Predictive and prognostic values of transient ischemic dilatation of left ventricular cavity for coronary artery disease and impact of various managements on clinical outcome using technetium-99m sestamibi gated myocardial perfusion imaging
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Transient ischemic dilatation (TID) of LV cavity during stress gated myocardial perfusion imaging (GMPI) is known as a predictor of severe CAD and signifies worse prognosis.
To assess predictive and prognostic value of TID of LV cavity using GMPI and clinical outcome in patients treated conservatively or with revascularization.
189 patients out of 2689 were recruited (M:F 127/62, mean age 56 ± 9 years) whose same-day stress GMPI revealed TID ratio (>1.22) with no (sum stress score, SSS < 2) or reversible perfusion defects (sum difference score, SDS > 2). Coronary angiography (CA) was performed within 3 months in 125/189 cases who were followed for mean period of 18 ± 4 months for fatal or non-fatal MI.
CA was positive in 121/125 patients with TID for significant CAD (LAD = 11, multi vessel disease = 110 patients, positive predictive value 95%) and negative for obstructive disease in 4/125 (false-positive cases). 41/121 underwent revascularization within 2 months of CA (Intervention group), and remaining 80/121 were managed conservatively (Non-Intervention group). Overall event rate was 20% (4/16%: fatal/non-fatal MIs). Kaplan–Meier survival curves revealed event-free survival in Intervention and Non-Intervention groups for fatal MI 98/96% (P = 0.758), and for non-fatal MI, it was 97/58%, respectively (P = 0.042).
We conclude that TID is a reliable predictor of multi vessel CAD and is associated with high incidence of non-fatal MIs than fatal MIs. Revascularization (PCI/CABG) rather than medical treatment should be considered in patients with TID for better clinical outcome.
KeywordsTID Positive predictive value Gated SPECT Clinical outcome
Conflict of interest
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