BACKGROUND AND PURPOSE:

• Women with suspected ischemia and no obstructive coronary artery disease (INOCA) have a increased rate of major adverse cardiac events, including nonfatal myocardial infarction (MI)
  • Women presenting with chest pain suggestive of angina and/or with abnormal stress tests have non-obstructive CAD more often than men
  • Women have a high burden of microvascular dysfunction when presenting with ischemic symptoms, but will have normal cardiac vessels on angiogram
• Cardiac magnetic resonance (CMR) with gadolinium can visualize myocardial scars which can predict serious adverse cardiac events, but this is not well studied in women
• Wei et al. (Circulation, 2018) evaluated the prevalence, incidence, and myocardial scar pattern in women with INOCA and suspected ischemia

METHODS:

• Participants were part of the Women’s Ischemia Syndrome Evaluation–Coronary Vascular Dysfunction (WISE-CVD) study
  • Women with signs and symptoms of ischemia, had clinically indicated invasive coronary reactive test, and underwent CRI
• Scans were read blinded to clinical information
• Sub sets of subjects underwent baseline CMR with
  • late gadolinium enhancement (LGE), to assess myocardial fibrosis/scar detection
  • and/or an invasive coronary reactivity test
• The SAQ (Seattle Angina Questionnaire) was completed at baseline and 1-year follow-up
• Retrospective review included clinical diagnosis of MI, electrocardiogram, and troponin levels

RESULTS:

• 369 women enrolled in the study
• LGE was present at baseline in 8% of women
  • Of those women, 69% had a documented prior history of MI and 92% had evidence on electrocardiogram of previous MI
• At 1 year, new LGE was present in 1% (2) women
  • Hospitalized with angina but no diagnosis of MI
• Interval index events in the cohort occurred in 12% of patients and included
  • 1 MI, 1 heart failure, and 19 angina hospitalizations in 21 women (12%)

CONCLUSION:

• In women with suspected INOCA, LGE prevalence was 8%, with an annual 1% incidence of new LGE
• Approximately 1/3 of women with LGE did not have prior diagnosis of MI, suggesting that a substantial number of women with suspected ischemia will have a clinically underdiagnosed myocardial scar

Learn More – Primary Sources:

Myocardial Scar Is Prevalent and Associated With Subclinical Myocardial Dysfunction in Women With Suspected Ischemia But No Obstructive Coronary Artery Disease

Cardiac Magnetic Resonance Myocardial Perfusion Reserve Index Is Reduced in Women With Coronary Microvascular Dysfunction

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