Quantitative cardiovascular magnetic resonance perfusion imaging identifies reduced flow reserve in microvascular coronary artery disease

Benjamin Zorach, Peter W Shaw, Jamieson Bourque, Sujith Kuruvilla, Pelbreton C Balfour Jr, Yang Yang, Roshin Mathew, Jonathan Pan, Jorge A Gonzalez, Angela M Taylor, Craig H Meyer, Frederick H Epstein, Christopher M Kramer, Michael Salerno, Benjamin Zorach, Peter W Shaw, Jamieson Bourque, Sujith Kuruvilla, Pelbreton C Balfour Jr, Yang Yang, Roshin Mathew, Jonathan Pan, Jorge A Gonzalez, Angela M Taylor, Craig H Meyer, Frederick H Epstein, Christopher M Kramer, Michael Salerno

Abstract

Background: Preliminary semi-quantitative cardiovascular magnetic resonance (CMR) perfusion studies have demonstrated reduced myocardial perfusion reserve (MPR) in patients with angina and risk factors for microvascular disease (MVD), however fully quantitative CMR has not been studied. The purpose of this study is to evaluate whether fully quantitative CMR identifies reduced MPR in this population, and to investigate the relationship between epicardial atherosclerosis, left ventricular hypertrophy (LVH), extracellular volume (ECV), and perfusion.

Methods: Forty-six patients with typical angina and risk factors for MVD (females, or males with diabetes or metabolic syndrome) who had no obstructive coronary artery disease by coronary angiography and 20 healthy control subjects underwent regadenoson stress CMR perfusion imaging using a dual-sequence quantitative spiral pulse sequence to quantify MPR. Subjects also underwent T1 mapping to quantify ECV, and computed tomographic (CT) coronary calcium scoring to assess atherosclerosis burden.

Results: In patients with risk factors for MVD, both MPR (2.21 [1.95,2.69] vs. 2.93 [2.763.19], p < 0.001) and stress myocardial perfusion (2.65 ± 0.62 ml/min/g, vs. 3.17 ± 0.49 ml/min/g p < 0.002) were reduced as compared to controls. These differences remained after adjusting for age, left ventricular (LV) mass, body mass index (BMI), and gender. There were no differences in native T1 or ECV between subjects and controls.

Conclusions: Stress myocardial perfusion and MPR as measured by fully quantitative CMR perfusion imaging are reduced in subjects with risk factors for MVD with no obstructive CAD as compared to healthy controls. Neither myocardial hypertrophy nor fibrosis accounts for these differences.

Keywords: Angina; Cardiovascular magnetic resonance; Diabetes; Metabolic syndrome; Microvascular disease; Myocardial perfusion reserve; Non-obstructive coronary artery disease; Women.

Conflict of interest statement

Ethics approval and consent to participate

All patients provided written informed consent on a protocol (#16056) approved by our local institutional review board (IRB).

Consent for publication

Not Applicable.

Competing interests

MS receives grant support from Astra Zeneca and is a consultant to IBM. CK is a consultant for Bayer and IBM, and has research support from Novartis, and JB receives grant support from Astellas. The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Stress and Rest Absolute Perfusion Quantification. Comparison of absolute stress flow values of mid-ventricular short axis slice. Left column: Pixel based flow map. Top Row: Patient with microvascular disease (MVD). Bottom Row: Control subject
Fig. 2
Fig. 2
Comparison of Stress myocardial blood flow (MBF) and myocardial perfusion reserve (MPR). Box and whisker plots representing stress MBF (a) and MPR (b), between study patients and controls. Stress MBF and MPR were lower in study patients by statistically significant values, p < 0.002 and p < 0.001, respectively. The + sign indicates the mean of each patient group

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