No gadolinium necessary: Imaging technique IDs patients with CAD without contrast agent

A new imaging technique may be able to help identify patients with coronary artery disease (CAD) without the use of drugs or any contrast agents, according to research published in the Journal of the American College of Cardiology: Cardiovascular Imaging.

As more researchers find evidence of gadolinium deposition in the brain, the push to find imaging approaches that don’t need gadolinium-based contrast agents (GBCAs) has been on the rise.

“Current stress cardiac imaging requires administration of gadolinium contrast agent,” author Reza Nezafat, PhD, scientific director of the Cardiovascular Magnetic Resonance Center at Beth Israel Deaconess Medical Center and a Professor of Medicine at Harvard Medical School, said in a prepared statement. “However, recent data have shown that gadolinium deposits in the brain and other organs. We aimed to develop a non-invasive imaging technique that eliminates the need for any contrast administration to measure changes in the blood flow in the myocardium.”

Nezafat et al. developed a new technique that tracks changes in a patient’s heart as they exercise. Healthy patients were asked to undergo a series of baseline imaging examinations before lying on their backs and pedaling an exercise bicycle at the opening of an MRI scanner. Scans occurred within 30 seconds, allowing the researchers to look for changes in blood flow in the myocardium.

The entire process was then repeated, but with research subjects with known or suspected CAD. The researchers compared images from the two groups and noted they “revealed that magnetic properties of myocardium change differently in areas impacted by coronary atherosclerosis than in normal areas.”  

“In this proof-of-concept study, we demonstrated that a quantitative cardiac MR approach that measures tissue properties of heart muscles, combined with an exercise protocol using an MRI-compatible ergometer in an MRI suite might have the potential to assess flow-limiting coronary artery stenosis in patients with suspected CAD without the need for gadolinium contrast injection or pharmacological stress agents,” Nezefat said in the same statement. “Larger studies are warranted to confirm the clinical performance of our quantitative cardiac MR approach with exercise stress as an alternative to the currently common method of non-invasive assessment of coronary artery disease.”