Background
==========

Cardiovascular disease is the leading cause of mortality and morbidity in end-stage renal failure (ESRF) population, mostly from coronary artery disease (CAD).  Majority of CAD in ESRF patients is asymptomatic and current cardiac stress imaging modalities are sub-optimal as risk predictors.  Advances in cardiovascular magnetic resonance (CMR) with the novel blood oxygen level-dependent (BOLD) technique provides unprecedented capability to assess regional myocardial deoxygenation.  We hypothesized that myocardial oxygenation would be reduced in ESRF patients and may form a novel strategy to assess myocardial ischemia. 

Methods
=======

Sixteen chronic renal failure (CRF) patients (7 on dialysis, 9 pre-dialysis) with no known history of CAD underwent CMR scanning at 3.0 T. Given known reductions in BOLD signals in hypertrophied myocardium, we also assessed a control group of HT patients with no history of CAD (n = 6) Myocardial function, rest and stress BOLD was performed.  To measure oxygenation, using a T2-prepared BOLD sequence, myocardial Signal Intensity (SI) was measured at adenosine stress (140 μg/kg/min) and at rest (corrected to RR interval).  Comparison of myocardial SI analyses were performed using multivariate linear regression. 

Results
=======

Baseline clinical characteristics were similar in both CRF case and HT control groups, except higher body mass index in HT group (p = 0.02).  Left and right ventricular dimensions and functions were similar.  Interventricular septal thickness and LV mass were similar in both RF case and HT control groups (LV septum: 1.2 ± 0.1 cm RF vs 1.2 ± 0.1 cm HT, p \> NS; LV mass index 78 ± 6 g/m2 RF vs 63 ± 4 g/m2 HT, p \> NS).  Rate Pressure Product (RPP) was similar in both groups.  Global myocardial BOLD SI change was significantly lower in RF case group compared to HT control group (-1.79 ± 9.13 vs 17.36 ± 9.19, p = 0.0004) (Figure [1](#F1){ref-type="fig"}).  BOLD SI Change globally and in the LAD and RCA coronary artery territory level were significantly lower in patients with renal failure (Table [1](#T1){ref-type="table"}), (although did not reach statisticalsignificance in the left circumflex territory). 

![** Global Myocardial Oxygenation (BOLD SI Change)**.](1532-429X-16-S1-P184-1){#F1}

###### 

Myocardial Oxygenation in Left Anterior Descending (LAD), Left Circumflex (LCx) and Right Coronary Artery (RCA) Territories

  ----------------------------------------------------------------
  BOLD SI Change      RF Cases\         HT Controls\      p
                      (n = 16)          (n = 6)           
  ------------------- ----------------- ----------------- --------
  Global Myocardium   -1.79 +/- 9.13    17.36 +/- 9.19    0.0004

                                                          

  LAD                 -3.08 +/- 14.37   18.97 +/- 2.39    0.0016

                                                          

  LCx                 1.49 +/- 13.66    14.29 +/- 18.74   0.097

                                                          

  RCA                 -5.03 +/- 8.47    17.21 +/- 12.21   0.0001
  ----------------------------------------------------------------

Conclusions
===========

Chronic renal failure patients have global reductions in myocardial oxygenation even controlling for the degree of LVH.  BOLD CMR is a promising tool to detect myocardial ischemia in the renal failure population, and may form a novel risk predictor of cardiovascular prognosis. 

Funding
=======

None.