad-fSENC: sensitivity 67%[52-80], specificity 93%[90-96], p < 0.05; HVBH-fSENC: sensitivity 63%[47-76], specificity 95%[91-97], p < 0.05). The stress response of longitudinal strain differs significantly between ischemic and non-ischemic segments to Adenosine (LSischemic = 0.6 ± 5.4%, LSnon-ischemic = 0.9 ± 2.7%, p < 0.05) and HVBH (LSischemic = 1.3 ± 3.8%, LSnon-ischemic=-0.3 ± 1.8%, p = 0.002). Stress test duration of HVBH-fSENC (t = 64 ± 2s) was significantly shortened compared to Ad-fSENC (t = 184 ± 59s, p < 0.0001) or Ad-FPP (t = Ad-FPP: 172 ± 59s, p < 0.0001). Conclusions: Stress testing by HVBH-fSENC provides promising diagnostic accuracy to detect myocardial ischemia and is faster than established methods without the necessity to apply contrast agent or pharmacological stressors.