Stress Imaging Research Articles

Prognostic value of myocardial perfusion entropy in patients with normal thallium-201 myocardial perfusion with a CZT camera : PROMHETE study

Objectives We assessed the prognostic value of myocardial perfusion heterogeneity (entropy) in patients with normal myocardial perfusion as estimated from a dual isotope high-speed protocol (Thallium-201 stress and technetium- 99m-sestamibi rest) performed on a semiconductor camera. Background The prognostic value of normal myocardial perfusion scintigraphic imaging has been widely established for over twenty years but the clinical value of perfusion heterogeneity quantification beyond perfusion imaging as routinely performed is unknown. Methods From May 2011 to September 2012, 1159 patients with a normal scan or a non-significant perfusion abnormality (SSS 45%) were retrospectively identified. This study reports an interim analysis of 443 patients. A dual isotope high-speed protocol was performed on a semiconductor camera following exercise testing (37%) or pharmacological stress (63%). Myocardial perfusion images were then used to quantify myocardial perfusion heterogeneity as estimated by stress and rest image entropy. The primary endpoint was the occurrence of a cardiovascular event (cardiovascular death, non-fatal myocardial infarction, coronary angiography with or without revascularization, and stroke). Results The primary endpoint occurred in 73 patients during follow-up (3.3 ± 0.4 years). In a multivariate analysis, age (HR 1.04 [1.01; 1.06] P 4.06) underwent more events than those with a lower entropy ( Conclusions Myocardial perfusion heterogeneity (entropy) determined from thallium-201 stress perfusion images acquired on a semiconductor camera represent an independent prognostic factor of cardiovascular events with additive value over the classical interpretation of images from patients with normal myocardial perfusion scintigraphy. Myocardial perfusion heterogeneity (entropy) might represent a surrogate of coronary microvascular dysfunction.

Positron emission tomography absolute stress myocardial blood flow for risk stratification in nonischemic cardiomyopathy.

Sudden cardiac death is a substantial cause of mortality in patients with cardiomyopathy, but evidence supporting implantable cardioverter-defibrillator (ICD) implantation is less robust in nonischemic cardiomyopathy (NICM) than in ischemic cardiomyopathy. Improved risk stratification is needed. We assessed whether absolute quantification of stress myocardial blood flow (sMBF) measured by positron emission tomography (PET) predicts ventricular arrhythmias (VA) and/or death in patients with NICM. In this pilot study, we prospectively followed patients with NICM (left ventricular ejection fraction ≤ 35%) and an ICD who underwent cardiac PET stress imaging with sMBF quantification. NICM was defined as the absence of angiographic obstructive coronary stenosis, significant relative perfusion defects on imaging, coronary revascularization, or acute coronary syndrome. Endpoints were appropriate device therapy for VA and all-cause mortality. Subgroup analysis was performed in patients who had no prior history of VA (ie, the primary prevention population). We followed 37 patients (60 ± 14 years, 46% male) for 41 ± 23 months. The median sMBF was 1.56 mL/g/min (interquartile range: 1.00-1.82). Lower sMBF predicted VA, both in the whole population (hazard ratio [HR] for each 0.1 mL/g/min increase: 0.84, P = .015) and in the primary prevention subset (n = 27; HR for each 0.1 mL/g/min increase: 0.81, P = .049). Patients with sMBF below the median had significantly more VA than those above the median, both in the whole population (P = .004) and in the primary prevention subset (P = .046). Estimated 3-year VA rates in the whole population were 67% among low-flow patients vs 13% among high-flow patients, and 39% vs 8%, respectively, among primary-prevention patients. sMBF did not predict all-cause mortality. In patients with NICM, lower sMBF predicts VA. This relationship may be useful for risk stratification for ventricular arrhythmia and decision making regarding ICD implantation.

