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023 Myocardial perfusion reserve falls in diabetes and with increasing age – a perfusion mapping study
  1. Kristopher Knott1,
  2. Claudia Camaioni1,
  3. Anish Bhuva1,2,
  4. Gabriella Captur1,2,
  5. Hui Xue3,
  6. Charlotte Manisty1,2,
  7. Christos Bourantas1,
  8. Sven Plein4,
  9. Peter Kellman3,
  10. James C Moon1,2
  1. 1Barts Heart Centre, The Cardiovascular Magnetic Resonance Imaging Unit and The Inherited Cardiovascular Diseases Unit, St Bartholomew’s Hospital, West Smithfield, London, UK
  2. 2Institute of Cardiovascular Science, University College London, London, WC1E 6BT, UK
  3. 3National Heart, Lung, and Blood Institute, National Institutes of Health, DHHS, Bethesda, MD, USA
  4. 4University of Leeds, Leeds, LS2 9JT, UK

Abstract

Objectives Myocardial perfusion reserve (MPR) is the ratio of myocardial blood flow (MBF) at stress to rest. A reduced MPR has been associated with a poor prognosis in quantitative Positron Emission Tomography studies. A likely mechanism is microvascular disease. Patients with diabetes mellitus often have microvascular disease and may have reduced MPR. We used automated in-line perfusion mapping, to quantify MBF at a pixel level in order to assess the MPR in patients with diabetes and other patients referred for clinical perfusion CMR.

Method Over 7 months, stress perfusion CMR with perfusion mapping was performed on 1201 clinically referred patients. Of these, we identified 121 who had also had angiography (invasive or CT) within 6 months (mean 6.4 weeks). Patients with unobstructed epicardial coronary arteries (<50% stenosis) were used in the final analysis (n=45). Global LV MPR was averaged across 3 short axis LV slice perfusion maps. The MPR of patients with diabetes (n=10) was compared to those without. Patient age, sex, body surface area (BSA), LV end-diastolic volume (EDV), ejection fraction (EF) and the presence or absence of hypertension and late gadolinium enhancement (LGE) were recorded. A multivariable analysis was performed to determine the contributions of these factors to the MPR.

Results Global LV MPR was: 3.07 across all patients, 2.33 for those with diabetes and 3.27 in those without diabetes (p=0.009). Multivariable analysis indicated that diabetes and age were negatively associated with MPR even after adjustment for sex, BSA, LGE, hypertension, LV EF and EDV (p<0.05 for each group).

Conclusion In patients with non-obstructive epicardial coronary artery disease, the myocardial perfusion reserve falls with diabetes and increasing age. This is immediately visualisable by used automated in-line perfusion mapping.

Abstract 023 Figure 1

Perfusion maps (basal mid and apical LV slices) for a 50-year-old male with unobstructed coronary arteries at stress (a-c) and rest (d-f). The MPR is 4.54.

Abstract 023 Figure 2

Perfusion maps for a 63-year-old male with diabetes and hypertension. The MPR is 2.34.

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