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Patients with Cardiac syndrome X have decreased global myocardial perfusion compared to gender matched controls; insights from CMR coronary sinus flow measurements
© Gyllenhammar et al. 2016
- Published: 27 January 2016
- Myocardial Perfusion
- Cardiovascular Magnetic Resonance
- Late Gadolinium Enhancement
- Myocardial Perfusion Scintigraphy
- Adenosine Stress
To determine if patients with Cardiac syndrome X (CSX) have decreased global myocardial perfusion during adenosine stress as assessed by cardiovascular magnetic resonance (CMR) compared to healthy controls.
Thirteen CSX patients (64 ± 12SD years, 9 females), here defined as a history of chest pain and pathological ECG reaction during stress (> 1 mm ST-depression at stress or after 4 minutes of recovery) but normal myocardial perfusion assessed by myocardial perfusion scintigraphy (SPECT), were included. In addition, 15 positive controls (66 ± 9SD years, 6 females) with stress-induced perfusion defects by SPECT, and 18 healthy controls (44 ± 14SD years 9 females) were also included. All subjects underwent quantitative flow measurement in the coronary sinus by CMR at rest and during adenosine stress. Coronary sinus flow (ml/min) was normalized to LVM enabling quantification of global myocardial perfusion (ml/min/g). All patients underwent first-pass perfusion at rest and during adenosine stress and presence of myocardial fibrosis/infarction was assessed by late gadolinium enhancement (LGE).
CSX patients showed significantly lower global myocardial perfusion during adenosine stress compared to healthy controls (3.1 ± 0.4 vs. 4.1 ± 0.4 ml/min/g, P = 0.025). There was, however, no significant difference between CSX patients and positive controls (2.5 ± 0.3 ml/min/g, P = 0.13; fig 1). Female controls showed significantly higher global myocardial perfusion compared to male controls (p < 0.001; fig 2). Furthermore, female CSX patients (N=9) showed significantly lower global myocardial perfusion during adenosine stress compared to female controls (3.6 ± 0.4 vs. 5.0 ± 0.3 ml/min/g, P = 0.0014). The same trend was seen for male CSX patients (N=4) compared to male controls, (2.2 ± 0.5 vs. 3.2 ± 0.2 ml/min/g, P = 0.07). No CSX patient showed myocardial fibrosis/infarction on LGE. All patients except one had normal findings on first-pass perfusion, who showed a mild regional subendocardial perfusion deficit in the inferior part of the midventricular septum.
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