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Coronary MR Imaging: Breath-hold Capability and Patterns, Coronary Artery Rest Periods, and ß-Blocker Use¹

¹ From the Department of Internal Medicine/Cardiology, German Heart Institute Berlin, Augustenburger Platz 1, 13353 Berlin, Germany (C.J., I.P., B.S., R.G., E.F., E.N.); Department of Cardiology, University of Freiburg, Freiburg, Germany (C.J.); and Department of Internal Medicine/Cardiology, University of Erlangen, Erlangen, Germany (S.A.). Received November 29, 2004; revision requested January 28, 2005; revision received March 11; accepted April 5; final version accepted May 17. Address correspondence to C.J. (e-mail: jahnke{at}dhzb.de).

View larger version (86K): [in a new window]   Figure 1a: Navigator display of breath-hold patterns shows position of diaphragm (red dots) by depicting liver-lung interface during free breathing and subsequent breath-hold period at end expiration. Distance between two vertical blue lines is 1 second. (a) Steady plateau position of diaphragm throughout breath hold, with no deviation. (b) At start of breath hold, diaphragm initially drifted to end expiration; immediately after, plateau phase with minimal diaphragm movement (2-mm deviation) was recorded. (c) During breath hold, diaphragm continuously drifted to end expiration, rendering depiction of a period of minimal diaphragm movement impossible (19% of patients). (d) Completely irregular and unsteady diaphragm movement during breath hold; thus, a period of minimal diaphragm movement could not be determined.

View larger version (70K): [in a new window]   Figure 1b: Navigator display of breath-hold patterns shows position of diaphragm (red dots) by depicting liver-lung interface during free breathing and subsequent breath-hold period at end expiration. Distance between two vertical blue lines is 1 second. (a) Steady plateau position of diaphragm throughout breath hold, with no deviation. (b) At start of breath hold, diaphragm initially drifted to end expiration; immediately after, plateau phase with minimal diaphragm movement (2-mm deviation) was recorded. (c) During breath hold, diaphragm continuously drifted to end expiration, rendering depiction of a period of minimal diaphragm movement impossible (19% of patients). (d) Completely irregular and unsteady diaphragm movement during breath hold; thus, a period of minimal diaphragm movement could not be determined.

View larger version (83K): [in a new window]   Figure 1c: Navigator display of breath-hold patterns shows position of diaphragm (red dots) by depicting liver-lung interface during free breathing and subsequent breath-hold period at end expiration. Distance between two vertical blue lines is 1 second. (a) Steady plateau position of diaphragm throughout breath hold, with no deviation. (b) At start of breath hold, diaphragm initially drifted to end expiration; immediately after, plateau phase with minimal diaphragm movement (2-mm deviation) was recorded. (c) During breath hold, diaphragm continuously drifted to end expiration, rendering depiction of a period of minimal diaphragm movement impossible (19% of patients). (d) Completely irregular and unsteady diaphragm movement during breath hold; thus, a period of minimal diaphragm movement could not be determined.

View larger version (70K): [in a new window]   Figure 1d: Navigator display of breath-hold patterns shows position of diaphragm (red dots) by depicting liver-lung interface during free breathing and subsequent breath-hold period at end expiration. Distance between two vertical blue lines is 1 second. (a) Steady plateau position of diaphragm throughout breath hold, with no deviation. (b) At start of breath hold, diaphragm initially drifted to end expiration; immediately after, plateau phase with minimal diaphragm movement (2-mm deviation) was recorded. (c) During breath hold, diaphragm continuously drifted to end expiration, rendering depiction of a period of minimal diaphragm movement impossible (19% of patients). (d) Completely irregular and unsteady diaphragm movement during breath hold; thus, a period of minimal diaphragm movement could not be determined.

View larger version (29K): [in a new window]   Figure 2: Histogram of breath-hold capability in 141 patients shows leftward shift to shorter breath-hold durations in comparison with the normal distribution with the same mean and standard deviation, mainly resulting from the exceptionally good breath-hold capability (60 seconds) of 14 patients alone.

View larger version (23K): [in a new window]   Figure 3a: Scatter plots of (a) starting point and (b) duration of RCA and LCA rest period in 210 patients. Black line is line of identity. (a) In the majority of patients, LCA rest period started earlier, with corresponding data points located below the line of identity; in 45 patients (21%), LCA rest period began later. The two clusters of data points correspond to end-systolic and mid-diastolic rest periods. (b) In most patients, LCA rest period was longer (data points above line of identity); in 29 patients (14%), LCA rest period was shorter.

View larger version (25K): [in a new window]   Figure 3b: Scatter plots of (a) starting point and (b) duration of RCA and LCA rest period in 210 patients. Black line is line of identity. (a) In the majority of patients, LCA rest period started earlier, with corresponding data points located below the line of identity; in 45 patients (21%), LCA rest period began later. The two clusters of data points correspond to end-systolic and mid-diastolic rest periods. (b) In most patients, LCA rest period was longer (data points above line of identity); in 29 patients (14%), LCA rest period was shorter.

View larger version (24K): [in a new window]   Figure 4a: (a,b) Scatter plot of rest period duration of (a) LCA and (b) RCA plotted against individual heart rate. Only weak linear correlation was found for the LCA, as well as for the RCA. Dashed lines are heart rate limits for patient subgroups. The tendency for longer rest periods in patients with lower heart rates and for shorter rest periods with higher heart rates can be appreciated. However, the majority of patients with heart rates of 60–90 beats per minute showed no obvious correlation between heart rate and rest period duration. (c,d) Box-and-whisker plots show relationship between individual heart rate and duration of (c) LCA and (d) RCA rest periods. If heart rate was less than 60 beats per minute, LCA and RCA rest periods were significantly prolonged (*) (P < .01). If heart rate was more than 90 beats per minute, a tendency toward shorter rest periods was recognized.

View larger version (26K): [in a new window]   Figure 4b: (a,b) Scatter plot of rest period duration of (a) LCA and (b) RCA plotted against individual heart rate. Only weak linear correlation was found for the LCA, as well as for the RCA. Dashed lines are heart rate limits for patient subgroups. The tendency for longer rest periods in patients with lower heart rates and for shorter rest periods with higher heart rates can be appreciated. However, the majority of patients with heart rates of 60–90 beats per minute showed no obvious correlation between heart rate and rest period duration. (c,d) Box-and-whisker plots show relationship between individual heart rate and duration of (c) LCA and (d) RCA rest periods. If heart rate was less than 60 beats per minute, LCA and RCA rest periods were significantly prolonged (*) (P < .01). If heart rate was more than 90 beats per minute, a tendency toward shorter rest periods was recognized.

View larger version (14K): [in a new window]   Figure 4c: (a,b) Scatter plot of rest period duration of (a) LCA and (b) RCA plotted against individual heart rate. Only weak linear correlation was found for the LCA, as well as for the RCA. Dashed lines are heart rate limits for patient subgroups. The tendency for longer rest periods in patients with lower heart rates and for shorter rest periods with higher heart rates can be appreciated. However, the majority of patients with heart rates of 60–90 beats per minute showed no obvious correlation between heart rate and rest period duration. (c,d) Box-and-whisker plots show relationship between individual heart rate and duration of (c) LCA and (d) RCA rest periods. If heart rate was less than 60 beats per minute, LCA and RCA rest periods were significantly prolonged (*) (P < .01). If heart rate was more than 90 beats per minute, a tendency toward shorter rest periods was recognized.

View larger version (15K): [in a new window]   Figure 4d: (a,b) Scatter plot of rest period duration of (a) LCA and (b) RCA plotted against individual heart rate. Only weak linear correlation was found for the LCA, as well as for the RCA. Dashed lines are heart rate limits for patient subgroups. The tendency for longer rest periods in patients with lower heart rates and for shorter rest periods with higher heart rates can be appreciated. However, the majority of patients with heart rates of 60–90 beats per minute showed no obvious correlation between heart rate and rest period duration. (c,d) Box-and-whisker plots show relationship between individual heart rate and duration of (c) LCA and (d) RCA rest periods. If heart rate was less than 60 beats per minute, LCA and RCA rest periods were significantly prolonged (*) (P < .01). If heart rate was more than 90 beats per minute, a tendency toward shorter rest periods was recognized.