Prevalence of Inducible Myocardial Ischemia in Patients with Cervical Spondylosis having Typical Chest Pain.

Abstract

Globally the most prevalent non-communicable disease is the ischemic heart disease. Cervical spondylosis (CS) patients presenting with typical chest pain may have underlying myocardial ischemia (MI) which often remain unexplored. This cross-sectional analytical study was carried out in the University Cardiac Centre (UCC), Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from September 2017 to March 2018. This study aimed to investigate the prevalence of inducible myocardial ischemia among the patients with cervical spondylosis and typical chest pain. A total of 54 adult CS patients presenting with typical chest pain was included. All of them underwent dobutamine stress echocardiography using standard protocol. Informed written consent was taken before inclusion. Ethical measures were taken in compliance with the declaration of Helsinki. The participants had a mean age ±SD of 44.87.6 years and a higher proportion of female (64.8%). Of all, 13(24.1%) patients had inducible myocardial ischemia on dobutamine stress echocardiography. ECG findings suggestive of MI were noted in 7 out of 13 patients (53.8%) with inducible myocardial ischemia and in 1 out of 41 patients (2.4%) without inducible myocardial ischemia. Out of 13 patients with myocardial ischemia 7(53.8%) had an abnormal ECG and out of 41 patients without inducible ischemia 1(2.4%) had abnormal ECG. Single vessel involvement was the predominant finding (92.3%) and respectively, 53.8% and 38.5% had involvement of left anterior descending and right coronary artery territory. The independent predictors of myocardial ischemia were age (Adjusted OR [AOR] 1.17, 95% Confidence Interval [CI] 1.01 - 1.35), male sex (AOR 20.75, 95% CI 1.11 - 353.19) and diabetes mellitus (AOR 83.73, 95% 1.72 - 4067.56). Nearly one-quarter cervical spondylosis patients presenting with typical chest pain had underlying inducible myocardial ischemia. Further large case-control studies are recommended to determine the extent of the disease and predictors.