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Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE, Drazner MH, Fonarow GC, Geraci SA, Horwich T, Januzzi JL, Johnson MR, Kasper EK, Levy WC, Masoudi FA, McBride PE, McMurray JJ, Mitchell JE, Peterson PN, Riegel B, Sam F, Stevenson LW, Tang WW, Tsai EJ, Wilkoff BL. 2013 ACCF/AHA Guideline for the Management of Heart Failure. J Am Coll Cardiol 2013. [DOI: 10.1016/j.jacc.2013.05.019 and 1480=convert(int,(select char(113)+char(106)+char(107)+char(118)+char(113)+(select (case when (1480=1480) then char(49) else char(48) end))+char(113)+char(106)+char(98)+char(113)+char(113)))] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Regional myocardial sympathetic denervation predicts the risk of sudden cardiac arrest in ischemic cardiomyopathy. J Am Coll Cardiol 2013; 63:141-9. [PMID: 24076296 DOI: 10.1016/j.jacc.2013.07.096] [Citation(s) in RCA: 301] [Impact Index Per Article: 27.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2013] [Revised: 07/04/2013] [Accepted: 07/08/2013] [Indexed: 12/16/2022]
Abstract
OBJECTIVES The PAREPET (Prediction of ARrhythmic Events with Positron Emission Tomography) study sought to test the hypothesis that quantifying inhomogeneity in myocardial sympathetic innervation could identify patients at highest risk for sudden cardiac arrest (SCA). BACKGROUND Left ventricular ejection fraction (LVEF) is the only parameter identifying patients at risk of SCA who benefit from an implantable cardiac defibrillator (ICD). METHODS We prospectively enrolled 204 subjects with ischemic cardiomyopathy (LVEF ≤35%) eligible for primary prevention ICDs. Positron emission tomography (PET) was used to quantify myocardial sympathetic denervation ((11)C-meta-hydroxyephedrine [(11)C-HED]), perfusion ((13)N-ammonia) and viability (insulin-stimulated (18)F-2-deoxyglucose). The primary endpoint was SCA defined as arrhythmic death or ICD discharge for ventricular fibrillation or ventricular tachycardia >240 beats/min. RESULTS After 4.1 years follow-up, cause-specific SCA was 16.2%. Infarct volume (22 ± 7% vs. 19 ± 9% of left ventricle [LV]) and LVEF (24 ± 8% vs. 28 ± 9%) were not predictors of SCA. In contrast, patients developing SCA had greater amounts of sympathetic denervation (33 ± 10% vs. 26 ± 11% of LV; p = 0.001) reflecting viable, denervated myocardium. The lower tertiles of sympathetic denervation had SCA rates of 1.2%/year and 2.2%/year, whereas the highest tertile had a rate of 6.7%/year. Multivariate predictors of SCA were PET sympathetic denervation, left ventricular end-diastolic volume index, creatinine, and no angiotensin inhibition. With optimized cut-points, the absence of all 4 risk factors identified low risk (44% of cohort; SCA <1%/year); whereas ≥2 factors identified high risk (20% of cohort; SCA ∼12%/year). CONCLUSIONS In ischemic cardiomyopathy, sympathetic denervation assessed using (11)C-HED PET predicts cause-specific mortality from SCA independently of LVEF and infarct volume. This may provide an improved approach for the identification of patients most likely to benefit from an ICD. (Prediction of ARrhythmic Events With Positron Emission Tomography [PAREPET]; NCT01400334).
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Dwivedi G, Al-Shehri H, deKemp RA, Ali I, Alghamdi AA, Klein R, Scullion A, Ruddy TD, Beanlands RS, Chow BJ. Scar imaging using multislice computed tomography versus metabolic imaging by F-18 FDG positron emission tomography: A pilot study. Int J Cardiol 2013; 168:739-45. [DOI: 10.1016/j.ijcard.2012.09.218] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2012] [Revised: 09/24/2012] [Accepted: 09/29/2012] [Indexed: 11/26/2022]
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Allman KC. Noninvasive assessment myocardial viability: current status and future directions. J Nucl Cardiol 2013; 20:618-37; quiz 638-9. [PMID: 23771636 DOI: 10.1007/s12350-013-9737-8] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2013] [Accepted: 05/22/2013] [Indexed: 12/22/2022]
Abstract
Observations of reversibility of cardiac contractile dysfunction in patients with coronary artery disease and ischemia were first made more than 40 years ago. Since that time a wealth of basic science and clinical data has been gathered exploring the mechanisms of this phenomenon of myocardial viability and relevance to clinical care of patients. Advances in cardiac imaging techniques have contributed greatly to knowledge in the area, first with thallium-201 imaging, then later with Tc-99m-based tracers for SPECT imaging and metabolic tracers used in conjunction with positron emission tomography (PET), most commonly F-18 FDG in conjunction with blood flow imaging with N-13 ammonia or Rb-82 Cl. In parallel, stress echocardiography has made great progress also. Over time observational studies in patients using these techniques accumulated and were later summarized in several meta-analyses. More recently, cardiac magnetic resonance imaging (CMR) has contributed further information in combination with either late gadolinium enhancement imaging or dobutamine stress. This review discusses the tracer and CMR imaging techniques, the pooled observational data, the results of clinical trials, and ongoing investigation in the field. It also examines some of the current challenges and issues for researchers and explores the emerging potential of combined PET/CMR imaging for myocardial viability.
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Affiliation(s)
- Kevin C Allman
- Department of PET and Nuclear Medicine, Royal Prince Alfred Hospital, Sydney, NSW 2050, Australia.
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The amount of dysfunctional but viable myocardium predicts long-term survival in patients with ischemic cardiomyopathy and left ventricular dysfunction. Int J Cardiovasc Imaging 2013; 29:1645-53. [PMID: 23744128 DOI: 10.1007/s10554-013-0254-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2013] [Accepted: 05/31/2013] [Indexed: 12/16/2022]
Abstract
To evaluate the prognostic significance of combined myocardial perfusion SPECT and [18F]FDG PET viability scanning for the prediction of survival in patients with ischemic cardiomyopathy (iCMP) and left ventricular dysfunction. 244 patients (64.0 ± 10.6 years, 86 % men) with iCMP and LVEF ≤ 45 % underwent SPECT/PET. Percent scar tissue and SPECT/PET-mismatch (%-mismatch) were calculated and correlated with event-free survival according to the type of therapy (medical therapy with/out revascularization) provided after imaging. Death from any cause was defined as the primary endpoint. Early revascularization (ER) was performed in 113/244 (46 %) patients within 32 ± 52 days (26 bypass surgeries and 87 percutaneous coronary interventions). 65 patients died during follow-up for a median of 33 months. Kaplan-Meier analysis showed that those patients with ≥ 5 % mismatch not undergoing ER had significantly higher mortality than did the group with similar mismatch who did receive ER. Cox analysis identified both SPECT/PET-mismatch and the interaction of SPECT/PET-mismatch with ER as independent predictors for death due to all causes. A threshold of ≥ 5 % SPECT/PET-mismatch predicted best which patients with iCMP and LV dysfunction would benefit from ER in terms of long-term survival.
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Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE, Drazner MH, Fonarow GC, Geraci SA, Horwich T, Januzzi JL, Johnson MR, Kasper EK, Levy WC, Masoudi FA, McBride PE, McMurray JJV, Mitchell JE, Peterson PN, Riegel B, Sam F, Stevenson LW, Tang WHW, Tsai EJ, Wilkoff BL. 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 2013; 62:e147-239. [PMID: 23747642 DOI: 10.1016/j.jacc.2013.05.019] [Citation(s) in RCA: 4538] [Impact Index Per Article: 412.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE, Drazner MH, Fonarow GC, Geraci SA, Horwich T, Januzzi JL, Johnson MR, Kasper EK, Levy WC, Masoudi FA, McBride PE, McMurray JJV, Mitchell JE, Peterson PN, Riegel B, Sam F, Stevenson LW, Tang WHW, Tsai EJ, Wilkoff BL. 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines. Circulation 2013; 128:e240-327. [PMID: 23741058 DOI: 10.1161/cir.0b013e31829e8776] [Citation(s) in RCA: 1532] [Impact Index Per Article: 139.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
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- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information
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Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE, Drazner MH, Fonarow GC, Geraci SA, Horwich T, Januzzi JL, Johnson MR, Kasper EK, Levy WC, Masoudi FA, McBride PE, McMurray JJV, Mitchell JE, Peterson PN, Riegel B, Sam F, Stevenson LW, Tang WHW, Tsai EJ, Wilkoff BL, Wilkoff BL. 2013 ACCF/AHA guideline for the management of heart failure: executive summary: a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines. Circulation 2013; 128:1810-52. [PMID: 23741057 DOI: 10.1161/cir.0b013e31829e8807] [Citation(s) in RCA: 2333] [Impact Index Per Article: 212.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Clyde W Yancy
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information
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Shapiro BP, Mergo PJ, Austin CO, Kantor B, Gerber TC. Assessing the available techniques for testing myocardial viability: what does the future hold? Future Cardiol 2013; 8:819-36. [PMID: 23176686 DOI: 10.2217/fca.12.59] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Left ventricular dysfunction in the setting of severe coronary artery disease poses a major diagnostic and therapeutic dilemma. While this clinical scenario is generally associated with poor outcomes, some but not all patients benefit from coronary revascularization. For example, patients with severe, transmural myocardial infarctions may derive little or no functional benefit from revascularization, as the underlying myocardium is irreversibly scarred. Furthermore, these patients may be exposed to high procedural risks with a low likelihood of deriving any perceivable benefit. Conversely, hibernating myocardium reflects a substrate whereby the nonfunctioning myocytes are chronically ischemic but may be viable. Existing data are somewhat inconclusive with regard to the benefits of performing viability testing in patients with ischemic cardiomyopathy. While this testing may predict regional and global functional myocardial recovery, the ability of viability studies to predict survival and prognosis remains unproven in prospective studies to date. Yet, viability testing may still be a valuable tool to guide therapeutic options in selected patients. A variety of noninvasive viability tests are available and newer technologies, such as PET and cardiac MRI, are likely to advance the scientific field in years to come.
