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Early onset of left ventricular regional asynchrony in arteries with sub-clinical stenosis

Andrew Van Tosh1, John R Votaw2, C David Cooke2

  • 1Research Department, St. Francis Hospital, Roslyn NY, 100 Port Washington Blvd., Roslyn, NY, 11576-1348, USA. Andrew.VanTosh@chsli.org.

Journal of Nuclear Cardiology : Official Publication of the American Society of Nuclear Cardiology
|July 25, 2020
PubMed

Insights

Mild left ventricular asynchrony may indicate reduced myocardial flow reserve (MFR) even in normal-appearing arteries. This finding suggests asynchrony is a physiological signal of reduced blood flow in coronary territories without significant blockages.

Area of Science:

  • Cardiovascular Imaging and Nuclear Cardiology
  • Coronary Artery Disease Assessment
  • Myocardial Perfusion and Function Analysis

Background:

  • Left ventricular asynchrony is a known marker of ischemic dysfunction, with severity correlating to coronary artery disease extent.
  • The relationship between mild asynchrony in normal-appearing arterial territories and reduced myocardial blood flow (MBF) or myocardial flow reserve (MFR) requires further investigation.

Purpose of the Study:

  • To determine if normal-appearing arterial territories with mild asynchrony exhibit lower absolute myocardial blood flow (MBF) and/or lower myocardial flow reserve (MFR).
  • To investigate the physiological underpinnings of reduced MFR in the context of coronary artery disease.

Main Methods:

  • Retrospective analysis of 105 patients with known/suspected coronary artery disease (CAD).
  • Utilized rest/regadenoson-stress 82Rb PET/CT and quantitative coronary angiography.
  • Quantified absolute MBF and MFR from 82Rb PET, alongside assessment of summed stress/rest scores, phase bandwidth, and asynchrony visual scores.

Main Results:

  • In arteries appearing normal (SSS < 4, SRS < 4, stenosis < 70%), patients with MFR < 2.0 showed significantly larger phase bandwidth (186° vs 158°, P=.02) and more visual asynchrony (5.7 vs 3.9, P=.02) compared to those with MFR ≥ 2.0.
  • Mild asynchrony was associated with increasing coronary stenosis (ρ=0.44, P<.0001).
  • These findings suggest a link between reduced MFR and subtle electrical/mechanical dyssynchrony.

Conclusions:

  • A subgroup of coronary territories with normal relative perfusion and non-obstructive coronary disease may exhibit reduced MFR.
  • This reduction in MFR is physiologically signaled by mild left ventricular asynchrony.
  • Asynchrony can serve as an early indicator of impaired myocardial blood flow even without significant epicardial coronary disease.
Abstract

Keywords:
PETPhysiology of myocardial/coronary perfusiondyssynchronymicrovascular dysfunctionmyocardial blood flowmyocardial ischemia and infarction

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