ORIGINAL ARTICLE 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 Maseeh uz Zaman • Nosheen Fatima • Abdus Samad • Mohammad Ishaq • Asif Wali • Kawish Rehman • Javeria Bano Received: 2 March 2011 / Accepted: 19 May 2011 / Published online: 1 June 2011 Ó The Japanese Society of Nuclear Medicine 2011 Abstract Background Transient ischemic dilatation (TID) of LV cavity during stress gated myocardial perfusion imaging (GMPI) is known as a predictor of severe CAD and sig- nifies worse prognosis. Objectives To assess predictive and prognostic value of TID of LV cavity using GMPI and clinical outcome in patients treated conservatively or with revascularization. Methods 189 patients out of 2689 were recruited (M:F 127/62, mean age 56 ± 9 years) whose same-day stress GMPI revealed TID ratio ( [ 1.22) with no (sum stress score, SSS \ 2) or reversible perfusion defects (sum dif- ference score, SDS [ 2). Coronary angiography (CA) was performed within 3 months in 125/189 cases who were followed for mean period of 18 ± 4 months for fatal or non-fatal MI. Results CA was positive in 121/125 patients with TID for significant CAD (LAD = 11, multi vessel disease = 110 patients, positive predictive value 95%) and negative for obstructive disease in 4/125 (false-positive cases). 41/121 underwent revascularization within 2 months of CA (Intervention group), and remaining 80/121 were managed conservatively (Non-Intervention group). Overall event rate was 20% (4/16%: fatal/non-fatal MIs). Kaplan–Meier survival curves revealed event-free survival in Intervention and Non-Intervention groups for fatal MI 98/96% (P = 0.758), and for non-fatal MI, it was 97/58%, respectively (P = 0.042). Conclusion We conclude that TID is a reliable predictor of multi vessel CAD and is associated with high incidence of non-fatal MIs than fatal MIs. Revascularization (PCI/ CABG) rather than medical treatment should be considered in patients with TID for better clinical outcome. Keywords TID Á Positive predictive value Á Gated SPECT Á Clinical outcome Introduction Radionuclide myocardial perfusion imaging (MPI) is a reliable and well-established multifaceted tool for the diagnosis and management of coronary artery disease (CAD). Incremental prognostic value of gated single pho- ton emission computerized tomography (GSPECT) is based on size and severity of reversible or fixed perfusion defects, lung uptake, left ventricular (LV) cavity size, post-stress LV dysfunction and TID (transient ischemic dilatation) of LV cavity [1, 2]. TID was first unveiled by Stolzenberg [3] in 1980 as an apparent increase in size of LV cavity at stress relative to resting study. A large body of data has shown that TID is a marker of severe and exten- sive CAD [4–6]. Although the underlying mechanism is debatable, the most likely explanations include subendo- cardial hypoperfusion [5], systolic LV dysfunction [6] and ischemia-induced actual LV dilatation in end diastole [4, 7]. False-positive causes of TID include hypertrophic cardiomyopathy [8], hypertensive LV hypertrophy [9], M. uz Zaman Á N. Fatima Á A. Samad Á M. Ishaq Á A. Wali Á K. Rehman Á J. Bano Karachi Institute of Heart Diseases (KIHD), Karachi, Pakistan M. uz Zaman (&) Department of Radiology, The Agha Khan University Hospital (AKUH), Stadium Road, Karachi, Pakistan e-mail: maseeh.uzzaman@aku.edu N. Fatima Á K. Rehman Karachi Institute of Radiotherapy and Nuclear Medicine, Karachi, Pakistan 123 Ann Nucl Med (2011) 25:566–570 DOI 10.1007/s12149-011-0500-4