Institute of Cardiology and Cardiovascular Surgery, Havana, Cuba.
Nuclear Medicine Department, Institute of Cardiology, 17 No. 702, Vedado, CP 10 400, Havana, Cuba.
J Nucl Cardiol. 2021 Jun;28(3):1055-1063. doi: 10.1007/s12350-019-01804-x. Epub 2019 Jul 2.
To detect ischemia in patients with angina and normal coronaries frequently represents a complex diagnosis.
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.
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.
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.
频繁检测心绞痛和正常冠状动脉患者的缺血情况是一个复杂的诊断。
为了研究相位分析左心室机械不同步是否有助于评估胸痛和正常冠状动脉患者，对 218 例心外膜冠状动脉正常的患者进行静息和应激后 30 分钟门控 SPECT 心肌灌注成像（MPI），这些患者分为两组：和总差评分（SDS）≥4（54 例，组 1），和 SDS＜4（164 例，组 2）。通过相位分析评估室间同步相位标准差（PSD）和直方图带宽（HBW）。
组 2（SPECT MPI 无缺血患者）中女性明显多于组 1（54 例中 113 例，占 69%）比 25 例（46%），P=0.00001。在男性中，缺血患者和非缺血患者的左心室射血分数（LVEF）和心室容积无显著差异。然而，缺血女性的心室容积明显较高，应激后 LVEF 较小，负的 delta LVEF 更明显（-3.9 比 0.34，P=0.0008）。男性 PSD 和 HBW 在应激后明显增加，而女性则不然。根据 SSS（≥4，有缺血/坏死；＜4，无缺血/坏死），应激后 PSD 和 HBW 在男性和女性中均显著增加，且 SSS≥4 的女性 PSD 和 HBW 明显高于 SSS＜4 的女性（PSD 静息：19.04°比 11.72°，P＜0.0001；HBW 静息：58.85°比 38.21°，P＜0.0001）。在 SSS≥4 的男性中，PSD 和 HBW 也高于 SSS＜4 的男性，但无统计学意义。
在胸痛和正常冠状动脉患者的 MPI 中，女性较高的心室容积和不同步与可诱导缺血有关。应激诱导的缺血增加了不同步的程度。
