Whole body cardiovascular magnetic resonance imaging to stratify symptomatic and asymptomatic atherosclerotic burden in patients with isolated cardiovascular disease | springermedicine.com

Springer Medicine

Top

BMC Medical Imaging

Published in:

Open Access 01-12-2016 | Research article

Whole body cardiovascular magnetic resonance imaging to stratify symptomatic and asymptomatic atherosclerotic burden in patients with isolated cardiovascular disease

Authors: Jonathan R. Weir-McCall, Suzanne L. Duce, Stephen J. Gandy, Shona Z. Matthew, Patricia Martin, Deirdre B. Cassidy, Lynne McCormick, Jill J. F. Belch, Allan D. Struthers, Helen M. Colhoun, J. Graeme Houston

Published in: BMC Medical Imaging | Issue 1/2016

Login to get access

Abstract

Background

The aim of this study was to use whole body cardiovascular magnetic resonance imaging (WB CVMR) to assess the heart and arterial network in a single examination, so as to describe the burden of atherosclerosis and subclinical disease in participants with symptomatic single site vascular disease.

Methods

64 patients with a history of symptomatic single site vascular disease (38 coronary artery disease (CAD), 9 cerebrovascular disease, 17 peripheral arterial disease (PAD)) underwent whole body angiogram and cardiac MR in a 3 T scanner. The arterial tree was subdivided into 31 segments and each scored according to the degree of stenosis. From this a standardised atheroma score (SAS) was calculated. Cine and late gadolinium enhancement images of the left ventricle were obtained.

Results

Asymptomatic atherosclerotic disease with greater than 50 % stenosis in arteries other than that responsible for their presenting complain was detected in 37 % of CAD, 33 % of cerebrovascular and 47 % of PAD patients. Unrecognised myocardial infarcts were observed in 29 % of PAD patients. SAS was significantly higher in PAD patients 24 (17.5-30.5) compared to CAD 4 (2–11.25) or cerebrovascular disease patients 6 (2-10) (ANCOVA p < 0.001). Standardised atheroma score positively correlated with age (β 0.36 p = 0.002), smoking status (β 0.34 p = 0.002), and LV mass (β -0.61 p = 0.001) on multiple linear regression.

Conclusion

WB CVMR is an effective method for the stratification of cardiovascular disease. The high prevalence of asymptomatic arterial disease, and silent myocardial infarctions, particularly in the peripheral arterial disease group, demonstrates the importance of a systematic approach to the assessment of cardiovascular disease.

1.

Rosamond W, Flegal K, Furie K, Go A, Greenlund K, Haase N, Hailpern SM, Ho M, Howard V, Kissela B, Kissela B, Kittner S, Lloyd-Jones D, McDermott M, Meigs J, Moy C, Nichol G, O’Donnell C, Roger V, Sorlie P, Steinberger J, Thom T, Wilson M, Hong Y. Heart disease and stroke statistics--2008 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation. 2008;117:e25–146.

2.

Mitchell JR, Schwartz CJ. Relationship between arterial disease in different sites. A study of the aorta and coronary, carotid, and iliac arteries. Br Med J. 1962;1:1293–301.CrossRefPubMedPubMedCentral

3.

Rigatelli G. Aortoiliac angiography during coronary artery angiography detects significant occult aortoiliac and renal artery atherosclerosis in patients with coronary atherosclerosis. Int J Cardiovasc Imaging. 2004;20:299–303.CrossRefPubMed

4.

Newman AB, Shemanski L, Manolio TA, Cushman M, Mittelmark M, Polak JF, Powe NR, Siscovick D. Ankle-arm index as a predictor of cardiovascular disease and mortality in the Cardiovascular Health Study. The Cardiovascular Health Study Group. Arterioscler Thromb Vasc Biol. 1999;19:538–45.

5.

Paraskevas KI, Mikhailidis DP, Liapis CD. Internal carotid artery occlusion: association with atherosclerotic disease in other arterial beds and vascular risk factors. Angiology. 2007;58:329–35.CrossRefPubMed

6.