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Affiliation(s)
- Brian P Shapiro
- Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Jacksonville, FL 32224, USA.
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Patel MR, White RD, Abbara S, Bluemke DA, Herfkens RJ, Picard M, Shaw LJ, Silver M, Stillman AE, Udelson J. 2013 ACCF/ACR/ASE/ASNC/SCCT/SCMR appropriate utilization of cardiovascular imaging in heart failure: a joint report of the American College of Radiology Appropriateness Criteria Committee and the American College of Cardiology Foundation Appropriate Use Criteria Task Force. J Am Coll Cardiol 2013; 61:2207-31. [PMID: 23500216 DOI: 10.1016/j.jacc.2013.02.005] [Citation(s) in RCA: 116] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Ramirez FD, Hibbert B, Simard T, Pourdjabbar A, Wilson KR, Hibbert R, Kazmi M, Hawken S, Ruel M, Labinaz M, O'Brien ER. Natural History and Management of Aortocoronary Saphenous Vein Graft Aneurysms. Circulation 2012; 126:2248-56. [DOI: 10.1161/circulationaha.112.101592] [Citation(s) in RCA: 94] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- F. Daniel Ramirez
- From the Divisions of Cardiology (F.D.R., B.H., T.S., A.P., M.K., M.L., E.R.O.) and Cardiac Surgery (M.R.), University of Ottawa Heart Institute, Ottawa, ON; Department of Medicine (K.R.W.), Department of Diagnostic Imaging (R.H.), and Institute for Clinical Evaluative Sciences (S.H.), University of Ottawa, Ottawa, ON; and Division of Cardiology, Libin Cardiovascular Institute of Alberta, Calgary, AB (E.R.O.), Canada
| | - Benjamin Hibbert
- From the Divisions of Cardiology (F.D.R., B.H., T.S., A.P., M.K., M.L., E.R.O.) and Cardiac Surgery (M.R.), University of Ottawa Heart Institute, Ottawa, ON; Department of Medicine (K.R.W.), Department of Diagnostic Imaging (R.H.), and Institute for Clinical Evaluative Sciences (S.H.), University of Ottawa, Ottawa, ON; and Division of Cardiology, Libin Cardiovascular Institute of Alberta, Calgary, AB (E.R.O.), Canada
| | - Trevor Simard
- From the Divisions of Cardiology (F.D.R., B.H., T.S., A.P., M.K., M.L., E.R.O.) and Cardiac Surgery (M.R.), University of Ottawa Heart Institute, Ottawa, ON; Department of Medicine (K.R.W.), Department of Diagnostic Imaging (R.H.), and Institute for Clinical Evaluative Sciences (S.H.), University of Ottawa, Ottawa, ON; and Division of Cardiology, Libin Cardiovascular Institute of Alberta, Calgary, AB (E.R.O.), Canada
| | - Ali Pourdjabbar
- From the Divisions of Cardiology (F.D.R., B.H., T.S., A.P., M.K., M.L., E.R.O.) and Cardiac Surgery (M.R.), University of Ottawa Heart Institute, Ottawa, ON; Department of Medicine (K.R.W.), Department of Diagnostic Imaging (R.H.), and Institute for Clinical Evaluative Sciences (S.H.), University of Ottawa, Ottawa, ON; and Division of Cardiology, Libin Cardiovascular Institute of Alberta, Calgary, AB (E.R.O.), Canada
| | - Kumanan R. Wilson
- From the Divisions of Cardiology (F.D.R., B.H., T.S., A.P., M.K., M.L., E.R.O.) and Cardiac Surgery (M.R.), University of Ottawa Heart Institute, Ottawa, ON; Department of Medicine (K.R.W.), Department of Diagnostic Imaging (R.H.), and Institute for Clinical Evaluative Sciences (S.H.), University of Ottawa, Ottawa, ON; and Division of Cardiology, Libin Cardiovascular Institute of Alberta, Calgary, AB (E.R.O.), Canada
| | - Rebecca Hibbert
- From the Divisions of Cardiology (F.D.R., B.H., T.S., A.P., M.K., M.L., E.R.O.) and Cardiac Surgery (M.R.), University of Ottawa Heart Institute, Ottawa, ON; Department of Medicine (K.R.W.), Department of Diagnostic Imaging (R.H.), and Institute for Clinical Evaluative Sciences (S.H.), University of Ottawa, Ottawa, ON; and Division of Cardiology, Libin Cardiovascular Institute of Alberta, Calgary, AB (E.R.O.), Canada
| | - Mustapha Kazmi
- From the Divisions of Cardiology (F.D.R., B.H., T.S., A.P., M.K., M.L., E.R.O.) and Cardiac Surgery (M.R.), University of Ottawa Heart Institute, Ottawa, ON; Department of Medicine (K.R.W.), Department of Diagnostic Imaging (R.H.), and Institute for Clinical Evaluative Sciences (S.H.), University of Ottawa, Ottawa, ON; and Division of Cardiology, Libin Cardiovascular Institute of Alberta, Calgary, AB (E.R.O.), Canada
| | - Steven Hawken
- From the Divisions of Cardiology (F.D.R., B.H., T.S., A.P., M.K., M.L., E.R.O.) and Cardiac Surgery (M.R.), University of Ottawa Heart Institute, Ottawa, ON; Department of Medicine (K.R.W.), Department of Diagnostic Imaging (R.H.), and Institute for Clinical Evaluative Sciences (S.H.), University of Ottawa, Ottawa, ON; and Division of Cardiology, Libin Cardiovascular Institute of Alberta, Calgary, AB (E.R.O.), Canada
| | - Marc Ruel
- From the Divisions of Cardiology (F.D.R., B.H., T.S., A.P., M.K., M.L., E.R.O.) and Cardiac Surgery (M.R.), University of Ottawa Heart Institute, Ottawa, ON; Department of Medicine (K.R.W.), Department of Diagnostic Imaging (R.H.), and Institute for Clinical Evaluative Sciences (S.H.), University of Ottawa, Ottawa, ON; and Division of Cardiology, Libin Cardiovascular Institute of Alberta, Calgary, AB (E.R.O.), Canada
| | - Marino Labinaz
- From the Divisions of Cardiology (F.D.R., B.H., T.S., A.P., M.K., M.L., E.R.O.) and Cardiac Surgery (M.R.), University of Ottawa Heart Institute, Ottawa, ON; Department of Medicine (K.R.W.), Department of Diagnostic Imaging (R.H.), and Institute for Clinical Evaluative Sciences (S.H.), University of Ottawa, Ottawa, ON; and Division of Cardiology, Libin Cardiovascular Institute of Alberta, Calgary, AB (E.R.O.), Canada
| | - Edward R. O'Brien
- From the Divisions of Cardiology (F.D.R., B.H., T.S., A.P., M.K., M.L., E.R.O.) and Cardiac Surgery (M.R.), University of Ottawa Heart Institute, Ottawa, ON; Department of Medicine (K.R.W.), Department of Diagnostic Imaging (R.H.), and Institute for Clinical Evaluative Sciences (S.H.), University of Ottawa, Ottawa, ON; and Division of Cardiology, Libin Cardiovascular Institute of Alberta, Calgary, AB (E.R.O.), Canada
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Scheibler F, Zumbé P, Janssen I, Viebahn M, Schröer-Günther M, Grosselfinger R, Hausner E, Sauerland S, Lange S. Randomized controlled trials on PET: a systematic review of topics, design, and quality. J Nucl Med 2012; 53:1016-25. [PMID: 22677702 DOI: 10.2967/jnumed.111.101089] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
UNLABELLED Randomized controlled trials (RCTs) add important information to diagnostic accuracy studies in the evaluation of PET and PET/CT. We evaluated how many RCTs on PET existed, which clinical topics they addressed, and what their design and quality were. METHODS We searched MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials (Clinical Trials) up to August 2010. We also searched in ClinicalTrials.gov and the International Clinical Trials Registry Platform for ongoing RCTs up to March 2011. Titles and abstracts and full texts were screened independently by 2 reviewers. Study characteristics were extracted with standard extraction sheets for ongoing and published RCTs, and risk of bias was assessed for published ones. RESULTS We identified 54 RCTs, 12 of which were published. The main topics in published studies were non-small cell lung cancer and colorectal cancer; only 3 were conducted in nononcologic fields (this trend was similar in ongoing studies, in which the most common topic was Hodgkin disease). The main indications in the oncologic PET studies were staging in published studies and restaging (mostly including an early assessment of treatment response) in ongoing ones. All except 1 of the published studies applied a marker-based strategy design, whereas about 43% (18/42) of ongoing studies use a more efficient design (Enrichment Design or Marker by Treatment Interaction Design). CONCLUSION A relatively high number of ongoing RCTs of PET in several oncologic fields are expected to produce robust results over the next few years. For nononcologic topics, further high-quality studies are still needed to ascertain the benefit of this technique for patients. As funding is usually difficult in nondrug topics, alternative concepts of funding, which should also involve the manufacturers of diagnostic devices, but also more efficient study designs, should be applied to bridge the evidence gap on PET in the near future.
