Coronary Vessel Wall Contrast Enhancement Imaging as a Potential Direct Marker of Coronary Involvement

• Published in: JACC. Cardiovascular imaging Vol. 7; no. 8; pp. 762 - 770
• Main Authors: Varma, Niharika, MBBS, Hinojar, Rocio, MD, Mres, D’Cruz, David, MD, Arroyo Ucar, Eduardo, MD, Indermuehle, Andreas, MD, Peel, Sarah, PhD, Greil, Gerald, MD, PhD, Gaddum, Nicholas, PhD, Chowienczyk, Phil, MD, PhD, Nagel, Eike, MD, PhD, Botnar, Rene M., PhD, Puntmann, Valentina O., MD, PhD
• Format: Journal Article
• Language: English
• Published: 01-08-2014
• Subjects: Cardiovascular; coronary artery disease; CE; contrast-to-noise ratio; left ventricle; CNR; CAD; CMR; vessel wall remodeling; LV; LGE; cardiovascular; pulse wave velocity; SLE; PWV; contrast to noise ratio; systemic lupus erythematosus; CV; late gadolinium enhancement; coronary enhancement; cardiac magnetic resonance; contrast enhancement
• ISSN: 1936-878X
• DOI: 10.1016/j.jcmg.2014.03.012

Abstract 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.