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Postischemic myocardial stunning is superior to transient ischemic dilation for detecting multivessel coronary artery
Satoshi Hida1, Taishiro Chikamori, Hirokazu Tanaka
1Department of Cardiology, Tokyo Medical University, Japan. hida-bin@tokyo-med.ac.jp
Insights
Post-ATP stress myocardial stunning, indicated by increased end-systolic volume, is a superior marker for detecting multivessel coronary artery disease (CAD) compared to transient ischemic dilation (TID) of the left ventricle.
Area of Science:
- Cardiology
- Nuclear Medicine
- Diagnostic Imaging
Background:
- Post-stress myocardial stunning is a known marker for severe coronary artery disease (CAD).
- No prior studies have directly compared post-stress stunning with transient ischemic dilation (TID) for detecting multivessel CAD.
Purpose of the Study:
- To compare the diagnostic value of post-ATP stress myocardial stunning versus TID for detecting multivessel CAD.
Main Methods:
- 271 patients with suspected or known CAD underwent adenosine triphosphate (ATP) stress and at-rest gated single-photon emission computed tomography.
- Myocardial perfusion was assessed using a 20-segment model; left ventricular (LV) volumetric analysis and TID ratio were analyzed.
- Multivariate logistic regression identified predictors of multivessel CAD.
Main Results:
- Multivessel CAD patients (n=147) showed higher multi-territorial ischemia and greater post-ATP increases in end-systolic volume (ESV) and TID ratio than single-vessel CAD patients (n=124).
- A post-ATP increase in ESV ≥5 ml combined with multi-territorial ischemia identified multivessel CAD with 78% sensitivity and 84% specificity.
- TID ratio was not an independent predictor of multivessel CAD.
Conclusions:
- Post-ATP stress myocardial stunning, specifically the increase in ESV, is superior to the TID ratio for diagnosing multivessel CAD.
Background:
Although poststress myocardial stunning is regarded as a marker for severe coronary artery disease (CAD), no study has yet compared the diagnostic value of poststress stunning with transient ischemic dilation (TID) of the left ventricle (LV) for detecting multivessel CAD.
Methods And Results:
A total of 271 patients with suspected or known CAD underwent adenosine triphosphate (ATP) loading and at-rest gated single-photon emission computed tomography. We assessed myocardial perfusion with a 20-segment model, and analyzed the changes in LV volumetric analysis induced by ATP and an automatically derived TID ratio. In 147 patients with multivessel CAD, the prevalence of multi-territorial ischemia was higher, and the post-ATP increase in end-systolic volume (ESV) and TID ratio were greater, than in the 124 with insignificant or single-vessel CAD (P<0.0001, for all cases). The receiver-operating characteristic curves analysis revealed cutoff values for ESV of 5 ml and a TID ratio of 1.11. Multivariate logistic regression analysis revealed that the combination of a poststress increase in ESV of ≥5 ml and multi-territorial ischemia best identified multivessel CAD, with a sensitivity of 78% and a specificity of 84%, whereas the TID ratio was not shown to be an independent predictor.
Conclusions:
Post-ATP stress myocardial stunning is superior to the TID ratio for detecting multivessel CAD.
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