Postischemic Myocardial Stunning Is Superior to Transient Ischemic Dilation for Detecting Multivessel Coronary Artery Disease

作者：Hida Satoshi^*; Chikamori Taishiro; Tanaka Hirokazu; Igarashi Yuko; Shiba Chie; Hatano Tsuguhisa; Usui Yasuhiro; Yamashina Akira

来源：Circulation Journal, 2012, 76(2): 430-438.

DOI：10.1253/circj.CJ-11-0946

• Adenosine triphosphate
• Coronary artery disease
• Myocardial stunning
• Quantitative gated single-photon emission computed tomography
• Transient ischemic dilation

Background: Although poststress myocardial stunning is regarded as a marker for severe coronary artery disease (CAD), no study has yet compared the diagnostic value of poststress stunning with transient ischemic dilation (TID) of the left ventricle (LV) for detecting multivessel CAD.
Methods and Results: A total of 271 patients with suspected or known CAD underwent adenosine triphosphate (ATP) loading and at-rest gated single-photon emission computed tomography. We assessed myocardial perfusion with a 20-segment model, and analyzed the changes in LV volumetric analysis induced by ATP and an automatically derived TID ratio. In 147 patients with multivessel CAD, the prevalence of multi-territorial ischemia was higher, and the post-ATP increase in end-systolic volume (ESV) and TID ratio were greater, than in the 124 with insignificant or single-vessel CAD (P<0.0001, for all cases). The receiver-operating characteristic curves analysis revealed cutoff values for ESV of 5 ml and a TID ratio of 1.11. Multivariate logistic regression analysis revealed that the combination of a poststress increase in ESV of >= 5ml and multi-territorial ischemia best identified multivessel CAD, with a sensitivity of 78% and a specificity of 84%, whereas the TID ratio was not shown to be an independent predictor.
Conclusions: Post-ATP stress myocardial stunning is superior to the TID ratio for detecting multivessel CAD. (Circ J 2012; 76: 430 438)

• 出版日期2012-2