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Mut F, Gaudiano MP, Kapitán M. Relationship between transient ischemic dilatation and changes in heart rate during gated SPECT acquisition in a low-risk population without perfusion defects. Nucl Med Commun 2024; 45:581-588. [PMID: 38618745 DOI: 10.1097/mnm.0000000000001852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/16/2024]
Abstract
OBJECTIVES Transient ischemic dilatation (TID) in myocardial perfusion single photon emission computed tomography (SPECT) is considered a marker of poor prognosis. However, it has been suggested that some cases are due to apparent volumetric changes secondary to differences in heart rate (HR) at the time of acquisition. We assessed the correlation between transient dilatation and HR in low risk patients with no perfusion defects. METHODS We retrospectively analyzed patients sent for 99mTc-MIBI SPECT using a 2-day protocol. We recorded the median HR during acquisition and the HR difference (HRD) between the rest and post-stress. We obtained the medium ventricular volume, end-diastolic volume (EDV), and end-systolic volume (ESV). We included patients in which TID using medium ventricular volume (TIDMV) was ≥1.2. TID was also calculated for the EDV and ESV (TIDEDV, TIDESV). We excluded patients with known coronary artery disease, perfusion defects, various ECG disorders, positive stress test, or ESV < 10 ml. RESULTS From a total of 2006 patients, 63 (50 exercise, 13 dipyridamole) met the criteria for analysis (age 63.8 ± 9.7, 44 men). TIDMV was 1.29 ± 0.09 and HRD 9.8 beats per minute (BPM) (range -10 to 41). There was positive correlation between HRD and TIDMV ( r = 0.51, P < 0.001) and TIDEDV ( r = 0.5, P < 0.001), but not TIDESV ( r = 0.23, P = 0.07). Correlation was stronger when HRD was ≥10 BPM ( r = 0.67, P < 0.001). CONCLUSION TID without perfusion defects should be interpreted with caution in the presence of HRD ≥ 10 BPM during post-stress acquisition.
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Affiliation(s)
- Fernando Mut
- Nuclear Medicine Service, Italian Hospital, Montevideo, Uruguay
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Muacevic A, Adler JR, Rodrigues J. The Impact of Left Ventricle Ejection Fraction Reduction and Transient Ischemic Dilation in Patients With Normal Single-Photon Emission Computed Tomography (SPECT) Myocardial Perfusion Imaging. Cureus 2022; 14:e32950. [PMID: 36712751 PMCID: PMC9875358 DOI: 10.7759/cureus.32950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/23/2022] [Indexed: 12/28/2022] Open
Abstract
INTRODUCTION Coronary artery disease (CAD) is a leading cause of death in developed countries. Non-invasive functional imaging modalities are currently recommended as initial diagnostic tests in patients with an intermediate-high pretest probability of CAD. Single-photon emission computed tomography myocardial perfusion imaging (SPECT-MPI) creates images of regional myocardial tracer uptake, reflecting relative myocardial blood flow. However, there are other non-perfusion predictors of CAD, such as transient ischemic dilatation (TID) and reduced post-stress left ventricle ejection fraction (LVEF). Available data regarding these parameters is controversial. The aim of our study was to evaluate the incidence of significant CAD in patients with non-perfusion high-risk markers of ischemia despite a normal SPECT-MPI. METHODS Single-center, observational, retrospective, and longitudinal study. Inclusion criteria were age ≥18 years, normal SPECT-MPI, and availability of gated study for LVEF and volume analysis. Exclusion criteria were any known cardiomyopathy or congenital heart disease and known CAD. Non-perfusion high-risk markers: LVEF reduction ≥5% on post-stress images; TID (defined as a stress/rest left ventricle volume ratio ≥ 1.15), including end-systolic, end-diastolic, and mean volumes. The primary endpoint was the identification of significant CAD (stenosis >70% on an epicardial coronary artery or >50% on the left main artery) on invasive coronary angiography. RESULTS A total of 197 patients met the inclusion criteria. Mean age was 64 ± 12.6 years and 59.4% (n = 117) of patients were male. Overall, 26% of patients had LVEF reduction ≥5% on stress study; 24.9% had a stress/rest end-systolic volume ratio ≥ 1.15; 7.1% had a stress/rest mean volume ratio ≥ 1.15; 7.1% had a stress/rest end-diastolic volume ratio ≥ 1.15. Time-to-primary endpoint was significantly lower in patients with LVEF reduction ≥5% on stress study (67.99 (95% CI 60.49-75.49) vs. 77.56 months (95% CI 75.14-79.99); p = 0.003) and in patients with stress/rest end-systolic volume ratio ≥ 1.15 (68.39 (95% CI 60.69-76.10) vs. 77.31 months (95% ICCI 74.68-79.76); p = 0.013). CONCLUSION In patients with normal perfusion on SPECT-MPI, the incidence of significant CAD was significantly higher in those with LVEF reduction ≥ 5% on stress study and in those with a stress/rest end-systolic volume ratio ≥ 1.15, during a follow-up period of five years.
