Elizabeth Carter, Rebecca L Moore, Kevin K Whitehead, Sara L Partington, David M Biko, Danish Vaiyani, Mark A Fogel, Matthew A Harris, Julie A Brothers
{"title":"运动应激心脏MRI在冠状动脉异常的青少年和年轻人中是可行的。","authors":"Elizabeth Carter, Rebecca L Moore, Kevin K Whitehead, Sara L Partington, David M Biko, Danish Vaiyani, Mark A Fogel, Matthew A Harris, Julie A Brothers","doi":"10.1016/j.jocmr.2025.101944","DOIUrl":null,"url":null,"abstract":"<p><strong>Aims: </strong>Anomalous aortic origin of a coronary artery (AAOCA) can result in sudden cardiac death in the young and risk stratification is challenging. Though dobutamine stress cardiac magnetic resonance (DS-CMR) is feasible in pediatric patients, exercise stress CMR (ES-CMR) may have lower rates of adverse events, higher diagnostic accuracy, and the ability to better reflect the physiologic changes occurring with exercise. We aimed to describe our institution's experience with ES-CMR using supine bicycle ergometry in pediatric and young adult patients with AAOCA.</p><p><strong>Methods and results: </strong>We retrospectively reviewed the medical records of AAOCA patients who underwent ES-CMR at our institution between 2011 and 2024 for demographic, clinical presentation, cardiopulmonary exercise test (CPET) and ESCMR data. The exercise-based portion of the CMR consisted of supine cycle ergometry utilizing a ramp protocol, immediately after which ES perfusion imaging was performed. Fifteen minutes after stress imaging, rest perfusion imaging was acquired.Of 38 patients who underwent ES-CMR, the median age was 16 years (range 13-24) and 68% were male. Diagnoses included anomalous right coronary artery (n=28),anomalous left coronary artery (n=8), and single coronary artery (n=1 single right, n=1single left). Median maximal heart rate (HR) during ES-CMR was 160 bpm (range 130-190, median 80% predicted) compared to a median maximal HR during patients' most recent CPET of 187 bpm (range 160-203, median 97% predicted). No patients had perfusion defects at rest or with exercise stress, or evidence of myocardial scarring.</p><p><strong>Conclusions: </strong>We demonstrate for the first time the use of ES-CMR in a cohort of pediatric and young adult patients with AAOCA. ES-CMR is a unique modality to assess for ischemia at rest and stress to assist with risk stratification by simulating physiologic changes with exercise stress. Although maximum heart rates during supine cycle ergometry are lower than those reached during CPET, they are similar to those reached during DS-CMR. ES-CMR is a valuable diagnostic tool and may be useful in the risk stratification of patients with AAOCA.</p>","PeriodicalId":15221,"journal":{"name":"Journal of Cardiovascular Magnetic Resonance","volume":" ","pages":"101944"},"PeriodicalIF":6.1000,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Exercise Stress Cardiac MRI is Feasible in Adolescents and Young Adults with Anomalous Coronary Arteries.\",\"authors\":\"Elizabeth Carter, Rebecca L Moore, Kevin K Whitehead, Sara L Partington, David M Biko, Danish Vaiyani, Mark A Fogel, Matthew A Harris, Julie A Brothers\",\"doi\":\"10.1016/j.jocmr.2025.101944\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Aims: </strong>Anomalous aortic origin of a coronary artery (AAOCA) can result in sudden cardiac death in the young and risk stratification is challenging. Though dobutamine stress cardiac magnetic resonance (DS-CMR) is feasible in pediatric patients, exercise stress CMR (ES-CMR) may have lower rates of adverse events, higher diagnostic accuracy, and the ability to better reflect the physiologic changes occurring with exercise. We aimed to describe our institution's experience with ES-CMR using supine bicycle ergometry in pediatric and young adult patients with AAOCA.</p><p><strong>Methods and results: </strong>We retrospectively reviewed the medical records of AAOCA patients who underwent ES-CMR at our institution between 2011 and 2024 for demographic, clinical presentation, cardiopulmonary exercise test (CPET) and ESCMR data. The exercise-based portion of the CMR consisted of supine cycle ergometry utilizing a ramp protocol, immediately after which ES perfusion imaging was performed. Fifteen minutes after stress imaging, rest perfusion imaging was acquired.Of 38 patients who underwent ES-CMR, the median age was 16 years (range 13-24) and 68% were male. Diagnoses included anomalous right coronary artery (n=28),anomalous left coronary artery (n=8), and single coronary artery (n=1 single right, n=1single left). Median maximal heart rate (HR) during ES-CMR was 160 bpm (range 130-190, median 80% predicted) compared to a median maximal HR during patients' most recent CPET of 187 bpm (range 160-203, median 97% predicted). No patients had perfusion defects at rest or with exercise stress, or evidence of myocardial scarring.