1. Date of download: 6/9/2016 Copyright © The American College of Cardiology. All rights reserved. From: Navigator-Gated 3D Blood Oxygen Level–Dependent CMR at 3.0-T for Detection of Stress-Induced Myocardial Ischemic Reactions J Am Coll Cardiol Img. 2010;3(4):375-384. doi:10.1016/j.jcmg.2009.12.008 Time Course of the CMR Protocol Time course of BOLD and first-pass contrast-enhanced perfusion CMR at rest and during adenosine stress (140 μg/kg/min) subsequently followed by delayed-enhancement CMR as carried out during a single-session CMR examination. Time and dosage of contrast agent application (gadolinium-DTPA) are indicated by blue arrows. BOLD = blood oxygen level–dependent; CMR = cardiac magnetic resonance; DTPA = diethylenetriaminepentaacetic acid. Figure Legend:

2. Date of download: 6/9/2016 Copyright © The American College of Cardiology. All rights reserved. From: Navigator-Gated 3D Blood Oxygen Level–Dependent CMR at 3.0-T for Detection of Stress-Induced Myocardial Ischemic Reactions J Am Coll Cardiol Img. 2010;3(4):375-384. doi:10.1016/j.jcmg.2009.12.008 Regression Analysis of BOLD and First-Pass Perfusion CMR Relationship between BOLD ΔSI and MPRI (black lines: regression line with 95% prediction band; green lines: 95% confidence interval). The BOLD ΔSI and MPRI showed a statistically significant correlation (r = 0.69, p < 0.001). Abbreviations as in Figures 1, 2, and 4. Figure Legend:

3. Date of download: 6/9/2016 Copyright © The American College of Cardiology. All rights reserved. From: Navigator-Gated 3D Blood Oxygen Level–Dependent CMR at 3.0-T for Detection of Stress-Induced Myocardial Ischemic Reactions J Am Coll Cardiol Img. 2010;3(4):375-384. doi:10.1016/j.jcmg.2009.12.008 Relationship of BOLD and First-Pass Perfusion With Degree of Stenosis Regression plots of BOLD ΔSI (A) and MPRI (B) showing the relationship with the degree of coronary stenosis (black lines: regression line with 95% confidence interval; green lines: 95% confidence band). The BOLD ΔSI and MPRI significantly correlated with the degree of stenosis (r = −0.65, p < 0.001; and r = −0.70, p < 0.001; respectively). Abbreviations as in Figures 1, 2, 3, and 4. Figure Legend:

4. Date of download: 6/9/2016 Copyright © The American College of Cardiology. All rights reserved. From: Navigator-Gated 3D Blood Oxygen Level–Dependent CMR at 3.0-T for Detection of Stress-Induced Myocardial Ischemic Reactions J Am Coll Cardiol Img. 2010;3(4):375-384. doi:10.1016/j.jcmg.2009.12.008 ROC Analysis of BOLD and First-Pass Perfusion CMR The ROC analysis to determine the cutoff value for BOLD ΔSI (A) and MPRI (B) being predictive of the presence or absence of significant coronary artery stenosis (≥50% luminal narrowing). A cutoff value of BOLD ΔSI = 2.7% resulted in a sensitivity and specificity of 85.0% and 80.5%, respectively. A cutoff value of MPRI = 1.35 resulted in a sensitivity and specificity of 89.5% and 85.8%. AUC = area under the curve; ROC = receiver-operator characteristic curve; other abbreviations as in Figures 1, 2, and 4. Figure Legend:

