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Figure 2 Patient Examples of CMR Stress Test in Women
Patient #1 is a 70-year-old, post-menopausal woman with typical angina and 3 coronary artery disease (CAD) risk factors. There is no evidence of prior infarction on delayed-enhancement (DE) images; however, stress perfusion indicates defects in all 3 vascular territories. Coronary angiography demonstrated 3-vessel coronary disease. Patient #2 is a 50-year-old, post-menopausal woman without chest pain. However, she has diabetes, hypertension, hyperlipidemia, and a positive family history for CAD. A reversible perfusion defect was noted, which was not confined to 1 coronary territory. Her coronary angiogram revealed no epicardial disease, thus microvascular disease may be suspected in this patient. Patient #3 is a 63-year-old woman with typical angina but no prior history of myocardial infarction. She is also post-menopausal and has 3 CAD risk factors. On DE-cardiovascular magnetic resonance (CMR), a transmural infarct is noted in the territory of the right coronary artery (RCA), with a corresponding dense perfusion defect in the same location. However, her coronary angiogram demonstrated only a 40% stenosis in the RCA. Although this was a false-positive CMR study, secondary CAD prevention therapy is certainly warranted in this woman. LAD = left anterior descending coronary artery; LCX = left circumflex coronary artery.
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