Detection of non-obstructive coronary artery disease: Is post-stress diastolic dysfunction assessed by myocardial perfusion imaging a useful tool?

Excerpt

In the paper entitled ≪Myocardial ischemia in the absence of obstructive coronary lesion: the role of post-stress diastolic dysfunction in detecting early coronary atherosclerosis≫, Gimelli et al evaluated the interactions between non-obstructive coronary atherosclerosis on invasive coronary angiography (ICA) and myocardial perfusion imaging (MPI) with a cadmium-zinc-telluride (CZT) camera.1 They calculated the summed stress score (SSS) for perfusion, left ventricular ejection fraction (LVEF) for global systolic function, and peak filling rate (PFR) for global diastolic function. This preliminary paper concludes that in patients with chest pain, despite the absence of anatomically obstructive coronary artery disease (CAD), the alteration of post-stress left ventricular diastolic function associates with the presence of non-obstructive atherosclerosis on ICA. In these subjects, the degree of post-stress left ventricular diastolic impairment correlates with myocardial perfusion abnormalities on MPI, despite the absence of a relevant reduction in post-stress LVEF. The authors suggest that a combined evaluation of myocardial perfusion and diastolic function may better detect the presence of early stages of CAD. This paper and its conclusions lead us to ask three key questions: …