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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

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Journal of Nuclear Cardiology Aims and scope

Abstract

Background

The critical threshold and clinical significance of transient ischemic dilation (TID) for regadenoson, single-isotope 99mTc SPECT myocardial perfusion imaging (MPI) are not defined.

Methods

From 100 patients with low likelihood of CAD, we derived the abnormal TID threshold (mean + 2 SD). We validated the threshold in a cohort of 547 patients who received one-day, rest/regadenoson-stress, 99mTc-tetrofosmin SPECT-MPI followed by coronary angiography within 6 months. Patients were classified into three CAD severity strata: no significant CAD, mild to moderate CAD, and severe and extensive CAD.

Results

The abnormal TID threshold was determined to be 1.31. Though mean TID ratios were different between the three CAD severity groups and the derivation cohort (P < .001), there was no difference in the mean TID ratios between the categories of CAD severity or in the prevalence of severe CAD between TID+ and TID− groups (P = .74). By ROC analysis, TID had a poor discriminatory capacity in identifying severe and extensive CAD [AUC of 0.55 (95% CI 0.47-0.62, P = .25)]. Stepwise multivariate logistic analysis demonstrated that adding TID to clinical and perfusion data did not provide incremental diagnostic value (P = .87).

Conclusions

The clinical utility of TID with regadenoson-stress MPI in this era of declining CAD burden is questionable.

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Disclosures

Dr. Rami Doukky received research support from Astellas Pharma (Northbrook, IL) and served on the advisory board of Astellas Pharma.

Author information

Authors and Affiliations

  1. Division of Cardiology, John H. Stroger, Jr. Hospital of Cook County, Chicago, IL, USA

    Yasmeen Golzar MD, FACC, Adebayo Olusanya MD & Rami Doukky MD, MSc, FACC, FASNC

  2. Division of Cardiology, Rush University Medical Center, 1653 W. Congress Pkwy, Chicago, IL, 60612, USA

    Yasmeen Golzar MD, FACC, Nadith Pe MD & Rami Doukky MD, MSc, FACC, FASNC

  3. Department of Radiology, Rush University Medical Center, 1653 W. Congress Pkwy, Chicago, IL, 60612, USA

    Sumeet G. Dua MD

  4. Division of Cardiology, Advocate Christ Medical Center, Oak Lawn, IL, USA

    Jaafer Golzar MD, FACC, FSCAI

  5. Division of Cardiology, Newark Beth Israel Medical Center, Newark, NJ, USA

    Claudia Gidea MD, FACC

Authors
  1. Yasmeen Golzar MD, FACC
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  2. Adebayo Olusanya MD
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  3. Nadith Pe MD
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  4. Sumeet G. Dua MD
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  5. Jaafer Golzar MD, FACC, FSCAI
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  6. Claudia Gidea MD, FACC
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  7. Rami Doukky MD, MSc, FACC, FASNC
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Corresponding author

Correspondence to Rami Doukky MD, MSc, FACC, FASNC.

Additional information

See related editorial, doi:10.1007/s12350-015-0122-7.

Funding

An investigator initiated research grant from Astellas Pharma and an internal Rush-Stroger collaborative research grant. The grants’ fiduciary was Rush University Medical Center; the principal investigator was Rami Doukky. The funding source had no input into the study design, execution, data analysis and interpretation, or manuscript preparation and approval.

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Golzar, Y., Olusanya, A., Pe, N. 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. 22, 526–534 (2015). https://doi.org/10.1007/s12350-015-0087-6

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  • DOI: https://doi.org/10.1007/s12350-015-0087-6

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