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Li T, Dou J, Zhang H, Su X, Liu Y, Gao M, Xiao J, Xu W, Gao J. Optimized gated a SPECT-derived myocardial salvage index: its prognostic significance in predicting major adverse cardiac events following acute myocardial infarction percussion. Ann Nucl Med 2024; 38:219-230. [PMID: 38175381 DOI: 10.1007/s12149-023-01894-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Accepted: 11/26/2023] [Indexed: 01/05/2024]
Abstract
PURPOSE Estimate myocardial salvage index (MSI) using a single-gated Single-Photon Emission Computed Tomography (SPECT) myocardial perfusion imaging (GSMPI) early after percutaneous coronary intervention (PCI) in patients with acute myocardial infarction (AMI) and compare its predictive value with the traditional method especially for post-PCI left ventricular ejection fraction (LVEF) improvement and major adverse cardiac events (MACEs). METHODS GSMPI was performed in 62 patients with AMI early after PCI (3-10 days). The MSI and the conventional parameters were obtained, including total perfusion deficit, LVEF, peak ejection rate (PER), and peak filling rate (PFR). The new calculation method (scoring evaluation method means the extent of abnormality is the percentage of the total scores of abnormal segments divided by the sum of the maximum scores of all myocardial segments using 4-point and 5-point scale semi-quantitative scoring method) and the reference method (number evaluation method means the extent of abnormality is the percentage of the number of abnormal segments divided by the total number of myocardial segments) were applied to acquire the MSI. We compared the predictive ability of the 2 methods based on the area under the receiver operating characteristic curve for LVEF improvement 6 months after PCI using MSI. The Kaplan-Meier method was used for depicting survival curves for predicting MACEs by the 2 methods. Cox proportional-hazards regression was applied to confirm the independent predictors of MACEs. RESULTS The MSI obtained by the new method indicated stronger prognostic significance in LVEF improvement [area under the curve (AUC): 0.793, 95% confidence interval (CI) 0.620-0.912, P < .001] compared with the reference method (AUC: 0.634, 95%CI 0.452-0.792, P = .187). Delong's test revealed a statistically significant difference in AUCs between the 2 methods (P < .05, 95%CI 0.003-0.316). The diagnostic value of the scoring evaluation method was higher than that of the number evaluation method. The Cox prevalence of MACEs was substantially higher in the < median MSI group than in the ≥ median MSI group (hazard ratio: 0.172; 95% CI 0.041-0.724; P < .05] using the new method, whereas no considerable differences were observed between the 2 groups using the reference method (P = .12). Further, the multivariate Cox regression analysis revealed that MSI was an independent indicator for predicting MACEs (P < .05). CONCLUSION The MSI obtained from a simple GSMPI early after PCI, using the scoring evaluation method, was a reliable prognostic indicator for predicting LVEF improvement and MACEs in AMI. It remarkably improved the prognostic value compared with the previous reference methods.
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Affiliation(s)
- Ting Li
- Department of Molecular Imaging and Nuclear Medicine, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, The Huan-Hu-Xi Road, Ti-Yuan-Bei, HeXi District, Tianjin, 300060, People's Republic of China
- Department of Nuclear Medicine, Tianjin Chest Hospital, No. 261 Tai Er Zhuang Road, Jinnan District, Tianjin, 300222, People's Republic of China
- Graduate School, Tianjin Medical University, No. 22 Qi Xiang Tai Road, Heping District, Tianjin, 300070, People's Republic of China
| | - Jing Dou
- Department of Cardiology, Tianjin Chest Hospital, No. 261 Tai Er Zhuang Road, Jinnan District, Tianjin, 300222, People's Republic of China
| | - Hong Zhang
- Department of Radiology, Tianjin Chest Hospital, No. 261 Tai Er Zhuang Road, Jinnan District, Tianjin, 300222, People's Republic of China
| | - Xuexiao Su
- Department of Nuclear Medicine, Tianjin Chest Hospital, No. 261 Tai Er Zhuang Road, Jinnan District, Tianjin, 300222, People's Republic of China
| | - Yin Liu
- Department of Cardiology, Tianjin Chest Hospital, No. 261 Tai Er Zhuang Road, Jinnan District, Tianjin, 300222, People's Republic of China
| | - Mingdong Gao
- Department of Cardiology, Tianjin Chest Hospital, No. 261 Tai Er Zhuang Road, Jinnan District, Tianjin, 300222, People's Republic of China
| | - Jianyong Xiao
- Department of Cardiology, Tianjin Chest Hospital, No. 261 Tai Er Zhuang Road, Jinnan District, Tianjin, 300222, People's Republic of China
| | - Wengui Xu
- Department of Molecular Imaging and Nuclear Medicine, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, The Huan-Hu-Xi Road, Ti-Yuan-Bei, HeXi District, Tianjin, 300060, People's Republic of China.
| | - Jing Gao
- Cardiovascular Institute, Tianjin Chest Hospital, No. 261 Tai Er Zhuang Road, Jinnan District, Tianjin, 300222, People's Republic of China.
- Thoracic Clinical College, Tianjin Medical University, No. 22 Qi Xiang Tai Road, Heping District, Tianjin, 300070, People's Republic of China.
