Transient ischemic dilation of the left ventricle on stress thallium-201 scintigraphy: A marker of severe and extensive coronary artery disease

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On exercise thallium-201 scintigraphy, it has been noted that the size of the left ventricle is sometimes larger on the immediate poststress image than on the 4 hour redistribution image; this phenomenon has been termed transient ischemic dilation of the left ventricle. The angiographic correlates of this finding were assessed in 89 consecutive patients who underwent both stress-redistribution thallium-201 scintigraphy and coronary arteriography. A transient dilation ratio was determined by dividing the computer-derived left ventricular area of the immediate postexercise anterior image by the area of the 4 hour redistribution image. In patients with a normal coronary arteriogram or nonsignificant coronary stenoses (<50%), the transient dilation ratio was 1.02 ± 0.05 and, therefore, an abnormal transient dilation ratio was defined as >1.12 (mean + 2SD).

The transient dilation ratio was insignificantly elevated in patients with noncritical coronary artery disease (50 to 89% stenosis) (1.05 ± 0.05) and in patients with critical stenosis (≥90%) of only one coronary artery (1.05 ± 0.05). In contrast, in patients with critical stenoses in two or three vessels, the transient dilation ratio was significantly elevated (1.12 ± 0.08 and 1.17 ± 0.09, respectively; p < 0.05 compared with all other patient groups). An abnormal transient dilation ratio had a sensitivity of 60% and a specificity of 95% for identifying patients with multivessel critical stenosis and was more specific (p < 0.05) than were other known markers of severe and extensive coronary artery disease, such as the presence of multiple perfusion defects or washout abnormalities, or both. Patients with multivessel critical stenoses frequently had an abnormal transient dilation ratio in the absence of multiple reversible defects. It is concluded that the transient ischemic dilation ratio, as observed on stress-redistribution thallium-201 images, is an easily derived and highly specific marker of multivessel critical stenosis.

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1

From the Division of Cardiology, Department of Medicine and the Department of Nuclear Medicine, Cedars-Sinai Medical Center and the Departments of Medicine and Radiological Sciences, University of California, Los Angeles, School of Medicine.

2

Dr. Weiss was supported by a grant from the Mirisch Foundation, Los Angeles, California.

*

Present address: Department of Cardiology, Hadassah University Hospital, Ein-Kerem, Jerusalem, Israel.