Myocardial first pass perfusion assessed by cardiac magnetic resonance and coronary microvascular dysfunction in women with angina and no obstructive coronary artery disease

Naja Dam Mygind; Adam Pena; Marie Mide Michelsen; Abbas Ali Qayyum; Daria Frestad; Thomas Emil Christensen; Adam Ali Ghotbi; Phillip Hasbak; Andreas Kjaer; Niels Vejlstrup; Ida Gustafsson; Peter Riis Hansen; Henrik Steen Hansen; Eva Prescott; Jens Kastrup

doi:10.1080/00365513.2019.1587670

Myocardial first pass perfusion assessed by cardiac magnetic resonance and coronary microvascular dysfunction in women with angina and no obstructive coronary artery disease

Naja Dam Mygind, Adam Pena, Marie Mide Michelsen, Abbas Ali Qayyum, Daria Frestad, Thomas Emil Christensen, Adam Ali Ghotbi, Phillip Hasbak, Andreas Kjaer, Niels Vejlstrup, Ida Gustafsson, Peter Riis Hansen, Henrik Steen Hansen, Eva Prescott, Jens Kastrup

Department of Clinical Medicine

2 Citations (Scopus)

Abstract

Coronary microvascular dysfunction (CMD) is associated with a poor prognosis even in absence of obstructive coronary artery disease. CMD can be assessed as a myocardial blood flow reserve by positron emission tomography (PETMBFR) and as coronary flow velocity reserve by transthoracic Doppler echocardiography (TTDECFVR). Impaired first-pass perfusion assessed by cardiac magnetic resonance (CMR) is an early sign of ischemia. We aimed to investigate the association between CMD and CMR first-pass perfusion. Women (n = 66) with angina pectoris and an invasive coronary angiogram (<50% stenosis) were assessed by TTDECFVR and in a subgroup of these (n = 54) also by PETMBFR. Semi-quantitative evaluation of first-pass perfusion at rest and adenosine stress was assessed by gadolinium CMR in all 66 women. Four measures of CMR perfusion reserve were calculated using contrast upslope, maximal signal intensity and both indexed to arterial input. Mean (standard deviation) age was 62 (8) years. Median (interquartile range) TTDECFVR was 2.3 (1.8;2.7) and PETMBFR was 2.7 (2.2;3.1). Using a cut-off of 2.0 for TTDECFVR and 2.5 for PETMBFR, 25 (38%) and 21 (39%) had CMD, respectively. CMR myocardial perfusion reserve from contrast upslope (CMR_MPRupslope) showed moderate but significant correlation with PETMBFR (R = .46, p < .001) while none of the other CMR variables were associated with CMD. A CMR_MPRupslope cut-off of 0.78 identified CMD, area under the curve 0.73 (p = .001). The results indicate that CMR_MPRupslope may be associated to PETMBFR; a measure of CMD. Further research is needed to validate and implement the use of CMR first pass perfusion in this population.

Original language	English
Journal	Scandinavian Journal of Clinical & Laboratory Investigation
Volume	79
Issue number	4
Pages (from-to)	238-246
ISSN	0036-5513
DOIs	https://doi.org/10.1080/00365513.2019.1587670
Publication status	Published - 19 May 2019

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Mygind, N. D., Pena, A., Mide Michelsen, M., Ali Qayyum, A., Frestad, D., Emil Christensen, T., Ali Ghotbi, A., Hasbak, P., Kjaer, A., Vejlstrup, N., Gustafsson, I., Riis Hansen, P., Steen Hansen, H., Prescott, E., & Kastrup, J. (2019). Myocardial first pass perfusion assessed by cardiac magnetic resonance and coronary microvascular dysfunction in women with angina and no obstructive coronary artery disease. Scandinavian Journal of Clinical & Laboratory Investigation, 79(4), 238-246. https://doi.org/10.1080/00365513.2019.1587670

Myocardial first pass perfusion assessed by cardiac magnetic resonance and coronary microvascular dysfunction in women with angina and no obstructive coronary artery disease. / Mygind, Naja Dam; Pena, Adam; Mide Michelsen, Marie et al.

In: Scandinavian Journal of Clinical & Laboratory Investigation, Vol. 79, No. 4, 19.05.2019, p. 238-246.

