Transient ischemic dilation ratio of the left ventricle is a significant predictor of future cardiac events in patients with otherwise normal myocardial perfusion SPECT
Abstract:An entirely normal stress MPS study does not always imply an excellent prognosis. In patients with otherwise normal MPS, TID is an independent and incremental prognostic marker of TE even after significant clinical variables--age, typical angina, and diabetes--are accounted for. When TID is present, caution in making low-risk prognostic statements may be warranted, especially in patients with typical angina, the elderly, and diabetics. Our findings also appear to apply to the broader population of "normal" MPS… Show more
“…An additional limitation may be the fact that our definition of normal MPI was mainly based on normal findings of perfusion and rest LVEF, as our protocol with scanning late after adenosine stress does not allow us to benefit from the increased diagnostic49 and prognostic23 value of TID or stress-induced wall motion abnormalities for identifying CAD. However, the prevalence of CAC >1000 in normal SPECT MPI approximates 7% at our institution, comparing favourably with the reported range of 9–11% 10 16 17.…”
In patients with normal SPECT MPI, a CAC >1000 confers a high diagnostic added value for detecting CAD. This is not solely based on unmasking balanced ischaemia due to epicardial 3-VD, as it occurred predominantly in patients with 1-VD and 2-VD. Methods: 50 patients with suspected CAD and normal stress/rest SPECT MPI and CAC >1000 prospectively underwent invasive coronary angiography as standard of reference. Coronary lesions with ≥50% luminal diameter narrowing on invasive coronary angiography were considered as significant stenosis.
Results:The median total CAC was 1975 (range 1018-8046). In 37/50 (74%) patients coronary angiography revealed 1-vessel disease (VD) (n = 15), 2-VD (n = 10) or 3-VD (n = 12). Twenty-six revascularizations (percutaneous coronary intervention/ coronary artery bypass grafting) were performed in 7 (6/1), 7 (6/1) and 12 (7/5) patients with 1-VD, 2-VD and 3-VD, respectively.
Conclusions:In patients with normal SPECT MPI a CAC >1000 confers a high diagnostic added value for detecting CAD. This is not solely based on unmasking balanced ischemia due to epicardial 3-VD as it occurred predominately in patients with 1-VD and 2-VD.
“…An additional limitation may be the fact that our definition of normal MPI was mainly based on normal findings of perfusion and rest LVEF, as our protocol with scanning late after adenosine stress does not allow us to benefit from the increased diagnostic49 and prognostic23 value of TID or stress-induced wall motion abnormalities for identifying CAD. However, the prevalence of CAC >1000 in normal SPECT MPI approximates 7% at our institution, comparing favourably with the reported range of 9–11% 10 16 17.…”
In patients with normal SPECT MPI, a CAC >1000 confers a high diagnostic added value for detecting CAD. This is not solely based on unmasking balanced ischaemia due to epicardial 3-VD, as it occurred predominantly in patients with 1-VD and 2-VD. Methods: 50 patients with suspected CAD and normal stress/rest SPECT MPI and CAC >1000 prospectively underwent invasive coronary angiography as standard of reference. Coronary lesions with ≥50% luminal diameter narrowing on invasive coronary angiography were considered as significant stenosis.
Results:The median total CAC was 1975 (range 1018-8046). In 37/50 (74%) patients coronary angiography revealed 1-vessel disease (VD) (n = 15), 2-VD (n = 10) or 3-VD (n = 12). Twenty-six revascularizations (percutaneous coronary intervention/ coronary artery bypass grafting) were performed in 7 (6/1), 7 (6/1) and 12 (7/5) patients with 1-VD, 2-VD and 3-VD, respectively.
Conclusions:In patients with normal SPECT MPI a CAC >1000 confers a high diagnostic added value for detecting CAD. This is not solely based on unmasking balanced ischemia due to epicardial 3-VD as it occurred predominately in patients with 1-VD and 2-VD.
“…47 In addition to perfusion imaging and LV function, transient LV dilation (transient ischaemic dilation—TID) may be appreciated on stress SPECT imaging, marking adverse prognosis. 48 Transient ischaemic dilation may either represent true dilation as a result of severe coronary disease and stunning, or rather may reflect sub-endocardial defects not appreciated on perfusion imaging. 49 Figure 7Imaging in chronic ischaemia: ( A ) cardiac magnetic resonance first pass perfusion demonstrating mid-ventricular anterior and septal abnormality.…”
Section: Taxonomy For Myocardial Segmentsmentioning
The terms used to describe different states of myocardial health and disease are poorly defined. Imprecision and inconsistency in nomenclature can lead to difficulty in interpreting and applying trial outcomes to clinical practice. In particular, the terms ‘viable’ and ‘hibernating’ are commonly applied interchangeably and incorrectly to myocardium that exhibits chronic contractile dysfunction in patients with ischaemic heart disease. The range of inherent differences amongst imaging modalities used to define myocardial health and disease add further challenges to consistent definitions. The results of several large trials have led to renewed discussion about the classification of dysfunctional myocardial segments. This article aims to describe the diverse myocardial pathologies that may affect the myocardium in ischaemic heart disease and cardiomyopathy, and how they may be assessed with non-invasive imaging techniques in order to provide a taxonomy of myocardial dysfunction.
“…"Transient ischemic dilation" (TID) of the left ventricular cavity is a marker of severe coronary artery disease and adverse outcomes [12,13]. Elevated TID measures have also been correlated with cardiac events in individuals with normal perfusion patterns [14].…”
Background: Transient arrhythmias can affect transient ischemic dilation (TID) ratios. This study was initiated to evaluate the frequency and effect of normal heart rate change on TID measures in routine clinical practice.
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