Abstract
Background: Assessment of calf muscle perfusion requires a physiological challenge. Exercise and cuff-occlusion hyperemia are commonly used methods, but it has been unclear if one is superior to the other. We hypothesized that post-occlusion calf muscle perfusion (Cuff) with pulsed arterial spin labeling (PASL) cardiovascular magnetic resonance (CMR) at 3 Tesla (T) would yield greater perfusion and improved reproducibility compared to exercise hyperemia in studies of peripheral arterial disease (PAD). Methods: Exercise and Cuff cohorts were independently recruited. PAD patients had an ankle brachial index (ABI) between 0.4-0.9. Controls (NL) had no risk factors and ABI 0.9-1.4. Subjects exercised until exhaustion (15 NL-Ex, 15 PAD-Ex) or had a thigh cuff inflated for 5 minutes (12 NL-Cuff, 11 PAD-Cuff). Peak exercise and average cuff (Cuff<inf> mean </inf>) perfusion were compared. Six participants underwent both cuff and exercise testing. Reproducibility was tested in 8 Cuff subjects (5 NL, 3 PAD). Results: Controls had greater perfusion than PAD independent of stressor (NL-Ex 74 ± 21 vs. PAD-Ex 43 ± 10, p = 0.01; NL-Cuff<inf> mean </inf> 109 ± 39 vs. PAD-Cuff<inf> mean </inf> 34 ± 17 ml/min-100 g, p < 0.001). However, there was no difference between exercise and Cuff<inf> mean </inf> perfusion within groups (p > 0.6). Results were similar when the same subjects had the 2 stressors performed. Cuff<inf> mean </inf> had superior reproducibility (Cuff<inf> mean </inf> ICC 0.98 vs. Exercise ICC 0.87) and area under the receiver operating characteristic curve (Cuff<inf> mean </inf> 0.992 vs. Exercise 0.905). Conclusions: Cuff hyperemia differentiates PAD patients from controls, as does exercise stress. Cuff<inf> mean </inf> and exercise calf perfusion values are similar. Cuff occlusion hyperemia has superior reproducibility and thus may be the preferred stressor.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 1-9 |
| Number of pages | 9 |
| Journal | Journal of Cardiovascular Magnetic Resonance |
| DOIs | |
| State | Accepted/In press - Feb 22 2015 |
| Externally published | Yes |
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Keywords
- Arterial spin labeling
- Cardiovascular magnetic resonance
- Cuff occlusion hyperemia
- Perfusion
- Peripheral arterial disease
ASJC Scopus subject areas
- Cardiology and Cardiovascular Medicine
- Radiology Nuclear Medicine and imaging
- Radiological and Ultrasound Technology
- Family Practice
Cite this
Arterial spin labeling perfusion cardiovascular magnetic resonance of the calf in peripheral arterial disease : Cuff occlusion hyperemia vs exercise. / Lopez, David; Pollak, Amy W.; Meyer, Craig H.; Epstein, Frederick H.; Zhao, Li; Pesch, Arthur J.; Jiji, Ronny; Kay, Jennifer R.; DiMaria, Joseph M.; Christopher, John M.; Kramer, Christopher M.
In: Journal of Cardiovascular Magnetic Resonance, 22.02.2015, p. 1-9.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Arterial spin labeling perfusion cardiovascular magnetic resonance of the calf in peripheral arterial disease
T2 - Cuff occlusion hyperemia vs exercise
AU - Lopez, David
AU - Pollak, Amy W.
AU - Meyer, Craig H.
AU - Epstein, Frederick H.
AU - Zhao, Li
AU - Pesch, Arthur J.
AU - Jiji, Ronny
AU - Kay, Jennifer R.
AU - DiMaria, Joseph M.
AU - Christopher, John M.
AU - Kramer, Christopher M.
