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Excimer laser coronary angioplasty versus manual aspiration thrombectomy in patients with ST-segment elevation myocardial infarction: analyzed by nuclear scintigraphy. Int J Cardiovasc Imaging 2022; 39:831-842. [PMID: 36508056 DOI: 10.1007/s10554-022-02771-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 11/27/2022] [Indexed: 12/14/2022]
Abstract
Clinical outcomes concerning the efficacy of excimer laser coronary angioplasty (ELCA) in real-world cases of acute myocardial infarction (MI) are limited. We evaluated and compared the impact of ELCA with manual aspiration thrombectomy on myocardial salvage and left ventricular (LV) systolic/diastolic function in patients with ST-segment elevation MI (STEMI) using nuclear scintigraphy. We enrolled 143 consecutive patients with STEMI treated with ELCA (63 patients) or manual aspiration thrombectomy (80 patients) between September 2016 and December 2020 in a single-center hospital. We evaluated the peak creatine kinase (CK)/ creatine kinase-myocardial band (CK-MB) levels and performed single-photon emission computed tomography (SPECT) analyses with Quantitative Gated SPECT and Quantitative Perfusion SPECT (Auto QUANT 7.2) at 3-10 days using 123I-BMIPP and 3 months following percutaneous coronary intervention using 99mTc-tetrofosmin to evaluate myocardial salvage and LV systolic/diastolic function. No significant difference was observed in the patient and periprocedural characteristics. Peak CK-MB level was significantly different between the groups (ELCA group, 190.0 [70.5-342.0] IU/L vs. aspiration group, 256.5 [157.0-354.8] IU/L, p = 0.047). Although no significant difference was observed in myocardial salvage, significant improvement in the LV ejection fraction (14.1 [6.2-19.8]% vs. 9.5 [3.9-15.3]%, respectively, p = 0.018) and peak emptying rate (-0.54 [-1.02- (-0.27)] mL/s vs. -0.38 [-0.76- (-0.05)] mL/s, respectively, p = 0.017) were detected. ELCA could suppress the myocardial deviation enzymes and potentially improve systolic function compared to manual aspiration thrombectomy in patients with STEMI.
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Nanasato M, Matsuo S, Nakajima K, Nishimura S, Nishimura T. Predictive value of electrocardiography-gated myocardial perfusion imaging to new-onset heart failure in patients with chronic kidney disease: findings from the J-ACCESS 3 study. Int J Cardiovasc Imaging 2020; 36:749-755. [DOI: 10.1007/s10554-019-01761-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 12/27/2019] [Indexed: 01/26/2023]
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Rawala MS, Memon A, Yasin M, Karpe V, Brewer ZS, Harrington CV, Kemper SE, Carter WH. Discordance in LVEF Between Nuclear SPECT and Echocardiography in Patients With Moderate Reduction in LVEF. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2019. [DOI: 10.1177/8756479319828378] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Muhammad Shabbir Rawala
- West Virginia University Health Sciences Center, Charleston Division/Charleston Area Medical Center, Charleston, WV, USA
| | - Adil Memon
- West Virginia University Health Sciences Center, Charleston Division/Charleston Area Medical Center, Charleston, WV, USA
| | - Muhammad Yasin
- West Virginia University Health Sciences Center, Charleston Division/Charleston Area Medical Center, Charleston, WV, USA
| | - Vallabh Karpe
- West Virginia University Health Sciences Center, Charleston Division/Charleston Area Medical Center, Charleston, WV, USA
| | - Zachary S. Brewer
- West Virginia University Health Sciences Center, Charleston Division/Charleston Area Medical Center, Charleston, WV, USA
| | - Cecilia V. Harrington
- West Virginia University Health Sciences Center, Charleston Division/Charleston Area Medical Center, Charleston, WV, USA
| | - Suzanne E. Kemper
- West Virginia University Health Sciences Center, Charleston Division/Charleston Area Medical Center, Charleston, WV, USA
| | - William H. Carter
- West Virginia University Health Sciences Center, Charleston Division/Charleston Area Medical Center, Charleston, WV, USA
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Nakamura S, Kawano Y, Nakajima K, Hase H, Joki N, Hatta T, Nishimura S, Moroi M, Nakagawa S, Kasai T, Kusuoka H, Takeishi Y, Momose M, Takehana K, Nanasato M, Yoda S, Nishina H, Matsumoto N, Nishimura T. Prognostic study of cardiac events in Japanese patients with chronic kidney disease using ECG-gated myocardial Perfusion imaging: Final 3-year report of the J-ACCESS 3 study. J Nucl Cardiol 2019; 26:431-440. [PMID: 28439760 PMCID: PMC6430747 DOI: 10.1007/s12350-017-0880-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2016] [Accepted: 03/23/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND Myocardial perfusion imaging (MPI) is considered useful for risk stratification among patients with chronic kidney disease (CKD), without renal deterioration by contrast media. METHODS AND RESULTS The Japanese Assessment of Cardiac Events and Survival Study by Quantitative Gated SPECT (J-ACCESS 3) is a multicenter, prospective cohort study investigating the ability of MPI to predict cardiac events in 529 CKD patients without a definitive coronary artery disease. All patients were assessed by stress and rest MPI with 99mTc-tetrofosmin and data were analyzed using a defect scoring method and QGS software. Major cardiac events were analyzed for 3 years after registration. The mean eGFR was 29.0 ± 12.8 (mL/minute/1.73 m2). The mean summed stress/rest/difference (SSS, SRS, SDS) scores were 1.9 ± 3.8, 1.1 ± 3.0, and 0.8 ± 1.8, respectively. A total of 60 cardiac events (three cardiac deaths, six sudden deaths, five nonfatal myocardial infarctions, 46 hospitalization cases for heart failure) occurred. The event-free survival rate was lower among patients with kidney dysfunction, higher SSS, and higher CRP values. Multivariate Cox regression analysis independently associated SSS ≥8, eGFR <15 (mL/minute/1.73 m2), and CRP ≥0.3 (mg/dL) with cardiac events. CONCLUSIONS Together with eGFR and CRP, MPI can predict cardiac events in patients with CKD.
