title: Association between plasma homocysteine and myocardial SPECT abnormalities in patients referred for suspected myocardial ischaemia.
abstract: BACKGROUND
  Elevated plasma homocysteine level has emerged as a relatively newly recognised risk factor for coronary artery disease (CAD). However, reduction of plasma homocysteine levels in large prospective studies did not appear to reduce the risk for subsequent cardiac events. In this study, we investigated the association between plasma homocysteine levels and quantitative indices of myocardial perfusion SPECT imaging in patients referred for myocardial ischaemia.
  
  
  METHODS
  Quantitative myocardial perfusion SPECT indices were obtained for 120 patients who were recruited for the study. All patients underwent a two-day rest-stress myocardial perfusion imaging. Plasma venous sampling was done on all patients after an overnight fast. Of the 120 participants (mean age 56 years, 53% males), 33% had elevated plasma homocysteine levels. The plasma homocysteine level was then compared to the results of imaging and other known risk factors.
  
  
  RESULTS
  After adjustment for traditional risk factors of coronary artery disease, patients with elevated homocysteine levels had a significantly higher mean summed stress score (SSS) (11.3 vs 6.9, p = 0.02) than patients with a normal homocysteine level. This was true for both single- and multivessel disease. Also, patients with elevated homocysteine levels had a higher stress end-systolic volume (SESV) (137 vs 105 ml, p = 0.03) and lower post-stress left ventricular ejection fraction (SEF) (54 vs 64%, p = 0.02). The patients with elevated plasma homocysteine levels also had a significantly lower mean body mass index (BMI) (26.6 vs 30.6 kg/m(2), p = 0.002). There was a significant relationship between the total number of known risk factors in a patient with CAD and the proportion of patients presenting with elevated plasma homocysteine levels (p = 0.03). Also, the extent of infarct, as measured by the summed rest score (SRS), was more closely correlated with an elevated homocysteine level than with the degree of ischaemia.
  
  
  CONCLUSIONS
  There was a correlation between plasma homocysteine level and the presence and extent of myocardial perfusion abnormalities in patients with established coronary artery disease, in particular those with multiple risk factors and multi-vessel infarction.
authors: Department of Nuclear Medicine, University of Pretoria and Steve Biko Academic Hospital, Pretoria, South Africa.
authors: Alfred
authors: A
authors: Ankrah
authors: John
authors: J
authors: Buscombe
authors: Mike Machaba
authors: MM
authors: Sathekge
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D015992:Body Mass Index; D002316:Cardiotonic Agents; D016009:Chi-Square Distribution; D003324:Coronary Artery Disease / Q000097:blood / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology; D005080:Exercise Test; D005260:Female; D006710:Homocysteine / Q000097:blood*; D006801:Humans; D020138:Hyperhomocysteinemia / Q000097:blood / Q000150:complications / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000097:blood / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000209:etiology; D017202:Myocardial Ischemia / Q000097:blood / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology; D055414:Myocardial Perfusion Imaging / Q000379:methods*; D016017:Odds Ratio; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012017:Referral and Consultation; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013019:South Africa; D013318:Stroke Volume; D015899:Tomography, Emission-Computed, Single-Photon; D015854:Up-Regulation; D014665:Vasodilator Agents; D016277:Ventricular Function, Left
chemical_list: D015415:Biomarkers; D002316:Cardiotonic Agents; D014665:Vasodilator Agents; D006710:Homocysteine