ABC | Volume 112, Nº2, February 2019

Original Article Dippe Jr. et al Study of myocardial perfusion in obese individuals without known IHD Arq Bras Cardiol. 2019; 112(2):121-128 Table 2 – Demographic characteristics of the patients by sex Men Women p value n = 2,605 n = 2,921 Age; mean (SD) 56.7(11.8) 61.7(12) < 0.0001 BMI (kg/m²); mean (SD) 33.6(4.1) 34.2(3.3) < 0.0001 Diabetes mellitus; n (%) 773 (29.7) 954 (32.7) 0.02 SAH; n (%) 1.843 (70.7) 2,263 (77.5) < 0.001 Family history of IHD; n (%) 429 (16.5) 652 (22.3) < 0.001 Smoking; n (%) 270 (10.4) 196 (6.7) < 0.001 Dyslipidemia; n (%) 1,369 (52.5) 1,627 (55.7) 0.02 Symptoms before SPECT-MPI; n (%) < 0.001 Asymptomatic 1,701 (65.8) 1.295 (45.2) Atypical angina 433 (16.7) 777 (27.2) Typical angina 108 (4.2) 254 (8.9) Tiredness 343 (13.3) 535 (18.7) Stress protocol; n (%) < 0.001 Physical 1,895 (72.7) 1,681 (57.5) Pharmacological 710 (27.3) 1,240 (42.5) Physical stress in METs; mean (SD) 8.7 (2.2) 6.8 (2.1) < 0.0001 %LVEF; mean(DP) 54.1 (18.4) 63.9 (15.5) 0.04 LVEF; n(SD) < 0.0001 LVEF > 50% 2,126 (89.4) 2,695 (95.9) LVEF 30 - 49% 227 (9.5) 103 (3.7) LVEF < 30% 25 (1.0) 13 (0.5) Abnormal SPECT-MPI abnormal; n (%) 475 (18.2) 813 (27.8) < 0.001 Ischemia 436 (16.7) 792 (27.1) Ischemia > 10% of the LV 45(1.7) 29 (0.9) 0.017 Fibrosis alone 13 (0.5) 9 (0.3) Fibrosis and ischemia 26 (1) 12 (0.4) SD: standard deviation; BMI: body mass index; SAH; systemic arterial hypertension; IHD: ischemic heart disease METs: metabolic equivalents; LVEF: post-stress left ventricular ejection fraction; SPECT-MPI: myocardial perfusion imaging with single-photon emission computed tomography; LV: left ventricle Table 3 – Distribution of patients by body mass index BMI Classification 30.0 - 34.9 kg/m 2 Class I obesity* 35.0 – 39.9 kg/m 2 Class II obesity* ≥ 40.0 kg/m 2 Class III obesity* Number (%) of patients n = 3,880 (70.2%) n = 1,207 (21.8%) n = 439 (7.9%) BMI: body mass index. *World Health Organization 1 with abnormal SPECT-MPI according to BMI. Figure 1 shows the percentage of abnormal SPECT-MPI according to BMI. Factors associated with abnormal myocardial perfusion Univariate analysis revealed that the following factors were associated with abnormal myocardial perfusion – age (OR: 1.04; 95%CI: 1.04-1.05. p < 0.001), female sex (OR: 1.18; 95%CI: 1.18-1.21; p < 0.001), DM (OR: 1.96; 95%CI; 1.72-2.23. p < 0.001); SAH (OR: 1.79; 95%CI: 1.53-2.10; p < 0.001), dyslipidemia (OR: 1.19; 95%CI: 1.04-1.34. p < 0.008), typical angina (OR: 1.96; 95%CI: 1.55-2.48; p < 0.001) or tiredness (OR: 1.29. IC 95%: 1.08-1.54. p = 0.004) before SPECT-MPI, lower stress test duration (mean) (OR: 0.81, 95%CI: 0.78‑0.84; p < 0.001) and lower (mean) LVEF (OR: 0.996, 95%CI: 0.993‑0.999, p <0.041). After multivariate analysis (Table 4), age, typical angina before SPECT-MPI, need of using the pharmacological stress protocol, less physical exertion (METs), and post-stress LVEF were found to be associated with abnormal myocardial perfusion. 123