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Affiliation(s)
- Satoko Nakamura
- Division of Hypertension and Nephrology, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Yuhei Kawano
- Division of Hypertension and Nephrology, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Kenichi Nakajima
- Department of Nuclear Medicine, Kanazawa University Hospital, Kanazawa, Japan
| | - Hiroki Hase
- Department of Nephrology, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Nobuhiko Joki
- Department of Nephrology, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Tsuguru Hatta
- Division of Nephrology, Department of Medicine, Ohmihachiman Community Medical Center, Ohmihachiman, Japan
| | | | - Masao Moroi
- Department of Cardiology, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Susumu Nakagawa
- Department of Cardiology, Saiseikai Central Hospital, Tokyo, Japan
| | - Tokuo Kasai
- Department of Cardiology, Jikei Medical University Aoto Hospital, Tokyo, Japan
| | - Hideo Kusuoka
- National Hospital Organization Osaka National Hospital, Osaka, Japan
| | | | - Mitsuru Momose
- Department of Radiology, Tokyo Women’s Medical University, Tokyo, Japan
| | - Kazuya Takehana
- Department of Cardiology, Kansai Medical University, Hirakata, Japan
| | - Mamoru Nanasato
- Department of Cardiology, Nagoya Daini Red-Cross Hospital, Nagoya, Japan
| | - Syunichi Yoda
- Department of Cardiology, Nihon University Itabashi Hospital, Tokyo, Japan
| | - Hidetaka Nishina
- Department of Cardiology, Tsukuba Medical Center Hospital, Tsukuba, Japan
| | - Naoya Matsumoto
- Department of Cardiology, Suruga-dai Nihon University Hospital, Tokyo, Japan
| | - Tsunehiko Nishimura
- Department of Radiology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajiicho, Kawara-machi Hirokoji, Kamigyo-ku, 602-8566 Kyoto, Japan
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Tamaki N. Ischemia and inflammation on chronic kidney disease. J Nucl Cardiol 2019; 26:441-442. [PMID: 28752312 DOI: 10.1007/s12350-017-0997-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 04/25/2017] [Indexed: 10/19/2022]
Affiliation(s)
- Nagara Tamaki
- Department of Nuclear Medicine, Hokkaido University, Sapporo, Japan.
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Yoneyama H, Nakajima K, Okuda K, Matsuo S, Onoguchi M, Kinuya S, Edenbrandt L. Reducing the small-heart effect in pediatric gated myocardial perfusion single-photon emission computed tomography. J Nucl Cardiol 2017; 24:1378-1388. [PMID: 27197818 DOI: 10.1007/s12350-016-0518-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2015] [Accepted: 04/10/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND We compared two reconstruction algorisms and two cardiac functional evaluation software programs in terms of their accuracy for estimating ejection fraction (EF) of small hearts (SH). METHODS The study group consisted of 66 pediatric patients. Data were reconstructed using a filtered back projection (FBP) method without the resolution correction (RC) and an iterative method based on an ordered subset expectation maximization (OSEM) algorithm with the RC. EF was evaluated using two software programs of quantitative gated single-photon emission computed tomography (SPECT) (QGS) and cardioREPO. We compared the EF of gated myocardial perfusion SPECT to echocardiographic measurement (Echo). RESULTS Forty-eight of 66 patients had an end-systolic volume < 20 mL which was used as the criterion for being included in the SH group, and the SH effect led to an overestimation of EF. While significant differences were observed between Echo (66.9 ± 5.0%) and QGS-FBP without RC (76.9 ± 8.4%, P < .0001), QGS-OSEM with RC (76.6 ± 8.6%, P < .0001), and cardioREPO-FBP without RC (72.1 ± 10.0%, P = .0011), no significant difference was observed between Echo and cardioREPO-OSEM with RC (67.4 ± 6.1%) in SH group. CONCLUSIONS In pediatric gated myocardial perfusion SPECT, the SH effect can be significantly reduced when an OSEM algorithm is used with RC in combination with the specific cardioREPO algorithm.
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Affiliation(s)
- Hiroto Yoneyama
- Department of Radiological Technology, Kanazawa University Hospital, 13-1 Takara-machi, Kanazawa, 920-8641, Japan.
| | - Kenichi Nakajima
- Department of Nuclear Medicine, Kanazawa University Hospital, Kanazawa, Japan
| | - Koichi Okuda
- Department of Physics, Kanazawa Medical University, Kanazawa, Japan
| | - Shinro Matsuo
- Department of Nuclear Medicine, Kanazawa University Hospital, Kanazawa, Japan
| | - Masahisa Onoguchi
- Department of Health Science, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan
| | - Seigo Kinuya
- Department of Nuclear Medicine, Kanazawa University Hospital, Kanazawa, Japan
| | - Lars Edenbrandt
- Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden
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Germano G, Kavanagh PB. Ready, shoot, aim? Summary justice for small hearts in nuclear cardiology. J Nucl Cardiol 2017; 24:1389-1392. [PMID: 27207632 DOI: 10.1007/s12350-016-0545-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Accepted: 05/05/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Guido Germano
- Department of Medicine, Cedars-Sinai Medical Center, Artificial Intelligence in Medicine Program, Los Angeles, USA.
