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Transient ischemic dilation in SPECT myocardial perfusion imaging for prediction of severe coronary artery disease in diabetic patients

  • Original Article
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Journal of Nuclear Cardiology Aims and scope

Abstract

Background

Transient ischemic dilation (TID) of the left ventricle during stress myocardial perfusion SPECT (MPS) has been shown to be a useful marker of severe coronary artery disease (CAD). However, investigations in diabetic patients with available coronary angiographic data are still limited. We evaluated the incremental diagnostic value of TID in identifying the presence of angiographically severe CAD in diabetic patients.

Methods and Results

TID ratio values were automatically derived from rest-stress MPS in 242 diabetic patients with available coronary angiography data. A cutoff of ≥1.19 was considered to represent TID. Severe CAD (≥70% stenosis in the proximal left anterior descending artery or the left main artery, or ≥90% stenosis in two or three vessels) was identified in 69 (29%) patients. At multivariate analysis, the best independent predictors of severe CAD were summed stress score and TID (both P < .001). At incremental analysis, the addition of TID improved the power of a model including clinical data and summed stress score, increasing the global χ2 value from 14.3 to 28.2 (P < .01). The best cutoff of summed stress score for identifying patients with severe CAD was ≥8. When the TID ratio was considered in patients with summed stress score between 3 and 7, the sensitivity for diagnosing severe CAD significantly improved from 71% to 77% (P < .05). In the overall study population, the net reclassification improvement by adding TID to a model including clinical data and summed stress score in the prediction of severe CAD was 0.40 (P < .005).

Conclusions

TID ratios obtained from rest-stress MPS provide incremental diagnostic information to standard perfusion analysis for the identification of severe and extensive CAD in diabetic patients.

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Conflict of interest

The authors have indicated that they have no financial conflict of interest.

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Authors and Affiliations

  1. Department of Clinical Medicine, Cardiovascular and Immunological Sciences, University Federico II, Naples, Italy

    Mario Petretta MD, Pierluigi Costanzo MD & Pasquale Perrone-Filardi MD, PhD

  2. Institute of Biostructures and Bioimages, National Council of Research, Naples, Italy

    Wanda Acampa MD, PhD & Stefania Daniele PhD

  3. Department of Biomorphological and Functional Sciences, University Federico II, Via Pansini 5, 80131, Naples, Italy

    Maria Piera Petretta MD, Roberta Assante MD, Emilia Zampella MD & Alberto Cuocolo MD

  4. SDN Foundation, Institute of Diagnostic and Nuclear Development, Naples, Italy

    Carmela Nappi MD & Alberto Cuocolo MD

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  1. Mario Petretta MD
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  2. Wanda Acampa MD, PhD
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  3. Stefania Daniele PhD
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  4. Maria Piera Petretta MD
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  10. Alberto Cuocolo MD
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Correspondence to Alberto Cuocolo MD.

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Petretta, M., Acampa, W., Daniele, S. et al. Transient ischemic dilation in SPECT myocardial perfusion imaging for prediction of severe coronary artery disease in diabetic patients. J. Nucl. Cardiol. 20, 45–52 (2013). https://doi.org/10.1007/s12350-012-9642-6

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  • DOI: https://doi.org/10.1007/s12350-012-9642-6

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