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Prognostic importance of scintigraphic left ventricular cavity dilation during intravenous dipyridamole technetium-99m sestamibi myocardial tomographic imaging in predicting coronary events

  • Joseph R. McClellan
    Correspondence
    Address for reprints: Joseph R. McClellan, MD, Hospital of the University of Pennsylvania, 9 Founders Pavilion, 3400 Spruce Street, Philadelphia, PA 19010.
    Affiliations
    From the Division of Cardiology, Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA

    From the Division of Cardiology, Roger Williams Medical Center, Providence, USA

    From the Division of Cardiology, Memorial Hospital of Rhode Island, Pawtucket, USA

    From the Department of Medicine, Brown University School of Medicine, Providence, Rhode Island, USA

    From the Division of Cardiology, Hartford Hospital, University of Connecticut School of Medicine, Hartford, Connecticut, USA
    Search for articles by this author
  • Mark I. Travin
    Affiliations
    From the Division of Cardiology, Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA

    From the Division of Cardiology, Roger Williams Medical Center, Providence, USA

    From the Division of Cardiology, Memorial Hospital of Rhode Island, Pawtucket, USA

    From the Department of Medicine, Brown University School of Medicine, Providence, Rhode Island, USA

    From the Division of Cardiology, Hartford Hospital, University of Connecticut School of Medicine, Hartford, Connecticut, USA
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  • Steven D. Herman
    Affiliations
    From the Division of Cardiology, Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA

    From the Division of Cardiology, Roger Williams Medical Center, Providence, USA

    From the Division of Cardiology, Memorial Hospital of Rhode Island, Pawtucket, USA

    From the Department of Medicine, Brown University School of Medicine, Providence, Rhode Island, USA

    From the Division of Cardiology, Hartford Hospital, University of Connecticut School of Medicine, Hartford, Connecticut, USA
    Search for articles by this author
  • John I. Baron
    Affiliations
    From the Division of Cardiology, Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA

    From the Division of Cardiology, Roger Williams Medical Center, Providence, USA

    From the Division of Cardiology, Memorial Hospital of Rhode Island, Pawtucket, USA

    From the Department of Medicine, Brown University School of Medicine, Providence, Rhode Island, USA

    From the Division of Cardiology, Hartford Hospital, University of Connecticut School of Medicine, Hartford, Connecticut, USA
    Search for articles by this author
  • Robert J. Golub
    Affiliations
    From the Division of Cardiology, Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA

    From the Division of Cardiology, Roger Williams Medical Center, Providence, USA

    From the Division of Cardiology, Memorial Hospital of Rhode Island, Pawtucket, USA

    From the Department of Medicine, Brown University School of Medicine, Providence, Rhode Island, USA

    From the Division of Cardiology, Hartford Hospital, University of Connecticut School of Medicine, Hartford, Connecticut, USA
    Search for articles by this author
  • James J. Gallagher
    Affiliations
    From the Division of Cardiology, Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA

    From the Division of Cardiology, Roger Williams Medical Center, Providence, USA

    From the Division of Cardiology, Memorial Hospital of Rhode Island, Pawtucket, USA

    From the Department of Medicine, Brown University School of Medicine, Providence, Rhode Island, USA

    From the Division of Cardiology, Hartford Hospital, University of Connecticut School of Medicine, Hartford, Connecticut, USA
    Search for articles by this author
  • David Waters
    Affiliations
    From the Division of Cardiology, Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA

    From the Division of Cardiology, Roger Williams Medical Center, Providence, USA

    From the Division of Cardiology, Memorial Hospital of Rhode Island, Pawtucket, USA

    From the Department of Medicine, Brown University School of Medicine, Providence, Rhode Island, USA

    From the Division of Cardiology, Hartford Hospital, University of Connecticut School of Medicine, Hartford, Connecticut, USA
    Search for articles by this author
  • Gary V. Heller
    Affiliations
    From the Division of Cardiology, Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA

    From the Division of Cardiology, Roger Williams Medical Center, Providence, USA

    From the Division of Cardiology, Memorial Hospital of Rhode Island, Pawtucket, USA

    From the Department of Medicine, Brown University School of Medicine, Providence, Rhode Island, USA

    From the Division of Cardiology, Hartford Hospital, University of Connecticut School of Medicine, Hartford, Connecticut, USA
    Search for articles by this author
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      Abstract

