title: Transient ischemic dilatation of the left ventricle with severe post stress left ventricular dysfunction in the setting of severe aortic stenosis and normal coronary arteries.
abstract: Transient ischemic dilatation (TID) of the left ventricle observed during single photon myocardial perfusion emission computed tomography (SPECT) is an important non-perfusion finding that may not only suggest underlying significant (usually multi-vessel) coronary artery disease (CAD) but also an independent prognostic factor of adverse outcomes regardless of abnormal or normal perfusion finding. We present a patient with no significant epicardial coronary disease who had significant TID and considerable decrease in the left ventricular ejection fraction with left ventricular dilatation after a rest-stress Tc-99 tetrofosmin SPECT study in the setting of severe aortic stenosis. With the advent of gated SPECT imaging the additive value of determining rest and post stress EF, as demonstrated in this case, aided in the recognition of TID and transient decrease in the left ventricular ejection fraction. These are not necessarily related to obstructive epicardial coronary disease, but are a result of severe aortic valve disease causing subendocardial ischemia in the setting of multilple other non-ischemic etiologies of TID such as left ventricular hypertrophy and diabetes mellitus.
authors.affiliation: Henry Ford Heart and Vascular Institute, K-14, Henry Ford Hospital, 2799 West Grand Blvd, Detroit, MI 48202, USA.
authors.forename: Marcin
authors.initials: M
authors.lastname: Kowalski
authors.forename: Beth A
authors.initials: BA
authors.lastname: Harkness
authors.forename: Karthik
authors.initials: K
authors.lastname: Ananthasubramaniam
mesh_terms: D000241:Adenosine; D001021:Aortic Valve / Q000503:physiopathology; D001024:Aortic Valve Stenosis / Q000150:complications*; D003324:Coronary Artery Disease / Q000175:diagnosis*; D003331:Coronary Vessels / Q000000981:diagnostic imaging; D005080:Exercise Test; D005260:Female; D006801:Humans; D008875:Middle Aged; D009943:Organophosphorus Compounds; D015609:Organotechnetium Compounds; D019275:Radiopharmaceuticals; D013318:Stroke Volume / Q000502:physiology*; D015899:Tomography, Emission-Computed, Single-Photon; D014665:Vasodilator Agents; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000209:etiology
chemical_list: D009943:Organophosphorus Compounds; D015609:Organotechnetium Compounds; D019275:Radiopharmaceuticals; D014665:Vasodilator Agents; C078700:technetium tc-99m tetrofosmin; D000241:Adenosine