Mosen H; Department of Clinical Physiology, Lund, Sweden.
Szekely A; Steding-Ehrenborg K; Akil Engblom S; et al

American Journal of Cardiology. 278:30-37, 2026 Nov 01.

Chronic coronary syndrome (CCS) is associated with reduced stress
perfusion, a predictor of adverse cardiovascular outcome. To what extent
myocardial perfusion is related to cardiorespiratory fitness is not
completely known. The aim was to investigate if change in myocardial
perfusion correlates to change in aerobic capacity after
revascularization. Sixty-two patients with suspected or established CCS
underwent cardiopulmonary exercise testing (CPET) and [13N]NH3 positron
emission tomography (PET) before and after elective invasive coronary
angiography. Thirty-six patients were revascularized and 26 were not. The
angiographer was blinded to the results from CPET and PET. Myocardial
perfusion was defined as decreased when below 2 ml/min/g and as myocardial
perfusion reserve (MPR) <2. Change in oxygen uptake at submaximal effort
(VO2 at AT) correlated positively to change in MPR in revascularized
patients (r = 0.36, p = 0.04), but not in conservatively treated patients
(r = 0.03, p = 0.90). Change in VO2 peak, however, did not correlate to
change in myocardial perfusion in any of the groups. Myocardial perfusion
at stress and MPR increased significantly after revascularization, when
baseline perfusion was decreased (p = 0.01 stress and p = 0.001 MPR,
respectively). Furthermore, the number of patients with exercise-induced
angina decreased significantly for the revascularized patients (42%
(14/33) at baseline versus 3% (1/33) at follow-up, p <0.001) whereas half
of the conservatively treated patients still had exercise-induced angina
at follow-up (42% (10/24) at baseline versus 21% (5/24) at follow-up, p =
0.12). In conclusion, change in myocardial perfusion correlates with
change in submaximal aerobic capacity after revascularization and
revascularization reduces exercise-induced angina.