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POSTER PRESENTATION Open Access
Determinants of myocardial perfusion reserve
measured from coronary sinus phase-contrast
imaging during regadenoson stress CMR
Michael A Bauml
*
, Jaehoon Chung, Vineet Dandekar, Andrew W Ertel, Carolyn Dickens, Rosalia C Gonzalez,
Afshin Farzaneh-Far
From 17th Annual SCMR Scientific Sessions
New Orleans, LA, USA. 16-19 January 2014
Background
Measurement of myocardial perfusion reserve (MPR)
can potentially extend the scope of conventional myo-
cardial perfusion imaging from detection of flow limiting
epicardial stenosis to assessment of coronary microvas-
cular function. Recent studies have suggested that MPR
may improve risk stratification of patients with known
or suspected CAD. MPR has traditionally been mea-
sured using PET or CMR time-intensity curves. How-
ever, these techniques are cumbersome, require
radiation (for PET) and are not practical for routine
clinical practice. Measurement of coronary sinus (CS)
flow with phase-contrast MRI is an alternative, simple
method for assessing MPR. The aim of this study was to
identify the clinical determinants of MPR using this
method in patients with symptoms of possible myocar-
dial ischemia presenting for CMR stress testing.
Methods
117 consecutive patients referred for suspected myocar-
dial ischemia underwent a CMR stress-rest perfusion
protocol. Perfusion imaging was performed at 1-minute
and 15-minutes after administration of 0.4 mg of rega-
denoson. CS through-plane flow was measured using a
phase-contrast segmented gradient echo sequence at
baseline (pre) and immediately after stress perfusion
(peak). MPR was calculated as peak CS flow/pre CS
flow. Clinical variables were stratified by impaired MPR
(<2) vs preserved MPR (≥2). Multivariable logistic
regression was performed to derive the clinical predic-
tors of impaired MPR (<2).
Results
36% of the population had known CAD, 31% were dia-
betic and 19% were current smokers. Mean ejection
fraction was 65 ± 12%. The mean 10-year Framingham
risk score was 23 ± 18%. Adequate CS images were
obtained in 108 patients (92%). Acquisition of CS
images added approximately 2-3 minutes to overall
scanning time with an additional 5 minutes required for
off-line quantitative flow analysis. The flow profile
obtained was typically biphasic with a first peak in early
systole and a second peak during early diastole. Mean
MPR in the population was 3.28 ± 0.32. Patients with
MPR<2 were significantly more likely to have advanced
age, diabetes, higher Framingham risk score, and history
of current smoking (Figure 1). On multivariate analysis,
current smoking was the only independent predictor of
reduced MPR(<2) (Figure 2).
Conclusions
MPR can be rapidly measured in the clinical setting
using CS flow measurements during stress CMR.
Patients with impaired MPR were significantly more
likely to have advanced age, diabetes, higher Framing-
ham risk score, and history of current smoking. On
multivariate analysis, current smoking was the only
independent predictor of reduced MPR. Whether this
method of MPR assessment can provide independent,
additive prognostic value requires further investigation.
Funding
None.
Cardiology, University of Illinois Hospital & Health Sciences System, Chicago,
Illinois, USA
Bauml et al.Journal of Cardiovascular Magnetic
Resonance 2014, 16(Suppl 1):P219
http://www.jcmr-online.com/content/16/S1/P219
© 2014 Bauml et al.; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons
Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unr estricted use, distribution, and reproduction in
any medium, pro vided the original work is properly cited. The Creativ e Commons Public Domain Dedication waiver (http://
creativecommons.org/publicdomain/zero/1.0/) applies to the dat a made available in this article, unless otherwise stated.
Published: 16 January 2014
doi:10.1186/1532-429X-16-S1-P219
Cite this article as: Bauml et al.: Determinants of myocardial perfusion
reserve measured from coronary sinus phase-contrast imaging during
regadenoson stress CMR. Journal of Cardiovascular Magnetic Resonance
2014 16(Suppl 1):P219. Submit your next manuscript to BioMed Central
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Figure 2
Figure 1
Bauml et al.Journal of Cardiovascular Magnetic
Resonance 2014, 16(Suppl 1):P219
http://www.jcmr-online.com/content/16/S1/P219
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