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Naghshtabrizi B, Alvandi M, Shaghaghi Z, Hadei SK, Fariba F, Moradi M, Rabie MAS. Transient ischemic dilation or transient RV visualization in patients with normal SPECT stress myocardial perfusion imaging: Correlation with CT coronary artery calcium scoring and coronary angiography. J Nucl Cardiol 2022; 29:2149-2156. [PMID: 34228333 DOI: 10.1007/s12350-021-02704-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 05/17/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Ancillary findings on MPI, such as transient ischemic dilation (TID) and transient right ventricular visualization (TRV), are recognized as markers of extensive CAD and predictive of adverse outcomes. They usually occur in association with stress-induced regional MPI abnormalities. However, the clinical significance of these ancillary markers in the presence of normal stress MPI is incompletely understood. METHODS From a cohort of 564 consecutive patients referred for clinical SPECT stress MPI, 44 patients had normal stress SPECT MPI and either TID (n = 28) or TRV (n = 16). These imaging findings were correlated with CT coronary calcium (CAC), CT coronary angiography (CTA), and invasive coronary angiography (ICA) in patients with severe CAC ≥ 1000 HU. TID and TRV were quantified as stress/rest ratios. Severe CAD was defined as > 70% luminal stenosis on CTA or ICA. RESULTS The median TID ratio was 1.23, with a range of 1.13-1.48; the median TRV ratio was 1.30, with a range of 1.20-1.48. Of 44 patients with TID or TRV, only 9 patients (20.5%) had severe obstructive > 70% CAD by angiography (6 of 28 patients (21.5%) with TID and 3 of 16 patients (19%) with TRV). Severe multi-vessel CAD occurred in only 2 of 44 patients (4.5%). In contrast, of 9 patients with CAC > 1000 HU, 6 (67%) had severe obstructive CAD. CONCLUSION In patients with normal stress SPECT MPI and TID or TRV, the incidence of severe obstructive CAD was relatively low and predominantly single-vessel CAD. These findings do not support the concept that TID or TRV with normal stress MPI is predictive of high-risk CAD.
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Affiliation(s)
- Behshad Naghshtabrizi
- Department of Cardiology, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Maryam Alvandi
- Department of Nuclear Medicine and Molecular Imaging, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran.
| | - Zahra Shaghaghi
- Department of Nuclear Medicine and Molecular Imaging, Clinical Development Research Unit of Farshchian Heart Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Seyed Kamaledin Hadei
- Department of Radiology, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Farnaz Fariba
- Department of Cardiology, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Mehdi Moradi
- Department of Cardiology, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
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Wong JJJ, Yew MS. Implications of transient ischemic dilatation and impaired left ventricular ejection fraction reserve in patients with normal stress myocardial perfusion imaging and elevated coronary artery calcium. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2022; 38:1651-1658. [PMID: 38819545 DOI: 10.1007/s10554-022-02549-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 02/01/2022] [Indexed: 11/05/2022]
Abstract
PURPOSE Guidelines recommend stress only (SO) myocardial perfusion imaging (MPI) without follow-up rest imaging if perfusion and left ventricular ejection fraction (LVEF) are normal. However additional rest imaging may show transient ischaemic dilation (TID) and/or impaired LVEF reserve (iLVEFr) suggestive of 'balanced ischemia'. Concurrent coronary artery calcium (CAC) scoring helps to identify subclinical atherosclerosis. The safety of SO MPI when CAC is elevated is unclear. We aim to assess the incidence and outcomes of TID and iLVEFr amongst stress/rest MPIs with normal SO images and elevated CAC. METHODS Retrospective analysis of normal stress/rest MPIs performed between 1 March 2016 to 31 January 2017 with concurrently measured CAC >300. Cases were stratified by presence of TID and/or iLVEFr. Major adverse cardiac events (MACE, defined as cardiac death, non-fatal myocardial infarction and revascularization) within 24 months were compared. RESULTS There were 230 cases included of which 43 (18.7%) had TID and/or iLVEFr. Presence of TID and/or iLVEFr was associated with higher 24-month MACE (23.3 vs. 8.6%, p = 0.013), driven by more elective revascularizations (18.6 vs. 4.3%, p = 0.001). Cardiac death and non-fatal myocardial infarction rates were similar. TID and/or iLVEFr significantly predicted overall MACE after multivariate analysis (OR 2.933 [1.214 - 7.087], p = 0.017). CONCLUSIONS TID and/or iLVEFr is seen in the minority of normal stress MPI with elevated CAC, and is associated with higher 24-month MACE, driven by higher elective revascularizations. Overall cardiac death and non-fatal myocardial infarction rates were low and not significantly different between both groups.
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Affiliation(s)
| | - Min Sen Yew
- Department of Cardiology, Tan Tock Seng Hospital, 11 Jln Tan Tock Seng, 308433, Singapore, Singapore.
