Department of Cardiology, Tan Tock Seng Hospital, 11 Jln Tan Tock Seng, Singapore, 308433, Singapore.
Int J Cardiovasc Imaging. 2020 Jul;36(7):1377-1384. doi: 10.1007/s10554-020-01836-2. Epub 2020 Apr 3.
Transient ischemic dilation (TID), a marker of severe coronary artery disease (CAD), is the post-stress to rest left ventricular (LV) volume ratio quantified using non ECG gated single photon emission computerized tomography (SPECT). Although prone positioning causes physiological reduction of LV volume in normal subjects, we hypothesize this may not occur in TID with underlying severe CAD as cardiac hemodynamics worsen when prone. We aim to evaluate the utility of the non ECG gated supine to prone LV volume ratio (SPLVr) for identifying severe CAD. Retrospective data analysis from 130 patients with TID ratio ≥ 1.21 and both post-stress supine and prone images. SPLVr had a significant negative correlation with summed stress (r = - 0.221, p = 0.011) and rest (r = - 0.292, p = 0.001) scores. Of the 129 cases with follow-up invasive or computed tomography coronary angiography, 52 (40.3%) had severe CAD (left main ≥ 50% stenosis, 3-vessel with ≥ 70% stenosis or 2-vessel with proximal left anterior descending ≥ 70% stenosis). Mean SPLVr was significantly lower in severe CAD cases (1.05 ± 0.14 vs 1.12 ± 0.17, p = 0.012). SPLVr predicted severe CAD on univariate [OR 0.12 (95% CI 0.00-0.35) p = 0.01] but not in multivariate analysis. SPLVr is a novel marker that negatively correlates with extent of perfusion abnormalities and is lower amongst TID patients with severe CAD. Larger studies are needed to assess if SPLVr can reliably identify underlying severe CAD amongst TID cases.
短暂性缺血性扩张（TID）是严重冠状动脉疾病（CAD）的标志物，是使用非心电图门控单光子发射计算机断层扫描（SPECT）定量测量应激后休息时左心室（LV）容积比。虽然在正常受试者中，俯卧位会导致 LV 容积生理性减少，但我们假设在严重 CAD 患者中可能不会发生这种情况，因为当患者处于俯卧位时，心脏血液动力学会恶化。我们旨在评估非心电图门控仰卧位到俯卧位 LV 容积比（SPLVr）用于识别严重 CAD 的效用。对 130 例 TID 比≥1.21 且应激后仰卧位和俯卧位图像均存在的患者进行回顾性数据分析。SPLVr 与总和应激评分（r=−0.221，p=0.011）和休息评分（r=−0.292，p=0.001）呈显著负相关。在 129 例有随访的侵入性或计算机断层冠状动脉造影的病例中，52 例（40.3%）有严重 CAD（左主干≥50%狭窄，3 支血管≥70%狭窄或 2 支血管近端前降支≥70%狭窄）。严重 CAD 病例的 SPLVr 显著较低（1.05±0.14 与 1.12±0.17，p=0.012）。SPLVr 在单变量分析中预测严重 CAD（OR 0.12（95%CI 0.00-0.35），p=0.01），但在多变量分析中则无此预测作用。SPLVr 是一种新的标志物，与灌注异常程度呈负相关，在 TID 患者中严重 CAD 患者中较低。需要更大规模的研究来评估 SPLVr 是否能可靠地识别 TID 病例中的严重 CAD。