- David Geffen School of Medicine, UCLA, Los Angeles, USA.
| | - Paul B Kavanagh
- Department of Medicine, Cedars-Sinai Medical Center, Artificial Intelligence in Medicine Program, Los Angeles, USA
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Angelidis G, Giamouzis G, Karagiannis G, Butler J, Tsougos I, Valotassiou V, Giannakoulas G, Dimakopoulos N, Xanthopoulos A, Skoularigis J, Triposkiadis F, Georgoulias P. SPECT and PET in ischemic heart failure. Heart Fail Rev 2017; 22:243-261. [DOI: 10.1007/s10741-017-9594-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Narihiro H, Masahisa O, Osamu H, Hiroyuki K, Masakazu M, Noriko M. Development of a 2-Layer Double-Pump Dynamic Cardiac Phantom. J Nucl Med Technol 2016; 44:31-5. [PMID: 26769601 DOI: 10.2967/jnmt.115.168252] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Accepted: 12/28/2015] [Indexed: 11/16/2022] Open
Abstract
UNLABELLED The conventional dynamic cardiac phantom used in the field of nuclear medicine has a structure for which the size of the external side of the heart (the outer membrane substituting the myocardial layer) is fixed and only the inner side (the inner membrane substituting the ventricle part) moves anteroposteriorly. Therefore, its usefulness in technical evaluation is limited. Hence, we developed a new dynamic cardiac phantom in which the outer and inner membranes freely move. METHODS Using a SPECT/CT system, we performed validation by filling the myocardial layer of the dynamic cardiac phantom with solution and the ventricle part with contrast medium. We evaluated myocardial wall motions of 3 segments (basal, mid, and apical) by setting the stroke ratios at 20:20 and 10:10 (ventricle-to-myocardial layer ratio). RESULTS The myocardial wall motions (mean ± SD) at the stroke ratio of 20:20 were 7.50 ± 0.44, 11.15 ± 0.56, and 9.90 ± 0.24 mm in the basal, mid, and apical segments, respectively. The wall motions (mean ± SD) at the stroke ratio of 10:10 were 3.82 ± 0.43, 5.63 ± 0.39, and 4.53 ± 0.10 mm, respectively. CONCLUSION In our dynamic cardiac phantom, different movements could be induced in the myocardial wall by freely changing the stroke ratio. These results suggest that the use of this phantom can realize technical evaluation that presumes various clinical conditions.
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Affiliation(s)
- Hara Narihiro
- Sumitomo Hospital, Radiological Technology, Nakanoshima, Kita-ku, Osaka, Japan; and Kanazawa University, Graduate School of Medical Sciences, Kodatsuno, Kanazawa, Japan
| | - Onoguchi Masahisa
- Kanazawa University, Graduate School of Medical Sciences, Kodatsuno, Kanazawa, Japan
| | - Hojyo Osamu
- Sumitomo Hospital, Radiological Technology, Nakanoshima, Kita-ku, Osaka, Japan; and
| | - Kawaguchi Hiroyuki
- Sumitomo Hospital, Radiological Technology, Nakanoshima, Kita-ku, Osaka, Japan; and
| | - Murai Masakazu
- Sumitomo Hospital, Radiological Technology, Nakanoshima, Kita-ku, Osaka, Japan; and
| | - Matsushima Noriko
- Sumitomo Hospital, Radiological Technology, Nakanoshima, Kita-ku, Osaka, Japan; and
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Abstract
Quantitative analysis of SPECT and PET has become a major part of nuclear cardiology practice. Current software tools can automatically segment the left ventricle, quantify function, establish myocardial perfusion maps, and estimate global and local measures of stress/rest perfusion, all with minimal user input. State-of-the-art automated techniques have been shown to offer high diagnostic accuracy for detecting coronary artery disease, as well as predict prognostic outcomes. This article briefly reviews these techniques, highlights several challenges, and discusses the latest developments.
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Affiliation(s)
- Manish Motwani
- Departments of Imaging and Medicine, Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Los Angeles, CA 90048, USA
| | - Daniel S Berman
- Departments of Imaging and Medicine, Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Los Angeles, CA 90048, USA; David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Guido Germano
- Departments of Imaging and Medicine, Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Los Angeles, CA 90048, USA; David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Piotr Slomka
- Departments of Imaging and Medicine, Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Los Angeles, CA 90048, USA; David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
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Joki N, Hase H, Kawano Y, Nakamura S, Nakajima K, Hatta T, Nishimura S, Moroi M, Nakagawa S, Kasai T, Kusuoka H, Takeishi Y, Momose M, Takehana K, Nanasato M, Yoda S, Nishina H, Matsumoto N, Nishimura T. Myocardial perfusion imaging for predicting cardiac events in Japanese patients with advanced chronic kidney disease: 1-year interim report of the J-ACCESS 3 investigation. Eur J Nucl Med Mol Imaging 2014; 41:1701-9. [PMID: 24827603 DOI: 10.1007/s00259-014-2781-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2013] [Accepted: 04/03/2014] [Indexed: 12/17/2022]
Abstract
PURPOSE Whether myocardial perfusion imaging (MPI) can predict cardiac events in patients with advanced conservative chronic kidney disease (CKD) remains unclear. METHODS The present multicenter prospective cohort study aimed to clarify the ability of MPI to predict cardiac events in 529 patients with CKD and estimated glomerular filtration rates (eGFR) < 50 ml/min per 1.73(2) without a definitive diagnosis of coronary artery disease. All patients were assessed by stress-rest MPI with (99m)Tc-tetrofosmin and analyzed using summed defect scores and QGS software. Cardiac events were analyzed 1 year after registration. RESULTS Myocardial perfusion abnormalities defined as summed stress score (SSS) ≥4 and ≥8 were identified in 19 and 7 % of patients, respectively. At the end of the 1-year follow-up, 33 (6.2 %) cardiac events had occurred that included cardiac death, sudden death, nonfatal myocardial infarction, and hospitalization due to heart failure. The event-free rates at that time were 0.95, 0.90, and 0.81 for groups with SSS 0-3, 4-7, and ≥8, respectively (p = 0.0009). Thus, patients with abnormal SSS had a higher incidence of cardiac events. Multivariate Cox regression analysis showed that SSS significantly impacts the prediction of cardiac events independently of eGFR and left ventricular ejection fraction. CONCLUSION MPI would be useful to stratify patients with advanced conservative CKD who are at high risk of cardiac events without adversely affecting damaged kidneys.
