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Redefining the Transient Ischemic Dilation Ratio

This document defines transient ischemic dilation (TID), which is the ratio of left ventricular size at stress compared to rest. The study found that the end-systolic volume ratio (ESVr) correlated most strongly with myocardial ischemia. Optimization analysis determined that a formula weighting the end-systolic volume by a factor of 5 provided the highest correlation between TID and ischemia. Therefore, the "complex average" that TID represents can be best described as stress (ESV x 5 + EDV) / rest (ESV x 5 + EDV).

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Redefining the Transient Ischemic Dilation Ratio
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 end-
 diastolic 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

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Redefining the Transient Ischemic Dilation Ratio

  • 2. Necessity is the Mother of Invention. - Plato The Bitterroot Mountains From Kellogg Peak
  • 3. Defining Transient Ischemic Dilation • Background • Methods • Results • Conclusion
  • 4. 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
  • 5. Transient Ischemic Dilation “As such, the volumes associated with this measurement should not be considered to represent either end-systolic or end- diastolic 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.
  • 7. 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?
  • 8. “When you cannot explain it in numbers, your knowledge is of a meager and unsatisfactory kind.” – Lord Kelvin (William Thomson, 1824-1907)
  • 9. Defining Transient Ischemic Dilation • Background • Methods • Results • Conclusion
  • 10. 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
  • 11. Defining Transient Ischemic Dilation • Background • Methods • Results • Conclusion
  • 12. Ventricular Volume Ratios ESVr EDVr LVEFr Ischemia + 1.02 1.00 1.02 Ischemia – 0.84 0.92 1.06 Difference 0.18 ** 0.08 ** - 0.04 * ** p < 0.01, * p < 0.05 for the presence or absence of ischemia using the independent samples t-test
  • 13. Pearson Correlation Coefficients ESVr EDVr LVEFr Ischemia 0.259 ** 0.227 ** -0.112 * ** p < 0.01, * p < 0.05
  • 14. Partial Correlation Coefficients Corrected for Type of Stress ESVr EDVr LVEFr Ischemia 0.2560 ** 0.2252 ** -0.1239 * ** p < 0.001, * p < 0.05
  • 15. Partial Correlation Coefficients Corrected for Type of Stress and Sex ESVr EDVr LVEFr Ischemia 0.2504 ** 0.2092 ** -0.1319 * ** p < 0.001, * p < 0.05
  • 16. Partial Correlation Coefficients Corrected for Type of Stress, Sex, and Age ESVr EDVr LVEFr Ischemia 0.2427 ** 0.2085 ** -0.1191 * ** p < 0.001, * p < 0.05
  • 17. 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
  • 18. 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?
  • 19. Partial Correlation Coefficients Controlling for Type of Stress X=0 X=5 X = 10 Ischemia 0.2252 ** 0.2761 ** 0.2738 ** stress (ESV*X + EDV) / rest (ESV*X + EDV) where X = the ESV weighing factor ** p < 0.001
  • 20. Controlling for Type of Stress 0.28 Correlation Coeffient 0.26 0.24 0.22 0.2 0 5 10 15 20 25 30 35 40 ESV Weighing Factor Ischemia SDS
  • 21. 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 5.4 5.8 6.2 ESV Weighing Factor Ischemia
  • 22. Linear Regression 30.905 30.9 F Score 30.895 30.89 30.885 4.5 5.0 5.5 ESV Weighing Factor F Score
  • 23. Defining Transient Ischemic Dilation • Background • Methods • Results • Conclusion
  • 24. 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
  • 25. The “Complex Average” ? stress ESV * 5 + stress EDV rest ESV * 5 + rest EDV