CLINICAL RESEARCH: CARDIAC IMAGING
Transient ischemic dilation ratio of the left ventricle is a significant predictor of future cardiac events in patients with otherwise normal myocardial perfusion SPECT
Aiden Abidov, MD, PhD*,
Jeroen J. Bax, MD ,
Sean W. Hayes, MD*,
Rory Hachamovitch, MD, MSc, FACC ,
Ishac Cohen, PhD*,
James Gerlach, CNMT*,
Xingping Kang, MD*,
John D. Friedman, MD, FACC*,
Guido Germano, PhD, FACC* and
Daniel S. Berman, MD, FACC*,*
* Department of Imaging (Division of Nuclear Medicine) and Department of Medicine (Division of Cardiology), Cedars-Sinai Medical Center, Los Angeles, California, USA
Leiden University Medical Center, Leiden, The Netherlands
Keck School of Medicine, University of Southern California, Los Angeles, California, USA
Manuscript received April 8, 2003;
revised manuscript received July 14, 2003,
accepted July 17, 2003.
* Reprint requests and correspondence: Dr. Daniel S. Berman, Department of Imaging, Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Taper Building, A1258, Los Angeles, California 90048, USA.
bermand{at}cshs.org
OBJECTIVES: This study evaluated the prognostic value of transient ischemic dilation (TID) of the left ventricle (LV) in patients with normal stress myocardial perfusion single photon emission computed tomography (MPS).
BACKGROUND: The prognostic value of TID in patients with an otherwise normal MPS has not been defined.
METHODS: We identified 1,560 patients who had normal stress MPS (436 vasodilator and 1,124 exercise stress), and no rest LV enlargement (Population 1) and followed up for 2.30 ± 0.67 years for hard events (HE) (cardiac death or myocardial infarction) and soft events (SE) (revascularization). Prediction of first HE or SE (total events [TE]) was evaluated by multivariable Cox analysis, which was also applied to a broader group of 2,037 patients (including patients with minimal defects (Population 2).
RESULTS: In Population 1, there were 13 HE, 36 SE, and 42 TE. Patients in the highest TID quartile (TID  1.21) had a higher TE rate than others, regardless of stress type. By multivariable analysis, highest TID quartile was predictive of TE (p = 0.008). Other independent predictors of TE were age, typical angina, and diabetes. In Population 2, TID was also predictive of TE.
CONCLUSIONS: 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, which included patients with minimal perfusion defects.
|
Abbreviations and Acronyms
| | CAD | = coronary artery disease | | CD | = cardiac death | | ECG | = electrocardiogram | | HE | = hard cardiac events | | LHR | = lung-heart ratio | | LV | = left ventricle/ventricular | | MI | = myocardial infarction | | MPS | = myocardial perfusion single photon emission computed tomography | | SE | = soft cardiac events | | SPECT | = single photon emission computed tomography | | SSS | = summed stress scores | | TE | = total cardiac events | | TID | = transient ischemic dilation of the left ventricle | | 201Tl | = thallium-201 | | 99mTc | = technetium-99m |
|
This article has been cited by other articles:
|
|
|
|
 
M. P. Turakhia, D. D. McManus, M. A. Whooley, and N. B. Schiller
Increase in end-systolic volume after exercise independently predicts mortality in patients with coronary heart disease: data from the Heart and Soul Study
Eur. Heart J.,
October 2, 2009;
30(20):
2478 - 2484.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. Abidov, R. Hachamovitch, S. W. Hayes, J. D. Friedman, I. Cohen, X. Kang, L. De Yang, L. Thomson, G. Germano, P. Slomka, et al.
Are Shades of Gray Prognostically Useful in Reporting Myocardial Perfusion Single-Photon Emission Computed Tomography?
Circ Cardiovasc Imaging,
July 1, 2009;
2(4):
290 - 298.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
I. Ali, T. D. Ruddy, A. Almgrahi, F. G. Anstett, and R. G. Wells
Half-Time SPECT Myocardial Perfusion Imaging with Attenuation Correction
J. Nucl. Med.,
April 1, 2009;
50(4):
554 - 562.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. Stirrup, K. Wechalekar, A. Maenhout, and C. Anagnostopoulos
Cardiac radionuclide imaging in stable coronary artery disease and acute coronary syndromes
Br. Med. Bull.,
March 1, 2009;
89(1):
63 - 78.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
L. D. Metz, M. Beattie, R. Hom, R. F. Redberg, D. Grady, and K. E. Fleischmann
The Prognostic Value of Normal Exercise Myocardial Perfusion Imaging and Exercise Echocardiography: A Meta-Analysis
J. Am. Coll. Cardiol.,
January 16, 2007;
49(2):
227 - 237.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
D. S. Berman, R. Hachamovitch, L. J. Shaw, J. D. Friedman, S. W. Hayes, L. E.J. Thomson, D. S. Fieno, G. Germano, N. D. Wong, X. Kang, et al.
Roles of Nuclear Cardiology, Cardiac Computed Tomography, and Cardiac Magnetic Resonance: Noninvasive Risk Stratification and a Conceptual Framework for the Selection of Noninvasive Imaging Tests in Patients with Known or Suspected Coronary Artery Disease
J. Nucl. Med.,
July 1, 2006;
47(7):
1107 - 1118.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. K. Min, K. A. Williams, T. M. Okwuosa, G. W. Bell, M. S. Panutich, and R. P. Ward
Prediction of Coronary Heart Disease by Erectile Dysfunction in Men Referred for Nuclear Stress Testing
Arch Intern Med,
January 23, 2006;
166(2):
201 - 206.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
T. F. Heston and D. M. Sigg
Quantifying Transient Ischemic Dilation Using Gated SPECT
J. Nucl. Med.,
December 1, 2005;
46(12):
1990 - 1996.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
L. Emmett, M. Magee, S. B. Freedman, H. Van der Wall, V. Bush, J. Trieu, W. Van Gaal, K. C. Allman, and L. Kritharides
The Role of Left Ventricular Hypertrophy and Diabetes in the Presence of Transient Ischemic Dilation of the Left Ventricle on Myocardial Perfusion SPECT Images
J. Nucl. Med.,
October 1, 2005;
46(10):
1596 - 1601.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. Abidov, J. J. Bax, S. W. Hayes, I. Cohen, H. Nishina, S. Yoda, X. Kang, F. Aboul-Enein, J. Gerlach, J. D. Friedman, et al.
Integration of Automatically Measured Transient Ischemic Dilation Ratio into Interpretation of Adenosine Stress Myocardial Perfusion SPECT for Detection of Severe and Extensive CAD
J. Nucl. Med.,
December 1, 2004;
45(12):
1999 - 2007.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
R. J. Gibbons and P. A. Araoz
The year in cardiac imaging
J. Am. Coll. Cardiol.,
November 16, 2004;
44(10):
1937 - 1944.
[Full Text]
[PDF]
|
|
|
|
|
|
|
C. J. Hardebeck
Transient ischemic dilation
J. Am. Coll. Cardiol.,
July 7, 2004;
44(1):
211 - 212.
[Full Text]
[PDF]
|
|
|
|
|
|
|
D. S. Berman, G. Germano, and A. Abidov
Reply
J. Am. Coll. Cardiol.,
July 7, 2004;
44(1):
212 - 213.
[Full Text]
[PDF]
|
|
|
|