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Affiliation(s)
- Nobuhiko Joki
- Department of Nephrology, Toho University Ohashi Medical Center, Tokyo, Japan
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Thorley PJ, Bould M, Chowdhury FU. Gated cardiac SPECT: can it be used for serial assessment of left ventricular function in oncology patients? Nucl Med Commun 2013; 34:1137-40. [PMID: 24157899 PMCID: PMC3815161 DOI: 10.1097/mnm.0000000000000000] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Accepted: 08/27/2013] [Indexed: 12/28/2022]
Affiliation(s)
- Penelope J Thorley
- Departments of aMedical Physics bNuclear Medicine cClinical Radiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
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UK audit of quantification of left-ventricular function using gated myocardial perfusion imaging. Nucl Med Commun 2013; 34:990-1004. [PMID: 23880898 DOI: 10.1097/mnm.0b013e328363f86d] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE The aim of the study was to evaluate UK-wide interinstitutional reproducibility of left-ventricular functional parameters, end-systolic volume, end-diastolic volume and ejection fraction, obtained from gated myocardial perfusion imaging (GMPI) studies using technetium-99m-labelled radiopharmaceuticals. The study was carried out by the UK Institute of Physics and Engineering in Medicine Nuclear Medicine Software Quality Group. MATERIALS AND METHODS Ten anonymized clinical GMPI studies, five with normal perfusion and five with perfusion defects, were made available in DICOM and proprietary formats for download and through manufacturers' representatives. Two of the studies were duplicated in order to assess intraoperator repeatability, giving a total of 12 studies. Studies were made available in 8 and 16 frames/cycle. RESULTS A total of 58 institutions across England, Scotland, Wales and Northern Ireland participated in this study using six different computer packages. Studies were processed at centres using their normal clinical computers and software. The overall mean±SD ejection fraction for all centres was 58.5±3%; the mean end-diastolic volume was 114±12 ml and the mean end-systolic volume was 54±6 ml. The results were affected by the number of frames per cycle and by the postprocessing computer package, but not by the reconstruction filter in the filtered back-projection. CONCLUSION Calculation of functional parameters from GMPI using technetium-99m-labelled radiopharmaceuticals is reliable and shows limited variability across the UK.
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Nakajima K, Okuda K, Nyström K, Richter J, Minarik D, Wakabayashi H, Matsuo S, Kinuya S, Edenbrandt L. Improved quantification of small hearts for gated myocardial perfusion imaging. Eur J Nucl Med Mol Imaging 2013; 40:1163-70. [PMID: 23632963 PMCID: PMC3699706 DOI: 10.1007/s00259-013-2431-x] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2013] [Accepted: 04/10/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE In patients with a small heart, defined as an end-systolic volume (ESV) of ≤20 mL calculated using the Quantitative Gated SPECT (QGS) program, underestimation of ESV and overestimation of ejection fraction (EF) using gated myocardial perfusion imaging are considered errors caused by inappropriate delineation of the left ventricle (LV). The aim of this study was to develop a new method for delineation of the LV and to evaluate it in studies using a digital phantom, normal subjects and patients. METHODS The active shape-based method for LV delineation, EXINI heart (ExH), was adjusted to more accurately process small hearts. In small hearts, due to the partial volume effect and the short distance to the opposite ventricular wall, the endocardial and the epicardial surfaces are shifted in the epicardial direction depending on the midventricular volume. The adjusted method was evaluated using digital XCAT phantoms with Monte Carlo simulation (8 virtual patients), a Japanese multicentre normal database (69 patients) and consecutive Japanese patients (116 patients). The LV volumes, EF and diastolic parameters derived from ExH and QGS were compared. RESULTS The digital phantom studies showed a mean ESV of 87% ± 9% of the true volume calculated using ExH and 22 % ± 18% calculated using QGS. In the normal database, QGS gave higher EFs in women than in men (71.4 ± 6.0 % vs. 67.2 ± 6.0%, p = 0.0058), but ExH gave comparable EFs (70.7 ± 4.9% and 71.4 ± 5 % in men and women, respectively, p = ns). QGS gave higher EFs in subjects with a small heart than in those with a normal-sized heart (74.5 ± 5.1% vs. 66.1 ± 4.9%), but ExH gave comparable values (70.0 ± 5.9% vs. 71.6 ± 4.2%, respectively, p = ns). In consecutive patients, the average EFs with QGS in patients with ESV >20 mL, 11-20 mL and ≤10 mL were 57.9%, 71.9% and 83.2%, but with ExH the differences among these groups were smaller (65.2%, 67.8% and 71.5%, respectively). CONCLUSION The volume-dependent edge correction algorithm was able to effectively reduce the effects on ESV and EF of a small heart. The uniform normal values might be applicable to both men and women and to both small and normal-sized hearts.
