Document Detail

The role of left ventricular hypertrophy and diabetes in the presence of transient ischemic dilation of the left ventricle on myocardial perfusion SPECT images.
MedLine Citation:
PMID:  16204708     Owner:  NLM     Status:  MEDLINE    
Transient ischemic dilation of the left ventricle found on SPECT myocardial perfusion imaging (MPI) is an accepted marker of severe and extensive coronary artery disease (CAD) and poor prognosis. The influence of other clinical variables on the incidence of transient ischemic dilation is less certain. The aim of this study was to investigate clinical factors that may influence the incidence of transient ischemic dilation. In particular, we looked at factors that may independently affect subendocardial perfusion, such as left ventricular hypertrophy (LVH) and diabetes. METHODS: MPI studies of 103 consecutive patients who had undergone recent coronary angiography (< or =6 mo) and transthoracic echocardiography within a year of stress electrocardiography-gated MPI were retrospectively analyzed. Transient ischemic dilation was assessed quantitatively using a software program. A ratio cutoff of > or =1.22 was considered to represent transient ischemic dilation. Summed stress score and summed difference score (ischemia score) were determined using the standard 17-segment 5-point scoring system to quantify myocardial ischemia. LVH was defined as a left ventricular wall thickness of >11 mm on M-mode echocardiography. Severe CAD was defined as severe stenosis (> or =90%) of either the left anterior descending artery or both the right coronary and lateral circumflex arteries. RESULTS: Nineteen (18%) of the 103 patients had transient ischemic dilation, 19 (18%) had LVH, and 23 (22%) were diabetic. A high percentage had severe CAD (46/103 [45%]), whereas 57 of 103 (55%) had less severe CAD (30/103 [29%]) or nonsignificant CAD (26/103 [25%]). Severe CAD (P < 0.001), diabetes (P < 0.0001), LVH (P < 0.003), and the ischemia score (P < 0.023) were independent predictors of transient ischemic dilation by multivariate logistic regression. In patients with severe CAD, the effect of LVH on the incidence of transient ischemic dilation was additive, increasing the incidence from 21% (8/38) without LVH to 75% (6/8) with LVH (P < 0.006). Likewise, with severe CAD, the incidence of transient ischemic dilation rose from 21% (7/33) in patients without diabetes to 54% (7/13) in those with diabetes (P < 0.04). CONCLUSION: The presence of transient ischemic dilation on myocardial perfusion SPECT is associated with the presence of severe CAD, but this association is modified by the presence of LVH and diabetes.
Louise Emmett; Michael Magee; S Ben Freedman; Hans Van der Wall; Vivienne Bush; Joseph Trieu; William Van Gaal; Kevin C Allman; Leonard Kritharides
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Publication Detail:
Type:  Controlled Clinical Trial; Journal Article    
Journal Detail:
Title:  Journal of nuclear medicine : official publication, Society of Nuclear Medicine     Volume:  46     ISSN:  0161-5505     ISO Abbreviation:  J. Nucl. Med.     Publication Date:  2005 Oct 
Date Detail:
Created Date:  2005-10-05     Completed Date:  2006-01-10     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0217410     Medline TA:  J Nucl Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1596-601     Citation Subset:  IM    
Department of Nuclear Medicine, Concord Hospital, University of Sydney, Sydney, Australia.
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MeSH Terms
Australia / epidemiology
Diabetes Mellitus / epidemiology*,  radionuclide imaging*
Hypertrophy, Left Ventricular / epidemiology*,  radionuclide imaging*
Myocardial Ischemia / epidemiology*,  radionuclide imaging*
Reproducibility of Results
Risk Assessment / methods
Risk Factors
Sensitivity and Specificity
Time Factors
Tomography, Emission-Computed, Single-Photon / statistics & numerical data
Ventricular Dysfunction, Left / epidemiology*,  radionuclide imaging*

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