Quantitative myocardial perfusion as a biomarker for myocardial disease

Heart failure patients are known to be at risk of both coronary artery disease (CAD) and coronary microvascular dysfunction (MVD). Both obstructive CAD and MVD can cause hypoperfusion, however the myocardial perfusion (MP) will follow a different pattern depending on the underlying condition. In patients with CAD the MP will be regionally decreased following the territory of the affected coronary artery. In patients where MVD is predominant, a more homogenous perfusion decrease in the left ventricle is expected. Furthermore, cardiac conduction abnormalities such as left bundle branch block often have a regional perfusion defect which mimics the hypoperfusion seen in CAD, increasing the risk of misdiagnosis. To enable assessment of coronary microvascular function, quantitative assessment of myocardial perfusion is needed. Perfusion imaging is routinely done with semi-quantitative methods that assess the relative impairment of perfusion to the best perfused myocardial region. Since the detection of MVD and global decrease in perfusion is missed, these methods are of limited use in some heart failure groups where MVD is predominant.
In this thesis I will look at the myocardial perfusion and coronary microvascular function in different cardiac patient groups using quantitative CMR.