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PET-determined prevalence of coronary microvascular dysfunction and different types in a cardio-metabolic risk
Anita R Bhandiwad1,2, Ines Valenta2, Sudhir Jain1,2
1Mallinckrodt Institute of Radiology, Division of Nuclear Medicine, Cardiovascular Medicine, Washington University School of Medicine, St. Louis, MO, USA.
Insights
Coronary microvascular dysfunction (CMD) affects over half of symptomatic patients, with the "classical" type being more common than the "endogen" type. This highlights the need for tailored treatments for improved patient outcomes.
Area of Science:
- Cardiology
- Medical Imaging
- Vascular Biology
Background:
- Coronary microvascular dysfunction (CMD) is increasingly recognized in patients without obstructive coronary artery disease.
- Understanding the prevalence of different CMD types (classical and endogen) is crucial for clinical management.
Purpose of the Study:
- To investigate the prevalence of "classical" and "endogen" normal coronary microvascular function (nCMF) and CMD.
- To characterize the clinical profiles associated with each type of nCMF and CMD.
Main Methods:
- Prospective enrollment of 239 symptomatic patients with normal myocardial perfusion on 13N-ammonia PET/CT.
- Assessment of myocardial flow reserve (MFR) using 13N-ammonia PET/CT to define CMD (MFR < 2.0) and nCMF (MFR ≥ 2.0).
- Subgrouping patients into classical and endogen types based on MFR alterations.
Main Results:
- 54% of patients exhibited CMD, with the classical type (65%) being more prevalent than the endogen type (35%).
- Classical CMD was associated with diabetes, metabolic syndrome, and obesity.
- Endogen CMD was linked to arterial hypertension and obesity.
- Classical nCMF (74%) was more common than endogen nCMF (26%), with endogen nCMF related to lower heart rate and blood pressure.
Conclusions:
- Slightly over half of symptomatic patients in this cohort had CMD, predominantly of the classical type.
- Standardized reporting of CMD is essential for individualized medical treatment and improved clinical outcomes.
Background:
The aim was to investigate the prevalence of "classical" (predominantly related to alterations in hyperemic MBFs) and "endogen" (predominantly related to alterations in resting MBF) normal coronary microvascular function (nCMF) or coronary microvascular dysfunction (CMD) in a clinical population without flow-limiting obstructive CAD.
Methods:
We prospectively enrolled 239 symptomatic patients with normal pharmacologically-stress and rest myocardial perfusion on 13N-ammonia PET/CT. 13N-ammonia PET/CT concurrently assessed myocardial flow reserve (MFR = MBF stress/MBF rest). Normal nCMF was defined by a MFR of ≥ 2.0, while an abnormal MFR of < 2.0 signified CMD. In addition, patients were subgrouped into classical and endogen type of nCMF and CMD, respectively.
Results:
In the whole study population, CMD was present in 54% (130/239). The classical type was more prevalent than the endogen type of CMD (65% vs 35%, p ≤ 0.008). The classical type of CMD was paralleled by a high prevalence of diabetes mellitus, metabolic syndrome, and obesity, while the endogen type of CMD was accompanied by a higher prevalence of arterial hypertension, obesity, and/or morbid obesity. Further, the classical type of nCMF was more frequently observed that the endogen type (74% vs. 26%, p ≤ 0.007). The endogen type of nCMF was related to lower heart rate and/or arterial blood pressures.
Conclusions:
In this contemporary clinical study population, slightly more than half of symptomatic patients had CMD with predominance of the classical type. These observations emphasize the need for standardized reporting of CMD to gear individualized and/or intensified medical treatment to improve symptoms and/or clinical outcome in these patients.
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