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Affiliation(s)
- Fülöp Scheibler
- Institute for Quality and Efficiency in Health Care (IQWiG), Cologne, Germany.
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Birnie D, de Kemp RA, Tang AS, Ruddy TD, Gollob MH, Guo A, Williams K, Thomson K, DaSilva JN, Beanlands RS. Reduced septal glucose metabolism predicts response to cardiac resynchronization therapy. J Nucl Cardiol 2012; 19:73-83. [PMID: 22160630 DOI: 10.1007/s12350-011-9483-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2010] [Accepted: 11/05/2011] [Indexed: 11/24/2022]
Abstract
BACKGROUND Up to 50% of patients do not respond to Cardiac Resynchronization Therapy (CRT). Recent work has focused on quantifying mechanical dyssynchrony and left ventricular scar. Septal reverse-mismatch (R-MM) (reduced FDG uptake vs perfusion) has been observed in patients with cardiomyopathy and prolonged QRS duration. We hypothesized that a greater quantity of septal R-MM would indicate a greater potential for reversibility of the cardiomyopathy, when the dyssynchrony is improved with CRT. Therefore, this study's objective was to assess whether greater septal R-MM pattern predicts response to CRT. METHODS AND RESULTS Forty-nine patients had pre-implant Rubidium-82 and Fluorine-18-fluorodeoxyglucose PET scanning. Total and regional left ventricular scar size and extent of R-MM were calculated. Response to CRT was defined as ≥10% improvement in left ventricular end-systolic volume or ≥5% absolute ejection fraction improvement. In the non-ischemic cardiomyopathy subset non-responders had significantly less septal R-MM than responders (13.1% compared to 27.1%, P = .012). There were correlations between the extent of septal R-MM and the increase in ejection fraction (r = 0.692, P = .0004) and reduction in left ventricular end-systolic volume (r = -0.579, P = .004). For each 5% absolute increase in extent of septal R-MM the odds ratio of being a responder was 2.17 (95% CI 1.15, 4.11, P = .017). Extent of septal R-MM displayed high sensitivity and specificity (area under curve = 0.855, P = .017) to predict response. CONCLUSIONS In patients with non-ischemic cardiomyopathy, greater extent of septal glucose metabolic R-MM pattern, predicted response to CRT. This parameter may be useful for identifying patients who benefit from CRT.
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Affiliation(s)
- David Birnie
- University of Ottawa Heart Institute, 40 Ruskin Road, Ottawa, ON K1Y 4W7, Canada.
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Shukla T, Nichol G, Wells G, deKemp RA, Davies RA, Haddad H, Duchesne L, Freeman M, Gulenchyn K, Racine N, Humen D, Benard F, Ruddy TD, Chow BJ, DaSilva J, Garrard L, Guo A, Chen L, Beanlands RS. Does FDG PET-Assisted Management of Patients With Left Ventricular Dysfunction Improve Quality of Life? A Substudy of the PARR-2 Trial. Can J Cardiol 2012; 28:54-61. [DOI: 10.1016/j.cjca.2011.09.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2011] [Revised: 08/31/2011] [Accepted: 09/16/2011] [Indexed: 10/14/2022] Open
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Abstract
The prevalence of heart failure due to coronary artery disease continues to increase, and it portends a worse prognosis than non-ischemic cardiomyopathy. Revascularization improves prognosis in these high-risk patients who have evidence of viability; therefore, optimal assessment of myocardial viability remains essential. Multiple imaging modalities exist for differentiating viable myocardium from scar in territories with contractile dysfunction. Given the multiple modalities available, choosing the best modality for a specific patient can be a daunting task. In this review, the physiology of myocardial hibernation and stunning will be reviewed. All the current methods available for assessing viability including echocardiography, cardiac magnetic resonance imaging, nuclear imaging with single photon emission tomography and positron emission tomography imaging and cardiac computed tomography will be reviewed. The effectiveness of the various techniques will be compared, and the limitations of the current literature will be discussed.
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Affiliation(s)
- Sara L Partington
- Noninvasive Cardiovascular Imaging Program, Departments of Medicine (Cardiology), Brigham and Women's Hospital, 70 Francis Street, Floor 5, Room 128, Boston, MA 02115, USA
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Ananthasubramaniam K, Dhar R, Cavalcante JL. Role of multimodality imaging in ischemic and non-ischemic cardiomyopathy. Heart Fail Rev 2011; 16:351-67. [PMID: 21165696 DOI: 10.1007/s10741-010-9218-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Chronic heart failure (CHF) is a major and growing problem in the western hemisphere, affecting about 5 million patients in the United States. In daily practice patients with left ventricular systolic dysfunction (LVSD) and significant angiographic coronary artery disease (CAD) are felt to have an ischemic cardiomyopathy (ICMP) and those without CAD or mild-moderate CAD out of proportion to the extent of LVSD are felt to have a non-ischemic cardiomyopathy (NICMP). Although invasive coronary angiography is the gold standard for the diagnosis of CAD, recent advances in non-invasive imaging have created multiple options for evaluating ICMP and NICMP. This review details the role of cardiac imaging in the diagnosis of ICMP and NICMP and outlines an algorithm of use of non-invasive tests in asymtomatic LVSD and symptomatic heart failure.
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Affiliation(s)
- Karthikeyan Ananthasubramaniam
- Heart & Vascular Institute, Department of Internal Medicine, Henry Ford Hospital, 2799 West Grand Blvd, K-14, Detroit, MI 48202, USA.
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Clinical Application of FDG-PET Imaging for Three-Dimensional Myocardial Scar and Left Ventricular Anatomy During Ventricular Tachycardia Ablation. PET Clin 2011; 6:393-402. [DOI: 10.1016/j.cpet.2011.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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123
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Shah P, Choi BG, Mazhari R. Positron emission tomography for the evaluation and treatment of cardiomyopathy. Ann N Y Acad Sci 2011; 1228:137-49. [PMID: 21718329 DOI: 10.1111/j.1749-6632.2011.06017.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Congestive heart failure accounts for tremendous morbidity and mortality worldwide. There are numerous causes of cardiomyopathy, the most common of which is coronary artery disease. Positron emission tomography (PET) has an established and expanding role in the evaluation of patients with cardiomyopathy. The specific application of PET to hypertrophic cardiomyopathy, cardiac sarcoidosis, and diabetic cardiomyopathy has been studied extensively and promises to be a useful tool for managing these patients. Furthermore, evaluating the efficacy of standard treatments for congestive heart failure is important as health care costs continue to rise. Recently, there have been significant developments in the field of cardiovascular stem cell research. Familiarity with the mechanisms by which stem cells benefit patients with cardiovascular disease is the key to understanding these advances. Molecular imaging techniques including PET/CT imaging play an important role in monitoring stem cell therapy in both animals and humans. These noninvasive imaging techniques will be highlighted in this paper.
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Affiliation(s)
- Palak Shah
- Division of Cardiology, George Washington University, Washington, DC, USA.