5. Date of download: 6/9/2016 Copyright © The American College of Cardiology. All rights reserved. From: Navigator-Gated 3D Blood Oxygen Level–Dependent CMR at 3.0-T for Detection of Stress-Induced Myocardial Ischemic Reactions J Am Coll Cardiol Img. 2010;3(4):375-384. doi:10.1016/j.jcmg.2009.12.008 BOLD and First-Pass Perfusion CMR Error bar charts of BOLD ΔSI (A) and MPRI (B) showing the mean values and corresponding 95% confidence intervals (CI) for normal myocardial segments, myocardial segments being supplied by a significantly narrowed coronary artery (QCA ≥50%), and infarcted myocardial segments. Differences between groups were statistically significant (analysis of variance, p < 0.001). MPRI = myocardial perfusion reserve index; other abbreviations as in Figures 1, 2, and 3. Figure Legend:

6. Date of download: 6/9/2016 Copyright © The American College of Cardiology. All rights reserved. From: Navigator-Gated 3D Blood Oxygen Level–Dependent CMR at 3.0-T for Detection of Stress-Induced Myocardial Ischemic Reactions J Am Coll Cardiol Img. 2010;3(4):375-384. doi:10.1016/j.jcmg.2009.12.008 Representative CMR Examples of BOLD and First-Pass Perfusion (Upper Row) Subtracted BOLD image (A), stress and rest first-pass perfusion (B), and corresponding invasive angiogram of the left and right coronary artery (C) in a patient with known coronary artery disease and prior stenting of the RCA. Subtracted BOLD and first-pass perfusion imaging show a stress-induced deficit in the anterior/anterolateral myocardial segments (yellow arrows). Invasive coronary angiography confirmed severe stenosis of the left anterior descending coronary artery (blue arrow) (QCA 63%). (Bottom Row) Subtracted BOLD image (D), stress and rest first-pass perfusion (E), and corresponding invasive angiogram of the left and right coronary artery (F) in a patient with suspected coronary artery disease. Subtracted BOLD and first-pass perfusion imaging detected a stress-induced deficit in the inferoseptal/inferior wall (yellow arrows). Invasive coronary angiography revealed a complete occlusion of the right coronary artery (blue arrow) (QCA 100%) with retrograde filling of the distal RCA via extensive collaterals. QCA = quantitative coronary angiography; RCA = right coronary artery; other abbreviations as in Figure 1. Figure Legend:

7. Date of download: 6/9/2016 Copyright © The American College of Cardiology. All rights reserved. From: Navigator-Gated 3D Blood Oxygen Level–Dependent CMR at 3.0-T for Detection of Stress-Induced Myocardial Ischemic Reactions J Am Coll Cardiol Img. 2010;3(4):375-384. doi:10.1016/j.jcmg.2009.12.008 Rest and Stress BOLD Images With Corresponding Subtraction Images (A) The BOLD CMR images at rest and during adenosine stress together with the corresponding subtraction image and its parametric color map. A stress-induced signal loss in the anterior myocardial segment can be seen (white arrows). (B) Bull's eye plot of the complete 3-dimensional data set of subtracted BOLD images showing a stress-inducible signal loss in the anterior segments. The color scale indicates the transmurality of the stress-induced signal loss (0 = no signal loss, 1 = 1% to 25%, 2 = 26% to 50%, 3 = 51% to 75%, 4 = 76% to 100% transmurality). ΔSI = relative signal intensity changes of blood oxygen level–dependent cardiac magnetic resonance; other abbreviations as in Figure 1. Figure Legend:

8. Date of download: 6/9/2016 Copyright © The American College of Cardiology. All rights reserved. From: Navigator-Gated 3D Blood Oxygen Level–Dependent CMR at 3.0-T for Detection of Stress-Induced Myocardial Ischemic Reactions J Am Coll Cardiol Img. 2010;3(4):375-384. doi:10.1016/j.jcmg.2009.12.008 Bland-Altman Plots Showing Intrareader and Inter-reader Agreement of BOLD Measurements Bland-Altman plots showing the intrareader (A) and inter-reader (B) agreement of BOLD ΔSI measurements. In each plot, the solid lines indicates the mean absolute difference; the dashed lines represent 95% confidence intervals. Abbreviations as in Figures 1 and 2. Figure Legend: