176 Chapter 8 Figure 4. MPR distribution among the ANOCA endotypes, showing similar distribution of MPR over the different ANOCA endotypes (one-way ANOVA, p=0.766). Data are presented as mean ± SD Abbreviations: MPR: Myocardial Perfusion Reserve; CFT: Coronary Function Testing; MVA: microvascular angina Association between MPR, cardiovascular risk factors and coronary function testing The association between MPR and cardiovascular risk factors in the ANOCA patients, such as age, sex, BMI, hypertension and hyperlipidemia is presented in Supplementary Table 4. In univariate regression analysis, only the presence of hyperlipidemia was associated with MPR (β = − 0.539, p < 0.001). However, in multivariate regression analysis, no association was found between MPR and the cardiovascular risk factors. Considering the association between invasively measured CFR and MPR, the ranking coefficient was not significantly different from zero [Supplementary Table 5]. DISCUSSION The present study investigated QP CMR in detecting regional ischemia in ANOCA, compared with healthy controls. We report that; 1) ANOCA patients have a significantly reduced MPR, indicating impaired perfusion, while contrastingly, visual assessment of perfusion did not show any group differences; 2) MPR was evaluated across different coronary territories, revealing heterogeneity in MPR over the different coronary territories, with the RCA showing the highest prevalence of the most diminished MPR; and 3) MPR did not significantly differ across the different established ANOCA endotypes, suggesting an impaired MPR is not only confined to MVA.
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