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5
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Gimelli A, Pugliese NR, Buechel RR, Bertasi M, Coceani M, Marzullo P. Changes in left ventricle myocardial volume during stress test using cadmium-zinc-telluride cardiac imaging: Implications in coronary artery disease. J Nucl Cardiol 2021; 28:1623-1633. [PMID: 31650497 DOI: 10.1007/s12350-019-01930-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 09/28/2019] [Accepted: 09/30/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Cadmium-zinc-telluride (CZT) SPECT allows the estimation of left ventricle myocardial volume (LVMV). We tested the clinical relevance of rest-stress LVMV changes (Δ LVMV) in detecting coronary artery disease (CAD, coronary stenosis > 70%), using CZT-SPECT. METHODS We prospectively enrolled 512 consecutive patients with known or suspected CAD (mean age: 70.3 ± 9.2 years, 72% male) for stress-rest myocardial perfusion imaging (MPI, single-day stress-rest protocol). We quantified summed stress scores (SSS), summed rest scores, and summed difference scores, together with LVMV and ejection fraction (EF) after stress and at rest. All patients underwent coronary angiography within 30 days. RESULTS Two hundred seventy-two patients had CAD at coronary angiography. ΔLVMV ≤ 5 mL, corresponding to 6% of change from rest LVMV, was the best predictor of CAD (AUC = 0.831, 79% sensitivity, 82% specificity), irrespective of the stress protocol (dipyridamole or exercise stress) and independently of MPI-SSS, LV EF, and clinical history (P = 0.004). Integrated discrimination improvement (IDI) and net reclassification improvement (NRI) were significant for the addition of ΔLVMV ≤ 5 mL (IDI = 6.1%, P < 0.0001; NRI = 29.7%, P = 0.02) to MPI-SSS, whereas the other parameters were not. CONCLUSIONS The evaluation of ΔLVMV using CZT-SPECT can improve the diagnostic accuracy in predicting the presence of CAD when added to conventional MPI.
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Affiliation(s)
| | - Nicola Riccardo Pugliese
- Department of Clinical and Experimental Medicine, University of Pisa, Fondazione CNR/Regione Toscana "Gabriele Monasterio", via Moruzzi n.1, 56124, Pisa, Italy.
| | - Ronny R Buechel
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Zurich, Switzerland
| | | | | | - Paolo Marzullo
- Fondazione Toscana G. Monasterio, Pisa, Italy
- CNR, Institute of Clinical Physiology, Pisa, Italy
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Juweid ME, Alhouri A, Baniissa B, Rimawi D, A-Risheq ZF, Rabadi N, Safi M, Akkawi M, Ismael AB, Alhanafi A, Alkhaldi S, Obeidat OS. Transient ischemic dilatation with adenosine 99mTc-sestamibi stress: prognostic significance in patients with normal myocardial perfusion. Ann Nucl Med 2021; 35:569-579. [PMID: 33689137 DOI: 10.1007/s12149-021-01599-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Accepted: 02/14/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To determine the significance of transient ischemic dilatation (TID) in patients with normal perfusion on adenosine stress/rest. METHODS We analyzed 430 consecutive patients with normal perfusion on 2-day adenosine stress/rest 99mTc-sestamibi. A group of 70 patients with Framingham 10-year coronary heart disease risk < 10% was used to derive abnormal TID thresholds (derivation group). The significance of TID at these thresholds was validated in the remaining 360 patients (validation group) followed for cardiac events for 31.2 ± 9.7 (mean ± SD) months. RESULTS Transient ischemic dilatation in the derivation group was 1.05 ± 0.13. Three definitions of an abnormal TID were used: > mean + 2SD (TID ≥ 1.32), > mean + 1SD (TID ≥ 1.19) and a TID in the group's highest quartile (TID ≥ 1.15). Of the 360 validation group patients, 12 (3.3%), 48 (13.3%) and 70 (19.4%) had TID ≥ 1.32, 1.19 and 1.15, respectively. Age, gender, family history of coronary artery disease (CAD), known CAD, smoking, hypertension, diabetes, dyslipidemia, rest LVEF, post-stress LVEF, ΔLVEF, ≥ 5% or 10% decrease in LVEF did not predict TID ≥ 1.32. However, TID ≥ 1.19 was predicted by rest LVEF and ≥ 5% decrease in LVEF (P = 0.04 and 0.02, respectively) and TID ≥ 1.15 was predicted by ≥ 5% decrease in LVEF (P = 0.02). Cardiac event-free survivals were similar in patients with a TID ≥ and < 1.32 (P = 0.68), ≥ and < 1.19 (P = 0.40) and ≥ and < 1.15 (P = 0.79). CONCLUSIONS Transient ischemic dilatation does not confer adverse prognosis in patients with normal perfusion on adenosine stress/rest 99mTc-sestamibi irrespective of the threshold used for its definition.
