title: Transient Ischemic Dilatation during Stress Echocardiography: An Additional Marker of Significant Myocardial Ischemia.
abstract: OBJECTIVE
  Left ventricular (LV) transient ischemic dilatation (TID) is not clear how it relates to inducible myocardial ischemia during stress echocardiography (SE).
  
  
  RESULTS
  Eighty-eight SEs were examined from the site certification phase of the ISCHEMIA Trial. LV end-diastolic volume (EDV) and end-systolic volume (ESV) were measured at rest and peak stages and the percent change calculated. Moderate or greater ischemia was defined as ≥3 segments with stress-induced severe hypokinesis or akinesis. Optimum cut points in stress-induced percent EDV and ESV change that identified moderate or greater myocardial ischemia were analyzed. Analysis from percentage distribution identified a > 13% LV volume increase in EDV or a > 9% LV volume increase in ESV as the optimum cutoff points for moderate or greater ischemia. Using these definitions for TID, there were 27 (31%) with TIDESV and 12 (14%) with TIDEDV . By logistic regression analysis and receiver operating characteristic curves, the percent change in ESV had a stronger association with moderate or greater myocardial ischemia than that of EDV change. Compared to those without TIDESV , cases with TIDESV had larger extent of inducible wall-motion abnormalities, lower peak stress LVEF, and higher likelihood of moderate or grater ischemia. For moderate or greater myocardial ischemia detection, TIDESV had a sensitivity of 46%, specificity of 83%, positive predictive value of 70%, and negative predictive value of 64%.
  
  
  CONCLUSIONS
  Transient ischemic dilatation by SE is a marker of extensive myocardial ischemia and can be used as an additional marker of higher risk.
authors.affiliation: Cardiac Ultrasound Laboratory, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.
authors.forename: Akihisa
authors.initials: A
authors.lastname: Kataoka
authors.affiliation: Cardiac Ultrasound Laboratory, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.
authors.forename: Marielle
authors.initials: M
authors.lastname: Scherrer-Crosbie
authors.affiliation: Department of Cardiovascular Medicine, Division of Cardiology, National Heart and Lung Institute and Imperial College, London, United Kingdom.
authors.forename: Roxy
authors.initials: R
authors.lastname: Senior
authors.affiliation: Department of Medicine, Montreal Heart Institute, Montreal, Canada.
authors.forename: Patrick
authors.initials: P
authors.lastname: Garceau
authors.affiliation: Department of Cardiology, La Paz University Hospital, Madrid, Spain.
authors.forename: Silvia
authors.initials: S
authors.lastname: Valbuena
authors.affiliation: Center of Cardiology and Angiology, Vilnius University Hospital Santariskiu Clinic, Vilnius, Lithuania.
authors.forename: Jelena
authors.initials: J
authors.lastname: Čelutkienė
authors.affiliation: Division of Cardiology, V.A. North Texas Health Care System, Dallas, Texas.
authors.forename: Jeffrey L
authors.initials: JL
authors.lastname: Hastings
authors.affiliation: Division of Cardiology, Saint Michael's Hospital, Toronto, Canada.
authors.forename: Asim N
authors.initials: AN
authors.lastname: Cheema
authors.affiliation: Department of Medicine, Specialty Hospital, La Raza National Medical Center, Mexico City, Mexico.
authors.forename: Alfonso
authors.initials: A
authors.lastname: Lara
authors.affiliation: Department of Internal Medicine, University Clinic of Cardiology, Skopje, Macedonia.
authors.forename: Elizabeta
authors.initials: E
authors.lastname: Srbinovska-Kostovska
authors.affiliation: Department of Medicine, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Canada.
authors.forename: Renee
authors.initials: R
authors.lastname: Hessian
authors.affiliation: Department of Medicine, Division of Cardiology, Monza Polyclinic, Monza, Italy.
authors.forename: Daniele
authors.initials: D
authors.lastname: Poggio
authors.affiliation: Department of Medicine, Division of Cardiology, Englewood Hospital and Medical Center, Englewood, New Jersey.
authors.forename: Richard
authors.initials: R
authors.lastname: Goldweit
authors.affiliation: Department of Medicine, Division of Cardiology, New York University Medical Center, New York, New York.
authors.forename: Muhamed
authors.initials: M
authors.lastname: Saric
authors.affiliation: Department of Medicine, Division of Cardiology, Loyola University Medical Center, Maywood, Illinois.
authors.forename: Khaled A
authors.initials: KA
authors.lastname: Dajani
authors.affiliation: Department of Medicine, New York Medical Associates, New York, New York.
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Kohn
authors.affiliation: Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Leslee J
authors.initials: LJ
authors.lastname: Shaw
authors.affiliation: Department of Medicine, Division of Cardiology, New York University Langone Medical Center, New York, New York.
authors.forename: Harmony R
authors.initials: HR
authors.lastname: Reynolds
authors.affiliation: Cardiac Ultrasound Laboratory, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.
authors.forename: Michael H
authors.initials: MH
authors.lastname: Picard
mesh_terms: D015415:Biomarkers; D025401:Echocardiography, Stress / Q000379:methods*; D005260:Female; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000000981:diagnostic imaging* / Q000209:etiology*; D038622:Internationality; D008297:Male; D017202:Myocardial Ischemia / Q000150:complications / Q000000981:diagnostic imaging*; D015588:Observer Variation; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity
chemical_list: D015415:Biomarkers
keywords: coronary artery disease; myocardial ischemia; stress echocardiography