Is subendocardial ischaemia present in patients with chest pain and normal coronary angiograms? A cardiovascular MR study.
OBJECTIVE
On the basis of an MRI study it has been suggested that subendocardial hypoperfusion is present in patients with cardiac syndrome X. However, further work is required to test whether these findings can be generalized.


RESULTS
MRI was used to visually and semi-quantitatively assess subendocardial and subepicardial perfusion, at rest and during an infusion of adenosine, in 20 patients with angina pectoris and normal coronary angiograms. A myocardial perfusion index (MPI) was calculated using the normalized upslope of myocardial signal enhancement. An index for myocardial perfusion reserve (MPRI) was calculated by dividing the MPI values at maximal vasodilatation by the values at rest. The MPI in our study population increased significantly during adenosine infusion in both the subendocardium (from 0.091 +/- 0.020 to 0.143 +/- 0.030; P < 0.001) and the subepicardium (from 0.074 +/- 0.017 to 0.135 +/- 0.03; P < 0.001). The overall MPRI was 1.83 +/- 0.50.


CONCLUSIONS
The results show that patients with chest pain and normal coronary angiograms had significant perfusion responses to adenosine in both the subendocardium and subepicardium. In the present study we found no evidence for subendocardial hypoperfusion in these patients.
Vermeltfoort
Ilse A C
IA
Department of Nuclear Medicine and PET Research, VU University Medical Centre, de Boelelaan 1117, 1007 MB Amsterdam, The Netherlands. i.vermeltfoort@vumc.nl
Bondarenko
Olga
O
Raijmakers
Pieter G H M
PG
Odekerken
Diego A M
DA
Kuijper
Aaf F M
AF
Zwijnenburg
Anton
A
van der Vis-Melsen
Mary J E
MJ
Twisk
Jos W R
JW
Beek
Aernout M
AM
Teule
Gerrit J J
GJ
van Rossum
Albert C
AC
D001794:Blood Pressure / Q000502:physiology; D002637:Chest Pain / Q000209:etiology* / Q000503:physiopathology; D017023:Coronary Angiography; D005260:Female; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D018487:Ventricular Dysfunction, Left / Q000209:etiology / Q000503:physiopathology