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Affiliation(s)
- Malik E Juweid
- Division of Nuclear Medicine, Department of Radiology and Nuclear Medicine, University of Jordan Hospital, University of Jordan, Queen Rania Street, Al Jubeiha, Amman, 11942, Jordan.
| | - Abdullah Alhouri
- Division of Cardiology, Department of Medicine, University of Jordan, Amman, Jordan
| | - Bayan Baniissa
- Division of Cardiology, Department of Medicine, University of Jordan, Amman, Jordan
| | | | - Ziad F A-Risheq
- Division of Nuclear Medicine, Department of Radiology and Nuclear Medicine, University of Jordan Hospital, University of Jordan, Queen Rania Street, Al Jubeiha, Amman, 11942, Jordan
| | - Nidal Rabadi
- Division of Nuclear Medicine, Department of Radiology and Nuclear Medicine, University of Jordan Hospital, University of Jordan, Queen Rania Street, Al Jubeiha, Amman, 11942, Jordan
| | - Mohannad Safi
- Division of Cardiology, Department of Medicine, University of Jordan, Amman, Jordan
| | - Mohammad Akkawi
- Division of Cardiology, Department of Medicine, University of Jordan, Amman, Jordan
| | - Anas Bany Ismael
- Division of Cardiology, Department of Medicine, University of Jordan, Amman, Jordan
| | - Aiman Alhanafi
- Division of Cardiology, Department of Medicine, University of Jordan, Amman, Jordan
| | - Saif Alkhaldi
- Division of Cardiology, Department of Medicine, University of Jordan, Amman, Jordan
| | - Omar S Obeidat
- Division of Cardiology, Department of Medicine, University of Jordan, Amman, Jordan
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Chen L, Zhang M, Jiang J, Lei B, Sun X. Coronary microvascular dysfunction: An important interpretation on the clinical significance of transient ischemic dilation of the left ventricle on myocardial perfusion imaging. JOURNAL OF X-RAY SCIENCE AND TECHNOLOGY 2021; 29:347-360. [PMID: 33492269 DOI: 10.3233/xst-200803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
PURPOSE To further investigate the clinical significance of transient ischemic dilation (TID) on myocardial perfusion imaging (MPI) by analyzing the effect of anisodamine hydrobromide (a drug that can effectively ameliorate microcirculation) on the patients with isolated TID and the findings of previous literatures. METHODS Total 107 patients with isolated TID (TID value≥1.11) were randomly divided into group A (n = 36; intravenous administration of anisodamine hydrobromide), group N (n = 36; intravenous administration of isosorbide dinitrate), and group C (n = 35; intravenous administration of normal saline). MPI and treadmill exercise test (TET) were performed again after 14-day course of intervention. Pre- and post-intervention frequencies of symptom were recorded. RESULTS In group A, after intervention of anisodamine hydrobromide, the summed stress score (SSS) and TID value on MPI significantly decreased than those before intervention (P < 0.001), the durations of exercise (DEs) and metabolic equivalents (METs) in TET notably ascended (P < 0.001), as well as the symptom remarkably improved. In group N and group C, there were no significant differences in SSS, TID value, DEs, METs, and frequencies of symptom between pre- and post-intervention (P > 0.05). No significant improvement of symptoms in group N before and after treatment. CONCLUSIONS TID with perfusion defect may usually predict a possibility of severe and extensive coronary artery disease (CAD). An isolated TID should be considered as a likelihood of coronary microvascular dysfunction (CMD). TET and coronary CT angiography (cCTA) are extremely helpful for the antidiastole on CAD and CMD. The administration of anisodamine hydrobromide might be an optional treatment for the patients with isolated TID.
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Affiliation(s)
- Liang Chen
- Department of Emergency, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Min Zhang
- Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Jinqi Jiang
- Department of Nuclear Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Bei Lei
- Department of Nuclear Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Xiaoyan Sun
- Department of Nuclear Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
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Serum metabolomics reveals the progression of coronary artery stenosis in patients with hypercholesterolemia: a pilot study. Blood Coagul Fibrinolysis 2019; 30:205-216. [PMID: 31157678 DOI: 10.1097/mbc.0000000000000819] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
: The current study explores potential characteristic metabolic signatures associated with the high cholesterol (CHO), and the progression of coronary artery stenosis (CAS) in high-CHO patients. A metabolomics strategy based on ultra high-performance liquid chromatography/MS-MS and multivariate statistics has been implemented to identify potential biomarkers in high-CHO patients with different levels of CAS. The current study included 57 individuals, comprising 17 healthy paticipants, and 40 high-CHO patients. The high CHO patients were subgrouped based on the computed tomography angiography results, that is, CHO+ no ART (n = 10), CHO+ ART less than 50% (n = 13), CHO+ ART 50-75% (n = 11), and CHO+ ART more than 75% (n = 6). After metabolomics study, 16 discriminating metabolites in positive ion mode and 17 discriminating metabolites in negative ion mode were regarded as possible biomarker candidates to reflect metabolic traits differences between patients with healthy subjects and CHO. A total of six metabolites were tentatively identified as potential biomarkers for the progression diagnosis of CAS: three lysophosphatidylcholines (Lyso-phosphocholine, lysoPC and Lysopersicon esculentum, lysoPE), proline betaine and tryptophan, and prasterone sulfate. The results demonstrated that tryptophan and proline betaine could differentiate the patients with or without high CHO. Tryptophan, prasterone sulfate, LysoPE (0 : 0/18 : 2) or LysoPE (18 : 2/0 : 0), and LysoPE (0 : 0/18 : 1) or LysoPE (18 : 1/0 : 0) could differentiate the patients with severe stenosis (ART > 70%) from the healthy or mild stenosis ones. Proline betaine and significant decrease of LysoPC (17 : 0) could also be a promising biomarker for the mild stenosis (ART < 50%).