</p><p><strong>Conclusions: </strong>We demonstrate for the first time the use of ES-CMR in a cohort of pediatric and young adult patients with AAOCA. ES-CMR is a unique modality to assess for ischemia at rest and stress to assist with risk stratification by simulating physiologic changes with exercise stress. Although maximum heart rates during supine cycle ergometry are lower than those reached during CPET, they are similar to those reached during DS-CMR. ES-CMR is a valuable diagnostic tool and may be useful in the risk stratification of patients with AAOCA.</p>\",\"PeriodicalId\":15221,\"journal\":{\"name\":\"Journal of Cardiovascular Magnetic Resonance\",\"volume\":\" \",\"pages\":\"101944\"},\"PeriodicalIF\":6.1000,\"publicationDate\":\"2025-08-20\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Cardiovascular Magnetic Resonance\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1016/j.jocmr.2025.101944\",\"RegionNum\":1,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"CARDIAC & CARDIOVASCULAR SYSTEMS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Cardiovascular Magnetic Resonance","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.jocmr.2025.101944","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
Exercise Stress Cardiac MRI is Feasible in Adolescents and Young Adults with Anomalous Coronary Arteries.
Aims: Anomalous aortic origin of a coronary artery (AAOCA) can result in sudden cardiac death in the young and risk stratification is challenging. Though dobutamine stress cardiac magnetic resonance (DS-CMR) is feasible in pediatric patients, exercise stress CMR (ES-CMR) may have lower rates of adverse events, higher diagnostic accuracy, and the ability to better reflect the physiologic changes occurring with exercise. We aimed to describe our institution's experience with ES-CMR using supine bicycle ergometry in pediatric and young adult patients with AAOCA.
Methods and results: We retrospectively reviewed the medical records of AAOCA patients who underwent ES-CMR at our institution between 2011 and 2024 for demographic, clinical presentation, cardiopulmonary exercise test (CPET) and ESCMR data. The exercise-based portion of the CMR consisted of supine cycle ergometry utilizing a ramp protocol, immediately after which ES perfusion imaging was performed. Fifteen minutes after stress imaging, rest perfusion imaging was acquired.Of 38 patients who underwent ES-CMR, the median age was 16 years (range 13-24) and 68% were male. Diagnoses included anomalous right coronary artery (n=28),anomalous left coronary artery (n=8), and single coronary artery (n=1 single right, n=1single left). Median maximal heart rate (HR) during ES-CMR was 160 bpm (range 130-190, median 80% predicted) compared to a median maximal HR during patients' most recent CPET of 187 bpm (range 160-203, median 97% predicted). No patients had perfusion defects at rest or with exercise stress, or evidence of myocardial scarring.
Conclusions: We demonstrate for the first time the use of ES-CMR in a cohort of pediatric and young adult patients with AAOCA. ES-CMR is a unique modality to assess for ischemia at rest and stress to assist with risk stratification by simulating physiologic changes with exercise stress. Although maximum heart rates during supine cycle ergometry are lower than those reached during CPET, they are similar to those reached during DS-CMR. ES-CMR is a valuable diagnostic tool and may be useful in the risk stratification of patients with AAOCA.
期刊介绍:
Journal of Cardiovascular Magnetic Resonance (JCMR) publishes high-quality articles on all aspects of basic, translational and clinical research on the design, development, manufacture, and evaluation of cardiovascular magnetic resonance (CMR) methods applied to the cardiovascular system. Topical areas include, but are not limited to:
New applications of magnetic resonance to improve the diagnostic strategies, risk stratification, characterization and management of diseases affecting the cardiovascular system.
New methods to enhance or accelerate image acquisition and data analysis.
Results of multicenter, or larger single-center studies that provide insight into the utility of CMR.
Basic biological perceptions derived by CMR methods.