Key result
Patients with liver cirrhosis had a significantly lower mean % uptake increase of 99mTc-MIBI during exercise compared to healthy controls (52.5% vs 61.0%, p<0.05), indicating impaired coronary flow reserve.
Why the study?
Does liver cirrhosis reduce coronary flow reserve during exercise compared to healthy controls?
Cross-Sectional (n=21)
Yes
Does liver cirrhosis reduce coronary flow reserve during exercise compared to healthy controls?
Absolute Event Rate: 52.5% vs 61%
p-value: p=<0.05
Patients with liver cirrhosis exhibit reduced coronary flow reserve during exercise despite angiographically normal coronary arteries, potentially explaining false-positive ST-segment depressions.
May link cirrhosis to impaired exercise coronary flow reserve; hypothesis-generating for false-positive stress tests and requires prospective confirmation.
PURPOSE: To our experience, ST segment depression is sometimes detected in an exercise electrocardiogram (ECG) test in patients with liver cirrhosis who have no significant coronary stenosis. In this study, the mechanism of ST segment depression in liver cirrhosis was examined using (99m)Tc-methoxy-isobutyl-isonitrile (MIBI) myocardial scintigraphy. METHODS: Six patients with liver cirrhosis (LC group), and 15 normal subjects (N group) were examined. To evaluate the level of myocardial blood flow, a Bull's eye display of myocardial blood flow was performed after dividing the left ventricle into 9 segments. Exercise myocardial scintigraphy with MIBI was performed to obtain the increase in % uptake. Angiographies were performed with a CAG system by inserting a 5 French Judkins catheter via the right femoral artery. RESULTS: No significant coronary stenosis was found in any of the LC patients. Neither a decrease in MIBI uptake nor defect was observed on Bull's eye images from the LC group. The mean % uptake increase was 61.0 +/- 5.6% in the N group. In the LC group, although neither a decrease in MIBI uptake nor a defect was visually observed on Bull's eye images obtained during exercise, the % uptake increases (mean: 52.5 +/- 5.8%) were lower than those of the N group (p<0.05). CONCLUSION: These findings suggest that a disorder in coronary flow reserve occurs in liver cirrhosis patients, because the decreased MIBI uptake during exercise is due to the depression of flow-mediated vasodilatation controlled by the endothelium of the coronary artery and the estrogenic digitalis action of blood flow independency.
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Mori et al. (2007) conducted a cross-sectional in Liver cirrhosis (n=21). Liver cirrhosis vs. Healthy normal subjects was evaluated on Mean % uptake increase of 99mTc-MIBI during exercise (p=<0.05). Patients with liver cirrhosis had a significantly lower mean % uptake increase of 99mTc-MIBI during exercise compared to healthy controls (52.5% vs 61.0%, p<0.05), indicating impaired coronary flow reserve.
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