Arnold, Ranjit

Francis, Jane

Howells, Ruairidh K

Jerosch-Herold, Michael

Karamitsos, Theodoros D

Neubauer, Stefan

Pegg, Tammy J

Robson, Matthew D

Selvanayagam, Joseph B

English

PubMed

Theodoros D Karamitsos

Ranjit Arnold

Tammy J Pegg

Jane Francis

Ruairidh K Howells

Matthew D Robson

Stefan Neubauer

Michael Jerosch-Herold

Joseph B Selvanayagam

Springer - Publisher Connector

POSTER PRESENTATION Open Access
Patients with Syndrome X have normal
myocardial oxygenation and perfusion compared
to normal volunteers: a 3 Tesla cardiovascular
magnetic resonance imaging study
Theodoros D Karamitsos1*, Ranjit Arnold1, Tammy J Pegg1, Jane Francis1, Ruairidh K Howells1, Matthew D Robson1,
Stefan Neubauer1, Michael Jerosch-Herold2, Joseph B Selvanayagam3
From 2011 SCMR/Euro CMR Joint Scientific Sessions
Nice, France. 3-6 February 2011
Objective
The aim of our study was to assess regional myocardial
perfusion and oxygenation in patients with Syndrome X
and in normal volunteers, using cardiovascular magnetic
resonance (CMR) imaging at 3 Tesla.
Introduction
The pathophysiology of chest pain in patients with Syn-
drome X remains controversial. Previous studies using
nuclear techniques or CMR to assess myocardial perfu-
sion have shown conflicting results. Advances in perfu-
sion imaging with CMR now enable absolute
quantification of regional myocardial blood flow. Further-
more, blood oxygenation level-dependent (BOLD) CMR
provides the unprecedented capability to assess regional
myocardial oxygenation. We hypothesized that the com-
bined assessment of regional perfusion and oxygenation
with CMR could clarify whether patients with cardiac
Syndrome X show evidence of myocardial ischemia
(reduced perfusion and oxygenation) during vasodilator
stress compared to normal volunteers.
Methods
18 patients (15 women) with Syndrome X (chest pain,
abnormal exercise treadmill test, normal coronary angio-
gram but no hypertension, diabetes or other causes of
microvascular dysfunction) and 14 age and sex-matched
normal volunteers (11 women) underwent CMR scanning
at 3 Tesla. Myocardial function (cine CMR), scar (late
gadolinium enhancement), perfusion and oxygenation
were assessed. For perfusion, 2-3 short axis slices were
acquired (depending on heart rate response to stress) with
a saturation recovery fast-gradient echo sequence and 0.04
mmol/kg Gd-DTPA bolus. Absolute myocardial blood
flow (MBF) was measured during adenosine stress (140μg/
kg/min) and at rest by model independent deconvolution
after saturation correction. Rest MBF was corrected for
rate-pressure product. For oxygenation, using a T2-pre-
pared blood oxygen level dependent (BOLD) SSFP
sequence, signal intensity was measured at stress and rest
in the slice matched to the mid-slice of the perfusion test.
Results
All subjects successfully completed the study protocol.
There were no differences in LV volumes and ejection
fraction between patients and normal controls. No sub-
ject had evidence of late gadolinium enhancement. Myo-
cardial blood flow at stress, BOLD signal change, and
coronary flow reserve measurements showed no signifi-
cant differences in Syndrome X patients and controls
(see table 1). Oxygenation and perfusion measurements
per coronary territory (LAD, LCx, RCA) were also simi-
lar between the two groups (see table).
Conclusions
Patients with Syndrome X have no reduction of absolute
perfusion or impairment in oxygenation during vasodila-
tory stress. Our findings are in contrast to other CMR stu-
dies and might reflect differences in patient population
and CMR methodology (absolute vs relative quantification
of perfusion).
1OCMR Unit, University of Oxford, Oxford, UK
Full list of author information is available at the end of the article
Karamitsos et al. Journal of Cardiovascular Magnetic Resonance 2011, 13(Suppl 1):P126
http://jcmr-online.com/content/13/S1/P126
© 2011 Karamitsos et al; licensee BioMed Central Ltd. This is an open access article distributed under the terms of the Creative
Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and
reproduction in any medium, provided the original work is properly cited.
Author details
1OCMR Unit, University of Oxford, Oxford, UK. 2Brigham and Women’s
Hospital, Boston, MA, USA. 3Department of Cardiovascular Medicine, Flinders
University, Adelaide, Australia.
Published: 2 February 2011
doi:10.1186/1532-429X-13-S1-P126
Cite this article as: Karamitsos et al.: Patients with Syndrome X have
normal myocardial oxygenation and perfusion compared to normal
volunteers: a 3 Tesla cardiovascular magnetic resonance imaging study.
Journal of Cardiovascular Magnetic Resonance 2011 13(Suppl 1):P126.
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Table 1 Perfusion and oxygenation measurements
Normal
(n= 14)
Syndrome
X (n= 18)
p-value
Global Measurements
Rest (corrected) MBF
(ml/min/gr)
0.96±0.18 0.93±0.21 0.07
Stress MBF (ml/min/gr) 2.37±0.45 2.32±0.58 0.29
CFR 2.53±0.56 2.59±0.74 0.30
BOLD SI change (%) 17.08±7.43 17.30±7.92 0.85
Left Anterior Descending Artery
Rest (corrected) MBF
(ml/min/gr)
0.98±0.15 0.96 ±0.16 0.84
Stress MBF (ml/min/gr) 2.43±0.32 2.39±0.50 0.83
CFR 2.53±0.42 2.54±0.60 0.96
BOLD SI change (%) 17.4±5.90 16.7±5.61 0.74
Left Circumflex artery
Rest (corrected) MBF
(ml/min/gr)
0.95±0.17 0.92±0.21 0.72
Stress MBF (ml/min/gr) 2.34±0.31 2.32±0.58 0.90
CFR 2.50±0.33 2.59±0.74 0.66
BOLD SI change (%) 18.22±8.03 18.88±9.65 0.84
Right Coronary Artery
Rest (corrected) MBF
(ml/min/gr)
0.93±0.16 0.87±0.15 0.28
Stress MBF (ml/min/gr) 2.30±0.32 2.31±0.57 0.94
CFR 2.51±0.30 2.71±0.68 0.27
BOLD SI change (%) 16.10±7.15 17.44±6.78 0.59
BOLD, blood oxygen level-dependent; CFR, coronary flow reserve; MBF,
myocardial blood flow; SI, signal intensity
Karamitsos et al. Journal of Cardiovascular Magnetic Resonance 2011, 13(Suppl 1):P126
http://jcmr-online.com/content/13/S1/P126
Page 2 of 2


Patients with Syndrome X have normal myocardial oxygenation and perfusion compared to normal volunteers: a 3 Tesla cardiovascular magnetic resonance imaging study

Patients with Syndrome X have normal myocardial oxygenation and perfusion compared to normal volunteers: a 3 Tesla cardiovascular magnetic resonance imaging study

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