Division of Nuclear Medicine, Department of Radiology and Nuclear Medicine, University of Jordan Hospital, University of Jordan, Queen Rania Street, Al Jubeiha, Amman, 11942, Jordan.
Division of Cardiology, Department of Medicine, University of Jordan, Amman, Jordan.
Ann Nucl Med. 2021 May;35(5):569-579. doi: 10.1007/s12149-021-01599-3. Epub 2021 Mar 10.
To determine the significance of transient ischemic dilatation (TID) in patients with normal perfusion on adenosine stress/rest.
We analyzed 430 consecutive patients with normal perfusion on 2-day adenosine stress/rest Tc-sestamibi. A group of 70 patients with Framingham 10-year coronary heart disease risk < 10% was used to derive abnormal TID thresholds (derivation group). The significance of TID at these thresholds was validated in the remaining 360 patients (validation group) followed for cardiac events for 31.2 ± 9.7 (mean ± SD) months.
Transient ischemic dilatation in the derivation group was 1.05 ± 0.13. Three definitions of an abnormal TID were used: > mean + 2SD (TID ≥ 1.32), > mean + 1SD (TID ≥ 1.19) and a TID in the group's highest quartile (TID ≥ 1.15). Of the 360 validation group patients, 12 (3.3%), 48 (13.3%) and 70 (19.4%) had TID ≥ 1.32, 1.19 and 1.15, respectively. Age, gender, family history of coronary artery disease (CAD), known CAD, smoking, hypertension, diabetes, dyslipidemia, rest LVEF, post-stress LVEF, ΔLVEF, ≥ 5% or 10% decrease in LVEF did not predict TID ≥ 1.32. However, TID ≥ 1.19 was predicted by rest LVEF and ≥ 5% decrease in LVEF (P = 0.04 and 0.02, respectively) and TID ≥ 1.15 was predicted by ≥ 5% decrease in LVEF (P = 0.02). Cardiac event-free survivals were similar in patients with a TID ≥ and < 1.32 (P = 0.68), ≥ and < 1.19 (P = 0.40) and ≥ and < 1.15 (P = 0.79).
Transient ischemic dilatation does not confer adverse prognosis in patients with normal perfusion on adenosine stress/rest Tc-sestamibi irrespective of the threshold used for its definition.
确定腺苷负荷/静息心肌灌注显像中短暂性缺血性扩张（TID）对正常灌注患者的意义。
我们分析了 430 例连续接受 2 天腺苷负荷/静息 Tc-sestamibi 检查的患者。使用Framingham 10 年冠心病风险<10%的 70 例患者来得出异常 TID 阈值（推导组）。在随后 31.2±9.7（平均值±标准差）个月的随访中，在其余 360 例患者（验证组）中验证 TID 阈值的意义。
推导组的 TID 为 1.05±0.13。使用三种异常 TID 的定义：>均值+2SD（TID≥1.32）、>均值+1SD（TID≥1.19）和 TID 处于组内最高四分位数（TID≥1.15）。在 360 例验证组患者中，分别有 12 例（3.3%）、48 例（13.3%）和 70 例（19.4%）的 TID≥1.32、1.19 和 1.15。年龄、性别、冠心病家族史、已知冠心病、吸烟、高血压、糖尿病、血脂异常、静息 LVEF、负荷后 LVEF、ΔLVEF、LVEF 下降≥5%或 10% 均不能预测 TID≥1.32。然而，TID≥1.19 可以由静息 LVEF 和 LVEF 下降≥5%预测（P=0.04 和 0.02），TID≥1.15 可以由 LVEF 下降≥5%预测（P=0.02）。TID≥1.32 和<1.32（P=0.68）、TID≥1.19 和<1.19（P=0.40）以及 TID≥1.15 和<1.15（P=0.79）患者的无心脏事件生存率相似。
无论用于定义 TID 的阈值如何，腺苷负荷/静息 Tc-sestamibi 灌注正常的患者中 TID 并不预示不良预后。
