Abnormal Subendocardial Perfusion in Cardiac Syndrome X Detected by Cardiovascular Magnetic Resonance Imaging

Panting, Jonathan; Gatehouse, Peter; Yang, Guang‐Zhong; Grothues, Frank; Firmin, David N.; Collins, Peter; Pennell, Dudley J.

doi:10.1056/nejmoa012369

Cited by 661 publications

(207 citation statements)

References 34 publications

Supporting

Mentioning

197

Contrasting

Unclassified

Order By: Relevance

“…26 In a recent study, such an analysis of subendocardial data has been shown to allow the detection of patients with syndrome X. 27 In the present study, the inner 10% and outer 30% of the myocardium were excluded from the analysis to avoid influence from the blood pool and to generate a stronger weighting of the subendocardium. However, spatial resolution did not allow for a differentiation into endocardium and epicardium.…”

Section: Limitationsmentioning

confidence: 96%

Magnetic Resonance Perfusion Measurements for the Noninvasive Detection of Coronary Artery Disease

et al. 2003

View full text Add to dashboard Cite

Background-With MRI, an index of myocardial perfusion reserve (MPRI) can be determined. We assessed the value of this technique for the noninvasive detection of coronary artery disease (CAD) in patients with suspected CAD. Methods and Results-Eighty-four patients referred for a primary diagnostic coronary angiography were examined with a 1.5 T MRI tomograph (Philips-ACS). For each heartbeat, 5 slices were acquired during the first pass of 0.025 mmol gadolinium-diethylenetriamine pentaacetic acid/kg body weight before and during adenosine vasodilation by using a turbo-gradient echo/echo-planar imaging-hybrid sequence. MPRI was determined from the alteration of the upslope of the myocardial signal intensity curves for 6 equiangular segments per slice. Receiver operating characteristics were performed for different criteria to differentiate ischemic and nonischemic segments. Prevalence of CAD was 51%. Best results were achieved when only the 3 inner slices were assessed and a threshold value of 1.1 was used for the second smallest value as a marker for significant CAD. This approach yielded a sensitivity of 88%, specificity of 90%, and accuracy of 89%. Conclusion-The determination of MPRI with MRI yields a high diagnostic accuracy in patients with suspected CAD.(Circulation. 2003;108:432-437.)

show abstract

Section: Limitationsmentioning

confidence: 96%

Magnetic Resonance Perfusion Measurements for the Noninvasive Detection of Coronary Artery Disease

et al. 2003

View full text Add to dashboard Cite

show abstract

“…The specific advantages of CMR are its excellent soft-tissue characterization, 3 dimensionality, superior temporal and spatial resolution, and lack of ionizing radiation. 7,45 Dobutamine CMR has been studied to identify flowlimiting coronary artery stenoses in women. 45 In a recent study of 266 women, inducible left ventricular wall-motion abnormalities during dobutamine CMR predicted cardiac death and MI in women with known or suspected ischemic heart disease.…”

Section: Cardiac Magnetic Resonance Imagingmentioning

confidence: 99%

“…7,45 Dobutamine CMR has been studied to identify flowlimiting coronary artery stenoses in women. 45 In a recent study of 266 women, inducible left ventricular wall-motion abnormalities during dobutamine CMR predicted cardiac death and MI in women with known or suspected ischemic heart disease. 46 Although the studies have been small, current data suggest that dobutamine CMR is a valuable noninvasive stress imaging modality for identifying disease in at-risk women, with a sensitivity and a specificity for detecting obstructive CAD in women of 85% and 86%, respectively.…”

Section: Cardiac Magnetic Resonance Imagingmentioning

confidence: 99%

“…Contemporary CMR techniques allow for the identification of subendocardial ischemia through the delineation of subendocardial vs epicardial perfusion. 45 Also, CMR has the ability to detect prior or recent MI and evaluate myocardial viability to help determine which patients may benefit from revascularization if severe CAD and myocardial dysfunction are present. 54,55 Also, CMR is a valuable noninvasive imaging modality for the detection and risk stratification of symptomatic women with suspected CAD.…”

Section: Cardiac Magnetic Resonance Imagingmentioning

confidence: 99%

See 1 more Smart Citation

Noninvasive Diagnostic Techniques for Coronary Disease in Women

Vavas¹,

Hong²,

Rosen³

et al. 2012

Clinical Cardiology

View full text Add to dashboard Cite

Significant advances in medical treatment, medical technology, and the focus on sex-specific research have contributed to a reduction in cardiovascular mortality in women. Despite these advances, coronary artery disease (CAD) is the leading cause of cardiovascular death of women in the Western world. In the past 2 decades, the focused research on women at risk for CAD has helped to clarify our understanding of some of the sex-specific factors that are important in the detection of CAD. In women, the detection and evaluation of physiologically significant CAD can be challenging. Many of the traditional tests that are designed to detect focal areas of coronary artery stenosis are less sensitive and specific in female patients, who have a greater burden of symptoms, higher atherosclerotic burden, and lower prevalence of obstructive coronary disease. In this article, we review the available evidence on the role of contemporary noninvasive diagnostic techniques in the evaluation of women with symptoms of CAD.

show abstract

“…5 Moreover, endothelial dysfunction of the microvasculature has been implicated in cardiac syndrome X, a condition characterized by typical angina, ST-segment depression during exercise electrocardiogram stress testing and normal coronary arteries by angiography. 32 Patients with cardiac syndrome X have evidence of endothelial dysfunction 33 and showed subendocardial ischemia and chest pain in response to adenosine, 34 which vasodilates the microvasculature in a partially endothelial-dependent manner. 35 The critical role of endothelial cells in relation to atherosclerosis and cardiovascular events is becoming apparent.…”

Section: No-dependent Penile Erectionmentioning

confidence: 99%

The endothelial cell in health and disease: its function, dysfunction, measurement and therapy

et al. 2009

View full text Add to dashboard Cite

Endothelial cells have numerous endocrine functions and contribute to a variety of processes, including penile erection and vasodilation. Endothelial dysfunction is associated with cardiovascular risk factors and has been implicated in the pathogenesis of atherosclerosis and ED. This study reviews endothelial function, in addition to endothelial dysfunction and its role in atherosclerosis and ED. Measurement of endothelial function is reviewed, including catheter-based methods, venous occlusion plethysmography, high-frequency ultrasound, peripheral arterial tonometry, digital pulse amplitude tonometry, digital thermal monitoring, the L-arginine test and measurement of compounds released by endothelial cells. Therapy and medications that improve endothelial function are reviewed. As the scientific community learns more about the importance of the endothelium, it is increasingly important for the clinician to understand endothelial function, dysfunction, measurement of endothelial function and therapies that affect this remarkable cell type.

show abstract

Abnormal Subendocardial Perfusion in Cardiac Syndrome X Detected by Cardiovascular Magnetic Resonance Imaging

Abstract: In patients with syndrome X, cardiovascular magnetic resonance imaging demonstrates subendocardial hypoperfusion during the intravenous administration of adenosine, which is associated with intense chest pain. These data support the notion that the chest pain may have an ischemic cause.

Cited by 661 publications

References 34 publications

Magnetic Resonance Perfusion Measurements for the Noninvasive Detection of Coronary Artery Disease

Magnetic Resonance Perfusion Measurements for the Noninvasive Detection of Coronary Artery Disease

Noninvasive Diagnostic Techniques for Coronary Disease in Women

The endothelial cell in health and disease: its function, dysfunction, measurement and therapy

Contact Info

Product

Resources

About