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Eber J, Blondet C, Le Fevre C, Chambrelant I, Hubele F, Morel O, Antoni D, Noel G. Nuclear medicine imaging methods of early radiation-induced cardiotoxicity: a ten-year systematic review. Front Oncol 2023; 13:1240889. [PMID: 37876964 PMCID: PMC10591197 DOI: 10.3389/fonc.2023.1240889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 09/25/2023] [Indexed: 10/26/2023] Open
Abstract
Introduction Radiotherapy has significantly improved cancer survival rates, but it also comes with certain unavoidable complications. Breast and thoracic irradiation, for instance, can unintentionally expose the heart to radiation, leading to damage at the cellular level within the myocardial structures. Detecting and monitoring radiation-induced heart disease early on is crucial, and several radionuclide imaging techniques have shown promise in this regard. Method In this 10-year review, we aimed to identify nuclear medicine imaging modalities that can effectively detect early cardiotoxicity following radiation therapy. Through a systematic search on PubMed, we selected nineteen relevant studies based on predefined criteria. Results The data suggest that incidental irradiation of the heart during breast or thoracic radiotherapy can cause early metabolic and perfusion changes. Nuclear imaging plays a prominent role in detecting these subclinical effects, which could potentially serve as predictors of late cardiac complications. Discussion However, further studies with larger populations, longer follow-up periods, and specific heart dosimetric data are needed to better understand the relationship between early detection of cardiac abnormalities and radiation-induced heart disease.
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Affiliation(s)
- Jordan Eber
- Institut de Cancérologie Strasbourg Europe (ICANS), Department of Radiation Oncology, Strasbourg, France
| | - Cyrille Blondet
- Institut de Cancérologie Strasbourg Europe (ICANS), Department of Nuclear Medicine, Strasbourg, France
| | - Clara Le Fevre
- Institut de Cancérologie Strasbourg Europe (ICANS), Department of Radiation Oncology, Strasbourg, France
| | - Isabelle Chambrelant
- Institut de Cancérologie Strasbourg Europe (ICANS), Department of Radiation Oncology, Strasbourg, France
| | - Fabrice Hubele
- Institut de Cancérologie Strasbourg Europe (ICANS), Department of Nuclear Medicine, Strasbourg, France
| | - Olivier Morel
- Nouvel Hôpital Civil, Department of Cardiology, Strasbourg, France
| | - Delphine Antoni
- Institut de Cancérologie Strasbourg Europe (ICANS), Department of Radiation Oncology, Strasbourg, France
| | - Georges Noel
- Institut de Cancérologie Strasbourg Europe (ICANS), Department of Radiation Oncology, Strasbourg, France
- Strasbourg University, Institut Centre national de la recherche scientifique (CNRS), Institut Pluridisciplinaire Hubert Curien (IPHC) UMR 7178, Centre Paul Strauss, UNICANCER, Strasbourg, France
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Morishima M, Kiriyama T, Miyagi Y, Otsuka T, Fukushima Y, Kumita SI, Ishii Y. Serial change in perfusion-metabolism mismatch after coronary artery bypass grafting. Ann Nucl Med 2021; 36:244-254. [PMID: 34822103 PMCID: PMC8897360 DOI: 10.1007/s12149-021-01696-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 11/14/2021] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Myocardial ischemia is known to suppress fatty acid metabolism and favor glucose metabolism. However, changes in myocardial metabolism after coronary revascularization are not fully elucidated. METHODS Thirty-eight patients with coronary artery disease were retrospectively enrolled. These patients had undergone stress perfusion single photon emission computed tomography (SPECT) and 123I-BMIPP SPECT in both the short-term (6.4 ± 4.7 months) and mid-term (29.9 ± 7.2 months) after isolated coronary artery bypass grafting. Tracer uptake was graded using a 17-segment, 5-point scoring model. Serial changes in SRS (summed rest score), SDS (summed difference score), the BMIPP score (total defect score of BMIPP), and the mismatch score (BMIPP score-SRS) were evaluated. In addition, persistent perfusion-metabolism mismatch (PM) was defined as mismatch score minus SDS of 3 or more during the mid-term postoperative period. The clinical parameters associated with PM were examined. RESULTS From short- to mid-term postoperative period, the extent of infarcted myocardium (SRS) did not change significantly (7.8 ± 8.0 to 7.1 ± 7.0, P = 0.117). The extent of ischemic myocardium (SDS), the BMIPP score and the mismatch score, which reflects perfusion-metabolism mismatch, were significantly improved (2.0 ± 2.8 to 0.7 ± 1.0, P = 0.010; 12.2 ± 9.0 to 9.5 ± 7.9, P < 0.001; 4.4 ± 3.7 to 2.5 ± 2.6, P < 0.001; respectively). Remarkably, perfusion-metabolism mismatch persisted in 13 patients (34%) even in the mid-term postoperative period. eGFR and SYNTAX score were independent predictors of persistent perfusion-metabolic mismatch in multivariable analysis (OR = 0.951, 95% CI 0.898-0.985, P = 0.010 and OR = 1.126, 95% CI 1.011-1.254, P = 0.031, respectively). The mismatch score both in the short- and mid-term significantly correlated with SYNTAX score (r = 0.400 and r = 0.472, respectively). CONCLUSIONS Fatty acid metabolism disturbance improved from short- to mid-term postoperative period in patients with successful reperfusion by coronary artery bypass grafting. However, in patients with severe atherosclerosis, impaired fatty acid metabolism was sustained until the mid-term postoperative period, even though ischemia had resolved.