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Chapter 4: Other complications of CKD: CVD, medication dosage, patient safety, infections, hospitalizations, and caveats for investigating complications of CKD. Kidney Int Suppl (2011) 2013; 3:91-111. [PMID: 25599000 PMCID: PMC4284425 DOI: 10.1038/kisup.2012.67] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
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Nakajima K, Matsuo S, Okuda K, Wakabayashi H, Tsukamoto K, Nishimura T. Estimation of cardiac event risk by gated myocardial perfusion imaging and quantitative scoring methods based on a multi-center J-ACCESS database. Circ J 2011; 75:2417-23. [PMID: 21799273 DOI: 10.1253/circj.cj-11-0371] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Myocardial perfusion imaging (MPI) has been used to estimate cardiac event risk. The aim of the present study is to achieve stable risk estimation based on perfusion scoring and a multi-center prognostic database. METHODS AND RESULTS Multivariate logistic regression analysis was performed to estimate cardiac event risk based on a J-ACCESS study. A stress-MPI was performed in 45 patients with coronary artery disease (CAD) and in 25 non-CAD patients. Perfusion defect scoring of summed stress score (SSS) was performed by 5 methods: (1) visual scoring; (2) automatic scoring of 3 short-axis and 1 vertical long-axis slices; (3) visual modification of Method 2; (4) automatic polar map scoring based on a Japanese multi-center database; and (5) visual modification of Method 4. Agreement of SSS between 2 observers was good (r=0.87-0.97). Agreement of estimated cardiac event risk between observers and among 5 methods was very good (r=0.99-1.00). Regarding diagnostic accuracy for CAD, Method 5 showed optimal diagnostic yields (sensitivity 84%, accuracy 77%). CONCLUSIONS Estimation of cardiac event risk in conjunction with polar map segmentation and common normal databases resulted in stable risk values, and might be used for risk stratification in patients suspected of having CAD.
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Affiliation(s)
- Kenichi Nakajima
- Department of Nuclear Medicine, Kanazawa University Hospital, Kanazawa, Japan.
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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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Moroi M, Yamashina A, Tsukamoto K, Nishimura T. Coronary revascularization does not decrease cardiac events in patients with stable ischemic heart disease but might do in those who showed moderate to severe ischemia. Int J Cardiol 2011; 158:246-52. [PMID: 21342709 DOI: 10.1016/j.ijcard.2011.01.040] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2010] [Revised: 01/10/2011] [Accepted: 01/13/2011] [Indexed: 01/29/2023]
Abstract
BACKGROUND As an initial management strategy for stable ischemic heart disease (IHD), coronary revascularization therapy is thought to be equal to optimal medical therapy alone regarding prognosis. METHODS Whether or not the effects of revascularization on the prognosis of patients with stable IHD are associated with the amount of ischemic myocardium detected by nuclear stress imaging was evaluated. This retrospective study analyzed data from 4629 patients with suspected or known IHD who underwent gated stress myocardial-perfusion SPECT at 117 hospitals in Japan. The follow-up periods were three years and the combined endpoints consisted of cardiac death, nonfatal myocardial infarction, and congestive heart failure requiring hospitalization. After matching propensity scores between patients who underwent early revascularization and those who did not (n=316 per group), we compared cardiac event rates in relation to the amount of ischemic myocardium. RESULTS Cardiac event rates did not significantly differ between patients who underwent early revascularization and those who did not (5.4% vs. 6.4%). Among patients with ≤ 5%, 6-10%, and >10% ischemic myocardium, cardiac event rates were 8%, 3% and 0% respectively, who underwent early revascularization compared with 4.5%, 6.1%, and 12.3%, respectively, among those who did not. Cardiac event rates were significantly lower among patients with >10% ischemic myocardium who underwent early revascularization compared with those who did not (0% vs. 12.3%, p=0.0062). CONCLUSIONS Coronary revascularization for stable IHD does not decrease major cardiac events in all patients but might do in patients with moderate to severe ischemia.
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Affiliation(s)
- Masao Moroi
- Division of Cardiovascular Medicine, Toho University Ohashi Medical Center, Tokyo, Japan.
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Nakamura S, Kawano Y, Hase H, Hatta T, Nishimura S, Moroi M, Nakagawa S, Kasai T, Kusuoka H, Takeishi Y, Nakajima K, Momose M, Takehana K, Nanasato M, Yoda S, Nishina H, Matsumoto N, Nishimura T. Prognostic study of cardiac and renal events in Japanese patients with chronic kidney disease and cardiovascular risk using myocardial perfusion SPECT: J-ACCESS 3 study design. Ther Apher Dial 2010; 14:379-85. [PMID: 20649758 DOI: 10.1111/j.1744-9987.2010.00823.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Cardiovascular disease is the leading cause of morbidity and mortality in patients with chronic kidney disease. Recent studies have indicated that the incidence of cardiovascular disease increases inversely with estimated glomerular filtration rate. Although coronary angiography is considered the gold standard for detecting coronary artery disease, contrast-induced nephropathy or cholesterol microembolization remain serious problems; therefore, a method of detecting coronary artery disease without renal deterioration is desirable. From this viewpoint, stress myocardial perfusion single photon emission computed tomography (SPECT) might be useful for patients with chronic kidney disease. We recently performed the Japanese Assessment of Cardiac Events and Survival Study by Quantitative Gated SPECT (J-ACCESS) investigating patients with suspected or extant coronary artery disease and the J-ACCESS 2 study of patients with diabetes. The findings from these studies showed that SPECT can detect coronary artery disease and help to predict future cardiac events. Thus, we proposed a multicenter, prospective cohort study called "J-ACCESS 3" in patients with chronic kidney disease and cardiovascular risk. The study aimed at predicting cardiovascular and renal events based on myocardial perfusion imaging and clinical backgrounds. We began enrolling patients in J-ACCESS 3 at 74 facilities from April 2009 and will continue to do so until 31 March 2010, with the aim of having a cohort of 800 patients. These will be followed up for three years. The primary endpoints will be cardiac death and sudden death. The secondary endpoints will comprise any cardiovascular or renal events. This study will be completed in 2013. Here, we describe the design of the J-ACCESS 3 study.
