The significance of automatically measured transient ischemic dilation in identifying severe and extensive coronary artery disease in regadenoson, single-isotope technetium-99m myocardial perfusion SPECT

J Nucl Cardiol. 2015 Jun;22(3):526-34. doi: 10.1007/s12350-015-0087-6. Epub 2015 Apr 1.

Abstract

Background: The critical threshold and clinical significance of transient ischemic dilation (TID) for regadenoson, single-isotope (99m)Tc SPECT myocardial perfusion imaging (MPI) are not defined.

Methods: From 100 patients with low likelihood of CAD, we derived the abnormal TID threshold (mean + 2 SD). We validated the threshold in a cohort of 547 patients who received one-day, rest/regadenoson-stress, (99m)Tc-tetrofosmin SPECT-MPI followed by coronary angiography within 6 months. Patients were classified into three CAD severity strata: no significant CAD, mild to moderate CAD, and severe and extensive CAD.

Results: The abnormal TID threshold was determined to be 1.31. Though mean TID ratios were different between the three CAD severity groups and the derivation cohort (P < .001), there was no difference in the mean TID ratios between the categories of CAD severity or in the prevalence of severe CAD between TID+ and TID- groups (P = .74). By ROC analysis, TID had a poor discriminatory capacity in identifying severe and extensive CAD [AUC of 0.55 (95% CI 0.47-0.62, P = .25)]. Stepwise multivariate logistic analysis demonstrated that adding TID to clinical and perfusion data did not provide incremental diagnostic value (P = .87).

Conclusions: The clinical utility of TID with regadenoson-stress MPI in this era of declining CAD burden is questionable.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Cohort Studies
  • Coronary Angiography
  • Coronary Artery Disease / diagnosis*
  • Coronary Artery Disease / diagnostic imaging*
  • Exercise Test
  • Female
  • Humans
  • Image Processing, Computer-Assisted
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Myocardial Ischemia / diagnostic imaging
  • Myocardial Perfusion Imaging*
  • Pattern Recognition, Automated
  • Prevalence
  • Purines / chemistry
  • Pyrazoles / chemistry
  • ROC Curve
  • Radiopharmaceuticals
  • Regression Analysis
  • Reproducibility of Results
  • Rest
  • Technetium / chemistry*
  • Tomography, Emission-Computed, Single-Photon*

Substances

  • Purines
  • Pyrazoles
  • Radiopharmaceuticals
  • regadenoson
  • Technetium