title: Cardiac magnetic resonance myocardial perfusion reserve index is reduced in women with coronary microvascular dysfunction. A National Heart, Lung, and Blood Institute-sponsored study from the Women's Ischemia Syndrome Evaluation.
abstract: BACKGROUND
  Women with signs and symptoms of ischemia and no obstructive coronary artery disease often have coronary microvascular dysfunction (CMD), diagnosed by invasive coronary reactivity testing (CRT). Although traditional noninvasive stress imaging is often normal in CMD, cardiac MRI may be able to detect CMD in this population.
  
  
  RESULTS
  Vasodilator stress cardiac MRI was performed in 118 women with suspected CMD who had undergone CRT and 21 asymptomatic reference subjects. Semi-quantitative evaluation of the first-pass perfusion images was completed to determine myocardial perfusion reserve index (MPRI). The relationship between CRT findings and MPRI was examined by Pearson correlations, logistic regression, and sensitivity/specificity. Symptomatic women had lower mean pharmacological stress MPRI compared with reference subjects (1.71±0.43 versus 2.23±0.37; P<0.0001). Lower MPRI was predictive of ≥1 abnormal CRT variables (odds ratio =0.78 [0.70, 0.88], P<0.0001, c-statistic 0.78 [0.68, 0.88]). An MPRI threshold of 1.84 predicted CRT abnormality with sensitivity 73% and specificity 74%.
  
  
  CONCLUSIONS
  Noninvasive cardiac MRI MPRI can detect CMD defined by invasive CRT. Further work is aimed to optimize the noninvasive identification and management of CMD patients.
  
