Women With Ischemia, Non-Obstructive CAD May Have Myocardial Scars
Cardiac MR accurately diagnoses; myocardial scars may affect 8% of women with non-obstructive CAD
(HealthDay News) -- Among women with suspected ischemia and no obstructive coronary artery disease (INOCA), the prevalence of baseline late gadolinium enhancement (LGE) indicating presence of myocardial scars is 8%, according to a research letter published in Circulation, a Go Red For Women issue focused on women's heart health.
Janet Wei, MD, from the Cedars-Sinai Heart Institute in Los Angeles, and colleagues describe the prevalence, incidence, and scar patterns in women with INOCA. A total of 369 women were enrolled, and 341 underwent baseline cardiac magnetic resonance (CMR) with LGE imaging.
The researchers found that 8% of women had LGE present at baseline. Compared to women without LGE, they were younger, had lower blood pressure, and were more likely to be prescribed calcium channel blockers and clopidogrel. These women also had lower Seattle Angina Questionnaire treatment satisfaction. Of the patients with baseline LGE, 69% had a documented prior history of myocardial infarction. There was no significant correlation between troponin level and scar size. Eighteen of the 26 LGE cases demonstrated a typical scar pattern; the atypical scar pattern (seen in 8 cases) tended to be in younger participants with a larger scar size. Among 179 patients with one-year CMR scans, new LGE was present in 1% (2 patients), both with an atypical scar pattern. Eight percent had LGE in both baseline and 1-year CMR, of which 71% had a typical scar pattern.
"Our results raise the importance of diagnosis and improved mechanistic understanding of INOCA as well as clinical trials to develop evidence-based treatment guidelines," the authors write.
Several authors disclosed financial ties to the pharmaceutical industry.
Wei J, Bakir M, Darounian N, et al. Myocardial Scar Is Prevalent and Associated With Subclinical Myocardial Dysfunction in Women With Suspected Ischemia But No Obstructive Coronary Artery Disease: From the Women's Ischemia Syndrome Evaluation–Coronary Vascular Dysfunction Study. Circ. 2018;137:874-876. doi:10.1161/CIRCULATIONAHA.117.031999