Key result
Suspected microvascular angina links to ~22% lower myocardial perfusion during adenosine stress versus healthy volunteers.
Why the study?
Patients with chest pain may have normal coronary arteries and microvascular angina (MVA), but whether global myocardial perfusion during adenosine stress differs from healthy controls and CAD patients or exhibits sex differences was uncertain.
Does global myocardial perfusion measured by CMR coronary sinus flow differ in patients with suspected microvascular angina compared to healthy controls and CAD patients, and are there sex differences?
Observational (n=66)
No
Does global myocardial perfusion measured by CMR coronary sinus flow differ in patients with suspected microvascular angina compared to healthy controls and CAD patients, and are there sex differences?
Absolute Event Rate: 2.9% vs 3.7%
p-value: p=0.018
CMR-derived global myocardial perfusion is reduced in suspected microvascular angina compared to healthy controls, and exhibits significant sex differences, highlighting the need for sex-specific normal limits.
Associates lower CMR perfusion with suspected microvascular angina; hypothesis-generating for sex-specific thresholds pending prospective validation.
BACKGROUND: Patients with chest pain may have normal coronary arteries and suffer from microvascular angina (MVA). The aim of this study was to determine if patients with suspected MVA have lower global myocardial perfusion (global MP) during adenosine stress compared with healthy controls and coronary artery disease (CAD) patients and to determine if there are sex differences in global MP. METHODS: Twenty-three patients with suspected MVA (66 ± 11 years), 19 CAD patients (69 ± 5 years) with stress-induced ischaemia and 24 healthy controls (61 ± 10 years) underwent cardiac magnetic resonance (CMR) including coronary sinus flow measurements and first-pass perfusion at rest and during adenosine stress. Global MP was quantified as coronary sinus flow normalized to left ventricular mass. RESULTS: Global perfusion was lower during stress in patients with suspected MVA (2.9 ± 1.0 ml/min/g) compared with healthy volunteers (3.7 ± 1.1 ml/min/g, p = 0.018), but higher compared with CAD patients (2.0 ± 0.9 ml/min/g, p = 0.019). Female controls had higher global MP than male controls both at rest (1.0 ± 0.3 vs. 0.7 ± 0.2 ml/min/g, p = 0.003) and during stress (4.4 ± 1.0 vs. 3.1 ± 0.6 ml/min/g, p = 0.001). Furthermore, females with suspected MVA showed higher global MP than males with suspected MVA (3.3 ± 1.0 vs. 2.4 ± 0.7, p = 0.04). CONCLUSIONS: Patients with suspected MVA have lower global MP at stress than healthy volunteers but higher than patients with CAD. Furthermore, there seems to be a sex difference in global MP at stress both in healthy volunteers and in patients with suspected MVA, with higher global MP in females, which implies a need for sex-specific normal limits when assessing quantitative MP.
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Gyllenhammar et al. (2022) conducted an observational in Suspected microvascular angina (n=66). Adenosine stress cardiac magnetic resonance vs. Healthy volunteers and CAD patients was evaluated on Global myocardial perfusion during adenosine stress (p=0.018). Patients with suspected microvascular angina had significantly lower global myocardial perfusion during adenosine stress (2.9 ml/min/g) compared to healthy volunteers (3.7 ml/min/g).
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