Assessment of coronary heart disease with carbon dioxide
The invention provides methods for diagnosing coronary heart disease in a subject in need thereof comprising administering an admixture comprising CO2 to a subject to reach a predetermined PaCO2 in the subject to induce hyperemia, monitoring vascular reactivity in the subject and diagnosing the presence or absence of coronary heart disease in the subject, wherein decreased vascular reactivity in the subject compared to a control subject is indicative of coronary heart disease. The invention also provides methods for increasing sensitivity and specificity of BOLD MRI.
1. A method of producing coronary vasodilation and monitoring vascular reactivity in a subject comprising:
(a) administering an admixture comprising carbon dioxide (CO 2 ) to attain two or more predetermined arterial partial pressure of carbon dioxide (PaCO 2 ) levels within a range from 20 mmHg to 65 mmHg in the subject,
wherein at least two of the two or more predetermined PaCO 2 levels exhibit an increase of at least 20 mmHg within the range from 20 mmHg to 65 mmHg and correspond to an increase in CO 2 concentration in the administered admixture and/or an increase in length of time of the administered admixture, such that a hyperemic response in the subject's myocardium is induced due to the increase in the PaCO 2 level, and
wherein the admixture is administered for at least one minute to maintain each of the at least two of the two or more predetermined PaCO 2 levels;
(b) imaging the subject's myocardium at each respective maintained level of the at least two of the two or more predetermined PaCO 2 levels to obtain respective images corresponding to the increase in the PaCO 2 level; and
(c) quantifying vascular reactivity from the respective images, wherein images obtained at the predetermined PaCO 2 level corresponding to the hyperemic response identify a region of the myocardium in which the vascular reactivity is impaired in individuals with coronary heart disease.
2. The method of claim 1 , comprising the step of administering a radiotracer to the subject, and wherein the vascular reactivity corresponding to the two or more predetermined PaCO 2 levels is monitored using at least one of positron emission tomography (PET) and single photon emission computed tomography (SPECT).
3. The method of claim 1 , comprising the step of administering a contrast agent to the subject, and wherein the vascular reactivity corresponding to the two or more predetermined PaCO 2 levels is monitored using first-pass perfusion magnetic resonance imaging (MRI).
4. The method of claim 1 , wherein the vascular reactivity corresponding to the at least one two or more predetermined PaCO 2 levels is monitored using one of blood oxygen-level-dependent (BOLD) MRI and first-pass perfusion MRI.
5. The method of claim 1 , wherein the vascular reactivity corresponding to the two or more predetermined PaCO 2 levels is monitored via BOLD MRI.
6. The method of claim 1 , wherein the admixture comprising CO 2 is administered via inhalation.
7. The method of claim 1 , wherein the admixture comprising CO 2 is administered in a stepwise manner.
8. The method of claim 1 , wherein the admixture comprising CO 2 is administered to alter the subject's PaCO 2 level in a block manner.
9. The method of claim 8 , wherein the administering of CO 2 to alter the subject's PaCO 2 level in a block manner is repeated over time.
10. The method of claim 9 , wherein the at least two of the two or more predetermined PaCO 2 levels are attained via inhalation of the admixture and are selected from the group consisting of 20 mmHg and 40 mmHg, 20 mmHg and 50 mmHg, 30 mmHg and 50 mmHg, 20 mmHg and 60 mmHg, 30 mmHg and 60 mmHg, and 40 mmHg and 60 mmHg.
11. The method of claim 1 , wherein the at least two of the two or more predetermined PaCO 2 levels are levels selected from the group consisting of 20 mmHg and 40 mmHg, 20 mmHg and 50 mmHg, 30 mmHg and 50 mmHg, 20 mmHg and 60 mmHg, 30 mmHg and 60 mmHg, 40 mmHg and 60 mmHg, and, 45 mmHg and 65 mmHg.
12. The method of claim 1 , wherein the vascular reactivity is monitored using any one or more of positron emission tomography (PET), single photon emission computed tomography (SPECT), computed tomography (CT), magnetic resonance imaging (MRI), single photon emission computed tomography/computed tomography (SPECT/CT), positron emission tomography/computed tomography (PET/CT), ultrasound, electrocardiogram (ECG), Electron-beam computed tomography (EBCT), echocardiogram (ECHO), and electron spin resonance (ESR).
13. The method of claim 1 , wherein the subject is selected from the group consisting of a human, a monkey, an ape, a dog, a cat, a cow, a horse, a goat, a pig, a rabbit, a mouse and a rat.
14. The method of claim 1 , wherein the administering of the admixture comprising CO 2 alters the PaCO 2 level in the subject and a PaO 2 level in the subject.
15. The method of claim 1 , wherein the vascular reactivity is monitored using fractional flow reserve.
16. The method of claim 1 , wherein each of the two or more of predetermined PaCO 2 levels is a level in a range of 30 to 65 mmHg.
17. The method of claim 16 , wherein the admixture maintains each of the at least two of the two or more of predetermined PaCO 2 levels for a period of time, the admixture administered for each respective period of time, each respective period of time independently selected from the group consisting of 20 minutes, 15 minutes, 10 minutes, 9 minutes, 8 minutes, 7 minutes, 6 minutes, 5 minutes, 4 minutes, 3 minutes, 2 minutes, and 1 minute.
18. The method of claim 1 , wherein the admixture maintains each of the two or more predetermined PaCO 2 levels for a period of time, the admixture administered for each respective period of time, each respectively period of time independently selected from the group consisting of 20 minutes, 15 minutes, 10 minutes, 9 minutes, 8 minutes, 7 minutes, 6 minutes, 5 minutes, 4 minutes, 3 minutes, and 2 minutes.
19. The method of claim 1 , wherein the administering of the admixture comprising CO 2 alters the PaCO 2 level in the subject, which does not alter arterial partial pressure of O 2 (PaO 2 ).
20. The method of claim 1 , wherein the subject has coronary artery narrowing or stenosis, and the method identifies the region of the subject's myocardium in which the vascular reactivity is impaired due to the coronary artery narrowing or stenosis.
21. The method of claim 1 , wherein the subject is a human, and the admixture comprising CO 2 is administered in a free-breathing manner without anesthesia.