Log in to MyACC
Coronary Microvascular Function in Asymptomatic Middle-Aged Adults
Quick Takes
- CMR has been shown to accurately measure myocardial blood flow, which allows for noninvasive prognostic markers to assess for myocardial perfusion and coronary microvascular function.
- Cardiometabolic risk factors in asymptomatic middle-aged adults affect coronary microvascular function by reducing stress myocardial blood flow and are associated with subclinical atherosclerosis.
Study Questions:
How can the presence of coronary microvascular dysfunction be predicted in asymptomatic middle-aged adults using noninvasive imaging?
Methods:
The PESA (Progression of Early Subclinical Atherosclerosis) trial prospectively studied asymptomatic middle-aged adults (aged 48-55 years) without known ischemic heart disease. Noninvasive imaging using cardiac magnetic resonance (CMR) assessed the myocardial perfusion at rest and under stress to determine the myocardial perfusion reserve. Subclinical atherosclerosis was assessed at baseline and at the 3-year follow-up using three-dimensional vascular ultrasound of the carotid and femoral arteries and computed tomography coronary artery calcium scoring (CAC), and the SCORE-2 was calculated to predict the risk for coronary artery disease. Using the forementioned values, a linear regression model adjusting for age, sex, and the extent of systemic atherosclerosis was used to determine cardiac risk factors and their association for coronary microvascular dysfunction.
Results:
The study population included 453 participants with median age 52.6 years and 84% male. The resting myocardial blood flow was directly associated with the number of components for metabolic syndrome (46.4% with 1-2, 14.8% with ≥3; p = 0.002), elevated systolic and diastolic blood pressure (p = 0.002; p = 0.007, respectively), and inversely associated with total cholesterol (p = 0.005) and low-density lipoprotein cholesterol (p = 0.005). Stress myocardial blood flow was lower with higher triglyceride levels (p = 0.071). The myocardial perfusion reserve was inversely associated with the number of metabolic syndrome components (p = 0.015); diastolic blood pressure (p = 0.037); and trended lower with elevated systolic blood pressure, diabetes, or elevated fasting plasma glucose (p = 0.051, p = 0.038, p = 0.001, respectively). Stress myocardial blood flow was decreased in the presence of subclinical atherosclerosis and higher triglyceride levels (p = 0.071). Stress myocardial blood flow was reduced in the presence of CAC (p = 0.047) and with increased global plaque burden (p = 0.036), and the myocardial perfusion reserve was reduced (p = 0.064) with elevated CAC.
Conclusions:
The greater the number of cardiometabolic risk factors and presence of systemic subclinical atherosclerosis in asymptomatic middle-aged patients without known ischemic heart disease, the greater the association with coronary microvascular dysfunction. In addition, a higher stress myocardial blood flow and myocardial perfusion reserve at baseline was associated with lower atherosclerotic plaque burden at the 3-year follow-up.
Perspective:
Although a primarily homogeneous Spanish businessmen population was studied, the results provide objective data regarding how noninvasive methods can predict the risk for coronary artery disease progression in seemingly healthy middle-aged adults. These data can be used to generate prediction models when counseling patients regarding their cardiac risk factors, including how to enhance their dietary and lifestyle changes, and to recommend optimal cost-effective management and surveillance strategies for asymptomatic patients.
Clinical Topics: Noninvasive Imaging, Magnetic Resonance Imaging, Nuclear Imaging, Cardiovascular Care Team, Vascular Medicine
Keywords: Atherosclerosis, Cardiometabolic Risk Factors, Magnetic Resonance Imaging, Myocardial Perfusion Imaging
< Back to Listings
