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The prognostic value of transient ischemic dilatation with otherwise normal SPECT myocardial perfusion imaging: A cautionary note in patients with diabetes and coronary artery disease

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Journal of Nuclear Cardiology Aims and scope

Abstract

Background

The prognostic implications of transient ischemic dilatation (TID) of the left ventricle with otherwise normal single-photon emission computed tomography myocardial perfusion imaging (MPI) remain controversial. Whether this finding may have prognostic implications only in high-risk populations, such as patients with diabetes or manifest coronary artery disease (CAD), is uncertain.

Methods

We conducted a prospective cohort study of 1,236 consecutive patients with normal 99mTc-sestamibi MPI, defined as normal perfusion (summed stress score = 0) and normal left ventricle volume and function. TID was defined as >2 standard deviations above the mean of patients with low likelihood of CAD.

Results

The study subjects were followed for 27 ± 9 months. The 76 (6%) patients with TID had a greater rate of cardiac death or myocardial infarction (MI) [4 (5.3%) vs 11 (0.6%), P = .003] independent of covariates [hazard ratio = 6.4, P = .004]. This finding was entirely derived from the subgroup of 294 patients with diabetes or CAD [4 (13.3%) with TID vs 1 (0.4%) without TID, P = .001] independent of covariates. However, TID was not predictive of cardiac death or MI among the 941 patients without diabetes or CAD. Furthermore, TID was not predictive of coronary revascularization.

Conclusions

This study confirms a benign prognosis of TID with otherwise normal MPI in patients without diabetes or CAD, but cautions against extending this conclusion to high-risk individuals, particularly those with diabetes or CAD.

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Conflicts of interest

Rami Doukky served on the advisory board of Astellas Pharma US and received past funding investigator-initiated grant support from Astellas Pharma US.

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Authors and Affiliations

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

    Rami Doukky MD, MSc, FACC, Nathan Frogge MBA, Kara Confer BS, Kalindi Parikh MD & Russell F. Kelly MD, FACC

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

    Rami Doukky MD, MSc, FACC, Yohannes A. Bayissa MD & Russell F. Kelly MD, FACC

  3. Department of Medicine, Iowa Methodist Medical Center, Des Moines, IA, USA

    Gautam Balakrishnan MD

  4. Medical Outsourcing Solutions, Midwest Imaging Consultants, Sycamore, IL, USA

    Jacob M. Skelton CNMT, RT(N)

Authors
  1. Rami Doukky MD, MSc, FACC
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  2. Nathan Frogge MBA
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  3. Yohannes A. Bayissa MD
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  4. Gautam Balakrishnan MD
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  5. Jacob M. Skelton CNMT, RT(N)
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  6. Kara Confer BS
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  7. Kalindi Parikh MD
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  8. Russell F. Kelly MD, FACC
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Correspondence to Rami Doukky MD, MSc, FACC.

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Doukky, R., Frogge, N., Bayissa, Y.A. et al. The prognostic value of transient ischemic dilatation with otherwise normal SPECT myocardial perfusion imaging: A cautionary note in patients with diabetes and coronary artery disease. J. Nucl. Cardiol. 20, 774–784 (2013). https://doi.org/10.1007/s12350-013-9765-4

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  • DOI: https://doi.org/10.1007/s12350-013-9765-4

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