Wei Janet, Jalnakupur Sawan, Cruz Sherwin Dela, Wiens Galen Cook, Motwani Manish, Zhang Xiao, Petersen John W, Mehta Puja K, Shufelt Chrisandra, Sharif Behzad, Handberg Eileen, Sopko George, Rogatko Andre, Pepine Carl J, Berman Daniel S, Thomson Louise E, Merz C Noel Bairey
Barbra Streisand Women's Heart Center, Cedars-Sinai Smidt Heart Institute, Los Angeles, CA.
Biostatistics and Bioinformatics Research Center, Cedars-Sinai Medical Center, Los Angeles, CA.
Cardiovasc Disord Med. 2019;2019. doi: 10.31487/j.cdm.2019.01.01. Epub 2019 Dec 31.
Stress cardiac magnetic resonance (CMR) imaging with myocardial perfusion reserve index (MPRI) measurement has emerged as a noninvasive method for assessing coronary microvascular dysfunction (CMD) in the absence of obstructive coronary artery disease (CAD). Pharmacologic stress with adenosine or regadenoson is typically used with comparable coronary vasodilation, but higher unadjusted MPRI has been reported with regadenoson in healthy men. This difference has not been assessed in symptomatic or healthy women.
In a prospective cohort study, 139 symptomatic women with suspected CMD and no obstructive CAD underwent stress CMR and invasive coronary flow reserve (CFR) testing. Adenosine was the default vasodilator (n=99), while regadenoson was used if history of asthma or prior adenosine intolerance (n=40). Stress CMR was also performed in 40 age-matched healthy controls using adenosine (n=20) and regadenoson (n=20). Unpaired t-tests and analysis of covariance were performed to compare MPRI with adenosine and regadenoson in the symptomatic women and healthy controls.
Compared to regadenoson cases, adenosine cases had lower invasive CFR (2.64±0.62 vs 2.94±0.68, p=0.01) and pharmacologic heart rate change (28±16 vs 38±15 bpm, p=0.0008). Unadjusted MPRI was lower in the adenosine compared to regadenoson cases (1.73±0.38 vs 2.27±0.59, <0.0001). When adjusted for heart rate, rate-pressure-product, and invasive CFR, MPRI remained lower in the adenosine cases (<0.0001). Invasive CFR to adenosine correlated with adenosine MPRI (r 0.17, p=0.02) but not regadenoson MPRI (r -0.14, p=0.19). There was no significant difference in MPRI in the controls who received adenosine vs regadenoson (2.27±0.33 vs 2.38±0.44, p=0.36).
In women undergoing stress CMR for suspected CMD, those who received adenosine had lower MPRI than those who received regadenoson. However, there were no differences in MPRI in the healthy controls. These findings suggest there may be physiologic differences in adenosine and regadenoson response in the coronary microcirculation of symptomatic women.
采用心肌灌注储备指数（MPRI）测量的应激心脏磁共振成像（CMR）已成为在无阻塞性冠状动脉疾病（CAD）情况下评估冠状动脉微血管功能障碍（CMD）的一种非侵入性方法。通常使用腺苷或瑞加诺生进行药物应激，两者具有相似的冠状动脉血管舒张作用，但据报道健康男性使用瑞加诺生时未调整的MPRI更高。这种差异在有症状或健康女性中尚未得到评估。
在一项前瞻性队列研究中，139例疑似CMD且无阻塞性CAD的有症状女性接受了应激CMR和有创冠状动脉血流储备（CFR）检测。默认使用腺苷作为血管扩张剂（n = 99），如果有哮喘病史或既往腺苷不耐受则使用瑞加诺生（n = 40）。还对40例年龄匹配的健康对照者进行了应激CMR检测，其中20例使用腺苷，20例使用瑞加诺生。采用不成对t检验和协方差分析比较有症状女性和健康对照者中使用腺苷和瑞加诺生时的MPRI。
与使用瑞加诺生的病例相比，使用腺苷的病例有创CFR较低（2.64±0.62对2.94±0.68，p = 0.01）且药物引起的心率变化较小（28±16对38±15次/分钟，p = 0.0008）。与使用瑞加诺生的病例相比，使用腺苷的病例未调整的MPRI较低（1.73±0.38对2.27±0.59，<0.0001）。在调整心率、心率 - 血压乘积和有创CFR后，使用腺苷的病例MPRI仍然较低（<0.0001）。对腺苷的有创CFR与腺苷MPRI相关（r = 0.17，p = 0.02），但与瑞加诺生MPRI不相关（r = -0.14，p = 0.19）。接受腺苷与接受瑞加诺生的对照者MPRI无显著差异（2.27±0.33对2.38±0.44，p = 0.36）。
在因疑似CMD接受应激CMR检测的女性中，接受腺苷的女性MPRI低于接受瑞加诺生的女性。然而，健康对照者的MPRI没有差异。这些发现表明，有症状女性冠状动脉微循环中腺苷和瑞加诺生反应可能存在生理差异。