Myocardial Ischemia in Children With Anomalous Aortic Origin of a Coronary Artery With Intraseptal Course

Intraseptal anomalous aortic origin of a coronary artery is considered a benign condition. However, there have been case reports of patients with myocardial ischemia, arrhythmia, and sudden cardiac death. The purpose of this study was to determine the clinical presentation, myocardial perfusion on provocative stress testing, and management of children with anomalous aortic origin of a coronary artery with an intraseptal course in a prospective cohort. Patients with anomalous aortic origin of a coronary artery and intraseptal course were prospectively enrolled from December 2012 to May 2019, evaluated, and managed following a standardized algorithm. Myocardial perfusion was assessed using stress imaging. Fractional flow reserve was performed in patients with myocardial hypoperfusion on noninvasive testing. Exercise restriction, β-blockers, and surgical intervention were discussed with the families. Eighteen patients (female 6, 33.3%), who presented with no symptoms (10, 55.6%), nonexertional (4, 22.2%), and exertional symptoms (4, 22.2%), were enrolled at a median age of 12.4 years (0.3-15.9). Perfusion imaging was performed in 14/18 (77.8%) and was abnormal in 7/14 (50%); fractional flow reserve was positive in 5/8 (62.5%). All 4 patients with exertional symptoms and 3/10 (30%) with no or nonexertional symptoms had myocardial hypoperfusion. Coronary artery bypass grafting was performed in a 4-year-old patient; β-blocker and exercise restriction were recommended in 4 patients not suitable for surgery. One patient had nonexertional chest pain and 17 were symptom-free at median follow-up of 2.5 years (0.2-7.1). Up to 50% of patients with intraseptal anomalous aortic origin of a coronary artery had inducible myocardial hypoperfusion during noninvasive provocative testing. Long-term follow-up is necessary to understand the natural history of this rare anomaly.

Preoperative cardiac assessment in liver transplant candidates.

New and extended indications, older age, higher cardiovascular risk, and the long-standing cirrhosis-associated complications mandate specific skills for an appropriate preoperative assessment of the liver transplant (LT) candidate. The incidence of cardiac diseases (dysrhythmias, cardiomyopathies, coronary artery disease, valvular heart disease) are increasing among LT recipients: however, no consensus exists among clinical practice guidelines for cardiovascular screening and risk stratification. In spite of different "transplant center-centered protocols", basic "pillars" are common (electrocardiography, baseline echocardiography, functional assessment). Owing to intrinsic limitations, yields and relevance of noninvasive stress tests, under constant scrutiny even if used, are discussed, focusing the definition of the "high risk" candidate and exploring noninvasive imaging and new forms of stress imaging. The aim is to find an appropriate and rational stepwise algorithm. The final commitment is to select the right candidate for a finite resource, the graft, able to save (and change) lives.

Outcomes in Anomalous Aortic Origin of a Coronary Artery Following a Prospective Standardized Approach

Anomalous aortic origin of a coronary artery (CA) is the second leading cause of sudden cardiac death in young athletes. Management is controversial and longitudinal follow-up data are sparse. We aim to evaluate outcomes in a prospective study of anomalous aortic origin of CA patients following a standardized algorithm. Patients with anomalous aortic origin of a CA were followed prospectively from December 2012 to April 2017. All patients were evaluated following a standardized algorithm, and data were reviewed by a dedicated multidisciplinary team. Assessment of myocardial perfusion was performed using stress imaging. High-risk patients (high-risk anatomy-anomalous left CA from the opposite sinus, presence of intramurality, abnormal ostium-and symptoms or evidence of myocardial ischemia) were offered surgery or exercise restriction (if deemed high risk for surgical intervention). Univariate and multivariable analyses were used to determine predictors of high risk. Of 201 patients evaluated, 163 met inclusion criteria: 116 anomalous right CA (71%), 25 anomalous left CA (15%), 17 single CA (10%), and 5 anomalous circumflex CA (3%). Patients presented as an incidental finding (n=80, 49%), with exertional (n=31, 21%) and nonexertional (n=32, 20%) symptoms and following sudden cardiac arrest/shock (n=5, 3%). Eighty-two patients (50.3%) were considered high risk. Predictors of high risk were older age at diagnosis, black race, intramural course, and exertional syncope. Most patients (82%) are allowed unrestrictive sports activities. Forty-seven patients had surgery (11 anomalous left CA and 36 anomalous right CA), 3 (6.4%) remained restricted from sports activities. All patients are alive at a median follow-up of 1.6 (interquartile range, 0.7-2.8) years. In this prospective cohort of patients with anomalous aortic origin of a CA, most have remained free of exercise restrictions. Development of a multidisciplinary team has allowed a consistent approach and may have implications in risk stratification and long-term prognosis.