Kawarada O, Yokoi Y, Morioka N, Nakata S, Higashiue S, Mori T, Iwahashi M, Hatada A. Carotid stenosis and peripheral artery disease in Japanese patients with coronary artery disease undergoing coronary artery bypass grafting. Circ J. 2003;67:1003–6.

7.

Wachtell K, Ibsen H, Olsen MH, Laybourn C, Christoffersen JK, Nørgaard H, Mantoni M, Lund JO. Prevalence of renal artery stenosis in patients with peripheral vascular disease and hypertension. J Hum Hypertens. 1996;10:83–5.

8.

Alexandrova NA, Gibson WC, Norris JW, Maggisano R. Carotid artery stenosis in peripheral vascular disease. J Vasc Surg. 1996;23:645–9.CrossRefPubMed

9.

Von Kemp K, van den Brande P, Peterson T, Waegeneers S, Scheerlinck T, Danau W, van Tussenbroek F, Debing E, Staelens I. Screening for concomitant diseases in peripheral vascular patients. Results of a systematic approach. Int Angiol. 1997;16:114–22.

10.

Bamberg F, Parhofer KG, Lochner E, Marcus RP, Theisen D, Findeisen HM, Hoffmann U, Schönberg SO, Schlett CL, Reiser MF, Weckbach S. Diabetes mellitus: long-term prognostic value of whole-body MR imaging for the occurrence of cardiac and cerebrovascular events. Radiology. 2013;269:730–7.

11.

Lundberg C, Johansson L, Barbier CE, Lind L, Ahlström H, Hansen T. Total atherosclerotic burden by whole body magnetic resonance angiography predicts major adverse cardiovascular events. Atherosclerosis. 2013;228:148–52.CrossRefPubMed

12.

Lehrke S, Egenlauf B, Steen H, Lossnitzer D, Korosoglou G, Merten C, Ivandic BT, Giannitsis E, Katus H a. Prediction of coronary artery disease by a systemic atherosclerosis score index derived from whole-body MR angiography. J Cardiovasc Magn Reson. 2009;11:36.

13.

Hansen T, Ahlström H, Wikström J, Lind L, Johansson L. A total atherosclerotic score for whole-body MRA and its relation to traditional cardiovascular risk factors. Eur Radiol. 2008;18:1174–80.CrossRefPubMed

14.

Lin J, Chen B, Wang J-H, Zeng M-S, Wang Y-X. Whole-body three-dimensional contrast-enhanced magnetic resonance (MR) angiography with parallel imaging techniques on a multichannel MR system for the detection of various systemic arterial diseases. Heart Vessels. 2006;21:395–8.CrossRefPubMed

15.

Goyen M, Herborn CU, Kröger K, Ruehm SG, Debatin JF. Total-body 3D magnetic resonance angiography influences the management of patients with peripheral arterial occlusive disease. Eur Radiol. 2006;16:685–91.CrossRefPubMed

16.

Ladd SC, Debatin JF, Stang A, Bromen K, Moebus S, Nuefer M, Gizewski E, Wanke I, Doerfler A, Ladd ME, Benemann J, Erbel R, Forsting M, Schmermund A, Jöckel K-H. Whole-body MR vascular screening detects unsuspected concomitant vascular disease in coronary heart disease patients. Eur Radiol. 2007;17:1035–45.

17.

Waugh SA, Ramkumar PG, Gandy SJ, Nicholas RS, Martin P, Belch JJF, Struthers AD, Houston JG. Optimization of the contrast dose and injection rates in whole-body MR angiography at 3.0 T. J Magn Reson Imaging. 2009;30:1059–67.

18.

Weir-McCall JR, Khan F, Lambert MA, Adamson CL, Gardner M, Gandy SJ, Ramkumar PG, Belch JJF, Struthers AD, Rauchhaus P, Morris AD, Houston JG. Common carotid intima media thickness and ankle-brachial pressure index correlate with local but not global atheroma burden: a cross sectional study using whole body magnetic resonance angiography. PLoS One. 2014;9:e99190.

