Objectives: Transient left ventricular (LV) dilation is a well-known marker for coronary artery disease (CAD). However only limited data correlating severity and behavior over time of post-ischemic stunning with CAD extension are available. So the purpose of this study was to assess if there is a relationship among the duration of left ventricular contractile dysfunction induced by physical effort, the extent of reversible defects and the number of coronary vessels involved in the atherosclerotic process. Methods: The study population consisted of 298 patients (124 women and 174 men, mean age 64±9 years) showing at least one reversible defect (Summed Difference Score SDS>3) during a separate day rest/stress Tc-99m sestamibi gated-SPECT myocardial scintigraphy, clinically indicated for suspected CAD. All subjects underwent physical exercise and stress images were acquired 15 minutes after tracer injection. In patients with a reduction of left ventricular ejection fraction (LVEF) more than 5% in comparison with rest data a second gated-SPECT acquisition was performed at 60 minutes. All patients underwent coronary angiography within 3 months of gated SPECT studies. Results: On the basis of scintigraphic results, subjects were divided as follows: group A (137) “no evidence of LVEF decrease after stress or less than 5%”; group B (103) “decrease of LVEF >5% only in early stress acquisition”; group C (58) “evidence of decrease of LVEF >5% both in early and late post-stress studies”. The comparison between coronary anatomy findings and gated-SPECT data showed that 74% of subjects with not significant or single vessel CAD were in group A, 71% with two vessels disease belonged to group B and 72% with left-main or three vessels involvement were included in group C. In particular only 6% of group A patients had multivessel disease. Moreover SDS were significantly higher (P<.0001) in both group B (7.3±6.2) and C (9.8±7.3) patients in comparison to group A (3.5±3.9). Finally the multivariate analysis revealed that the combination of SDS, long-lasting post-stress left ventricular dysfunction, and diabetes mellitus best identified multivessel CAD, with a sensitivity of 82% and a specificity of 86% (χ2, 83.5). Conclusions: The results of this preliminary study support the hypothesis that sustained LV functional abnormalities after exercise stress as assessed by gated- SPECT may significantly contribute to the detection of multivessel disease, a high-risk subset of CAD. Larger prospective trials are needed to confirm these findings and to assess their potential impact on clinical practice.

Role of duration of post-stress left ventricular dysfunction in the identification of multivassel coronary artery disease: a Tc-99m sestamibi gated-SPECT study

C. Cittanti
Primo
;
G. Guardigli;S. Panareo;
2016

Abstract

Objectives: Transient left ventricular (LV) dilation is a well-known marker for coronary artery disease (CAD). However only limited data correlating severity and behavior over time of post-ischemic stunning with CAD extension are available. So the purpose of this study was to assess if there is a relationship among the duration of left ventricular contractile dysfunction induced by physical effort, the extent of reversible defects and the number of coronary vessels involved in the atherosclerotic process. Methods: The study population consisted of 298 patients (124 women and 174 men, mean age 64±9 years) showing at least one reversible defect (Summed Difference Score SDS>3) during a separate day rest/stress Tc-99m sestamibi gated-SPECT myocardial scintigraphy, clinically indicated for suspected CAD. All subjects underwent physical exercise and stress images were acquired 15 minutes after tracer injection. In patients with a reduction of left ventricular ejection fraction (LVEF) more than 5% in comparison with rest data a second gated-SPECT acquisition was performed at 60 minutes. All patients underwent coronary angiography within 3 months of gated SPECT studies. Results: On the basis of scintigraphic results, subjects were divided as follows: group A (137) “no evidence of LVEF decrease after stress or less than 5%”; group B (103) “decrease of LVEF >5% only in early stress acquisition”; group C (58) “evidence of decrease of LVEF >5% both in early and late post-stress studies”. The comparison between coronary anatomy findings and gated-SPECT data showed that 74% of subjects with not significant or single vessel CAD were in group A, 71% with two vessels disease belonged to group B and 72% with left-main or three vessels involvement were included in group C. In particular only 6% of group A patients had multivessel disease. Moreover SDS were significantly higher (P<.0001) in both group B (7.3±6.2) and C (9.8±7.3) patients in comparison to group A (3.5±3.9). Finally the multivariate analysis revealed that the combination of SDS, long-lasting post-stress left ventricular dysfunction, and diabetes mellitus best identified multivessel CAD, with a sensitivity of 82% and a specificity of 86% (χ2, 83.5). Conclusions: The results of this preliminary study support the hypothesis that sustained LV functional abnormalities after exercise stress as assessed by gated- SPECT may significantly contribute to the detection of multivessel disease, a high-risk subset of CAD. Larger prospective trials are needed to confirm these findings and to assess their potential impact on clinical practice.
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11392/2382554
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