Patients with Cardiac syndrome X have decreased global myocardial perfusion compared to gender matched controls; insights from CMR coronary sinus flow measurements

Methods Thirteen CSX patients (64 ± 12SD years, 9 females), here defined as a history of chest pain and pathological ECG reaction during stress (> 1 mm ST-depression at stress or after 4 minutes of recovery) but normal myocardial perfusion assessed by myocardial perfusion scintigraphy (SPECT), were included. In addition, 15 positive controls (66 ± 9SD years, 6 females) with stress-induced perfusion defects by SPECT, and 18 healthy controls (44 ± 14SD years 9 females) were also included. All subjects underwent quantitative flow measurement in the coronary sinus by CMR at rest and during adenosine stress. Coronary sinus flow (ml/min) was normalized to LVM enabling quantification of global myocardial perfusion (ml/min/g). All patients underwent first-pass perfusion at rest and during adenosine stress and presence of myocardial fibrosis/ infarction was assessed by late gadolinium enhancement (LGE).