Investigation of the physical effects of respiratory motion compensation in a large population of patients undergoing Tc-99m cardiac perfusion SPECT/CT stress imaging

BackgroundRespiratory motion can deteriorate image fidelity in cardiac perfusion SPECT. We determined the extent of respiratory motion, assessed its impact on image fidelity, and investigated the existence of gender differences, thereby examining the influence of respiratory motion in a large population of patients. MethodsOne thousand one hundred and three SPECT/CT patients underwent visual tracking of markers on their anterior surface during stress acquisition to track respiratory motion. The extent of motion was estimated by registration. Visual indicators of changes in cardiac slices with motion correction, and the correlation between the extent of motion with changes in segmental-counts were assessed. ResultsRespiratory motion in the head-to-feet direction was the largest component of motion, varying between 1.1 and 37.4 mm, and was statistically significantly higher (p = 0.002) for males than females. In 33.0% of the patients, motion estimates were larger than 10 mm. Patients progressively show more distinct visual changes with an increase in the extent of motion. The increase in segmental-count differences in the anterior, antero-lateral, and inferior segments correlated with the extent of motion. ConclusionsRespiratory motion correction diminished the artefactual reduction in anterior and inferior wall counts associated with respiratory motion. The extent of improvement was strongly related to the magnitude of motion.

УРҒУ–ПРОСОДИКАНИНГ АСОСИЙ ЭЛЕМЕНТИ

This article discusses lexical stress, which is the unit of intonation. As a prosodic feature, stress is studied through experimental methods. The division of languages into dynamic, quantitative and musical-accented languages according tomelodic, elongated and quantitative signs of stress is determined experimentally. Visual images of lexical stress are provided through experimental analysis carried out using modern technologies. Based on the results obtained, various views on the types of lexical stress in the Uzbek language are critically generalized

Implications of Abnormal Exercise Electrocardiography With Normal Stress Echocardiography

Patients with abnormal (positive) exercise electrocardiography, but normal stress echocardiography (+ECG/-Echo) are commonly encountered in clinical practice; however, the prognostic significance of this discordant result is unclear. To determine whether patients with +ECG/-Echo have a higher rate of adverse clinical events and a poorer prognosis than patients with negative exercise ECG and normal stress Echo imaging (-ECG/-Echo). Between January 1, 2000, and February 28, 2014, a total of 47 944 consecutive patients without known coronary artery disease who underwent exercise stress Echo at Duke University Medical Center were evaluated for inclusion in this observational cohort study. Data analysis was conducted from January 1, 2000, to December 31, 2016. Patients were categorized as having -ECG/-Echo, +ECG/-Echo, or +Echo (-ECG/+Echo and +ECG/+Echo). The primary outcome was a composite end point of death, myocardial infarction, hospitalization for unstable angina, and coronary revascularization. Secondary outcomes included individual adverse events and downstream testing. After excluding submaximal tests and nondiagnostic ECG or stress imaging results, 15 077 patients (mean [SD] age, 52 [13] years; 6228 [41.3%] men) were classified by stress test results. Of these, 12 893 patients (85.5%) had -ECG/-Echo, 1286 patients (8.5%) had +ECG/-Echo, and 898 patients (6.0%) had +Echo. Through a median follow-up of 7.3 (interquartile range, 4.4-10.0) years, the composite end point occurred in 794 patients with -ECG/-Echo (8.5%), 142 patients with +ECG/-Echo (14.6%), and 297 patients with +Echo (37.4%). Death occurred in 425 patients with -ECG/-Echo (4.8%), 50 patients with +ECG/-Echo (5.9%), and 70 patients with +Echo (11.2%). Myocardial infarction occurred in 195 patients with -ECG/-Echo (2.2%), 31 patients with +ECG/-Echo (3.6%), and 59 patients with +Echo (8.7%). The addition of stress ECG findings to clinical and exercise data yielded incremental prognostic value. Patients with -ECG/-Echo imaging results had the least downstream testing (2.3%), followed by +ECG/-Echo (12.8%), and +Echo (33.6%) (P < .001). The presence of +ECG results with normal stress Echo imaging may identify a population of patients who are at slightly increased risk for adverse cardiac events, which was not previously recognized. Further study is needed to determine whether these patients will benefit from intensification of medical management.

