Expertise in Microvascular Imaging and Important Applications in Women’s Heart Health

A few areas of study warrant additional attention specific to women’s heart health. One of these is a condition called Myocardial Infarction with Non-obstructive Coronary Artery Disease (MINOCA) or ischemia (pain) with non-obstructive coronary arteries (INOCA). Angiograms appear normal in nearly half of women who have experienced a heart attack. Many women who come in experiencing symptoms of heart attacks and troponin elevations, and are taken for cardiac catheterization, are found to have no clear culprit for the heart attack.

In fact, up to 70 percent of patients undergoing invasive angiography (a diagnostic procedure using a catheter to determine a blockage in an artery) do not have obstructive coronary artery disease. This reality is more common in women than in men, with a large proportion of women having ischemia (pain) with non-obstructive coronary arteries (INOCA), meaning there is no blockage to explain their symptoms. INOCA can result from a variety of causes, including microvascular dysfunction (small vasculature or arteries). Yet, the evaluation of patients with INOCA is challenging given the wide spectrum of symptoms and signs that are often misdiagnosed and not treated.

The role that microvascular arteries may play is a growing area of study, particularly in women’s heart disease. It may require more aggressive treatment to improve outcomes and decrease the risk of developing more aggressive heart disease later. This is where special expertise in imaging becomes important.

A new cutting-edge technology in cardiac MRI (cMRI) is now available at the Minneapolis Heart Institute®, through a research collaboration with the National Institute of Health/NHLBI. The focus is on evaluating myocardial blood flow (MBF) and diagnosing microvascular disease in patients with symptoms. If reduced MBF is identified, it may be the answer to the symptoms we see in women with INOCA. This advanced imaging expertise will be important to ongoing research in this area.

The MHIF Cardiovascular Imaging Research Center is a state-of-the art, cardiac magnetic resonance imaging (MRI) and computerized tomography (CT) imaging laboratory led by Dr. João Cavalcante, a multi-modality trained imaging cardiologist. In 2018, Dr. Cavalcante joined the MHIF research team and clinical practice at the Minneapolis Heart Institute® (MHI). He leads a team of cardiologists who are working to advance the capabilities of imaging in research and clinical practice. Physicians come to MHI® from around the world to learn techniques because of the excellence of the imaging team, led by Drs. Cavalcante and John Lesser