Diagnostic value of adenosine-induced left ventricular diastolic dysfunction for detecting coronary artery restenosis in patients undergoing stent implantation by Stress ECG-gated myocardial perfusion SPECT. A pilot study.
BACKGROUND
Usefulness of diastolic dysfunction after adenosine stress for detecting coronary stenosis has not been defined. The diagnostic accuracy of a combination of myocardial perfusion and diastolic function, as defined by prolongation of time to peak-filling rate (TTPF)/R-R and myocardial perfusion alone for the detection of coronary restenosis, was evaluated.


RESULTS
We used rest (201)Tl/ adenosine stress (99m)Tc-tetrofosmin myocardial perfusion singlephoton emission computed tomography (SPECT) in 70 patients. Patients were divided into the following 4 groups: 20 patients with normal SPECT without stent (Control group), 20 patients showing normal SPECT without coronary restenosis (Group 1), 16 patients showing significant coronary restenosis and myocardial ischemia (Group 2a) and 14 patients showing significant coronary restenosis without myocardial ischemia (Group 2b). The TTPF, which was calculated by quantitative gated SPECT (QGS)/R-R, was not different between after stress and at rest in Control group (0.18±0.02 vs 0.19±0.04, P=NS). The TTPF/R-R after stress was significantly lower than that at rest in Group 1 (0.17±0.02 vs 0.18±0.03, P<0.05), but TTPF/R-R after stress was significantly higher than that at rest in Groups 2a and 2b (0.22±0.03 vs 0.16±0.03, P<0.001 in Group 2a and 0.19±0.02 vs 0.16±0.02, P<0.001 in Group 2b, respectively). Diagnostic accuracy improved from 72% to 92% when prolongation of TTPF/R-R was taken into account (P<0.001).


CONCLUSIONS
Diastolic dysfunction after stress was an accurate marker for detecting significant restenosis following stent implantation.
Department of Medicine, Nihon University School of Medicine, Tokyo, Japan.
Yoshimochi
Y
Nakano
Naoya
N
Matsumoto
Yasuyuki
Y
Suzuki
Masahiko
M
Kato
Takaaki
T
Miki
Jun
J
Iida
Shunichi
S
Yoda
Keiko
K
Sugiyama
Yuichi
Y
Sato
Shu
S
Kasama
Toshio
T
Kushiro
Ken
K
Nagao
Atsushi
A
Hirayama
D000241:Adenosine / Q000008:administration & dosage*; D000368:Aged; D000889:Anti-Arrhythmia Agents / Q000008:administration & dosage*; D023903:Coronary Restenosis / Q000000981:diagnostic imaging*; D004562:Electrocardiography; D005080:Exercise Test; D005260:Female; D006801:Humans; D008297:Male; D015425:Myocardial Reperfusion; D009943:Organophosphorus Compounds / Q000008:administration & dosage; D015609:Organotechnetium Compounds / Q000008:administration & dosage; D011859:Radiography; D019275:Radiopharmaceuticals / Q000008:administration & dosage; D015607:Stents; D013794:Thallium Radioisotopes; D015899:Tomography, Emission-Computed, Single-Photon; D018487:Ventricular Dysfunction, Left / Q000139:chemically induced / Q000000981:diagnostic imaging
D000889:Anti-Arrhythmia Agents; D009943:Organophosphorus Compounds; D015609:Organotechnetium Compounds; D019275:Radiopharmaceuticals; D013794:Thallium Radioisotopes; C078700:technetium tc-99m tetrofosmin; D000241:Adenosine