European Heart Journal Advance Access originally published online on May 15, 2007
European Heart Journal 2007 28(13):1554-1558; doi:10.1093/eurheartj/ehm088
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Is subendocardial ischaemia present in patients with chest pain and normal coronary angiograms? A cardiovascular MR study
1 Department of Nuclear Medicine and PET Research, VU University Medical Centre, de Boelelaan 1117, 1007 MB Amsterdam, The Netherlands
2 Department of Cardiology, VU University Medical Centre, Amsterdam, The Netherlands
3 Department of Clinical Epidemiology and Biostatistics, VU University Medical Centre, Amsterdam, The Netherlands
4 Department of Cardiology, Spaarne Hospital, Hoofddorp, The Netherlands
5 Department of Nuclear Medicine, Spaarne Hospital, Hoofddorp, The Netherlands
Received 5 July 2006; revised 13 March 2007; accepted 15 March 2007; online publish-ahead-of-print 15 May 2007.
* Corresponding author. Tel: +31 20 4444214; fax: +31 20 4443090. E-mail address: i.vermeltfoort{at}vumc.nl
See page 1539 for the editorial comment on this article (doi:10.1093/eurheartj/ehm167)
Aims: 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.
Methods and 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.
Conclusion: 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.
Key Words: Angina pectoris with normal coronary arteries • Cardiac syndrome X • Cardiovascular MR • Microvascular angina
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