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Potential Role of 13N-NH3 Cardiac PET in Monitoring Treatment Response in Patients with Microvascular Angina

Harpreet Singh1, Dinkar Bhasin2,1, Vinisha Gunasekaran1

  • 1Department of Nuclear Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India.

Indian Journal of Nuclear Medicine : IJNM : the Official Journal of the Society of Nuclear Medicine, India
|July 30, 2025
PubMed

Insights

Ischemia with nonobstructive coronary artery disease (INOCA) can stem from coronary microvascular dysfunction (CMD). This case study shows improved cardiac function in a microvascular angina patient after medical treatment.

Area of Science:

  • Cardiology
  • Nuclear Medicine
  • Physiology

Background:

  • Ischemia with nonobstructive coronary artery disease (INOCA) affects patients with myocardial ischemia symptoms but no obstructive coronary artery disease.
  • Coronary microvascular dysfunction (CMD) is a key cause of INOCA, linked to higher risks of major adverse cardiac events.
  • Impaired coronary flow reserve (CFR) during angiography often indicates CMD.

Observation:

  • A patient with microvascular angina (MVA) presented with reduced myocardial flow reserve and perfusion deficits on cardiac positron emission tomography (PET) imaging.
  • This case highlights the diagnostic utility of PET in assessing myocardial perfusion in INOCA.

Findings:

  • The patient's cardiac PET imaging revealed impaired myocardial flow reserve and perfusion defects, consistent with CMD.
  • Medical management led to significant improvements in the patient's myocardial perfusion and dynamic PET parameters.

Implications:

  • This case demonstrates the effectiveness of medical management in improving outcomes for patients with microvascular angina.
  • Cardiac PET imaging is a valuable tool for diagnosing and monitoring CMD in INOCA patients.
  • Addressing CMD is crucial for managing patients with INOCA and reducing cardiovascular event risk.

Keywords:
Coronary microvascular dysfunctionischemia with nonobstructive coronary artery diseasemicrovascular anginapositron emission tomography-myocardial flow reserve

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