Caitlin E M Vink, Sonia Borodzicz-Jazdzyk, Elize A M de Jong, Janneke Woudstra, Tim P van de Hoef, Steven A J Chamuleau, Etto C Eringa, Marco J W Götte, Yolande Appelman
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Participants underwent adenosine stress perfusion CMR, including visual assessment and quantification of MBF and MPR. ANOCA patients underwent coronary function testing to identify vasospasm and/or coronary microvascular dysfunction.</p><p><strong>Results: </strong>Twenty-four ANOCA patients (83% women, 57 ± 9 years) and 25 healthy controls (80% women, 56 ± 7 years) were included. Visual perfusion assessment did not differ between groups (p = 0.54). Additionally, no differences in resting MBF were observed. However, ANOCA patients had significantly lower global MBF during stress (2.43 ± 0.72 vs 2.99 ± 0.65 ml/g/min, p < 0.01) and a significantly lower global MPR (2.24 ± 0.79 vs 2.68 ± 0.64, p = 0.04) compared to healthy controls. MPR was significantly reduced in the RCA territory in ANOCA patients (2.16 ± 0.71 vs 2.69 ± 0.69, p = 0.01), with no significant differences in other coronary territories. 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引用次数: 0
摘要
心脏磁共振（CMR）可有效检测心肌缺血。在冠状动脉非梗阻性心绞痛（ANOCA）中，视觉评估的第一次灌注通常显示正常。自动定量灌注（QP）可能有助于ANOCA诊断，提供心肌血流量（MBF）和心肌灌注储备（MPR）的绝对定量。目的：评价QP对ANOCA的检测效果。方法：本研究将ANOCA患者的全自动QP CMR与年龄和性别匹配的健康对照进行了比较。参与者接受腺苷应激灌注CMR，包括MBF和MPR的目视评估和量化。ANOCA患者接受冠状动脉功能检查以确定血管痉挛和/或冠状动脉微血管功能障碍。结果：纳入24例ANOCA患者（83%女性，57±9岁）和25例健康对照（80%女性，56±7岁）。各组间视觉灌注评估无差异（p = 0.54）。此外，静息MBF无差异。然而，ANOCA患者在应激时整体MBF显著降低（2.43±0.72 vs 2.99±0.65 ml/g/min, p）。结论：ANOCA患者整体MPR降低，提示灌注受损。冠状动脉各区域MPR的差异突出了评估所有区域灌注的重要性。这些发现是有希望的，并支持QP用于ANOCA患者血管舒缩功能障碍的无创检测。预注册临床试验号：预注册临床试验号：NL-OMON23861。
Quantitative perfusion by cardiac magnetic resonance imaging reveals compromised myocardial perfusion in patients with angina with non-obstructive coronary artery disease.
Introduction: Stress perfusion cardiac magnetic resonance (CMR) effectively detects myocardial ischemia. In angina with non-obstructive coronary arteries (ANOCA), visually assessed first-pass perfusion often appears normal. Automated quantitative perfusion (QP) might benefit ANOCA diagnosis, offering absolute quantification of myocardial blood flow (MBF) and myocardial perfusion reserve (MPR).
Aim: We aimed to evaluate the efficacy of QP in detecting ANOCA.
Methods: This study compared fully automated QP CMR in ANOCA patients with age- and sex-matched healthy controls. Participants underwent adenosine stress perfusion CMR, including visual assessment and quantification of MBF and MPR. ANOCA patients underwent coronary function testing to identify vasospasm and/or coronary microvascular dysfunction.
Results: Twenty-four ANOCA patients (83% women, 57 ± 9 years) and 25 healthy controls (80% women, 56 ± 7 years) were included. Visual perfusion assessment did not differ between groups (p = 0.54). Additionally, no differences in resting MBF were observed. However, ANOCA patients had significantly lower global MBF during stress (2.43 ± 0.72 vs 2.99 ± 0.65 ml/g/min, p < 0.01) and a significantly lower global MPR (2.24 ± 0.79 vs 2.68 ± 0.64, p = 0.04) compared to healthy controls. MPR was significantly reduced in the RCA territory in ANOCA patients (2.16 ± 0.71 vs 2.69 ± 0.69, p = 0.01), with no significant differences in other coronary territories. MPR did not significantly differ between ANOCA endotypes.
Conclusions: ANOCA patients display reduced global MPR, suggesting compromised perfusion. Variation in MPR across coronary territories highlights the importance of assessing perfusion in all teritories. These findings are promising and support the use of QP for non-invasive detection of vasomotor dysfunction in ANOCA patients.
Pre-registered clinical trial number: The pre-registered clinical trial number is NL-OMON23861.
期刊介绍：
Clinical Research in Cardiology is an international journal for clinical cardiovascular research. It provides a forum for original and review articles as well as critical perspective articles. Articles are only accepted if they meet stringent scientific standards and have undergone peer review. The journal regularly receives articles from the field of clinical cardiology, angiology, as well as heart and vascular surgery.
As the official journal of the German Cardiac Society, it gives a current and competent survey on the diagnosis and therapy of heart and vascular diseases.
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