Significance of dipyridamole-lnduced transient dilation of the left ventricle during thallium-201 scintigraphy in suspected coronary artery disease

Chouraqui, Pierre; Rodrigues, E.; Berman, Daniel S.; Maddahi, Jamshid

doi:10.1016/0002-9149(90)91131-o

Cited by 100 publications

(47 citation statements)

References 16 publications

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“…Phase Analysis of Gated SPECT for Multivessel CAD nostic challenge of balanced ischemia on myocardial SPECT in patients with multivessel CAD, numerous studies reported the usefulness of scintigraphic markers such as diffuse slow washout, lung uptake of radiotracer and TID. [21][22][23][24][25] In this regard, the application of LV dyssynchrony as assessed using phase analysis can be considered a novel approach.…”

Section: Comparison With Previous Studiesmentioning

confidence: 99%

Diagnostic Value of Left Ventricular Dyssynchrony After Exercise and at Rest in the Detection of Multivessel Coronary Artery Disease on Single-Photon Emission Computed Tomography

Hida

Chikamori

Tanaka

et al. 2012

Circ J

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Circulation Journal Official Journal of the Japanese Circulation Society http://www. j-circ.or.jp he development of electrocardiogram-gated single-photon emission computed tomography (SPECT) has enabled the assessment of left ventricular (LV) function after stress and at rest, which has in turn enabled better detection of coronary artery disease (CAD), particularly that of multivessel pathology. 1-4 Recently, a novel technique was developed to evaluate not only myocardial function, but also LV mechanical dyssynchrony using phase analysis on gated SPECT. 5,6 Using this method, several studies have reported the diagnostic and prognostic value of LV mechanical dyssynchrony in patients with heart failure. 7-9 Although LV regional disparities in contractility are known to occur during periods of demand ischemia such as in exercise or dobutamine infusion, 10,11 few studies have analyzed LV mechanical dyssynchrony after stress and at rest to detect high-risk CAD by applying count-based temporal and spatial phase analysis. 12, 13 Considering the diagnostic challenge of multivessel CAD due to balanced ischemia on myocardial SPECT, we retrospectively evaluated whether exercise-induced LV mechanical dyssynchrony as assessed on phase analysis may have enhanced diagnostic value over conventional perfusion analysis in the detection of multivessel CAD. Editorial p 1832Methods Subjects Subjects consisted of 278 consecutive patients (241 men and 37 women; mean age 62±10 years) with suspected or known Background: Although stress-induced left ventricular (LV) wall motion abnormality is a well-known marker for extensive coronary artery disease (CAD), no study has yet analyzed whether phase analysis of exercise-induced LV mechanical dyssynchrony may have enhanced diagnostic value over conventional perfusion analysis in the detection of multivessel CAD.

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Section: Comparison With Previous Studiesmentioning

confidence: 99%

Diagnostic Value of Left Ventricular Dyssynchrony After Exercise and at Rest in the Detection of Multivessel Coronary Artery Disease on Single-Photon Emission Computed Tomography

Hida

Chikamori

Tanaka

et al. 2012

Circ J

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“…(71) TID is a marker of risk and it has been found to add incrementally over perfusion data. (66,75,76) The approach suggested by R. Hachamovitch and D. Berman (67,71) based on published evidence, is to manage patients with normal scans medically, as revascularization has not been shown to provide potential benefi t in mortality. Patients whose MPIs show reversible perfusion defects extending to <10% of the myocardium (mild to moderate ischemia) should be managed medically including risk factor modifi cation too, as revascularization will not provide a mortality benefi t. If however they are symptomatic and the symptoms impact negatively on their quality of life, or if they have additional markers of severity such as increased pulmonary accumulation of 201Tl or TID, they should be referred for catheterization with a view to intervention.…”

Section: Discussionmentioning

confidence: 99%

Value of nuclear cardiology for the diagnosis and risk stratification of coronary artery disease