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Camm CF, Emery A, Rose-Innes E, Pavlitchouk S, Sabharwal N, Kelion AD. How variable are the volumetric measurements from gated perfusion SPECT when a one-day stress-rest protocol is used? J Nucl Cardiol 2019; 26:1709-1716. [PMID: 29546491 PMCID: PMC6775029 DOI: 10.1007/s12350-018-1253-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Accepted: 02/20/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND Using myocardial perfusion scintigraphy (MPS), an increase in left ventricular (LV) volumes or a decrease in ejection fraction (EF) from rest to stress may be clinically important. The variation in these measures between the low-dose stress acquisition and high-dose rest acquisition in a one-day stress-rest protocol has not been established. We assessed the reproducibility of gated volumetric indices between stress and rest and the normal variation in ungated TID ratio for a one-day stress-rest 99mTc-tetrofosmin protocol. METHODS Two thousand and one hundred and fifty eight (2158) 99mTc-tetrofosmin MPS patient studies were analyzed retrospectively. Studies were excluded for incomplete data, significant technical difficulties, or (for gated analysis but not for analysis of TID ratio) if the LV EF was > 75%. An analysis of gated data was undertaken to establish the reproducibility of ventricular volumes and EF between stress and rest scans. Ungated volume data were analyzed to determine the confidence limits of TID ratio according to ventricular volume. RESULTS Gated data were analyzed for 621 patients without inducible hypoperfusion. Mean EF at rest was slightly higher than after stress (62.4% ± 10.3% vs 61.2% ± 10.4%, P < 0.001), and the standard deviation of the difference was 5.2% (95% CI 4.9% to 5.5%). Ungated volumes were available for 992 non-ischaemic patients. The upper 95% CI for TID ratio was 1.23. This increased from 1.20 to 1.37 between the highest and lowest deciles of rest ungated volume. CONCLUSION Using a one-day stress-rest 99mTc-tetrofosmin protocol, a fall in LV EF between rest and stress of > 11.6% or a TID ratio of > 1.23 is likely to be clinically reliable. The upper limit of normal for TID ratio needs to be increased for patients with small LV chamber volumes.
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Affiliation(s)
- C. Fielder Camm
- Radcliffe Department of Medicine, University of Oxford, Oxford, UK
- Department of Cardiology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | | | | | - Sergei Pavlitchouk
- Department of Cardiology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Nikant Sabharwal
- Department of Cardiology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Andrew D. Kelion
- Department of Cardiology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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Adenosine single-photon emission computed tomography-derived transient ischemic dilatation and ejection fraction reserve fail to predict multivessel coronary artery disease. Nucl Med Commun 2019; 40:773-774. [DOI: 10.1097/mnm.0000000000001033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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11
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Sharir T. Transient ischemic dilation: An old but not obsolete marker of extensive coronary artery disease. J Nucl Cardiol 2018; 25:738-741. [PMID: 28975548 DOI: 10.1007/s12350-017-1082-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Accepted: 09/05/2017] [Indexed: 10/18/2022]
Affiliation(s)
- Tali Sharir
- Department of Nuclear Cardiology, Assuta Medical Center, 96 Igal Alon, C Building, 67891, Tel Aviv, Israel.
- Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheba, Israel.
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Rubio M, Dias A, Koshkelashvili N, Codolosa JN, Jalife-Bucay M, Rodriguez-Ziccardi M, Amanullah AM. Transient Ischemic Dilation Ratio in Regadenoson, Single Isotope Gated Single-photon Emission Computed Tomography Myocardial Perfusion Imaging. World J Nucl Med 2017; 16:218-222. [PMID: 28670181 PMCID: PMC5460306 DOI: 10.4103/1450-1147.207282] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Single isotope 99mTc single-photon emission computed tomography-myocardial perfusion imaging (SPECT-MPI) is the most commonly used protocol for nuclear stress testing. Transient ischemic dilation of the left ventricle (TID) has been considered a specific marker of severe coronary artery disease (CAD). Recent publications have questioned the clinical utility of TID, specifically with regadenoson as a stressor and 4DM-SPECT software for TID analysis. These findings have not been demonstrated using other imaging packages. The goal of our study was to establish the TID threshold in the identification of Multi-vessel CAD using Quantitative Perfusion SPECT (QPS) software. Included in this study are 190 patients that had undergone regadenoson-stress, same day, single-isotope 99mTc MPI and had a coronary angiography within a designated 3-month period. QPS (Cedars-Sinai, LA, CA) automated image analysis software was used to calculate TID ratios which were compared across different CAD categories. Coronary angiograms were reviewed to identify both obstructive and nonobstructive CAD. The mean TID for patients with nonobstructive CAD (n = 91) was 1.02 ± 0.11, and the threshold for TID was 1.24. A receiver operating characteristic curve showed that TID had a poor discriminatory capacity to identify MVD (area under the curve 0.58) with a sensitivity of 3% and a specificity of 97%. In our study with regadenoson MPI in a predominantly African-American population, TID was found to be a poor predictor of MVD using QPS software. The reason is unclear but possibly related to the significant decline in the prevalence of severe CAD in the area where our study took place.