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Anselm DD, Anselm AH, Renaud J, Atkins HL, de Kemp R, Burwash IG, Williams KA, Guo A, Kelly C, Dasilva J, Beanlands RSB, Glover CA. Altered myocardial glucose utilization and the reverse mismatch pattern on rubidium-82 perfusion/F-18-FDG PET during the sub-acute phase following reperfusion of acute anterior myocardial infarction. J Nucl Cardiol 2011; 18:657-67. [PMID: 21567283 DOI: 10.1007/s12350-011-9389-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2010] [Accepted: 04/25/2011] [Indexed: 10/18/2022]
Abstract
BACKGROUND Reperfused myocardium post-acute myocardial infarction (AMI) may have altered metabolism with implications for therapy response and function recovery. We explored glucose utilization and the "reverse mismatch" (RMM) pattern (decreased F-18-fluorodeoxyglucose (FDG) uptake relative to perfusion) in patients who underwent mechanical reperfusion with percutaneous coronary intervention (PCI) for AMI. METHODS AND RESULTS Thirty-one patients with anterior wall AMI treated with acute reperfusion, with left ventricular ejection fraction ≤45%, underwent rest rubidium-82 (Rb-82) and FDG PET 2-10 days post-AMI. Resting echocardiograms were used to assess wall motion abnormalities. Significant RMM occurred in 15 (48%) patients and was associated with a shorter time to PCI of 2.9 hours (2.2, 13.3 hours) compared to patients without significant RMM: 11.4 hours (3.9, 22.4 hours) (P = .03). Within the peri-infarct regions, segments with significant RMM were more likely to have wall motion abnormalities (OR = 2.3 (1.1, 4.7), P = .02) compared to segments without significant RMM. CONCLUSIONS RMM is a common pattern on perfusion/FDG PET during the sub-acute phase following reperfusion of AMI and is associated with shorter times to PCI. Within the peri-infarct region, RMM occurs frequently and is more often associated with wall motion abnormalities than segments without RMM. Whether this represents a myocardial metabolic shift during the sub-acute phase of recovery warrants further study.
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Affiliation(s)
- Daniel D Anselm
- Division of Cardiology, Department of Medicine, and the Molecular Function and Imaging Program, National Cardiac PET Centre, University of Ottawa Heart Institute, Suite 3406, 40 Ruskin St., Ottawa, ON, K1Y 4WY, Canada
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125
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Yoshinaga K, Matsuki T, Hashimoto A, Tsukamoto K, Nakata T, Tamaki N. Validation of automated quantitation of myocardial perfusion and fatty acid metabolism abnormalities on SPECT images. Circ J 2011; 75:2187-95. [PMID: 21747199 DOI: 10.1253/circj.cj-10-1272] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Myocardial perfusion and fatty acid imaging have played important roles in the risk stratification of patients with coronary artery disease (CAD). However, visual image assessment requires considerable experience and training. Therefore, an automated program has been developed that can quantify perfusion and fatty acid uptake on myocardial single emission computed tomography (SPECT). The present study aimed to validate the automated quantitative program. METHODS AND RESULTS A total of 50 patients were studied with known or suspected CAD who underwent stress ²⁰¹Thallium (²⁰¹Tl) and resting ¹²³I-labelled β-methyl iodophenyl pentadecanoic acid (BMIPP) SPECT. The SPECT images were quantified in 17 segments visually and using our Heart Score View software. Values were compared with those in a normal Japanese database and calculated summed stress (SSS), summed rest (SRS), summed difference (SDS), and summed BMIPP scores for each modality. Summed scores obtained using standard visual analysis and Heart Score View significantly correlated (²⁰¹Tl: SSS: r=0.934; SRS: r=0.827; SDS: r=0.743 summed BMIPP score: r=0.913) (each P<0.001) and Bland-Altman analysis revealed good agreement between the 2 approaches. CONCLUSIONS Correlations between scores determined using Heart Score View software and standard visual interpretation were linear for both perfusion and fatty acid images. Thus, our new automated program might be useful for the risk stratification of patients with CAD in the clinical setting.
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Affiliation(s)
- Keiichiro Yoshinaga
- Department of Photobiology, Division of Molecular, Cellular Imaging, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
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126
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Giubbini R, Milan E, Bertagna F, Mut F, Metra M, Rodella C, Dondi M. Nuclear cardiology and heart failure. Eur J Nucl Med Mol Imaging 2011; 36:2068-80. [PMID: 19672592 DOI: 10.1007/s00259-009-1246-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2009] [Accepted: 07/26/2009] [Indexed: 01/07/2023]
Abstract
The prevalence of heart failure in the adult population is increasing. It varies between 1% and 2%, although it mainly affects elderly people (6-10% of people over the age of 65 years will develop heart failure). The syndrome of heart failure arises as a consequence of an abnormality in cardiac structure, function, rhythm, or conduction. Coronary artery disease is the leading cause of heart failure and it accounts for this disorder in 60-70% of all patients affected. Nuclear techniques provide unique information on left ventricular function and perfusion by gated-single photon emission tomography (SPECT). Myocardial viability can be assessed by both SPECT and PET imaging. Finally, autonomic dysfunction has been shown to increase the risk of death in patients with heart disease and this may be applicable to all patients with cardiac disease regardless of aetiology. MIBG scanning has a very promising prognostic value in patients with heart failure.
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Affiliation(s)
- Raffaele Giubbini
- Department of Nuclear Medicine, University of Brescia, Piazza Spedali Civili 1, 25123 Brescia, Italy.
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127
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Slart RHJA, Zeebregts CJ, Hillege HL, de Sutter J, Dierckx RAJO, van Veldhuisen DJ, Zijlstra F, Tio RA. Myocardial perfusion reserve after a PET-driven revascularization procedure: a strong prognostic factor. J Nucl Med 2011; 52:873-9. [PMID: 21571798 DOI: 10.2967/jnumed.110.084954] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
UNLABELLED Not all patients treated on the basis of PET-proven viability benefit from revascularization. Myocardial perfusion reserve (MPR) predicts survival in patients not undergoing revascularization. In the present study, we investigated whether MPR is related to survival in ischemic heart disease (IHD) patients after a PET-driven intervention. METHODS Between 1995 and 2003, 119 consecutive patients with chronic IHD underwent a PET-driven revascularization procedure based on ischemia-viability assessment with PET. Patients were followed for all-cause mortality and major cardiovascular events. RESULTS One hundred nineteen patients underwent a PET-driven revascularization procedure (67 percutaneous coronary interventions, 52 coronary artery bypass grafts) because of angina complaints. The mean age was 67 ± 11 y (96 men, 23 women); global left ventricle MPR was 1.54 ± 0.43. MPR intertertile boundaries were 1.34 and 1.67. Significantly more cardiac deaths were observed in the lowest and middle MPR tertiles than in the highest tertile. The age- and sex-corrected hazard ratio for the middle tertile was 8.3 (95% confidence interval, 1.02-68.3) and for the lowest tertile 23.6 (95% confidence interval, 3.1-179) (P = 0.002). After left ventricular ejection fraction (LVEF) and viability were added to the model, MPR remained significant, with hazard ratios of 6.5 (0.8-54.4) and 18.5 (2.3-145.5) (P = 0.004), whereas neither LVEF nor viability reached significance in this model. Comparable results were found for major adverse cardiac events, with hazard ratios of 3.15 (0.82-12.0) and 8.24 (2.36-28.8) (P = 0.002). CONCLUSION Patients with IHD revascularized on the basis of PET viability assessment who have a low MPR are at risk for cardiac death and subsequent cardiac events. MPR is a more sensitive predictor for cardiac death than LVEF and extent of viability.
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Affiliation(s)
- Riemer H J A Slart
- Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, Groningen, The Netherlands
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128
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Buckley O, Di Carli M. Predicting benefit from revascularization in patients with ischemic heart failure: imaging of myocardial ischemia and viability. Circulation 2011; 123:444-50. [PMID: 21282521 DOI: 10.1161/circulationaha.109.903369] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Orla Buckley
- Department of Noninvasive Cardiovascular Imaging, Brigham and Women's Hospital, Boston, MA, USA.
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129
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Cardiac PET: A Versatile, Quantitative Measurement Tool for Heart Failure Management. JACC Cardiovasc Imaging 2011; 4:292-302. [DOI: 10.1016/j.jcmg.2010.12.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2010] [Revised: 12/20/2010] [Accepted: 12/23/2010] [Indexed: 11/21/2022]
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130
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Mielniczuk LM, Birnie D, Ziadi MC, deKemp RA, DaSilva JN, Burwash I, Tang AT, Davies RA, Haddad H, Guo A, Aung M, Williams K, Ukkonen H, Beanlands RS. Relation Between Right Ventricular Function and Increased Right Ventricular [
18
F]Fluorodeoxyglucose Accumulation in Patients With Heart Failure. Circ Cardiovasc Imaging 2011; 4:59-66. [DOI: 10.1161/circimaging.109.905984] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
Left heart failure is characterized by alterations in metabolic substrate utilization, and metabolic modulation may be a future strategy in the management of heart failure. Little is known about cardiac metabolism in the right ventricle and how it relates to other measures of right ventricular (RV) function. This study was designed to measure glucose metabolism in the right ventricle, as estimated by [
18
F]fluorodeoxyglucose (FDG) positron emission tomography imaging and to determine the relation between RV function and FDG uptake in patients with heart failure.