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Affiliation(s)
- Motoko Morishima
- Department of Cardiovascular Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
| | | | - Yasuo Miyagi
- Department of Cardiovascular Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
| | - Toshiaki Otsuka
- Department of Hygiene and Public Health, Nippon Medical School, Tokyo, Japan.,Center for Clinical Research, Nippon Medical School, Tokyo, Japan
| | | | | | - Yosuke Ishii
- Department of Cardiovascular Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan.
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Aygun H, Basol N, Gul SS. Cardioprotective Effect of Paricalcitol on Amitriptyline-Induced Cardiotoxicity in Rats: Comparison of [ 99mTc]PYP Cardiac Scintigraphy with Electrocardiographic and Biochemical Findings. Cardiovasc Toxicol 2020; 20:427-436. [PMID: 32219715 DOI: 10.1007/s12012-020-09569-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Taking an overdose of AMT, a commonly prescribed tricyclic antidepressant drug, has an increased risk of sudden cardiac death. The cardiotoxicity of amitriptyline (AMT) is a commonly observed toxicity with high morbidity and mortality rates in emergency departments (ED). Nevertheless, there are still no effective treatment options for AMT-induced cardiotoxicity. The aim of the present study was to evaluate the effects of paricalcitol (PRC), a Vitamin D receptor agonist, using electrocardiographic (ECG), biochemical, and scintigraphic methods. Twenty-eight male Wistar rats were randomly divided into four groups: untreated control (CON), amitriptyline-induced cardiotoxicity (AMT), paricalcitol (PRC), and amitriptyline + paricalcitol (AMT + PRC). Cardiotoxicity was induced by intraperitoneal (i.p) injection of a single-dose AMT (100 mg/kg). PRC was administered as 10 μg/kg (i.p.) after the injection of AMT. We examined ECG, biochemical, and scintigraphic results of PRC administration on AMT-induced changes. Cardiotoxicity of AMT was characterized by conduction abnormalities (increased QRS complex, T wave, and QT interval duration and elevation of ST segment amplitude), elevated 99mTechnetium Pyrophosphate ([99mTc]PYP) uptake, and increased cardiac troponin T (cTnT) levels. Treatment with PRC significantly decreased all AMT-associated conduction abnormalities in ECG (p < 0.001), and decreased [99mTc]PYP uptake (p < 0.001) and serum cTnT level (p < 0.001). The present study indicated that the vitamin D receptor agonist paricalcitol could decrease the AMT-induced cardiotoxicity. This suggests [99mTc]PYP as a non-invasive method for the evaluation of myocardial injury induced by AMT. According to the results of the present study, PRC has beneficial effects on AMT-induced cardiotoxicity.
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Affiliation(s)
- Hatice Aygun
- Department of Physiology, Faculty of Medicine, Tokat Gaziosmanpasa University, Tokat, 60030, Turkey.
| | - Nursah Basol
- Department of Emergency Medicine, Faculty of Medicine, Tokat Gaziosmanpasa University, Tokat, Turkey
| | - Serdar Savas Gul
- Department of Nuclear Medicine, Faculty of Medicine, Tokat Gaziosmanpasa University, Tokat, Turkey
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Beneficial effects of edaravone in experimental model of amitriptyline-induced cardiotoxicity in rats. Naunyn Schmiedebergs Arch Pharmacol 2019; 392:1447-1453. [DOI: 10.1007/s00210-019-01683-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 06/26/2019] [Indexed: 10/26/2022]
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Myocardial Infarction With Nonobstructive Coronary Arteries Assessed by 11C-Acetate Cardiac PET. Clin Nucl Med 2019; 44:e166-e167. [DOI: 10.1097/rlu.0000000000002431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Gül SS, Aygün H. Cardioprotective effect of vitamin D and melatonin on doxorubicin-induced cardiotoxicity in rat model: an electrocardiographic, scintigraphic and biochemical study. ACTA ACUST UNITED AC 2018. [DOI: 10.18621/eurj.410029] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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8
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Çiftçi ÖD, Gül SS, Açıksarı K, Maman A, Çavuşoğlu T, Bademci R, Taskiran D, Erbaş O. The diagnostic utility of scintigraphy in esophageal burn: a rat model. J Surg Res 2016; 200:495-500. [DOI: 10.1016/j.jss.2015.09.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Revised: 07/29/2015] [Accepted: 09/03/2015] [Indexed: 01/21/2023]
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9
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Kobayashi M, Matsunari I, Nishi K, Mizutani A, Miyazaki Y, Ogai K, Sugama J, Shiba K, Kawai K, Kinuya S. Simultaneous acquisition of (99m)Tc- and (123)I-labeled radiotracers using a preclinical SPECT scanner with CZT detectors. Ann Nucl Med 2016; 30:263-71. [PMID: 26747655 DOI: 10.1007/s12149-015-1055-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Accepted: 12/23/2015] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Simultaneous acquisition of (99m)Tc and (123)I was evaluated using a preclinical SPECT scanner with cadmium zinc telluride (CZT)-based detectors. METHODS 10-ml cylindrical syringes contained about 37 MBq (99m)Tc-tetrofosmin ((99m)Tc-TF) or 37 MBq (123)I-15-(p-iodophenyl)-3R,S-methyl pentadecanoic acid ((123)I-BMIPP) were used to assess the relationship between these SPECT radioactive counts and radioactivity. Two 10-ml syringes contained 100 or 300 MBq (99m)Tc-TF and 100 MBq (123)I-BMIPP to assess the influence of (99m)Tc upscatter and (123)I downscatter, respectively. A rat-sized cylindrical phantom also contained both 100 or 300 MBq (99m)Tc-TF and 100 MBq (123)I-BMIPP. The two 10-ml syringes and phantom were scanned using a pinhole collimator for rats. Myocardial infarction model rats were examined