Quantification of myocardial blood flow with cardiovascular magnetic resonance throughout the cardiac cycle

Background: Myocardial blood flow (MBF) varies throughout the cardiac cycle in response to phasic changes in myocardial tension. The aim of this study was to determine if quantitative myocardial perfusion imaging with cardiovascular magnetic resonance (CMR) can accurately track physiological variations in MBF throughout the cardiac cycle. Methods: 30 healthy volunteers underwent a single stress/rest perfusion CMR study with data acquisition at 5 different time points in the cardiac cycle (early-systole, mid-systole, end-systole, early-diastole and end-diastole). MBF was estimated on a per-subject basis by Fermi-constrained deconvolution. Interval variations in MBF between successive time points were expressed as percentage change. Maximal cyclic variation (MCV) was calculated as the percentage difference between maximum and minimum MBF values in a cardiac cycle. Results: At stress, there was significant variation in MBF across the cardiac cycle with successive reductions in MBF from end-diastole to early-, mid- and end-systole, and an increase from early- to end-diastole (end-diastole: 4.50 +/- 0.91 vs. early-systole: 4.03 +/- 0.76 vs. mid-systole: 3.68 +/- 0.67 vs. end-systole 3.31 +/- 0.70 vs. early-diastole: 4.11 +/- 0.83 ml/g/min; all p values <0.0001). In all cases, the maximum and minimum stress MBF values occurred at end-diastole and end-systole respectively (mean MCV = 26 +/- 5%). There was a strong negative correlation between MCV and peak heart rate at stress (r = -0.88, p < 0.001). The largest interval variation in stress MBF occurred between end-systole and early-diastole (24 +/- 9% increase). At rest, there was no significant cyclic variation in MBF (end-diastole: 1.24 +/- 0.19 vs. early-systole: 1.28 +/- 0.17 vs. mid-systole: 1.28 +/- 0.17 vs. end-systole: 1.27 +/- 0.19 vs. early-diastole: 1.29 +/- 0.19 ml/g/min; p = 0.71). Conclusion: Quantitative perfusion CMR can be used to non-invasively assess cyclic variations in MBF throughout the cardiac cycle. In this study, estimates of stress MBF followed the expected physiological trend, peaking at end-diastole and falling steadily through to end-systole. This technique may be useful in future pathophysiological studies of coronary blood flow and microvascular function.