Jannike Nickander

Bakgrund: Approximately 90% of the cardiac blood volume resides in the microvasculature. It is evident that obstructive epicardial disease is not the only cause of myocardial ischemia a mircovascular dysfunction (CMD) has been linked to angina and mortality. This highlights that myocardial ischemia is a physiological continuum of focal and diffuse disease, however major knowledge gaps of CMD exist. This projects intended to reveal pathophysiological knowledge of CMD by investigating both cardiac and non-cardiac diseases. With a unique set-up of beyond state-of-the-art cardiac imaging, the presence of CMD will be studied in both ischemic and non-ischemic diseases with the underlying hypothesis that CMD is a unifying pathophysiological mechanism of non-obstructive myocardial ischemia. Målsättning: The overall purpose of the project is to provide new fundamental insights necessary for improving the clinical diagnosis of CMD, and identify mechanisms for therapeutic choice trough comprehensive assessment of CMD in difference clinical populations. Arbetsplan: Different patient populations with both cardiac and non-cardiac disease will be investigated using state-of-the-art stress perfusion magnetic resonance imaging to reveal the presence and temporal trends in CMD in a broad population. Specific patient populations include myocardial infarction with non-obstructive coronary arteries, myocardial infarction with multivessel disease, Takotusbo syndrome, Wilson's disease, Fabry disease and covid-19. Betydelse: The proposed project uses quantitative perfusion mapping by cardiovascular magnetic resonance to address major knowledge gaps regarding CMD and its pathophysiological mechanisms in both cardiac and non-cardiac diseases. The project goals are well defined and are highly relevant for a large group of patients that are currently under-diagnosed and without specific treatment. Furthermore, the project aim to elucidate potential sex differences in CMD. The project is highly feasible for our research group with both broad and deep interdisciplinary medical and technical competence with the potential to improve cardiac care. With the innovative use of highly advanced cardiovascular magnetic resonance technology for combined scientific and clinical benefit, knowledge on CMD in separate clinical populations will add to the current body of knowledge regarding the coronary microvasculature and the mechanisms for pathology in non-obstructive myocardial ischemia.