using 300 MBq (99m)Tc-TF and 100 MBq (123)I-BMIPP. Two 1-ml syringes contained 105 MBq (99m)Tc-labeled hexamethylpropyleneamine oxime ((99m)Tc-HMPAO) and 35 MBq (123)I-labeled N-ω-fluoropropyl-2β-carbomethoxy-3β-(4-iodophenyl) nortropane ((123)I-FP-CIT). The two 1-ml syringes were scanned using a pinhole collimator for mice. Normal mice were examined using 105 MBq (99m)Tc-HMPAO and 35 MBq (123)I-FP-CIT. RESULTS The relationship between SPECT radioactive counts and radioactivity was excellent. Downscatter contamination of (123)I-BMIPP exhibited fewer radioactive counts for 300 MBq (99m)Tc-TF without scatter correction (SC) in 125-150 keV. There was no upscatter contamination of (99m)Tc-TF in 150-175 keV. In the rat-sized phantom, the radioactive count ratio decreased to 4.0 % for 300 MBq (99m)Tc-TF without SC in 125-150 keV. In the rats, myocardial images and radioactive counts of (99m)Tc-TF with the dual tracer were identical to those of the (99m)Tc-TF single injection. Downscatter contamination of (123)I-FP-CIT was 4.2 % without SC in 125-150 keV. In the first injection of (99m)Tc-HMPAO and second injection of (123)I-FP-CIT, brain images and radioactive counts of (99m)Tc-HMPAO with the dual tracer in normal mice also were the similar to those of the (99m)Tc-HMPAO single injection. In the first injection of (123)I-FP-CIT and second injection of (99m)Tc-HMPAO, the brain images and radioactive counts with the dual tracer were not much different from those of the (123)I-FP-CIT single injection. CONCLUSIONS Dual-tracer imaging of (99m)Tc- and (123)I-labeled radiotracers is feasible in a preclinical SPECT scanner with CZT detector. When higher radioactivity of (99m)Tc-labeled radiotracers relative to (123)I-labeled radiotracers is applied, correction methods are not necessarily required for the quantification of (99m)Tc- and (123)I-labeled radiotracers when using a preclinical SPECT scanner with CZT detector.
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Affiliation(s)
- Masato Kobayashi
- Wellness Promotion Science Center, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, 5-11-80 Kodatsuno, Kanazawa, 920-0942, Japan.
| | - Ichiro Matsunari
- Clinical Research Department, The Medical and Pharmacological Research Center Foundation, Hakui, Japan
- Division of Nuclear Medicine, Department of Radiology, Saitama Medical University Hospital, Saitama, Japan
| | - Kodai Nishi
- Department of Radioisotope Medicine, Atomic Bomb Disease Institute, Nagasaki University, Nagasaki, Japan
| | - Asuka Mizutani
- Graduate School of Medicine, Division of Health Sciences, Osaka University, Osaka, Japan
| | - Yoshiharu Miyazaki
- Clinical Research Department, The Medical and Pharmacological Research Center Foundation, Hakui, Japan
| | - Kazuhiro Ogai
- Wellness Promotion Science Center, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, 5-11-80 Kodatsuno, Kanazawa, 920-0942, Japan
| | - Jyunko Sugama
- Wellness Promotion Science Center, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, 5-11-80 Kodatsuno, Kanazawa, 920-0942, Japan
| | - Kazuhiro Shiba
- Division of Tracer Kinetics, Advanced Science Research Center, Kanazawa University, Kanazawa, Japan
| | - Keiichi Kawai
- School of Health Sciences, College of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, Japan
| | - Seigo Kinuya
- School of Medical Sciences, College of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, Japan
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Umezawa R, Takanami K, Kadoya N, Nakajima Y, Saito M, Ota H, Matsushita H, Sugawara T, Kubozono M, Yamamoto T, Ishikawa Y, Takeda K, Taki Y, Takase K, Jingu K. Assessment of myocardial metabolic disorder associated with mediastinal radiotherapy for esophageal cancer -a pilot study. Radiat Oncol 2015; 10:96. [PMID: 25896887 PMCID: PMC4407329 DOI: 10.1186/s13014-015-0410-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Accepted: 04/15/2015] [Indexed: 12/25/2022] Open
Abstract
Background To evaluate the dose-effect relations for myocardial metabolic disorders after mediastinal radiotherapy (RT) by performing iodine-123 β-methyl-iodophenyl pentadecanoic acid (I-123 BMIPP) scintigraphy. Methods Between 2011 and 2012, we performed I-123 BMIPP scintigraphy for patients with esophageal cancer before and six months after curative mediastinal RT. Single photon emission computed tomography (SPECT) images of pre-RT and post-RT were registered into RT dose distributions. The myocardium was contoured, and the regional RT dose was calculated. Normalization is required to compare pre- and post-RT SPECT images because the uptake pattern is changed due to the breathing level. Normalization was applied on the mean of SPECT counts in regions of the myocardium receiving less than 5 Gy. Relative values in each dose region (interval of 5 Gy) were calculated on the basis of this normalization for each patient. The reduction in the percent of relative values was calculated. Results Five patients were enrolled in this study. None of the patients had a past history of cardiac disease. The left ventricle was partially involved in RT fields in all patients. The patients received RT with median total doses of 60-66 Gy for the primary tumor and metastatic lymph nodes. Concomitant chemotherapy consisting of cisplatin or nedaplatin and 5-fluorouracil with RT was performed in 4 patients. All patients had reduced uptake corresponding to RT fields. Dose-effect relations for reduced uptake tended to be observed at 6 months after RT with mean decreases of 8.96% in regions at 10-15 Gy, 12.6% in regions at 20-25 Gy, 15.6% in regions at 30-35 Gy, 19.0% in regions at 40-45 Gy and 16.0% in regions at 50-55 Gy. Conclusions Dose-effect relations for myocardial metabolic disorders tended to be observed. We may need to make an effort to reduce high-dose mediastinal RT to the myocardium in RT planning.
