A new cardiac variable identified?

Women with suspected cardiac syndrome X (CSX) are difficult to diagnosis and treat by conventional means. The women's ischemic syndrome evaluation (WISE) study, which started as an exploration of ischemic heart disease, increasingly focused on CSX, and two papers that represent an outgrowth and extension of this work are featured in this issue. Cardiovascular magnetic resonance imaging (CMRI) can generate a myocardial perfusion reserve index (MPRI) that is shown to be lower in women with CSX compared to normal controls. The MPRI is a ratio of resting to vasodilatation myocardial perfusion uptake and is relatively easy to measure. There is growing evidence that the CMRI measured MPRI provides unique information that should be regarded as a primary indicator of CSX disease severity. The papers describe the low levels of MPRI in a well documented CSX all female patient population. The context of this work and its relationship to other findings is discussed with an emphasis on the unique information that CMRI can provide.