19.

Natori S, Lai S, Finn JP, Gomes AS, Hundley WG, Jerosch-Herold M, Pearson G, Sinha S, Arai A, Lima JAC, Bluemke DA. Cardiovascular function in multi-ethnic study of atherosclerosis: normal values by age, sex, and ethnicity. AJR Am J Roentgenol. 2006;186(6 Suppl 2):S357–65.

20.

Cerqueira MD, Weissman NJ, Dilsizian V, Jacobs AK, Kaul S, Laskey WK, Pennell DJ, Rumberger JA, Ryan T, Verani MS. Standardized myocardial segmentation and nomenclature for tomographic imaging of the heart. A statement for healthcare professionals from the Cardiac Imaging Committee of the Council on Clinical Cardiology of the American Heart Association. Circulation. 2002;105:539–42.

21.

The Academy of Medical Sciences. Realising the potential of stratified medicine. 2013.

22.

Trusheim MR, Berndt ER, Douglas FL. Stratified medicine: strategic and economic implications of combining drugs and clinical biomarkers. Nat Rev Drug Discov. 2007;6:287–93.CrossRefPubMed

23.

Bhatt DL, Eagle K a, Ohman EM, Hirsch AT, Goto S, Mahoney EM, Wilson PWF, Alberts MJ, D’Agostino R, Liau C-S, Mas J-L, Röther J, Smith SC, Salette G, Contant CF, Massaro JM, Steg PG. Comparative determinants of 4-year cardiovascular event rates in stable outpatients at risk of or with atherothrombosis. JAMA. 2010;304:1350–7.

24.

Steg PG, Bhatt DL, Wilson PWF, D’Agostino R, Ohman EM, Röther J, Liau C-S, Hirsch AT, Mas J-L, Ikeda Y, Pencina MJ, Goto S. One-year cardiovascular event rates in outpatients with atherothrombosis. JAMA. 2007;297:1197–206.

25.

Bluemke D a, Kronmal R a, Lima J a C, Liu K, Olson J, Burke GL, Folsom AR. The relationship of left ventricular mass and geometry to incident cardiovascular events: the MESA (Multi-Ethnic Study of Atherosclerosis) study. J Am Coll Cardiol. 2008;52:2148–55.

26.

Lind L, Andersson J, Hansen T, Johansson L, Ahlström H. Atherosclerosis measured by whole body magnetic resonance angiography and carotid artery ultrasound is related to arterial compliance, but not to endothelium-dependent vasodilation - the Prospective Investigation of the Vasculature in Uppsala Seniors (PIV. Clin Physiol Funct Imaging. 2009;29:321–9.CrossRefPubMed

27.

Laurent S, Cockcroft J, Van Bortel L, Boutouyrie P, Giannattasio C, Hayoz D, Pannier B, Vlachopoulos C, Wilkinson I, Struijker-Boudier H. Expert consensus document on arterial stiffness: methodological issues and clinical applications. Eur Heart J. 2006;27:2588–605.

28.

Roghi A, Palmieri B, Crivellaro W, Faletra F, Puttini M. Relationship of unrecognised myocardial infarction, diabetes mellitus and type of surgery to postoperative cardiac outcomes in vascular surgery. Eur J Vasc Endovasc Surg. 2001;21:9–16.CrossRefPubMed

29.

Hertzer NR, Beven EG, Young JR, O’Hara PJ, Ruschhaupt WF, Graor RA, Dewolfe VG, Maljovec LC. Coronary artery disease in peripheral vascular patients. A classification of 1000 coronary angiograms and results of surgical management. Ann Surg. 1984;199:223–33.

30.

Barbier CE, Bjerner T, Johansson L, Lind L, Ahlström H. Myocardial scars more frequent than expected: magnetic resonance imaging detects potential risk group. J Am Coll Cardiol. 2006;48:765–71.CrossRefPubMed

31.

