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Final Program


Program-At-A-Glance

Oral Abstracts Session

Virtual Recording

Session: Oral Abstracts Clinical Session 4

Correlation of Quantitative Stress Myocardial Blood Flow and Epicardial Adipose Tissue Characterization with Quality of life in Women with Angina and No Obstructive Coronary Artery Disease

Saturday, February 7, 2026
11:40 AM - 11:50 AM  
Location: Asia IV and Hall 8 (3rd Floor)

    Presenting Author(s)

  • Patricia F. Rodriguez Lozano, MD, MSc

    Director Women's Heart Care Program
    University of Virginia Health System
    Charlottesville, Virginia, United States

    • Primary Author(s)

  • Patricia F. Rodriguez Lozano, MD, MSc

    Director Women's Heart Care Program
    University of Virginia Health System
    Charlottesville, Virginia, United States

    • Co-Author(s)

  • SW

    Shuo Wang, MD, PhD

    Research Associate
    University of Virginia Health System
    Charlottesville, Virginia, United States

  • John T. Echols, PhD

    Post-doctoral Research Associate
    University of Virginia
    Charlottesville, Virginia, United States

  • Bishow Paudel, MD

    Advanced Cardiovascular Imaging Fellow
    University of Virginia
    Charlottesville, Virginia, United States

  • NH

    Nisha Hosadurg, MD

    Advanced Cardiovascular Imaging Fellow
    University of Virginia, United States

  • LP

    Lauren Preston

    Research Coordinator
    University of Virginia Health System, United States

  • GL

    Genevieve Lyons

    Senior Biostatistician
    University of Virginia, United States

  • KW

    Kelsey Watts

    Senior Biostatistician
    University of Virginia, United States

  • Jonathan A. Pan, MD, MSc, MBA

    Assistant Professor
    University of Virginia Health System
    Charlottesville, Virginia, United States

  • PK

    Peter Kellman, PhD

    Dr.
    National Institutes of Health, Maryland, United States

  • MC

    Mete Civelek, PhD

    Professor of Molecular Medicine
    University of California, Los Angeles, United States

  • MW

    Matthew Wolf, MD, PhD

    Associate Professor, Medicine: Cardiovascular Medicine
    University of Virginia, United States

  • Amit R. Patel, MD, FSCMR

    Professor of Medicine
    Division of Cardiology, University of Virginia Health System, Charlottesville, Virginia, USA.
    Charlottesville, Virginia, United States

  • Christopher M. Kramer, MD

    Professor of Medicine, Division of Cardiology
    University of Virginia Health System, Charlottesville, Virginia, USA
    Charlottesville, Virginia, United States

  • Frederick H. Epstein, PhD

    Professor
    University of Virginia
    Charlottesville, Virginia, United States

Background: Women with angina and no obstructive coronary artery disease (ANOCA) often experience impaired quality of life (QOL) related to coronary microvascular dysfunction (CMD). Epicardial adipose tissue (EAT), a metabolically active depot sharing the myocardial microcirculation, may contribute to CMD. Quantitative cardiovascular magnetic resonance (CMR) enables simultaneous assessment of stress myocardial blood flow (MBF), myocardial perfusion reserve (MPR), and EAT burden. Whether these imaging biomarkers relate to patient-reported QOL at baseline in women with ANOCA is not well established.

Methods: In this prospective single-center cohort, 32 women with ANOCA (mean age 64 ± 9 years, BMI 32 ± 11 kg/m²) underwent 1.5T CMR including regadenoson stress/rest perfusion for quantitative global MBF and MPR (automatic inline analysis). EAT volume index (EATVI) was quantified and indexed to body surface area. Baseline QOL was measured using the Seattle Angina Questionnaire (SAQ-7), Duke Activity Status Index, Patient Health Questionnaire (PHQ-9), and Generalized Anxiety Disorder scale (GAD-7). Associations between imaging biomarkers and QOL at baseline were assessed using Pearson correlations.

