title: 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.
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).
  
  
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Nuclear Medicine Department, Concord Repatriation General Hospital, University of Sydney, Sydney, Australia. louisee@nucmed.crg.cs.nsw.gov.au
authors.forename: Louise
authors.initials: L
authors.lastname: Emmett
authors.forename: William J
authors.initials: WJ
authors.lastname: Van Gaal
authors.forename: Michael
authors.initials: M
authors.lastname: Magee
authors.forename: Sarah
authors.initials: S
authors.lastname: Bass
authors.forename: Onn
authors.initials: O
authors.lastname: Ali
authors.forename: S Ben
authors.initials: SB
authors.lastname: Freedman
authors.forename: Hans
authors.initials: H
authors.lastname: Van der Wall
authors.forename: Leonard
authors.initials: L
authors.lastname: Kritharides