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Oxygenation-sensitive Cardiac MRI with Vasoactive Breathing Maneuvers for the Non-invasive Assessment of Coronary Microvascular Dysfunction
Published on: August 17, 2022
Use of Blood Oxygenation Level-Dependent MRI to Predict Clinical Outcomes After Endovascular Revascularization in
Shiteng Suo1, Hui Tang1, Mengqiu Cao1
1Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
Background:
Blood oxygenation level-dependent (BOLD) MRI can noninvasively quantify lower extremity perfusion in peripheral artery disease (PAD) patients. However, its ability to reflect perfusion change in response to lower extremity revascularization (LER) and its prognostic value for clinical outcomes are not fully understood.
Purpose:
To evaluate BOLD MRI response to LER and its predictive value for major adverse cardiovascular events (MACE) and major adverse limb events (MALE) in PAD patients.
Study Type:
Prospective.
Population:
Forty-one patients (median age, 73 years; 29 men) undergoing LER for symptomatic PAD.
Field Strength/Sequence:
3.0 T/BOLD MRI with a multi-echo gradient-recalled echo sequence.
Assessment:
Pre- and post-LER BOLD MRI was performed under an ischemia-hyperemia paradigm. Normalized T2* time course curves were generated in each of 5 calf muscle compartments (anterior, lateral, deep posterior, soleus, and gastrocnemius) and times to peak (TTP), minimum/maximum values, and gradients during hyperemia (Grad) analyzed. Follow-up was every 6-12 months via hospital records and telephone interviews for MACE and MALE outcomes. Model 1 (clinical factors) and Model 2 (+BOLD MRI) were compared.
Statistical Tests:
Chi-square test or Fisher's exact test, Student's t-test or Wilcoxon rank-sum test, area under the receiver operating characteristic curve (AUC), Kaplan-Meier survival analysis, and Cox proportional hazards regression analysis. Significance was set at p < 0.05.
Results:
During a median 38-month follow-up, 9 patients experienced MACE and 20 experienced MALE. Successful LER improved TTP and Grad in all muscle compartments. Grad change (ΔGradsol ) and post-LER TTP (TTPsol ) in the soleus muscle achieved the highest AUC values of 0.92 and 0.80 in predicting MACE and MALE, respectively. In multivariable Cox regression analysis, ΔGradsol and TTPsol were independent predictors of MACE (hazard ratio [HR] per standard deviation [SD] increase, 0.23) and MALE (HR per SD increase, 1.62), respectively. BOLD MRI added incremental prognostic value to clinical factors, increasing C-index by 0.06 for MACE and 0.05 for MALE.
Data Conclusion:
BOLD MRI showed perfusion changes in skeletal muscles following revascularization and provided incremental prognostic value in PAD patients.
Evidence Level:
2.
Technical Efficacy:
Stage 4.
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