Abstract 19008: Is Cold Pressor Cardiac Magnetic Resonance Imaging Testing Useful for Detection of Coronary Endothelial Dysfunction?
Background: Coronary endothelial dysfunction is typically assessed by invasive coronary reactivity testing (CRT) to measure coronary blood flow ([[Unable to Display Character: ∆]]CBF) and diameter responses to acetylcholine (Ach). We evaluated if cold pressor testing (CPT) during noninvasive cardiac magnetic resonance imaging (CMRI) measurement of myocardial perfusion reserve index (MPRI) reflects invasive measurements with Ach and CPT in subjects suspected of having endothelial dysfunction.
Methods: CRT was performed in 137 symptomatic women using incremental infusions of Ach in the left coronary artery for 3 minutes and with CPT using ice pack on their hand and forearm for 2 minutes. Quantitative coronary angiography was performed 5 mm distal to the Doppler wire positioned in the proximal left anterior descending artery. In 132 women, [[Unable to Display Character: ∆]]CBF was calculated from average peak velocity and vessel cross sectional area. Invasive CPT could not be completed on 4 women. All women underwent CPT CMRI (1.5 T) to measure MPRI as a ratio of stress and rest upslopes of the whole myocardium. Five definitions of normal invasive CPT and Ach diameter response (dilation > 0, 5, 10, 15 or 20%) were compared to two abnormal definitions (≤ 0 or - 5%) of endothelial function. Normal [[Unable to Display Character: ∆]]CBF was defined as ≤ 50%. We used Wilcoxon Two-Sample statistical test to compare MPRI in each group.
Results: CPT MPRI was significantly different in those with normal versus abnormal invasive Ach when Ach diameter response was defined as ≥ 20% or < - 5 % (p=0.04), though not with other thresholds (Table).
Conclusion: Noninvasive CPT CMRI may not be useful for detection of endothelial dysfunction in symptomatic women as no significant difference in MPRI was found in those with normal and abnormal invasive CRT. However, there may be a role for CPT MPRI in detecting endothelial dysfunction at higher thresholds of normal diameter response. Additional investigation will evaluate CPT CMRI and cardiovascular outcomes.
Author Disclosures: S. Dela Cruz: None. J. Wei: None. C. Shufelt: Research Grant; Significant; Gilead. P. Mehta: Research Grant; Modest; General Electric. Research Grant; Significant; Gilead. Honoraria; Modest; Little Company of Mary, Dignity Health, John F. Kennedy Hospital, Kaiser Permanente, San Diego Institute of Cardiology, Emory. A. Rogatko: None. X. Zhang: None. L.E. Thomson: None. J. Petersen: None. R. Anderson: None. C.J. Pepine: Research Grant; Significant; Gilead Sciences, Inc, Pfizer, Park-Davis, Sanofi-Aventis, Fujisawa HealthCare Inc, Baxter, Brigham & Women’s Hospital, AstraZeneca, NIH/NHLBI, Amorcyte/Neostem, Cytori, InfraReDx, NHLBI/NCRR CTSA grant 1UL1RR029890, AHA. Consultant/Advisory Board; Significant; NIH Study Section of Cardiovascular Sciences Small Business Activities 2RG1 CVS-K-10, Lilly/Cleveland Clinic DSMB Member for a Phase 2 Efficancy and Safety Study of Ly2484595, Medtelligence, NHLBI Study Section for Progenitor Cell Biology Consortium, NHLBI DSMB Chair for Freedom Trial. D.S. Berman: Research Grant; Significant; Siemens, Astellas, GE/Amersham, Lantheus, Cardium Therapeutics Inc. Consultant/Advisory Board; Significant; Spectrum Dynamics, Cedars Sinai Medical Center -software royalties, Lantheus. Other; Significant; Cedars-Sinai Medical Center. C. Bairey Merz: Research Grant; Significant; WISE CVD, FAMRI, RWISE, Normal Control, Microvascular. Speakers Bureau; Significant; Practice Pont Communications (lectures), Vox Media (lectures). Honoraria; Significant; Research Triangle Institute (RTI) Internaltional, UCSF, Kaiser, Gilead (grant review committee), Garden State AHA, Allegheny General Hospital, PCNA, Mayo Foundation (lectures; symposiums), Bryn Mawr Hospital, Victor Chang Cardiac Research Institute (Australia). Consultant/Advisory Board; Significant; Duke (Consulting, Japense Circ Society, U of New Mexico, Emory. Other; Significant; NIH-SEP (grant review Study Section), NIH-SEP.
- © 2014 by American Heart Association, Inc.