Libhaber

Vangu

2017

SAHJ

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Value of nuclear cardiology for the diagnosis and risk stratifi cation of coronary artery disease 106 INTRODUCTIONNuclear cardiology has undergone an outstanding growth during the last 25 years.With technical improvements and new radiopharmaceuticals, higher sensitivity and specifi city of myocardial perfusion imaging (MPI) scans has been achieved for detection and evaluation of ischemic heart disease.MPI is performed with the administration of radiopharmaceuticals which are taken up by the myocardial cells. Different radiotracers can be used, such as: 99m Tc- Sestamibi, 99m Tc-Tetrofosmin, etc.The investigation is performed at rest and stress, providing semiquantitative information on areas of myocardial infarction and ischemia.Beller et al. showed in the "anginal cascade"(1) that, with increasing stress time and myocardial oxygen demand, ischemic ST depression and anginal symptoms appear after fl ow heterogeneity, regional myocardial dysfunction, signifi cant perfusion defects and global left ventricular dysfunction. This accounts for the increased sensitivity, specifi city and accuracy of MPI over symptoms and stress ECG in the diagnosis and follow-up of coronary artery disease.It has developed into one of the most contributory fi elds in clinical decision making for the detection and risk stratifi cation in patients with suspected and known coronary artery disease. USE OF MYOCARDIAL PERFUSION SCINTIGRAPHY IN THE CLINICAL SETTINGMyocardial perfusion SPECT (single photon emission computed tomography) is a widely utilized noninvasive imaging modality for the diagnosis and management of ischemic heart disease. This modality allows a three-dimensional assessment and quantitation of the myocardium and functional assessment through ECG-gating of the perfusion images. Vol. 5, No. 3, 2008 There are several indications for the use of myocardial perfusion SPECT, whether it is for a patient who is not known to have coronary artery disease and the aim is confi rm or rule out the diagnosis, or in the patient with known ischemic heart disease, whether symptomatic or not, for risk-stratifi cation (Table 1). Indications for myocardial perfusion scintigraphy If the patient does not have diagnosis of CADTo exclude or diagnose CAD in patients with suspected CAD As a screening test in those with intermediate or high risk of CAD, e.g. familial hyperlipidemia, type II diabetes mellitus, family history of CAD, and those with atypical symptoms of ischemic heart disease (IHD). In patients with high pretest likelihood for CAD, MPI is mainly useful for risk stratifi cation purposes.In patients with non-diagnostic electrocardiography (ECG), at rest or post-stress. While there are many causes for an abnormal baseline ECG (Table 2), STRESS-ECG is frequently not conclusive. (range 17 to 100).Patients who are at risk of developing peri or postoperative cardiovascular events, i.e. peripheral vascular disease, aortic aneurysm, and the elderly.Acute chest pain -diagnosis of CAD.LBBB can induce perfusion defect in the basal ante...

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“…[6][7][8] The specificity is particularly high compared with the sensitivity, which is similar to that for exercise 201 Tl MPI. The mechanism responsible for transient LV dilation on stress MPI has been reported to be subendocardial hypoperfusion resulting from ischemia.…”

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confidence: 97%

Prediction of Cardiac Events in Patients With Transient Left Ventricle Dilation on Stress Myocardial Perfusion SPECT Images

Fukuda

Moroi

2005

Circ J

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revious studies have shown that patients with multivessel coronary artery disease (CAD) show transient left ventricle (LV) dilation on exercise thallium-201 ( 201 Tl) myocardial perfusion single-photon emission computed tomography imaging (MPI). 1,2 Recently, several investigators have reported the detection of transient LV dilation on exercise MPI, using technetium-99m ( 99m Tc) sestamibi and 99m Tc tetrofosmin. [3][4][5] The sensitivity and specificity for identifying patients with multivessel CAD based on transient LV dilation was 60-91% and 77-95%, respectively, 1,3-5 and furthermore, the specificity was high.There are similar reports for dipyridamole pharmacologic stress MPI in which the sensitivity and specificity for identifying patients as having multivessel CAD based on transient LV dilation is 27-72% and 85-95%, respectively. [6][7][8] The specificity is particularly high compared with the sensitivity, which is similar to that for exercise 201 Tl MPI. The mechanism responsible for transient LV dilation on stress MPI has been reported to be subendocardial hypoperfusion resulting from ischemia. 2,7,9 A few investigators have determined the prognosis of patients with transient LV dilation. Methods Patient Population and Follow-upBetween July 1997 and May 1999, 2,382 consecutive patients with known or suspected CAD were referred for 201 Tl stress MPI at Toho University Ohashi Hospital, in Tokyo. Echocardiography was performed within 1 month before or after stress MPI. The LV diameter and LV ejection fraction (LVEF) were measured by M mode. Patients with obvious enlargement of the LV in both post-stress and rest SPECT images and with an LVEF ≤30% or an LV end-diastolic diameter ≥55 mm on echocardiography were excluded because poor LV function and LV enlargement are considered as predictors of poor prognosis. [13][14][15][16] Of the 2,382 patients 56 had transient LV dilation with normal LV size at rest; 3 patients were lost to follow-up and therefore were excluded, leaving 53 patients with data available to be analyzed (exercise: 21, pharmacologic: 32).Patients were contacted by phone by a physician, unless it was clearly documented in the hospital chart that the patient had been referred for coronary revascularization or had sustained a cardiac event, such as cardiac death, hos-

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Significance of dipyridamole-lnduced transient dilation of the left ventricle during thallium-201 scintigraphy in suspected coronary artery disease

Cited by 100 publications

References 16 publications

Diagnostic Value of Left Ventricular Dyssynchrony After Exercise and at Rest in the Detection of Multivessel Coronary Artery Disease on Single-Photon Emission Computed Tomography

Diagnostic Value of Left Ventricular Dyssynchrony After Exercise and at Rest in the Detection of Multivessel Coronary Artery Disease on Single-Photon Emission Computed Tomography

Value of nuclear cardiology for the diagnosis and risk stratification of coronary artery disease

Prediction of Cardiac Events in Patients With Transient Left Ventricle Dilation on Stress Myocardial Perfusion SPECT Images

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