Case Session 01: Ischemic Heart Disease and Acute Chest Pain (2018)-Pixel-wise Quantitative Stress Perfusion Imaging of Coronary Microvascular Dysfunction

Pixel-wise Quantitative Stress Perfusion Imaging of Coronary Microvascular Dysfunction

Video Transcription

Video Summary

A 49-year-old woman had five years of exertional angina despite normal coronary angiograms and no traditional risk factors. Exercise ECG showed ischemia, prompting invasive coronary physiology testing, which confirmed no epicardial obstruction but reduced coronary flow reserve and borderline elevated microvascular resistance, consistent with coronary microvascular dysfunction. Stress perfusion CMR then showed inducible subendocardial perfusion abnormalities with reduced myocardial blood flow and perfusion reserve, matching invasive findings. She improved on medical therapy. The talk highlighted ANOCA, the limitations of angiography alone, and the value of quantitative perfusion MRI in diagnosing microvascular ischemia.

Keywords

coronary microvascular dysfunction

ANOCA

stress perfusion CMR

microvascular ischemia

coronary flow reserve