1. * Shared first co-authors
Journal of Nuclear Cardiology | Official Journal of the American Society of Nuclear Cardiology
Stress-induced alteration of left ventricular eccentricity: an additional marker of multivessel CAD
Alessia Gimelli, MD*1, Riccardo Liga, MD*2, Assuero Giorgetti, MD1, Mirta Casagranda, RT1, Paolo Marzullo, MD1, 3
1Fondazione Toscana G. Monasterio, Pisa; 2Cardio-Thoracic and Vascular department, University Hospital of Pisa; 3CNR, Institute of Clinical Physiology, Pisa
* Shared first co-authors
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2. Journal of Nuclear Cardiology | Official Journal of the American Society of Nuclear Cardiology
BACKGROUND
1- In patients with multivessel coronary artery disease (CAD), the accuracy of myocardial perfusion imaging (MPI) can be diminished
2- Apart from perfusion and functional data, MPI on SPECT may also give information on LV three-dimensional structure, by the quantification of the LV eccentricity index (EI)
3- A lower EI, representing a more spherical left ventricle (LV), has been associated with the presence of CAD, ultimately predicting adverse patients prognosis
4- The possible clinical impact of abnormal values of LV EI in patients with preserved LV systolic function has not been yet evaluated
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3. METHODS Study type: Retrospective
Journal of Nuclear Cardiology | Official Journal of the American Society of Nuclear Cardiology
METHODS
Study type: Retrospective
Study subjects: 343 consecutive patients with chest pain and normal LV systolic function [ejection fraction (EF) >50%] that underwent MPI followed by coronary angiography within 3 months
Study endpoints:
Primary end point: the possible clinical value of the assessment of LV EI in patients with preserved LV systolic function submitted to MPI, and its ability in unmasking the presence of multivessel CAD
Secondary end point: the interaction between stress-protocol (exercise vs vasodilator) and stress-induced LV functional impairment
Study variables: eccentricity index; ejection fraction; multivessel CAD; summed difference score
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4. Journal of Nuclear Cardiology | Official Journal of the American Society of Nuclear Cardiology
RESULTS 50 55 60 65 70
No CAD
Single-vessel CAD
Multivessel CAD
LV Ejection Fraction after Stress (%)
Exercise stress-test
LV Eccentricity Index after Stress
Vasodilator stress-test A B
,75 ,8
,85 ,9
,95
P = 0.005
P < 0.001
P < 0.026
P = 0.461
P = 0.152
Relationships between CAD burden and (A) functional (EF) and (B) structural (EI) signs of stress-induced LV impairment on either exercise (left) or vasodilator (right) stress-test.
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5. Suppl. Table 1 Predictors of Multivessel CAD in patients submitted to exercise-stress CZT
Journal of Nuclear Cardiology | Official Journal of the American Society of Nuclear Cardiology
RESULTS
Predictors of Multivessel CAD in patients submitted to exercise-stress CZT
Variables
Univariate OR (95% CI) P
Multivariate OR (95% CI)
Clinical data
Age, years
1.02 ( )
0.158 NA
Male sex, 1-0
1.06 ( )
0.874
Diabetes mellitus, 1-0
2.59 ( )
0.002
2.08 ( )
0.013
Hypercholesterolemia, 1-0
1.54 ( )
0.140
Hypertension, 1-0
1.53 ( )
0.162
Smoking, 1-0
1.72 ( )
0.226
LV structure and function at rest
Stress end-diastolic volume, %
1.01 ( )
0.370
Stress ejection fraction, %
0.99 ( )
0.425
Eccentricity index (per 0.01 increase)
0.91 ( )
0.012 NS
LV structure and function after stress
1.01 ( )
0.098
0.97 ( )
0.019
0.89 ( )
0.93 ( )
0.039
Perfusion data
Mild ischemia (3<SDS≤7)
4.82 ( )
<0.001
4.87 ( )
Significant ischemia (SDS>7)
15.71 ( )
12.92 ( )
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6. Journal of Nuclear Cardiology | Official Journal of the American Society of Nuclear Cardiology
CONCLUSIONS
1- In patients with preserved LV systolic function, the presence of multivessel CAD associates with significantly more impaired values of post-stress LV eccentricity as a measure of stress-induced transient LV remodeling
2- Interestingly, alterations of post-stress LV EI were limited to patients undergoing exercise stress-test, while disappeared in those submitted to vasodilator stress
3- Only a marginal fraction of the variability of post-stress LV EI could be explained by alterations of either EF or end-diastolic volume, confirming the possible value of this novel parameter of adverse remodelling
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