PREVALENCE OF MYOCARDIAL SCAR IN WOMEN WITH SIGNS AND SYMPTOMS OF ISCHEMIA BUT NO OBSTRUCTIVE CORONARY ARTERY DISEASE: A REPORT FROM THE WOMEN’S ISCHEMIA SYNDROME EVALUATION

Moderated Poster ContributionsStable Ischemic Heart Disease Moderated Poster Theater, Poster Hall B1Sunday, March 15, 2015, 10:00 a.m.-10:10 a.m.Session Title: Ischemia in Women without Obstructive Coronary Artery DiseaseAbstract Category: 26. Stable Ischemic Heart Disease: ClinicalPresentation Number: 1205M-05Authors: May Bakir, Janet Wei, Louise Thomson, John Petersen, Quanlin Li, Erika Jones, Puja Mehta, Chrisandra Shufelt, Daniel Berman, Eileen Handberg, Sheryl Kelsey, George Sopko, Carl Pepine, C. Noel Bairey Merz, Cedars-Sinai Medical Center, Los Angeles, CA, USABackground: Women with signs and symptoms of ischemia and no obstructive coronary artery disease (CAD) have an elevated major adverse cardiac event rate. We evaluated the presence, extent and distribution of scar using cardiac magnetic resonance imaging (CMRI) late gadolinium enhancement (LGE) in the Women’s Ischemia Syndrome Evaluation.methods: Women (n=344) with signs and symptoms of ischemia and no obstructive CAD underwent 1.5T CMRI LGE. Scans were read blindly for presence and segmental distribution of LGE. Scar size was quantified using Pie Medical Imaging software. LGE type was defined as ischemic when subendocardial or transmural and localized to a coronary artery distribution, and non-ischemic when mid-myocardial or epicardial. Fisher’s exact and two sample t-tests were used for statistical analysis.results: LGE was present in 20 (5.8%) women, including 15 (75%) with ischemic LGE. Women with non-ischemic LGE (n=5) had larger scar size compared to women with ischemic LGE (Table). There were no significant differences in cardiac risk factors among women with no LGE, ischemic LGE, or non-ischemic LGE, and there was no significant correlation between LGE presence and cardiac risk factors.Conclusion: Women with signs and symptoms of ischemia and no obstructive CAD have a 5.8% prevalence of myocardial scar detected by CMRI, with a predominant ischemic LGE pattern. These findings demonstrate that these women can develop irreversible myocardial injury, which may be clinically under-diagnosed.No LGE(n=324)Ischemic LGE(n=15)Non-ischemic LGE(n=5)Age 54 ± 11 years 55 ± 8 years 37 ± 15 yearsBody Mass Index 30 ± 8 32 ± 11 35 ± 7Hypertension 40% 31% 75%Diabetes 11% 14% 50%Dyslipidemia 20% 10% 33%Family History of Coronary Artery Disease 48% 21% 50%Scar pattern n/a4 LAD6 LCX4 RCA1 LAD and RCA3 patchy epicardial1 midmyocardial ASH1 RV insertion pointsScar size n/a 4.83 ± 3.12g* 9.57 ± 6.10g*ASH= asymmetric septal hypertrophy, LAD= left anterior descending artery, LCX= left circumflex artery, LGE= late gadolinium enhancement, RCA= right coronary artery, RV= right ventricular*p=0.0034