Feasibility of adenosine stress cardiovascular magnetic resonance perfusion imaging in patients with MR-conditional transvenous permanent pacemakers and defibrillators

Fig. 1. study flowchart

Fig. 2. Stress perfusion-CMR in a permanent pacemaker dependent (PPM) patient. A 74-year-old man was referred to stress perfusion CMR due to exertional dyspnea and angor. A double chamber PPM was implanted for a 2-degree atrioventricular block and the patient was PPM-dependent (Panel A). X-ray coronary angiography showed a severe stenosis of the proximal portion of the left anterior descending artery (Panel B, C, yellow arrowed) that was treated by drug-eluting stent implantation. Stress perfusion CMR, performed before x.ray coronary angiography showed an extensive hypoperfusion in the anterior and septal wall (Panel D–G, red arrowed) without the presence of myocardial scar in late gadolinium (LGE) images (Panel H, I, L, M) indicating a positive stress test, consistent with the lesion found in x-ray coronary angiography

Fig. 3. Stress perfusion-CMR in a PPM dependent patient. 67-year-old with known an antero-septal myocardial infarction, was referred to stress perfusion CMR to exclude myocardial ischemia after implantation of a MR-conditional implantable cardiodefibrillator (ICD) for primary prevention. A Cine fast-gradient echo acquisition of a 4-chamber view demonstrating a mural thrombus (Th) in the apex and the artifact of the ICD electrode (red arrow). B Corresponding standard phase sensitive inversion recovery (PSIR) 4-chamber view with visualization of the post-infarct scar in septal and apical segments as well as the apical thrombus (Th) and the ICD electrode (red arrow). Standard short-axis PSIR in C (with bandwidth of 140 Hz/pixel) and PSIR with increased bandwidth in D (300 Hz/pixel) to eliminate the ICD-related artifact on the anterior wall (black arrow in C), electrode (red arrow). The mural thrombus (Th) and the antero-lateral scar is visualized. E/F/G: Myocardial perfusion upslope maps of motion-compensated perfusion images in the basal (E), mid-ventricular (F) and apical (G) slices. Visualization of hypoperfused scar (black arrow heads) thereby excluding ischemia in this patient.…

Fig. 4. Hemodynamic parameters. Panel A heart rate response in patients under pacing (red) or not-paced (green), Panel B systolic blood pressure (BP) changes in patients under pacing (red) or not-paced (green), Panel C Diastolic BP changes under pacing (red) or not-paced (p = 0.007) (green)