Journal of Nuclear Cardiology

, Volume 19, Issue 4, pp 735–742 | Cite as

Comparative assessment of rest and post-stress left ventricular volumes and left ventricular ejection fraction on gated myocardial perfusion imaging (MPI) and echocardiography in patients with transient ischaemic dilation on adenosine MPI: Myocardial stunning or subendocardial hypoperfusion?

  • Louise EmmettEmail author
  • Austin Ng
  • Leo Ha
  • Robert Russo
  • Robert Mansberg
  • Wei Zhao
  • S. Vincent Chow
  • Leonard Kritharides
Original Article



Transient ischaemic dilation (TID) on myocardial perfusion imaging (MPI) is an important finding, conveying a high risk of subsequent cardiac events. However, the mechanism leading to TID on MPI is not well elucidated. This study aimed to determine if TID is due to true LV cavity dilation and ventricular stunning, or is due to relative subendocardial hypoperfusion.


31 patients undergoing single-day Tc-99m adenosine sestamibi MPI were recruited. All had routine ECG-gated single-day rest-stress adenosine MPI, with transthoracic echocardiograms (echo) acquired concurrently at rest, and both immediately, and 2 hours, post-stress. Echocardiography was performed using a Vivid-7 (GE). LV volumes and LVEF were quantified blinded to MPI results, using biplane Simpson method on echo, and quantitatively (including TID) with QGS®, on MPI.


Patients were divided into quartiles for TID, with the top quartile considered TID positive [TID+ 9/31 (TID ratio 1.3 ± 0.09)], and TID negative [TID− 22/31 (TID ratio 1.01 ± 0.04)]. There was good correlation between resting echo and MPI physical measurements (LVEDV r 2 = 0.79, LVESV r 2 = 0.9, and LVEF r 2 = 0.75). On MPI, a significant drop in LVEF was observed between rest and early stress in the TID+ group (56.6% vs 46.5%, P < .002), as well as an increase in both LVESV (62 vs 79 mls, P < .0001) and LVEDV (113 vs 131 mls, P < .0001). However, no statistically significant change in LVEF, LVESV or LVEDV was identified on concurrent echo imaging (LVEF 57% vs 56%, P < .66; LVESV 48 vs 54 mls, P < .26; LVEDV 87 vs 97 mls, P < .299). No significant change in LVEF or ventricular volumes was noted in the TID− group by either echo or MPI.


Transient dilation of the left ventricle on adenosine MPI is not related to chamber enlargement and myocardial stunning, but is more likely a function of subendocardial hypoperfusion and impaired coronary flow reserve.


