Diagnosis of Microvascular Angina Using Cardiac Magnetic Resonance

• Published in: Journal of the American College of Cardiology 2018-03, Vol.71 (9), p.969-979
• Main Authors: Liu, Alexander, Wijesurendra, Rohan S, Liu, Joanna M, Forfar, John C, Channon, Keith M, Jerosch-Herold, Michael, Piechnik, Stefan K, Neubauer, Stefan, Kharbanda, Rajesh K, Ferreira, Vanessa M
• Format: Article
• Language: English
• Subjects: Adenosine; Aged; Angina; Angina pectoris; Angiography; Augmentation; Blood flow; Cardiology; Cardiovascular disease; Coronary Angiography - methods; Coronary artery; Coronary artery disease; Coronary vessels; Diagnostic systems; Female; Gadolinium; Heart attacks; Heart diseases; Humans; Infarction; Ischemia; Magnetic resonance; Magnetic Resonance Imaging, Cine - methods; Male; Medical diagnosis; Medical imaging; Microcirculation - physiology; Microvascular Angina - diagnostic imaging; Microvascular Angina - physiopathology; Microvasculature; Middle Aged; Myocardium; NMR; Nuclear magnetic resonance; Patients; Perfusion; Prospective Studies; Resonance; Software; Spatial discrimination; Spatial resolution; Stress; Stresses; Ventricle
• ISSN: 0735-1097; 1558-3597
• DOI: 10.1016/j.jacc.2017.12.046

In patients with angina and nonobstructive coronary artery disease (NOCAD), confirming symptoms due to coronary microvascular dysfunction (CMD) remains challenging. Cardiac magnetic resonance (CMR) assesses myocardial perfusion with high spatial resolution and is widely used for diagnosing obstructive coronary artery disease (CAD). The goal of this study was to validate CMR for diagnosing microvascular angina in patients with NOCAD, compared with patients with obstructive CAD and correlated to the index of microcirculatory resistance (IMR) during invasive coronary angiography. Fifty patients with angina (65 ± 9 years of age) and 20 age-matched healthy control subjects underwent adenosine stress CMR (1.5- and 3-T) to assess left ventricular function, inducible ischemia (myocardial perfusion reserve index [MPRI]; myocardial blood flow [MBF]), and infarction (late gadolinium enhancement). During subsequent angiography within 7 days, 28 patients had obstructive CAD (fractional flow reserve [FFR] ≤0.8) and 22 patients had NOCAD (FFR >0.8) who underwent 3-vessel IMR measurements. In patients with NOCAD, myocardium with IMR 0.8) (area under the curve: 0.90; specificity: 95%; sensitivity: 89%; p < 0.001). Impaired MPRI in patients with NOCAD was driven by impaired augmentation of MBF during stress, with normal resting MBF. Myocardium with FFR >0.8 and normal IMR (