      Left ventricular (LV) cavity dilation during stress myocardial perfusion imaging has been associated with multivessel disease, and may be an independent prognostic marker in addition to perfusion defects. The present study examines the predictive value for future cardiac events of transient or fixed LV dilation during dipyridamole technetium-99m (Tc-99m) sestamibi single-photon emission computed tomography (SPECT) imaging. The study included 512 consecutive patients who underwent SPECT imaging with Tc-99m sestamibi after dipyridamole infusion. Transient LV dilation was seen in 70 patients (14%) and 74 had fixed cavity dilation (14%); cavity size was normal in 368 patients (72%). Each perfusion scan was classified as normal or abnormal, and if abnormal, defects were categorized as transient or fixed, and as small, medium, or large (depending upon the number of abnormal vascular territories). Events during a mean follow-up of 12.8 ± 6.8 months were tabulated by direct review of hospital charts and death certificates. The cardiac event rate (cardiac death or nonfatal infarction) was 1.9% in patients with normal cavity size, 11.4% with transient LV dilation, and 13.5% with fixed LV dilation (p < 0.01). Compared with patients with normal cavity size, those with transient LV dilation were more likely to sustain a myocardial infarction (p < 0.01) and those with fixed dilation more frequently suffered cardiac death (p < 0.01) and hospitalization for heart failure (p < 0.01). The group with the highest risk had both a large perfusion defect and cavity dilation. By Cox proportional hazard regression analysis, both transient and fixed LV dilation were strong independent predictors of cardiac events. Transient or fixed LV dilation are commonly seen during dipyridamole Tc-99m sestamibi SPECT imaging (14% incidence for each) and are useful predictors of cardiac events.
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      References

