Thomson Louise E J, Wei Janet, Agarwal Megha, Haft-Baradaran Afsaneh, Shufelt Chrisandra, Mehta Puja K, Gill Edward B, Johnson B Delia, Kenkre Tanya, Handberg Eileen M, Li Debiao, Sharif Behzad, Berman Daniel S, Petersen John W, Pepine Carl J, Bairey Merz C Noel
From the Barbra Streisand Women's Heart Center, Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (L.E.J.T., J.W., M.A., A.H.-B., C.S., P.K.M., E.B.G., D.S.B., C.N.B.M.); School of Public Health, University of Pittsburgh, PA (B.D.J., T.K.); Division of Cardiology, University of Florida, Gainesville (E.M.H., J.W.P., C.J.P.); and Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA (D.L., B.S.).
Circ Cardiovasc Imaging. 2015 Apr;8(4). doi: 10.1161/CIRCIMAGING.114.002481.
Women with signs and symptoms of ischemia and no obstructive coronary artery disease often have coronary microvascular dysfunction (CMD), diagnosed by invasive coronary reactivity testing (CRT). Although traditional noninvasive stress imaging is often normal in CMD, cardiac MRI may be able to detect CMD in this population.
Vasodilator stress cardiac MRI was performed in 118 women with suspected CMD who had undergone CRT and 21 asymptomatic reference subjects. Semi-quantitative evaluation of the first-pass perfusion images was completed to determine myocardial perfusion reserve index (MPRI). The relationship between CRT findings and MPRI was examined by Pearson correlations, logistic regression, and sensitivity/specificity. Symptomatic women had lower mean pharmacological stress MPRI compared with reference subjects (1.71±0.43 versus 2.23±0.37; P<0.0001). Lower MPRI was predictive of ≥1 abnormal CRT variables (odds ratio =0.78 [0.70, 0.88], P<0.0001, c-statistic 0.78 [0.68, 0.88]). An MPRI threshold of 1.84 predicted CRT abnormality with sensitivity 73% and specificity 74%.
Noninvasive cardiac MRI MPRI can detect CMD defined by invasive CRT. Further work is aimed to optimize the noninvasive identification and management of CMD patients.
URL: http://www.clinicaltrials.gov. Unique identifier: NCT00832702.
有缺血症状和体征但无阻塞性冠状动脉疾病的女性通常存在冠状动脉微血管功能障碍（CMD），通过有创冠状动脉反应性测试（CRT）进行诊断。尽管传统的无创应激成像在CMD中通常正常，但心脏磁共振成像（MRI）可能能够在该人群中检测到CMD。
对118例疑似CMD且已接受CRT的女性和21例无症状对照者进行了血管扩张剂负荷心脏MRI检查。完成首过灌注图像的半定量评估以确定心肌灌注储备指数（MPRI）。通过Pearson相关性分析、逻辑回归分析以及敏感性/特异性分析来研究CRT结果与MPRI之间的关系。有症状的女性与对照者相比，平均药物负荷MPRI较低（1.71±0.43对2.23±0.37；P<0.0001）。较低的MPRI可预测≥1个CRT变量异常（比值比=0.78[0.70, 0.88]，P<0.0001，c统计量0.78[0.68, 0.88]）。MPRI阈值为1.84时预测CRT异常的敏感性为73%，特异性为74%。
无创心脏MRI的MPRI能够检测出由有创CRT定义CMD。进一步的工作旨在优化CMD患者的无创识别和管理。