A cancer-specific activatable theranostic nanodrug for enhanced therapeutic efficacy via amplification of oxidative stress.

Rationale: Despite considerable advances, the reactive oxygen species (ROS)-mediated cancer treatment suffers from the problems of up-regulation of adaptive antioxidants in cancer cells as well as side effects to normal cells. Therefore, development of a new generation of cancer-specific nanomedicine capable of amplifying oxidative stress would be of great interest for accurate and effective cancer treatment.Methods: Herein, transferrin (Tf)-decorated, dihydroartemisinin (DHA), L-buthionine-sulfoximine (BSO), and CellROX-loaded liposomal nanoparticles (Tf-DBC NPs) were developed for precise cancer theranositcs. Tf-DBC NPs could specifically recognize cancer cells via Tf-Tf receptor binding and be uptaken into the lysosomes of cancer cells, where Tf-DBC NPs were activated to release Fe(II), DHA, and BSO. ROS was generated by DHA in the presence of Fe(II), and GSH was depleted by BSO to disrupt the redox balance in cancer cells. Furthermore, CellROX, as a fluorescent probe for imaging of intracellular oxidative stress, was used to monitor the therapeutic efficacy.Results: The integration of Tf, DHA, and BSO into the acidic pH-responsive liposomes selectively and effectively killed cancer cells and prevented the oxidative injury to normal cells. The high oxidative state was visualized at the tumor site and the amplification of oxidative stress enabled tumor eradication by Tf-DBC NPs, demonstrating the successful implementation of this novel strategy in vivo.Conclusion: Our study provides a new paradigm for the design of ROS-mediated therapeutics and offers a promising perspective for precise cancer treatment.

An activity-based two-photon fluorescent probe for real-time and reversible imaging of oxidative stress in the rat brain.

The real-time and reversible detection of cellular glutathione and oxidative stress challenges the study of the redox homeostasis of biological systems. We report herein a modular approach to design the Michael addition between glutathione and coumarin derivatives for fluorescence imaging of the reversible and dynamic change of oxidative stress in living cells and the rat brain.

Acculturative Stress and Body Image of Latina College Students Attending PWIs and HSIs

Acculturative Stress and Body Image of Latina College Students Attending PWIs and HSIs