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Affiliation(s)
- Manolo Rubio
- Department of Medicine, Einstein Medical Center, Philadelphia, PA, USA
| | - Andre Dias
- Institute for Heart and Vascular Health, Einstein Medical Center, Philadelphia, PA, USA
| | | | - Jose N Codolosa
- Institute for Heart and Vascular Health, Einstein Medical Center, Philadelphia, PA, USA
| | | | | | - Aman M Amanullah
- Institute for Heart and Vascular Health, Einstein Medical Center, Philadelphia, PA, USA
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Makrilakis K, Liatis S. Cardiovascular Screening for the Asymptomatic Patient with Diabetes: More Cons Than Pros. J Diabetes Res 2017; 2017:8927473. [PMID: 29387731 PMCID: PMC5745704 DOI: 10.1155/2017/8927473] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 10/17/2017] [Accepted: 11/05/2017] [Indexed: 12/29/2022] Open
Abstract
Diabetes mellitus is associated with an increased risk of coronary heart disease (CHD) morbidity and mortality. Although it frequently coexists with other cardiovascular disease (CVD) risk factors, it confers an increased risk for CVD events on its own. Coronary atherosclerosis is generally more aggressive and widespread in people with diabetes (PWD) and is frequently asymptomatic. Screening for silent myocardial ischaemia can be applied in a wide variety of ways. In nearly all asymptomatic PWD, however, the results of screening will generally not change medical therapy, since aggressive preventive measures, such as control of blood pressure and lipids, would have been already indicated, and above all, invasive revascularization procedures (either with percutaneous coronary intervention or coronary artery bypass grafting) have not been shown in randomized clinical trials to confer any benefit on morbidity and mortality. Still, unresolved issues remain regarding the extent of the underlying ischaemia that might affect the risk and the benefit of revascularization (on top of optimal medical therapy) in ameliorating this risk in patients with moderate to severe ischaemia. The issues related to the detection of coronary atherosclerosis and ischaemia, as well as the studies related to management of CHD in asymptomatic PWD, will be reviewed here.
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Affiliation(s)
- Konstantinos Makrilakis
- First Department of Propaedeutic Internal Medicine, National and Kapodistrian University of Athens Medical School, Laiko General Hospital, Athens, Greece
| | - Stavros Liatis
- First Department of Propaedeutic Internal Medicine, National and Kapodistrian University of Athens Medical School, Laiko General Hospital, Athens, Greece
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Hämäläinen H, Hedman M, Laitinen T, Hedman A, Kivelä A, Laitinen T. Reference values for left ventricular systolic synchrony according to phase analysis of ECG-gated myocardial perfusion SPECT. Clin Physiol Funct Imaging 2016; 38:38-45. [PMID: 27453042 DOI: 10.1111/cpf.12379] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Accepted: 05/13/2016] [Indexed: 11/27/2022]
Abstract
BACKGROUND The aim of this study was to define reference values for left ventricular systolic synchrony and for the volume parameters of the left ventricle using myocardial perfusion SPECT-derived phase analysis method. METHODS We evaluated data of 433 patients who underwent myocardial perfusion SPECT/CT during January 2012-February 2013 in Kuopio University Hospital. The final study population consisted of 52 patients (aged 42-84 years) who met the criteria: (1) no previously diagnosed cardiac disease, (2) normal ECG at rest, (3) no advanced coronary artery disease in CT and 4) normal myocardial perfusion in stress/rest myocardial perfusion SPECT/CT. The severity of mechanical dyssynchrony was assessed by phase analysis of gated myocardial SPECT at stress stage after pharmacological exercise and at rest using Quantitative Gated SPECT (QGS) software. Volume parameters of the left ventricle were also assessed. RESULTS The phase histogram bandwidth at rest was 28.0 [63.7] degrees (median [95th percentile]). The standard deviation of phase histogram at rest was 7.8 [26.5] degrees. Entropy at the rest study was 54.0 [63.7] %. All left ventricular dyssynchrony parameters were statistically significantly higher at stress compared to rest. There were no statistically significant differences in dyssynchrony values between men and women. In volume parameters, reference values in male were expectedly higher than in female. Cardiac output did not differ significantly between genders. CONCLUSION In subjects without signs of cardiac diseases, the left ventricular systolic function is well synchronized. Phase analysis measurement does not depend on gender, age, BMI or blood pressure, but the values of dyssynchrony parameters increase during pharmacological stress.
