Improving predictive value of transient ischemic dilation ratio after correction based on the left ventricular mass

Document Type : Original Article


Nuclear Medicine and Molecular Imaging Research Center, Namazi Teaching Hospital, Shiraz University of Medical Sciences, Shiraz, Iran



Introduction: For the interpretation of myocardial perfusion imaging, considering non-perfusion variables, such as transient ischemic dilatation (TID), are also important in diagnostic and prognostic evaluation of a patient. TID has a relatively high false positive and false negative results, which reduces its diagnostic and prognostic values. In this study, we aimed to compare the accuracy of TID after normalization based on changes in LV wall mass.
Methods: Patients referred for dipyridamole myocardial perfusion imaging single-photon emission computed tomography (MPI/SPECT), one to two year prior to the study with TID ratio >1 were enrolled. Patients with any previous history of revascularization and structural heart disease were excluded. Follow-up was done by phone call. The occurrence of cardiac death, myocardial infarction, revascularization or evidence of abnormal angiography during one year after MPI was considered positive for short-term cardiac events. The corrected TID (cTID) was calculated by the following formula: cTID = TID/(Wallstress/Wallrest).
Results: Among 196 participants, 30 (15%) had cardiovascular events during the follow-up. The area under the receiver operating characteristic (ROC) curve for the short-term prognosis of the cardiac events were 0.57 and 0.50 for cTID and TID with a p-value of 0.17 and 0.92, respectively. Considering the best cut-off points that were achieved by ROC curves, cTID showed significant odds ratio (OR: 2.53) for prediction of short-term cardiac events, while respecting, TID failed to be statistically significant.
Conclusion: Making correction on TID using LV wall volumes can improve short-term prognostic value of this variable.


