Cardiac Magnetic Resonance Myocardial Perfusion Reserve Index Is Reduced in Women With Coronary Microvascular Dysfunction

Thomson, Louise; Wei, Janet; Agarwal, Megha; Haftbaradaran, Afsaneh; Shufelt, Chrisandra; Mehta, Puja K.; Gill, Edward; Johnson, B. Delia; Kenkre, Tanya S.; Handberg, Eileen M.; Li, Debiao; Sharif, Behzad; Berman, Daniel S.; Petersen, John W.; Pepine, Carl J.; Merz, C. Noel Bairey

doi:10.1161/circimaging.114.002481

Cited by 202 publications

(93 citation statements)

References 27 publications

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“…Performance of semiquantitative perfusion CMR for detection of coronary microvascular dysfunction was evaluated in a recent study of 118 women who also underwent coronary reactivity testing, resulting in a sensitivity and specificity of 73% and 74%, respectively. 24 It is expected that quantification of myocardial blood flow and perfusion reserve will further improve the diagnostic performance compared with semiquantitative analysis. Further standardization of techniques and improved inline automatic postprocessing for rapid quantification of myocardial blood flow will be necessary for widespread utility and clinical impact.…”

Section: Advanced Techniques and Applications For First-pass Perfusiomentioning

confidence: 99%

Recent Advances in Cardiovascular Magnetic Resonance

Salerno

Sharif

Arheden³

et al. 2017

Circ: Cardiovascular Imaging

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145

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Cardiovascular magnetic resonance imaging has become the gold standard for evaluating myocardial function, volumes, and scarring. Additionally, cardiovascular magnetic resonance imaging is unique in its comprehensive tissue characterization, including assessment of myocardial edema, myocardial siderosis, myocardial perfusion, and diffuse myocardial fibrosis. Cardiovascular magnetic resonance imaging has become an indispensable tool in the evaluation of congenital heart disease, heart failure, cardiac masses, pericardial disease, and coronary artery disease. This review will highlight some recent novel cardiovascular magnetic resonance imaging techniques, concepts, and applications.

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Section: Advanced Techniques and Applications For First-pass Perfusiomentioning

confidence: 99%

Recent Advances in Cardiovascular Magnetic Resonance

Salerno

Sharif

Arheden³

et al. 2017

Circ: Cardiovascular Imaging

Self Cite

145

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“…[45,81] In addition, enhancement of CMR with adenosine perfusion MRI (also called 'adenosine stress MRI') can be used to identify both ischemic coronary artery disease as well as non-obstructive coronary disease in symptomatic women without major plaques. [82] It is unclear whether or not there is a role for adenosine stress MRI in the detection of cardiac dysfunction in asymptomatic women. However, CMR can be used to identify macroscopic fibrosis with late gadolinium enhancement, and evaluate early (preclinical) myocardial fibrosis with so-called T1 mapping.…”

Section: Coronary Artery Calcium Scorementioning

confidence: 99%

Determinants of future cardiovascular health in women with a history of preeclampsia

