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Publications

Journal Article Epublish

PubMed: 42163843 DOI: 10.1093/ehjimp/qyaf141

Vasoactive breathing manoeuvres as an effective coronary vasodilator in patients with suspected coronary artery disease: a prospective comparative oxygenation-sensitive CMR study.

Eur Heart J Imaging Methods Pract 3(4):qyaf141

Authors: Simran Shergill, Elizabeth Hillier, Anju Velvet, Charley A Budgeon, Aida Moafi, Mohamed Elshibly, Rachel England, Kelly S Parke, Joanne V Wormleighton, David Adlam, Sandeep S Hothi, Andrew Ladwiniec, Matthias G Friedrich, Gerry P McCann, J Ranjit Arnold

Affiliations

  • Department 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.
  • Department of Medicine, McGill University Health Centre, 3605 de la Montagne, Montreal, QC H3G 2M1, Canada.
  • Cardiovascular Epidemiology Research Centre, School of Population and Global Health, University of Western Australia, 35 Stirling Highway, Crawley 6009, Australia.
  • Heart and Lung Centre, Royal Wolverhampton NHS Trust, Wolverhampton Road, Wolverhampton WV10 0QP, UK.
  • Institute of Cardiovascular Sciences, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK.
  • Department of Cardiology, University Hospitals of Leicester NHS Trust, Glenfield Hospital, Groby Road, Leicester LE3 9QP, UK.

Abstract

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-MORE max)] 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-MORE max 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.

MeSH

Coronary Artery Disease, Respiration, Arteries, Adenosine, Angina, Stable, Vasodilator Agents