Absolute Quantification of Coronary Flow Reserve by Stress Perfusion MRI
Condition: Myocardial Ischemia
MeSH terms: Myocardial Ischemia; Ischemia
Study type: Interventional
Phase: Phase 2

Summary: 
      Coronary artery disease (CAD, coronary heart disease) is the leading cause of death in the
      U.S., causing 1 in 5 deaths in 2005. The current method for diagnosing coronary artery
      disease that is considered most accurate is coronary angiography however it involves risk and
      radiation. Alternatively nuclear imaging test and MRI stress test only permits the semi
      qualitative analysis of the myocardial perfusion images.

      In this proposal the investigators will develop a means to calculate Coronary Flow Reserve
      (CFR) using the MRI. the investigators approach has the potential to reduce mortality from
      myocardial infarction by effecting a change in the patient management paradigm. Absolute
      quantification of myocardial perfusion will detect coronary stenosis and CAD in patients with
      more accuracy than the semi-quantitative or qualitative analysis of perfusion images.
      Measurement of Coronary Flow Reserve is important for the following reasons: decrease of
      coronary flow reserve has been identified as a first effect of CAD; it provides an objective
      measure of treatment efficacy.

      The purpose of this study is to compare images from nuclear stress test and/or coronary
      angiography with Magnetic Resonance Imaging (MRI) that will evaluate subjects with coronary
      artery disease calculating myocardial blood flow using a novel MRI technique combined to an
      extracellular Gadolinium-based contrast agent and stressor agent
    

Detailed description: 
      The main hypothesis the investigators will test is that changes in myocardial blood volume,
      under physiologic stress, correlate with myocardial flow reserve as measured in low spatial
      resolution nuclear SPECT scans. Secondary hypothesis is that stress perfusion as quantified
      with bolus height corrected gadofosveset trisodium images, better correlate with SPECT
      perfusion than uncorrected, relative perfusion values.

      The investigators propose implementing the scan protocol using a 1.5T or 3.0T MRI scanner.
      The investigators will scan a series of 20 patients recruited from the nuclear stress lab at
      Northwestern Memorial Hospital. These subjects will be approached and enrolled into a HIPPA
      Compliant, IRB approved research study to assess the effectiveness of myocardial perfusion
      and blood volume images to measure myocardial blood volume. Subjects will be scanned with a
      modified version of the clinical stress-perfusion protocol. Correlation analysis will be used
      to test the hypothesis that quantitative blood volume is an indicator of myocardial flow
      reserve.
    

Intervention name(s): Regadenoson; gadofoveset trisodium
Intervention type(s): Drug; Drug
Intervention description(s): Regadenoson will be infused intravenously 0.4 mg/5 mL (0.08 mg/mL) as a single bolus.; All subjects to receive 5 ml IV gadofoveset trisodium contrast (Ablavar) at both stress and rest.
Other intervention name(s): Lexiscan; Ablavar
Intervention MeSH terms: Regadenoson
Intervention model: Single Group Assignment
Masking: Single
Primary purpose: Diagnostic
Keywords: Magnetic Resonance Imaging; regadenoson