Microvascular dysfunction identified by innovative cardiac MRI techniques

A pair of studies published online Feb. 26 in the Journal of the American College of Cardiology found two novel forms of cardiac MRI that may accurately detect microvascular coronary artery disease (CAD) and cardiac microvascular dysfunction (CMD), according to a recent article by Cardiovascular Business.  

Both studies were led by Alexander Liu, MBBS, from the University of Oxford. The first study compared the performance of cardiac magnetic resonance (CMR) stress T1 mapping to gadolinium-based first pass perfusion imaging. Liu and his team found that CMR stress T1 mapping outperformed the gadolinium-based imaging technique in using visual, semi-quantitative or quantitative analysis techniques.  

“Furthermore, stress T1 mapping accurately detected coronary microvascular dysfunction defined invasively by a high MRI value (≥25 U) downstream of non-obstructive (FFR >0.8) coronary arteries.” Liu et al. wrote. “Although these patients with ‘microvascular angina’ are often reassured as having no significant CAD or are treated empirically with antianginal medication, they experience reduced quality of life and adverse long-term prognosis. Therefore, a noninvasive test to accurately detect CMD can improve clinical risk stratification and guide targeted therapy in patients with microvascular angina."   

The second study reviewed how well myocardial perfusion accurately assessed the presence of cardiac microvascular dysfunction, which proved to be a successful non-invasive approach, according to study results. 

“Integration of myocardial perfusion reserve index and (myocardial blood flow) assessment into the clinical CMR workflow can provide a noninvasive approach for evaluating both epicardial and microvascular CAD in patients with angina, which deserves further validation in an all-comers population,” the researchers concluded.  

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