Association between plasma homocysteine and myocardial SPECT abnormalities in patients referred for suspected myocardial ischaemia

Abstract

BackgroundElevated plasma homocysteine level has emerged as a relatively newly recognised risk factor for coronary artery disease (CAD). However, reduction of plasma homocysteine levels in large prospective studies did not appear to reduce the risk for subsequent cardiac events. In this study, we investigated the association between plasma homocysteine levels and quantitative indices of myocardial perfusion SPECT imaging in patients referred for myocardial ischaemia.MethodsQuantitative myocardial perfusion SPECT indices were obtained for 120 patients who were recruited for the study. All patients underwent a two-day rest–stress myocardial perfusion imaging. Plasma venous sampling was done on all patients after an overnight fast. Of the 120 participants (mean age 56 years, 53% males), 33% had elevated plasma homocysteine levels. The plasma homocysteine level was then compared to the results of imaging and other known risk factors.ResultsAfter adjustment for traditional risk factors of coronary artery disease, patients with elevated homocysteine levels had a significantly higher mean summed stress score (SSS) (11.3 vs 6.9, p = 0.02) than patients with a normal homocysteine level. This was true for both single- and multivessel disease. Also, patients with elevated homocysteine levels had a higher stress end-systolic volume (SESV) (137 vs 105 ml, p = 0.03) and lower post-stress left ventricular ejection fraction (SEF) (54 vs 64%, p = 0.02). The patients with elevated plasma homocysteine levels also had a significantly lower mean body mass index (BMI) (26.6 vs 30.6 kg/m2, p = 0.002). There was a significant relationship between the total number of known risk factors in a patient with CAD and the proportion of patients presenting with elevated plasma homocysteine levels (p = 0.03). Also, the extent of infarct, as measured by the summed rest score (SRS), was more closely correlated with an elevated homocysteine level than with the degree of ischaemia.ConclusionThere was a correlation between plasma homocysteine level and the presence and extent of myocardial perfusion abnormalities in patients with established coronary artery disease, in particular those with multiple risk factors and multi-vessel infarction.

Plasma homocysteine is associated with ischemic findings without organic stenosis in patients with slow coronary flow

“…Hcy is a potentially cytotoxic amino acid that is synthesized during methionine metabolism. Several studies have identified that even mild hyperhomocysteinemia is associated with an increased risk of cardiovascular, and related vascular diseases, independently of classic risk factors [9][10][11][12]. The main detrimental effects of Hcy are probably on vascular endothelium.…”

“…Oudi et al [32] have demonstrated that elevated levels of Hcy are associated with a greater number of diseased arteries and, consequently, the severity of coronary artery disease. In addition, Ankrah et al [12] showed that there was a correlation between plasma Hcy level and the presence of myocardial perfusion defects in patients with coronary artery disease, especially those with multiple risk factors and multivessel infarction. In keeping with these findings, we detected that patients with SCF in all of three vessels had higher plasma levels of Hcy when compared to the controls and patients with SCF in one and two vessels.…”

“…Homocysteine (Hcy) is a sulfhydryl-containing amino acid that might give rise to endothelial damage and generate free radicals that induce oxidative damage and stress. Hyperhomocysteinemia has been determined as emerging independent risk factor for cardiovascular system and related diseases [9][10][11][12].…”