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Affiliation(s)
- Rei Umezawa
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai, Japan.
| | - Kentaro Takanami
- Department of Diagnostic Radiology, Tohoku University Graduate School of Medicine, Sendai, Japan.
| | - Noriyuki Kadoya
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai, Japan.
| | - Yujiro Nakajima
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai, Japan.
| | - Masahide Saito
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai, Japan.
| | - Hideki Ota
- Department of Diagnostic Radiology, Tohoku University Graduate School of Medicine, Sendai, Japan.
| | - Haruo Matsushita
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai, Japan.
| | - Toshiyuki Sugawara
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai, Japan.
| | - Masaki Kubozono
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai, Japan.
| | - Takaya Yamamoto
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai, Japan.
| | - Yojiro Ishikawa
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai, Japan.
| | - Ken Takeda
- Department of Radiological Technology, School of Health Sciences, Faculty of Medicine, Tohoku University, Sendai, Japan.
| | - Yasuyuki Taki
- Department of Developmental Cognitive Neuroscience Institute of Development, Aging and Cancer, Tohoku University, Sendai, Japan.
| | - Kei Takase
- Department of Diagnostic Radiology, Tohoku University Graduate School of Medicine, Sendai, Japan.
| | - Keiichi Jingu
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai, Japan.
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Tanabe Y, Yoneyama K, Izumo M, Kongoji K, Harada T, Akashi YJ. A case of coronary microvascular spasm with slow flow induced by the intracoronary acetylcholine provocation test. Cardiovasc Interv Ther 2014; 30:372-6. [PMID: 25403747 DOI: 10.1007/s12928-014-0308-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2014] [Accepted: 11/06/2014] [Indexed: 02/07/2023]
Abstract
Microvascular angina is a rare condition in which myocardial ischemia is caused by microvascular dysfunction without any abnormalities of the epicardial coronary arteries. In clinical practice, it is difficult to diagnose because the microvascular alterations cannot be detected by conventional angiography. Herein we present a rare case of a 67-year-old woman with unstable angina pectoris in whom considerably slow coronary flow was induced by the acetylcholine provocation test with mild epicardial arterial spasm, suggesting the presence of microvascular spasm. Moreover, we show that β-methyl-p-[(123)I]-iodophenyl-pentadecanoic ((123)I-BMIPP) single-photon emission computed tomography imaging is useful for proving myocardial ischemia.
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Affiliation(s)
- Yasuhiro Tanabe
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, 2-16-1, Sugao, Miyamae-ku, Kawasaki, Kanagawa, 216-8511, Japan.
| | - Kihei Yoneyama
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, 2-16-1, Sugao, Miyamae-ku, Kawasaki, Kanagawa, 216-8511, Japan
| | - Masaki Izumo
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, 2-16-1, Sugao, Miyamae-ku, Kawasaki, Kanagawa, 216-8511, Japan
| | - Ken Kongoji
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, 2-16-1, Sugao, Miyamae-ku, Kawasaki, Kanagawa, 216-8511, Japan
| | - Tomoo Harada
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, 2-16-1, Sugao, Miyamae-ku, Kawasaki, Kanagawa, 216-8511, Japan
| | - Yoshihiro J Akashi
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, 2-16-1, Sugao, Miyamae-ku, Kawasaki, Kanagawa, 216-8511, Japan
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Umezawa R, Takase K, Jingu K, Takanami K, Ota H, Kaneta T, Takeda K, Matsushita H, Ariga H, Takahashi S, Yamada S. Evaluation of radiation-induced myocardial damage using iodine-123 β-methyl-iodophenyl pentadecanoic acid scintigraphy. JOURNAL OF RADIATION RESEARCH 2013; 54:880-9. [PMID: 23412468 PMCID: PMC3766284 DOI: 10.1093/jrr/rrt011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
We evaluated radiation-induced myocardial damage using iodine-123 β-methyl-iodophenyl pentadecanoic acid (I-123 BMIPP) scintigraphy. Between May 2010 and April 2011 we performed I-123 BMIPP scintigraphy for patients who had maintained complete response to curative radiotherapy (RT) for esophageal cancer for more than six months. We compared the area of the myocardium in the RT fields with that of reduced I-123 BMIPP uptake using a 15-segment model that is based on axial computed tomography (CT) images. We classified the segments into three categories: segments receiving 40 Gy (Segment 40 Gy), segments receiving 60 Gy (Segment 60 Gy) and segments out of the radiation fields (Segment 0 Gy). A segment with reduced uptake in the RT fields was defined as positive. A total of 510 segments in 34 patients were used for analysis. The median interval from completion of RT to I-123 BMIPP scintigraphy was 22 months (range, 6-103 months). The numbers of Segment 0 Gy, Segment 40 Gy and Segment 60 Gy were 324, 133 and 53, respectively. Reduced uptake was detected in 42.9% (57/133) of Segment 40 Gy, 67.9% (36/53) of Segment 60 Gy and 13.3% (43/324) of Segment 0 Gy. The odds ratios of 40 Gy and 60 Gy compared with regions out of the RT fields were 5.2 (95% confidence interval [CI]: 3.7-7.4) and 15.4 (95% CI: 6.9-34.6), respectively. Reduced myocardial I-123 BMIPP uptake in RT fields, suggesting RT-induced myocardial damage, was frequently observed. I-123 BMIPP myocardial scintigraphy may be useful for identifying RT-induced myocardial damage.
