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Prognostic value of transient ischemic dilation with regadenoson myocardial perfusion imaging

  • Original Article
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Journal of Nuclear Cardiology Aims and scope

Abstract

Background

Transient ischemic dilation (TID) of the left ventricle seen on myocardial perfusion imaging (MPI) is sometimes used as a marker of severe coronary artery disease. The prognostic value of TID obtained using regadenoson, a selective adenosine A2A receptor agonist, as a stress agent for MPI has not been studied.

Methods

TID ratio was measured using an automated software program on consecutive patients with normal and abnormal perfusion pattern on regadenoson MPI at a single institution. An abnormal TID was defined as greater than 1.33. The primary outcome was a composite of cardiac death, non-fatal myocardial infarction (MI), and late coronary revascularization (CR, >90 days after MPI).

Results

The study population consisted of 887 patients (62 ± 12 years, 66% male, 48% diabetes, 46% prior CR, 75% with abnormal perfusion pattern, left ventricular ejection fraction—LVEF 55 ± 6%). An abnormal TID was present in 51 (6%) patients. Baseline characteristics were not different based on the presence or absence of TID. Early CR (≤90 days) was performed in 11 (22%) patients with vs 92 (11%) patients without TID (P = .04). During a mean follow-up of 29 ± 19 months, the primary outcome occurred in 271 (31%) patients (22% cardiac death, 6% MI, 9% late CR). TID was associated with increased risk of the primary outcome (log-rank P = .017), an association largely driven by late CR. In a Cox proportional model adjusted for multiple variables including perfusion defect size (PDS) and LVEF, the hazard ratio for TID was 1.92 (95% CI 1.20-3.08, P = .007). In the subset of patients with normal perfusion pattern, there was no association between TID and outcomes.

Conclusions

TID on regadenoson MPI carries important prognostic information that is independent from PDS and LVEF, but this association is restricted to patients with abnormal perfusion on imaging.

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Abbreviations

CAD:

Coronary artery disease

CR:

Coronary revascularization

HR:

Hazard ratio

LV:

Left ventricle

LVEF:

Left ventricular ejection fraction

MI:

Myocardial infarction

MPI:

Myocardial perfusion imaging

PDS:

Perfusion defect size

TID:

Transient ischemic dilation

References

  1. Stolzenberg J. Dilatation of left ventricular cavity on stress thallium scan as an indicator of ischemic disease. Clin Nucl Med 1980;5:289-91.

    Article  CAS  PubMed  Google Scholar 

  2. Chouraqui P, Rodrigues EA, Berman DS, Maddahi J. Significance of dipyridamole-induced transient dilation of the left ventricle during thallium-201 scintigraphy in suspected coronary artery disease. Am J Cardiol 1990;66:689-94.

    Article  CAS  PubMed  Google Scholar 

  3. Lette J, Bertrand C, Gossard D, Ruscito O, Cerino M, McNamara D, et al. Long-term risk stratification with dipyridamole imaging. Am Heart J 1995;129:880-6.

    Article  CAS  PubMed  Google Scholar 

  4. McClellan JR, Travin MI, Herman SD, Baron JI, Golub RJ, Gallagher JJ, et al. Prognostic importance of scintigraphic left ventricular cavity dilation during intravenous dipyridamole technetium-99m sestamibi myocardial tomographic imaging in predicting coronary events. Am J Cardiol 1997;79:600-5.

    Article  CAS  PubMed  Google Scholar 

  5. Abidov A, Bax JJ, Hayes SW, Hachamovitch R, Cohen I, Gerlach J, et al. Transient ischemic dilation ratio of the left ventricle is a significant predictor of future cardiac events in patients with otherwise normal myocardial perfusion SPECT. J Am Coll Cardiol 2003;42:1818-25.

    Article  PubMed  Google Scholar 

  6. Abidov A, Bax JJ, Hayes SW, Cohen I, Nishina H, Yoda S, et al. Integration of automatically measured transient ischemic dilation ratio into interpretation of adenosine stress myocardial perfusion SPECT for detection of severe and extensive CAD. J Nucl Med 2004;45:1999-2007.

    CAS  PubMed  Google Scholar 

  7. Valdiviezo C, Motivala AA, Hachamovitch R, Chamarthy M, Navarro PC, Ostfeld RJ, et al. The significance of transient ischemic dilation in the setting of otherwise normal SPECT radionuclide myocardial perfusion images. J Nucl Cardiol 2011;18:220-9.