Schelbert EB, Cao JJ, Sigurdsson S, Aspelund T, Kellman P, Aletras AH, Dyke CK, Thorgeirsson G, Eiriksdottir G, Launer LJ, Gudnason V, Harris TB, Arai AE. Prevalence and prognosis of unrecognized myocardial infarction determined by cardiac magnetic resonance in older adults. JAMA. 2012;308:890–6.

32.

Barbier CE, Nylander R, Themudo R, Ahlström H, Lind L, Larsson E-M, Bjerner T, Johansson L. Prevalence of unrecognized myocardial infarction detected with magnetic resonance imaging and its relationship to cerebral ischemic lesions in both sexes. J Am Coll Cardiol. 2011;58:1372–7.

33.

Ebeling Barbier C, Bjerner T, Hansen T, Andersson J, Lind L, Hulthe J, Johansson L, Ahlström H. Clinically unrecognized myocardial infarction detected at MR imaging may not be associated with atherosclerosis. Radiology. 2007;245:103–10.

34.

Sheifer SE, Gersh BJ, Yanez ND, Ades PA, Burke GL, Manolio TA. Prevalence, predisposing factors, and prognosis of clinically unrecognized myocardial infarction in the elderly. J Am Coll Cardiol. 2000;35:119–26.CrossRefPubMed

35.

Erne P, Schoenenberger AW, Burckhardt D, Zuber M, Kiowski W, Buser PT, Dubach P, Resink TJ, Pfisterer M. Effects of percutaneous coronary interventions in silent ischemia after myocardial infarction: the SWISSI II randomized controlled trial. JAMA. 2007;297:1985–91.

36.

Erne P, Schoenenberger AW, Zuber M, Burckhardt D, Kiowski W, Dubach P, Resink T, Pfisterer M. Effects of anti-ischaemic drug therapy in silent myocardial ischaemia type I: the Swiss Interventional Study on Silent Ischaemia type I (SWISSI I): a randomized, controlled pilot study. Eur Heart J. 2007;28:2110–7.

37.

Faglia E, Manuela M, Antonella Q, Michela G, Vincenzo C, Maurizio C, Roberto M, Alberto M. Risk reduction of cardiac events by screening of unknown asymptomatic coronary artery disease in subjects with type 2 diabetes mellitus at high cardiovascular risk: an open-label randomized pilot study. Am Heart J. 2005;149:e1–6.

38.

Hirsch AT, Criqui MH, Treat-Jacobson D, Regensteiner JG, Creager MA, Olin JW, Krook SH, Hunninghake DB, Comerota AJ, Walsh ME, McDermott MM, Hiatt WR. Peripheral arterial disease detection, awareness, and treatment in primary care. JAMA. 2001;286:1317–24.

39.

Gassull D, Schulthess D, Suttie S, Houston G. Whole-Body Magnetic Resonance Angiography (WBMRA) as a tool for driving efficiency in the cost and treatment of Claudication Co-morbities. Heal Policy Technol. 2013;2:181–7.CrossRef

Title: Whole body cardiovascular magnetic resonance imaging to stratify symptomatic and asymptomatic atherosclerotic burden in patients with isolated cardiovascular disease
Authors: Jonathan R. Weir-McCall
Suzanne L. Duce
Stephen J. Gandy
Shona Z. Matthew
Patricia Martin
Deirdre B. Cassidy
Lynne McCormick
Jill J. F. Belch
Allan D. Struthers
Helen M. Colhoun
J. Graeme Houston
Publication date: 01-12-2016
Publisher: BioMed Central
Published in: BMC Medical Imaging / Issue 1/2016
Electronic ISSN: 1471-2342
DOI: https://doi.org/10.1186/s12880-016-0121-4

Home
Congress Coverage
Clinical Collections
- Advances in Alzheimer’s
About Springer Medicine
Key Specialties