Skip to main content
SpringerLink
Log in

Relationship between myocardial perfusion abnormalities and contractile impairment in anginal patients

  • Original Article
  • Published:
Journal of Nuclear Cardiology Aims and scope

Abstract

Background

A relationship between left ventricular (LV) contractile impairment and myocardial perfusion abnormalities has been suggested.

Methods and Results

Three-hundred and thirty-seven patients underwent myocardial perfusion imaging at CZT and coronary angiography. On scintigraphic images, the summed difference score (SDS) and LV-ejection fraction (EF) were computed. Patients were categorized as follows: Group-1 (LV-EF < 40%; 71 patients), Group-2 (LV-EF ≥ 40% and < 55%; 77 patients), and Group-3 (LV-EF ≥ 55%; 189 patients). Significant coronary artery disease (CAD; ≥50% stenosis) was recognized in 159/337 (47%) patients. Interestingly, while in Group-3 subjects an inverse relationship between SDS values and post-stress LV-EF was evident (P < .001), Group-1 patients presented a significant association between an increased SDS and more elevated post-stress LV-EF values (P = .009). Similarly, despite in the overall population an increasing severity of CAD was associated with higher SDS values (P < .001), this relationship disappeared in Group-1 patients (P = .298). At multiple regression analysis, after correction for CAD, LV dysfunction was negatively associated with an elevated SDS (P = .018). Conversely in patients with normal LV function and no history of myocardial infarction, CAD extent, and functional measures of stress-induced myocardial ischemia were strictly correlated.

Conclusions

Independently from CAD, a significantly impaired LV function associates with a lower prevalence of reversible ischemia.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Figure 1
Figure 2
Figure 3
Figure 4
Figure 5

Similar content being viewed by others

References

  1. Parker MW, Iskandar A, Limone B, Perugini A, Kim H, Jones C, et al. Diagnostic accuracy of cardiac positron emission tomography versus single photon emission computed tomography for coronary artery disease: A bivariate meta-analysis. Circ Cardiovasc Imaging 2012;5:700-7.

    Article  PubMed  Google Scholar 

  2. Giorgetti A, Masci PG, Marras G, Rustamova YK, Gimelli A, Genovesi D, et al. Gated SPECT evaluation of left ventricular function using a CZT camera and a fast low-dose clinical protocol: Comparison to cardiac magnetic resonance imaging. Eur J Nucl Med Mol Imaging 2013;40:1869-75.

    Article  PubMed  Google Scholar 

  3. Hachamovitch R, Rozanski A, Shaw LJ, Stone GW, Thomson LE, Friedman JD, et al. Impact of ischaemia and scar on the therapeutic benefit derived from myocardial revascularization vs. medical therapy among patients undergoing stress-rest myocardial perfusion scintigraphy. Eur Heart J 2011;32:1012-24.

    Article  PubMed  Google Scholar 

  4. Liga R, Marini C, Coceani M, Filidei E, Schlueter M, Bianchi M, et al. Structural abnormalities of the coronary arterial wall—In addition to luminal narrowing—Affect myocardial blood flow reserve. J Nucl Med 2011;52:1704-12.

    Article  PubMed  Google Scholar 

  5. Gimelli A, Marzullo P, Landi P, L’Abbate A, Bottai M, Rovai D. Paucity of anginal symptoms and stress-induced perfusion abnormalities in ischemic cardiomyopathy. J Nucl Cardiol 2008;15:680-6.

    Article  PubMed  Google Scholar 

  6. Ling LF, Marwick TH, Flores DR, Jaber WA, Brunken RC, Cerqueira MD, et al. Identification of therapeutic benefit from revascularization in patients with left ventricular systolic dysfunction: Inducible ischemia versus hibernating myocardium. Circ Cardiovasc Imaging 2013;6:363-72.

    Article  PubMed  Google Scholar 

  7. Gimelli A, Bottai M, Genovesi D, Giorgetti A, Di Martino F, Marzullo P. High diagnostic accuracy of low-dose gated-SPECT with solid-state ultrafast detectors: Preliminary clinical results. Eur J Nucl Med Mol Imaging 2012;39:83-90.

