Left ventricular mechanical dyssynchrony in patients with chest pain and normal epicardial coronary arteries
Amalia Peix1,2, Kenia Padrón3,4, Lázaro O Cabrera3,4
1Institute of Cardiology and Cardiovascular Surgery, Havana, Cuba. peix@infomed.sld.cu.
Insights
Detecting ischemia in patients with normal coronaries is challenging. Left ventricular dyssynchrony, assessed by phase analysis, aids in diagnosing inducible ischemia, particularly in females, and is exacerbated by stress.
Area of Science:
- Cardiology
- Nuclear Cardiology
- Diagnostic Imaging
Background:
- Diagnosing ischemia in patients with angina and normal coronary arteries presents a clinical challenge.
- Assessing left ventricular mechanical dyssynchrony may aid in evaluating these complex cases.
Purpose of the Study:
- To investigate the role of left ventricular mechanical dyssynchrony, evaluated by phase analysis, in diagnosing inducible ischemia.
- To determine if phase analysis parameters contribute to the evaluation of patients with chest pain and normal coronary arteries.
Main Methods:
- Gated-SPECT myocardial perfusion imaging (MPI) was performed at rest and post-stress in 218 patients with normal epicardial coronaries.
- Patients were categorized based on summed difference score (SDS): ≥4 (ischemia) and <4 (no ischemia).
- Intraventricular synchronism, including phase standard deviation (PSD) and histogram bandwidth (HBW), was assessed using phase analysis.
Main Results:
- Women were more prevalent in the non-ischemic group (SDS <4).
- Ischemic females exhibited higher ventricular volumes and reduced post-stress left ventricular ejection fraction (LVEF) compared to non-ischemic females.
- Post-stress PSD and HBW significantly increased in both males and females with ischemia (SDS ≥4), with higher values observed in females with ischemia.
Conclusions:
- Increased ventricular volumes in females and evidence of left ventricular dyssynchrony are associated with inducible ischemia in patients presenting with chest pain and normal coronaries.
- Stress-induced ischemia demonstrably increases the degree of left ventricular dyssynchrony.
Background:
To detect ischemia in patients with angina and normal coronaries frequently represents a complex diagnosis.
Methods:
To investigate whether left ventricular mechanical dyssynchrony by phase analysis contributes in the evaluation of patients with chest pain and normal coronaries, gated-SPECT myocardial perfusion imaging (MPI) at rest and 30 minutes post-stress was performed in 218 patients with normal epicardial coronaries, who were divided into two groups: those with summed difference score (SDS) ≥ 4 (54 patients, Group 1), and those with SDS < 4 (164 patients, Group 2). Intraventricular synchronism-phase standard deviation (PSD) and histogram bandwidth (HBW)-was evaluated by phase analysis.
Results:
Women were significantly more frequent in Group 2 (those without ischemia in SPECT MPI): 113 (69%) vs 25 (46%), P = .00001. In males, left ventricular ejection fraction (LVEF) and ventricular volumes were not significantly different between patients with or without ischemia. However, ischemic females showed significantly higher ventricular volumes, minor post-stress LVEF and more negative delta LVEF (- 3.9 vs 0.34, P = .0008) than the non-ischemic ones. There was a significant post-stress increase of PSD and HBW among males, although not among females. According to SSS (≥ 4, with ischemia/necrosis; < 4, without ischemia/necrosis), post-stress PSD and HBW significantly increase both in male and female, and PSD and HBW were significantly higher in females with SSS ≥ 4 compared to those with SSS < 4 (PSD rest: 19.04° vs 11.72°, P < .0001; HBW rest: 58.85° vs 38.21°, P < .0001). PSD and HBW were also higher among males with SSS ≥ 4 compared to those with SSS < 4, although not significantly.
Conclusion:
Higher ventricular volumes in females and dyssynchrony are associated with inducible ischemia in MPI in patients with chest pain and normal coronaries. Stress-induced ischemia increases degree of dyssynchrony.
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