Gated SPECT coronary flow reserve PET SPECT 


  1. 1.
    Iskandrian AS, et al. 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.PubMedCrossRefGoogle Scholar
  2. 2.
    Mazzanti M, 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.PubMedCrossRefGoogle Scholar
  3. 3.
    McClellan JR, 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.PubMedCrossRefGoogle Scholar
  4. 4.
    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.PubMedCrossRefGoogle Scholar
  5. 5.
    Weiss AT, et al. Transient ischemic dilation of the left ventricle on stress thallium-201 scintigraphy: A marker of severe and extensive coronary artery disease. J Am Coll Cardiol 1987;9:752-9.PubMedCrossRefGoogle Scholar
  6. 6.
    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.PubMedCrossRefGoogle Scholar
  7. 7.
    Abidov A, Berman DS. Transient ischemic dilation associated with poststress myocardial stunning of the left ventricle in vasodilator stress myocardial perfusion SPECT: True marker of severe ischemia? J Nucl Cardiol 2005;12:258-60.PubMedCrossRefGoogle Scholar
  8. 8.
    Emmett L, et al. Prospective evaluation of the impact of diabetes and left ventricular hypertrophy on the relationship between ischemia and transient ischemic dilation of the left ventricle on single-day adenosine Tc-99m myocardial perfusion imaging. J Nucl Cardiol 2008;15:638-43.PubMedCrossRefGoogle Scholar
  9. 9.
    Emmett L, et al. The role of left ventricular hypertrophy and diabetes in the presence of transient ischemic dilation of the left ventricle on myocardial perfusion SPECT images. J Nucl Med 2005;46:1596-601.PubMedGoogle Scholar
  10. 10.
    Fallahi B, et al. The additive value of transient left ventricular dilation using two-day dipyridamole 99mTc-MIBI SPET for screening coronary artery disease in patients with otherwise normal myocardial perfusion: A comparison between diabetic and non-diabetic cases. Hell J Nucl Med 2010;13:246-52.PubMedGoogle Scholar
  11. 11.
    Sugihara H, et al. Assessment of transient dilation of the left ventricular cavity in patients with hypertrophic cardiomyopathy by exercise thallium-201 scintigraphy. Kaku Igaku 1990;27:1281-9.PubMedGoogle Scholar
  12. 12.
    Cerqueira MD, et al. Standardized myocardial segmentation and nomenclature for tomographic imaging of the heart. A statement for healthcare professionals from the Cardiac Imaging Committee of the Council on Clinical Cardiology of the American Heart Association. Int J Cardiovasc Imaging 2002;18:539-42.PubMedGoogle Scholar
  13. 13.
    Schiller NB, et al. Recommendations for quantitation of the left ventricle by two-dimensional echocardiography. American Society of Echocardiography Committee on Standards, Subcommittee on Quantitation of Two-Dimensional Echocardiograms. J Am Soc Echocardiogr 1989;2:358-67.PubMedGoogle Scholar
  14. 14.
    Manrique A, et al. Effect of perfusion pattern and imaging sequence on gated perfusion SPECT evaluation of myocardial stunning. J Nucl Med 2005;46:176-83.PubMedGoogle Scholar
  15. 15.
    Ward RP, et al. Overestimation of postischemic myocardial stunning on gated SPECT imaging: Correlation with echocardiography. J Nucl Cardiol 2006;13:514-20.PubMedCrossRefGoogle Scholar
  16. 16.
    Ambrosio G, et al. Prolonged impairment of regional contractile function after resolution of exercise-induced angina. Evidence of myocardial stunning in patients with coronary artery disease. Circulation 1996;94:2455-64.PubMedCrossRefGoogle Scholar
  17. 17.
    Borges-Neto S, et al. Poststress measurements of left ventricular function with gated perfusion SPECT: Comparison with resting measurements by using a same-day perfusion-function protocol. Radiology 2000;215:529-33.PubMedGoogle Scholar
  18. 18.
    Emmett L, et al. Reversible regional wall motion abnormalities on exercise technetium-99m-gated cardiac single photon emission computed tomography predict high-grade angiographic stenoses. J Am Coll Cardiol 2002;39:991-8.PubMedCrossRefGoogle Scholar
  19. 19.
    Heiba SI, et al. Transient postischemic stunning evaluation by stress gated Tl-201 SPECT myocardial imaging: Effect on systolic left ventricular function. J Nucl Cardiol 2002;9:482-90.PubMedCrossRefGoogle Scholar
  20. 20.
    Hung GU, et al. Relationship of transient ischemic dilation in dipyridamole myocardial perfusion imaging and stress-induced changes of functional parameters evaluated by Tl-201 gated SPECT. J Nucl Cardiol 2005;12:268-75.PubMedCrossRefGoogle Scholar
  21. 21.
    Paul AK, et al. Exercise-induced stunning continues for at least one hour: Evaluation with quantitative gated single-photon emission tomography. Eur J Nucl Med 1999;26:410-5.PubMedCrossRefGoogle Scholar
  22. 22.
    Van Tosh A, et al. Exercise echocardiographic correlates of transient dilatation of the left ventricular cavity on exercise thallium-201 SPECT imaging. Chest 1994;106:1725-9.PubMedCrossRefGoogle Scholar
  23. 23.
    Iskandrian AS. Adenosine myocardial perfusion imaging. J Nucl Med 1994;35:734-6.PubMedGoogle Scholar
  24. 24.
    Druz RS, et al. Postischemic stunning after adenosine vasodilator stress. J Nucl Cardiol 2004;11:534-41.PubMedCrossRefGoogle Scholar
  25. 25.
    Robinson VJ, et al. Causes of transient dilatation of the left ventricle during myocardial perfusion imaging. AJR Am J Roentgenol 2000;174:1349-52.PubMedGoogle Scholar
  26. 26.
    Allen JW, Cox TA, Kloner RA. Myocardial stunning: A post-ischemic syndrome with delayed recovery. EXS 1996;76:443-52.PubMedGoogle Scholar
  27. 27.
    Barnes E, et al. Prolonged left ventricular dysfunction occurs in patients with coronary artery disease after both dobutamine and exercise induced myocardial ischaemia. Heart 2000;83:283-9.PubMedCrossRefGoogle Scholar
  28. 28.
    Rinaldi CA, et al. Effect of repetitive episodes of exercise induced myocardial ischaemia on left ventricular function in patients with chronic stable angina: Evidence for cumulative stunning or ischaemic preconditioning? Heart 1999;81:404-11.PubMedGoogle Scholar

Copyright information

© American Society of Nuclear Cardiology 2012

Authors and Affiliations

  • Louise Emmett
    • 1
    Email author
  • Austin Ng
    • 1
  • Leo Ha
    • 1
  • Robert Russo
    • 1
  • Robert Mansberg
    • 1
  • Wei Zhao
    • 2
  • S. Vincent Chow
    • 2
  • Leonard Kritharides
    • 2
  1. 1.Nuclear Medicine Department, Concord HospitalUniversity of SydneySydneyAustralia
  2. 2.Cardiology Department, Concord HospitalUniversity of SydneySydneyAustralia

Personalised recommendations