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Affiliation(s)
- Rei Umezawa
- Department of Radiation Oncology, Tohoku University School of Medicine, Seiryou-machi 1-1, Aobaku, Sendai 980-8574, Japan
- Corresponding author. Department of Radiation Oncology, Tohoku University School of Medicine, Seiryou-machi 1-1, Aobaku, Sendai 980-8574, Japan. Tel: +81-22-717-7312; Fax: +81-22-717-7316;
| | - Kei Takase
- Department of Diagnostic Radiology, Tohoku University School of Medicine, Seiryou-machi 1-1, Aobaku, Sendai 980-8574, Japan
| | - Keiichi Jingu
- Department of Radiation Oncology, Tohoku University School of Medicine, Seiryou-machi 1-1, Aobaku, Sendai 980-8574, Japan
| | - Kentaro Takanami
- Department of Diagnostic Radiology, Tohoku University School of Medicine, Seiryou-machi 1-1, Aobaku, Sendai 980-8574, Japan
| | - Hideki Ota
- Department of Diagnostic Radiology, Tohoku University School of Medicine, Seiryou-machi 1-1, Aobaku, Sendai 980-8574, Japan
| | - Tomohiro Kaneta
- Department of Diagnostic Radiology, Tohoku University School of Medicine, Seiryou-machi 1-1, Aobaku, Sendai 980-8574, Japan
| | - Ken Takeda
- Department of Radiation Oncology, Tohoku University School of Medicine, Seiryou-machi 1-1, Aobaku, Sendai 980-8574, Japan
| | - Haruo Matsushita
- Department of Radiation Oncology, Tohoku University School of Medicine, Seiryou-machi 1-1, Aobaku, Sendai 980-8574, Japan
| | - Hisanori Ariga
- Department of Radiation Oncology, Tohoku University School of Medicine, Seiryou-machi 1-1, Aobaku, Sendai 980-8574, Japan
| | - Shoki Takahashi
- Department of Diagnostic Radiology, Tohoku University School of Medicine, Seiryou-machi 1-1, Aobaku, Sendai 980-8574, Japan
| | - Shogo Yamada
- Department of Radiation Oncology, Tohoku University School of Medicine, Seiryou-machi 1-1, Aobaku, Sendai 980-8574, Japan
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The relationship between reverse redistribution of 99mTc-tetrofosmin in sub-acute phase and left ventricular functional recovery in chronic phase in patients with acute myocardial infarction. Ann Nucl Med 2009; 23:863-8. [DOI: 10.1007/s12149-009-0318-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2009] [Accepted: 10/14/2009] [Indexed: 10/20/2022]
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14
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Aksu B, Durmus-Altun G, Ustun F, Torun N, Kanter M, Umit H, Sut N. A new imaging modality in detection of caustic oesophageal injury: Technetium-99m pyrophosphate scintigraphy. Int J Pediatr Otorhinolaryngol 2009; 73:409-15. [PMID: 19124162 DOI: 10.1016/j.ijporl.2008.11.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2008] [Revised: 11/18/2008] [Accepted: 11/18/2008] [Indexed: 12/30/2022]
Abstract
OBJECTIVES Early oesophagoscopy is usually recommended in children after caustic ingestion to assess the severity of the initial digestive lesions. An oesophagoscopic procedure in children always demands to be performed under sedation and bears a certain risk of iatrogenic injury. The purpose of the study is to determine the value and sensitivity of Tc-99m pyrophosphate (99mTc-PYP) scintigraphy for the detection of caustic oesophageal injury. METHODS The caustic oesophageal burns were created with 25% NaOH in an experimental rat model. Seventeen rats were divided into two groups. The BURN group (n=9) included caustic oesophageal burning rats. Non-BURN group (n=8) included sham-operated rats. All animals underwent 99mTc-PYP scintigraphy 72 h after the burning experiment. Anterior static and single-photon emission computed tomography images were obtained using a low-energy all-purpose collimator, 2.55 zoom factor, 3h after intravenous injection of 10 mCi 99mTc-PYP. After the imaging, all the oesophagi were explored for external determination of the injury sites and macroautoradiographic scintigraphy as well. Rectangular region of interest were placed in the visually determined lesion of oesophagus (O) as well as non-lesion area (N), and an ON ratio was created. The severity and extension of oesophageal burn were assessed 3 days after burning by histopathologic evaluation. The injuries were graded according to the ulcer depth, ulcer width, thrombus formation, and the development of perivascular fibrinoid necrosis. RESULTS The oesophageal burning areas were demonstrated by visual evaluation of the Tc-99m PYP scintigraphy on all animals. The mean ON ratio of 99mTc-PYP was 21.61+/-7.01 in the BURN group and in the non-BURN group, was 2.25+/-0.24 (p<0.001). The best cut-off point of the ON ratio for caustic oesophageal injury was 5.45, with sensitivity and specificity of 100%. PYP scan findings were also confirmed by histological evidence of ulcer depth, ulcer width, thrombus formation, and perivascular fibrinoid necrosis in the same areas. CONCLUSIONS The caustic oesophageal injuries have been demonstrated by 99mTc-PYP scintigraphy in burning experiment. 99mTc-PYP scintigraphy is sensitive for detection of caustic oesophageal injury. This new imaging tool is found to be sensitive and specific for the detection of caustic oesophageal injury in the rats.
