Related Experiment Video
Updated: May 15, 2026
Oxygenation-sensitive Cardiac MRI with Vasoactive Breathing Maneuvers for the Non-invasive Assessment of Coronary Microvascular Dysfunction
Published on: August 17, 2022
Detecting myocardial ischemia at rest with cardiac phase-resolved blood oxygen level-dependent cardiovascular
Sotirios A Tsaftaris1, Xiangzhi Zhou, Richard Tang
1Departments of Radiology, Northwestern University, Chicago, IL, USA.
Insights
Cardiac phase-resolved blood oxygen level-dependent (CP-BOLD) cardiovascular magnetic resonance effectively detects myocardial ischemia at rest. This technique shows promise for managing severe coronary artery disease before tissue damage occurs.
Area of Science:
- Cardiovascular Imaging
- Biomedical Engineering
- Diagnostic Medicine
Background:
- Early detection of myocardial ischemia is crucial for managing severe coronary artery disease.
- Noninvasive methods are needed to identify ischemic territories and assess cardiac function before irreversible tissue changes.
- Cardiac phase-resolved blood oxygen level-dependent (CP-BOLD) cardiovascular magnetic resonance is explored for its potential in diagnosing resting ischemia.
Purpose of the Study:
- To investigate the efficacy of CP-BOLD cardiovascular magnetic resonance in detecting myocardial ischemia at rest.
- To assess the ability of CP-BOLD to identify ischemic regions secondary to severe coronary artery stenosis.
- To compare CP-BOLD's diagnostic performance with standard cine imaging and functional assessments.
Main Methods:
- CP-BOLD, standard cine, and T2-weighted MRI sequences were acquired in canines at baseline and during induced ischemia.
- Myocardial segments were analyzed for systolic-to-diastolic (S/D) signal intensity ratios using CP-BOLD and cine images.
- Affected and remote myocardial regions were identified using late-gadolinium-enhancement imaging post-reperfusion.
Main Results:
- CP-BOLD demonstrated a significant decrease in the S/D ratio in ischemic myocardial territories during rest, a change not observed in standard cine images.
- The S/D ratio derived from CP-BOLD accurately identified affected regions, with an area under the curve of 0.87 in receiver-operating characteristic analysis.
- CP-BOLD derived ejection fraction and segmental wall thickening also showed diagnostic capability, comparable to the S/D ratio.
Conclusions:
- Preclinical findings suggest CP-BOLD cardiovascular magnetic resonance is a viable tool for detecting myocardial ischemia at rest.
- The study highlights CP-BOLD's potential for early diagnosis in severe coronary artery disease management.
- Further clinical studies are warranted to validate these findings in human patients.
Background:
Fast noninvasive identification of ischemic territories at rest (before tissue-specific changes) and assessment of functional status can be valuable in the management of severe coronary artery disease. This study investigated the use of cardiac phase-resolved blood oxygen level-dependent (CP-BOLD) cardiovascular magnetic resonance in detecting myocardial ischemia at rest secondary to severe coronary artery stenosis.
Methods And Results:
CP-BOLD, standard cine, and T2-weighted images were acquired in canines (n=11) at baseline and within 20 minutes of ischemia induction (severe left anterior descending stenosis) at rest. After 3 hours of ischemia, left anterior descending stenosis was removed, and T2-weighted and late-gadolinium-enhancement images were acquired. From standard cine and CP-BOLD images, end-systolic and end-diastolic myocardium was segmented. Affected and remote sections of the myocardium were identified from postreperfusion late-gadolinium-enhancement images. Systolic-to-diastolic ratio (S/D), quotient of mean end-systolic and end-diastolic signal intensities (on CP-BOLD and standard cine), was computed for affected and remote segments at baseline and ischemia. Ejection fraction and segmental wall thickening were derived from CP-BOLD images at baseline and ischemia. On CP-BOLD images, S/D was >1 (remote and affected territories) at baseline; S/D was diminished only in affected territories during ischemia, and the findings were statistically significant (ANOVA, post hoc P<0.01). The dependence of S/D on ischemia was not observed in standard cine images. Computer simulations confirmed the experimental findings. Receiver-operating characteristic analysis showed that S/D identifies affected regions with performance (area under the curve, 0.87) similar to ejection fraction (area under the curve, 0.89) and segmental wall thickening (area under the curve, 0.75).
Conclusions:
Preclinical studies and computer simulations showed that CP-BOLD cardiovascular magnetic resonance could be useful in detecting myocardial ischemia at rest. Patient studies are needed for clinical translation.
Related Concept Videos
01:21Imaging Studies for Cardiovascular System IV: CMRI
01:24Magnetic Resonance Imaging