title: Diastolic dysfunction measured by cardiac magnetic resonance imaging in women with signs and symptoms of ischemia but no obstructive coronary artery disease.
abstract: BACKGROUND
  Women with chest pain and no obstructive coronary artery disease often have coronary microvascular dysfunction (CMD), diagnosed by invasive coronary reactivity testing (CRT). The relationship between CMD and diastolic function measured by cardiac magnetic resonance imaging (CMR) is not well described.
  
  
  METHODS
  41 women with suspected CMD underwent CRT and CMR. Left ventricular end-diastolic pressure (LVEDP), coronary flow reserve (CFR) and coronary blood flow (CBF) were measured invasively. Resting CMR of these women and 20 reference controls was assessed for LV mass, septal wall thickness, ejection fraction (LVEF), end-diastolic volume (EDV), peak filling rate (PFR) and time-to-peak-filling rate (tPFR). Pearson correlations and linear regression models were made.
  
  
  RESULTS
  Mean age was 55±9, all had LVEF≥50%, and 16/41 (40%) had LVEDP>15mmHg. CMD (CFR<2.5 or CBF<50%) was present in 34/41 (83%) women. tPFR (mean 178±110ms) and PFR (mean 3.2±0.64 EDV/s) were not significantly different in women with or without CMD. tPFR increased with age (r=0.37, p=0.017) and septal wall thickness (r=0.47, p=0.002), while PFR decreased with age (r=-0.45, p=0.003). There was an inverse relationship between CFR and tPFR (r=-0.3, p=0.058). Increasing mass was associated with decreasing CBF (p=0.02). Compared to controls, cases had lower LVEF (p=0.049) and lower EDV (p=0.0002).
  
  
  CONCLUSIONS
  In women with signs and symptoms of ischemia but no obstructive coronary artery disease, CMD and elevated LVEDP are prevalent. While non-endothelial dependent CMD may be related to diastolic dysfunction, further investigation is needed regarding links between CMD, diastolic dysfunction and the development of heart failure with preserved LVEF.
authors.affiliation: Barbara Streisand Women's Heart Center, Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States.
authors.forename: Janet
authors.initials: J
authors.lastname: Wei
authors.affiliation: Barbara Streisand Women's Heart Center, Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States.
authors.forename: Puja K
authors.initials: PK
authors.lastname: Mehta
authors.affiliation: Barbara Streisand Women's Heart Center, Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States.
authors.forename: Chrisandra
authors.initials: C
authors.lastname: Shufelt
authors.affiliation: Barbara Streisand Women's Heart Center, Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States.
authors.forename: YuChing
authors.initials: Y
authors.lastname: Yang
authors.affiliation: S. Mark Taper Foundation Imaging Center, Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States.
authors.forename: Edward
authors.initials: E
authors.lastname: Gill
authors.affiliation: Barbara Streisand Women's Heart Center, Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States.
authors.forename: Ravi
authors.initials: R
authors.lastname: Kahlon
authors.affiliation: Biostatistics & Bioinformatics Core, Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States.
authors.forename: Galen
authors.initials: G
authors.lastname: Cook-Wiens
authors.affiliation: Barbara Streisand Women's Heart Center, Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States.
authors.forename: Margo
authors.initials: M
authors.lastname: Minissian
authors.affiliation: Barbara Streisand Women's Heart Center, Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States.
authors.forename: Saibal
authors.initials: S
authors.lastname: Kar
authors.affiliation: S. Mark Taper Foundation Imaging Center, Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States.
authors.forename: Louise
authors.initials: L
authors.lastname: Thomson
authors.affiliation: S. Mark Taper Foundation Imaging Center, Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States.
authors.forename: Daniel
authors.initials: D
authors.lastname: Berman
authors.affiliation: Barbara Streisand Women's Heart Center, Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States. Electronic address: noel.baireymerz@cshs.org.
authors.forename: C Noel Bairey
authors.initials: CN
authors.lastname: Merz
mesh_terms: D017023:Coronary Angiography / Q000379:methods; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000503:physiopathology; D003430:Cross-Sectional Studies; D003971:Diastole / Q000502:physiology; D005260:Female; D054144:Heart Failure, Diastolic / Q000000981:diagnostic imaging* / Q000503:physiopathology; D006801:Humans; D019028:Magnetic Resonance Imaging, Cine / Q000379:methods; D055806:Microvessels / Q000000981:diagnostic imaging* / Q000503:physiopathology; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000000981:diagnostic imaging* / Q000503:physiopathology
keywords: Diastolic dysfunction; Microvascular coronary dysfunction; Women's heart disease