et al. 2015

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Please cite this article as: Zoet Gerbrand A, Koster Maria PH, Velthuis Birgitta K, de Groot Christianne JM, Maas Angela HEM, Fauser Bart CJM, Franx Arie, Rijn Bas B.van.Determinants of future cardiovascular health in women with a history of preeclampsia.Maturitas http://dx.doi.org/10.1016/j.maturitas. 2015.07.004 This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. Keywords:Preeclampsia, cardiovascular disease, risk assessment, screening, prevention Highlights  Female-specific risk factors, among which preeclampsia, may have additional value in cardiovascular screening.  Non-invasive imaging techniques can be helpful to detect early-stage cardiovascular lesions as a sign of subclinical atherosclerotic disease.  Preliminary studies show positive effects of short-term lifestyle interventions following preeclampsia.  There is a need for clinical practice guidelines that provide long-term strategies in women after preeclampsia in pregnancy to improve cardiovascular health. AbstractWomen who develop preeclampsia have an increased risk of cardiovascular disease (CVD) later in life.However, current guidelines on cardiovascular risk assessment and prevention are unclear on how and when to screen these women postpartum, and about the role of a positive history of preeclampsia in later-life CVD risk management. The aim of this review is to discuss the present knowledge on commonly used cardiovascular screening modalities available to women with a history of preeclampsia, and to discuss recent developments in early detection of CVD using cardiovascular imaging.Furthermore, we explore how female-specific risk factors may have additional value in cardiovascular screening, in particular in relatively young women, although their implementation in clinical practice is challenged by inconsistent results and lack of long-term outcome data. Non-invasive imaging techniques, e.g. coronary artery intima-media thickness (CIMT), can be helpful to detect subclinical atherosclerotic disease, and coronary artery calcium scoring (CACS) has shown to be effective in early detection of cardiovascular damage. However, whilst more short-term and long-term follow-up studies are becoming available, few studies have investigated women with a history of preeclampsia in the fourth and fifth decade of life, when early signs of premature CVD are most likely to become apparent.Further studies are needed to inform new and improved clinical practice guidelines, and provide longterm strategies to effectively prevent CVD, specifically targeted at women with a history of preeclampsia. Additionally, evaluation of feasibility, cost-effectiveness ...

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“…Global MPRI was the average of MPRI values for all segments and was considered abnormal if ≤1.84. 26 Location of abnormal myocardial perfusion was compared with location of LGE or T2+, when present, using 16 segments of the AHA 17-segment model (true apex was not included in perfusion analysis).…”

Section: Image Analysismentioning

confidence: 99%

Stress Cardiac MRI in Women With Myocardial Infarction and Nonobstructive Coronary Artery Disease

Mauricio

Srichai

Axel

et al. 2016

Clinical Cardiology

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BackgroundIn a prospective study, cardiac MRI (CMR) and intravascular ultrasound were performed in women with myocardial infarction (MI) and nonobstructive coronary artery disease (MINOCA). Forty participants underwent adenosine‐stress CMR (sCMR).HypothesisAbnormal perfusion may co‐localize with ischemic late gadolinium enhancement (LGE) and T2‐weighted signal hyperintensity (T2+), suggesting microvascular dysfunction contributed to MI.MethodsQualitative perfusion analysis was performed by 2 independent readers. Abnormal myocardial perfusion reserve index (MPRI) was defined as global average ≤1.84.ResultsAbnormal rest perfusion was present in 10 patients (25%) and stress perfusion abnormalities in 25 (63%). Abnormal stress perfusion was not associated with LGE but tended to occur with T2+. Among patients with abnormal perfusion and LGE, the LGE pattern was ischemic in half. The locations of abnormal perfusion and LGE matched in 75%, T2+ in 100%. Abnormal stress perfusion was not associated with plaque disruption and matched in location in 63%. MPRI was abnormal in 10 patients (25%) and was not associated with LGE, T2+ or plaque disruption.ConclusionsAbnormal perfusion on sCMR is common among women with MINOCA. Abnormal perfusion usually co‐localized with LGE and/or T2+ when present. Variability in LGE pattern leads to uncertainty about whether the finding of abnormal perfusion was cause or consequence of the tissue state leading to LGE. Low MPRI, possibly indicating diffuse microvascular disease, was observed with and without LGE and T2+. Multiple mechanisms may lead to abnormal perfusion on sCMR. Microvascular dysfunction may contribute to the pathogenesis of and coexist with other causes of MINOCA.

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Cardiac Magnetic Resonance Myocardial Perfusion Reserve Index Is Reduced in Women With Coronary Microvascular Dysfunction

Cited by 202 publications

References 27 publications

Recent Advances in Cardiovascular Magnetic Resonance

Recent Advances in Cardiovascular Magnetic Resonance

Determinants of future cardiovascular health in women with a history of preeclampsia

Stress Cardiac MRI in Women With Myocardial Infarction and Nonobstructive Coronary Artery Disease

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