title: Cardiovascular magnetic resonance profiling of coronary atherosclerosis: vessel wall remodelling and related myocardial blood flow alterations.
abstract: OBJECTIVE
  To determine the association between coronary vessel wall morphology and haemodynamic consequences to the myocardium using a combined cardiovascular magnetic resonance (CMR) imaging protocol. Non-invasive CMR profiling of coronary atherosclerotic wall changes and related myocardial blood flow impairment has not been established yet.
  
  
  RESULTS
  Sixty-three patients (45 men, 61.5 ± 10.7 years) with suspected or known coronary artery disease underwent 3.0 Tesla CMR imaging. The combined CMR protocol consisted of the following imaging modules at rest: 3D vessel wall imaging and flow measurement of the proximal right coronary artery (RCA), myocardial T2*, and first-pass perfusion imaging. During adenosine stress coronary flow, T2* and first-pass perfusion imaging were repeated. Coronary X-ray angiography classified patient groups: (i) all-smooth (n = 19); (ii) luminal irregular (diameter reduction < 30%; n = 35); and (iii) stenosed RCA (diameter reduction ≥ 50%; n = 9). The ratio of CMR-derived vessel wall area-to-lumen area significantly increased stepwise for the comparison of all-smooth vs. luminal irregular vs. stenosed RCA (1.9 ± 0.6 vs. 2.6 ± 0.6 vs. 3.6 ± 0.9, P < 0.01). Epicardial coronary flow reserve exhibited a stepwise significant decrease (3.4 ± 0.5 vs. 2.9 ± 0.7 vs. 1.7 ± 0.3, P < 0.01). On the myocardial level, stress-induced percentage gain of T2* values (ΔT2*) was significantly decreased between groups (29.2 ± 10.6 vs. 9.0 ± 9.8 vs. 2.2 ± 11.8%, P < 0.01) while perfusion reserve index decreased in the presence of stenosed RCA only (2.2 ± 0.6 vs. 2.0 ± 0.4 vs. 1.3 ± 0.3, P = ns and P < 0.01, respectively).
  
  
  CONCLUSIONS
  The proposed comprehensive CMR imaging protocol provided a non-invasive approach for direct assessment of coronary vessel wall remodelling and resultant pathophysiological consequences on the level of epicardial coronary and myocardial blood flow in patients.
authors.affiliation: Department of Cardiology, University Hospital RWTH Aachen, Pauwelsstrasse 30, 52074 Aachen, Germany cjahnke@alice.de.
authors.forename: Cosima
authors.initials: C
authors.lastname: Jahnke
authors.affiliation: Department of Cardiology, German Heart Institute Berlin, Berlin, Germany Institute for Biomedical Engineering, University and ETH Zurich, Zurich, Switzerland.
authors.forename: Robert
authors.initials: R
authors.lastname: Manka
authors.affiliation: Institute for Biomedical Engineering, University and ETH Zurich, Zurich, Switzerland.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Kozerke
authors.affiliation: Philips Clinical Science, Hamburg, Germany.
authors.forename: Bernhard
authors.initials: B
authors.lastname: Schnackenburg
authors.affiliation: Department of Cardiology, German Heart Institute Berlin, Berlin, Germany.
authors.forename: Rolf
authors.initials: R
authors.lastname: Gebker
authors.affiliation: Department of Cardiology, University Hospital RWTH Aachen, Pauwelsstrasse 30, 52074 Aachen, Germany.
authors.forename: Nikolaus
authors.initials: N
authors.lastname: Marx
authors.affiliation: Department of Cardiology, University Hospital RWTH Aachen, Pauwelsstrasse 30, 52074 Aachen, Germany.
authors.forename: Ingo
authors.initials: I
authors.lastname: Paetsch
mesh_terms: D000241:Adenosine; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017023:Coronary Angiography / Q000379:methods; D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000503:physiopathology*; D005260:Female; D053805:Fractional Flow Reserve, Myocardial; D006801:Humans; D018810:Magnetic Resonance Angiography / Q000379:methods*; D019028:Magnetic Resonance Imaging, Cine / Q000379:methods*; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000175:diagnosis / Q000503:physiopathology; D055414:Myocardial Perfusion Imaging / Q000379:methods; D011237:Predictive Value of Tests; D011446:Prospective Studies; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D014665:Vasodilator Agents
chemical_list: D014665:Vasodilator Agents; D000241:Adenosine
keywords: Coronary atherosclerosis; Coronary flow reserve; Magnetic resonance imaging; Myocardial blood flow; Myocardial oxygenation; Vessel wall imaging