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Coronary Microvascular Dysfunction as a Mechanism of Angina in Severe AS: Prospective Adenosine-Stress CMR Study

Jong-Hwa Ahn1, Sung Mok Kim2, Sung-Ji Park1

  • 1Division of Cardiology, Department of Medicine, Cardiovascular Imaging Center, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.

Journal of the American College of Cardiology
|March 26, 2016
PubMed

Insights

Exertional angina in severe aortic stenosis (AS) without coronary artery disease (CAD) is linked to impaired microvascular function. Cardiac magnetic resonance imaging revealed reduced myocardial perfusion reserve index (MPRI) in patients with angina.

Area of Science:

  • Cardiology
  • Medical Imaging
  • Vascular Biology

Background:

  • Exertional angina is common in severe aortic stenosis (AS) without obstructive coronary artery disease (CAD), but its cause is poorly understood.
  • Understanding the pathogenesis of angina in this patient group is crucial for effective treatment strategies.

Purpose of the Study:

  • To investigate the role of microvascular dysfunction in causing chest pain in patients with severe AS and normal epicardial coronary arteries.
  • To utilize adenosine-stress cardiac magnetic resonance (CMR) imaging to assess myocardial perfusion reserve index (MPRI).

Main Methods:

  • Prospective enrollment of 117 severe AS patients (without obstructive CAD) and 20 controls.
  • Division of AS patients into angina (n=43) and asymptomatic (n=41) groups based on exertional chest pain.
  • Calculation of semiquantitative myocardial perfusion reserve index (MPRI) using adenosine-stress CMR.

Main Results:

  • Severe AS patients had significantly lower MPRI than controls (0.90 ± 0.31 vs. 1.25 ± 0.21; p < 0.001).
  • The angina group exhibited significantly lower MPRI than the asymptomatic group (0.74 ± 0.25 vs. 1.08 ± 0.28; p < 0.001).
  • MPRI was the sole independent predictor of angina (OR: 0.003; p < 0.001), with left ventricular mass index (LVMI) being the strongest factor influencing MPRI (β = -0.428; p < 0.001).

Conclusions:

  • Angina in severe AS without obstructive CAD is associated with impaired coronary microvascular function.
  • Left ventricular hypertrophy, assessed by LVMI, significantly contributes to reduced MPRI.
  • Adenosine-stress CMR and semiquantitative MPRI are valuable tools for evaluating angina in this patient population.
Abstract

Keywords:
cardiac magnetic resonanceexertional anginaleft ventricular mass indexmyocardial perfusion reserve

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