Determinants of left ventricular mechanical dyssynchrony in patients submitted to myocardial perfusion imaging: A
Alessia Gimelli1, Riccardo Liga2, Assuero Giorgetti1
1Fondazione Toscana G. Monasterio, Via Moruzzi 1, 56124, Pisa, Italy.
Insights
Left ventricular dyssynchrony (LVD) is common in patients with coronary artery disease (CAD). LVD correlates with impaired myocardial perfusion and increased LV end-systolic volume, independent of CAD burden.
Area of Science:
- Cardiology
- Nuclear Cardiology
- Cardiac Imaging
Background:
- Mechanical left ventricular dyssynchrony (LVD) is associated with coronary artery disease (CAD).
- The interplay between coronary anatomy, myocardial perfusion, and left ventricular (LV) function in LVD development is not fully understood.
- Cadmium-zinc-telluride camera imaging can assess these parameters.
Purpose of the Study:
- To investigate the correlates of LVD in a large cohort of patients with suspected or known CAD.
- To determine the independent predictors of LVD in this population.
Main Methods:
- Retrospective analysis of 657 patients undergoing myocardial perfusion imaging (MPI) and coronary angiography.
- Significant CAD defined as stenosis >70%.
- LVD assessed using phase standard deviation and histogram bandwidth from MPI data.
Main Results:
- 63% of patients had significant CAD; 38% exhibited LVD.
- LVD was associated with higher CAD burden, impaired LV perfusion and contractile function, and larger LV volumes.
- LV end-systolic volume index and ischemic burden were the strongest independent predictors of LVD.
Conclusions:
- LVD is prevalent in patients undergoing MPI for CAD.
- LVD is independently predicted by LV end-systolic volume and ischemic burden.
- Myocardial perfusion abnormalities are key determinants of LVD in CAD patients.
Background:
An interaction between coronary anatomy, myocardial perfusion, and left ventricular (LV) functional parameters in the development of mechanical LV dyssynchrony (LVD) has been suggested. This study examined the correlates of LVD in a large sample size of patients with known or suspected coronary artery disease (CAD) using cadmium-zinc-telluride camera.
Methods:
Six-hundred and fifty-seven consecutive patients who underwent myocardial perfusion imaging (MPI) and coronary angiography were included. Coronary stenosis >70% was considered significant. LV perfusion and functional parameters were computed from MPI images. The presence of significant LVD was evaluated by phase standard deviation and histogram bandwidth.
Results:
415/657 (63%) patients had significant CAD. LVD was present in 247 (38%) patients and was associated with the presence of a higher CAD burden (P < .001), more impaired measures of LV perfusion (P < .001), contractile function (P < .001), and larger LV volumes (P < .001). By multivariate analysis, the LV end-systolic volume index (P < .001) and ischemic burden (P < .001) were the strongest predictors of LVD independent of CAD extent and LV systolic dysfunction.
Conclusions:
LVD is frequent in patients undergoing MPI for suspected or known CAD. Its presence is independent of CAD burden and LV systolic dysfunction, but is dependent on the presence of myocardial perfusion abnormalities and LV end-systolic volume.
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