title: Transient ischemic dilation in SPECT myocardial perfusion imaging for prediction of severe coronary artery disease in diabetic patients.
abstract: BACKGROUND
  Transient ischemic dilation (TID) of the left ventricle during stress myocardial perfusion SPECT (MPS) has been shown to be a useful marker of severe coronary artery disease (CAD). However, investigations in diabetic patients with available coronary angiographic data are still limited. We evaluated the incremental diagnostic value of TID in identifying the presence of angiographically severe CAD in diabetic patients.
  
  
  RESULTS
  TID ratio values were automatically derived from rest-stress MPS in 242 diabetic patients with available coronary angiography data. A cutoff of ≥1.19 was considered to represent TID. Severe CAD (≥70% stenosis in the proximal left anterior descending artery or the left main artery, or ≥90% stenosis in two or three vessels) was identified in 69 (29%) patients. At multivariate analysis, the best independent predictors of severe CAD were summed stress score and TID (both P < .001). At incremental analysis, the addition of TID improved the power of a model including clinical data and summed stress score, increasing the global χ(2) value from 14.3 to 28.2 (P < .01). The best cutoff of summed stress score for identifying patients with severe CAD was ≥8. When the TID ratio was considered in patients with summed stress score between 3 and 7, the sensitivity for diagnosing severe CAD significantly improved from 71% to 77% (P < .05). In the overall study population, the net reclassification improvement by adding TID to a model including clinical data and summed stress score in the prediction of severe CAD was 0.40 (P < .005).
  
  
  CONCLUSIONS
  TID ratios obtained from rest-stress MPS provide incremental diagnostic information to standard perfusion analysis for the identification of severe and extensive CAD in diabetic patients.
authors.affiliation: Department of Clinical Medicine, Cardiovascular and Immunological Sciences, University Federico II, Naples, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Petretta
authors.forename: Wanda
authors.initials: W
authors.lastname: Acampa
authors.forename: Stefania
authors.initials: S
authors.lastname: Daniele
authors.forename: Maria Piera
authors.initials: MP
authors.lastname: Petretta
authors.forename: Carmela
authors.initials: C
authors.lastname: Nappi
authors.forename: Roberta
authors.initials: R
authors.lastname: Assante
authors.forename: Emilia
authors.initials: E
authors.lastname: Zampella
authors.forename: Pierluigi
authors.initials: P
authors.lastname: Costanzo
authors.forename: Pasquale
authors.initials: P
authors.lastname: Perrone-Filardi
authors.forename: Alberto
authors.initials: A
authors.lastname: Cuocolo
mesh_terms: D000368:Aged; D000465:Algorithms; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging*; D048909:Diabetes Complications / Q000175:diagnosis / Q000000981:diagnostic imaging; D003920:Diabetes Mellitus / Q000000981:diagnostic imaging / Q000473:pathology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D017202:Myocardial Ischemia / Q000000981:diagnostic imaging*; D055414:Myocardial Perfusion Imaging / Q000379:methods*; D011237:Predictive Value of Tests; D019275:Radiopharmaceuticals; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D012984:Software; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods*
chemical_list: D019275:Radiopharmaceuticals