Correlation between transient ischemic dilatation (TID) and coronary artery disease in Saudi male patients
Asim Aldhilan1, Ghulam M S Syed2, Ihab Suleiman2
1Nuclear Medicine Section, Department of Medical Imaging, King Fahad Hospital, King Saud Bin Abdulaziz University for Health Sciences (KSAU-HS) and King Abdullah International Medical Research Centre (KAIMRC), King Abdulaziz Medical City, Riyadh.
Insights
A high transient ischemic dilatation ratio (TID) in gated myocardial perfusion imaging (G-MPI) is a sensitive indicator of significant coronary artery disease (CAD) in Saudi Arabian men. Further investigation is recommended for patients with normal perfusion but high TID.
Area of Science:
- Cardiology
- Nuclear Medicine
- Radiology
Background:
- Transient ischemic dilatation ratio (TID) on gated myocardial perfusion imaging (G-MPI) is a known indicator of coronary artery disease (CAD).
- The association between TID and CAD requires further investigation in specific populations.
Purpose of the Study:
- To investigate the relationship between TID and the presence and severity of CAD in male Saudi Arabian patients.
- To determine if a high TID is a reliable marker for significant CAD in this demographic.
Main Methods:
- Retrospective analysis of G-MPI studies in male Saudi Arabian patients with TID ≥ 1.20.
- Quantitative analysis of perfusion parameters and ejection fraction using AutoQuant software.
- Correlation of TID with visual perfusion assessment and coronary angiogram findings.
Main Results:
- A high TID (≥ 1.20) was observed in 52 male patients, with a mean TID of 1.30.
- Significant correlation found between high TID and perfusion abnormalities (p=0.009) and Summed Difference Scores (p=0.000).
- Coronary angiography revealed significant CAD in 39 out of 44 patients, with a strong correlation between CAD and perfusion abnormalities (p=0.002).
Conclusions:
- High TID on G-MPI is a highly sensitive marker for significant CAD in male Saudi Arabian patients.
- Patients presenting with normal perfusion but a high TID warrant further diagnostic workup for CAD.
Objective:
A high transient ischemic dilatation ratio (TID) for the left ventricle (LV) from a gated myocardial perfusion imaging (G-MPI) study is widely believed to be associated with significant coronary artery disease (CAD). We have investigated the relationship between TID and CAD for our male Saudi Arabian patient population.
Methods:
In this retrospective study, all male Saudi Arabian patients who underwent a two-day G-MPI study using Tc99m MIBI during the year 2011 having a TID ⩾ 1.20 were included. Quantitative perfusion and gated parameters were obtained using Cedar Sinai's AutoQuant software version 3.0, 2003, Means of summed stress scores, summed rest scores and summed difference scores (SSS, SRS, SDS, respectively), stress and rest ejection fraction (EF) were calculated. Visual interpretation was performed to classify the perfusion as normal, fixed, mixed (fixed and reversible defects), single reversible or multiple reversible defects. Coronary angiograms were assessed as normal with no CAD, single vessel, two-vessel or three-vessel disease. Correlations between the TID and other parameters were studied using analysis of variance (ANOVA) with IBM-SPSS version 20.
Results:
A total of 52 male patients had a high TID of ⩾1.20 (mean 1.30 ± 0.13). Ten patients had a SSS of 0-3 and 16 were classified as normal by visual assessment. Stress EF (mean 50.4 ± 12%) was lower than the rest EF (mean 56.6 ± 12.8%) with the difference being statistically significant (Students paired t-test, p = 0.001). Angiography results were available in 44 patients, 3 having a normal angiogram, 24 having three vessel disease, 7 having two vessel disease and 10 having one vessel disease. Five patients with normal perfusion and SSS = 0-3 had CAD as seen on a coronary angiography. CAD on coronary angiography showed a significant correlation with perfusion abnormalities as assessed by visual interpretation (p = 0.002). TID showed a significantly correlation with both perfusion abnormalities (p = 0.009), as assessed by visual interpretation, and with Summed difference scores, SDS (p = 0.000).
Conclusion:
A high TID on G-MPI was a very sensitive indicator of significant CAD. In patients with normal perfusion and high TID further workup is warranted.
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