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Affiliation(s)
- Satoko Nakamura
- Department of Medicine, Division of Hypertension and Nephrology, National Cardiovascular Center, Suita, Japan
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Matsuo S, Nakajima K, Kinuya S. Clinical use of nuclear cardiology in the assessment of heart failure. World J Cardiol 2010; 2:344-56. [PMID: 21160612 PMCID: PMC2999043 DOI: 10.4330/wjc.v2.i10.344] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2010] [Revised: 09/01/2010] [Accepted: 09/08/2010] [Indexed: 02/06/2023] Open
Abstract
A nuclear cardiology test is the most commonly performed non-invasive cardiac imaging test in patients with heart failure, and it plays a pivotal role in their assessment and management. Quantitative gated single positron emission computed tomography (QGS) is used to assess quantitatively cardiac volume, left ventricular ejection fraction (LVEF), stroke volume, and cardiac diastolic function. Resting and stress myocardial perfusion imaging, with exercise or pharmacologic stress, plays a fundamental role in distinguishing ischemic from non-ischemic etiology of heart failure, and in demonstrating myocardial viability. Diastolic heart failure also termed as heart failure with a preserved LVEF is readily identified by nuclear cardiology techniques and can accurately be estimated by peak filling rate (PFR) and time to PFR. Movement of the left ventricle can also be readily assessed by QGS, with newer techniques such as three-dimensional, wall thickening evaluation aiding its assessment. Myocardial perfusion imaging is also commonly used to identify candidates for implantable cardiac defibrillator and cardiac resynchronization therapies. Neurotransmitter imaging using (123)I-metaiodobenzylguanidine offers prognostic information in patients with heart failure. Metabolism and function in the heart are closely related, and energy substrate metabolism is a potential target of medical therapies to improve cardiac function in patients with heart failure. Cardiac metabolic imaging using (123)I-15-(p-iodophenyl)3-R, S-methylpentadecacoic acid is a commonly used tracer in clinical studies to diagnose metabolic heart failure. Nuclear cardiology tests, including neurotransmitter imaging and metabolic imaging, are now easily preformed with new tracers to refine heart failure diagnosis. Nuclear cardiology studies contribute significantly to guiding management decisions for identifying cardiac risk in patients with heart failure.
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Affiliation(s)
- Shinro Matsuo
- Shinro Matsuo, Kenichi Nakajima, Seigo Kinuya, Department of Nuclear Medicine, Kanazawa University Hospital, Kanazawa 920-8641, Ishikawa, Japan
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Usui Y, Chikamori T, Nakajima K, Hida S, Yamashina A, Nishimura T. Prognostic value of post-ischemic stunning as assessed by gated myocardial perfusion single-photon emission computed tomography: a subanalysis of the J-ACCESS study . Circ J 2010; 74:1591-9. [PMID: 20571246 DOI: 10.1253/circj.cj-10-0074] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND To determine the prognostic value of post-ischemic stunning, the Japanese assessment of cardiac event and survival study by quantitative gated myocardial single-photon emission computed tomography (SPECT) (J-ACCESS) study was reevaluated. METHODS AND RESULTS Of the 4,031 patients of the J-ACCESS, the present study evaluated 1,089 who completed gated SPECT both after stress and at rest. To assess post-ischemic stunning, the following measurements (left ventricular volumes after stress minus volumes at rest) were made: Deltaend-systolic volume (DeltaESV), Deltaenddiastolic volume (DeltaEDV) and Deltaejection fraction (DeltaEF). Myocardial stunning defined either as DeltaESV >or=5 ml, DeltaEDV >or=5 ml or DeltaEF <or=5% was observed in 21%, 22%, or 26%, respectively. During a 3-year follow-up, 101 cardiac events occurred. Kaplan-Meier survival estimation indicated worse event-free survival rates in patients with dilated ESV, dilated EDV, LVEF <or=45%, DeltaESV >or=5 ml or DeltaEDV >or=5 ml than in those without, whereas DeltaEF <or=5% did not predict events. Multivariate analysis demonstrated that LVEF <or=45% was the independent predictor for cardiac events. Nevertheless, DeltaEDV >or=5 ml was also an independent parameter, in addition to LVEF <or=45%, to predict the combined endpoint of cardiac death, myocardial infarction, and revascularization, but excluding heart failure. CONCLUSIONS These results indicate that post-ischemic stunning, as assessed by gated SPECT, is a marker for poor prognosis, particularly for ischemic cardiac events.
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Affiliation(s)
- Yasuhiro Usui
- Department of Cardiology, Tokyo Medical University, Tokyo, Japan
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Sciagrà R, Berti V, Genovese S, Pupi A. Reliability of myocardial perfusion gated SPECT for the reproducible evaluation of resting left ventricular functional parameters in long-term follow-up. Eur J Nucl Med Mol Imaging 2010; 37:1722-9. [PMID: 20393711 DOI: 10.1007/s00259-010-1444-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2009] [Accepted: 03/08/2010] [Indexed: 11/28/2022]
Affiliation(s)
- Roberto Sciagrà
- Department of Clinical Physiopathology, University of Florence, Florence, Italy.
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Nakata T, Hashimoto A, Wakabayashi T, Kusuoka H, Nishimura T. Prediction of new-onset refractory congestive heart failure using gated myocardial perfusion SPECT imaging in patients with known or suspected coronary artery disease subanalysis of the J-ACCESS database. JACC Cardiovasc Imaging 2010; 2:1393-400. [PMID: 20083074 DOI: 10.1016/j.jcmg.2009.09.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2009] [Revised: 09/16/2009] [Accepted: 09/22/2009] [Indexed: 10/20/2022]
Abstract
OBJECTIVES The purpose of this study was to evaluate the predictive value of perfusion/function parameters measured by gated myocardial perfusion single-photon emission computed tomography (SPECT)in combination with clinical variables in patients with known or suspected coronary artery disease to predict refractory heart failure (HF). BACKGROUND The increasing number of HF patients requires the establishment of a prophylactic strategy that can identify patients at high risk of HF due to coronary artery disease. METHODS We analyzed clinical and stress/rest-gated SPECT data from the multicenter, prospective, and observational J-ACCESS (Japanese Assessment of Cardiac Events and Survival Study by Quantitative Gated SPECT) database of 3,835 known or suspected coronary artery disease patients in which new-onset congestive HF symptoms requiring aggressive medical treatment were observed in 71 patients for 3 years. RESULTS The multivariable Cox hazard model revealed that chronic renal dysfunction (hazard ratio(HR): 6.227 [95% confidence interval (CI): 2.920 to 13.279]), the end-systolic volume index (ESVI) (HR:1.019 [95% CI: 1.011 to 1.029]), and moderate to high stress summed score (SSS) (HR: 3.012 [95% CI: 1.757 to 5.181]) independently (p < 0.0001) predicted HF. In addition to the close (p < 0.0001) correlation of ESVI and SSS with HF incidence, the combined tertiles of SSS and ESVI revealed high-risk patients with a maximally 17.3 times greater risk (5.2%/3 years) compared with the minimal risk (0.3%/3 years) at a normal to low SSS and lower ESVI. Chronic renal dysfunction combined with ESVI and SSS categories had the greatest (p < 0.005 to 0.001) incremental prognostic value with a global chi-square value (125.0)over single or other combined risks. CONCLUSIONS Chronic renal dysfunction, greater stress-induced perfusion abnormality, and higher ESVI provide independent and additive information for predicting the risk of refractory HF in known or suspected coronary patients, indicating the efficacy of perfusion/function parameters measured by stress gated perfusion SPECT for identifying patients at greater risk of future refractory HF.
