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

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.