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

Kataoka, Akihisa; Scherrer-Crosbie, Marielle; Senior, Roxy; Garceau, Patrick; Valbuena, Silvia; Celutkiene, Jelena; Hastings, Jeffrey L; Cheema, Asim N; Lara, Alfonso; Srbinovska-Kostovska, Elizabeta; Hessian, Renee; Poggio, Daniele; Goldweit, Richard; Saric, Muhamed; Dajani, Khaled A; Kohn, Jeffrey A; Shaw, Leslee J; Reynolds, Harmony R; Picard, Michael H
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.
PMID: 27040889
ISSN: 1540-8175
CID: 2065972

Transient Ischemic Dilatation During Stress Echocardiography: A Marker of Significant Myocardial Ischemia [Meeting Abstract]

Kataoka, Akihisa; Scherrer-Crosbie, Marielle; Dajani, Khaled A; Garceau, Patrick; Hastings, Jeffrey I; Kohn, Jeffrey A; Srbinovska-Kostovska, Elizabeta; Poggio, Daniele; Saric, Muhamed; Senior, Roxy; Sokhon, Kozhaya; Shaw, Leslee; Reynolds, Harmony; Picard, Michael H
ISI:000332162901389
ISSN: 1524-4539
CID: 1015442