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Clinical significance of ischemic electrocardiographic changes during stress myocardial perfusion imaging: sub-analysis of the J-ACCESS study. Ann Nucl Med 2010; 24:215-24. [DOI: 10.1007/s12149-010-0346-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2009] [Accepted: 01/18/2010] [Indexed: 11/25/2022]
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Nakajima K. Normal values for nuclear cardiology: Japanese databases for myocardial perfusion, fatty acid and sympathetic imaging and left ventricular function. Ann Nucl Med 2010; 24:125-35. [PMID: 20108130 PMCID: PMC2855806 DOI: 10.1007/s12149-009-0337-2] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2009] [Accepted: 12/15/2009] [Indexed: 08/30/2023]
Abstract
Myocardial normal databases for stress myocardial perfusion study have been created by the Japanese Society of Nuclear Medicine Working Group. The databases comprised gender-, camera rotation range- and radiopharmaceutical-specific data-sets from multiple institutions, and normal database files were created for installation in common nuclear cardiology software. Based on the electrocardiography-gated single-photon emission computed tomography (SPECT), left ventricular function, including ventricular volumes, systolic and diastolic functions and systolic wall thickening were also analyzed. Normal databases for fatty acid imaging using 123I-beta-methyl-iodophenyl-pentadecanoic acid and sympathetic imaging using 123I-meta-iodobenzylguanidine were also examined. This review provides lists and overviews of normal values for myocardial SPECT and ventricular function in a Japanese population. The population-specific approach is a key factor for proper diagnostic and prognostic evaluation.
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Affiliation(s)
- Kenichi Nakajima
- Department of Nuclear Medicine, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Japan.
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Matsuo S, Nakajima K, Yamasaki Y, Kashiwagi A, Nishimura T. Prognostic Value of Normal Stress Myocardial Perfusion Imaging and Ventricular Function in Japanese Asymptomatic Patients With Type 2 Diabetes - A Study Based on the J-ACCESS-2 Database -. Circ J 2010; 74:1916-21. [DOI: 10.1253/circj.cj-10-0098] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Shinro Matsuo
- Department of Nuclear Medicine, Kanazawa University Hospital
| | | | | | | | - Tsunehiko Nishimura
- Department of Radiology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine
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The validity of multi-center common normal database for identifying myocardial ischemia: Japanese Society of Nuclear Medicine working group database. Ann Nucl Med 2009; 24:99-105. [PMID: 20035388 DOI: 10.1007/s12149-009-0331-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2009] [Accepted: 11/26/2009] [Indexed: 10/20/2022]
Abstract
PURPOSE The Japanese Society of Nuclear Medicine (JSNM) working group has created a myocardial perfusion imaging database applicable to standard acquisition protocol. The aim of this study is to validate the diagnostic accuracy of the common normal database compared with the expert interpretation of each institute. METHODS Five institutions participated in this study and used different acquisition settings which included 360 degrees /180 degrees rotation, camera configuration and camera orbits. The software and its version used in each institution also varied. The working group database was applied to detect the culprit coronary territory from a total of 166 patients with coronary artery disease (CAD) and 145 patients with low-likelihood of CAD. RESULTS When summed stress score > or =4 was defined as significant abnormality, overall sensitivity, specificity and accuracy of patient-based analysis were 77, 72 and 75%, respectively, based on quantitative analysis using the common database, whereas those by institutional visual expert reading were 72, 79 and 75%, respectively. CONCLUSION The common database, which was created by a multi-center working group and separated between male/female with 180/360 degrees acquisitions, demonstrated comparable diagnostic accuracy to expert interpretation by each institute, and it may be applicable to multi-center studies.
