Skip to main content
SpringerLink
Log in

Myocardial ischemia in the absence of obstructive coronary lesion: The role of post-stress diastolic dysfunction in detecting early coronary atherosclerosis

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

Abstract

Background

The interactions between non-obstructive coronary atherosclerosis (<50% stenosis) and myocardial perfusion and functional parameters on myocardial perfusion imaging (MPI) have never been evaluated.

Methods and Results

One-hundred and ninety-five patients were submitted to stress-rest MPI and invasive coronary angiography. The presence of obstructive coronary lesions (>50% stenosis) was excluded. The summed stress score (SSS) was calculated in every patient. Moreover, the left ventricular (LV) ejection fraction (EF) and peak filling rate (PFR) were computed from gated MPI images as measures of systolic and diastolic functions. Sixty/195 patients (31%) showed the presence of non-obstructive atherosclerosis (>20% and <50% diameter reduction). Interestingly, they presented a higher SSS than those with normal coronary arteries (P < 0.001) despite a similar myocardial scar burden. If compared to patients with normal coronary arteries, those with non-obstructive atherosclerosis showed more abnormal post-stress PFR values (2.5 ± 0.9 vs 2.9 ± 0.8, P = 0.004), despite a similar EF. On multivariate analysis, the presence non-obstructive atherosclerosis was the only significant predictor (P = 0.026) of post-stress LV diastolic impairment, independently from perfusion parameters.

Conclusions

In patients without anatomically significant coronary lesions, the development of post-stress LV diastolic dysfunction on MPI associates with the presence of non-obstructive atherosclerosis on coronary angiography.

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

Similar content being viewed by others

Abbreviations

CZT:

Cadmium-zinc-telluride

CAD:

Coronary artery disease

IHD:

Ischemic heart disease

SRS:

Summed rest score

SSS:

Summed stress score

PFR:

Peak filling rate

References

  1. Task Force Members. 2013 ESC guidelines on the management of stable coronary artery disease: The Task Force on the management of stable coronary artery disease of the European Society of Cardiology. Eur Heart J 2013;34:2949-3003.

    Article  Google Scholar 

  2. Camici PG, Crea F. Coronary microvascular dysfunction. N Engl J Med 2007;356:830-40.

    Article  CAS  PubMed  Google Scholar 

  3. 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 

  4. Uren NG, Melin JA, De Bruyne B, Wijns W, Baudhuin T, Camici PG. Relation between myocardial blood flow and the severity of coronary-artery stenosis. N Engl J Med 1994;330:1782-8.

    Article  CAS  PubMed  Google Scholar 

  5. Johnson NP, Kirkeeide RL, Gould KL. Is discordance of coronary flow reserve and fractional flow reserve due to methodology or clinically relevant coronary pathophysiology? JACC Cardiovasc Imaging 2012;5:193-202.

    Article  PubMed  Google Scholar 

  6. De Bruyne B, Hersbach F, Pijls NH, Bartunek J, Bech JW, Heyndrickx GR, et al. Abnormal epicardial coronary resistance in patients with diffuse atherosclerosis but “Normal” coronary angiography. Circulation 2001;104:2401-6.

    Article  PubMed  Google Scholar 

  7. Gould KL, Nakagawa Y, Nakagawa K, Sdringola S, Hess MJ, Haynie M, et al. Frequency and clinical implications of fluid dynamically significant diffuse coronary artery disease manifest as graded, longitudinal, base-to-apex myocardial perfusion abnormalities by noninvasive positron emission tomography. Circulation 2000;101:1931-9.

    Article  CAS  PubMed  Google Scholar 

  8. 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 

  9. Hesse B, Tägil K, Cuocolo A, Anagnostopoulos C, Bardiés M, Bax J, et al. EANM/ESC procedural guidelines for myocardial perfusion imaging in nuclear cardiology. Eur J Nucl Med Mol Imaging 2005;32:855-97.

    Article  CAS  PubMed  Google Scholar 

  10. 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 

  11. Gimelli A, Liga R, Pasanisi EM, Giorgetti A, Marras G, Favilli B, et al. Evaluation of left ventricular diastolic function with a dedicated cadmium-zinc-telluride cardiac camera: Comparison with Doppler echocardiography. Eur Heart J Cardiovasc Imaging 2014;15:972-9.

    Article  PubMed  Google Scholar 

  12. Gimelli A, Liga R, Bottai M, Pasanisi EM, Giorgetti A, Fucci S, et al. Diastolic dysfunction assessed by ultra-fast cadmium-zinc-telluride cardiac imaging: Impact on the evaluation of ischaemia. Eur Heart J Cardiovasc Imaging 2015;16:68-73.

    Article  PubMed  Google Scholar 

  13. Detry JMR. The pathophysiology of myocardial ischemia. Eur Heart J 1996;17:48-52.

    Article  PubMed  Google Scholar 

  14. Ishii K, Imai M, Suyama T, Maenaka M, Nagai T, Kawanami M, et al. Exercise-induced postischemic left ventricular delayed relaxation or diastolic stunning: Is it a reliable marker in detect in coronary artery disease? J Am Coll Cardiol 2009;53:698-705.