Research output: Contribution to journal › Journal article › Research › peer-review

Mygind, ND, Pena, A, Mide Michelsen, M, Ali Qayyum, A, Frestad, D, Emil Christensen, T, Ali Ghotbi, A, Hasbak, P, Kjaer, A, Vejlstrup, N, Gustafsson, I, Riis Hansen, P, Steen Hansen, H, Prescott, E & Kastrup, J 2019, 'Myocardial first pass perfusion assessed by cardiac magnetic resonance and coronary microvascular dysfunction in women with angina and no obstructive coronary artery disease', Scandinavian Journal of Clinical & Laboratory Investigation, vol. 79, no. 4, pp. 238-246. https://doi.org/10.1080/00365513.2019.1587670

Mygind ND, Pena A, Mide Michelsen M, Ali Qayyum A, Frestad D, Emil Christensen T et al. Myocardial first pass perfusion assessed by cardiac magnetic resonance and coronary microvascular dysfunction in women with angina and no obstructive coronary artery disease. Scandinavian Journal of Clinical & Laboratory Investigation. 2019 May 19;79(4):238-246. doi: 10.1080/00365513.2019.1587670

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title = "Myocardial first pass perfusion assessed by cardiac magnetic resonance and coronary microvascular dysfunction in women with angina and no obstructive coronary artery disease",

abstract = "Coronary microvascular dysfunction (CMD) is associated with a poor prognosis even in absence of obstructive coronary artery disease. CMD can be assessed as a myocardial blood flow reserve by positron emission tomography (PETMBFR) and as coronary flow velocity reserve by transthoracic Doppler echocardiography (TTDECFVR). Impaired first-pass perfusion assessed by cardiac magnetic resonance (CMR) is an early sign of ischemia. We aimed to investigate the association between CMD and CMR first-pass perfusion. Women (n = 66) with angina pectoris and an invasive coronary angiogram (<50% stenosis) were assessed by TTDECFVR and in a subgroup of these (n = 54) also by PETMBFR. Semi-quantitative evaluation of first-pass perfusion at rest and adenosine stress was assessed by gadolinium CMR in all 66 women. Four measures of CMR perfusion reserve were calculated using contrast upslope, maximal signal intensity and both indexed to arterial input. Mean (standard deviation) age was 62 (8) years. Median (interquartile range) TTDECFVR was 2.3 (1.8;2.7) and PETMBFR was 2.7 (2.2;3.1). Using a cut-off of 2.0 for TTDECFVR and 2.5 for PETMBFR, 25 (38%) and 21 (39%) had CMD, respectively. CMR myocardial perfusion reserve from contrast upslope (CMR_MPRupslope) showed moderate but significant correlation with PETMBFR (R = .46, p < .001) while none of the other CMR variables were associated with CMD. A CMR_MPRupslope cut-off of 0.78 identified CMD, area under the curve 0.73 (p = .001). The results indicate that CMR_MPRupslope may be associated to PETMBFR; a measure of CMD. Further research is needed to validate and implement the use of CMR first pass perfusion in this population.",

author = "Mygind, {Naja Dam} and Adam Pena and {Mide Michelsen}, Marie and {Ali Qayyum}, Abbas and Daria Frestad and {Emil Christensen}, Thomas and {Ali Ghotbi}, Adam and Phillip Hasbak and Andreas Kjaer and Niels Vejlstrup and Ida Gustafsson and {Riis Hansen}, Peter and {Steen Hansen}, Henrik and Eva Prescott and Jens Kastrup",

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doi = "10.1080/00365513.2019.1587670",

language = "English",

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T1 - Myocardial first pass perfusion assessed by cardiac magnetic resonance and coronary microvascular dysfunction in women with angina and no obstructive coronary artery disease

