Coronary microvascular function and myocardial fibrosis in women with angina pectoris and no obstructive coronary artery disease: the iPOWER study

Journal of Cardiovascular Magnetic Resonance

Research

Marie Mide Michelsen¹  Rebekka Faber¹  Nynne Dose¹  Eva Prescott¹  Naja Dam Mygind²  Adam Pena³  Daria Frestad⁴  Niels Vejlstrup⁵  Abbas Ali Qayyum⁵  Jens Kastrup⁵  Andreas Kjaer⁶  Thomas Emil Christensen⁶  Adam Ali Ghotbi⁶  Philip Hasbak⁶ 

[1] Department of Cardiology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark;Department of Cardiology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark;Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark;Department of Cardiology, Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark;Department of Cardiology, Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark;Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark;Department of Clinical Physiology, Nuclear Medicine & PET and Cluster for Molecular Imaging, Rigshospitalet and University of Copenhagen, Copenhagen, Denmark;

关键词: Microvascular dysfunction;    Women;    Angina pectoris;    T1 mapping;    Coronary flow velocity reserve;    Cardiovascular magnetic resonance;    Doppler echocardiography;    Positron emission tomography;    Diffuse fibrosis;    Extracellular volume;   

DOI  :  10.1186/s12968-016-0295-5

 received in 2016-06-11, accepted in 2016-10-12,  发布年份 2016

来源: Springer

【 摘 要 】

BackgroundEven in absence of obstructive coronary artery disease women with angina pectoris have a poor prognosis possibly due to coronary microvascular disease. Coronary microvascular disease can be assessed by transthoracic Doppler echocardiography measuring coronary flow velocity reserve (CFVR) and by positron emission tomography measuring myocardial blood flow reserve (MBFR). Diffuse myocardial fibrosis can be assessed by cardiovascular magnetic resonance (CMR) T1 mapping. We hypothesized that coronary microvascular disease is associated with diffuse myocardial fibrosis.MethodsWomen with angina, a clinically indicated coronary angiogram with <50 % stenosis and no diabetes were included. CFVR was measured using dipyridamole (0.84 mg/kg) and MBFR using adenosine (0.84 mg/kg). Focal fibrosis was assessed by 1.5 T CMR late gadolinium enhancement (0.1 mmol/kg) and diffuse myocardial fibrosis by T1 mapping using a modified Look-Locker pulse sequence measuring T1 and extracellular volume fraction (ECV).ResultsCFVR and CMR were performed in 64 women, mean (SD) age 62.5 (8.3) years. MBFR was performed in a subgroup of 54 (84 %) of these women. Mean native T1 was 1023 (86) and ECV (%) was 33.7 (3.5); none had focal fibrosis. Median (IQR) CFVR was 2.3 (1.9; 2.7), 23 (36 %) had CFVR < 2 indicating coronary microvascular disease, and median MBFR was 2.7 (2.2; 3.0) and 19 (35 %) had a MBFR value below 2.5. No significant correlations were found between CFVR and ECV or native T1 (R2 = 0.02; p = 0.27 and R2 = 0.004; p = 0.61, respectively). There were also no correlations between MBFR and ECV or native T1 (R2 = 0.1; p = 0.13 and R2 = 0.004, p = 0.64, respectively). CFVR and MBFR were correlated to hypertension and heart rate.ConclusionIn women with angina and no obstructive coronary artery disease we found no association between measures of coronary microvascular disease and myocardial fibrosis, suggesting that myocardial ischemia induced by coronary microvascular disease does not elicit myocardial fibrosis in this population. The examined parameters seem to provide independent information about myocardial and coronary disease.

【 授权许可】

CC BY   
© The Author(s). 2016