PY - 2015/2/22
Y1 - 2015/2/22
N2 - Background: Assessment of calf muscle perfusion requires a physiological challenge. Exercise and cuff-occlusion hyperemia are commonly used methods, but it has been unclear if one is superior to the other. We hypothesized that post-occlusion calf muscle perfusion (Cuff) with pulsed arterial spin labeling (PASL) cardiovascular magnetic resonance (CMR) at 3 Tesla (T) would yield greater perfusion and improved reproducibility compared to exercise hyperemia in studies of peripheral arterial disease (PAD). Methods: Exercise and Cuff cohorts were independently recruited. PAD patients had an ankle brachial index (ABI) between 0.4-0.9. Controls (NL) had no risk factors and ABI 0.9-1.4. Subjects exercised until exhaustion (15 NL-Ex, 15 PAD-Ex) or had a thigh cuff inflated for 5 minutes (12 NL-Cuff, 11 PAD-Cuff). Peak exercise and average cuff (Cuff mean ) perfusion were compared. Six participants underwent both cuff and exercise testing. Reproducibility was tested in 8 Cuff subjects (5 NL, 3 PAD). Results: Controls had greater perfusion than PAD independent of stressor (NL-Ex 74 ± 21 vs. PAD-Ex 43 ± 10, p = 0.01; NL-Cuff mean 109 ± 39 vs. PAD-Cuff mean 34 ± 17 ml/min-100 g, p < 0.001). However, there was no difference between exercise and Cuff mean perfusion within groups (p > 0.6). Results were similar when the same subjects had the 2 stressors performed. Cuff mean had superior reproducibility (Cuff mean ICC 0.98 vs. Exercise ICC 0.87) and area under the receiver operating characteristic curve (Cuff mean 0.992 vs. Exercise 0.905). Conclusions: Cuff hyperemia differentiates PAD patients from controls, as does exercise stress. Cuff mean and exercise calf perfusion values are similar. Cuff occlusion hyperemia has superior reproducibility and thus may be the preferred stressor.
AB - Background: Assessment of calf muscle perfusion requires a physiological challenge. Exercise and cuff-occlusion hyperemia are commonly used methods, but it has been unclear if one is superior to the other. We hypothesized that post-occlusion calf muscle perfusion (Cuff) with pulsed arterial spin labeling (PASL) cardiovascular magnetic resonance (CMR) at 3 Tesla (T) would yield greater perfusion and improved reproducibility compared to exercise hyperemia in studies of peripheral arterial disease (PAD). Methods: Exercise and Cuff cohorts were independently recruited. PAD patients had an ankle brachial index (ABI) between 0.4-0.9. Controls (NL) had no risk factors and ABI 0.9-1.4. Subjects exercised until exhaustion (15 NL-Ex, 15 PAD-Ex) or had a thigh cuff inflated for 5 minutes (12 NL-Cuff, 11 PAD-Cuff). Peak exercise and average cuff (Cuff mean ) perfusion were compared. Six participants underwent both cuff and exercise testing. Reproducibility was tested in 8 Cuff subjects (5 NL, 3 PAD). Results: Controls had greater perfusion than PAD independent of stressor (NL-Ex 74 ± 21 vs. PAD-Ex 43 ± 10, p = 0.01; NL-Cuff mean 109 ± 39 vs. PAD-Cuff mean 34 ± 17 ml/min-100 g, p < 0.001). However, there was no difference between exercise and Cuff mean perfusion within groups (p > 0.6). Results were similar when the same subjects had the 2 stressors performed. Cuff mean had superior reproducibility (Cuff mean ICC 0.98 vs. Exercise ICC 0.87) and area under the receiver operating characteristic curve (Cuff mean 0.992 vs. Exercise 0.905). Conclusions: Cuff hyperemia differentiates PAD patients from controls, as does exercise stress. Cuff mean and exercise calf perfusion values are similar. Cuff occlusion hyperemia has superior reproducibility and thus may be the preferred stressor.
KW - Arterial spin labeling
KW - Cardiovascular magnetic resonance
KW - Cuff occlusion hyperemia
KW - Perfusion
KW - Peripheral arterial disease
UR - http://www.scopus.com/inward/record.url?scp=84928685528&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84928685528&partnerID=8YFLogxK
U2 - 10.1186/s12968-015-0128-y
DO - 10.1186/s12968-015-0128-y
M3 - Article
C2 - 25890198
AN - SCOPUS:84928685528
SP - 1
EP - 9
JO - Journal of Cardiovascular Magnetic Resonance
JF - Journal of Cardiovascular Magnetic Resonance
SN - 1097-6647
ER -