Perfusion and diastolic function assessment in patients with microvascular angina according to the single-photon emission computed tomography

Objective. To study the correlation between quantitative perfusion parameters and the diastolic function in patients with microvascular angina according to the single-photon emission computed tomography with 99mTc. Material and methods. The study included 17 patients, each of whom underwent selective coronary angiography (CAG) and ECG-synchronized C-SPECT/CT of myocardium with 99mTc-technetril at rest and in combination with exercise testing on bicycle ergometer (ergonometer Anaerobic Test). Verification of ischemia was performed using C-SPECT/CT with 99mTc-technetril at rest (r) and with ergonometer Anaerobic Test (s) according to a 2-day protocol. Quantitative perfusion indices (QPI) and DF were assessed by 17 segmental LV model: rExtent/sExtent, area of perfusion impairment (PI); SRS, SSS, severity of NP; rTPD/sTPD, total perfusion deficit; SDS, stress-induced (reversible) ischemia index; iTPD, ischemic perfusion deficit; PFR, peak LV volume filling rate; MFR/3, avg. LV filling rate in the first/3 of diastole; TTPF, time from the beginning of diastole to the peak LV filling level; PFR2, peak LV filling volume rate during the 2nd peak. Results. The present study revealed a diastolic dysfunction in patients with microvascular angina and increased diastolic filling disturbances during myocardial ischemia with exercise. When comparing the perfusion and diastolic function, a direct link between the prevalence and the intensity of perfusion dysfunction at rest and stress-induced ischemia and temporary parameters and inverse correlation - with speed parameters of diastole was revealed. Conclusion. Patients with microvascular angina show signs of left ventricular dysfunction. The conducted correlational analysis revealed the existence of interconnection between perfusion and diastolic function.

1. Cannon R.O. Microvascular angina and the continuing dilemma of chest pain with normal coronary angiograms. J Am Coll Cardiol. 2009;54:877-885. DOI: 10.1016/j.jacc.2009.03.080.

2. Camici P.G., Crea F. Coronary microvascular dysfunction. N Engl J Med. 2007;356:830-840. DOI: 10.1056/NEJMra061889.

3. Maseri A., Crea F., Kaski J.C., Crake T. Mechanisms of angina pectoris in syndrome X. J Am Coll Cardiol. 1991;17:499-506. DOI: 10.1016/s0735-1097(10)80122-6.

4. Djaïleb L., Riou L., Piliero N., Carabelli A., Vautrin E., Broisat A., Leenhardt J., Machecourt J. et al. SPECT myocardial ischemia in the absence of obstructive CAD: Contribution of the invasive assessment of microvascular dysfunction. J Nucl Cardiol. 2018;25(3):1017-1022. DOI: 10.1007/s12350-017- 1135-1.

5. Jones E., Eteiba W., Merz N.B. Cardiac syndrome X and microvascular coronary dysfunction. Trends Cardiovasc Med. 2012;22(6):161-168. DOI: 10.1016/j.tcm.2012.07.014.

6. Alekseeva O.P., Dolbin I.V., Fedorenko A.A. Cardiac syndrome X (features of pathogenesis and treatment). Nizhniy Novgorod: Nizhny Novgorod State Medical Academy, 2007. 120 p. (in Russ.)

7. Chen G., Redberg R.F. Noninvasive diagnostic testing of coronary artery disease in women. Cardiol Rev. 2000;8(6):354-360. DOI: 10.1097/00045415-200008060-00009.

8. Gould K.L., Johnson N.P. Coronary physiology beyond coronary flow reserve in microvascular angina. J Am Coll Cardiol. 2018;72(21):2642-2662. DOI: 10.1016/j.jacc.2018.07.106.

9. Karpova I.E., Soboleva G.N., Samoylenko L.E., Karpov Yu.A. Modern methods of diagnosis of myocardial ischemia in patients with cardiac syndrome X.Russian cardiology bulletin. 2013;(2): 57-60 (in Russ.). EDN: RNDYXT.

10. Vancheri F., Longo G., Vancheri S., Henein M. Coronary мicrovascular dysfunction. J Clin Med. 2020;9(9):2880. DOI: 10.3390/jcm9092880.

11. Godo S., Suda A., Takahashi J., Yasuda S., Shimokawa H. Coronary Microvascular Dysfunction. Arterioscler Thromb Vasc Biol. 2021;41(5):1625-1637. DOI: 10.1161/ATVBAHA.121.316025.

12. Thakker R.A., Rodriguez Lozano J., Rodriguez Lozano P., Motiwala A., Rangasetty U., Khalife W., Chatila K. Coronary Microvascular Disease. Cardiol Ther. 2022;11(1):23-31. DOI: 10.1007/s40119-021-00250-6.

13. Hogg K., Swedberg K., McMurray J. Heart Failure with preserved left ventricular systolic function. Epidemiology, clinical characteristics and prognosis. J Am Coll Cardiol. 2004;43(3):317-327. DOI: 10.1016/j.jacc.2003.07.046.

14. Kemp H.G. Left ventricular function in patients with the angina syndrome and normal coronary arteriograms. Am J Cardiol. 1973;32:375-376. DOI: 10.1016/s0002-9149(73)80150-x.

