Evaluation of computed tomography myocardial perfusion in women with angina and no obstructive coronary artery disease

  • Daria Frestad BechsgaardEmail author
  • Ida Gustafsson
  • Marie Mide Michelsen
  • Naja Dam Mygind
  • Kristoffer Flintholm Raft
  • Jesper James Linde
  • Klaus Fuglsang Kofoed
  • Fay Yu-Huei Lin
  • James K. Min
  • Eva Prescott
  • Jens Dahlgaard Hove
Original Paper


Women with angina and no obstructive coronary artery disease (CAD) have worse cardiovascular prognosis than asymptomatic women. Limitation in myocardial perfusion caused by coronary microvascular dysfunction (CMD) is one of the proposed mechanisms contributing to the adverse prognosis. The aim of this study was to assess myocardial perfusion in symptomatic women with no obstructive CAD suspected for CMD compared with asymptomatic sex-matched controls using static CT perfusion (CTP). We performed a semi-quantitative assessment of the left ventricular myocardial perfusion and myocardial perfusion reserve (MPR), using static CTP with adenosine provocation, in 105 female patients with angina and no obstructive CAD (< 50% stenosis) and 33 sex-matched controls without a history of angina or ischemic heart disease.  Patients were on average 4 years older (p = 0.04) and had a higher burden of cardiovascular risk factors. While global perfusion during rest was comparable between the groups (age-adjusted p = 0.12), global perfusion during hyperemia was significantly reduced in patients compared with controls (163 ± 23 HU vs. 171 ± 25 HU; age-adjusted p = 0.023). The ability to increase myocardial perfusion during adenosine-induced vasodilation was significantly diminished in patients (MPR 148% vs. 158%; age-adjusted p < 0.001). This remained unchanged after adjustment for cardiovascular risk factors (p = 0.008). Women with angina and no obstructive CAD have reduced hyperemic myocardial perfusion and MPR compared with sex-matched controls. Impaired myocardial perfusion may be related to the presence of CMD in some of these women.


Myocardial CT perfusion imaging Myocardial perfusion reserve Stress testing Angina pectoris Women 



Attenuation density


Body mass index


Coronary artery calcium


Coronary artery disease


Coronary computed tomography angiography


Coronary heart disease


Coronary microvascular dysfunction


Computed tomography


CT perfusion


Daria Frestad Bechsgaard


Hounsfield units


Ischemic heart disease


Jesper James Linde


Myocardial perfusion reserve


Left anterior descending coronary artery


Left ventricle


Left circumflex coronary artery


Positron emission tomography


Right coronary artery


Transmural perfusion ratio



This work was supported by the Danish Heart, Arvid Nilssons Foundation and Hvidovre Hospital Research Council. The Authors would like to thank the Copenhagen City Heart study, Departments of Cardiology and Radiology, Hvidovre University Hospital, and Department of Cardiology, Bispebjerg University Hospital, for their collaboration on this project. We thank chief radiologist Dennis Møller and radiologists Tina Berland Larsen, Anja Nielsen, Linn Haraldseid, and the nursing head of the outpatient department of Cardiology Sussie Foghmar for their assistance in data acquisition. Lastly, we want to express our deepest gratitude to the women participating in the iPOWER study for their time and willingness to contribute to the research.

Compliance with ethical standards

Conflict of interest

All the authors declared that they no conflict of interest.


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Copyright information

© Springer Nature B.V. 2019

Authors and Affiliations

  • Daria Frestad Bechsgaard
    • 1
    Email author
  • Ida Gustafsson
    • 1
  • Marie Mide Michelsen
    • 2
  • Naja Dam Mygind
    • 3
  • Kristoffer Flintholm Raft
    • 2
  • Jesper James Linde
    • 3
  • Klaus Fuglsang Kofoed
    • 3
  • Fay Yu-Huei Lin
    • 4
  • James K. Min
    • 4
  • Eva Prescott
    • 2
  • Jens Dahlgaard Hove
    • 1
  1. 1.Department of Cardiology, Hvidovre University HospitalUniversity of CopenhagenCopenhagenDenmark
  2. 2.Department of Cardiology, Bispebjerg University HospitalUniversity of CopenhagenCopenhagenDenmark
  3. 3.Department of Cardiology, RigshospitaletUniversity of CopenhagenCopenhagenDenmark
  4. 4.Dalio Institute of Cardiovascular Imaging, Department of RadiologyNew York-Presbyterian Hospital and Weill Cornell MedicineNew YorkUSA

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