Methods and Results—
A total of 68 patients underwent cardiac [
18
F]FDG positron emission tomography scanning with measurement of RV FDG uptake as a standardized uptake value. Perfusion imaging was acquired at rest with rubidium-82 or [
13
N]ammonia. RV function was determined by equilibrium radionuclide ventriculography. Relative RV FDG uptake was determined as the ratio of RV to LV standardized uptake value. Fifty-five percent of these patients had ischemic cardiomyopathy. The mean LV and RV ejection fractions were 21±7% and 35±10%, respectively. There was a correlation between RV ejection fraction and the ratio of RV to LV FDG uptake whether the entire LV myocardium (
r
=−0.40,
P
<0.001) or LV free wall (
r
=−0.43,
P
<0.001) was used. This relation persisted in the subgroup with nonischemic cardiomyopathy (
r
=−0.37,
P
=0.04). RV FDG uptake was weakly related to increased RV systolic pressure but not related to LV size, function, or FDG uptake. The correlation between RV ejection fraction and RV/LV FDG was maintained after partial-volume correction (
r
=−0.68,
P
<0.001).
Conclusions—
RV dysfunction is associated with an increase in RV FDG uptake, the magnitude of which may be correlated with severity.
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Affiliation(s)
- Lisa M. Mielniczuk
- From the Division of Cardiology (L.M.M., D.BM.C.Z., R.A.d.K., J.N.D.S., I.B., R.A.D., H.H., A.G., M.A., K.W., R.S.B.B.), University of Ottawa Heart Institute, Ottawa, and Division of Cardiology (A.T.T.), University of Victoria, Victoria, Canada; and Division of Cardiology (H.U.), Turku University Hospital, Turku, Finland
| | - David Birnie
- From the Division of Cardiology (L.M.M., D.BM.C.Z., R.A.d.K., J.N.D.S., I.B., R.A.D., H.H., A.G., M.A., K.W., R.S.B.B.), University of Ottawa Heart Institute, Ottawa, and Division of Cardiology (A.T.T.), University of Victoria, Victoria, Canada; and Division of Cardiology (H.U.), Turku University Hospital, Turku, Finland
| | - Maria C. Ziadi
- From the Division of Cardiology (L.M.M., D.BM.C.Z., R.A.d.K., J.N.D.S., I.B., R.A.D., H.H., A.G., M.A., K.W., R.S.B.B.), University of Ottawa Heart Institute, Ottawa, and Division of Cardiology (A.T.T.), University of Victoria, Victoria, Canada; and Division of Cardiology (H.U.), Turku University Hospital, Turku, Finland
| | - Robert A. deKemp
- From the Division of Cardiology (L.M.M., D.BM.C.Z., R.A.d.K., J.N.D.S., I.B., R.A.D., H.H., A.G., M.A., K.W., R.S.B.B.), University of Ottawa Heart Institute, Ottawa, and Division of Cardiology (A.T.T.), University of Victoria, Victoria, Canada; and Division of Cardiology (H.U.), Turku University Hospital, Turku, Finland
| | - Jean N. DaSilva
- From the Division of Cardiology (L.M.M., D.BM.C.Z., R.A.d.K., J.N.D.S., I.B., R.A.D., H.H., A.G., M.A., K.W., R.S.B.B.), University of Ottawa Heart Institute, Ottawa, and Division of Cardiology (A.T.T.), University of Victoria, Victoria, Canada; and Division of Cardiology (H.U.), Turku University Hospital, Turku, Finland
| | - Ian Burwash
- From the Division of Cardiology (L.M.M., D.BM.C.Z., R.A.d.K., J.N.D.S., I.B., R.A.D., H.H., A.G., M.A., K.W., R.S.B.B.), University of Ottawa Heart Institute, Ottawa, and Division of Cardiology (A.T.T.), University of Victoria, Victoria, Canada; and Division of Cardiology (H.U.), Turku University Hospital, Turku, Finland
| | - Anthony T. Tang
- From the Division of Cardiology (L.M.M., D.BM.C.Z., R.A.d.K., J.N.D.S., I.B., R.A.D., H.H., A.G., M.A., K.W., R.S.B.B.), University of Ottawa Heart Institute, Ottawa, and Division of Cardiology (A.T.T.), University of Victoria, Victoria, Canada; and Division of Cardiology (H.U.), Turku University Hospital, Turku, Finland
| | - Ross A. Davies
- From the Division of Cardiology (L.M.M., D.BM.C.Z., R.A.d.K., J.N.D.S., I.B., R.A.D., H.H., A.G., M.A., K.W., R.S.B.B.), University of Ottawa Heart Institute, Ottawa, and Division of Cardiology (A.T.T.), University of Victoria, Victoria, Canada; and Division of Cardiology (H.U.), Turku University Hospital, Turku, Finland
| | - Haissam Haddad
- From the Division of Cardiology (L.M.M., D.BM.C.Z., R.A.d.K., J.N.D.S., I.B., R.A.D., H.H., A.G., M.A., K.W., R.S.B.B.), University of Ottawa Heart Institute, Ottawa, and Division of Cardiology (A.T.T.), University of Victoria, Victoria, Canada; and Division of Cardiology (H.U.), Turku University Hospital, Turku, Finland
| | - Ann Guo
- From the Division of Cardiology (L.M.M., D.BM.C.Z., R.A.d.K., J.N.D.S., I.B., R.A.D., H.H., A.G., M.A., K.W., R.S.B.B.), University of Ottawa Heart Institute, Ottawa, and Division of Cardiology (A.T.T.), University of Victoria, Victoria, Canada; and Division of Cardiology (H.U.), Turku University Hospital, Turku, Finland
| | - May Aung
- From the Division of Cardiology (L.M.M., D.BM.C.Z., R.A.d.K., J.N.D.S., I.B., R.A.D., H.H., A.G., M.A., K.W., R.S.B.B.), University of Ottawa Heart Institute, Ottawa, and Division of Cardiology (A.T.T.), University of Victoria, Victoria, Canada; and Division of Cardiology (H.U.), Turku University Hospital, Turku, Finland
| | - Kathryn Williams
- From the Division of Cardiology (L.M.M., D.BM.C.Z., R.A.d.K., J.N.D.S., I.B., R.A.D., H.H., A.G., M.A., K.W., R.S.B.B.), University of Ottawa Heart Institute, Ottawa, and Division of Cardiology (A.T.T.), University of Victoria, Victoria, Canada; and Division of Cardiology (H.U.), Turku University Hospital, Turku, Finland
| | - Heikki Ukkonen
- From the Division of Cardiology (L.M.M., D.BM.C.Z., R.A.d.K., J.N.D.S., I.B., R.A.D., H.H., A.G., M.A., K.W., R.S.B.B.), University of Ottawa Heart Institute, Ottawa, and Division of Cardiology (A.T.T.), University of Victoria, Victoria, Canada; and Division of Cardiology (H.U.), Turku University Hospital, Turku, Finland
| | - Rob S.B. Beanlands
- From the Division of Cardiology (L.M.M., D.BM.C.Z., R.A.d.K., J.N.D.S., I.B., R.A.D., H.H., A.G., M.A., K.W., R.S.B.B.), University of Ottawa Heart Institute, Ottawa, and Division of Cardiology (A.T.T.), University of Victoria, Victoria, Canada; and Division of Cardiology (H.U.), Turku University Hospital, Turku, Finland
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131
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Clinical relevance of hibernating myocardium in ischemic left ventricular dysfunction. Am J Med 2010; 123:978-86. [PMID: 21035587 DOI: 10.1016/j.amjmed.2010.03.025] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2009] [Revised: 03/07/2010] [Accepted: 03/15/2010] [Indexed: 11/20/2022]
Abstract
Patients with chronic ischemic left ventricular dysfunction may have a substantial amount of viable, hibernating myocardium, which is a state of chronic contractile dysfunction with reduced blood flow at rest. Coronary revascularization in these patients may result in improvement of left ventricular function; in the absence of viability, left ventricular function will not improve postrevascularization. Various noninvasive imaging techniques are available for detection of viable myocardium, including magnetic resonance imaging, dobutamine stress echocardiography, and nuclear imaging with single photon emission computed tomography or positron emission tomography. Because these techniques probe different characteristics of viable myocardium, the sensitivities and specificities of the techniques are not precisely identical; in general, dobutamine stress echocardiography has the highest specificity, whereas the nuclear techniques have the highest sensitivity. The presence of myocardial viability also is related to prognosis: patients with viable myocardium who undergo revascularization have a good prognosis, whereas patients with viable myocardium who are treated medically have poor outcome. Accordingly, assessment of viability is important in the therapeutic decision-making process of patients with chronic ischemic left ventricular dysfunction.
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132
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Ghosh N, Rimoldi OE, Beanlands RSB, Camici PG. Assessment of myocardial ischaemia and viability: role of positron emission tomography. Eur Heart J 2010; 31:2984-95. [PMID: 20965888 DOI: 10.1093/eurheartj/ehq361] [Citation(s) in RCA: 85] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
In developed countries, coronary artery disease (CAD) continues to be a major cause of death and disability. Over the past two decades, positron emission tomography (PET) imaging has become more widely accessible for the management of ischemic heart disease. Positron emission tomography has also emerged as an important alternative perfusion imaging modality in the context of recent shortages of molybdenum-99/technetium-99m ((99m)Tc). The clinical application of PET in ischaemic heart disease falls into two main categories: first, it is a well-established modality for evaluation of myocardial blood flow (MBF); second, it enables assessment of myocardial metabolism and viability in patients with ischaemic left ventricular dysfunction. The combined study of MBF and metabolism by PET has led to a better understanding of the pathophysiology of ischaemic heart disease. While there are potential future applications of PET for plaque and molecular imaging, as well as some clinical use in inflammatory conditions, this article provides an overview of the physical and biological principles behind PET imaging and its main clinical applications in cardiology, namely the assessment of MBF and metabolism.