    Article  CAS  PubMed  Google Scholar 

  8. Gimelli A, Bottai M, Giorgetti A, Genovesi D, Kusch A, Ripoli A, et al. Comparison between ultrafast and standard single-photon emission ct in patients with coronary artery disease: A pilot study. Circ Cardiovasc Imaging 2011;4:51-8.

    Article  PubMed  Google Scholar 

  9. van Velzen JE, Schuijf JD, Schuijf JD, van Werkhoven JM, Herzog BA, Pazhenkottil AP, Boersma E, et al. Predictive value of multislice computed tomography variables of atherosclerosis for ischemia on stress-rest single-photon emission computed tomography. Circ Cardiovasc Imaging 2010;3:718-26.

    Article  PubMed  Google Scholar 

  10. Curtis JP, Sokol SI, Wang Y, Rathore SS, Ko DT, Jadbabaie F, et al. The association of left ventricular ejection fraction, mortality, and cause of death in stable outpatients with heart failure. J Am Coll Cardiol 2003;42:736-42.

    Article  PubMed  Google Scholar 

  11. McMurray JJ, Ostergren J, Swedberg K, Granger CB, Held P, Michelson EL, et al. Effects of candesartan in patients with chronic heart failure and reduced left-ventricular systolic function taking angiotensin-converting-enzyme inhibitors: The CHARM-added trial. Lancet 2003;362:767-71.

    Article  CAS  PubMed  Google Scholar 

  12. Hida S, Chikamori T, Tanaka H, Usui Y, Igarashi Y, Nagao T, et al. Diagnostic value of left ventricular function after stress and at rest in the detection of multivessel coronary artery disease as assessed by electrocardiogram-gated SPECT. J Nucl Cardiol 2007;14:68-74.

    Article  PubMed  Google Scholar 

  13. Panza JA, Holly TA, Asch FM, She L, Pellikka PA, Velazquez EJ, et al. Inducible myocardial ischemia and outcomes in patients with coronary artery disease and left ventricular dysfunction. J Am Coll Cardiol 2013;61:1860-70.

    Article  PubMed Central  PubMed  Google Scholar 

  14. Shaw LJ, Iskandrian AE. Prognostic value of gated myocardial perfusion SPECT. J Nucl Cardiol 2004;11:171-85.

    Article  PubMed  Google Scholar 

  15. Jameel MN, Li Q, Mansoor A, Xiong Q, Swingen C, Zhang J. Long-term preservation of myocardial energetic in chronic hibernating myocardium. Am J Physiol Heart Circ Physiol 2011;300:H836-44.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  16. Imbert L, Poussier S, Franken PR, Songy B, Verger A, Morel O, et al. Compared performance of high-sensitivity cameras dedicated to myocardial perfusion SPECT: A comprehensive analysis of phantom and human images. J Nucl Med 2012;53:1897-903.

    Article  PubMed  Google Scholar 

  17. Sun Z, Ng KH. Diagnostic value of coronary CT angiography with prospective ECG-gating in the diagnosis of coronary artery disease: A systematic review and meta-analysis. Int J Cardiovasc Imaging 2012;28:2109-19.

    Article  PubMed  Google Scholar 

Download references

Disclosures

Alessia Gimelli, Riccardo Liga, Assuero Giorgetti, Mirta Casagranda, and Paolo Marzullo declare no relationship with industry or conflict of interest.

Author information

Authors and Affiliations

  1. Fondazione Toscana Gabriele Monasterio, Via Moruzzi, 1, 56124, Pisa, Italy

    Alessia Gimelli MD, Assuero Giorgetti MD, Mirta Casagranda RT & Paolo Marzullo MD

  2. University Hospital of Pisa, Pisa, Italy

    Riccardo Liga MD

  3. CNR, Institute of Clinical Physiology, Pisa, Italy

    Paolo Marzullo MD

Authors
  1. Alessia Gimelli MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Riccardo Liga MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Assuero Giorgetti MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Mirta Casagranda RT
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Paolo Marzullo MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Alessia Gimelli MD.

Additional information

Alessia Gimelli and Riccardo Liga have contributed equally to this study.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Gimelli, A., Liga, R., Giorgetti, A. et al. Relationship between myocardial perfusion abnormalities and contractile impairment in anginal patients. J. Nucl. Cardiol. 21, 1181–1190 (2014). https://doi.org/10.1007/s12350-014-9950-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12350-014-9950-0

Keywords

Search

Navigation