The significance of transient ischemic dilation in the setting of otherwise normal SPECT radionuclide myocardial perfusion images

Carolina Valdiviezo, Apurva A. Motivala, Rory Hachamovitch, Murthy Chamarthy, Pablo C. Navarro, Robert J Ostfeld, Mimi Kim, Mark I. Travin

Research output: Contribution to journalArticle

28 Citations (Scopus)

Abstract

Background. Transient ischemic dilation (TID) in the setting of an abnormal SPECT radionuclide myocardial perfusion imaging (MPI) study is considered a marker of severe and extensive coronary artery disease (CAD). However, the clinical significance of TID and its association with CAD in patients with an otherwise normal MPI study is unclear. Methods. From a database of patients who underwent MPI over a 9-year period, 96 without known cardiac history who had normal image perfusion patterns, and who underwent coronary angiography within 6 months, were identified. TID quantitative values were derived. To adjust for varying stress and image protocols, a TID index based on published threshold values was derived for each patient, with >1 considered as TID. We examined the relationship of TID to the presence/extent of CAD, and to a CAD prognostic index. TID was also correlated with patient survival. To address referral bias, survival in a separate cohort of 3,691 patients with a normal perfusion MPI who did not undergo angiography in the 6-month interval was correlated with the presence and severity of TID. Results. For 28 (29.2%) patients with normal MPI perfusion patterns but with TID, there was no increased incidence of CAD, multivessel or left main disease, or a higher prognostic index compared with no TID. In addition, there was no increased mortality associated with TID in both the angiography cohort and in the patients who did not undergo immediate angiography. Conclusions. TID in patients with an otherwise normal SPECT MPI study does not increase the likelihood of CAD, its extent or severity, and is not associated with worsened patient survival.

Original languageEnglish (US)
Pages (from-to)220-229
Number of pages10
JournalJournal of Nuclear Cardiology
Volume18
Issue number2
DOIs
StatePublished - Apr 2011

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Single-Photon Emission-Computed Tomography
Radioisotopes
Dilatation
Perfusion
Myocardial Perfusion Imaging
Coronary Artery Disease
Angiography
Survival
Coronary Angiography
Referral and Consultation
History
Databases

Keywords

  • Coronary artery disease
  • Myocardial perfusion imaging
  • Transient ischemic dilation

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Radiology Nuclear Medicine and imaging

Cite this

The significance of transient ischemic dilation in the setting of otherwise normal SPECT radionuclide myocardial perfusion images. / Valdiviezo, Carolina; Motivala, Apurva A.; Hachamovitch, Rory; Chamarthy, Murthy; Navarro, Pablo C.; Ostfeld, Robert J; Kim, Mimi; Travin, Mark I.

In: Journal of Nuclear Cardiology, Vol. 18, No. 2, 04.2011, p. 220-229.

Research output: Contribution to journalArticle

Valdiviezo, Carolina ; Motivala, Apurva A. ; Hachamovitch, Rory ; Chamarthy, Murthy ; Navarro, Pablo C. ; Ostfeld, Robert J ; Kim, Mimi ; Travin, Mark I. / The significance of transient ischemic dilation in the setting of otherwise normal SPECT radionuclide myocardial perfusion images. In: Journal of Nuclear Cardiology. 2011 ; Vol. 18, No. 2. pp. 220-229.
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AU - Navarro, Pablo C.

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N2 - Background. Transient ischemic dilation (TID) in the setting of an abnormal SPECT radionuclide myocardial perfusion imaging (MPI) study is considered a marker of severe and extensive coronary artery disease (CAD). However, the clinical significance of TID and its association with CAD in patients with an otherwise normal MPI study is unclear. Methods. From a database of patients who underwent MPI over a 9-year period, 96 without known cardiac history who had normal image perfusion patterns, and who underwent coronary angiography within 6 months, were identified. TID quantitative values were derived. To adjust for varying stress and image protocols, a TID index based on published threshold values was derived for each patient, with >1 considered as TID. We examined the relationship of TID to the presence/extent of CAD, and to a CAD prognostic index. TID was also correlated with patient survival. To address referral bias, survival in a separate cohort of 3,691 patients with a normal perfusion MPI who did not undergo angiography in the 6-month interval was correlated with the presence and severity of TID. Results. For 28 (29.2%) patients with normal MPI perfusion patterns but with TID, there was no increased incidence of CAD, multivessel or left main disease, or a higher prognostic index compared with no TID. In addition, there was no increased mortality associated with TID in both the angiography cohort and in the patients who did not undergo immediate angiography. Conclusions. TID in patients with an otherwise normal SPECT MPI study does not increase the likelihood of CAD, its extent or severity, and is not associated with worsened patient survival.

AB - Background. Transient ischemic dilation (TID) in the setting of an abnormal SPECT radionuclide myocardial perfusion imaging (MPI) study is considered a marker of severe and extensive coronary artery disease (CAD). However, the clinical significance of TID and its association with CAD in patients with an otherwise normal MPI study is unclear. Methods. From a database of patients who underwent MPI over a 9-year period, 96 without known cardiac history who had normal image perfusion patterns, and who underwent coronary angiography within 6 months, were identified. TID quantitative values were derived. To adjust for varying stress and image protocols, a TID index based on published threshold values was derived for each patient, with >1 considered as TID. We examined the relationship of TID to the presence/extent of CAD, and to a CAD prognostic index. TID was also correlated with patient survival. To address referral bias, survival in a separate cohort of 3,691 patients with a normal perfusion MPI who did not undergo angiography in the 6-month interval was correlated with the presence and severity of TID. Results. For 28 (29.2%) patients with normal MPI perfusion patterns but with TID, there was no increased incidence of CAD, multivessel or left main disease, or a higher prognostic index compared with no TID. In addition, there was no increased mortality associated with TID in both the angiography cohort and in the patients who did not undergo immediate angiography. Conclusions. TID in patients with an otherwise normal SPECT MPI study does not increase the likelihood of CAD, its extent or severity, and is not associated with worsened patient survival.

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