Myocardial perfusion findings evaluated by gated-SPECT in dyslipidemic very high-risk patients

Abstract

\n \n \n Type of funding sources: None.\n Background. Dyslipidemia is one of the main risk factors for atherosclerotic disease. Timely diagnosis and appropriate treatment are therefore essential in the prevention and recurrence of cardiovascular disease (CVD). The detection of ischemia with myocardial perfusion gated-SPECT is a valuable diagnostic option that provides complete information to select the best therapeutic option, reducing morbidity and mortality in this group of patients.\n Purpose. To evaluate the findings of myocardial perfusion imaging (MPI) using gated-SPECT in a group of patients with dyslipidemia and very high cardiovascular risk.\n Methods. We retrospectively evaluated gated-SPECT results of 66 very high-risk dyslipidemic patients with a diagnosis or clinical suspicion of coronary artery disease (CAD). Exclusion criteria: structural heart disease, dilated hypertrophic cardiomyopathy, hemodynamic instability, low-intermediate risk. Rest-stress imaging with gated-SPECT Technetium-99m Sestamibi was acquired on a dedicated cardio gamma camera and subjectively evaluated in a 17-segment analysis. Ischemia was classified as mild, moderate, and severe.\xa0Statistical analysis: SPSS system, continuous data were expressed as mean ± SD, percentages were rounded; Chi-square and Student’s t-tests were used.\n Results. Mean age 61.06\u2009±\u200912.87 years old, 40 (61%) were men; 61 (92%) with primary and 5 (8%) with familial hypercholesterolemia. More than 80% have at least one or more cardiovascular (CV) risk factors; 73% have dyslipidemia, diabetes, and arterial hypertension, 52% tabaquism, 36% obesity, 11% kidney disease, and 30% family history of CV disease; all women were post-menopausal (44%). Asymptomatic (56%), 30% with dyspnea or equivalents, 9% atypical chest pain, and 5% typical angina. Gated-SPECT: 56% with ischemia; mild ischemia was present in 33% and 11% of men and women, and moderate in 35% and 27% respectively. Primary hypercholesterolemia: 26 % with mild, 28% moderate, and 46% without ischemia; 80% of familial hypercholesterolemia with moderate and 20% without ischemia.\n Conclusion.\xa0Myocardial ischemia was present in 56% of very high-risk dyslipidemic patients, predominantly in men (67.5%). Although 56% were asymptomatic, ischemia was detected in 54% of the patients with primary and 80% with familial hypercholesterolemia. It is advisable to perform MPI with gated-SPECT for the early detection of ischemia in high-risk dyslipidemic patients, even asymptomatic.\n