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CLINICAL RESEARCH: CARDIAC IMAGING

Relation Between Stress-Induced Myocardial Perfusion Defects on Cardiovascular Magnetic Resonance and Coronary Microvascular Dysfunction in Patients With Cardiac Syndrome X

Gaetano A. Lanza, MD^_*,_*, Antonino Buffon, MD^_*, Alfonso Sestito, MD^_*, Luigi Natale, MD, Gregory A. Sgueglia, MD^_*, Leda Galiuto, MD, FACC^_*, Fabio Infusino, MD^_*, Luca Mariani, MD^_*, Antonio Centola, MD^_* and Filippo Crea, MD, FACC^_*

^_* Istituto di Cardiologia, Università Cattolica del Sacro Cuore, Rome, Italy
Istituto di Radiologia, Università Cattolica del Sacro Cuore, Rome, Italy.

Manuscript received May 3, 2007; revised manuscript received July 9, 2007, accepted August 8, 2007.

^_* Reprint requests and correspondence: Dr. Gaetano A. Lanza, Istituto di Cardiologia, Università Cattolica del Sacro Cuore, Largo A. Gemelli, 8, 00168 Roma, Italy. (Email: g.a.lanza{at}inwind.it).

Objectives: The purpose of this study was to investigate whether a direct relation can be demonstrated between myocardial perfusion defects detected during dobutamine stress test (DST) by cardiovascular magnetic resonance (CMR) and impairment of coronary microvascular dilatory function in patients with cardiac syndrome X (CSX).

Background: Despite the fact that coronary microvascular dysfunction has been shown in most patients with CSX, the ischemic origin of CSX remains debated. No previous study assessed whether a strict relation exists between abnormalities in myocardial perfusion and coronary microvascular dysfunction in CSX patients.

Methods: Eighteen CSX patients (mean age 58 ± 7 years, 7 men) and 10 healthy control subjects (mean age 54 ± 8 years, 4 men) underwent myocardial perfusion study by gadolinium-enhanced CMR at rest and at peak DST (maximal dose 40 µg/kg/min). Coronary flow response (CFR) to adenosine (140 µg/kg/min in 90 s) in the left anterior descending (LAD) coronary artery was assessed by high-resolution transthoracic echo-Doppler and expressed as the ratio between coronary flow velocity at peak adenosine and at rest.

Results: At peak DST, reversible perfusion defects on CMR were found in 10 CSX patients (56%) but in none of the control subjects (p = 0.004). The CFR to adenosine in the LAD coronary artery was lower in CSX patients than in control subjects (2.03 ± 0.63 vs. 3.29 ± 1.0, p = 0.0004). The CSX patients with DST-induced myocardial perfusion defects in the LAD territory on CMR had a lower CFR to adenosine compared with those without perfusion defects in the LAD territory (1.69 ± 0.5 vs. 2.31 ± 0.6, p = 0.01). A significant correlation was found in CSX patients between CFR to adenosine and a DST perfusion defect score on CMR in the LAD territory (r = –0.45, p = 0.019).

Conclusions: Our data concurrently show DST-induced myocardial perfusion defects on CMR and reduced CFR in the LAD coronary artery territory in CSX patients, thus giving strong evidence that a dysfunction of coronary microcirculation resulting in myocardial perfusion abnormalities is present in these patients.

Abbreviations and Acronyms   CMR = cardiovascular magnetic resonance   CSX = cardiac syndrome X   DST = dobutamine stress test   ECG = electrocardiography   LAD = left anterior descending

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