Evaluation of the relationship between cardiovascular risk factors and left ventricular diastolic function parameters in myocardial perfusion scan

Document Type : Original Article


1 Student Research Committee, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran

2 Department of Nuclear Medicine, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran


Introduction:  Heart failure is an important life-threatening problem, with left ventricular diastolic dysfunction as a major initial pathophysiologic process and identification and treatment of related risk factors lead to better prognosis. Gated single-photon emission computed tomography (G-SPECT) myocardial perfusion imaging (MPI) is a feasible tool to evaluate the diastolic function. The aim of this study was to assess the correlation of cardiovascular risk factors with the diastolic function parameters in G-SPECT MPI.
Methods: This is a cross-sectional retrospective study including 274 patients with normal ejection fraction (EF) and no previous history of heart disease. Demographic data and history of cardiovascular risk factors were collected. Correlation of quantitative functional parameters of G-SPECT including diastolic indices (peak filling rate (PFR), time to peak filling rate (TTPF), mean filling rate at the first third of diastolic phase (MFR/3), and second peak filling rate (PFR2)) with cardiovascular factors was studied using SPSS software.
Results: In this study, 274 patients with a mean age of 56 years (with 172 females) were evaluated. There was a significant relationship between age and all diastolic parameters. Diabetic patients had a significantly lower TTPF, and hypertensive patients revealed a significantly lower MFR/3. Hyperlipidemia and chronic kidney disease were not associated with any diastolic parameters. PFR was significantly lower in smokers, and family history had a significant relationship with PFR2.
Conclusion: Most of CAD risk factors, except for CKD and hyperlipidemia, had a significant relationship with at least one parameter of the left ventricular diastolic function in G-SPECT MPI.


