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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

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Journal of Nuclear Cardiology Aims and scope

Abstract

Background. Diabetes and left ventricular hypertrophy (LVH) can cause coronary flow reserve abnormalities in the absence of coronary artery disease (CAD). We sought to evaluate the impact of LVH and diabetes on the relationship between ischemia, severe CAD, and transient ischemic dilation (TID) on adenosine myocardial perfusion imaging (MPI).

Methods and Results. We prospectively recruited 157 patients referred for routine single-day adenosine technetium 99m MPI. LVH was assessed by use of transthoracic echocardiography. A ratio of 1.19 or greater on MPI defined TID in men and 1.31 or greater in women. Summed difference scores were determined by use of a 17-segment 5-point scoring system. TID was present in 22 of 157 patients (14%), diabetes in 54 of 157 (34%), and LVH in 42 of 157 (27%). By multivariate logistic regression, LVH, ischemia (summed difference score >2), and diabetes were independently predictive of TID. The incidence of TID was stratified by the presence or absence of diabetes and/or LVH in those with ischemia on MPI (8/8 [100%] vs 0/11 [0%], P<.002) or severe CAD on angiography (5/7 [71%] vs 0/8 [0%], P<.01). All those with TID (22/22 [100%]) had either diabetes or LVH (or both).

Conclusion. Although this study confirms the association between TID and both ischemia and severe CAD, all patients with TID had diabetes, LVH, or frequently, both, suggesting that the pathophysiology of these disease processes may play an integral role in the manifestation of TID on adenosine MPI.

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Authors and Affiliations

  1. From the Nuclear Medicine Departmenta, Concord Repatriation General Hospital, University of Sydney, Sydney, Australia

    Louise Emmett MBChB, William J. Van Gaal MBBS, Michael Magee MBBS, Sarah Bass BAppSc & Hans Van der Wall MBBS, PhD

  2. Cardiology Department, Concord Repatriation General Hospital, University of Sydney, Sydney, Australia

    Onn Ali MBBS, S. Ben Freedman MBBS, PhD & Leonard Kritharides MBBS, PhD

Authors
  1. Louise Emmett MBChB
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  2. William J. Van Gaal MBBS
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  3. Michael Magee MBBS
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  4. Sarah Bass BAppSc
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  5. Onn Ali MBBS
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  6. S. Ben Freedman MBBS, PhD
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  7. Hans Van der Wall MBBS, PhD
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  8. Leonard Kritharides MBBS, PhD
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Correspondence to Louise Emmett MBChB.

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Emmett, L., Van Gaal, W.J., Magee, M. 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 15, 638–643 (2008). https://doi.org/10.1016/j.nuclcard.2008.06.005

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  • DOI: https://doi.org/10.1016/j.nuclcard.2008.06.005

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