Results: Population characteristics and images are showed in Table 1 and Figure 1. At baseline, women with ANOCA reported impaired QOL with frequent angina symptoms. EATVI demonstrated a moderate inverse correlation with Duke Activity (ρ = −0.47, p = 0.11) and a weak inverse correlation with SAQ-7 (ρ = −0.28, p = 0.17). Stress MBF was moderately correlated with Duke Activity (ρ = 0.40, p = 0.19) and weak-to-moderately correlated with SAQ-7 (ρ = 0.32, p = 0.11) Figure 2. No meaningful associations were observed with PHQ-9 or GAD-7. Although not statistically significant—likely reflecting small pairwise sample sizes—the direction and magnitude of these associations support a plausible link between greater EAT burden, impaired perfusion, and reduced QOL.

Conclusion: Quantitative CMR measures of perfusion and EAT burden align with symptom burden and functional limitation in women with ANOCA. Findings support integrating patient-reported outcomes with quantitative perfusion and EAT volume phenotyping to refine ANOCA phenotypes and endpoint selection; larger, adequately powered cohorts are warranted.

Table 1. Patient Demographics and Clinical Characteristics

Parameters

Mean ± SD or Median (interquartile range) or n (%)

Clinical

Overall (n=33)

Age, yrs

64 ± 9

BMI, kg/m2

32 ± 11

BSA, m2

1.94 ± 0.29

Female, n (%)

33(100%)

Ethnicity, n (%)

 

    White

32 (97%)

    Black

1 (3%)

Comorbidities, n (%)

 

    Prior smoker

4 (12%)

    Current smoker

2 (6%)

    Diabetes

5 (15%)

    Hypertension

18 (55%)

    Hyperlipidemia

9 (27%)

    Prior COVID-19 infection

3 (9%)

NYHA, n (%)

 

         I

8 (24%)

         II

18 (55%)

         III

7 (21%)

CCS, n (%)

 

         I

14 (42%)

         II

13 (39%)

         III

4 (12%)

       Ⅳ

1 (3%)

Women risk factor

 

Polycystic ovary syndrome

1 (3%)

Pregestational DM

5 (15%)

Gestational DM

5 (15%)

Pregestational HTN

3 (9%)

Gestational HTN

5 (15%)

Eclampsia

6 (18%)

Preterm birth

4 (12%)

Hx of infertility

7 (21%)

Autoimmune disorder

8 (24%)

Lupus erythematosus

6 (18%)

Psoriatic arthritis

1 (3%)

Rheumatoid arthritis

2 (6%)

CMR parameters

 

    LVEF, %

66 ± 6

    LVEDVI, ml/m2

67 ± 12

    LVESVI, ml/m2

25 ± 7

    LVMI, g/m2

40 ± 7

    RVEF, %

58 ± 6

    RVEDVI, ml/m2

65 ± 16

    RVESVI, ml/m2

28 ± 8

    Native myocardium T1, ms

1018 ± 29

    ECV, ms

28 ± 2

    T2, ms

47 ± 3

    LGE, n (%)

1 (3%)

    Rest heart rate, beats/min

70 ± 10

    Stress heart rate, beats/min

96 ± 13

    Global rest MBF (ml/g/min)

0.75 ± 0.15

    Global stress MBF (ml/g/min)

2.17 ± 0.60

    Global MPR

2.93 ± 0.84

EAT parameters by CMR

 

    EATVI, g/m2

43 ± 15

Figure 1. Myocardial quantitative perfusion and epicardial adipose tissue volume measurements using cardiovascular magnetic resonance imaging. A. EAT volume (EATV) was manually quantified at end-systole on short-axis (SA) cine images. Automated inline pixel-wise perfusion mapping and fully quantitative perfusion of rest MBF (B), stress MBF (C) and MPR (D).
Figure 2. Baseline Pearson correlation matrix (ρ). EAT volume index), QOL/psychosocial scores (SAQ-7, PHQ-9, GAD-7, Motivation, Knowledge, Duke Activity), and CMR perfusion (Stress MBF, Global MPR) in women with ANOCA