The prognostic value of transient ischemic dilatation with otherwise normal SPECT myocardial perfusion imaging: a cautionary note in patients with diabetes and coronary artery disease.
BACKGROUND
The prognostic implications of transient ischemic dilatation (TID) of the left ventricle with otherwise normal single-photon emission computed tomography myocardial perfusion imaging (MPI) remain controversial. Whether this finding may have prognostic implications only in high-risk populations, such as patients with diabetes or manifest coronary artery disease (CAD), is uncertain.


METHODS
We conducted a prospective cohort study of 1,236 consecutive patients with normal (99m)Tc-sestamibi MPI, defined as normal perfusion (summed stress score = 0) and normal left ventricle volume and function. TID was defined as >2 standard deviations above the mean of patients with low likelihood of CAD.


RESULTS
The study subjects were followed for 27 ± 9 months. The 76 (6%) patients with TID had a greater rate of cardiac death or myocardial infarction (MI) [4 (5.3%) vs 11 (0.6%), P = .003] independent of covariates [hazard ratio = 6.4, P = .004]. This finding was entirely derived from the subgroup of 294 patients with diabetes or CAD [4 (13.3%) with TID vs 1 (0.4%) without TID, P = .001] independent of covariates. However, TID was not predictive of cardiac death or MI among the 941 patients without diabetes or CAD. Furthermore, TID was not predictive of coronary revascularization.


CONCLUSIONS
This study confirms a benign prognosis of TID with otherwise normal MPI in patients without diabetes or CAD, but cautions against extending this conclusion to high-risk individuals, particularly those with diabetes or CAD.
Division of Cardiology, Rush University Medical Center, 1653 W. Congress Pkwy, Chicago, IL, 60612, USA, rami_doukky@rush.edu.
Rami
R
Doukky
Nathan
N
Frogge
Yohannes A
YA
Bayissa
Gautam
G
Balakrishnan
Jacob M
JM
Skelton
Kara
K
Confer
Kalindi
K
Parikh
Russell F
RF
Kelly
D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D003324:Coronary Artery Disease / Q000150:complications*; D048909:Diabetes Complications / Q000175:diagnosis*; D004106:Dilatation; D018572:Disease-Free Survival; D006801:Humans; D008875:Middle Aged; D055414:Myocardial Perfusion Imaging; D009204:Myocardial Revascularization; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D019275:Radiopharmaceuticals; D015203:Reproducibility of Results; D012307:Risk Factors; D017256:Technetium Tc 99m Sestamibi; D013997:Time Factors; D015899:Tomography, Emission-Computed, Single-Photon; D016896:Treatment Outcome
D019275:Radiopharmaceuticals; D017256:Technetium Tc 99m Sestamibi