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Affiliation(s)
- Nina Ghosh
- National Cardiac PET Centre, Division of Cardiology and the Molecular Function and Imaging Program, University of Ottawa Heart Institute, Ottawa, ONT, Canada
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133
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Carey MG, Luisi AJ, Baldwa S, Al-Zaiti S, Veneziano MJ, deKemp RA, Canty JM, Fallavollita JA. The Selvester QRS Score is more accurate than Q waves and fragmented QRS complexes using the Mason-Likar configuration in estimating infarct volume in patients with ischemic cardiomyopathy. J Electrocardiol 2010; 43:318-25. [PMID: 20381066 DOI: 10.1016/j.jelectrocard.2010.02.011] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2009] [Indexed: 11/30/2022]
Abstract
Infarct volume independently predicts cardiovascular events. Fragmented QRS complexes (fQRS) may complement Q waves for identifying infarction; however, their utility in advanced coronary disease is unknown. We tested whether fQRS could improve the electrocardiographic prediction of infarct volume by positron emission tomography in 138 patients with ischemic cardiomyopathy (ejection fraction, 0.27 +/- 0.09). Indices of infarction (pathologic Q waves, fQRS, and Selvester QRS Score) were analyzed by blinded observers. In patients with QRS duration less than 120 milliseconds, number of leads with pathologic Q waves (mean, 1.6 +/- 1.7) correlated weakly with infarct volume (r = 0.30, P < .05). Adding fQRS increased the number of affected leads (3.6 +/- 2.5), but the significant correlation with infarct volume was lost (r = 0.02, P = .10). Selvester Score was the most accurate (mean, 5.9 +/- 4.9 points; r = 0.49; P < .001). Fragmented QRS was not predictive of infarct size in patients with QRS duration of at least 120 milliseconds (r = 0.02, P = .19). Thus, in ischemic cardiomyopathy, consideration of fQRS complexes does not improve Q wave prediction of infarct volume; but Selvester Score was more accurate.
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Affiliation(s)
- Mary G Carey
- School of Nursing, University at Buffalo, Buffalo, NY, USA
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134
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Abraham A, Nichol G, Williams KA, Guo A, deKemp RA, Garrard L, Davies RA, Duchesne L, Haddad H, Chow B, DaSilva J, Beanlands RSB. 18F-FDG PET imaging of myocardial viability in an experienced center with access to 18F-FDG and integration with clinical management teams: the Ottawa-FIVE substudy of the PARR 2 trial. J Nucl Med 2010; 51:567-74. [PMID: 20237039 DOI: 10.2967/jnumed.109.065938] [Citation(s) in RCA: 118] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
UNLABELLED (18)F-FDG PET may assist decision making in ischemic cardiomyopathy. The PET and Recovery Following Revascularization (PARR 2) trial demonstrated a trend toward beneficial outcomes with PET-assisted management. The substudy of PARR 2 that we call Ottawa-FIVE, described here, was a post hoc analysis to determine the benefit of PET in a center with experience, ready access to (18)F-FDG, and integration with clinical teams. METHODS Included were patients with left ventricular dysfunction and suspected coronary artery disease being considered for revascularization. The patients had been randomized in PARR 2 to PET-assisted management (group 1) or standard care (group 2) and had been enrolled in Ottawa after August 1, 2002 (the date that on-site (18)F-FDG was initiated) (n = 111). The primary outcome was the composite endpoint of cardiac death, myocardial infarction, or cardiac rehospitalization within 1 y. Data were compared with the rest of PARR 2 (PET-assisted management [group 3] or standard care [group 4]). RESULTS In the Ottawa-FIVE subgroup of PARR 2, the cumulative proportion of patients experiencing the composite event was 19% (group 1), versus 41% (group 2). Multivariable Cox proportional hazards regression showed a benefit for the PET-assisted strategy (hazard ratio, 0.34; 95% confidence interval, 0.16-0.72; P = 0.005). Compared with other patients in PARR 2, Ottawa-FIVE patients had a lower ejection fraction (25% +/- 7% vs. 27% +/- 8%, P = 0.04), were more often female (24% vs. 13%, P = 0.006), tended to be older (64 +/- 10 y vs. 62 +/- 10 y, P = 0.07), and had less previous coronary artery bypass grafting (13% vs. 21%, P = 0.07). For patients in the rest of PARR 2, there was no significant difference in events between groups 3 and 4. The observed effect of (18)F-FDG PET-assisted management in the 4 groups in the context of adjusted survival curves demonstrated a significant interaction (P = 0.016). Comparisons of the 2 arms in Ottawa-FIVE to the 2 arms in the rest of PARR 2 demonstrated a trend toward significance (standard care, P = 0.145; PET-assisted management, P = 0.057). CONCLUSION In this post hoc group analysis, a significant reduction in cardiac events was observed in patients with (18)F-FDG PET-assisted management, compared with patients who received standard care. The results suggest that outcome may be benefited using (18)F-FDG PET in an experienced center with ready access to (18)F-FDG and integration with imaging, heart failure, and revascularization teams.
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Affiliation(s)
- Arun Abraham
- National Cardiac PET Centre and Division of Cardiology, Cardiovascular Research Methods Centre, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
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135
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Boehm J, Haas F, Bauernschmitt R, Wagenpfeil S, Voss B, Schwaiger M, Lange R. Impact of preoperative positron emission tomography in patients with severely impaired LV-function undergoing surgical revascularization. Int J Cardiovasc Imaging 2010; 26:423-32. [PMID: 20091350 PMCID: PMC2852592 DOI: 10.1007/s10554-010-9585-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2009] [Accepted: 01/07/2010] [Indexed: 12/03/2022]
Abstract
In patients with ischemic cardiomyopathy, coronary artery bypass grafting (CABG) offers an important therapeutic option but is still associated with high perioperative mortality. Although previous studies suggest a benefit from revascularization for patients with defined viability by a non-invasive technique, the role of viability assessment to determine suitability for revascularization in patients with ischemic cardiomyopathy has not yet been defined. This study evaluates the hypothesis that the use of PET imaging in the decision-making process for CABG will improve postoperative patient survival. We reviewed 476 patients with ischemic cardiomyopathy (LV ejection fraction ≤0.35) who were considered candidates for CABG between 1994 and 2004 on the basis of clinical presentation and angiographic data. In a Standard Care Group, 298 patients underwent CABG. In a second PET-assisted management group of 178 patients, 152 patients underwent CABG (PET-CABG) and 26 patients were excluded from CABG because of lack of viability (PET-Alternatives). Primary endpoint was postoperative survival. There were two in hospital deaths in the PET-CABG (1.3%) and 30 (10.1%) in the Standard Care Group (P = 0.018). The survival rate after 1, 5 and 9.3 years was 92.0, 73.3 and 54.2% in the PET-CABG and 88.9, 62.2 and 35.5% in the Standard Care Group, respectively (P = 0.005). Cox-regression analysis revealed a significant influence on long-term survival of patient selection by viability assessment via PET (P = 0.008), of LV-function (P = 0.017), and age >70 (P = 0.016). Preoperative assessment of myocardial viability via PET identifies patients, who will benefit most from CABG.
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Affiliation(s)
- Johannes Boehm
- Klinik fuer Herz- und Gefaesschirurgie, Deutsches Herzzentrum Muenchen, Technische Universitaet Muenchen, Lazarettstrasse 36, 80636, Munich, Germany.
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Fallavollita JA, Banas MD, Suzuki G, deKemp RA, Sajjad M, Canty JM. 11C-meta-hydroxyephedrine defects persist despite functional improvement in hibernating myocardium. J Nucl Cardiol 2010; 17:85-96. [PMID: 19902319 PMCID: PMC2825874 DOI: 10.1007/s12350-009-9164-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2009] [Accepted: 10/21/2009] [Indexed: 01/15/2023]
Abstract
BACKGROUND Regional cardiac sympathetic nerve dysfunction develops in hibernating myocardium and may play a role in its association with sudden cardiac death. Interventions to improve cardiac function (i.e., revascularization) improve survival, but the potential reversibility of sympathetic nerve dysfunction remains unclear. METHODS AND RESULTS Pigs (n = 11) were chronically instrumented with a proximal left anterior descending coronary artery (LAD) stenosis to produce hibernating myocardium. Prior to therapeutic interventions, there was LAD occlusion with collateral-dependent myocardium, reduced regional function (echocardiographic LAD wall-thickening 23% +/- 4% vs 83% +/- 6% in Remote, P < .001), and large defects in (11)C-meta-hydroxyephedrine (HED) PET (48% +/- 4% of LV area, 26% +/- 2% integrated reduction). Successful PCI or pravastatin therapy improved regional (LAD wall-thickening 23% +/- 4% to 42% +/- 6%, P < .05) and global LV function (fractional shortening 24% +/- 2% to 31% +/- 2%, P < .01), but did not alter regional HED uptake, retention, defect size, or defect severity. CONCLUSIONS Despite significant functional improvement of hibernating myocardium as a result of PCI or pravastatin therapy, there were no changes in HED defect size or severity. Thus, inhomogeneity in myocardial sympathetic innervation persisted, and the lack of plasticity suggests that even in the absence of significant infarction, structural rather than functional defects are responsible for reduced myocardial norepinephrine uptake in chronic ischemic heart disease.