Main Subjects

  1. Akincioglu C, Berman DS, Nishina H, Kavanagh PB, Slomka PJ, Abidov A, Hayes S, Friedman JD, Germano G. Assessment of diastolic function using 16-frame 99mTc-sestamibi gated myocardial perfusion SPECT: normal values. J Nucl Med. 2005 Jul;46(7):1102-8.
  2. Paulus WJ, Tschöpe C, Sanderson JE, Rusconi C, Flachskampf FA, Rademakers FE, Marino P, Smiseth OA, De Keulenaer G, Leite-Moreira AF, Borbély A, Edes I, Handoko ML, Heymans S, Pezzali N, Pieske B, Dickstein K, Fraser AG, Brutsaert DL. How to diagnose diastolic heart failure: a consensus statement on the diagnosis of heart failure with normal left ventricular ejection fraction by the Heart Failure and Echocardiography Associations of the European Society of Cardiology. Eur Heart J. 2007 Oct;28(20):2539-50.
  3. Deswal A. Diastolic dysfunction and diastolic heart failure: mechanisms and epidemiology. Curr Cardiol Rep. 2005 May;7(3):178-83.
  4. Gazoti Debessa CR, Mesiano Maifrino LB, Rodrigues de Souza R. Age related changes of the collagen network of the human heart. Mech Ageing Dev. 2001 Jul 31;122(10):1049-58.
  5. Hees PS, Fleg JL, Dong SJ, Shapiro EP. MRI and echocardiographic assessment of the diastolic dysfunction of normal aging: altered LV pressure decline or load? Am J Physiol Heart Circ Physiol. 2004 Feb;286(2):H782-8.
  6. von Bibra H, St John Sutton M. Diastolic dysfunction in diabetes and the metabolic syndrome: promising potential for diagnosis and prognosis. Diabetologia. 2010 Jun;53(6):1033-45.
  7. Korkmaz AN, Caliskan B, Erdem F. Evaluation of diastolic function in patients with normal perfusion and type 2 diabetes mellitus with gated single-photon emission computed tomography. World J Nucl Med. 2017 Jul-Sep;16(3):206-11.
  8. Nadruz W, Shah AM, Solomon SD. Diastolic dysfunction and hypertension. Med Clin North Am. 2017 Jan;101(1):7-17.
  9. Rafi Mohamed, Jaber Monna Mohamed. Study on prevalence of left ventricular diastolic dysfunction in chronic obstructive pulmonary disease. Int J Adv Med. 2019 Mar; 6(2): 222-6
  10. Störk T, Eichstädt H, Möckel M, Bortfeldt R, Müller R, Hochrein H. Changes of diastolic function induced by cigarette smoking: an echocardiographic study in patients with coronary artery disease. Clin Cardiol. 1992 Feb;15(2):80-6.
  11. Tzatzaki E, Spartalis M, Kamperidis V, Spartalis E, Giannakoulas G, Karvounis H. Diastolic dysfunction in end-stage renal disease patients. Hell J Atheroscler. 2017;8(2):96-102.
  12. Malek H, Samiei N, Yaghoobi N, Bavaghar N, Firoozabadi H, Rastgou F, Bakhshande H, Rajabi AB, Hedayati R. Assessment of LV diastolic dysfunction in myocardial perfusion imaging: a correlative study with transthoracic echocardiography. Nucl Med Commun. 2021 Sep 1;42(9):979-83.
  13. Dorbala S, Ananthasubramaniam K, Armstrong IS, Chareonthaitawee P, DePuey EG, Einstein AJ, Gropler RJ, Holly TA, Mahmarian JJ, Park MA, Polk DM, Russell R 3rd, Slomka PJ, Thompson RC, Wells RG. Single Photon Emission Computed Tomography (SPECT) myocardial perfusion imaging guidelines: instrumentation, acquisition, processing, and interpretation. J Nucl Cardiol. 2018 Oct;25(5):1784-846.
  14. Sarebani M, Shiran MB, Bitarafan-Rajabi A, Rastgou F, Ojaghi Haghighi Z, Abbasian Ardakani A. The impact of frame numbers on cardiac ECG-gated SPECT images with interpolated extra frames using echocardiography. Med J Islam Repub Iran. 2020 Jun 3;34:57.
  15. Muntinga HJ, van den Berg F, Knol HR, Niemeyer MG, Blanksma PK, Louwes H, van der Wall EE. Normal values and reproducibility of left ventricular filling parameters by radionuclide angiography. Int J Card Imaging. 1997 Apr;13(2):165-71; discussion 173.
  16. Nakajima K. Normal values for nuclear cardiology: Japanese databases for myocardial perfusion, fatty acid and sympathetic imaging and left ventricular function. Ann Nucl Med. 2010 Apr;24(3):125-35.
  17. Charvát J, Michalova K, Chlumský J, Valenta Z, Kvapil M. The association between left ventricle diastolic dysfunction and endothelial dysfunction and the results of stress myocardial SPECT in asymptomatic patients with type 2 diabetes. J Int Med Res. 2005 Sep-Oct;33(5):473-82.
  18. Sayed MH, Eltayeb AO, Farghaly HR. The impact of hypertension on diastolic left ventricular function, evaluated by quantitative ECG-gated myocardial perfusion SPECT. Egypt J Radiol Nucl Med. 2015 Sep 1;46(3):599-603.
  19. Poulsen SH, Andersen NH, Ivarsen PI, Mogensen CE, Egeblad H. Doppler tissue imaging reveals systolic dysfunction in patients with hypertension and apparent "isolated" diastolic dysfunction. J Am Soc Echocardiogr. 2003 Jul;16(7):724-31.
  20. Sato W, Kosaka T, Koyama T, Ishida M, Iino K, Watanabe H, Ito H. Impaired renal function is a major determinant of left ventricular diastolic dysfunction: assessment by stress myocardial perfusion imaging. Ann Nucl Med. 2013 Oct;27(8):729-36.
  21. Di Salvo G, D'Aiello AF, Castaldi B, Fadel B, Limongelli G, D'Andrea A, Pergola V, Pacileo G, Del Giudice EM, Perrone L, Calabrò R, Russo MG. Early left ventricular abnormalities in children with heterozygous familial hypercholesterolemia. J Am Soc Echocardiogr. 2012 Oct;25(10):1075-82.
  22. Van daele CM, De Meyer T, De Buyzere ML, Gillebert TC, Denil SL, Bekaert S, Chirinos JA, De Backer GG, De Bacquer D, Rietzschel ER; Asklepios Investigators. Family history of cardiovascular disease and offspring echocardiographic left ventricular structure and function: the Asklepios Study. J Am Soc Echocardiogr. 2013 Nov;26(11):1290-97.e2.