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Left ventricular dyssynchrony in patients with moderate coronary stenosis and border line fractional flow reserve

Yohei Shibata1, Takahito Sone2, Hideyuki Tsuboi2

  • 1Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan ; Division of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan.

Nagoya Journal of Medical Science
|March 24, 2015
PubMed

Insights

Left ventricular (LV) dyssynchrony may occur in patients with coronary artery disease and borderline fractional flow reserve (FFR) after stress, even without reduced perfusion. This finding highlights potential functional changes in moderate coronary stenosis.

Area of Science:

  • Cardiology
  • Nuclear Medicine
  • Medical Imaging

Background:

  • Fractional flow reserve (FFR) cutoff values for myocardial ischemia detection remain debated.
  • Left ventricular (LV) dyssynchrony has been observed in coronary artery disease (CAD) patients.

Purpose of the Study:

  • To investigate LV dyssynchrony in patients with moderate coronary stenosis and borderline FFR.
  • Utilize stress electrocardiographically-gated myocardial perfusion single-photon emission computed tomography (SPECT) for assessment.

Main Methods:

  • 10 patients with moderate (50-75% diameter) stenosis and FFR 0.75-0.90 were compared to 10 controls.
  • Stress myocardial SPECT using (99m)Tc-sestamibi or tetrofosmin was performed.
  • Gated SPECT (pFAST) and cardioGRAF assessed regional time to end systole (TES), time to peak ejection (TPE), and time to peak filling (TPF), calculating the dyssynchrony index (DI).

Main Results:

  • The DI of post-stress TES was significantly higher in patients with moderate CAD compared to rest (4.8 ± 2.8 vs. 2.7 ± 1.5, P = 0.01).
  • No significant differences in DI were found in control subjects (3.0 ± 1.7 vs. 2.9 ± 1.9, P = 0.99).
  • No significant differences in TPE and TPF were observed between groups.

Conclusions:

  • LV dyssynchrony can occur post-stress in patients with coronary stenosis and borderline FFR.
  • This dyssynchrony may be present even without significant perfusion reduction.
  • Findings suggest functional impairment beyond perfusion deficits in moderate CAD.

Keywords:
fractional flow reserveleft ventricular dyssynchronystress electrocardiographically-gated myocardial perfusion single-photon emission computed tomography

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