        • Heller GV
        • Brown KA
        Prognosis of acute and chronic coronary artery disease by myocardial perfusion imaging.
        Cardiol Clin. 1994; 12: 271-287
        • Brown KA
        Prognostic value of thallium-201 myocardial perfusion imaging.
        Circulation. 1991; 83: 363-381
        • Iskandrian AS
        • Chae SC
        • Heo J
        • Stanberry CD
        • Wasserleben V
        • Cave V
        Independent and incremental prognostic value of exercise single-photon emission computed tomography (SPECT) thallium imaging in coronary artery disease.
        J Am Coll Cardiol. 1993; 22: 665-670
        • Hendel RC
        • Layden JJ
        • Leppo JA
        Prognostic value of dipyridamole thallium scintigraphy for evaluation of ischemic heart disease.
        J Am Coll Cardiol. 1990; 15: 109-116
        • Younis LT
        • Byers S
        • Shaw L
        • Barth G
        • Goodgold H
        • Chaitman BR
        Prognostic importance of silent myocardial ischemia detected by intravenous dipyridamole thallium myocardial imaging in asymptomatic patients with coronary artery disease.
        J Am Coll Cardiol. 1989; 14: 1635-1641
        • Stratmann HG
        • Younis LT
        • Kong B
        Prognostic value of dipyridamole thallium-201 scintigraphy in patients with stable chest pain.
        Am Heart J. 1992; 123: 317-323
        • Ladenheim ML
        • Pollock BH
        • Rozanski A
        • Berman DS
        • Staniloff HM
        • Forrester JS
        • Diamond GA
        Extent and severity of myocardial hypoperfusion as predictors of prognosis in patients with suspected coronary artery disease.
        J Am Coll Cardiol. 1986; 7: 464-471
        • Gill JB
        • Ruddy TD
        • Newell JB
        • Finkelstein DM
        • Strauss HW
        • Boucher CA
        Prognostic importance of thallium uptake by the lungs during exercise in coronary artery disease.
        N Engl J Med. 1987; 317: 1485-1489
        • Giubbini R
        • Campini R
        • Milan E
        • Zoccarato O
        • Orlandi C
        • Rossini P
        • Giannuzzi P
        • LaCanna G
        • Galli M
        Evaluation of technitium-99m-sestamibi lung uptake: correlation with left ventricular function.
        J Nucl Med. 1995; 36: 58-63
        • Kahn JK
        • Carry IM
        • McGhie I
        • Pippin JJ
        • Akers MS
        • Corbett JR
        Quantitation of post-exercise lung thallium-201 uptake during single-photon emission computed tomography.
        J Nucl Med. 1989; 30: 288-294
        • Christian TF
        • Miller TD
        • Bailey KR
        • Gibbons RJ
        Noninvasive identification of severe coronary artery disease using exercise tomographic thallium-201 imaging.
        Am J Cardiol. 1992; 70: 14-20
        • Fintel W
        • Links JM
        • Brinker JA
        • Frank RL
        • Parker M
        • Becker LC
        Improved diagnostic performance of exercise thallium-201 single photon emission computed tomography over planar imaging in the diagnosis of coronary artery disease: a receiver operating characteristic analysis.
        J Am Coll Cardiol. 1989; 13: 600-612
        • Ilmer B
        • Reijs AE
        • Reiber JH
        • Bakker W
        • Fioretti P
        Relationships between lung-heart ratio assessed from post-exercise thallium-201 myocardial tomograms, myocardial ischemia and the extent of coronary artery disease.
        Int J Card Imaging. 1990; 6: 135-141
        • Lette J
        • Lapointe J
        • Waters D
        • Cerino M
        • Picard M
        • Gagnon A
        Transient left ventricular cavity dilation during dipyridamole-thallium imaging as an indicator of severe coronary artery disease.
        Am J Cardiol. 1990; 66: 1163-1170
        • Takeishi Y
        • Tono-oka I
        • Ikeda K
        • Komatani A
        • Tsuiki K
        • Yasui S
        Dilatation of the left ventricular cavity on dipyridamole thallium-201 imaging: a new marker of triple-vessel disease.
        Am Heart J. 1991; 121: 466-475
        • Chouraqui P
        • Rodrigues EA
        • Berman DS
        • Maddahi J
        Significance of dipyridamole-induced transient dilation of the left ventricle during thallium-201 scintigraphy in suspected coronary artery disease.
        Am J Cardiol. 1990; 66: 689-694
        • Stratmann HG
        • Tamesis BR
        • Younis LT
        • Wittry MD
        • Miller DD
        Prognostic value of dipyridamole technitium-99m sestamibi myocardial tomography in patients with stable chest pain who are unable to exercise.
        Am J Cardiol. 1994; 73: 647-652
        • Heller GV
        • Herman SD
        • Travin MI
        • Baron JI
        • Santos-Ocampo C
        • McClellan JR
        Independent prognostic value of intravenous dipyridamole with technetium99m sestamibi tomographic imaging in predicting cardiac events and cardiac nospitalizations.
        J Am Coll Cardiol. 1995; 26: 1202-1208
        • Weiss AT
        • Berman DS
        • Lew AS
        • Nielsen J
        • Potkin B
        • Swan HJC
        • Waxman A
        • Maddahi J
        Transient ischemic dilation of the left ventricle on stress thallium-201 scintigraphy: a marker of severe and extensive coronary artery disease.
        J Am Coll Cardiol. 1987; 9: 752-759
        • Iskandrian AS
        • Heo J
        • Nguyen T
        • Lyons E
        • Paugh E
        Left ventricular dilatation and pulmonary thallium uptake after single-photon emission computer tomography using thallium-201 during adenosine-induced coronary hyperemia.
        Am J Cardiol. 1990; 66: 807-811
        • Lee KL
        • Pryor DB
        • Pieper KS
        • Harrell FE
        • Califf RM
        • Mark DB
        • Hlatky MA
        • Coleman RE
        • Cobb FR
        • Jones RH
        Prognostic value of radionuclide angiography in medically treated patients with coronary artery disease. A comparison with clinical and catheterization variables.
        Circulation. 1990; 82: 1705-1717
        • St. John Sutton M
        • Pfeffer MA
        • Plappert T
        • Rouleau J-L
        • Moyé LA
        • Dagenais GR
        • Lamas GA
        • Klein M
        • Sussex B
        • Goldman S
        • et al.
        Quantitative two-dimensional echocardiographic measurements are major predictors of adverse cardiovascular events after myocardial infarction. The protective effects of captopril.
        Circulation. 1994; 89: 68-75
        • Chilian WM
        • Layne SM
        • Klausner EC
        • Eastham CL
        • Marcus ML
        Redistribution of coronary microvascular resistance produced by dipyridamole.
        Am J Physiol. 1989; 256: H383-H390
        • Becker LC
        Effect of nitroglycerin and dipyridamole on regional left ventricular blood flow during coronary artery occlusion.
        J Clin Invest. 1976; 58: 1287-1296
        • Gould KL
        • Lipscomb K
        • Calvert C
        Compensatory changes of the distal coronary vascular bed during progressive coronary constriction.
        Circulation. 1975; 51: 1085-1094
        • Kiat H
        • Maddahi J
        • Roy L
        • Van Train K
        • Friedman J
        • Resser K
        • Berman D
        Comparison of technitium-99m methoxy isobutylisonitrile and thallium-201 for evaluation of coronary artery disease by planar and tomographic methods.
        Am Heart J. 1989; 117: 1-11
        • Narahara RA
        • Villanueva-Meyer J
        • Thompson CJ
        • Brizendine M
        • Mena I
        Comparison of thallium-201 and technitium-99m hexakis 2-methoxyisobutyl isonitrile single-photon emission computed tomography for estimating the extent of myocardial ischemia and infarction in coronary artery disease.
        Am J Cardiol. 1990; 66: 1438-1444