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Impaired Coronary Vasodilation by Magnetic Resonance Angiography Is Associated With Advanced Coronary Artery Calcification

Masahiro Terashima, MD, PhD, FACC^_*, Patricia K. Nguyen, MD^_*, Geoffrey D. Rubin, MD, Carlos Iribarren, MD, MPH, PhD, Brian K. Courtney, MD^_*, Alan S. Go, MD^,||, Stephen P. Fortmann, MD, Michael V. McConnell, MD, MSEE, FACC^_*,_*

^_* Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California
Department of Radiology, Stanford University School of Medicine, Stanford, California
Stanford Prevention Research Center, Stanford University School of Medicine, Stanford, California
Division of Research, Kaiser Permanente of Northern California, Oakland, California
^|| Departments of Epidemiology, Biostatistics, and Medicine, University of California, San Francisco, San Francisco, California.

^_* Reprint requests and correspondence: Dr. Michael V. McConnell, Division of Cardiovascular Medicine, Stanford University School of Medicine, 300 Pasteur Drive, Room H-2157, Stanford, California 94305-5233. (Email: mcconnell{at}stanford.edu).

Objectives: This study evaluated the hypothesis that impaired nitroglycerin (NTG)-induced coronary vasodilation is associated with advanced coronary atherosclerosis in asymptomatic older patients.

Background: Atherosclerosis is associated with both structural and functional abnormalities of the vessel wall. Noninvasive functional measures of subclinical coronary atherosclerosis may help characterize high-risk subjects and guide preventive therapy.

Methods: A total of 236 older patients (age 60 to 72 years, 33% female) without a history of cardiovascular disease were studied. Nitroglycerin-induced coronary vasodilation was measured by magnetic resonance angiography (MRA). Cross-sectional images of the right coronary artery were acquired before and 5 min after 0.4-mg sublingual NTG using a gated, breath-held spiral coronary MRA sequence (0.7-mm resolution). Quantitative analysis of the increase in cross-sectional area was performed in the 90% of patients (n = 212) with adequate image quality. Quantitation of coronary artery calcification (CAC) was performed by multidetector computed tomography using the Agatston method.

Results: Forty patients (19%) had advanced CAC (400). Coronary vasodilation to NTG was significantly impaired (p = 0.02) in patients with advanced CAC (median [interquartile range] = 15.9% [4.2% to 28.0%] vs. 21.5% [9.6% to 36.6%] for CAC <400). Importantly, NTG-induced coronary vasodilation remained independently associated with advanced CAC after multivariate analysis incorporating risk factors (p = 0.02) and other potential confounders (p = 0.04). There was no significant difference in coronary vasodilation between men and women, but few women (n = 3) had advanced CAC.

Conclusions: Impaired NTG-induced coronary vasodilation by MRA is associated with advanced coronary atherosclerosis in a community-based cohort of older asymptomatic subjects. Coronary MRA may provide a noninvasive functional assessment of subclinical coronary atherosclerosis.

Abbreviations and Acronyms   CAC = coronary artery calcium/calcification   CT = computed tomography   ECG = electrocardiography   HDL = high-density lipoprotein   MDCT = multidetector computed tomography   MRA = magnetic resonance angiography   MRI = magnetic resonance imaging   NTG = nitroglycerin   RCA = right coronary artery   RCAC = coronary artery calcification score for the right coronary artery   SNR = signal-to-noise ratio

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