    Article  PubMed  Google Scholar 

  8. Petretta M, Acampa W, Daniele S, Petretta MP, Nappi C, Assante R, et al. Transient ischemic dilation in SPECT myocardial perfusion imaging for prediction of severe coronary artery disease in diabetic patients. J Nucl Cardiol 2013;20:45-52.

    Article  PubMed  Google Scholar 

  9. Golzar Y, Olusanya A, Pe N, Dua SG, Golzar J, Gidea C, et al. The significance of automatically measured transient ischemic dilation in identifying severe and extensive coronary artery disease in regadenoson, single-isotope technetium-99m myocardial perfusion SPECT. J Nucl Cardiol 2015;22:526-34.

    Article  PubMed  Google Scholar 

  10. Bourque JM. Contemporary relevance of TID: Based on the company it keeps. J Nucl Cardiol 2015;22:535-8.

    Article  PubMed  Google Scholar 

  11. Iskandrian AS, Heo J, Nguyen T, Lyons E, Paugh E. Left ventricular dilatation and pulmonary thallium uptake after single-photon emission computer tomography using thallium-201 during adenosine-induced coronary hyperemia. Am J Cardiol 1990;66:807-11.

    Article  CAS  PubMed  Google Scholar 

  12. Takeishi Y, Tono-oka I, Ikeda K, Komatani A, Tsuiki K, Yasui S. Dilatation of the left ventricular cavity on dipyridamole thallium-201 imaging: A new marker of triple-vessel disease. Am Heart J 1991;121:466-75.

    Article  CAS  PubMed  Google Scholar 

  13. McLaughlin MG, Danias PG. Transient ischemic dilation: A powerful diagnostic and prognostic finding of stress myocardial perfusion imaging. J Nucl Cardiol 2002;9:663-7.

    Article  PubMed  Google Scholar 

  14. 2013 Nuclear Cardiology Trend Survey. J Nucl Cardiol 2014;21:S5-88.

  15. Iskandrian AE, Bateman TM, Belardinelli L, Blackburn B, Cerqueira MD, Hendel RC, et al. Adenosine versus regadenoson comparative evaluation in myocardial perfusion imaging: Results of the ADVANCE phase 3 multicenter international trial. J Nucl Cardiol 2007;14:645-58.

    Article  PubMed  Google Scholar 

  16. Cerqueira MD, Nguyen P, Staehr P, Underwood SR, Iskandrian AE. Effects of age, gender, obesity, and diabetes on the efficacy and safety of the selective A2A agonist regadenoson versus adenosine in myocardial perfusion imaging integrated ADVANCE-MPI trial results. JACC Cardiovasc Imaging 2008;1:307-16.

    Article  PubMed  Google Scholar 

  17. Iqbal FM, Hage FG, Ahmed A, Dean PJ, Raslan S, Heo J, et al. Comparison of the prognostic value of normal regadenoson with normal adenosine myocardial perfusion imaging with propensity score matching. JACC Cardiovasc Imaging 2012;5:1014-21.

    Article  PubMed  Google Scholar 

  18. Ghimire G, Hage FG, Heo J, Iskandrian AE. Regadenoson: A focused update. J Nucl Cardiol 2013;20:284-8.

    Article  PubMed  Google Scholar 

  19. Hage FG, Ghimire G, Lester D, McKay J, Bleich S, El-Hajj S, et al. The prognostic value of regadenoson myocardial perfusion imaging. J Nucl Cardiol 2015;. doi:10.1007/s12350-014-0050-y.

    Google Scholar 

  20. Farzaneh-Far A, Shaw LK, Dunning A, Oldan JD, O’Connor CM, Borges-Neto S. Comparison of the prognostic value of regadenoson and adenosine myocardial perfusion imaging. J Nucl Cardiol 2015;. doi:10.1007/s12350-015-0155-y.

    PubMed  Google Scholar 

  21. Katz JS, Ruisi M, Giedd KN, Rachko M. Assessment of transient ischemic dilation (TID) ratio in gated SPECT myocardial perfusion imaging (MPI) using regadenoson, a new agent for pharmacologic stress testing. J Nucl Cardiol 2012;19:727-34.