AU - Mygind, Naja Dam

AU - Pena, Adam

AU - Mide Michelsen, Marie

AU - Ali Qayyum, Abbas

AU - Frestad, Daria

AU - Emil Christensen, Thomas

AU - Ali Ghotbi, Adam

AU - Hasbak, Phillip

AU - Kjaer, Andreas

AU - Vejlstrup, Niels

AU - Gustafsson, Ida

AU - Riis Hansen, Peter

AU - Steen Hansen, Henrik

AU - Prescott, Eva

AU - Kastrup, Jens

PY - 2019/5/19

Y1 - 2019/5/19

N2 - Coronary microvascular dysfunction (CMD) is associated with a poor prognosis even in absence of obstructive coronary artery disease. CMD can be assessed as a myocardial blood flow reserve by positron emission tomography (PETMBFR) and as coronary flow velocity reserve by transthoracic Doppler echocardiography (TTDECFVR). Impaired first-pass perfusion assessed by cardiac magnetic resonance (CMR) is an early sign of ischemia. We aimed to investigate the association between CMD and CMR first-pass perfusion. Women (n = 66) with angina pectoris and an invasive coronary angiogram (<50% stenosis) were assessed by TTDECFVR and in a subgroup of these (n = 54) also by PETMBFR. Semi-quantitative evaluation of first-pass perfusion at rest and adenosine stress was assessed by gadolinium CMR in all 66 women. Four measures of CMR perfusion reserve were calculated using contrast upslope, maximal signal intensity and both indexed to arterial input. Mean (standard deviation) age was 62 (8) years. Median (interquartile range) TTDECFVR was 2.3 (1.8;2.7) and PETMBFR was 2.7 (2.2;3.1). Using a cut-off of 2.0 for TTDECFVR and 2.5 for PETMBFR, 25 (38%) and 21 (39%) had CMD, respectively. CMR myocardial perfusion reserve from contrast upslope (CMR_MPRupslope) showed moderate but significant correlation with PETMBFR (R = .46, p < .001) while none of the other CMR variables were associated with CMD. A CMR_MPRupslope cut-off of 0.78 identified CMD, area under the curve 0.73 (p = .001). The results indicate that CMR_MPRupslope may be associated to PETMBFR; a measure of CMD. Further research is needed to validate and implement the use of CMR first pass perfusion in this population.

AB - Coronary microvascular dysfunction (CMD) is associated with a poor prognosis even in absence of obstructive coronary artery disease. CMD can be assessed as a myocardial blood flow reserve by positron emission tomography (PETMBFR) and as coronary flow velocity reserve by transthoracic Doppler echocardiography (TTDECFVR). Impaired first-pass perfusion assessed by cardiac magnetic resonance (CMR) is an early sign of ischemia. We aimed to investigate the association between CMD and CMR first-pass perfusion. Women (n = 66) with angina pectoris and an invasive coronary angiogram (<50% stenosis) were assessed by TTDECFVR and in a subgroup of these (n = 54) also by PETMBFR. Semi-quantitative evaluation of first-pass perfusion at rest and adenosine stress was assessed by gadolinium CMR in all 66 women. Four measures of CMR perfusion reserve were calculated using contrast upslope, maximal signal intensity and both indexed to arterial input. Mean (standard deviation) age was 62 (8) years. Median (interquartile range) TTDECFVR was 2.3 (1.8;2.7) and PETMBFR was 2.7 (2.2;3.1). Using a cut-off of 2.0 for TTDECFVR and 2.5 for PETMBFR, 25 (38%) and 21 (39%) had CMD, respectively. CMR myocardial perfusion reserve from contrast upslope (CMR_MPRupslope) showed moderate but significant correlation with PETMBFR (R = .46, p < .001) while none of the other CMR variables were associated with CMD. A CMR_MPRupslope cut-off of 0.78 identified CMD, area under the curve 0.73 (p = .001). The results indicate that CMR_MPRupslope may be associated to PETMBFR; a measure of CMD. Further research is needed to validate and implement the use of CMR first pass perfusion in this population.

U2 - 10.1080/00365513.2019.1587670

DO - 10.1080/00365513.2019.1587670

M3 - Journal article

C2 - 30889989

SN - 0036-5513

VL - 79

SP - 238

EP - 246

JO - Scandinavian Journal of Clinical & Laboratory Investigation

JF - Scandinavian Journal of Clinical & Laboratory Investigation

IS - 4

ER -

Myocardial first pass perfusion assessed by cardiac magnetic resonance and coronary microvascular dysfunction in women with angina and no obstructive coronary artery disease

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