Necessity is the Mother of Invention.

- Plato

The Bitterroot Mountains From Kellogg Peak

Defining Transient Ischemic Dilation

Background Methods Results Conclusion

Transient Ischemic Dilation

The ratio of the left ventricular size after stress compared to rest The left ventricular size is determined from the ungated SPECT data TID is the ratio of the average wall position at stress compared to rest

Transient Ischemic Dilation

As such, the volumes associated with this measurement should not be considered to represent either end-systolic or enddiastolic volumes alone but rather a complex average of the two.

Dan Berman, Rory Hachamovitch, Guido Germano and others, as quoted in the J Nucl Med. 2004 Dec;45(12):1999-2007.

Transient Ischemic Dilation

Defining the Complex Average

What is the contribution of the ESV? What is the contribution of the EDV? Can this complex average be derived from the gated SPECT data?

When you cannot explain it in numbers, your knowledge is of a meager and unsatisfactory kind.
Lord Kelvin (William Thomson, 1824-1907)

Defining Transient Ischemic Dilation

Background Methods Results Conclusion

Methods
Retrospective review of 422 consecutive patients Ischemia determined semi-quantitatively using a 17 segment, 5 point scale Post-stress to rest ventricular volume ratios correlated with ischemia

Defining Transient Ischemic Dilation

Background Methods Results Conclusion

Ventricular Volume Ratios

ESVr Ischemia + 1.02 Ischemia 0.84 Difference 0.18 ** EDVr 1.00 0.92 0.08 ** LVEFr 1.02 1.06 - 0.04 *

** p < 0.01, * p < 0.05 for the presence or absence of ischemia using the independent samples t-test

Pearson Correlation Coefficients

ESVr Ischemia 0.259 **

EDVr 0.227 **

LVEFr -0.112 *

** p < 0.01, * p < 0.05

Partial Correlation Coefficients

Corrected for Type of Stress

ESVr Ischemia 0.2560 **

EDVr 0.2252 **

LVEFr -0.1239 *

** p < 0.001, * p < 0.05

Partial Correlation Coefficients

Corrected for Type of Stress and Sex

ESVr Ischemia 0.2504 **

EDVr 0.2092 **

LVEFr -0.1319 *

** p < 0.001, * p < 0.05

Partial Correlation Coefficients

Corrected for Type of Stress, Sex, and Age

ESVr Ischemia 0.2427 **

EDVr 0.2085 **

LVEFr -0.1191 *

** p < 0.001, * p < 0.05

Optimization
Both the ESV and EDV contain significant correlations The ESV is more highly correlated than is the EDV The contribution of the ESV is greater than that of the EDV to the TID ratio

Optimization stress (ESV * X + EDV) rest (ESV * X + EDV)

where X = the ESV weighing factor

What value of X will lead to the highest correlation with myocardial ischemia?

Partial Correlation Coefficients

Controlling for Type of Stress X=0 Ischemia 0.2252 ** X=5 0.2761 ** X = 10 0.2738 **

stress (ESV*X + EDV) / rest (ESV*X + EDV) where X = the ESV weighing factor
** p < 0.001

Controlling for Type of Stress

0.28

Correlation Coeffient

0.26

0.24

0.22

0.2 0 5 10 15 20 ESV Weighing Factor Ischemia SDS 25 30 35 40

Controlling for Type of Stress

0.2762

0.276

Correlation Coefficient

0.2758

0.2756

0.2754 3.4 3.8 4.2 4.6 5 ESV Weighing Factor Ischemia 5.4 5.8 6.2

Linear Regression
30.905

30.9

F Score

30.895

30.89

30.885 4.5 5.0 ESV Weighing Factor F Score 5.5

Defining Transient Ischemic Dilation

Background Methods Results Conclusion

Conclusion
The ESVr, EDVr, and LVEFr all are significantly correlated with myocardial ischemia The ESVr is more highly correlated with myocardial ischemia than the EDVr or LVEFr The stress (ESVx5 + EDV) / rest (ESVx5 + EDV) has the strongest correlation with myocardial ischemia

The Complex Average ?

stress ESV * 5 + stress EDV rest ESV * 5 + rest EDV