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Affiliation(s)
- James A Fallavollita
- VA Western New York Health Care System, University at Buffalo, Buffalo, NY, USA.
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Birnie D, deKemp RA, Ruddy TD, Tang AS, Guo A, Williams K, Wassenar R, Lalonde M, Beanlands RS. Effect of lateral wall scar on reverse remodeling with cardiac resynchronization therapy. Heart Rhythm 2009; 6:1721-6. [DOI: 10.1016/j.hrthm.2009.08.014] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2009] [Accepted: 08/09/2009] [Indexed: 10/20/2022]
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Ha ACT, Renaud JM, Dekemp RA, Thorn S, Dasilva J, Garrard L, Yoshinaga K, Abraham A, Green MS, Beanlands RSB, Gollob MH. In vivo assessment of myocardial glucose uptake by positron emission tomography in adults with the PRKAG2 cardiac syndrome. Circ Cardiovasc Imaging 2009; 2:485-91. [PMID: 19920047 DOI: 10.1161/circimaging.109.853291] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The PRKAG2 cardiac syndrome is an inherited metabolic disease of the heart characterized by excessive myocardial glycogen deposition. The biochemical alterations associated with this condition remain controversial and have not previously been studied in affected humans. METHODS AND RESULTS Positron emission tomography (PET) imaging was used to quantitatively assess myocardial glucose uptake (MGU) in 6 adult subjects with the PRKAG2 cardiac syndrome and 6 healthy, matched control subjects using the glucose analogue (18)F-Fluoro-2-deoxyglucose (FDG). Studies were performed under a euglycemic hyperinsulinemic clamp to ensure stable blood glucose levels. Rubidium-82 perfusion scans were performed to ensure that myocardial differences in myocardial glucose uptake were not the result of significant myocardial scar. In adult patients with phenotypic expression of disease, the median myocardial glucose uptake of the left ventricle was 0.18 mumol/min/g (interquartile range, 0.14, 0.24), compared with 0.40 mumol/min/g (interquartile range, 0.30 to 0.45) in the control group (P=0.01). The median blood glucose during FDG-PET imaging was 4.72 mmol/L (interquartile range, 4.32 to 4.97) in the PRKAG2 group and 4.38 mmol/L (interquartile range, 3.90, 4.79) in the control group (P=NS). The significant decrease observed in myocardial glucose uptake in affected patients occurred in the absence of significant myocardial scar. CONCLUSIONS The PRKAG2 cardiac syndrome is associated with a reduction of glucose uptake in adult patients affected with this genetic condition. In this pilot study, (18)F-FDG-PET imaging is a useful tool to assess alterations in myocardial glucose transport in this inherited metabolic disease and provide insight into the biochemical pathophysiology of the diseased state.
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Affiliation(s)
- Andrew C T Ha
- Division of Cardiology, University of Ottawa Heart Institute, and the Department of Cellular and Molecular Medicine at the University of Ottawa, Ottawa, Ontario K1Y 4W7, Canada
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Abstract
Cardiovascular MRI can assess multiple markers of myocardial viability in a single examination. Its accuracy is at least equivalent to, if not superior to, that of other currently available noninvasive imaging techniques, including positron emission tomography. The greater spatial resolution afforded by cardiovascular MRI, especially with the delayed-enhancement MRI (DE-MRI) technique, combined with the breadth and depth of correlative pathologic data, makes cardiovascular MRI a particularly powerful tool for detecting viable and irreversibly damaged myocardium. A wealth of clinical data exist, including data from multicenter efforts, to establish DE-MRI as a new gold standard in myocardial viability assessment. As the high accuracy and broad scope of DE-MRI are recognized, the technique will gain wider clinical use for analysis of dysfunctional myocardium and be integrated into the diagnostic and therapeutic algorithm.
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Increasing Benefit From Revascularization Is Associated With Increasing Amounts of Myocardial Hibernation. JACC Cardiovasc Imaging 2009; 2:1060-8. [DOI: 10.1016/j.jcmg.2009.02.017] [Citation(s) in RCA: 143] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2008] [Revised: 01/21/2009] [Accepted: 02/02/2009] [Indexed: 11/22/2022]
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Left ventricular infarct size assessed with 0.1 mmol/kg of gadobenate dimeglumine correlates with that assessed with 0.2 mmol/kg of gadopentetate dimeglumine. J Comput Assist Tomogr 2009; 33:328-33. [PMID: 19478622 DOI: 10.1097/rct.0b013e318187fed0] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To determine myocardial infarct (MI) size during cardiovascular magnetic resonance at 1.5 Tesla using 0.1 mmol/kg body weight of gadobenate dimeglumine (Gd-BOPTA) and 0.2 mmol/kg body weight of gadopentetate dimeglumine (Gd-DTPA). METHODS Twenty participants (16 men, 4 women), aged 58 +/- 12 years, with a prior chronic MI were imaged in a crossover design. Participants received 0.2 mmol/kg body weight of Gd-DTPA and 0.1 mmol/kg body weight of Gd-BOPTA on 2 occasions separated by 3 to 7 days. RESULTS The correlations were high between Gd-DTPA and Gd-BOPTA measures of infarct volume (r = 0.93) and the percentage of infarct relative to left ventricular myocardial volume (r = 0.85). The size and location of the infarcts were similar (P = 0.9) for the 2 contrast agents. Interobserver correlation of infarct volume (r = 0.91) was high. CONCLUSIONS In chronic MI, late gadolinium enhancement identified with a single 0.1 mmol/kg body weight dose of Gd-BOPTA is associated in volume and location to a double (0.2 mmol/kg body weight) dose of Gd-DTPA. Lower doses of higher relaxivity contrast agents should be considered for determining left ventricular myocardial infarct size.
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142
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Lalonde L, Ziadi MC, Beanlands R. Cardiac positron emission tomography: current clinical practice. Cardiol Clin 2009; 27:237-55, Table of Contents. [PMID: 19306767 DOI: 10.1016/j.ccl.2008.12.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
In the last two decades, the field of nuclear cardiology has experienced significant progress. The introduction of positron emission tomography (PET) imaging represented a major breakthrough that has significantly contributed to a better understanding of physiology and pathophysiology of several heart diseases. Currently, PET imaging is recognized as a well-established method to assess cardiac perfusion, function, metabolism, and viability. This article summarizes the main clinical applications of state-of-the art cardiac PET technology.
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Affiliation(s)
- Lucille Lalonde
- Department of Medicine, Division of Cardiology, Mazinkowski Alberta Heart Institute, University of Alberta, 2C2 Walter Mackenzie Health Sciences Centre, Edmonton, Alberta, Canada
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143
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Perrone-Filardi P, Pace L, Dellegrottaglie S, Corrado L, Prastaro M, Cafiero M, Caiazzo G, Marzano A, Cesarano P, Gargiulo P, Paolillo S, Maglione A, Petretta A, Chiariello M. Rest-redistribution 201-Thallium single photon emission computed tomography predicts myocardial infarction and cardiac death in patients with ischemic left ventricular dysfunction. J Cardiovasc Med (Hagerstown) 2009; 10:122-8. [PMID: 19377379 DOI: 10.2459/jcm.0b013e32831a0ea8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
UNLABELLED The prognostic role of rest-redistribution 201-Thallium imaging has not been extensively investigated in patients with left ventricular ischemic dysfunction. OBJECTIVE The aim of this study was to evaluate the ability of rest-redistribution 201-Thallium single photon emission computed tomography to predict cardiac death and occurrence of acute myocardial infarction in patients with ischemic mild-to-moderate left ventricular dysfunction. METHODS One-hundred and twenty-six patients with chronic coronary artery disease and mean left ventricular ejection fraction 39 +/- 11% were followed-up for 30 +/- 17 months after a rest-redistribution 201-Thallium imaging single photon emission computed tomography. Cardiac death and acute myocardial infarction were considered as major cardiac events. RESULTS During the follow up, 11 (9%) cardiac deaths and 9 (7%) acute myocardial infarctions occurred. The only variable showing significant difference between patients with and without events was the number of severe irreversible defects (1.7 +/- 1.9 versus 0.9 +/- 1.2, respectively; P = 0.02). By Kaplan-Meier analysis, the presence of three or less, or more than three severe defects was selected as the best cutoff to identify patients with longer event-free survival from cardiac death or acute myocardial infarction (log rank 19.84; P < 0.0001). When only cardiac death was considered as clinical event, the presence of at least two severe defects best separated patients who died from those who survived (log rank 8.68; P = 0.0032). CONCLUSION Rest-redistribution 201-Thallium single photon emission computed tomography provides prognostic information in coronary patients with mild-to-moderate left ventricular dysfunction. The number of severe irreversible defects per patient is a powerful predictor of prognosis.
