Hyperventilation-breath-hold maneuver to detect ischemia by strain-encoded CMR: a pilot study to evaluate a needle-free stress protocol

Funding Acknowledgements Type of funding sources: None. Background Safety concerns for gadolinium-containing contrast agents and pharmacological stressors, together with tremendous costs and inconsistent reimbursement modalities are still limiting a widespread application of CMR stress testing despite proven benefits. Like the effect of adenosine, hyperventilation-breath-hold-maneuver (HVBH) has demonstrated to induce myocardial vasodilation and might serve as a stressor to induce coronary steal with consecutive hypokinesia. Purpose To evaluate the diagnostic accuracy of a needle-free, ultrafast stress test to detect myocardial ischemia by strain-encoded CMR (fSENC) after HVBH. Methods Patients referred for CMR stress testing underwent an extended protocol in order to evaluate three different stress forms: (1) Adenosine first-pass perfusion (Ad-FPP), (2) Adenosine-fSENC (Ad-fSENC) and (3) HVBH-fSENC. Diagnostic accuracy was assessed using quantitative coronary angiography as reference. Results One-hundred-twenty-two predominantly male patients (age 66 ± 11years; 80% men) suspected for obstructive CAD were enrolled. Ad-fSENC and HVBH-fSENC provided significantly better diagnostic accuracy than Ad-FPP, both on a patient-level (Ad-fSENC: sensitivity 82%[65-93], specificity 83%[73-90], p Conclusions Stress testing by HVBH-fSENC provides promising diagnostic accuracy to detect myocardial ischemia and is faster than established methods without the necessity to apply contrast agent or pharmacological stressors.