Diagnostic Value of Adenosine-Induced Left Ventricular Diastolic Dysfunction for Detecting Coronary Artery Restenosis in Patients Undergoing Stent Implantation by Stress ECG-Gated Myocardial Perfusion SPECT A Pilot Study

• Published in: Circulation Journal Vol. 74; no. 12; pp. 2658 - 2665
• Main Authors: Nakano, Yoshimochi, Matsumoto, Naoya, Suzuki, Yasuyuki, Kato, Masahiko, Miki, Takaaki, Iida, Jun, Yoda, Shunichi, Sugiyama, Keiko, Sato, Yuichi, Kasama, Shu, Kushiro, Toshio, Nagao, Ken, Hirayama, Atsushi
• Format: Journal Article
• Language: English
• Published: Japan The Japanese Circulation Society 2010
• Subjects: Adenosine - administration & dosage; Aged; Anti-Arrhythmia Agents - administration & dosage; Coronary artery disease; Coronary restenosis; Coronary Restenosis - diagnostic imaging; Diastolic function; Electrocardiography; Exercise Test; Female; Humans; Male; Myocardial Reperfusion; Organophosphorus Compounds - administration & dosage; Organotechnetium Compounds - administration & dosage; Radiography; Radiopharmaceuticals - administration & dosage; Stent; Stents; Thallium Radioisotopes; Time to peak filling; Tomography, Emission-Computed, Single-Photon; Ventricular Dysfunction, Left - chemically induced; Ventricular Dysfunction, Left - diagnostic imaging
• ISSN: 1346-9843; 1347-4820
• DOI: 10.1253/circj.CJ-10-0095

Background: Usefulness of diastolic dysfunction after adenosine stress for detecting coronary stenosis has not been defined. The diagnostic accuracy of a combination of myocardial perfusion and diastolic function, as defined by prolongation of time to peak-filling rate (TTPF)/R-R and myocardial perfusion alone for the detection of coronary restenosis, was evaluated. Methods and Results: We used rest 201Tl/ adenosine stress 99mTc-tetrofosmin myocardial perfusion singlephoton emission computed tomography (SPECT) in 70 patients. Patients were divided into the following 4 groups: 20 patients with normal SPECT without stent (Control group), 20 patients showing normal SPECT without coronary restenosis (Group 1), 16 patients showing significant coronary restenosis and myocardial ischemia (Group 2a) and 14 patients showing significant coronary restenosis without myocardial ischemia (Group 2b). The TTPF, which was calculated by quantitative gated SPECT (QGS)/R-R, was not different between after stress and at rest in Control group (0.18±0.02 vs 0.19±0.04, P=NS). The TTPF/R-R after stress was significantly lower than that at rest in Group 1 (0.17±0.02 vs 0.18±0.03, P<0.05), but TTPF/R-R after stress was significantly higher than that at rest in Groups 2a and 2b (0.22±0.03 vs 0.16±0.03, P<0.001 in Group 2a and 0.19±0.02 vs 0.16±0.02, P<0.001 in Group 2b, respectively). Diagnostic accuracy improved from 72% to 92% when prolongation of TTPF/R-R was taken into account (P<0.001). Conclusions: Diastolic dysfunction after stress was an accurate marker for detecting significant restenosis following stent implantation. (Circ J 2010; 74: 2658-2665)