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.
N1 - Funding Information:
Supported by National Heart Lung Blood Institute R01 HL075792 (CMK), and National Institute of Biomedical Imaging and Bioengineering T32 EB003841 (DL, AWP, RJ).
Publisher Copyright:
© 2015 Lopez et al.
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 (Cuffmean) 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-Cuffmean 109 ± 39 vs. PAD-Cuffmean 34 ± 17 ml/min-100 g, p < 0.001). However, there was no difference between exercise and Cuffmean perfusion within groups (p > 0.6). Results were similar when the same subjects had the 2 stressors performed. Cuffmean had superior reproducibility (Cuffmean ICC 0.98 vs. Exercise ICC 0.87) and area under the receiver operating characteristic curve (Cuffmean 0.992 vs. Exercise 0.905). Conclusions: Cuff hyperemia differentiates PAD patients from controls, as does exercise stress. Cuffmean 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 (Cuffmean) 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-Cuffmean 109 ± 39 vs. PAD-Cuffmean 34 ± 17 ml/min-100 g, p < 0.001). However, there was no difference between exercise and Cuffmean perfusion within groups (p > 0.6). Results were similar when the same subjects had the 2 stressors performed. Cuffmean had superior reproducibility (Cuffmean ICC 0.98 vs. Exercise ICC 0.87) and area under the receiver operating characteristic curve (Cuffmean 0.992 vs. Exercise 0.905). Conclusions: Cuff hyperemia differentiates PAD patients from controls, as does exercise stress. Cuffmean 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
VL - 17
JO - Journal of Cardiovascular Magnetic Resonance
JF - Journal of Cardiovascular Magnetic Resonance
SN - 1097-6647
IS - 1
M1 - 23
ER -