Response of myocardial oxygenation to breathing manoeuvres and adenosine infusion

Günsch, Dominik; Fischer, Kady Anne; Friedrich, Matthias G (2014). Response of myocardial oxygenation to breathing manoeuvres and adenosine infusion. European heart journal - cardiovascular imaging, 16(4), pp. 395-401. Oxford University Press 10.1093/ehjci/jeu202

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AIMS: Testing for inducible myocardial ischaemia is one of the most important diagnostic procedures and has a strong impact on clinical decision-making. Current standard protocols are typically limited by the required infusion of vasodilatory substances. Recent data indicate that changes of myocardial oxygenation induced by hyperventilation and breath-holds can be monitored by oxygenation-sensitive (OS) cardiovascular magnetic resonance (CMR) and may be useful for assessing coronary vascular function. As tests using breathing manoeuvres may be safer, easier, and more comfortable than vasodilator stress agent infusion, we compared its impact on myocardial oxygenation with that of a standard adenosine infusion protocol. METHODS AND RESULTS: In 20 healthy volunteers, we assessed changes of myocardial oxygenation using OS-CMR at 3 T during adenosine infusion (140 µg/kg/min, i.v.) and during voluntary breathing manoeuvres: a maximal breath-hold following normal breathing and a maximal breath-hold following 60 s of hyperventilation. The study was successfully completed in 19 subjects. There was a significantly stronger myocardial response for hyperventilation (decrease of -10.6 ± 7.8%) and the following breath-hold (increase of 14.8 ± 6.6%) than adenosine (3.9 ± 6.5%), whereas a simple maximal voluntary breath-hold yielded a similar signal intensity increase (3.1 ± 3.9%). Subjective side effects occurred significantly more often with adenosine, especially in females. CONCLUSIONS: Hyperventilation combined with a subsequent long breath-hold and hyperventilation alone both have a greater impact on myocardial oxygenation changes than an intravenous administration of a standard dose of adenosine, as assessed by OS-CMR. Breathing manoeuvres may be more efficient, safer, and more comfortable than adenosine for the assessment of the coronary vasomotor response.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Intensive Care, Emergency Medicine and Anaesthesiology (DINA) > Clinic and Policlinic for Anaesthesiology and Pain Therapy

UniBE Contributor:

Günsch, Dominik and Fischer, Kady Anne

Subjects:

600 Technology > 610 Medicine & health

ISSN:

2047-2412

Publisher:

Oxford University Press

Language:

English

Submitter:

Jeannie Wurz

Date Deposited:

02 Apr 2015 16:13

Last Modified:

02 Apr 2019 15:40

Publisher DOI:

10.1093/ehjci/jeu202

PubMed ID:

25336541

BORIS DOI:

10.7892/boris.66062

URI:

https://boris.unibe.ch/id/eprint/66062

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