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The value of transient ischemic dilation for detecting restenosis after coronary artery revascularization
Salih Sinan Gultekin1, Murat Sadic2, Murat Bilgin3
1Department of Nuclear Medicine, Ministry of Health, Diskapi Yildirim Beyazit Training and Research Hospital, Etlik, Ankara, Turkey. gultekinsinan@gmail.com.
Insights
Transient ischemic dilation (TID) significantly improves detection of obstructive coronary artery disease (CAD) after revascularization. Adding TID to SPECT MPI increases diagnostic accuracy for CAD recurrence in symptomatic patients.
Area of Science:
- Cardiology
- Nuclear Cardiology
- Diagnostic Imaging
Background:
- Transient ischemic dilation (TID) is recognized as an indicator of severe coronary artery disease (CAD).
- Recurrence of symptoms after coronary revascularization necessitates accurate diagnostic methods to identify persistent or new obstructive CAD.
Purpose of the Study:
- To evaluate the added diagnostic value of TID in patients with known significant CAD experiencing symptom recurrence post-revascularization.
- To assess if TID improves the detection of obstructive CAD when combined with SPECT MPI.
Main Methods:
- A cohort of 104 patients with recent revascularization (PCI or CABG) and recurrent symptoms was analyzed.
- All patients underwent follow-up stress SPECT MPI and repeat coronary angiography.
- Myocardial perfusion findings, including ischemia and TID, were correlated with significant obstructive CAD (>70% stenosis).
Main Results:
- Inducible ischemia was detected in 36.5% and TID > 1.20 in 47% of patients.
- Significant obstructive CAD was confirmed in 42% of patients via coronary angiography.
- The sensitivity for detecting obstructive CAD increased from 61% with SPECT MPI alone to 93% with the addition of TID (P < 0.0001).
Conclusions:
- In patients with prior revascularization and recurrent symptoms, TID is a valuable marker for obstructive CAD.
- TID provides incremental diagnostic value beyond SPECT MPI alone for identifying significant CAD in this patient population.
Aim:
Transient ischemic dilation (TID) is a marker of severe coronary artery disease (CAD). We aimed to assess the incremental value of TID in a cohort of patients with known significant CAD who had recurrence of symptoms after revascularization.
Methods:
We identified in our databases 104 patients who had recent coronary revascularization and recurrence of symptoms. 62 patients had PCI (75 arteries) and 42 patients had CABG (104 arteries). All had follow-up stress SPECT MPI and repeat coronary angiography. Myocardial perfusion findings of ischemia and TID were correlated with presence of significant obstructive CAD (>70% stenosis).
Results:
Follow-up stress Tc-99m Sestamibi SPECT MPI revealed inducible ischemia in 38 patients (36.5%) and TID > 1.20 in 49 patients (47%). Subsequent coronary angiography showed significant obstructive CAD in 44 patients (42%). The sensitivity for detecting obstructive CAD was 61% for SPECT MPI alone, but increased significantly to 93% by the addition of TID as a diagnostic criterion (P < 0.0001).
Conclusions:
In this selected patient cohort with prior coronary revascularization, TID is an important marker of obstructive CAD and has incremental value over SPECT MPI alone.
