title: Postischemic myocardial stunning is superior to transient ischemic dilation for detecting multivessel coronary artery disease.
abstract: BACKGROUND
  Although poststress myocardial stunning is regarded as a marker for severe coronary artery disease (CAD), no study has yet compared the diagnostic value of poststress stunning with transient ischemic dilation (TID) of the left ventricle (LV) for detecting multivessel CAD.
  
  
  RESULTS
  A total of 271 patients with suspected or known CAD underwent adenosine triphosphate (ATP) loading and at-rest gated single-photon emission computed tomography. We assessed myocardial perfusion with a 20-segment model, and analyzed the changes in LV volumetric analysis induced by ATP and an automatically derived TID ratio. In 147 patients with multivessel CAD, the prevalence of multi-territorial ischemia was higher, and the post-ATP increase in end-systolic volume (ESV) and TID ratio were greater, than in the 124 with insignificant or single-vessel CAD (P<0.0001, for all cases). The receiver-operating characteristic curves analysis revealed cutoff values for ESV of 5 ml and a TID ratio of 1.11. Multivariate logistic regression analysis revealed that the combination of a poststress increase in ESV of ≥5 ml and multi-territorial ischemia best identified multivessel CAD, with a sensitivity of 78% and a specificity of 84%, whereas the TID ratio was not shown to be an independent predictor.
  
  
  CONCLUSIONS
  Post-ATP stress myocardial stunning is superior to the TID ratio for detecting multivessel CAD.
authors.affiliation: Department of Cardiology, Tokyo Medical University, Japan. hida-bin@tokyo-med.ac.jp
authors.forename: Satoshi
authors.initials: S
authors.lastname: Hida
authors.forename: Taishiro
authors.initials: T
authors.lastname: Chikamori
authors.forename: Hirokazu
authors.initials: H
authors.lastname: Tanaka
authors.forename: Yuko
authors.initials: Y
authors.lastname: Igarashi
authors.forename: Chie
authors.initials: C
authors.lastname: Shiba
authors.forename: Tsuguhisa
authors.initials: T
authors.lastname: Hatano
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Usui
authors.forename: Akira
authors.initials: A
authors.lastname: Yamashina
mesh_terms: D000255:Adenosine Triphosphate; D000368:Aged; D000369:Aged, 80 and over; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging*; D003331:Coronary Vessels / Q000000981:diagnostic imaging; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D017202:Myocardial Ischemia / Q000000981:diagnostic imaging*; D055414:Myocardial Perfusion Imaging / Q000379:methods / Q000592:standards; D017682:Myocardial Stunning / Q000000981:diagnostic imaging*; D019275:Radiopharmaceuticals; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D017256:Technetium Tc 99m Sestamibi; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods* / Q000592:standards*
chemical_list: D019275:Radiopharmaceuticals; D000255:Adenosine Triphosphate; D017256:Technetium Tc 99m Sestamibi