Left ventricular ejection fraction decrease after adenosine-induced stress as a predictor of ischemia

Abstract

Coronary artery disease (CAD) causes approximately 42 % of all deaths related to cardiovascular conditions.1 In Mexico, heart disease is the leading cause of death.2 Invasive coronary angiography is the gold standard in coronary artery disease diagnosis, but it is not regarded as the initial study, and diagnosis can therefore be supported by functional tests (stress test or imaging stress test).3,4 Scintigraphy is a proven resource for myocardial effusion assessment;4,5 it allows to simultaneously assess left ventricular perfusion, function and volumes.3 Post-stress and at rest perfusion images synchronized with electrocardiogram or gated-SPECT has enabled assessment of the post-ischemic stunning phenomenon; the magnitude of left ventricular ejection fraction (LVEF) post-stress depression with regard to rest is correlated with ischemia severity. Bestetti et al.4,5 reported that post-stress LVEF significant reduction in gated-SPECT is due to end-systolic volume (ESV) increase caused by endocardial stunning. Currently, post-stress transient ischemic dilation and LVEF decrease are known to be important predictors of severe coronary artery disease in SPECT studies.6 Cardiac magnetic resonance (CMR) imaging is an increasingly used method owing to its high resolution, unlimited image planes and capability to provide different types of information in a single study; it is considered the gold standard for volumetric and functional quantification.7-9 Perfusion quantification with CMR has shown good correlation with fractional flow reserve measures, the gold standard for the diagnosis of myocardial ischemia.8 As for ischemic heart disease, stress CMR can be used to detect ischemia-induced wall motion abnormalities; visual analysis enables observing areas of reduced perfusion, and with computational aid, identifying enhancement Abstract