Early post-stress decrease in cardiac performance by impedance cardiography and its relationship to the severity and extent of ischemia by myocardial perfusion imaging

Abstract Background While single photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) is a well-established noninvasive procedure for the evaluation of patients with coronary artery disease (CAD), it is unable to detect the presence of, or underestimates the extent of CAD in certain patients. We aimed to show that a bio-impedance device can detect early post-stress changes in several hemodynamic parameters, thereby serving as a potential marker for the presence of significant ischemia. Methods Prospectively enrolled patients, referred to our Medical Center for clinically-indicated MPI, underwent testing using a Non-Invasive Cardiac System (NICaS) before and immediately after exercise. The differences between rest and stress hemodynamic parameters were compared with the severity and extent of myocardial ischemia by MPI. The study included 198 patients; mean age was 62 years, 26% were women, 54% had hypertension, and 29% diabetes mellitus. Of them, 188 patients had ≤ 10%, and 10 had > 10% of myocardial ischemia. Results In the first group, there was a significantly greater increase in post-exercise stroke index, stroke work index, cardiac index and cardiac power index (19.2%, 29.1%, 90.5% and 107%, respectively) compared with the second group (-2.7%, 3.8%, 43.7% and 53.5%, respectively), as well as a significantly greater decrease in total peripheral resistance index (-38.7% compared with − 16.3%), with corresponding p values of 0.015, 0.017, 0.040, 0.016, and < 0.001, respectively. Conclusions Our data suggest that immediate post-stress changes in several hemodynamic parameters, detected by the NICaS, can be used as an important adjunct to SPECT MPI for the early detection of myocardial ischemia.

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Early post-stress decrease in cardiac performance by impedance cardiography and its relationship to the severity and extent of ischemia by myocardial perfusion imaging

10.21203/rs.3.rs-21518/v2 ◽

2020 ◽

Author(s):

Ronen Goldkorn ◽

Alexey Naimushin ◽

Eli Rozen ◽

Dov Freimark

Keyword(s):

Myocardial Perfusion Imaging ◽

Myocardial Perfusion ◽

Myocardial Ischemia ◽

Perfusion Imaging ◽

Emission Computed Tomography ◽

Stroke Index ◽

Stroke Work ◽

Hemodynamic Parameters ◽

Stress Changes ◽

Post Stress

Abstract Background: While single photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) is a well-established noninvasive procedure for the evaluation of patients with coronary artery disease (CAD), it is unable to detect the presence of, or underestimates the extent of CAD in certain patients. We aimed to show that a bio-impedance device can detect early post-stress changes in several hemodynamic parameters, thereby serving as a potential marker for the presence of significant ischemia. Methods: Prospectively enrolled patients, referred to our Medical Center for clinically-indicated MPI, underwent testing using a Non-Invasive Cardiac System (NICaS) before and immediately after exercise. The differences between rest and stress hemodynamic parameters were compared with the severity and extent of myocardial ischemia by MPI. The study included 198 patients; mean age was 62 years, 26% were women, 54% had hypertension, and 29% diabetes mellitus. Of them, 188 patients had ≤10%, and 10 had >10% of myocardial ischemia. Results: In the first group, there was a significantly greater increase in post-exercise stroke index, stroke work index, cardiac index and cardiac power index (19.2%, 29.1%, 90.5% and 107%, respectively) compared with the second group (-2.7%, 3.8%, 43.7% and 53.5%, respectively), as well as a significantly greater decrease in total peripheral resistance index (-38.7% compared with -16.3%), with corresponding p values of 0.015, 0.017, 0.040, 0.016, and <0.001, respectively. Conclusions: Our data suggest that immediate post-stress changes in several hemodynamic parameters, detected by the NICaS, can be used as an important adjunct to SPECT MPI for the early detection of myocardial ischemia.

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Detecting Myocardial Ischemia With 99mTechnetium-Tetrofosmin Myocardial Perfusion Imaging in Ischemic Stroke

The Neurohospitalist ◽

10.1177/1941874417704752 ◽

2017 ◽

Vol 7 (4) ◽

pp. 164-168 ◽

Cited By ~ 1

Author(s):

Sotirios Giannopoulos ◽

Sofia Markoula ◽

Chrissa Sioka ◽

Sofia Zouroudi ◽

Maria Spiliotopoulou ◽

...

Keyword(s):

Ischemic Stroke ◽

Myocardial Perfusion Imaging ◽

Myocardial Perfusion ◽

Myocardial Ischemia ◽

Perfusion Imaging ◽

Single Photon ◽

Photon Emission ◽

Emission Computed Tomography ◽

Spect Mpi ◽

Artery Disease

Background: To assess the myocardial status in patients with stroke, employing myocardial perfusion imaging (MPI) with 99mTechnetium-tetrofosmin (99mTc-TF)-single-photon emission computed tomography (SPECT). Methods: Fifty-two patients with ischemic stroke were subjected to 99mTc-TF-SPECT MPI within 1 month after stroke occurrence. None of the patients had any history or symptoms of coronary artery disease or other heart disease. Myocardial perfusion imaging was evaluated visually using a 17-segment polar map. Myocardial ischemia (MIS) was defined as present when the summed stress score (SSS) was >4; MIS was defined as mild when SSS was 4 to 8, and moderate/severe with SSS ≥9. Patients with SSS >4 were compared to patients with SSS <4. Parameters such as age, body mass index, waist perimeter, smoking habits, and medical history (diabetes mellitus, dyslipidemia, etc) were evaluated according to MPI results. Results: Myocardial ischemia was present in 32 (62%) of 52 patients with stroke. Among them, 20 (62%) of 32 patients had mild abnormalities and 12 (38%) of 32 had moderate/severe. The age and waist perimeter showed a tendency to relate to severe MIS when patients with SSS >9 were compared to patients with SSS <4. In MPI-positive patients, an age was to be association with SSS, with the oldest age exhibiting the highest SSS ( P = .01). The association of age with SSS remained statistically significant in the multivariate analysis ( P = .04). Conclusion: The study suggested that more than half of patients with stroke without a history of cardiac disease have MIS. Although most of them have mild MIS, we suggest a thorough cardiological evaluation in this group of patients for future prevention of severe myocardial outcome.

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