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Affiliation(s)
- Hanna Hämäläinen
- Department of Clinical Physiology and Nuclear Medicine, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland
| | - Marja Hedman
- Department of Clinical Physiology and Nuclear Medicine, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland
| | - Tiina Laitinen
- Department of Clinical Physiology and Nuclear Medicine, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland
| | - Antti Hedman
- Heart Center, Kuopio University Hospital, Kuopio, Finland
| | - Antti Kivelä
- Heart Center, Kuopio University Hospital, Kuopio, Finland
| | - Tomi Laitinen
- Department of Clinical Physiology and Nuclear Medicine, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland
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Vliegenthart R, De Cecco CN, Wichmann JL, Meinel FG, Pelgrim GJ, Tesche C, Ebersberger U, Pugliese F, Bamberg F, Choe YH, Wang Y, Schoepf UJ. Dynamic CT myocardial perfusion imaging identifies early perfusion abnormalities in diabetes and hypertension: Insights from a multicenter registry. J Cardiovasc Comput Tomogr 2016; 10:301-8. [DOI: 10.1016/j.jcct.2016.05.005] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Revised: 05/17/2016] [Accepted: 05/22/2016] [Indexed: 11/27/2022]
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Nakanishi R, Gransar H, Slomka P, Arsanjani R, Shalev A, Otaki Y, Friedman JD, Hayes SW, Thomson LEB, Fish M, Germano G, Abidov A, Shaw L, Rozanski A, Berman DS. Predictors of high-risk coronary artery disease in subjects with normal SPECT myocardial perfusion imaging. J Nucl Cardiol 2016; 23:530-41. [PMID: 25971987 PMCID: PMC6377163 DOI: 10.1007/s12350-015-0150-3] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Revised: 03/30/2015] [Indexed: 11/25/2022]
Abstract
BACKGROUND While uncommon, normal stress SPECT myocardial perfusion imaging (MPI) can be seen in patients with high-risk coronary artery disease (CAD) by invasive coronary angiography (ICA).The predictors of high-risk CAD in patients with normal SPECT-MPI have not been described. METHODS We studied 580 patients (age 64 ± 12 years, 49% men) without known CAD who underwent stress-gated SPECT-MPI [exercise (41%) or vasodilator (59%)] <2 months before ICA and had summed stress score (SSS) <4. High-risk CAD was defined as 3 vessels with ≥70% stenosis, 2 vessels with ≥70% stenosis including proximal left anterior descending, or left main with ≥50% stenosis. Obstructive non-high-risk CAD was defined by the presence of a ≥70% stenosis but without having other high-risk criteria. Tenfold cross-validated receiver operating characteristic (ROC) estimates were obtained to assess the predictors of high-risk CAD. RESULTS Forty-two subjects (7.2%) had high-risk CAD and 168 (29.0%) had obstructive non-high-risk CAD. Variables associated with high-risk CAD were pretest probability of CAD ≥66% (Odds ratio [OR] 3.63, 95% CI 1.6-8.3, P = .002), SSS > 0 (OR 7.46, 95% CI 2.6-21.1, P < 0.001), and abnormal TID (OR 2.16, 95% CI 1.0-4.5, P = 0.044). When substituted for TID, EF change was also predictive of high-risk CAD (OR 0.93, 95% CI 0.9-1.0, P = 0.023). The prevalence of high-risk CAD increased as the number of these predictors increased. In a sub-analysis of patients in whom quantitative total perfusion deficit (TPD) was available, TPD > 0 was also a predictor of high-risk CAD (OR 6.01, 95% CI 1.5-22.2, P = 0.011). CONCLUSION Several clinical, stress, and SPECT-MPI findings are associated high-risk CAD among patients with normal SPECT-MPI. Consideration of these factors may improve the overall assessment of the likelihood of high-risk CAD in patients undergoing stress SPECT-MPI.