P707 Positive rest and negative adenosine stress perfusion in typical angina

Abstract Clinical Presentation A 45 year old gentleman seen in Rapid Access Chest Pain Clinic with typical angina (exertional chest pain). No risk factors for CAD. Normal ECG. Pre-test probability of significant CAD 51% . Diagnostic techniques and findings The patient was referred for adenosine stress CMR. CMR was performed on a 1.5 Tesla scanner. Cine was performed first, followed by stress perfusion, gadolinium enhance images and finally rest perfusion images. LV systolic function was normal. A significant perfusion defect of the LAD territory was noted on the rest but not on the stress perfusion images. The radiographers confirmed that stress and rest perfusion images were performed normally (stress first). A good physiological response was obtained during the assumed vasodilator stress with &amp;gt; 20% in the HR (from 65-75bpm to 91-107bpm respectively). During the presumed rest perfusion acquisition, HR was similar to the previously recorded resting HR. The spleen was not adequately visible to comment on splenic switch off. This type of perfusion defect (normal stress/abnormal rest) had not been described before, and there is no evidence that it was due to acquisition error. A coronary CT was advised to assess the LAD. CT coronary angiogram showed mild coronary calcification. A severe (80%), focal, non-calcified mid LAD stenosis was identified. A mild proximal OM1 stenosis was also noted. The patient subsequently underwent an invasive angiogram which confirmed the presence of a severe mid LAD stenosis. PCI was performed in the same setting with deployment of a single 4x18mm XIENCE drug eluting stent. The successful procedure was optimised with OCT guidance. Learning points Resting perfusion is often considered an integral part of adenosine perfusion imaging in order to overcome dark ring artefact, but it requires an additional contrast injection, prolongs imaging time and adds to cost. Some experts suggest that resting perfusion does not add to clinical interpretation and is not required. Our case is interesting, showing a previously unreported phenomenon. We cannot explain the reason for it but do not believe that the stress/rest order was reversed (as this would require two radiographers to go off protocol, and they and the supervising physician to be lying) and the physiological response is as expected. It therefore suggests that a rest study may occasionally provide helpful diagnostic information. Abstract P707 Figure.

Cardiovascular Risk Scores in Women Undergoing Stress Myocardial Perfusion Scan and Comparison with Scan-Predicted Risk.

Background:Death due to cardiovascular disease is a major concern in the field of noncommunicable disease. Assessment of cardiovascular risk score using Framingham score and WHO/ISH score is a noninvasive, easier method of predicting the adverse cardiovascular event in the general population.Aims and Objectives:The aim of the study was to assess the cardiovascular risk using Framingham score and WHO/ISH in women undergoing stress myocardial perfusion imaging (MPI) and comparison with scan-predicted risk.Materials and Methods:Adult females with suspected coronary artery disease referred to the department of nuclear medicine for 2 months were included in the study. Data pertaining to the risk score assessment were collected, and the risk scores were calculated. Subsequently, the patients underwent scheduled Tc-99m methoxy-isobutyl-isonitrile myocardial stress imaging, and scan-predicted risks were calculated. Then, the risk score of Framingham and WHO/ISH methods were compared with stress myocardial perfusion score using Cohen's kappa statistic.Results:The mean age of the sample was 52 years (standard deviation: 11). Framingham and WHO/ISH risk scores predicted low, intermediate, and high risk in 62.2%, 28.9%, and 8.9% and 68.9%, 22.1%, and 8.89% of the population. The two scoring methods showed moderate agreement (κ =0.59). However, the scores showed only slight and fair agreement, respectively, with risk predicted by stress MPI.Conclusion:Although the risk scores have been shown to benefit in screening general population, they may not perform well in symptomatic patients with suspected angina. Out of the two methods, WHO/ISH fares better than Framingham score in this population.

The application of exercise stress cardiovascular magnetic resonance in patients with suspected dilated cardiomyopathy

