Abstract
BackgroundCoronary 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.MethodsCoronary 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.ResultsWhile 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.ConclusionDespite correlation with pharmacological stress MPRI, non-invasive CPT MPRI does not appear to be useful for detecting CMD in symptomatic women.
Highlights
While cold pressor testing (CPT) myocardial perfusion reserve index (MPRI) correlated with pharmacological stress MPRI, it did not correlate with invasive measures of coronary microvascular dysfunction (CMD) including invasively measured responses to intracoronary (IC) adenosine, IC acetylcholine, CPT, or IC nitroglycerin
Women with symptoms and signs of ischemia and no obstructive coronary artery disease (CAD) by angiography frequently have coronary microvascular dysfunction (CMD)[1, 2], which carries an adverse prognosis for cardiovascular events including myocardial infarction (MI), stroke, heart failure, and sudden cardiac death compared to normal controls. [3,4,5,6,7,8,9,10,11] Treatment targeting endothelial dysfunction can reduce angina, coronary spasm, heart failure, and stroke. [12,13,14,15] It is important to establish the diagnosis in order to provide appropriate medical management
We evaluated 189 women with signs and symptoms of myocardial ischemia and no obstructive CAD (
Summary
Women with symptoms and signs of ischemia and no obstructive coronary artery disease (CAD) by angiography frequently have coronary microvascular dysfunction (CMD)[1, 2], which carries an adverse prognosis for cardiovascular events including myocardial infarction (MI), stroke, heart failure, and sudden cardiac death compared to normal controls. [3,4,5,6,7,8,9,10,11] Treatment targeting endothelial dysfunction can reduce angina, coronary spasm, heart failure, and stroke. [12,13,14,15] It is important to establish the diagnosis in order to provide appropriate medical management.The gold standard for diagnosis of CMD is invasive coronary reactivity testing (CRT). [16] While CRT has been shown to be safe [16] it is time consuming and requires an experienced interventionist with advanced training to perform, and therefor is not routinely available. Studies have demonstrated that cardiac magnetic resonance imaging (CMRI) with myocardial perfusion imaging has been shown to be predictive of death, MI, hospitalization for worsening angina in women with CMD. [17] Myocardial perfusion reserve index (MPRI), a semi-quantitative measurement on CMRI, has shown promise for non-invasive detection of CMD. Pharmacologic vasodilator stress MPRI (adenosine or regadenoson) is reduced in women with angina and coronary endothelial dysfunction, and predicts presence of invasive CRT abnormality. Cold pressor testing (CPT) is a non-pharmacologic stressor [19] which has been shown to elicit the same endothelial dependent response in the coronary microvasculature. 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
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