Relationship between impaired myocardial perfusion and left ventricular contractile dysfunction based on magnetic resonance feature tracking in patients with multivessel coronary artery disease

Aim . To study the relationship between impaired left ventricular (LV) myocardial perfusion identified by dynamic single-photon emission computed tomography (SPECT) and left ventricular contractile dysfunction assessed using magnetic resonance feature tracking (MR-FT). Material and methods. The study included 31 patients (men, 80,6%; median age, 63 years) with multivessel coronary artery disease (CAD). All patients underwent contrast-enhanced cardiac magnetic resonance imaging (MRI) and dynamic SPECT with myocardial flow reserve (MFR) quantification. Depending on the global MFR, patients were divided into 2 following groups: group 1 (n=23) included patients with reduced MFR (≤2), and group 2 (n=8) included patients with preserved MFR (>2). R e sults . According to contrast-enhanced cardiac MRI, patients with multivessel CAD and preserved MFR were characterized by a lower median LV mass, compared with the group with reduced MFR (105,68 (89,04; 108,70) g; 120,71 (84,13; 132,0) g, respectively). Moreover, the group of patients with preserved MFR had a higher proportion of LV myocardial fibrosis. Subanalysis of data by vascular regions based on two subgroups (with (MFR ≤2,0) and without microcirculatory disorders) showed that regional microcirculatory disorders are associated with a higher perfusion defect value, maximum stenosis, and an increase in regional longitudinal strain in a related vascular system. Correlation analysis revealed a relationship between regional MFR according to SPECT data and regional longitudinal strain according to cardiac MRI data (p=0,002; r=-0,404). Conclusion . The combined use of quantitative SPECT perfusion and regional myocardial strein assessment using MR-FT provides unique, complementary information in patients with multivessel CAD. This directly links hemodynamic significance of stenosis with related myocardial function consequences. Regional longitudinal strain analysis serves as a highly sensitive and specific marker of ischemic dysfunction, maintaining diagnostic value even in patients with multivessel CAD, making it an additional marker of the functional significance of stenosis.