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Affiliation(s)
- Burhan Aksu
- Department of Pediatric Surgery, Faculty of Medicine, Trakya University, 22030 Edirne, Turkey.
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Estimate of myocardial salvage in late presentation acute myocardial infarction by comparing functional and perfusion abnormalities in predischarge gated SPECT. Eur J Nucl Med Mol Imaging 2007; 35:906-11. [DOI: 10.1007/s00259-007-0663-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2007] [Accepted: 11/18/2007] [Indexed: 10/22/2022]
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Abstract
INTRODUCTION In normal condition, the heart obtains more than two-thirds of its energy from the oxidative metabolism of long chain fatty acids, although a wide variety of substrates such as glucose, lactate, ketone bodies and amino acids are also utilised. In ischaemic myocardium, on the other hand, oxidative metabolism of free fatty acid is suppressed and anaerobic glucose metabolism plays a major role in residual oxidative metabolism. Therefore, metabolic imaging can be an important technique for the assessment of various cardiac diseases and conditions. MATERIALS AND METHODS In SPECT, several iodinated fatty acid traces have been introduced and studied. Of these, (123)I-labelled 15-(p-iodophenyl)3-R, S-methylpentadecanoic acid (BMIPP) has been the most commonly used tracer in clinical studies, especially in some of the European countries and Japan. RESULTS AND DISCUSSION In this review article, several fatty acid tracers for SPECT are characterised, and the mechanism of uptake and clinical utility of BMIPP are discussed in detail.
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Affiliation(s)
- Junichi Taki
- Department of Biotracer Medicine, Kanazawa University Graduate School of Medical Science, 13-1 Takara-machi, Kanazawa 920-8640, Japan.
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Oliveira MM, Fiarresga A, Pelicano N, da Silva N, Timóteo AT, Carlos I, Silva S, Quininha J. Temporal variations in microvolt T-wave alternans testing after acute myocardial infarction. Ann Noninvasive Electrocardiol 2007; 12:98-103. [PMID: 17593177 PMCID: PMC6932366 DOI: 10.1111/j.1542-474x.2007.00147.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Microvolt T-wave alternans (TWA) have been accepted as a tool for assessing vulnerability to ventricular tachyarrhythmias. There is lack of data concerning prospective temporal variations in TWA measurements after acute myocardial infarction (AMI). We analysed the temporal patterns of TWA in post-AMI patients. METHODS AND RESULTS TWA tests were performed <1 month (TWA_early) and 6 months (TWA_late) after AMI in 51 consecutive patients treated with successful percutaneous coronary intervention (PCI). Twenty seven patients (53%) had anterior wall infarctions and 24 (47%) had inferior/lateral wall infarctions. TWA was measured during a treadmill manual exercise protocol and defined as positive, negative and indeterminate. Group A included patients with TWA negative in both tests and Group B included those with TWA abnormal (positive or indeterminate) at first or second determinations. TWA_early was negative, positive and indeterminate in 38 (74.6%), 8 (15.6%) and 5 (9.8%) patients, respectively, whereas TWA_late was negative, positive and indeterminate in 30 (58.9%), 14 (27.4%) and 7 (13.7%) patients, respectively. TWA_early was classified as normal in 74.6% and abnormal in 25.4% of the cases, and TWA_late was normal in 58.9% and abnormal in 41.1%. TWA tests were concordant in 36 patients (70.6%) and discordant 15 patients (29.4%). At TWA_late, 10 patients (19.6%) changed from TWA negative to TWA abnormal and 4 patients (7.8%) from TWA abnormal to TWA negative. After TWA_early+TWA_late, 45% of the patients had 1 test classified as abnormal. Left ventricular ejection fraction was <50% in 22% of Group A and 52% of Group B (P = 0.037). CONCLUSIONS In the era of primary PCI, temporal changes in TWA measurements may occur frequently during the first 6 months post-AMI. These findings should be considered in risk stratification strategies following AMI.
