Abnormal stress perfusion was found in 63% of women with MINOCA, co-localizing with ischemic LGE in half of cases, indicating potential microvascular dysfunction.
Does adenosine-stress CMR detect abnormal perfusion correlating with LGE and T2+ in women with MINOCA?
Abnormal perfusion on stress CMR is common in women with MINOCA and often co-localizes with LGE and T2+, suggesting microvascular dysfunction may contribute to its pathogenesis.
Absolute Event Rate: 0% vs 0%
Background In a prospective study, cardiac MRI ( CMR ) and intravascular ultrasound were performed in women with myocardial infarction ( MI ) and nonobstructive coronary artery disease ( MINOCA ). Forty participants underwent adenosine‐stress CMR ( sCMR ). Hypothesis Abnormal perfusion may co‐localize with ischemic late gadolinium enhancement ( LGE ) and T2 ‐weighted signal hyperintensity ( T2 +), suggesting microvascular dysfunction contributed to MI . Methods Qualitative perfusion analysis was performed by 2 independent readers. Abnormal myocardial perfusion reserve index ( MPRI ) was defined as global average ≤1.84. Results Abnormal rest perfusion was present in 10 patients (25%) and stress perfusion abnormalities in 25 (63%). Abnormal stress perfusion was not associated with LGE but tended to occur with T2 +. Among patients with abnormal perfusion and LGE , the LGE pattern was ischemic in half. The locations of abnormal perfusion and LGE matched in 75%, T2 + in 100%. Abnormal stress perfusion was not associated with plaque disruption and matched in location in 63%. MPRI was abnormal in 10 patients (25%) and was not associated with LGE , T2 + or plaque disruption. Conclusions Abnormal perfusion on sCMR is common among women with MINOCA . Abnormal perfusion usually co‐localized with LGE and/or T2 + when present. Variability in LGE pattern leads to uncertainty about whether the finding of abnormal perfusion was cause or consequence of the tissue state leading to LGE . Low MPRI , possibly indicating diffuse microvascular disease, was observed with and without LGE and T2 +. Multiple mechanisms may lead to abnormal perfusion on sCMR . Microvascular dysfunction may contribute to the pathogenesis of and coexist with other causes of MINOCA .
Mauricio et al. (Tue,) reported a other. Abnormal stress perfusion was found in 63% of women with MINOCA, co-localizing with ischemic LGE in half of cases, indicating potential microvascular dysfunction.