Author + information
- Received December 19, 2013
- Revision received February 10, 2014
- Accepted March 10, 2014
- Published online August 1, 2014.
- Niharika Varma, MBBS∗,
- Rocio Hinojar, MD, Mres∗,
- David D’Cruz, MD†,
- Eduardo Arroyo Ucar, MD∗,
- Andreas Indermuehle, MD‡,
- Sarah Peel, PhD‡,
- Gerald Greil, MD, PhD∗,
- Nicholas Gaddum, PhD‡,
- Phil Chowienczyk, MD, PhD§,
- Eike Nagel, MD, PhD∗,
- Rene M. Botnar, PhD‡ and
- Valentina O. Puntmann, MD, PhD∗∗ ()
- ∗Cardiovascular Imaging Department, Division of Imaging Sciences and Biomedical Engineering, King’s College London, London, United Kingdom
- †The Lupus Unit, Rayne’s Institute, King’s College London, London, United Kingdom
- ‡Department of Medical Physics and Bioengineering, Division of Imaging Sciences and Biomedical Engineering, King’s College London, London, United Kingdom
- §Cardiovascular Division, King’s College London, London, United Kingdom
- ↵∗Reprint requests and correspondence:
Dr. Valentina O. Puntmann, King's College London, Department of Cardiovascular Imaging, The Rayne Institute, 3rd Floor, Lambeth Wing, St Thomas' Hospital Campus, London SE1 7EH, United Kingdom.
Objectives This study investigated the feasibility of visual and quantitative assessment of coronary vessel wall contrast enhancement (CE) for detection of symptomatic atherosclerotic coronary artery disease (CAD) and subclinical coronary vasculitis in autoimmune inflammatory disease (systemic lupus erythematosus [SLE]), as well as the association with aortic stiffness, an established marker of risk.
Background Coronary CE by cardiac magnetic resonance (CMR) is a novel noninvasive approach to visualize gadolinium contrast uptake within the coronary artery vessel wall.
Methods A total of 75 subjects (CAD: n = 25; SLE: n = 27; control: n = 23) underwent CMR imaging using a 3-T clinical scanner. Coronary arteries were visualized by a T2-prepared steady state free precession technique. Coronary wall CE was visualized using inversion-recovery T1 weighted gradient echo sequence 40 min after administration of 0.2 mmol/kg gadobutrol. Proximal coronary segments were visually examined for distribution of CE and quantified for contrast-to-noise ratio (CNR) and total CE area.
Results Coronary CE was prevalent in patients (93%, n = 42) with a diffuse pattern for SLE and a patchy/regional distribution in CAD patients. Compared with control subjects, CNR values and total CE area in patients with CAD and SLE were significantly higher (mean CNR: 3.9 ± 2.5 vs. 6.9 ± 2.5 vs. 6.8 ± 2.0, respectively; p < 0.001; total CE area: median 0.8 [interquartile range (IQR): 0.6 to 1.2] vs. 3.2 [IQR: 2.6 to 4.0] vs. 3.3 [IQR: 1.9 to 4.5], respectively; p < 0.001). Both measures were positively associated with aortic stiffness (CNR: r = 0.61, p < 0.01; total CE area: 0.36, p = 0.03), hypercholesterolemia (r = 0.68, p < 0.001; r = 0.61, p < 0.001) and hypertension (r = 0.40, p < 0.01; r = 0.32, p < 0.05).
Conclusions We demonstrate that quantification of coronary CE by CNR and total CE area is feasible for detection of subclinical and clinical uptake of gadolinium within the coronary vessel wall. Coronary vessel wall CE may become an instrumental novel direct marker of vessel wall injury and remodeling in subpopulations at risk.
This study was supported by the Department of Health via the National Institute for Health Researchhttp://dx.doi.org/10.13039/501100000272 comprehensive Biomedical Research Centre award to Guy’s and St Thomas’ NHS Foundation Trust, in partnership with King’s College London and King’s College Hospital National Health Service Foundation Trust and British Heart Foundation Research Centre of Excellence Award. Dr. Hinojar was supported by the Fundacion Alfonso Martin Escudero. Dr. Nagel has received research support and speaking honoraria from Philips Healthcare and Bayer Healthcare. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Drs. Varma and Hinojar contributed equally to this work. Raymond Y. Kwong, MD, MPH, has served as the Guest Editor for this article.
- Received December 19, 2013.
- Revision received February 10, 2014.
- Accepted March 10, 2014.
- American College of Cardiology Foundation