Usefulness of thallium-201 for distinction of ischemic from idiopathic dilated cardiomyopathy

Tauberg, Stuart G.; Orie, Judith E.; Bartlett, Bruce E.; Cottington, Eric; Flores, Angel R.

doi:10.1016/0002-9149(93)91009-7

Cited by 49 publications

(14 citation statements)

References 21 publications

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“…Regional wall motion at rest might be abnormal in as many as two thirds of patients with nonischemic cardiomyopathy, whereas patients with ischemic cardiomyopathy might have uniform hypokinesis. 2 Dobutamine stress echocardiography and thallium scintigraphy detect coronary artery disease (CAD) in dilated cardiomyopathy with greater accuracy than does resting echocardiography, [3][4][5][6] but both techniques might give conflicting results. 7 Moreover, their performance in cases with coexisting left bundlebranch block (LBBB) has been disappointing; scintigraphy might give false-positive anteroseptal and septal perfusion defects, 8 whereas conventional wall-motion analysis might be degraded.…”

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confidence: 99%

Differentiation of Ischemic From Nonischemic Cardiomyopathy During Dobutamine Stress by Left Ventricular Long-Axis Function

et al. 2003

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Background-Resting regional wall-motion abnormalities do not reliably distinguish ischemic from nonischemic cardiomyopathy. Dobutamine stress echocardiography with use of the wall-motion score index (WMSI) identifies coronary artery disease (CAD) in dilated cardiomyopathy (DCM), but the technique is subjective and further complicated by left bundle-branch block (LBBB). Long-axis motion is sensitive to ischemia and can be assessed quantitatively. We aimed to compare long-axis function with WMSI for detecting CAD in DCM with or without LBBB. Methods and Results-Seventy-three patients with DCM, 48 with CAD (16 with LBBB), and 25 without CAD (10 with LBBB) were studied. Long-axis M-mode, pulsed-wave tissue Doppler echograms (lateral, septal, and posterior walls), and WMSI were assessed at rest and at peak dobutamine stress. Failure to increase systolic amplitude (total amplitude minus postejection shortening) by 2 mm or early diastolic velocity by 1.1 cm/s was the best discriminator for CAD (systolic amplitude, sensitivity 85%, specificity 86%; lengthening velocity, 71% and 94%, respectively; PϭNS). Both had greater predictive accuracy than did WMSI (sensitivity 67%, specificity 76%; PϽ0.001). The predictive accuracy of changes in septal long-axis function was similar to those of average long-axis function (systolic amplitude cutoffϭ1.5 mm, lengthening velocity cutoffϭ1.5 cm/s). However in LBBB, systolic amplitude proved to be the only significant discriminator for CAD, with sensitivity and specificity reaching 94% and 100%, respectively (PϽ0.01 versus early diastolic lengthening velocity). Conclusions-Quantified stress long-axis function identifies CAD in DCM with greater sensitivity and specificity than does standard WMSI, particularly in the presence of LBBB.

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confidence: 99%

Differentiation of Ischemic From Nonischemic Cardiomyopathy During Dobutamine Stress by Left Ventricular Long-Axis Function

et al. 2003

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“…Prior scintigraphic studies, all based on visual analysis, have observed that patients with ischemic cardiomyopathy tend to have myocardial perfusion defects of more substantial mag- nitude than do patients with nonischemic cardiomyopathy. [8][9][10][11][12][13][14][15][16][17] Because of the subjective nature of visual analysis, such studies do not provide objective guidelines for interpreting the results in any given patient. Hence, a quantitative approach to measuring perfusion defects was developed in this study.…”

Section: Discussionmentioning

confidence: 99%

“…In this current and in prior studies, the presence of defect reversibility was not found to be a reliable discriminator of ischemic from nonischemic cardiomyopathy. 9,10,16 Group: Retrospective (top) Prospective ( …”

Section: Study Limitationsmentioning

confidence: 99%

Prospective validation of a quantitative method for differentiating ischemic versus nonischemic cardiomyopathy by technetium‐99m sestamibi myocardial perfusion single‐photon emission computed tomography

Yao

Qureshi

Nichols

et al. 2004

Clinical Cardiology

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SummaryBackground: Myocardial perfusion single-photon emission computed tomography (SPECT) permits assessment of stress perfusion and resting left ventricular (LV) function. Quantitative analysis of perfusion patterns among patients with LV dysfunction offers an opportunity for developing criteria to differentiate ischemic from nonischemic cardiomyopathy.Hypothesis: Quantitative assessment of SPECT may allow differentiation between ischemic and nonischemic cardiomyopathy.Methods: We evaluated 144 patients with LV ejection fraction ≤ 40%, divided into 63 patients with nonischemic and 81 with ischemic cardiomyopathy. Mean relative myocardial counts were obtained for regions drawn over defect and normal zones on rest and stress polar perfusion maps.Results: Multivariate logistic regression analysis of significant univariate SPECT predictors of ischemic cardiomyopathy revealed that the stress defect severity ratio (SDSR) was the best predictor of ischemic cardiomyopathy (p < 0.0001). By receiver operator characteristic (ROC) curve analysis, an SDSR of ≤ 45% optimized prediction of ischemic cardiomy-

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“…Thus, severely reduced myocardial perfusion might be an optimizing predictor for differentiating patients with ischemic LV dysfunction from those with severe LV dysfunction. Several studies reported that the extent, severity, and reversibility of myocardial perfusion determined by scintigraphy indicate a high likelihood of ischemic LV dysfunction [17,18]. However, the overlap in myocardial perfusion between ischemic LV dysfunction and nonischemic LV dysfunction has limited the applicability of such non-invasive methods as defi nitive diagnostic tools.…”

Section: Regional Wall Motionmentioning

confidence: 99%

“…In this study, we used QGS to assess only the diastolic image to minimize the partial volume effect [10], and thus minimize the overlap of myocardial perfusion between ischemic LV dysfunction and nonischemic LV dysfunction. The usefulness of stress ECG-gated SPECT in differentiating ischemic LV dysfunction from non-ischemic LV dysfunction has been reported, and it has been proved that exercise or dipyridamole perfusion imaging can differentiate patients with LV dysfunction [8,9,17,18]. However, the patients with LV dilatation and depressed systolic function often suffer uncontrollable or underlying congestive heart failure, and thus, there is reluctance to perform stress perfusion imaging for fear of worsening congestion.…”

Section: Regional Wall Motionmentioning

confidence: 99%

Non-invasive detection of ischemic left ventricular dysfunction using rest gated SPECT: expectation of simultaneous evaluation of both myocardial perfusion and wall motion abnormality

et al. 2008

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Usefulness of thallium-201 for distinction of ischemic from idiopathic dilated cardiomyopathy

Cited by 49 publications

References 21 publications

Differentiation of Ischemic From Nonischemic Cardiomyopathy During Dobutamine Stress by Left Ventricular Long-Axis Function

Differentiation of Ischemic From Nonischemic Cardiomyopathy During Dobutamine Stress by Left Ventricular Long-Axis Function

Prospective validation of a quantitative method for differentiating ischemic versus nonischemic cardiomyopathy by technetium‐99m sestamibi myocardial perfusion single‐photon emission computed tomography

Non-invasive detection of ischemic left ventricular dysfunction using rest gated SPECT: expectation of simultaneous evaluation of both myocardial perfusion and wall motion abnormality

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