期刊
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY
卷 67, 期 4, 页码 420-431出版社
ELSEVIER SCIENCE INC
DOI: 10.1016/j.jacc.2015.10.085
关键词
angioplasty; cardiovascular magnetic resonance; perfusion; surgery
资金
- British Heart Foundation [FS/13/74/30425, FS/11/37/28819]
- Siemens Healthcare
- Bayer Healthcare
- Philips Healthcare
- MEDIS
- TomTec
- CVI42
- Academy of Medical Sciences (AMS) [AMS-SGCL12-Saha] Funding Source: researchfish
- British Heart Foundation [FS/13/74/30425, FS/11/37/28819] Funding Source: researchfish
- National Institute for Health Research [CL-2011-17-006] Funding Source: researchfish
BACKGROUND Use of blood oxygenation level-dependent cardiovascular magnetic resonance (BOLD-CMR) to assess perfusion in the lower limb has been hampered by poor reproducibility and a failure to reliably detect post-revascularization improvements in patients with critical limb ischemia (CLI). OBJECTIVES This study sought to develop BOLD-CMR as an objective, reliable clinical tool for measuring calf muscle perfusion in patients with CLI. METHODS The calf was imaged at 3-T in young healthy control subjects (n =12), age-matched control subjects (n = 10), and patients with CLI (n =34). Signal intensity time curves were generated for each muscle group and curve parameters, including signal reduction during ischemia (SRi) and gradient during reactive hyperemia (Grad). BOLD-CMR was used to assess changes in perfusion following revascularization in 12 CLI patients. Muscle biopsies (n = 28), obtained at the level of BOLD-CMR measurement and from healthy proximal muscle of patients undergoing lower limb amputation (n = 3), were analyzed for capillary-fiber ratio. RESULTS There was good interuser and interscan reproducibility for Grad and SRi (all p < 0.0001). The ischemic limb had lower Grad and SRi compared with the contralateral asymptomatic limb, age-matched control subjects, and young control subjects (p < 0.001 for all comparisons). Successful revascularization resulted in improvement in Grad (p < 0.0001) and SRi (p < 0.0005). There was a significant correlation between capillary-fiber ratio (p < 0.01) in muscle biopsies from amputated limbs and Grad measured pre-operatively at the corresponding level. CONCLUSIONS BOLD-CMR showed promise as a reliable tool for assessing perfusion in the lower limb musculature and merits further investigation in a clinical trial. (C) 2016 by the American College of Cardiology Foundation.
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