Coronary microvascular dysfunction: An important interpretation on the clinical significance of transient ischemic dilation of the left ventricle on myocardial perfusion imaging
Restricted accessResearch articleFirst published online March 11, 2021
Coronary microvascular dysfunction: An important interpretation on the clinical significance of transient ischemic dilation of the left ventricle on myocardial perfusion imaging
To further investigate the clinical significance of transient ischemic dilation (TID) on myocardial perfusion imaging (MPI) by analyzing the effect of anisodamine hydrobromide (a drug that can effectively ameliorate microcirculation) on the patients with isolated TID and the findings of previous literatures.
METHODS:
Total 107 patients with isolated TID (TID value≥1.11) were randomly divided into group A (n = 36; intravenous administration of anisodamine hydrobromide), group N (n = 36; intravenous administration of isosorbide dinitrate), and group C (n = 35; intravenous administration of normal saline). MPI and treadmill exercise test (TET) were performed again after 14-day course of intervention. Pre- and post-intervention frequencies of symptom were recorded.
RESULTS:
In group A, after intervention of anisodamine hydrobromide, the summed stress score (SSS) and TID value on MPI significantly decreased than those before intervention (P < 0.001), the durations of exercise (DEs) and metabolic equivalents (METs) in TET notably ascended (P < 0.001), as well as the symptom remarkably improved. In group N and group C, there were no significant differences in SSS, TID value, DEs, METs, and frequencies of symptom between pre- and post-intervention (P > 0.05). No significant improvement of symptoms in group N before and after treatment.
CONCLUSIONS:
TID with perfusion defect may usually predict a possibility of severe and extensive coronary artery disease (CAD). An isolated TID should be considered as a likelihood of coronary microvascular dysfunction (CMD). TET and coronary CT angiography (cCTA) are extremely helpful for the antidiastole on CAD and CMD. The administration of anisodamine hydrobromide might be an optional treatment for the patients with isolated TID.
TakeishiY., ChibaJ., AbeS., KomataniA., TakahashiK., TomoikeH., Noninvasive identifification of left main and three-vessel coronary artery disease by thallium-201 single photon emission computed tomography during adenosine infusion, Ann Nucl Med8 (1994), 1–7.
2.
IskandrianA.S., HeoJ., NguyenT.et al., Left ventricular dilatation and pulmonary thallium uptake after singlephoton emission computer tomography using thallium-201 during adenosine-induced coronary hyperemia, Am J Cardiol66 (1990), 801–811.
3.
TakeishiY., Tono-okaI., IkedaK.et al.,Dilatation of the left ventricular cavity on dipyridamole thallium-201 imaging: A new marker of triple-vessel disease, Am Heart J121 (1991), 466–475.
4.
EmmettL., NgA., HaL.et al.,Comparative assessment of rest and post-stress left ventricular volumes and left ventricular ejection fraction on gated myocardial perfusion imaging (MPI) and echocardiography in patients with transient ischaemic dilation on adenosine MPI: myocardial stunning or subendocardial hypoperfusion?J Nucl Cardiol19 (2012), 735–742.
5.
SharirT., Transient ischemic dilation: An old but not obsolete marker of extensive coronary artery disease, J Nucl Cardiol25 (2017), 738–741.
6.
HungG.U., LeeK.W., ChenC.P.et al., Relationship of transient ischemic dilation in dipyridamole myocardial perfusion imaging and stress-induced changes of functional parameters evaluated by Tl-201 gated SPECT, J Nucl Cardiol12 (2005), 268–275.
7.
BestettiA., DiC., Leo AlessiA., et al.,Post-stress end-systolic left ventricular dilation: A marker of endocardial post-ischemic stunning, Nucl Med Commun22 (2001), 685–693.
8.
WeissA.T., BermanD.S., LewA.S.et al.,Transient ischemic dilation of the left ventricle on stress thallium-201 scintigraphy: a marker of severe and extensive coronary artery disease, J Am Coll Cardiol9 (1987), 752–759.
9.
uz ZamanM.FatimaN.SamadA.et al.,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, Ann Nucl Med25 (2011), 566–570.
10.
XuY., ArsanjaniR., ClondM.et al.,Transient ischemic dilation for coronary artery disease in quantitative analysis of same-day sestamibi myocardial perfusion SPECT, J Nucl Cardiol19 (2012), 465–473.
11.
AlamaM., LabosC., EmeryH.et al., Diagnostic and prognostic significance of transient ischemic dilation (TID) in myocardial perfusion imaging: A systematic review and meta-analysis, J Nucl Cardiol25 (2017), 724–737.
12.
ValdiviezoC., MotivalaA.A., HachamovitchR.et al.,The significance of transient ischemic dilation in the setting of otherwise normal SPECT radionuclide myocardial perfusion images., J Nucl Cardiol18 (2011), 220–229.
13.