  
  BACKGROUND
  URL: http://www.clinicaltrials.gov. Unique identifier: NCT00832702.
authors: From the Barbra Streisand Women's Heart Center, Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (L.E.J.T., J.W., M.A., A.H.-B., C.S., P.K.M., E.B.G., D.S.B., C.N.B.M.); School of Public Health, University of Pittsburgh, PA (B.D.J., T.K.); Division of Cardiology, University of Florida, Gainesville (E.M.H., J.W.P., C.J.P.); and Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA (D.L., B.S.). Louise.Thomson@cshs.org.
authors: Louise E J
authors: LE
authors: Thomson
authors: From the Barbra Streisand Women's Heart Center, Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (L.E.J.T., J.W., M.A., A.H.-B., C.S., P.K.M., E.B.G., D.S.B., C.N.B.M.); School of Public Health, University of Pittsburgh, PA (B.D.J., T.K.); Division of Cardiology, University of Florida, Gainesville (E.M.H., J.W.P., C.J.P.); and Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA (D.L., B.S.).
authors: Janet
authors: J
authors: Wei
authors: From the Barbra Streisand Women's Heart Center, Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (L.E.J.T., J.W., M.A., A.H.-B., C.S., P.K.M., E.B.G., D.S.B., C.N.B.M.); School of Public Health, University of Pittsburgh, PA (B.D.J., T.K.); Division of Cardiology, University of Florida, Gainesville (E.M.H., J.W.P., C.J.P.); and Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA (D.L., B.S.).
authors: Megha
authors: M
authors: Agarwal
authors: From the Barbra Streisand Women's Heart Center, Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (L.E.J.T., J.W., M.A., A.H.-B., C.S., P.K.M., E.B.G., D.S.B., C.N.B.M.); School of Public Health, University of Pittsburgh, PA (B.D.J., T.K.); Division of Cardiology, University of Florida, Gainesville (E.M.H., J.W.P., C.J.P.); and Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA (D.L., B.S.).
authors: Afsaneh
authors: A
authors: Haft-Baradaran
authors: From the Barbra Streisand Women's Heart Center, Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (L.E.J.T., J.W., M.A., A.H.-B., C.S., P.K.M., E.B.G., D.S.B., C.N.B.M.); School of Public Health, University of Pittsburgh, PA (B.D.J., T.K.); Division of Cardiology, University of Florida, Gainesville (E.M.H., J.W.P., C.J.P.); and Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA (D.L., B.S.).
authors: Chrisandra
authors: C
authors: Shufelt
authors: From the Barbra Streisand Women's Heart Center, Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (L.E.J.T., J.W., M.A., A.H.-B., C.S., P.K.M., E.B.G., D.S.B., C.N.B.M.); School of Public Health, University of Pittsburgh, PA (B.D.J., T.K.); Division of Cardiology, University of Florida, Gainesville (E.M.H., J.W.P., C.J.P.); and Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA (D.L., B.S.).
authors: Puja K
authors: PK
authors: Mehta
authors: From the Barbra Streisand Women's Heart Center, Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (L.E.J.T., J.W., M.A., A.H.-B., C.S., P.K.M., E.B.G., D.S.B., C.N.B.M.); School of Public Health, University of Pittsburgh, PA (B.D.J., T.K.); Division of Cardiology, University of Florida, Gainesville (E.M.H., J.W.P., C.J.P.); and Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA (D.L., B.S.).
authors: Edward B
authors: EB
authors: Gill
authors: From the Barbra Streisand Women's Heart Center, Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (L.E.J.T., J.W., M.A., A.H.-B., C.S., P.K.M., E.B.G., D.S.B., C.N.B.M.); School of Public Health, University of Pittsburgh, PA (B.D.J., T.K.); Division of Cardiology, University of Florida, Gainesville (E.M.H., J.W.P., C.J.P.); and Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA (D.L., B.S.).
authors: B Delia
authors: BD
authors: Johnson
authors: From the Barbra Streisand Women's Heart Center, Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (L.E.J.T., J.W., M.A., A.H.-B., C.S., P.K.M., E.B.G., D.S.B., C.N.B.M.); School of Public Health, University of Pittsburgh, PA (B.D.J., T.K.); Division of Cardiology, University of Florida, Gainesville (E.M.H., J.W.P., C.J.P.); and Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA (D.L., B.S.).
authors: Tanya
authors: T
authors: Kenkre
authors: From the Barbra Streisand Women's Heart Center, Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (L.E.J.T., J.W., M.A., A.H.-B., C.S., P.K.M., E.B.G., D.S.B., C.N.B.M.); School of Public Health, University of Pittsburgh, PA (B.D.J., T.K.); Division of Cardiology, University of Florida, Gainesville (E.M.H., J.W.P., C.J.P.); and Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA (D.L., B.S.).
authors: Eileen M
authors: EM
authors: Handberg
authors: From the Barbra Streisand Women's Heart Center, Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (L.E.J.T., J.W., M.A., A.H.-B., C.S., P.K.M., E.B.G., D.S.B., C.N.B.M.); School of Public Health, University of Pittsburgh, PA (B.D.J., T.K.); Division of Cardiology, University of Florida, Gainesville (E.M.H., J.W.P., C.J.P.); and Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA (D.L., B.S.).
authors: Debiao
authors: D
authors: Li
authors: From the Barbra Streisand Women's Heart Center, Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (L.E.J.T., J.W., M.A., A.H.-B., C.S., P.K.M., E.B.G., D.S.B., C.N.B.M.); School of Public Health, University of Pittsburgh, PA (B.D.J., T.K.); Division of Cardiology, University of Florida, Gainesville (E.M.H., J.W.P., C.J.P.); and Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA (D.L., B.S.).
authors: Behzad
authors: B
authors: Sharif
authors: From the Barbra Streisand Women's Heart Center, Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (L.E.J.T., J.W., M.A., A.H.-B., C.S., P.K.M., E.B.G., D.S.B., C.N.B.M.); School of Public Health, University of Pittsburgh, PA (B.D.J., T.K.); Division of Cardiology, University of Florida, Gainesville (E.M.H., J.W.P., C.J.P.); and Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA (D.L., B.S.).
authors: Daniel S
authors: DS
authors: Berman
authors: From the Barbra Streisand Women's Heart Center, Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (L.E.J.T., J.W., M.A., A.H.-B., C.S., P.K.M., E.B.G., D.S.B., C.N.B.M.); School of Public Health, University of Pittsburgh, PA (B.D.J., T.K.); Division of Cardiology, University of Florida, Gainesville (E.M.H., J.W.P., C.J.P.); and Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA (D.L., B.S.).
authors: John W
authors: JW
authors: Petersen
authors: From the Barbra Streisand Women's Heart Center, Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (L.E.J.T., J.W., M.A., A.H.-B., C.S., P.K.M., E.B.G., D.S.B., C.N.B.M.); School of Public Health, University of Pittsburgh, PA (B.D.J., T.K.); Division of Cardiology, University of Florida, Gainesville (E.M.H., J.W.P., C.J.P.); and Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA (D.L., B.S.).
authors: Carl J
authors: CJ
authors: Pepine
authors: From the Barbra Streisand Women's Heart Center, Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (L.E.J.T., J.W., M.A., A.H.-B., C.S., P.K.M., E.B.G., D.S.B., C.N.B.M.); School of Public Health, University of Pittsburgh, PA (B.D.J., T.K.); Division of Cardiology, University of Florida, Gainesville (E.M.H., J.W.P., C.J.P.); and Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA (D.L., B.S.).
authors: C Noel
authors: CN
authors: Bairey Merz
mesh_terms: D000241:Adenosine; D000368:Aged; D003326:Coronary Circulation / Q000502:physiology*; D003331:Coronary Vessels / Q000503:physiopathology*; D005260:Female; D053805:Fractional Flow Reserve, Myocardial / Q000502:physiology*; D006801:Humans; D017078:Laser-Doppler Flowmetry; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008833:Microcirculation; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000175:diagnosis*; D055414:Myocardial Perfusion Imaging; D014665:Vasodilator Agents; D016387:Women's Health
chemical_list: D014665:Vasodilator Agents; D000241:Adenosine
keywords: magnetic resonance imaging; microvascular angina; myocardial perfusion; women