    Article  CAS  PubMed  Google Scholar 

  22. Iskandrian AE. Stress-only myocardial perfusion imaging a new paradigm. J Am Coll Cardiol 2010;55:231-3.

    Article  PubMed  Google Scholar 

  23. Henzlova MJ, Cerqueira MD, Hansen CL, Taillefer R, Yao SS. Stress protocols and tracers. ASNC imaging guidelines for nuclear cardiology procedures. J Nucl Cardiol 2009;. doi:10.1007/s12350-009-9062-4.

    Google Scholar 

  24. Mazzanti M, Germano G, Kiat H, Kavanagh PB, Alexanderson E, Friedman JD, et al. Identification of severe and extensive coronary artery disease by automatic measurement of transient ischemic dilation of the left ventricle in dual-isotope myocardial perfusion SPECT. J Am Coll Cardiol 1996;27:1612-20.

    Article  CAS  PubMed  Google Scholar 

  25. Abidov A, Germano G, Berman DS. Transient ischemic dilation ratio: A universal high-risk diagnostic marker in myocardial perfusion imaging. J Nucl Cardiol 2007;14:497-500.

    Article  PubMed  Google Scholar 

  26. Iskandrian AE, Garcia EV. Nuclear cardiac imaging: Principles and applications. Oxford: Oxford University Press; 2008. p. 732.

    Google Scholar 

  27. Ali MAM, Bourque JM, Allam AH, Beller GA, Watson DD. The prevalence and predictive accuracy of quantitatively defined transient ischemic dilation of the left ventricle on otherwise normal SPECT myocardial perfusion imaging studies. J Nucl Cardiol 2011;18:1036-43.

    Article  Google Scholar 

  28. Doukky R, Frogge N, Bayissa YA, Balakrishnan G, Skelton JM, Confer K, et al. The prognostic value of transient ischemic dilatation with otherwise normal SPECT myocardial perfusion imaging: A cautionary note in patients with diabetes and coronary artery disease. J Nucl Cardiol 2013;20:774-84.

    Article  PubMed  Google Scholar 

  29. Rozanski A, Gransar H, Hayes SW, Min J, Friedman JD, Thomson LE, et al. Temporal trends in the frequency of inducible myocardial ischemia during cardiac stress testing: 1991 to 2009. J Am Coll Cardiol 2013;61:1054-65.

    Article  PubMed  Google Scholar 

  30. Iskandrian AE, Hage FG. Declining frequency of ischemia detection using stress myocardial perfusion imaging. J Am Coll Cardiol 2013;61:1066-8.

    Article  PubMed  Google Scholar 

  31. Beller GA. Decrease in the frequency of stress-induced ischemia over the past two decades. J Nucl Cardiol 2013;20:322-3.

    Article  PubMed  Google Scholar 

  32. Duvall WL, Rai M, Ahlberg AW, O’Sullivan DM, Henzlova MJ. A multi-center assessment of the temporal trends in myocardial perfusion imaging. J Nucl Cardiol 2015;22:539-51.

    Article  PubMed  Google Scholar 

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Disclosures

Drs. Hage and Iskandrian have received research grants from Astellas Pharma USA.

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Author notes

    Authors and Affiliations

    1. University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA

      Davis Lester BS

    2. Division of Cardiovascular Disease, University of Alabama at Birmingham, Lyons Harrison Research Building 306, 1720 2nd AVE S, Birmingham, AL, 35294-0007, USA

      Stephanie El-Hajj MD, Ayman A. Farag MD, Lindsey Tauxe MEd, Jaekyeong Heo MD, Ami E. Iskandrian MD & Fadi G. Hage MD

    3. Division of Molecular Imaging and Therapeutics, University of Alabama at Birmingham, Birmingham, AL, USA

      Pradeep Bhambhvani MD

    4. Section of Cardiology, Birmingham Veterans Affairs Medical Center, Birmingham, AL, USA

      Fadi G. Hage MD

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    1. Davis Lester BS
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    Correspondence to Fadi G. Hage MD.

    Additional information

    See related editorial, doi:10.1007/s12350-015-0299-9.

    Davis Lester and Stephanie El-Hajj have contributed equally.

    All editorial decisions for this article, including selection of reviewers and the final decision, were made by guest editor Alberto Cuocolo, MD.

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    Lester, D., El-Hajj, S., Farag, A.A. et al. Prognostic value of transient ischemic dilation with regadenoson myocardial perfusion imaging. J. Nucl. Cardiol. 23, 1147–1155 (2016). https://doi.org/10.1007/s12350-015-0272-7

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