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The value of transient ischemic dilation for detecting restenosis after coronary artery revascularization

Journal of Nuclear Cardiology volume 25, pages 586–592 (2018)Cite this article

Abstract

Aim

Transient ischemic dilation (TID) is a marker of severe coronary artery disease (CAD). We aimed to assess the incremental value of TID in a cohort of patients with known significant CAD who had recurrence of symptoms after revascularization.

Methods

We identified in our databases 104 patients who had recent coronary revascularization and recurrence of symptoms. 62 patients had PCI (75 arteries) and 42 patients had CABG (104 arteries). All had follow-up stress SPECT MPI and repeat coronary angiography. Myocardial perfusion findings of ischemia and TID were correlated with presence of significant obstructive CAD (>70% stenosis).

Results

Follow-up stress Tc-99m Sestamibi SPECT MPI revealed inducible ischemia in 38 patients (36.5%) and TID > 1.20 in 49 patients (47%). Subsequent coronary angiography showed significant obstructive CAD in 44 patients (42%). The sensitivity for detecting obstructive CAD was 61% for SPECT MPI alone, but increased significantly to 93% by the addition of TID as a diagnostic criterion (P < 0.0001).

Conclusions

In this selected patient cohort with prior coronary revascularization, TID is an important marker of obstructive CAD and has incremental value over SPECT MPI alone.

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Figure 1

Abbreviations

CAD:

Coronary artery disease

CABG:

Coronary artery bypass grafting

EF:

Ejection fraction

EDV:

End-diastolic volume

ESV:

End-systolic volume

MPI:

Myocardial perfusion imaging

PCI:

Percutaneous coronary intervention

SPECT:

Single-photon emission computed tomography

TID:

Transient ischemic dilation

Tc-99m Sestamibi:

Technetium-99m-methoxyisobutylisonitrile

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Acknowledgments

This article was finalized under the auspices of the “Mentorship at Distance” committee of the Journal of Nuclear Cardiology. We gratefully acknowledge the editorial suggestions by Frans J. Th. Wackers, MD, PhD.

Disclosure

The authors declared no potential conflicts of interests with respect to the authorship and/or publication of this article. The authors received no financial support for the research and/or authorship of this article.

Proprietary Interest

The authors state that they have no proprietary interest in the products named in this article.

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Affiliations

  1. Department of Nuclear Medicine, Ministry of Health, Diskapi Yildirim Beyazit Training and Research Hospital, Etlik, Ankara, Turkey

    Salih Sinan Gultekin MD

  2. Department of Nuclear Medicine, Ministry of Health, Ankara Training and Research Hospital, Ulucanlar Street, 06560, Ankara, Turkey

    Murat Sadic MD, Gökhan Koca MD & Meliha Korkmaz MD

  3. Department of Cardiology, Ministry of Health, Diskapi Yildirim Beyazit Training and Research Hospital, Altindag, Ankara, Turkey

    Murat Bilgin MD, Sadik Acikel MD & Ekrem Yeter MD

Authors
  1. Salih Sinan Gultekin MD
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  2. Murat Sadic MD
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  3. Murat Bilgin MD
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  4. Gökhan Koca MD
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  5. Sadik Acikel MD
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  6. Ekrem Yeter MD
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  7. Meliha Korkmaz MD
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Correspondence to Salih Sinan Gultekin MD.

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Gultekin, S.S., Sadic, M., Bilgin, M. et al. The value of transient ischemic dilation for detecting restenosis after coronary artery revascularization. J. Nucl. Cardiol. 25, 586–592 (2018). https://doi.org/10.1007/s12350-016-0607-z

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  • DOI: https://doi.org/10.1007/s12350-016-0607-z

Keywords

  • Coronary artery disease
  • coronary revascularization
  • myocardial perfusion imaging: SPECT
  • transient ischemic dilation