Association of resting left ventricular global longitudinal strain with myocardial perfusion abnormalities evaluated by ¹³N‐ammonia positron emission tomography in patients with stable angina pectoris and normal left ventricular ejection fraction

Abstract

Aims Little is known about whether resting left ventricular global longitudinal strain (GLS) impairment is associated with myocardial perfusion abnormalities evaluated using 13N‐ammonia positron emission tomography (13N‐NH3‐PET)‐myocardial perfusion imaging (MPI). This study aimed to investigate the correlation between resting GLS and myocardial perfusion parameters in patients with a normal left ventricular ejection fraction (LVEF). We evaluated whether resting GLS can predict myocardial perfusion abnormalities in these patients. Methods and Results We selected 157 patients with suspected stable angina pectoris who underwent both ATP‐stress NH3‐PET‐MPI and 2‐dimentional speckle tracing echocardiography. All subjects had a preserved LVEF and no known history of myocardial infarction. Patients were stratified into Group N (normal perfusion; summed stress score [SSS], 0–3; n = 101), Group M (mildly to moderately abnormal perfusion; SSS, 4–11; n = 41), or Group S (severely abnormal perfusion; SSS, 12+; n = 15). GLS was more impaired as myocardial perfusion abnormality severity increased (–17.9 ± 2.9% for Group N, –16.8 ± 3.1% for Group M, and –14.2 ± 3.5% for Group S; p < .001). GLS was weakly but significantly correlated with SSS (R = .32, p < .001), summed difference score (R = .32, p < .001), and myocardial blood flow during stress (R = –0.27, p < .001). Multivariate logistic regression analysis showed that male sex, diabetes mellitus, systolic blood pressure, and GLS were independent predictors of myocardial perfusion abnormality defined as Groups M and S. Additionally, the area under the curve for GLS for detecting myocardial perfusion abnormality was .65, and the optimal cutoff value for GLS was –16.5%, with sensitivity and specificity of 59% and 66%, respectively. Conclusion In patients with suspected angina pectoris, resting GLS impairment despite a normal LVEF might aid the detection of hemodynamically significant coronary artery disease.