Feasibility of cardiovascular magnetic resonance derived coronary wave intensity analysis

Raphael, Claire E, Keegan, Jennifer, Parker, Kim H, Simpson, Robin, Collinson, Julian, Vassiliou, Vass, Wage, Ricardo, Drivas, Peter, Strain, Stephen, Cooper, Robert, de Silva, Ranil, Stables, Rod H, Di Mario, Carlo, Frenneaux, Michael, Pennell, Dudley J, Davies, Justin E, Hughes, Alun D, Firmin, David and Prasad, Sanjay K (2016) Feasibility of cardiovascular magnetic resonance derived coronary wave intensity analysis. Journal of Cardiovascular Magnetic Resonance, 18. ISSN 1097-6647

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Abstract

Background: Wave intensity analysis (WIA) of the coronary arteries allows description of the predominant mechanisms influencing coronary flow over the cardiac cycle. The data are traditionally derived from pressure and velocity changes measured invasively in the coronary artery. Cardiovascular magnetic resonance (CMR) allows measurement of coronary velocities using phase velocity mapping and derivation of central aortic pressure from aortic distension. We assessed the feasibility of WIA of the coronary arteries using CMR and compared this to invasive data. Methods: CMR scans were undertaken in a serial cohort of patients who had undergone invasive WIA. Velocity maps were acquired in the proximal left anterior descending and proximal right coronary artery using a retrospectively-gated breath-hold spiral phase velocity mapping sequence with high temporal resolution (19ms). A breath-hold segmented gradient echo sequence was used to acquire through-plane cross sectional area changes in the proximal ascending aorta which were used as a surrogate of an aortic pressure waveform after calibration with brachial blood pressure measured with a sphygmomanometer. CMRderived aortic pressures and CMR-measured velocities were used to derive wave intensity. The CMRderived wave intensities were compared to invasive data in 12 coronary arteries (8 left, 4 right). Waves were presented as absolute values and as a % of total wave intensity. Intra-study reproducibility of invasive and non-invasive WIA was assessed using Bland-Altman analysis and the intraclass correlation coefficient (ICC). Results: The combination of the CMR-derived pressure and velocity data produced the expected pattern of forward and backward compression and expansion waves. The intra-study reproducibility of the CMR derived wave intensities as a % of the total wave intensity (mean ±standard deviation of differences) was 0.0±6.8%, ICC = 0.91. Intra-study reproducibility for the corresponding invasive data was 0.0±4.4%, ICC = 0.96. The invasive and CMR studies showed reasonable correlation (r = 0.73) with a mean difference of 0.0± 11.5%. Conclusion: This proof of concept study demonstrated that CMR may be used to perform coronary WIA non-invasively with reasonable reproducibility compared to invasive WIA. The technique potentially allows WIA to be performed in a wider range of patients and pathologies than those who can be studied invasively.

Item Type: Article
Additional Information: This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
Faculty \ School: Faculty of Medicine and Health Sciences > Norwich Medical School
Depositing User: Pure Connector
Date Deposited: 14 Dec 2016 00:07
Last Modified: 22 Apr 2020 02:12
URI: https://ueaeprints.uea.ac.uk/id/eprint/61710
DOI: 10.1186/s12968-016-0312-8

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