Main Subjects

  1. Marcassa C, Galli M, Baroffio C, Campini R, Giannuzzi P. Transient left ventricular dilation at quantitative stress-rest sestamibi tomography: clinical, electrocardiographic, and angiographic correlates. J Nucl Cardiol. 1999 Jul-Aug;6(4):397-405.
  2. Bajaj NS, Singh S, Farag A, El-Hajj S, Heo J, Iskandrian AE, Hage FG. The prognostic value of non-perfusion variables obtained during vasodilator stress myocardial perfusion imaging. J Nucl Cardiol. 2016 Jun;23(3):390-413.
  3. Ghaedian T, Behbudnia T, Dehghani P. Comparison of quantitative perfusion and function parameters of gated-SPECT myocardial perfusion imaging in patients with concordant and discordant left bundle-branch block. Clin Nucl Med. 2020 Jan;45(1):7-10.
  4. Rastgou F, Shojaeifard M, Amin A, Ghaedian T, Firoozabadi H, Malek H, Yaghoobi N, Bitarafan-Rajabi A, Haghjoo M, Amouzadeh H, Barati H. Assessment of left ventricular mechanical dyssynchrony by phase analysis of gated-SPECT myocardial perfusion imaging and tissue Doppler imaging: comparison between QGS and ECTb software packages. J Nucl Cardiol. 2014 Dec;21(6):1062-71.
  5. Haghighatafshar M, Sarmadi B, Akbarialiabad H, Shekoohi-Shooli F, Ghaedian T. Prognostic value of myocardial perfusion imaging in Iranian patients using total perfusion deficits: Comparison with semi-quantitative assessment. Iran J Nucl Med. 2022 Jul;30(2):103-8.
  6. Alama M, Labos C, Emery H, Iwanochko RM, Freeman M, Husain M, Lee DS. Diagnostic and prognostic significance of transient ischemic dilation (TID) in myocardial perfusion imaging: A systematic review and meta-analysis. J Nucl Cardiol. 2018 Jun;25(3):724-737.
  7. Golzar Y, Olusanya A, Pe N, Dua SG, Golzar J, Gidea C, Doukky R. The significance of automatically measured transient ischemic dilation in identifying severe and extensive coronary artery disease in regadenoson, single-isotope technetium-99m myocardial perfusion SPECT. J Nucl Cardiol. 2015 Jun;22(3):526-34.
  8. Halligan WT, Morris PB, Schoepf UJ, Mischen BT, Spearman JV, Spears JR, Blanke P, Cho YJ, Silverman JR, Chiaramida SA, Ebersberger U. Transient ischemic dilation of the left ventricle on SPECT: correlation with findings at coronary CT angiography. J Nucl Med. 2014 Jun;55(6):917-22.
  9. Emmett L, Ng A, Ha L, Russo R, Mansberg R, Zhao W, Chow SV, Kritharides L. Comparative assessment of rest and post-stress left ventricular volumes and left ventricular ejection fraction on gated myocardial perfusion imaging (MPI) and echocardiography in patients with transient ischaemic dilation on adenosine MPI: myocardial stunning or subendocardial hypoperfusion? J Nucl Cardiol. 2012 Aug;19(4):735-42.
  10. Taillefer R. Transient dilation of the left ventricular cavity observed during myocardial perfusion imaging: What is its incremental diagnostic value. J Nucl Cardiol. 2018 Apr;25(2):593-595.
  11. McLaughlin MG, Danias PG. Transient ischemic dilation: a powerful diagnostic and prognostic finding of stress myocardial perfusion imaging. J Nucl Cardiol. 2002 Nov-Dec;9(6):663-7.
  12. van der Veen BJ, Kuperij N, Stokkel MP. Transient ischemic dilatation ratio derived from myocardial perfusion scintigraphy: What are we looking at? J Nucl Cardiol. 2010 Apr;17(2):207-15.
  13. Mandour Ali MA, Bourque JM, Allam AH, Beller GA, Watson DD. The prevalence and predictive accuracy of quantitatively defined transient ischemic dilation of the left ventricle on otherwise normal SPECT myocardial perfusion imaging studies. J Nucl Cardiol. 2011 Dec;18(6):1036-43.
  14. Xu Y, Arsanjani R, Clond M, Hyun M, Lemley M Jr, Fish M, Germano G, Berman DS, Slomka PJ. Transient ischemic dilation for coronary artery disease in quantitative analysis of same-day sestamibi myocardial perfusion SPECT. J Nucl Cardiol. 2012 Jun;19(3):465-73.
  15. Abidov A, Germano G, Berman DS. Transient ischemic dilation ratio: a universal high-risk diagnostic marker in myocardial perfusion imaging. J Nucl Cardiol. 2007 Jul;14(4):497-500.
  16. Hida S, Chikamori T, Tanaka H, Usui Y, Igarashi Y, Nagao T, Yamashina A. Diagnostic value of left ventricular function after stress and at rest in the detection of multivessel coronary artery disease as assessed by electrocardiogram-gated SPECT. J Nucl Cardiol. 2007 Jan;14(1):68-74.
  17. Mazzanti M, Germano G, Kiat H, Kavanagh PB, Alexanderson E, Friedman JD, Hachamovitch R, Van Train KF, Berman DS. Identification of severe and extensive coronary artery disease by automatic measurement of transient ischemic dilation of the left ventricle in dual-isotope myocardial perfusion SPECT. J Am Coll Cardiol. 1996 Jun;27(7):1612-20.
  18. Kakhki VR, Sadeghi R, Zakavi SR. Assessment of transient left ventricular dilation ratio via 2-day dipyridamole Tc-99m sestamibi nongated myocardial perfusion imaging. J Nucl Cardiol. 2007 Jul;14(4):529-36.
  19. Camm CF, Emery A, Rose-Innes E, Pavlitchouk S, Sabharwal N, Kelion AD. How variable are the volumetric measurements from gated perfusion SPECT when a one-day stress-rest protocol is used? J Nucl Cardiol. 2019 Oct;26(5):1709-1716.
  20. DePuey EG. Sources of variability of gated myocardial perfusion SPECT quantitative parameters. J Nucl Cardiol. 2016 Aug;23(4):818-23.
  21. Doukky R, Frogge N, Bayissa YA, Balakrishnan G, Skelton JM, Confer K, Parikh K, Kelly RF. The prognostic value of transient ischemic dilatation with otherwise normal SPECT myocardial perfusion imaging: a cautionary note in patients with diabetes and coronary artery disease. J Nucl Cardiol. 2013 Oct;20(5):774-84.
  22. Bravo PE, Tahari A, Pozios I, Luo HC, Bengel FM, Wahl RL, Abraham MR, Abraham TP. Apparent left ventricular cavity dilatation during PET/CT in hypertrophic cardiomyopathy: Clinical predictors and potential mechanisms. J Nucl Cardiol. 2016 Dec;23(6):1304-1314.
  23. Emmett L, Magee M, Freedman SB, Van der Wall H, Bush V, Trieu J, Van Gaal W, Allman KC, Kritharides L. The role of left ventricular hypertrophy and diabetes in the presence of transient ischemic dilation of the left ventricle on myocardial perfusion SPECT images. J Nucl Med. 2005 Oct;46(10):1596-601.
  24. Fallahi B, Beiki D, Fard-Esfahani A, Akbarpour S, Abolhassani A, Kakhki VR, Eftekhari M. The additive value of transient left ventricular dilation using two-day dipyridamole 99mTc-MIBI SPET for screening coronary artery disease in patients with otherwise normal myocardial perfusion: a comparison between diabetic and non-diabetic cases. Hell J Nucl Med. 2010 Sep-Dec;13(3):246-52.
  25. Petretta M, Acampa W, Daniele S, Petretta MP, Nappi C, Assante R, Zampella E, Costanzo P, Perrone-Filardi P, Cuocolo A. Transient ischemic dilation in SPECT myocardial perfusion imaging for prediction of severe coronary artery disease in diabetic patients. J Nucl Cardiol. 2013 Feb;20(1):45-52.
  26. uz Zaman M, Fatima N, Samad A, Ishaq M, Wali A, Rehman K, Bano J. Predictive and prognostic values of transient ischemic dilatation of left ventricular cavity for coronary artery disease and impact of various managements on clinical outcome using technetium-99m sestamibi gated myocardial perfusion imaging. Ann Nucl Med. 2011 Oct;25(8):566-70.