Key result
Patients with non-ischemic cardiomyopathy had a significantly lower myocardial perfusion reserve index compared to those with preserved LVEF (1.41 vs 1.74, p=0.02).
Why the study?
Microvascular dysfunction portends worse outcomes in cardiovascular diseases, prompting assessment of its prevalence in non-ischemic cardiomyopathy compared with preserved ejection fraction using stress CMR.
Does stress CMR detect a higher prevalence of microvascular dysfunction in patients with non-ischemic cardiomyopathy compared to subjects with preserved LVEF?
Cohort (n=99)
Does stress CMR detect a higher prevalence of microvascular dysfunction in patients with non-ischemic cardiomyopathy compared to subjects with preserved LVEF?
Microvascular dysfunction assessed by stress CMR is highly prevalent in patients with non-ischemic cardiomyopathy compared to those with preserved LVEF, and semiquantitative assessment detects more cases than visual methods alone.
BACKGROUND: Microvascular dysfunction (MVD) is present in various cardiovascular diseases and portends worse outcomes. We assessed the prevalence of MVD in patients with non-ischemic cardiomyopathy (NICM) as compared to subjects with preserved ejection fraction (EF) using stress cardiovascular magnetic resonance (CMR). METHODS: We retrospectively studied consecutive patients with NICM and 58 subjects with preserved left ventricular (LV) EF who underwent stress CMR between 2011-2016. MVD was defined visually as presence of a subendocardial perfusion defect and semiquantitatively by myocardial perfusion reserve index (MPRI<1.51). MPRI was compared between groups using univariate analysis and multivariable linear regression. RESULTS: In total, 41 patients with NICM (mean age 51 ± 14, 59% male) and 58 subjects with preserved LVEF (mean age 51 ± 13, 31% male) were identified. In the NICM group, MVD was present in 23 (56%) and 11 (27%) by semiquantitative and visual evaluation respectively. Compared to those with preserved LVEF, NICM patients had lower rest slope (3.9 vs 4.9, p = 0.05) and stress perfusion slope (8.8 vs 11.7, p<0.001), and MPRI (1.41 vs 1.74, p = 0.02). MPRI remained associated with NICM after controlling for age, gender, hypertension, ethnicity, diabetes, and late gadolinium enhancement (log MPR, β coefficient = -0.19, p = 0.007). CONCLUSIONS: MVD-as assessed using CMR-is highly prevalent in NICM as compared to subjects with preserved LVEF even after controlling for covariates. Semiquantitative is able to detect a greater number of incidences of MVD compared to visual methods alone. Further studies are needed to determine whether treatment of MVD is beneficial in NICM.
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Slivnick et al. (2022) conducted a cohort in Non-ischemic cardiomyopathy (n=99). Non-ischemic cardiomyopathy vs. Preserved LVEF was evaluated on Myocardial perfusion reserve index (MPRI) (p=0.02). Patients with non-ischemic cardiomyopathy had a significantly lower myocardial perfusion reserve index compared to those with preserved LVEF (1.41 vs 1.74, p=0.02).
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