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Quantifying Myocardial Blood Flow and Resistance Using 4D-Flow Cardiac Magnetic Resonance Imaging
Rebecca C Gosling1,2,3, Gareth Williams1, Abdulaziz Al Baraikan1
1Department of Infection Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK.
Insights
Quantifying myocardial blood flow (MBF) using 4D flow cardiac magnetic resonance (CMR) is feasible. Reduced MBF was observed in patients with myocardial infarction (MI) and microvascular obstruction (MVO).
Area of Science:
- Cardiovascular Imaging
- Medical Physics
- Physiology
Background:
- Coronary microvascular dysfunction is a common cause of ischaemia with nonobstructive coronary arteries, posing diagnostic challenges.
- Noninvasive myocardial blood flow (MBF) quantification via stress perfusion cardiac magnetic resonance (CMR) or positron emission tomography is limited by practical and technical constraints.
- Coronary sinus (CS) flow quantification using 4D flow CMR presents a potentially simpler method for MBF assessment.
Purpose of the Study:
- To evaluate the feasibility of quantifying myocardial blood flow (MBF) using 4D flow cardiac magnetic resonance (CMR).
- To assess MBF and myocardial resistance (MyoR) in healthy volunteers and patients with acute myocardial infarction (MI), with and without microvascular obstruction (MVO).
Main Methods:
- Cardiac magnetic resonance (CMR) imaging was performed on 30 subjects (10 healthy volunteers, 10 MI without MVO, 10 MI with MVO).
- Coronary sinus (CS) contours were traced, and flow was quantified using 4D flow CMR.
- Myocardial blood flow (MBF) and myocardial resistance (MyoR) were calculated and normalized for myocardial mass.
Main Results:
- Myocardial blood flow (MBF) was successfully quantified in all subjects.
- MBF was significantly lower in patients with MI (85.7 ± 30.5 mL/min) and MI with MVO (67.9 ± 29.2 mL/min) compared to healthy controls (123.8 ± 48.4 mL/min).
- Myocardial resistance (MyoR) was elevated in patients with MI and further increased in those with MI and MVO.
Conclusions:
- 4D flow CMR enables quantification of myocardial blood flow (MBF) and myocardial resistance (MyoR).
- Resting MBF is reduced in patients with myocardial infarction and microvascular obstruction.
Background:
Ischaemia with nonobstructive coronary arteries is most commonly caused by coronary microvascular dysfunction but remains difficult to diagnose without invasive testing. Myocardial blood flow (MBF) can be quantified noninvasively on stress perfusion cardiac magnetic resonance (CMR) or positron emission tomography but neither is routinely used in clinical practice due to practical and technical constraints. Quantification of coronary sinus (CS) flow may represent a simpler method for CMR MBF quantification. 4D flow CMR offers comprehensive intracardiac and transvalvular flow quantification. However, it is feasibility to quantify MBF remains unknown.
Methods:
Patients with acute myocardial infarction (MI) and healthy volunteers underwent CMR. The CS contours were traced from the 2-chamber view. A reformatted phase contrast plane was generated through the CS, and flow was quantified using 4D flow CMR over the cardiac cycle and normalised for myocardial mass. MBF and resistance (MyoR) was determined in ten healthy volunteers, ten patients with myocardial infarction (MI) without microvascular obstruction (MVO), and ten with known MVO.
Results:
MBF was quantified in all 30 subjects. MBF was highest in healthy controls (123.8 ± 48.4 mL/min), significantly lower in those with MI (85.7 ± 30.5 mL/min), and even lower in those with MI and MVO (67.9 ± 29.2 mL/min/) (P < 0.01 for both differences). Compared with healthy controls, MyoR was higher in those with MI and even higher in those with MI and MVO (0.79 (±0.35) versus 1.10 (±0.50) versus 1.50 (±0.69), P=0.02).
Conclusions:
MBF and MyoR can be quantified from 4D flow CMR. Resting MBF was reduced in patients with MI and MVO.
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