Introduction Microvascular Dysfunction defined as a Myocardial Flow Reserve (MFR) <2 or <2.5 depending on the center, may present in the absence of significant obstruction (1,2); it is included as a diagnosis criteria of Microvascular Angina (MVA) (3,4) and is an independent risk factor associated with poor prognosis (5–7). Traditional Coronary Artery Disease (CAD)risk factors have also been associated with MVA (8–10), however, there is reduced data in latin populations with high prevalence of comorbidities. The aim of this study was to identify the comorbidities that alter MFR with 13N-ammonia Positron Emission Tomography/Cardiac Tomography (PET/CT) and Cardiac Computed Tomography Angiography (CCTA) in a cardiovascular imaging referral center. Methods Retrospective cross-sectional study of patients with suspected CAD in which both PET/CT and CCTA were performed. Inclusion:CCTA with obstruction <50%. Exclusion: incomplete study, previous infarction or intervention. Clinical data was assessed. Mean (±DE) or median (interquartile range) to present continuous variables according to their distribution; T student or U Man Whitney to compare them. For each variable two groups were conformed depending on its presence or absence in order to compare MFR between them. Statistical analysis was performed with Statistical Package for Social Science (SPSs Inc, Chicago, IL; version 23.0) and GraphPad Prism version 9.0. p<0.05 was considered as significant. Results 335 patients included. MFR difference for each variable: female sex, hypertension (HT), Type 2 diabetes (T2D) and smoking – Appendix 1. Significant MFR difference for HT (p=0.024) and T2D (p=0.046). Severe ischemia had significant MFR reduction (p=0.006); patients with both HT and mild ischemia (p=0.018) – Appendix 2. Discussion Individuals with HT and T2D had a significantly lower MFR, consistent with previous studies (8,9). Absence of correlation with other risk factors, such as smoking (10) and female sex (11); latter may be caused by a significant lower number of women (108 vs 227). Further analysis in this subgroup ought to be done. When comparing MFR between level-of-ischemia groups, microvascular function was not reduced until severe ischemia. Remarkably, if we analyze the coexistence of HT with ischemia, MFR is reduced even in patients with mild ischemia. This finding highlights the importance of HT which alters function in early stages even in the absence of significant obstruction. This is one of the first studies correlating MFR with comorbidities in our population. Limitations the retrospective nature of the study. Conclusions MFR non-invasive assessment by PET/CT allows identifying very early stages of MVD, even in asymptomatic patients and when there's no evidence of ischemia or CAD. Therefore, timely recognition of this problem is mandatory to implement action strategies to stop the triggered events' cascade. FUNDunding Acknowledgement Type of funding sources: None.
Background There has been an increase in the number of comorbidities in that predispose to ischemic heart disease in developing countries. Nevertheless, the identification of associated risk factors could unveil impairments within myocardial function Purpose We aimed to assess the prevalence and factors associated with reduced modifications of LVEF (>5%), ischemia (SDS ≥6 pts), reduced coronary flow reserve (≤2.5 pts) and coronary artery obstruction (≥50%) using a positron emission tomography–computed tomography. Methods A cross-sectional study of patients with clinical suspicious of angina who attended the PET/CT unity in a faculty of medicine was designed. We designed a clinical questionnaire to capture information regarding clinical history of comorbidities, angina, medication use and lifestyle habits. A myocardial perfusion study (MPS) was performed to identify myocardial ischemia, infarction, dyssynchrony and reduced coronary flow reserve. Logistic regression analyses were performed to identify associated factors. Results 1273 patients underwent a PET/CT study; 66.1% (n=841) were male with a median age of 62.4 (±12.7) years. In our population, 36.4% (n=464) reported 1 or 2 comorbidities, 31.6% (n=402) 3 to 4 and 4.7% (n=60) more than 5; arterial hypertension (46.9%), dyslipidemia (43.9%), and diabetes (20.8%) were highly prevalent. Angina (34.4%) and palpitations (13%) were the most frequent symptoms at evaluation (Table 1). We found that that the presence of age ≥65 years, history of myocardial infarction, male sex, precordial chest pain, agrarians in chest pain, familiar history of myocardial infarction and comorbidities such as diabetes, arterial hypertension and obesity were associated with impairments in LVEF, ischemia, reduced coronary flow reserve and coronary artery obstruction (Figure 1). Conclusions The presence of comorbidities in our population is high. The identification of a cardiovascular profile using associated factors would allow early identification of those patients with alterations in myocardial function parameters. FUNDunding Acknowledgement Type of funding sources: None.
Funding Acknowledgements Type of funding sources: None. On Behalf of MiniFellows Research Group CLINICAL AND IMAGING VARIABLES IN MICROVASCULAR ANGINA. A 13N-AMMONIA MPI APPROACH Background Patients with typical angina may have no obstructive artery disease1 and 2/3 may present microvascular dysfunction(MVD)2 which is associated with poor prognosis3,4,5. In 2017 the Coronary Vasomotion Disorders International Study Group (COVADIS) included it as a criteria of MVA6; later, included in MINOCA ESC 2020 guidelines.7 For diagnosis6,7: symptoms of ischemia; absence of relevant epicardial CAD (<50% diameter reduction or FFR >0.80); myocardial ischemia; impaired coronary microvascular function (CFR < 2 or <2.5 depending on methodology). Our aim was to identify clinical and imaging variables in patients with MVA due to 13N-ammonia Positron Emission Tomography/Cardiac Tomography(PET/CT) and Cardiac Computed Tomography Angiography(CCTA) in a cardiovascular imaging referral center. Methods.Retrospective, cross-sectional study of patients with suspected CAD. For inclusion: ischemia quantitation (summed stress score,SDS < 3) and obstruction <50% in all vessels. Exclusion criteria: previous infarction, intervention, or incomplete study. Clinical data was assessed. Both studies performed on the same day. Frequencies and percentages to report categorical variables; x2 and Fisher´s exact tests to compare them. Mean (+/-DE) or median (interquartile range) to report continuous variables according to their distribution, and T student or Wilcoxon test to compare them. Results 274 patients included: Group A (CFR <2) and group B (CFR 2)(108vs166). Difference for systemic hypertension(p <0.001), type 2 diabetes mellitus(p <0.001), dyslipidemia(p = 0.019), smoking(p <0.001). Group B presented higher incidence for mild ischemia(p = 0.004) while MVA for severe ischemia(p = 0.002). Difference between groups for EDV and ESV at rest (p = 0.002), EDV at stress(p = 0.03) and at rest(p < 0.001), LVEF at rest and stress(p < 0.001) and for a negative change of LVEF(p < 0.001). Also, reduced Calcium Score(SC)(p < 0.001) Discussion With a higher prevalence reported in women8,9, no difference for women in both groups. Presentation been reported as atypical 3,6,10, as in our study. Traditional risk factors may affect the microvascular circulation earlier in the disease. Regarding mild and severe ischemia, CFR´s may be lower in defect perfusion zones and presence of both ischemia and MVD has worse prognosis11 suggesting ischemia could had already developed in this group. LVEF drop supports the relation between CFR and ventricular function12. Finally, MVA group had a reduced CS, associated with CAD and worse prognosis, suggesting it also affects the microvasculature function. Conclusions 13N-ammonia PET/CT MPI with CCTA is a great combination to diagnose MVA, whose main component is microvascular dysfunction. Recognizing the risk factors associated with this pathology allows making opportune detections, implementing early treatment strategies, controlling symptoms and avoiding the disease"s evolution
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