Angiographic correlations of patients with small vessel disease diagnosed by adenosine-stress cardiac magnetic resonance imaging

Abstract

Cardiac magnetic resonance imaging (CMR) with adenosine-stress myocardial perfusion is gaining importance for the detection and quantification of coronary artery disease (CAD). However, there is little knowledge about patients with CMR-detected ischemia, but having no relevant stenosis as seen on coronary angiography (CA). The aims of our study were to characterize these patients by CMR and CA and evaluate correlations and potential reasons for the ischemic findings. 73 patients with an indication for CA were first scanned on a 1.5T whole-body CMR-scanner including adenosine-stress first-pass perfusion. The images were analyzed by two independent investigators for myocardial perfusion which was classified as subendocardial ischemia (n = 22), no perfusion deficit (n = 27, control 1), or more than subendocardial ischemia (n = 24, control 2). All patients underwent CA, and a highly significant correlation between the classification of CMR perfusion deficit and the degree of coronary luminal narrowing was found. For quantification of coronary blood flow, corrected Thrombolysis in Myocardial Infarction (TIMI) frame count (TFC) was evaluated for the left anterior descending (LAD), circumflex (LCX) and right coronary artery (RCA). The main result was that corrected TFC in all coronaries was significantly increased in study patients compared to both control 1 and to control 2 patients. Study patients had hypertension or diabetes more often than control 1 patients. In conclusion, patients with CMR detected subendocardial ischemia have prolonged coronary blood flow. In connection with normal resting flow values in CAD, this supports the hypothesis of underlying coronary microvascular impairment. CMR stress perfusion differentiates non-invasively between this entity and relevant CAD.

Myocardial Ischemia in the Absence of Obstructive Coronary Artery Disease in Systemic Lupus Erythematosus

“…CMR results have been correlated with coronary angiography results in patients without SLE, but not yet in SLE patients (26). In addition to further validation testing with masked readings in SLE patients, CMR techniques will need additional standardization procedures for reproducibility.…”

Role of Noninvasive Testing in the Clinical Evaluation of Women With Suspected Ischemic Heart Disease

“…183 This was later validated in additional studies (46 women among 73 patients and 22 women among 34 patients). 184,185 In women with acute coronary syndrome and normal coronary arteries, subendocardial ischemia on CMR was a common finding. 186 As noted previously, in studies comparing CMR with invasive angiography, it is the minority of patients who undergo invasive angiography, and posttest referral bias elevates diagnostic sensitivity and may reduce specificity.…”

Strain-Encoded Cardiac Magnetic Resonance During High-Dose Dobutamine Stress Testing for the Estimation of Cardiac Outcomes

“…In addition, visual SENC improved sensitivity for CAD detection compared to WMA, while specificity was slightly lower, and a nonsignificant trend for higher accuracy was observed. The slightly lower specificity of SENC for ischemia detection may partially be attributed to induction of myocardial ischemia detectable by SENC: 1) in myocardial regions supplied by mildly stenotic vessels (e.g., 40% to 50%), which were classified as nonischemic by the predefined angiographic criteria (5,6); or 2) in myocardial segments with microvascular impairment in the absence of coronary lumen narrowing (29). Finally, our method comparison may suffer from a methodological mismatch, in that the assessment of wall motion that corresponds to radial myocardial function was assessed only visually, whereas SENC, which characterizes circumferential and longitudinal shortening, was assessed both visually and quantitatively.…”