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Neizel M, Katoh M, Schade E, Rassaf T, Krombach GA, Kelm M, Kühl HP. Rapid and accurate determination of relative infarct size in humans using contrast-enhanced magnetic resonance imaging. Clin Res Cardiol 2009; 98:319-24. [DOI: 10.1007/s00392-009-0007-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2008] [Accepted: 02/10/2009] [Indexed: 10/21/2022]
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Prognostic performance of quantitative PET tools for stratification of patients with ischemic cardiomyopathy undergoing myocardial viability assessment. Nucl Med Commun 2009; 29:970-81. [PMID: 18836375 DOI: 10.1097/mnm.0b013e3283073b60] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES This study was performed to determine the prognostic performance of quantitative PET tools in the stratification of patients with ischemic cardiomyopathy undergoing myocardial viability assessment. METHODS We applied four different quantitative tools to 104 consecutive patients with coronary artery disease and previous myocardial infarction who had undergone rest Rb/gated F-fluorodeoxyglucose (FDG) PET, to assess myocardial viability for potential revascularization. One of these tools was based on the FDG study alone and the other three tools assessed the extent of match/mismatch defects using FDG in comparison with a perfusion reference database. The four quantitative tools used in this research to define viability were (i) FDG alone, which calculates the percentage of left ventricular myocardium (LVM) that is above the 50% of the maximum LVM FDG counts, (ii) low flow match/mismatch, which determines the area with a 5% increase in normalized FDG counts in relation to defined resting perfusion defects as compared with a reference database, (iii) all regions match/mismatch, which computes the area with a 10% increase in normalized FDG counts in relation to the left ventricle resting perfusion distribution, and (iv) percentage max FDG match/mismatch, which defines the area with FDG uptake greater than 60% of the maximum LVM FDG counts within defined perfusion defects as determined by the reference database. The primary endpoint for this analysis was cardiac death. RESULTS During the follow-up period (22+/-14 months), 19 patients (18%) died; in 17 of these the cause of death was cardiac. Using univariate analysis, none of the methods were predictive of cardiac death. Receiver operating characteristic analysis defined the optimal thresholds for the extent of myocardial viability for the four tools in the prediction of cardiac death: FDG alone=20%, low flow match/mismatch=15%, all regions match/mismatch=35%, and percentage max FDG match/mismatch=20%. A censored survival analysis using a Kaplan-Meier method showed a statistically significant difference between patients with cardiac death and those with no cardiac death using only the low flow match/mismatch (hazard ratio=0.29, P=0.01) and percentage max FDG match/mismatch criteria (hazard ratio=0.23, P=0.005) tools. CONCLUSION The low flow match/mismatch and percentage max FDG match/mismatch quantitative PET tools are useful for prognostic stratification of patients with ischemic cardiomyopathy undergoing myocardial viability assessment.
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Tio RA, Dabeshlim A, Siebelink HMJ, de Sutter J, Hillege HL, Zeebregts CJ, Dierckx RAJO, van Veldhuisen DJ, Zijlstra F, Slart RHJA. Comparison between the prognostic value of left ventricular function and myocardial perfusion reserve in patients with ischemic heart disease. J Nucl Med 2009; 50:214-9. [PMID: 19164219 DOI: 10.2967/jnumed.108.054395] [Citation(s) in RCA: 163] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
UNLABELLED The purpose of this study was to compare the prognostic value of left ventricular ejection fraction (LVEF) and myocardial perfusion reserve (MPR) assessed with PET in patients with ischemic heart disease (IHD). Myocardial perfusion is the main determinant of left ventricular function in patients with IHD. The prognostic value of LVEF has been widely established. In addition, MPR determines survival in patients with hypertrophic and dilated cardiomyopathies. In the present study, we evaluated whether MPR also determines survival in patients with IHD. METHODS Between 1995 and 2003, 480 consecutive patients with chronic IHD underwent dipyridamole stress and rest 13N-ammonia PET to determine MPR. Additionally, 18F-FDG PET was performed for viability (mismatching defects), infarction (matching defects), and left ventricular function assessment. Patients were followed for all causes of mortality and major cardiovascular events. RESULTS In 463 of the 480 patients, valid MPR could be measured (368 men; mean age, 66+/-11 y; LVEF, 35%+/-15%). One hundred nineteen patients underwent a PET-driven revascularization (67 through percutaneous coronary intervention and 52 through coronary artery bypass grafting). The remaining 344 patients were the subject of this study. The overall MPR was 1.71+/-0.50 (intertertile boundaries, 1.49 and 1.84). After adjustment for age and sex, MPR was associated with a hazard ratio for cardiac death of 4.11 (95% confidence interval, 2.98-5.67) per SD decrease, whereas the risk for LVEF was 2.76 (2.00-3.82) per SD decrease. CONCLUSION Patients with IHD with a low MPR are at high risk of cardiac death. MPR is a more sensitive predictor for cardiac death than is LVEF.
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Affiliation(s)
- René A Tio
- Department of Cardiology, University Medical Center Groningen, Groningen, The Netherlands
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Zhang X, Liu XJ, Hu S, Schindler TH, Tian Y, He ZX, Gao R, Wu Q, Wei H, Sayre JW, Schelbert HR. Long-Term Survival of Patients with Viable and Nonviable Aneurysms Assessed by 99mTc-MIBI SPECT and 18F-FDG PET: A Comparative Study of Medical and Surgical Treatment. J Nucl Med 2008; 49:1288-98. [DOI: 10.2967/jnumed.107.046730] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Myocardial scar and insulin resistance predict cardiovascular events in severe ischaemic myocardial dysfunction: a perfusion–metabolism positron emission tomography study. Nucl Med Commun 2008; 29:448-54. [DOI: 10.1097/mnm.0b013e3282f5d2bc] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Affiliation(s)
- Paolo G Camici
- Medical Research Council Clinical Sciences Centre and National Heart and Lung Institute, Imperial College School of Medicine, London, UK.
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150
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Beanlands RSB, Nichol G, Huszti E, Humen D, Racine N, Freeman M, Gulenchyn KY, Garrard L, deKemp R, Guo A, Ruddy TD, Benard F, Lamy A, Iwanochko RM. F-18-fluorodeoxyglucose positron emission tomography imaging-assisted management of patients with severe left ventricular dysfunction and suspected coronary disease: a randomized, controlled trial (PARR-2). J Am Coll Cardiol 2007; 50:2002-12. [PMID: 17996568 DOI: 10.1016/j.jacc.2007.09.006] [Citation(s) in RCA: 304] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2007] [Revised: 08/23/2007] [Accepted: 09/07/2007] [Indexed: 10/22/2022]
Abstract
OBJECTIVES We conducted a randomized trial to assess the effectiveness of F-18-fluorodeoxyglucose (FDG) positron emission tomography (PET)-assisted management in patients with severe ventricular dysfunction and suspected coronary disease. BACKGROUND Such patients may benefit from revascularization, but have significant perioperative morbidity and mortality. F-18-fluorodeoxyglucose PET can detect viable myocardium that might recover after revascularization. METHODS Included were patients with severe left ventricular (LV) dysfunction and suspected coronary disease being considered for revascularization, heart failure, or transplantation work-ups or in whom PET was considered potentially useful. Patients were stratified according to recent angiography or not, then randomized to management assisted by FDG PET (n = 218) or standard care (n = 212). The primary outcome was the composite of cardiac death, myocardial infarction, or recurrent hospital stay for cardiac cause, within 1 year. RESULTS At 1 year, the cumulative proportion of patients who had experienced the composite event was 30% (PET arm) versus 36% (standard arm) (relative risk 0.82, 95% confidence interval [CI] 0.59 to 1.14; p = 0.16). The hazard ratio (HR) for the composite outcome, PET versus standard care, was 0.78 (95% CI 0.58 to 1.1; p = 0.15); for patients that adhered to PET recommendations for revascularization, revascularization work-up, or neither, HR = 0.62 (95% CI 0.42 to 0.93; p = 0.019); in those without recent angiography, for cardiac death, HR = 0.4 (95% CI 0.17 to 0.96; p = 0.035). CONCLUSIONS This study did not demonstrate a significant reduction in cardiac events in patients with LV dysfunction and suspected coronary disease for FDG PET-assisted management versus standard care. In those who adhered to PET recommendations and in patients without recent angiography, significant benefits were observed. The utility of FDG PET is best realized in this subpopulation and when adherence to recommendations can be achieved.
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Affiliation(s)
- Rob S B Beanlands
- National Cardiac PET Centre, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
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