Prognostic value of transient ischemic dilatation (TID) in patients with normal single photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI)

• Main Author: Fadiji, Isaac Olusola
• Format: Others
• Language: en
• Published: 2018
• Online Access: https://hdl.handle.net/10539/24218

A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand. In fulfilment of the requirements for the degree of Master of Medicine In the branch of Nuclear Medicine April 2016 === Objectives: This study evaluated the clinical significance of an isolated transient ischemic dilatation (TID) in the otherwise normal or relatively normal single photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) in determining the risk of future cardiac events. Background: the prognostic value of TID in patients with otherwise normal SPECT MPI has been a subject of controversy among clinicians. Therefore, there is no consensus on how best to manage this patient group of patients. Methods: From a database of 4000 consecutive patients who underwent stress-rest MPI studies over a 13 year period (2000 -2013) at department of Nuclear Medicine, University of the Witwatersrand academic hospital, Johannesburg. 123 patients without known cardiac history of coronary artery disease and had normal or relatively normal SPECT MPI but TID > 1.21 were identified (study group 1). 41 patients, from the study group 1, with valid telephone contacts and hospital records were interviewed to determine the prevalence of cardiac events. The images were retrieved, reviewed and re-processed by a 4th year Nuclear Medicine registrar to ensure they were rightly called. Both the telephone interviewer and the imaging analyst were blinded to the patients’ clinical data. Results: The prevalence of TID in a normal or relative normal SPECT MPI was 4%. There were 9 (21.9%) cases of angina, 2 (4.9%) cases of revascularization and 4 (9.8%) cases of myocardial infarction. Other independent predictor of cardiac events were; diabetes, summed stress score and summed rest score. Conclusion: TID in the setting of normal or relatively normal SPECT MPI may signify a prognosis that is not good and may be a predictor of future cardiac events. === MT2018