HalliganW.T., MorrisP.B., SchoepfU.J.et al.,Transient Ischemic Dilation of the Left Ventricle on SPECT: Correlation with Findings at Coronary CT Angiography, J Nucl Med55 (2014), 917–922.
ChenL., JiangJ.Q., ZhangD.L.et al.,Experimental observation on treatment of coronary microcirculatory disturbance by anisodamine (Chinese), J Shanghai Jiaotong Univ Med Sci30 (2010), 689–692.
16.
XingK., FuX., JiangL.et al.,Cardioprotective Effect of Anisodamine Against Myocardial Ischemia Injury and its Influence on Cardiomyocytes Apoptosis, Cell Biochem Biophys73 (2015), 707–716.
17.
BaiS., FuX., GuX.et al.,Intracoronary administration of different doses of anisodamine in primary percutaneous coronary intervention: protective effect in patients with ST-segment elevation myocardial infarction, Coron Artery Dis27 (2016), 02–310.
18.
LeipsicJ., AbbaraS., AchenbachS.et al.,SCCT guidelines for the interpretation and reporting of coronary CT angiography: a report of the Society of Cardiovascular Computed Tomography Guidelines Committee, J Cardiovasc Comput Tomogr8 (2014), 342–358.
CerqueiraM.D., WeissmanN.J., DilsizianV.et al.,Standardized myocardial segmentation and nomenclature for tomographic imaging of the heart: a statement for healthcare professionals from the Cardiac Imaging Committee of the Council on Clinical Cardiology of the American Heart Association, Circulation105 (2002), 539–542.
22.
BruceR.A., HornstenT.R., Exercise stress testing in evaluation of patients with ischemic heart disease, Prog Cardiovasc Dis11 (1969), 371–390.
23.
GuzikP., RogackaD., TrachalskiJ.et al.,Comparison of the exercise treadmill test and 24-hour ECG Holter monitoring in patients with syndrome X or coronary atherosclerosis., Kardiol Pol65 (2007), 262–269.
24.
GibbonsR.J., BaladyG.J., BrickerJ.T.et al.,ACC/AHA 2002 guideline update for exercise testing: summary article. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Update the 1997 Exercise Testing Guidelines), J Am Coll Cardiol40 (2002), 1531–1540.
25.
GibbonsR.J., BaladyG.J., BeasleyJ.W.et al.,ACC/AHA Guidelines for Exercise Testing. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Exercise Testing), J Am Coll Cardiol30 (1997), 260–311.
26.
PoupkoJ.M., BaskinS.I., MooreE., The pharmacological properties of anisodamine, J Appl Toxicol27 (2007), 116–121.
27.
LiuC., ShenF.M., LeY.Y.et al.,Antishock effect of anisodamine involves a novel pathway for activating alpha7 nicotinic acetylcholine receptor, Crit Care Med37 (2009), 634–641.
28.
ZhangS., ChangA.M., LiC.F.et al.,Mechanism of the therapeutic effect of anisodamine in disseminated intravascular coagulation: study of platelet adhesion and aggregation, malondialdehyde, thromboxane B2, 6-keto-prostaglandin F1 alpha, and microcirculation, Exp Hematol15 (1987), 65–71.
29.
ZhangZ., ZhouJ., ShangY.et al.,Effectiveness of anisodamine for the treatment of critically ill patients with septic shock (ACIdoSIS study): study protocol for randomized controlled trial, Ann Transl Med3 (2015), 246.
30.
DaiberA., MünzelT., Organic Nitrate Therapy, Nitrate Tolerance, and Nitrate-Induced Endothelial Dysfunction: Emphasis on Redox Biology and Oxidative Stress, Antioxid Redox Signal23 (2015), 899–942.
31.
GiuseppeC., PaulJ., Hans-UlrichI., Use of nitrates in ischemic heart disease, Expert Opin Pharmacother16 (2015), 1567–1572.
32.
KurzM.A., LampingK.G., BatesJ.N.et al.,Mechanisms responsible for the heterogeneous coronary microvascular response to nitroglycerin, Circ Res68 (1991), 847–855.
33.
RussoG., DiA., Franco LamendolaP., et al.,Lack of effect of nitrates on exercise stress test results in patients with microvascular angina, Cardiovasc Drugs Ther27 (2013), 229–234.
RobinsonV.J., CorleyJ.H., MarksD.S.et al.,Causes of transient dilatation of the left ventricle during myocardial perfusion imaging, AJR174 (2000), 1349–1352.
36.
BravoP.E., TahariA., PoziosI.et al., Apparent left ventricular cavity dilatation during PET/CT in hypertrophic cardiomyopathy: Clinical predictors and potential mechanisms, J Nucl Cardiol23 (2016), 1304–1314.
37.
EmmettL., MageeM., FreedmanS.B.et al.,The role of left ventricular hypertrophy and diabetes in the presence of transient ischemic dilation of the left ventricle on myocardial perfusion SPECT images, J Nucl Med46 (2005), 1596–1601.
