title: Cold Pressor Stress Cardiac Magnetic Resonance Myocardial Flow Reserve Is Not Useful for Detection of Coronary Endothelial Dysfunction in Women with Signs and Symptoms of Ischemia and No Obstructive CAD.
abstract: BACKGROUND
  Coronary endothelial function testing using acetylcholine is not routinely available, while non-pharmacological cold pressor testing (CPT) is considered an endothelial stressor. Noninvasive cardiac magnetic resonance imaging (CMRI) myocardial perfusion reserve index (MPRI) can detect coronary microvascular dysfunction (CMD). We evaluated if CPT stress CMRI MPRI could detect invasive coronary endothelial dysfunction.
  
  
  METHODS
  Coronary reactivity testing was performed in 189 women with symptoms and signs of ischemic but no obstructive coronary artery disease as previously described plus CPT stress. Subjects also underwent pharmacologic and CPT stress during CMRI (1.5 T). Statistical analysis comparing CPT MPRI between groups was performed by Welch`s t-test and Mann-Whitney where appropriate. Anderson-Darling test and Levene test were considered to verify the normality and homogeneity of variances assumptions. Correlation analyses between CPT MPRI and both invasive and noninvasive measures of CMD were performed using Spearman correlation.
  
  
  RESULTS
  While CPT MPRI correlated with pharmacological stress MPRI, it did not correlate with invasive measures of CMD including invasively measured responses to intracoronary (IC) adenosine, IC acetylcholine, CPT, or IC nitroglycerin. Additionally CPT MPRI was not significantly different between subjects with normal compared to abnormal pharm stress MPRI or normal compared to abnormal invasive CMD parameters.
  
  
  CONCLUSIONS
  Despite correlation with pharmacological stress MPRI, non-invasive CPT MPRI does not appear to be useful for detecting CMD in symptomatic women.
authors.affiliation: Barbra Streisand Women's Heart Center, Cedars-Sinai Heart Institute, Los Angeles, California, United States of America.
authors.forename: Sofy
authors.initials: S
authors.lastname: Landes
authors.affiliation: Barbra Streisand Women's Heart Center, Cedars-Sinai Heart Institute, Los Angeles, California, United States of America.
authors.forename: Sherwin
authors.initials: S
authors.lastname: Dela Cruz
authors.affiliation: Barbra Streisand Women's Heart Center, Cedars-Sinai Heart Institute, Los Angeles, California, United States of America.
authors.forename: Janet
authors.initials: J
authors.lastname: Wei
authors.affiliation: Barbra Streisand Women's Heart Center, Cedars-Sinai Heart Institute, Los Angeles, California, United States of America.
authors.forename: Ahmed
authors.initials: A
authors.lastname: AlBadri
authors.affiliation: Barbra Streisand Women's Heart Center, Cedars-Sinai Heart Institute, Los Angeles, California, United States of America.
authors.forename: Chrisandra
authors.initials: C
authors.lastname: Shufelt
authors.affiliation: Barbra Streisand Women's Heart Center, Cedars-Sinai Heart Institute, Los Angeles, California, United States of America.
authors.forename: Puja
authors.initials: P
authors.lastname: Mehta
authors.affiliation: Barbra Streisand Women's Heart Center, Cedars-Sinai Heart Institute, Los Angeles, California, United States of America.
authors.forename: Louise E
authors.initials: LE
authors.lastname: Thomson
authors.affiliation: Samuel Oschin Comprehensive Cancer Institute, Los Angeles, California, United States of America.
authors.forename: Marcio A
authors.initials: MA
authors.lastname: Diniz
authors.affiliation: Samuel Oschin Comprehensive Cancer Institute, Los Angeles, California, United States of America.
authors.forename: Xiao
authors.initials: X
authors.lastname: Zhang
authors.affiliation: Univerity of Florida, Gainesville, Florida, United States of America.
authors.forename: John W
authors.initials: JW
authors.lastname: Petersen
authors.affiliation: Univerity of Florida, Gainesville, Florida, United States of America.
authors.forename: R David
authors.initials: RD
authors.lastname: Anderson
authors.affiliation: Univerity of Florida, Gainesville, Florida, United States of America.
authors.forename: Carl J
authors.initials: CJ
authors.lastname: Pepine
authors.affiliation: Barbra Streisand Women's Heart Center, Cedars-Sinai Heart Institute, Los Angeles, California, United States of America.
authors.forename: Daniel S
authors.initials: DS
authors.lastname: Berman
authors.affiliation: Barbra Streisand Women's Heart Center, Cedars-Sinai Heart Institute, Los Angeles, California, United States of America.
authors.forename: C Noel
authors.initials: CN
authors.lastname: Bairey Merz
mesh_terms: D000328:Adult; D000368:Aged; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000473:pathology / Q000503:physiopathology; D003326:Coronary Circulation; D003331:Coronary Vessels / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology; D004730:Endothelium, Vascular / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology; D005080:Exercise Test; D005260:Female; D006801:Humans; D018810:Magnetic Resonance Angiography; D008875:Middle Aged