Abstract 11289: Transient Ischemic Dilatation During Stress Echocardiography: A Marker of Significant Myocardial Ischemia
Purpose: Left ventricular (LV) transient ischemic dilatation (TID) during myocardial perfusion imaging (MPI) is considered a marker of extensive coronary artery disease and a predictor of future cardiac events. TID has not been as well characterized in stress echocardiography (SE).
Materials and Methods: 118 stress echocardiograms were examined in the prerandomization pilot phase of the I nternational S tudy of C omparative H ealth E ffectiveness with M edical and I nvasive A pproaches (ISCHEMIA) Trial. In addition to typical visual assessment of regional LV function, the LV end-diastolic (EDV) and end-systolic (ESV) volumes were measured by the biplane method of discs at the rest and peak stages and left ventricular ejection fraction (LVEF) derived from volumes. TID was defined as > 10% LV volume increase in ESV. The patients with (+) and without (-) TIDESV were compared. Moderate to severe ischemia was defined as ≥ 3 segments with induced severe hypokinesis or akinesis.
Results: LV volume measurements at baseline and peak stress were feasible in 88 (75%) cases. There were 26 (30%) with TIDESV. Compared to those without TIDESV (-), cases with TIDESV (+) had larger extent of inducible wall motion abnormalities, lower peak stress LVEF and higher likelihood of moderate to severe ischemia. TIDESV had a positive predictive value of 69% to detect moderate to severe ischemia with sensitivity 44%, specificity 83% and negative predictive value 63%.
Conclusion: As with MPI, TIDESV by SE is a marker of more extensive myocardial ischemia and can be used as an additional marker of higher risk.
- © 2013 by American Heart Association, Inc.