Predictive and prognostic values of transient ischemic dilatation of left ventricular cavity for coronary artery disease and impact of various managements on clinical outcome using technetium-99m sestamibi gated myocardial perfusion imaging.

Autor: uz Zaman M; Karachi Institute of Heart Diseases (KIHD), Karachi, Pakistan. maseeh.uzzaman@aku.edu, Fatima N, Samad A, Ishaq M, Wali A, Rehman K, Bano J
Jazyk: angličtina
Zdroj: Annals of nuclear medicine [Ann Nucl Med] 2011 Oct; Vol. 25 (8), pp. 566-70. Date of Electronic Publication: 2011 Jun 01.
DOI: 10.1007/s12149-011-0500-4
Abstrakt: Background: Transient ischemic dilatation (TID) of LV cavity during stress gated myocardial perfusion imaging (GMPI) is known as a predictor of severe CAD and signifies worse prognosis.
Objectives: To assess predictive and prognostic value of TID of LV cavity using GMPI and clinical outcome in patients treated conservatively or with revascularization.
Methods: 189 patients out of 2689 were recruited (M:F 127/62, mean age 56 ± 9 years) whose same-day stress GMPI revealed TID ratio (> 1.22) with no (sum stress score, SSS < 2) or reversible perfusion defects (sum difference score, SDS > 2). Coronary angiography (CA) was performed within 3 months in 125/189 cases who were followed for mean period of 18 ± 4 months for fatal or non-fatal MI.
Results: CA was positive in 121/125 patients with TID for significant CAD (LAD = 11, multi vessel disease = 110 patients, positive predictive value 95%) and negative for obstructive disease in 4/125 (false-positive cases). 41/121 underwent revascularization within 2 months of CA (Intervention group), and remaining 80/121 were managed conservatively (Non-Intervention group). Overall event rate was 20% (4/16%: fatal/non-fatal MIs). Kaplan-Meier survival curves revealed event-free survival in Intervention and Non-Intervention groups for fatal MI 98/96% (P = 0.758), and for non-fatal MI, it was 97/58%, respectively (P = 0.042).
Conclusion: We conclude that TID is a reliable predictor of multi vessel CAD and is associated with high incidence of non-fatal MIs than fatal MIs. Revascularization (PCI/CABG) rather than medical treatment should be considered in patients with TID for better clinical outcome.
Databáze: MEDLINE
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