Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Apr 14.
doi: 10.1007/s00392-025-02636-1. Online ahead of print.

First-pass perfusion imaging using cardiovascular magnetic resonance in patients with various cardiac implantable electronic devices

Claudia Meier  1   2 , Michael Bietenbeck  3 , Maria Theofanidou  3 , Volker Vehof  3 , Philipp Stalling  3 , Dennis Korthals  3 , Bishwas Chamling  4   5 , Misael Estepa  6   7 , Patrick Doeblin  6   7 , Sebastian Kelle  6   7 , Ali Yilmaz  3
Affiliations

First-pass perfusion imaging using cardiovascular magnetic resonance in patients with various cardiac implantable electronic devices

Claudia Meier et al. Clin Res Cardiol. .

Abstract

Aims: The number of patients with cardiac implantable electronic devices (CIEDs) is increasing. However, there is limited experience regarding vasodilator-stress cardiovascular magnetic resonance (CMR) and resulting device artifacts on perfusion images. The aim of this study was to determine CMR image quality in patients with different CIED types for CMR-based perfusion stress testing.

Methods and results: A total of 156 patients with active CIEDs underwent CMR on a 1.5-Tesla scanner. Both conventional steady-state-free-precession (SSFP) and modified spoiled gradient-echo (sGE) protocols under stress and resting conditions were used to evaluate image artifacts in a 16-segment segment model of the heart. The study group comprised 39% conventional pacemaker (PM), 4% cardiac resynchronization therapy-pacemaker (CRT-P), 38% conventional implantable cardioverter-defibrillator (ICD), 6% cardiac resynchronization therapy-ICD (CRT-D), and 13% subcutaneous ICD (S-ICD) patients. PM-carriers showed only minor image artifacts in both perfusion protocols. Artifacts caused by ICDs were predominantly located in the left-ventricular (LV) inferolateral and anterior segments. S-ICDs showed the highest extent of artifacts with an anterolateral accentuation. The artifact extent was significantly reduced when sGE-based perfusion was used compared to SSFP-based sequences. 69% of the patients received a stress-perfusion protocol, and elective coronary angiography confirmed the presence of coronary stenosis in three cases. No major safety-relevant issues occurred.

Conclusion: Myocardial perfusion imaging by CMR is safe and feasible with moderate-to-high image quality in patients with all types of CIEDs, including non-conditional devices, ICDs, and S-ICDs. A sGE-based perfusion protocol should be preferred in patients with left-sided ICDs, CRT-Ds, or S-ICDs.

Keywords: Artefacts; Cardiovascular magnetic resonance; Perfusion; Spoiled gradient-echo; Steady-state-free-precession; Stress-testing.

PubMed Disclaimer

Conflict of interest statement

Declarations. Conflict of interest: Nothing to disclose. Ethical approval: This study was performed in line with the principles of the Declaration of Helsinki. The study protocol was approved by the local ethics committee (Ethik-Kommission Westfalen-Lippe, Germany, Nr. 2023-128-f-S). Informed consent: Informed consent was obtained from all individual participants included in the study.

References

    1. Kwong RY, Ge Y, Steel K, Bingham S, Abdullah S, Fujikura K et al (2019) Cardiac magnetic resonance stress perfusion imaging for evaluation of patients with chest pain. J Am Coll Cardiol 74(14):1741–1755 - DOI - PubMed - PMC
    1. Nagel E, Greenwood JP, McCann GP, Bettencourt N, Shah AM, Hussain ST et al (2019) Magnetic resonance perfusion or fractional flow reserve in coronary disease. N Engl J Med 380(25):2418–2428 - DOI - PubMed
    1. Knuuti J, Wijns W, Saraste A, Capodanno D, Barbato E, Funck-Brentano C et al (2019) ESC guidelines for the diagnosis and management of chronic coronary syndromes: the task force for the diagnosis and management of chronic coronary syndromes of the European Society of Cardiology (ESC). Eur Heart J 41(3):407–77. https://doi.org/10.1093/eurheartj/ehz425 - DOI
    1. Virani SS, Newby LK, Arnold SV, Bittner V, Brewer LC, Demeter SH et al (2023) AHA/ACC/ACCP/ASPC/NLA/PCNA guideline for the management of patients with chronic coronary disease: a report of the American heart association/American college of cardiology joint committee on clinical practice guidelines. Circulation 148(9):e9-119. https://doi.org/10.1161/CIR.0000000000001168 - DOI - PubMed
    1. Greenwood JP, Maredia N, Younger JF, Brown JM, Nixon J, Everett CC et al (2012) Cardiovascular magnetic resonance and single-photon emission computed tomography for diagnosis of coronary heart disease (CE-MARC): a prospective trial. Lancet 379(9814):453–460 - DOI - PubMed - PMC

LinkOut - more resources