Fig. 1

Baseline (a, b) and 10-year follow-up (c, d) adenosine stress first-pass perfusion cardiac magnetic resonance imaging showing evidence of circumferential subendocardial hypoperfusion at stress, consistent with coronary microvascular dysfunction-related ischemia. Myocardial perfusion reserve index decreased from 1.8 to 1.1 over 10-year period, indicating worsened ischemia