ObjectivesThe imaging features of dilated cardiomyopathy (DCM) overlap with physiological exercise-induced cardiac remodeling in active and otherwise healthy individuals. Distinguishing the two conditions is challenging. This study examined the diagnostic and prognostic roles of exercise stress imaging in asymptomatic patients with suspected DCM.MethodsExercise stress cardiovascular magnetic resonance (CMR) was performed in 60 asymptomatic patients with suspected DCM (dilated left ventricle and/or impaired systolic function on CMR), who also underwent DNA sequencing for DCM-causing genetic variants. Confirmed DCM was defined as genotype- and phenotype-positive (G+P+). Another 100 healthy subjects were recruited to establish normal exercise capacities (peak exercise cardiac index; PeakCI). The primary outcome was a composite of all-cause mortality, cardiac decompensation and ventricular arrhythmic events.ResultsNo patients with confirmed G+P+ DCM had PeakCI exceeding the 35th percentile specific for age and sex. Applying this threshold in G-P+ patients, those with PeakCI below 35th percentile had characteristics similar to confirmed DCM while patients with higher PeakCI were younger, more active and higher longitudinal strain. Adverse cardiovascular events occurred only in patients with low exercise capacity (P = 0.004).ConclusionsIn individuals with suspected DCM, exercise stress CMR demonstrates diagnostic and prognostic potential in distinguishing between pathological DCM and physiological exercise-induced cardiac remodeling.

Digital evaluation of nanoscale-pore shale fractal dimension with microstructural insights into shale permeability

Permeability significantly affects the production of shale oil and shale gas, and shale microstructures characterized by pore and fracture spaces innately affect the permeability. However, the quantitative characterization of permeability related to pore and facture spaces is not fully understood. This work aims to propose 3D spatial fracture-pore fractal dimensions to predict shale permeability and their effects on fluid flow behaviors. First, triaxial compressive stress and X-ray CT imaging tests are conducted on shale samples to establish fractural models. The digital surface roughness segmentation (DSRS) method is then proposed to obtain the fracture-pore microstructures. Next, spatial fractal dimensions of self-similarity microstructures are proposed to predict the microstructural permeability. Finally, two-phase fluid flows are simulated to study the hydrocarbon flow behaviors in fractural microstructures using the level set method. The results show that the average relative errors between the microstructural spatial dimensions and theoretical fractal dimensions are all less than 3%, highlighting the accuracy of the proposed method. The numerical results for permeability are very close to the analytical solutions, in which fracture permeability is almost 100 times the order of magnitude of the pore structure permeability in the nanoscale pore shale, and the facture and pore structure permeabilities both increase with increasing spatial fractal dimension. The changes of fluid flow behaviors are similar to the permeability variations, and the fluid phase fraction increases with increasing fractal dimension.

Low-dose dynamic myocardial perfusion imaging by CZT-SPECT in the identification of obstructive coronary artery disease.

We measured myocardial blood flow (MBF) and myocardial perfusion reserve (MPR) by a dynamic low-dose CZT-SPECT protocol in patients with suspected or known coronary artery disease (CAD) and investigated the capability of dynamic data in predicting obstructive CAD. A total of 173 patients with suspected or known CAD underwent dynamic CZT-SPECT after the injection of 155MBq and 370MBq of 99mTc-sestamibi for rest and stress imaging, respectively. Standard rest and stress imaging were performed at the end of each dynamic scan. A total perfusion defect (TPD) < 5% were considered normal. Obstructive CAD was defined as ≥ 70% stenosis at coronary angiography. Global MPR was lower (p < 0.05) in patients with abnormal compared with those with normal MPI (2.40 ± 0.7 vs. 2.70 ± 0.8). A weak, albeit significant correlation between TPD and MPR (r = - 0.179, p < 0.05) was found. In 91 patients with available angiographic data, hyperemic MBF (2.59 ± 1.2 vs. 3.24 ± 1.1ml/min/g) and MPR (1.96 ± 0.7 vs. 2.74 ± 0.9) were lower (both p < 0.05) in patients with obstructive CAD (n = 21) compared with those without (n = 70). At univariable analysis, TPD, hyperemic MBF, and MPR were significant predictors of obstructive CAD, whereas only MPR was independent predictor at multivariable analysis (p < 0.05). At per vessels analysis, regional hyperemic MBF (2.59 ± 1.2 vs. 3.24 ± 1.1ml/min/g) and regional MPR (1.96 ± 0.7 vs. 2.74 ± 0.9) were lower in the 31 vessels with obstructive CAD compared with 242 vessels without (both p < 0.05). In patients with suspected or known CAD, MPR assessed by low-dose dynamic CZT-SPECT showed a good correlation with myocardial perfusion imaging findings and it could be useful to predict obstructive CAD.