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Messina SA, Aras O, Dilsizian V. Delayed recovery of fatty acid metabolism after transient myocardial ischemia: a potential imaging target for "ischemic memory". Curr Cardiol Rep 2007; 9:159-65. [PMID: 17430684 DOI: 10.1007/bf02938343] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
The myocardium preferentially oxidizes free fatty acids for energy production. However, the dependency of this metabolic pathway on oxygen makes this process vulnerable to ischemia. The energy requirements of the myocardium are subsequently met by the oxidation of carbohydrates, particularly glucose. Recovery of fatty acid metabolism lags behind restoration of perfusion, resulting in the phenomenon of metabolic stunning. This decrease of fatty acid utilization following ischemia can be imaged with fatty acid radiotracers, particularly beta-Methyl-p-(123)I-iodophenyl pentadecanoic acid (BMIPP), which demonstrates markedly limited metabolism via beta-oxidation, resulting in prolonged retention in the cardiomyocyte. Thus, in patients presenting with chest pain and no prior myocardial infarction, abnormal BMIPP uptake at rest reflects metabolic alteration caused by the preceding ischemia, also termed ischemic memory.
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Affiliation(s)
- Steven A Messina
- Division of Nuclear Medicine, Department of Diagnostic Radiology, University of Maryland Hospital and School of Medicine, Baltimore, MD 21201-1595, USA
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Nakano R, Zen K, Yamano T, Sawada T, Azuma A, Matsubara H. A case presenting with myocardial ischemia-like electrocardiogram findings after laryngopharyngoesophagectomy. Ann Nucl Med 2007; 20:633-7. [PMID: 17294675 DOI: 10.1007/bf02984662] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Laryngopharyngoesophagectomy and reconstruction by using stomach roll with retrocardiac anastomosis were performed in a 60-year-old man with hypopharyngeal cancer. Postoperative electrocardiogram showed marked ST-segment elevation in leads I and aVL and depression in leads II, III, aVF, and V1-6. However, the patient did not present with abnormal findings on physical examination and vital signs were normal. Further, the laboratory data were normal. Echocardiography was a poor technique, but the stomach roll was observed to be expanded due to wall edema with exudates and exerted pressure on the posterior side of the heart. These findings were also ascertained by contrast-enhanced chest computed tomography scanning. Technetium-99m-tetrofosmin myocardial scintigraphy clearly showed that coronary blood perfusion and left ventricular wall motion were quite normal. The characteristic electrocardiogram returned to a near-normal state, and the expanded stomach roll shrank back to its ordinary size after one week. Coronary angiography showed neither organic stenoses nor vasospasm. The physical pressure of the expanded stomach roll might have influenced the electrocardiogram findings.
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Affiliation(s)
- Ritsuko Nakano
- Department of Cardiovascular Medicine, Kyoto Prefectural University of Medicine
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21
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Tamaki N. Role of BMIPP imaging for risk stratification in patients with coronary artery disease. J Nucl Cardiol 2005; 12:148-50. [PMID: 15812367 DOI: 10.1016/j.nuclcard.2005.01.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Nanasato M, Hirayama H, Ando A, Isobe S, Nonokawa M, Kinoshita Y, Nanbu I, Yokota M, Murohara T. Incremental predictive value of myocardial scintigraphy with 123I-BMIPP in patients with acute myocardial infarction treated with primary percutaneous coronary intervention. Eur J Nucl Med Mol Imaging 2004; 31:1512-21. [PMID: 15232655 DOI: 10.1007/s00259-004-1556-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2003] [Accepted: 03/24/2004] [Indexed: 11/25/2022]
Abstract
PURPOSE It is unclear whether 123I-labelled beta-methyl iodophenyl pentadecanoic acid (123I-BMIPP) myocardial scintigraphy adds further predictive value for future cardiac events compared with the variables obtained during cardiac catheterisation in patients with acute myocardial infarction (AMI) treated with primary percutaneous coronary intervention (PCI). We therefore investigated whether 123I-BMIPP imaging in patients with AMI treated by primary PCI was useful in predicting future cardiac events. METHODS One hundred and fifty-nine patients with AMI who were treated with primary PCI and underwent left ventriculography (LVG) on admission underwent 201Tl and 123I-BMIPP myocardial scintigraphy. Scintigrams were visually classified, and the total defect score (TDS) was calculated. Major adverse cardiac events (MACE) were defined as cardiac death including sudden death, congestive heart failure and recurrence of acute coronary syndrome. Patients were followed up for a mean of 34.5 months (12-63 months). RESULTS Twenty-six patients had MACE. Kaplan-Meier analysis indicated that patients with the top 50% of 123I-BMIPP TDSs had a significantly higher rate of MACE (P=0.007). Patients with mismatch between 201Tl and 123I-BMIPP images also had significantly more MACE (P=0.02). In the prediction of MACE, the global chi-square value was 5.2 (P=0.001) based on LVEF (<45%) and the number of diseased vessels (two or three). Adding 123I-BMIPP TDS and the mismatch improved the global chi-square value (chi2=7.2) CONCLUSION Myocardial scintigraphy using 201Tl and 123I-BMIPP predicts future cardiac events in patients with AMI treated with primary PCI, and provides additional predictive value compared with the variables obtained with cardiac catheterisation alone.
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Affiliation(s)
- Mamoru Nanasato
- Cardiovascular Center, Nagoya Daini Red Cross Hospital, 2-9 Myouken-cho, Showa, Nagoya, 466-8650 Japan.
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