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

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• 作者：Jong-Hwa Ahn ; MD^a ; Sung Mok Kim ; MD^b ; Sung-Ji Park ; MD ; PhD^a ; ^{tyche.park@gmail.com" class="auth_mail" title="E-mail the corresponding author} ; Dong Seop Jeong ; MD ; PhD^c ; Min-Ah Woo ; MS^d ; Sin-Ho Jung ; PhD^d ; Sang-Chol Lee ; MD ; PhD^a ; Seung Woo Park ; MD ; PhD^a ; Yeon Hyeon Choe ; MD ; PhD^b ; Pyo Won Park ; MD ; PhD^c ; Jae K. Oh ; MD^a ; ^e
• 关键词：cardiac magnetic resonance ; exertional angina ; left ventricular mass index ; myocardial perfusion reserve
• 刊名：Journal of the American College of Cardiology
• 出版年：2016
• 出版时间：29 March 2016
• 年：2016
• 卷：67
• 期：12
• 页码：1412-1422
• 全文大小：1674 K

文摘

Although a common symptom in patients with severe aortic stenosis (AS) without obstructive coronary artery disease (CAD), little is known about the pathogenesis of exertional angina.

Objectives

This study sought to prove that microvascular dysfunction is responsible for chest pain in patients with severe AS and normal epicardial coronary arteries using adenosine-stress cardiac magnetic resonance (CMR) imaging.

Methods

Between June 2012 and April 2015, 117 patients with severe AS without obstructive CAD and 20 normal controls were enrolled prospectively. After exclusions, study patients were divided into 2 groups according to presence of exertional chest pain: an angina group (n = 43) and an asymptomatic group (n = 41), and the semiquantitative myocardial perfusion reserve index (MPRI) was calculated.

Results

MPRI values were significantly lower in severe AS patients than in normal controls (0.90 ± 0.31 vs. 1.25 ± 0.21; p < 0.001), and were much lower in the angina group than the asymptomatic group (0.74 ± 0.25 vs. 1.08 ± 0.28; p < 0.001). In logistic regression analysis, the only independent predictor for angina was MPRI (odds ratio: 0.003; p < 0.001). Univariate associations with MPRI were identified for diastolic blood pressure, E/e′ ratio, left ventricular volume and ejection fraction, cardiac index, presence of late gadolinium enhancement, and left ventricular mass index (LVMI). In multivariate analysis, LVMI was the strongest contributing factor to MPRI (standardization coefficient: -0.428; p < 0.001).

Conclusions

Our results suggest that, in patients with severe AS without obstructive CAD, angina is related to impaired coronary microvascular function along with LV hypertrophy detectable by semiquantitative MPRI using adenosine-stress CMR. Clinical Trial Registration: NCT02575768