UK perspective on the changing landscape of non-invasive cardiac testing

ObjectiveTo document UK rates of exercise treadmill testing, functional stress testing and CT coronary angiography (CTCA). Specific aims were to determine how rates have changed in the context of changing...

Raman imaging of residual stress distribution in epoxy resin and metal interface

AbstractA method for the distribution analysis of residual stress in epoxy resins by Raman microspectroscopy was developed. By using the uniaxial tensile method, a negative correlation between the peak shift of the aromatic C─H stretching vibration and external stress was obtained. By optimizing the precision of the Raman shift measurement, a reliable stress image was obtained for a bulk epoxy resin. This method was applied to the evaluation of the residual stress distribution in epoxy resin/aluminum bonded materials. Raman spectra imaging revealed that stress concentration strongly occurred in the interface of the cured epoxy resin with aluminum, and it was found that Raman spectra images of the small residual stress of the resin interface were affected by the curing process and physical properties of the epoxy resin. Therefore, Raman spectra imaging would appear to have significant potential as a technique for the evaluation of local thermal residual stress in the interface of multimaterial structures.

Imaging crystal stress in diamond using ensembles of nitrogen-vacancy centers

We present a micrometer-resolution millimeter-field-of-view stress imaging method for diamonds containing a thin surface layer of nitrogen vacancy (NV) centers. In this method, we reconstruct stress tensor elements over a two-dimensional field of view from NV optically-detected magnetic resonance (ODMR) spectra. We use this technique to study how stress inhomogeneity affects NV magnetometry performance, and show how NV stress imaging is a useful and direct way to assess these effects. This new tool for mapping stress in diamond will aid optimization of NV-diamond sensing, with wide-ranging applications in the physical and life sciences.

Cardiac Magnetic Resonance Imaging used for Evaluation of Adipose-Derived Stromal Cell Therapy in Patients with Chronic Ischemic Heart Disease

Adipose-derived stromal cell (ASC) therapy is currently investigated as a new treatment option for patients with ischemic heart disease (IHD). The aim of this study was to evaluate the effect of ASC therapy in patients with chronic IHD measuring myocardial perfusion and cardiac function using cardiac magnetic resonance imaging (CMRI). Patients were included in MyStromalCell trial, a phase II, randomized, double-blinded, placebo-controlled study investigated the effect of ASCs in patients with chronic IHD with preserved left ventricular ejection fraction (LVEF). In total, 41 of 60 patients underwent cine, late enhancement, rest and stress imaging with CMRI. There was a non-significant difference between stress and rest values in maximal signal intensity, a measure of myocardial perfusion, from baseline to follow-up comparing placebo with ASC group (–52.52 ± 88.61 and 3.05 ± 63.17, p = 0.061, respectively). LVEF, myocardial mass, stroke volume, left ventricle end-diastolic volume and end-systolic volume changed non-significantly (–0.5 ± 4.7%, –3.5 ± 13.1 g, –0.7 ± 8.6 mL, 1.9 ± 25.1 mL and 2.6 ± 16.5 mL, respectively) in the placebo group and in the ASC group (0.7 ± 8.6%, 0.9 ± 10.8 g, –0.3 ± 26.1 mL, –3.0 ± 31.5 mL and –2.7 ± 20.4 mL, respectively) from baseline to 6 months follow-up. The amount of scar tissue was unchanged in the placebo group by 0.0 ± 1.6 g, p = 1.0 and in the ASC group with –0.3 ± 2.3 g, p = 0.540. There was no difference between the groups. There was a non-significant trend toward increased myocardial perfusion but no significant changes in functional parameters or amount of scar tissue in patients treated with ASCs compared with patients allocated into the placebo group.