Transient Ischemic Dilatation during Stress Echocardiography: An Additional Marker of Significant Myocardial Ischemia

Akihisa Kataoka, Marielle Scherrer-Crosbie, Roxy Senior, Patrick Garceau, Silvia Valbuena, Jelena Čelutkienė, Jeffrey L. Hastings, Asim N. Cheema, Alfonso Lara, Elizabeta Srbinovska-Kostovska, Renee Hessian, Daniele Poggio, Richard Goldweit, Muhamed Saric, Khaled A. Dajani, Jeffrey A. Kohn, Leslee J. Shaw, Harmony R. Reynolds, Michael H. Picard

Research output: Contribution to journalArticle

4 Scopus citations

Abstract

Aim: Left ventricular (LV) transient ischemic dilatation (TID) is not clear how it relates to inducible myocardial ischemia during stress echocardiography (SE). Methods and Results: Eighty-eight SEs were examined from the site certification phase of the ISCHEMIA Trial. LV end-diastolic volume (EDV) and end-systolic volume (ESV) were measured at rest and peak stages and the percent change calculated. Moderate or greater ischemia was defined as ≥3 segments with stress-induced severe hypokinesis or akinesis. Optimum cut points in stress-induced percent EDV and ESV change that identified moderate or greater myocardial ischemia were analyzed. Analysis from percentage distribution identified a > 13% LV volume increase in EDV or a > 9% LV volume increase in ESV as the optimum cutoff points for moderate or greater ischemia. Using these definitions for TID, there were 27 (31%) with TIDESV and 12 (14%) with TIDEDV. By logistic regression analysis and receiver operating characteristic curves, the percent change in ESV had a stronger association with moderate or greater myocardial ischemia than that of EDV change. 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 or grater ischemia. For moderate or greater myocardial ischemia detection, TIDESV had a sensitivity of 46%, specificity of 83%, positive predictive value of 70%, and negative predictive value of 64%. Conclusion: Transient ischemic dilatation by SE is a marker of extensive myocardial ischemia and can be used as an additional marker of higher risk.

Original languageEnglish (US)
Pages (from-to)1202-1208
Number of pages7
JournalEchocardiography
Volume33
Issue number8
DOIs
StatePublished - Aug 1 2016

Keywords

  • coronary artery disease
  • myocardial ischemia
  • stress echocardiography

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

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    Kataoka, A., Scherrer-Crosbie, M., Senior, R., Garceau, P., Valbuena, S., Čelutkienė, J., Hastings, J. L., Cheema, A. N., Lara, A., Srbinovska-Kostovska, E., Hessian, R., Poggio, D., Goldweit, R., Saric, M., Dajani, K. A., Kohn, J. A., Shaw, L. J., Reynolds, H. R., & Picard, M. H. (2016). Transient Ischemic Dilatation during Stress Echocardiography: An Additional Marker of Significant Myocardial Ischemia. Echocardiography, 33(8), 1202-1208. https://doi.org/10.1111/echo.13222