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Affiliation(s)
- Rine Nakanishi
- Departments of Imaging and Medicine, Cedars-Sinai Heart Institute, Cedars Sinai Medical Center, 8700 Beverly Boulevard, Los Angeles, CA, 90048, USA
| | - Heidi Gransar
- Departments of Imaging and Medicine, Cedars-Sinai Heart Institute, Cedars Sinai Medical Center, 8700 Beverly Boulevard, Los Angeles, CA, 90048, USA
| | - Piotr Slomka
- Departments of Imaging and Medicine, Cedars-Sinai Heart Institute, Cedars Sinai Medical Center, 8700 Beverly Boulevard, Los Angeles, CA, 90048, USA
| | - Reza Arsanjani
- Departments of Imaging and Medicine, Cedars-Sinai Heart Institute, Cedars Sinai Medical Center, 8700 Beverly Boulevard, Los Angeles, CA, 90048, USA
| | - Aryeh Shalev
- Departments of Imaging and Medicine, Cedars-Sinai Heart Institute, Cedars Sinai Medical Center, 8700 Beverly Boulevard, Los Angeles, CA, 90048, USA
| | - Yuka Otaki
- Departments of Imaging and Medicine, Cedars-Sinai Heart Institute, Cedars Sinai Medical Center, 8700 Beverly Boulevard, Los Angeles, CA, 90048, USA
| | - John D Friedman
- Departments of Imaging and Medicine, Cedars-Sinai Heart Institute, Cedars Sinai Medical Center, 8700 Beverly Boulevard, Los Angeles, CA, 90048, USA
| | - Sean W Hayes
- Departments of Imaging and Medicine, Cedars-Sinai Heart Institute, Cedars Sinai Medical Center, 8700 Beverly Boulevard, Los Angeles, CA, 90048, USA
| | - Louise E B Thomson
- Departments of Imaging and Medicine, Cedars-Sinai Heart Institute, Cedars Sinai Medical Center, 8700 Beverly Boulevard, Los Angeles, CA, 90048, USA
| | - Mathews Fish
- Oregon Heart and Vascular Institute, Sacred Heart Medical Center, Springfield, OR, USA
| | - Guido Germano
- Departments of Imaging and Medicine, Cedars-Sinai Heart Institute, Cedars Sinai Medical Center, 8700 Beverly Boulevard, Los Angeles, CA, 90048, USA
| | - Aiden Abidov
- Sarver Heart Center, University of Arizona College of Medicine, Tucson, AZ, USA
| | - Leslee Shaw
- Department of Medicine, Emory University, Atlanta, GA, USA
| | - Alan Rozanski
- Division of Cardiology, St. Luke's Roosevelt Hospital, New York, NY, USA
| | - Daniel S Berman
- Departments of Imaging and Medicine, Cedars-Sinai Heart Institute, Cedars Sinai Medical Center, 8700 Beverly Boulevard, Los Angeles, CA, 90048, USA.
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA.
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Kartamihardja AHS. Correlation between Transient Ischemic Dilation Index and Endothelin-1 Level in Patients with Type 2 Diabetes Mellitus. World J Nucl Med 2016; 15:109-13. [PMID: 27134561 PMCID: PMC4809151 DOI: 10.4103/1450-1147.167576] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Transient ischemic dilation (TID) is a sensitive and specific marker for detecting the severity and extent of coronary artery disease (CAD), which is closely associated with endothelial dysfunction. TID can be observed on stress-rest myocardial perfusion scan (MPS) due to subendocardial hypoperfusion. Hyperglycemia in type 2 diabetes mellitus (T2DM) could lead to micro- and macrovascular complications and begins with endothelial dysfunction. Endothelin-1 (ET-1), a potent vasocontrictor, increases in endothelial dysfunction. The aim of this study was to examine the correlation between TID index and ET-1 levels in T2DM patients without any sign or symptom of cardiovascular complication. An analytic-correlational cross-sectional study was done on T2DM patients who met the inclusion criteria and agreed to participate by signing an informed consent form. The TID index was calculated automatically using standard software provided by the gamma camera GE-Infinia. Stress-rest MPS was done using technetium-99m ((99m)Tc)-tetrofosmin and a pharmacological stress test using adenosine. The ET-1 level was determined by radioimmunoassay. Data distribution was analyzed using the Shapiro-Wilk normality test. The Mann-Whitney test was used to compare the average difference of the variables and Spearman's rank for correlation analysis. A total of 47 subjects consisting of 24 (51%) males and 23 (49%) females were included in this study. The age range was 37-74 years (54.3 ± 8.4). The TID index range was 0.86-1.26 (median = 1.12) and abnormal TID index was found in 23/47 (49%) subjects. ET-1 levels range 8.02-17.91 pg/mL (median = 11.08). The results showed no significant differences in age, ET-1 levels, and TID index based on age and sex (P > 0.05). There was a significant positive correlation between TID index and ET-1 level with r = 0.7 and P < 0.001. There was a positive correlation between TID index and ET-1 plasma level in patients with T2DM.
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Bourque JM. Contemporary relevance of TID: Based on the company it keeps. J Nucl Cardiol 2015; 22:535-8. [PMID: 25832984 PMCID: PMC5485415 DOI: 10.1007/s12350-015-0122-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Accepted: 03/11/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Jamieson M Bourque
- Cardiovascular Division and the Cardiovascular Imaging Center, Department of Medicine, University of Virginia Health System, Box 800158, 1215 Lee Street, Charlottesville, VA, 22908, USA,
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Prognostic and Diagnostic Implications of Nonperfusion Data on SPECT Myocardial Perfusion Imaging. CURRENT CARDIOVASCULAR IMAGING REPORTS 2015. [DOI: 10.1007/s12410-014-9307-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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