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In Vivo Quantitative Assessment of Myocardial Structure, Function, Perfusion and Viability Using Cardiac Micro-computed Tomography
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Paucity of anginal symptoms and stress-induced perfusion abnormalities in ischemic cardiomyopathy

Alessia Gimelli1, Paolo Marzullo, Patrizia Landi

  • 1CNR, Institute of Clinical Physiology, Pisa, Italy.

Journal of Nuclear Cardiology : Official Publication of the American Society of Nuclear Cardiology
|September 2, 2008
PubMed

Insights

Patients with ischemic cardiomyopathy experience fewer angina symptoms because they have less severe stress-induced myocardial ischemia and more necrosis. This study investigated the relationship between symptoms and ischemia severity.

Area of Science:

  • Cardiology
  • Nuclear Cardiology
  • Cardiovascular Imaging

Background:

  • Ischemic cardiomyopathy is often associated with a lack of anginal symptoms.
  • The underlying reasons for this symptom paucity require further investigation.

Purpose of the Study:

  • To determine if reduced anginal symptoms in ischemic cardiomyopathy correlate with less severe stress-induced myocardial ischemia.
  • To compare myocardial ischemia and necrosis extent across different ejection fraction groups.

Main Methods:

  • Stress gated single-photon emission computed tomography (SPECT) was performed on 114 patients with coronary artery disease.
  • Patients were categorized into three groups based on ejection fraction (EF): <=25% (Group 1), 26-45% (Group 2), and >45% (Group 3).
  • Myocardial perfusion was assessed using summed difference score (SDS) for stress-induced ischemia and summed rest score (SRS) for necrosis.

Main Results:

  • Effort angina was significantly less frequent in patients with severe left ventricular dysfunction (Group 1, 29%) compared to those with moderate (Group 2, 50%) and preserved EF (Group 3, 82%).
  • Stress-induced perfusion abnormalities (SDS) were less extensive in Group 1 (mean SDS, 3 +/- 3) than in Group 2 (6 +/- 5) and Group 3 (8 +/- 4).
  • Rest perfusion abnormalities indicating necrosis (SRS) were more extensive in Group 1 (mean SRS, 12 +/- 4) compared to Group 2 (6 +/- 3) and Group 3 (3 +/- 2).

Conclusions:

  • The reduced frequency of anginal symptoms in ischemic cardiomyopathy is attributed to a limited extent of stress-induced myocardial ischemia.
  • A higher degree of myocardial necrosis is observed in patients with ischemic cardiomyopathy and reduced ejection fraction.
Abstract

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