Relationship between Recent Cerebrovascular Events and the Severity and Extent of Myocardial Ischemia among Asymptomatic Patients Using Myocardial Perfusion Imaging

Objectives: Cerebrovascular disease (CVD) and coronary artery disease (CAD) can coexist in variable degree, and myocardial infarction is the main cause of long-term mortality in patients with stroke. However, it is not currently a routine practice to evaluate patients with early CVD for the presence of CAD. This study sought to evaluate the relationship between CVD and myocardial ischemia using myocardial perfusion imaging (MPI). Materials and methods: This study included 108 subjects who were divided into two groups: the study group consisted of 54 patients (18 males and 36 females, aged 20-78 years and a mean age of 62.3±11.5 years) with a history of cerebrovascular events in the recent two years and the control group comprised of 54 age-, gender-, and risk factor-matched controls with no history or evidence of CVD. All the subjects were asymptomatic in terms of CAD-related symptoms. Seeking for the presence of perfusion abnormality and myocardial ischemia, all of the individuals underwent Dipyridamole stress myocardial perfusion imaging (MPI) and the results were interpreted both visually and semiquantitatively. Results: Abnormal MPI was observed in 41 (75.93%) patients of the study group. Of this total, 21 (51.22%) patients had mild, 17 (41.46%) had moderate, and 3 (7.32%) had severe ischemia. In comparison, only 18 (33.33%) patients of the control group demonstrated abnormal MPI, of which 15 patients had mild and 3 patients had moderate ischemia with no case of severe ischemia. The rate of regional left ventricular dysfunction was also significantly higher (P < 0.001) amongst the patients of the study group. Conclusion: There is a significant association between ischemic heart disease and cerebrovascular event, even if they remain asymptomatic in terms of CAD-related symptoms. This underscores the implication of MPI in this group of patients.