- Poster presentation
- Open Access
Subendocardial reversible perfusion defects on adenosine stress MRI in ER patients with chest pain: relationship to cardiovascular risk factors
© Skrok et al; licensee BioMed Central Ltd. 2009
- Published: 28 January 2009
- Perfusion Defect
- Steady State Free Precession
- Stress Perfusion
- Gadopentetate Dimeglumine
- Reversible Perfusion Defect
Many patients with angina-type chest pain have normal coronary angiograms and nuclear cardiac SPECT exams. This is thought to be a result of microvascular disease.
To evaluate patients presenting to the ER with chest pain and negative cardiac enzymes by stress perfusion MRI and to correlate the findings with future cardiovascular events over a 9 month follow-up period.
On MRI, 8/27 patients (30%) had diffuse subendocardial perfusion defects on stress imaging in more than 1 coronary artery territory, which were reversible at rest. All of these patients had a normal SPECT cardiac stress exam and no myocardial delayed enhancement on MRI. Fifteen percent (4/27 patients) had focal reversible perfusion defects on MRI in a single coronary artery territory that correlated with ≥ 70% stenosis on conventional angiography. One patient had both small and large vessel disease (history of coronary artery bypass graft and stress induced diffuse subendocardial perfusion defects on MRI). Fifty-six percent (15/27 patients) had neither small nor large vessel disease on MRI; all were normal on SPECT and did not show any scar on MRI. Patients with diffuse perfusion defects had a significantly higher rate of diabetes (p = 0.03, two tailed Fisher's) and hypertension (p = 0.05, two tailed Fisher's) compared to patients without perfusion defects. Patients with diffuse perfusion defects had significantly more risk factors for cardiovascular disease (mean 4.4) compared to patients without diffuse subendocardial perfusion defects or significant large vessel disease (mean 2.9, p = 0.02 two-sided Wilcoxon test). Over a 9 month period, 3 patients presented again with angina-like chest pain, all of whom had shown diffuse subendocardial perfusion defects on adenosine stress MRI at baseline.
Diffuse subendocardial perfusion defects on stress MRI in the emergency room setting were frequent (30%) in our patient population in the absence of positive findings on cardiac SPECT or myocardial scar on MRI. These findings were more frequent in patients with hypertension and diabetes and may relate to underlying microvascular disease. This could account for chronic recurrent chest pain in this patient population.
This article is published under license to BioMed Central Ltd.