15. Weerts J., Mourmans S.G.J., Barandiarán Aizpurua A., Schroen B.L.M., Knackstedt C., Eringa E., Houben A.J.H.M., van Empel V.P.M. The Role of Systemic Microvascular Dysfunction in Heart Failure with Preserved Ejection Fraction. Biomolecules. 2022;12(2):278. DOI: 10.3390/biom12020278.

16. Khachirova E.A., Samoylenko L.E., Shevchenko O.P., Karpova I.E. Assessment of myocardial perfusion in chest pain and angiographically intact coronary arteries via singlephoton emission computed tomography combined with X-ray computed tomography. Kardiovaskulyarnaya terapiya i profilaktika. 2016;15(1):58-63 (in Russ.). DOI: 10.15829/1728-8800-2016-1-58-63. EDN: VOMVXX.

17. Khachirova E.A., Samoylenko L.E., Shevchenko O.P. Single-photon emission computed tomography with attenuation correction for verification of microcirculatory disorders in patients with chest pain and intact coronary arteries. Kursk scientific and practical bulletin «Man and his health». 2017;(1):29-34 (in Russ.). DOI: 10.21626/vestnik/2017-1/05. EDN: YLITST.

18. Jespersen L., Hvelplund A., Abildstrøm S.Z., Pedersen F., Galatius S., Madsen J.K., Jørgensen E., Kelbæk H. et al. Stable angina pectoris with no obstructive coronary artery disease is associated with increased risks of major adverse cardiovascular events. Eur Heart J. 2012;33(6):734-744. DOI: 10.1093/eurheartj/ehr331.

19. Likoff W., Segal B.L., Kasparian H. Paradox of normal selective coronary arteriograms in patients considered to have unmistakable coronary heart disease. N Engl J Med. 1967;276:1063-1066. DOI: 10.1056/NEJM196705112761904.

20. van de Hoef T.P., Bax M., Damman P., Delewi R., Hassell M.E., Piek M.A., Chamuleau S.A., Voskuil M. et al. Impaired Coronary Autoregulation Is Associated With Long-term Fatal Events in Patients With Stable Coronary Artery Disease. Circ Cardiovasc Interv. 2013;6(4):329-335. DOI: 10.1161/CIRCINTERVENTIONS.113.000378.

21. Samuel T.J., Wei J., Sharif B., Tamarappoo B.K., Pattisapu V., Maughan J., Cipher D.J., Suppogu N. et al. Diastolic dysfunction in women with ischemia and no obstructive coronary artery disease: Mechanistic insight from magnetic resonance imaging.Int J Cardiol. 2021;331:1-7. DOI: 10.1016/j.ijcard.2021.01.064.

22. Gimelli A., Liga R., Pasanisi E.M., Casagranda M., Marzullo P. Myocardial ischemia in the absence of obstructive coronary lesion: The role of post-stress diastolic dysfunction in detecting early coronary atherosclerosis. J Nucl Cardiol. 2017;24(5):1542-1550. DOI: 10.1007/s12350-016-0456-9.

23. Vinereanu D., Fraser A.G., Robinson M., Lee A., Tweddel A. Adenosine provokes diastolic dysfunction in microvascular angina. Postgrad Med J. 2002;78:40-42. DOI: 10.1136/pmj.78.915.40.

24. Nelson M.D. Left ventricular diastolic dysfunction in women with non obstructive ischemic heart disease: insights from magnetic resonance imaging and spectroscopy. Am J Physiol Regul Integr Comp Physiol. 2017;313(4). DOI: 10.1152/ajpregu.00249.2017.

25. Lam J.H., Quah J.X., Davies T., Boos C.J., Nel K., Anstey C.M., Stanton T., Greaves K. Relationship between coronary microvascular dysfunction and left ventricular diastolic function in patients with chest pain and unobstructed coronary arteries. Echocardiography. 2020;37(8):1199-1204. DOI: 10.1111/echo.14794.

26. Kim I.C., Hwang J., Lee C.H., Cho Y.K., Park H.S., Chung J.W., Yoon H.J., Kim H. et al. Correlation of coronary microvascular function and diastolic dysfunction. Eur Heart J. 2020;41(S2):ehaa946.0903. DOI: 10.1093/ehjci/ehaa946.0903

27. Samoilenko L., Sayutina E., Samko A. et al. Acetylcholine-exersise 99mTc-MIBI test in detection of myocardial ischemia due to endothelial dysfunction. Eur J Nucl Med.1 997;24(8):294-297.

28. Nelson M.D., Szczepaniak L.S., Wei J., Haftabaradaren A., Bharadwaj M., Sharif B., Mehta P., Zhang X. et al. Diastolic dysfunction in women with signs and symptoms of ischemia in the absence of obstructive coronary artery disease: a hypothesis-generating study. Circ Cardiovasc Imaging. 2014;7(3):510-516. DOI: 10.1161/CIRCIMAGING.114.001714.

29. Songy B. Detection of non-obstructive coronary artery disease: Is post-stress diastolic dysfunction assessed by myocardial perfusion imaging a useful tool. J Nucl Cardiol. 2017;24(5):1551-155. DOI: 10.1007/s12350-016-0486-3.