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Updated: May 22, 2026
Oxygenation-sensitive Cardiac MRI with Vasoactive Breathing Maneuvers for the Non-invasive Assessment of Coronary Microvascular Dysfunction
Published on: August 17, 2022
Vasoactive breathing manoeuvres as an effective coronary vasodilator in patients with suspected coronary artery
Simran Shergill1, Elizabeth Hillier2, Anju Velvet1
1Department of Cardiovascular Sciences, University of Leicester, the National Institute for Health and Care Research Leicester Biomedical Research Centre and British Heart Foundation Centre of Research Excellence, Glenfield Hospital, Groby Road, Leicester LE3 9QP, UK.
Aims:
In the assessment of myocardial ischaemia, vasoactive breathing manoeuvres have been proposed as a potential alternative to pharmacological vasodilator stress. However, it remains unclear whether the resultant physiological responses are comparable to those induced by adenosine in patients with suspected coronary artery disease (CAD). We sought to compare the myocardial oxygenation responses to a hyperventilation breath-hold (HVBH) manoeuvre with those elicited by adenosine, using oxygenation-sensitive cardiovascular magnetic resonance (OS-CMR).
Methods And Results:
Patients with suspected angina underwent 3-Tesla OS-CMR with (i) HVBH and (ii) adenosine (140-210 μg/kg/min) prior to invasive coronary angiography. The primary outcome was the maximal percentage change in OS-CMR signal intensity for (i) HVBH [breathing-induced myocardial oxygenation reserve (B-MOREmax)] and (ii) adenosine [adenosine-induced myocardial oxygenation reserve (A-MORE)]. Significant CAD was defined as fractional flow reserve ≤0.80 in epicardial vessels ≥2 mm diameter. From 53 prospectively recruited patients, 44 had complete, paired OS-CMR sequences (mean age 69 ± 9 years, 75% male, CAD prevalence 59%). The HVBH manoeuvre elicited a myocardial oxygenation response comparable to that of adenosine (B-MOREmax 7.0 ± 9.5% vs. A-MORE 8.6 ± 12.3%, mean difference: -1.6% [-6.0%, 2.8%]; P = 0.469), which remained similar at the segmental level following adjustment for age, sex, cardiovascular comorbidities, CAD, and infarction (mean difference: -1.7% [-4.0%, 0.5%]; P = 0.126).
Conclusion:
In patients with suspected CAD, HVBH induces a myocardial oxygenation response comparable to that elicited by adenosine. Future prospective studies evaluating the diagnostic accuracy of OS-CMR combined with vasoactive breathing manoeuvres for detecting significant CAD are warranted.
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