    Article  PubMed  Google Scholar 

  15. 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 

  16. Herzog BA, Buechel RR, Katz R, Brueckner M, Husmann L, Burger IA, et al. Nuclear myocardial perfusion imaging with a cadmium-zinc-telluride detector technique: Optimized protocol for scan time reduction. J Nucl Med 2010;51:46-51.

    Article  PubMed  Google Scholar 

  17. Gimelli A, Liga R, Coceani M, Quaranta A, Emdin M, Marzullo P. Chronotropic response to vasodilator-stress in patients submitted to myocardial perfusion imaging: Impact on the accuracy in detecting coronary stenosis. Eur J Nucl Med Mol Imaging 2015;42:1903-11.

    Article  PubMed  Google Scholar 

  18. Gimelli A, Liga R, Pasanisi EM, Casagranda M, Coceani M, Marzullo P. Influence of cardiac stress protocol on myocardial perfusion imaging accuracy: The role of exercise level on the evaluation of ischemic burden. J Nucl Cardiol 2015. doi:10.1007/s12350-015-0101-z.

    Google Scholar 

  19. Gimelli A, Liga R, Giorgetti A, Kusch A, Pasanisi EM, Marzullo P. Relationships between myocardial perfusion abnormalities and poststress left ventricular functional impairment on cadmium-zinc-telluride imaging. Eur J Nucl Med Mol Imaging 2015;42:94-1003.

    Google Scholar 

  20. Sicari R, Nihoyannopoulos P, Evangelista A, Kasprzak J, Lancellotti P, Poldermans D, et al. Stress echocardiography expert consensus statement: European Association of Echocardiography (EAE) (a registered branch of the ESC). Eur J Echocardiogr 2008;9:415-37.

    Article  PubMed  Google Scholar 

  21. Abidov A, Bax JJ, Hayes SW, Cohen I, Nishina H, Yoda S, et al. Integration of automatically measured transient ischemic dilation ratio into interpretation of adenosine stress myocardial perfusion SPECT for detection of severe and extensive CAD. J Nucl Med 2004;45:1999-2007.

    CAS  PubMed  Google Scholar 

  22. Cannon RO 3rd, Rosing DR, Maron BJ, Leon MB, Bonow RO, Watson RM, et al. Myocardial ischemia in patients with hypertrophic cardiomyopathy: Contribution of inadequate vasodilator reserve and elevated left ventricular fulling pressures. Circulation 1985;71:234-43.

    Article  PubMed  Google Scholar 

  23. Takx RA, Blomberg BA, El Aidi H, Habets J, de Jong PA, Nagel E, et al. Diagnostic accuracy of stress myocardial perfusion imaging compared to invasive coronary angiography with fractional flow reserve meta-analysis. Circ Cardiovasc Imaging 2015;8:e002666. doi:10.1161/CIRCIMAGING.114.002666.

    Article  PubMed  Google Scholar 

  24. Neglia D, Rovai D, Caselli C, Pietila M, Teresinska A, Aguadé-Bruix S, et al. Detection of significant coronary artery disease by noninvasive anatomical and functional imaging. Circ Cardiovasc Imaging 2015;8:e002179. doi:10.1161/CIRCIMAGING.114.002179.

    Article  PubMed  Google Scholar 

  25. Genovesi D, Giorgetti A, Gimelli A, Kusch A, D’Aragona Tagliavia I, Casagranda M, et al. Impact of attenuation correction and gated acquisition in SPECT myocardial perfusion imaging: Results of the multicentre SPAG (SPECT Attenuation Correction vs Gated) study. Eur J Nucl Med Mol Imaging 2011;38:1890-8.

    Article  CAS  PubMed  Google Scholar 

Download references

Disclosure

Alessia Gimelli, Riccardo Liga, Emilio Maria Pasanisi, Mirta Casagranda, and Paolo Marzullo have no conflict of interest or relationship with industries to disclose.

Author information

Authors and Affiliations

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

    Alessia Gimelli MD, Emilio Maria Pasanisi MD, Mirta Casagranda RT & Paolo Marzullo MD

  2. Cardio-thoracic and Vascular Department, University Hospital of Pisa, Pisa, Italy

    Riccardo Liga MD

  3. Institute of Clinical Physiology, CNR, 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. Emilio Maria Pasanisi 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 Riccardo Liga MD.

Additional information

See related editorial, doi:10.1007/s12350-016-0486-3.

Alessia Gimelli and Riccardo Liga share the first co-authorship.

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., Pasanisi, E.M. et al. Myocardial ischemia in the absence of obstructive coronary lesion: The role of post-stress diastolic dysfunction in detecting early coronary atherosclerosis. J. Nucl. Cardiol. 24, 1542–1550 (2017). https://doi.org/10.1007/s12350-016-0456-9

Download citation

  • Received:

  • Revised:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12350-016-0456-9

Keywords

Search

Navigation