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Left ventricular mechanical dyssynchrony in patients with chest pain and normal epicardial coronary arteries

  • ORIGINAL ARTICLE
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Journal of Nuclear Cardiology Aims and scope

Abstract

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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Abbreviations

CAD:

Coronary artery disease

ESV:

End-systolic volume

EDV:

End-diastolic volume

HBW:

Histogram bandwidth

LVEF:

Left ventricular ejection fraction

MPI:

Myocardial perfusion imaging

PSD:

Phase standard deviation

SDS:

Summed difference score

SRS:

Summed rest score

SSS:

Summed stress score

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Acknowledgements

We are grateful to Adrienne Hunter, Ph.D., for her dedication in reviewing the manuscript.

Disclosure

There are no conflicts of interest to disclose.

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Authors and Affiliations

  1. Institute of Cardiology and Cardiovascular Surgery, Havana, Cuba

    Amalia Peix MD, PhD, Kenia Padrón MD, Lázaro O. Cabrera MD & Leticia Pardo MD

  2. Institute of Cybernetics, Mathematics and Physics, Havana, Cuba

    Jesús Sánchez PhD

  3. Nuclear Medicine Department, Institute of Cardiology, 17 No. 702, Vedado, CP 10 400, Havana, Cuba

    Amalia Peix MD, PhD, Kenia Padrón MD, Lázaro O. Cabrera MD & Leticia Pardo MD

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  1. Amalia Peix MD, PhD
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  2. Kenia Padrón MD
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  3. Lázaro O. Cabrera MD
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Correspondence to Amalia Peix MD, PhD.

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Peix, A., Padrón, K., Cabrera, L.O. et al. Left ventricular mechanical dyssynchrony in patients with chest pain and normal epicardial coronary arteries. J. Nucl. Cardiol. 28, 1055–1063 (2021). https://doi.org/10.1007/s12350-019-01804-x

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