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Imamura Y, Fukuyama T, Nishimura S, Nishimura T. Normal myocardial perfusion scan portends a benign prognosis independent from the pretest probability of coronary artery disease. Sub-analysis of the J-ACCESS study. J Cardiol 2009; 54:93-100. [DOI: 10.1016/j.jjcc.2009.04.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2009] [Revised: 03/26/2009] [Accepted: 04/21/2009] [Indexed: 10/20/2022]
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Cardiovascular events in Japanese asymptomatic patients with type 2 diabetes: a 1-year interim report of a J-ACCESS 2 investigation using myocardial perfusion imaging. Eur J Nucl Med Mol Imaging 2009; 36:2049-57. [DOI: 10.1007/s00259-009-1207-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2009] [Accepted: 06/07/2009] [Indexed: 10/20/2022]
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Nakajima K, Kusuoka H, Nishimura S, Yamashina A, Nishimura T. Prognostic value of myocardial perfusion and ventricular function in a Japanese multicenter cohort study (J-ACCESS): the first-year total events and hard events. Ann Nucl Med 2009; 23:373-81. [DOI: 10.1007/s12149-009-0248-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2008] [Accepted: 01/19/2009] [Indexed: 10/20/2022]
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Nakajima K, Nishimura T. Prognostic table for predicting major cardiac events based on J-ACCESS investigation. Ann Nucl Med 2009; 22:891-7. [PMID: 19142708 DOI: 10.1007/s12149-008-0189-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2008] [Accepted: 07/03/2008] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The event risk of patients with coronary heart disease may be estimated by a large-scale prognostic database in a Japanese population. The aim of this study was to create a heart risk table for predicting the major cardiac event rate. METHODS Using the J-ACCESS database created by a prognostic investigation involving 117 hospitals and >4,000 patients in Japan, multivariate logistic regression analysis was performed. The major event rate over a 3-year period that included cardiac death, non-fatal myocardial infarction, and severe heart failure requiring hospitalization was predicted by the logistic regression equation. The algorithm for calculating the event rate was simplified for creating tables. RESULTS Two tables were created to calculate cardiac risk by age, perfusion score category, and ejection fraction with and without the presence of diabetes. A relative risk table comparing age-matched control subjects was also made. When the simplified tables were compared with the results from the original logistic regression analysis, both risk values and relative risks agreed well (P < 0.0001 for both). CONCLUSIONS The Heart Risk Table was created for patients suspected of having ischemic heart disease and who underwent myocardial perfusion gated single-photon emission computed tomography. The validity of risk assessment using a J-ACCESS database should be validated in a future study.
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Affiliation(s)
- Kenichi Nakajima
- Department of Nuclear Medicine, Faculty of Medicine, Institute of Medical, Pharmaceutical and Health Sciences, 13-1 Takaramachi, Kanazawa 920-8641, Japan.
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Hashimoto A, Nakata T, Wakabayashi T, Kusuoka H, Nishimura T. Incremental Prognostic Value of Stress/Rest Gated Perfusion SPECT in Patients With Coronary Artery Disease Subanalysis of the J-ACCESS Study. Circ J 2009; 73:2288-93. [DOI: 10.1253/circj.cj-09-0212] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
| | - Tomoaki Nakata
- Sapporo Medical University School of Medicine
- Hokkaido Prefectural Esashi Hospital
| | | | | | - Tsunehiko Nishimura
- Graduate School of Medical Science, Kyoto Prefectural University of Medicine
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Matsumoto N, Sato Y, Suzuki Y, Kasama S, Nakano Y, Kato M, Yoda S, Miki T, Iida J, Kunimasa T, Tadehara F, Nagao K, Hirayama A. Incremental prognostic value of cardiac function assessed by ECG-gated myocardial perfusion SPECT for the prediction of future acute coronary syndrome. Circ J 2008; 72:2035-9. [PMID: 18948667 DOI: 10.1253/circj.cj-08-0488] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The prognostic value of ECG-gated rest 201Tl/stress 99mTc-tetrofosmin myocardial perfusion single-photon emission computed tomography for the prediction of acute coronary syndrome (ACS: myocardial infarction (MI) and unstable angina (UA)) and the implications of ejection fraction (EF) has not yet been defined in Japanese. METHODS AND RESULTS The 1,895 patients were followed up for the occurrence ACS. The mean follow-up interval was 26.9+/-15.5 months. The 142 patients with revascularization within 60 days were censored. Summed stress score (SSS) and summed difference score (SDS) were calculated. The 19 MI and 29 UA occurred (1.1% and 1.6%, respectively). Univariate Cox analysis showed that hypertension (Wald 5.09, p<0.05), poststress EF (Wald 10.9, p<0.01), SSS (Wald 12.4, p<0.001) and SDS (Wald 18.7, p<0.001) were significant predictors of ACS. Multivariate Cox analysis showed that hypertension (Wald 4.27, p<0.05) and SDS (Wald 8.59, p<0.01) were independent predictors. When multiple clinical risk factors (number of coronary risk factors > or =2), significant ischemia (SDS > or =4) and low EF (EF <45%) were applied to multivariate Cox analysis, the combination of significant ischemia and low EF showed the highest predictive value (Wald 11.9; p<0.001) for future ACS. CONCLUSION Poststress EF added incremental prognostic value for the prediction of ACS.
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Affiliation(s)
- Naoya Matsumoto
- Department of Cardiology, Nihon University School of Medicine, Tokyo
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Prediction of functional recovery after revascularization using quantitative gated myocardial perfusion SPECT: a multi-center cohort study in Japan. Eur J Nucl Med Mol Imaging 2008; 35:2038-48. [DOI: 10.1007/s00259-008-0838-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2008] [Accepted: 05/02/2008] [Indexed: 11/27/2022]
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Surveillance study for creating the national clinical database relating to ECG-gated myocardial perfusion SPECT of asymptomatic ischemic heart disease in patients with type-2 diabetes mellitus: J-ACCESS 2 study design. Ann Nucl Med 2008; 22:13-21. [DOI: 10.1007/s12149-007-0079-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2007] [Accepted: 08/31/2007] [Indexed: 11/26/2022]
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Creation and characterization of Japanese standards for myocardial perfusion SPECT: database from the Japanese Society of Nuclear Medicine Working Group. Ann Nucl Med 2007; 21:505-11. [DOI: 10.1007/s12149-007-0059-2] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2007] [Accepted: 08/01/2007] [Indexed: 10/22/2022]
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Nishimura T, Nakajima K, Kusuoka H, Yamashina A, Nishimura S. Prognostic study of risk stratification among Japanese patients with ischemic heart disease using gated myocardial perfusion SPECT: J-ACCESS study. Eur J Nucl Med Mol Imaging 2007; 35:319-28. [DOI: 10.1007/s00259-007-0608-x] [Citation(s) in RCA: 81] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2007] [Accepted: 09/15/2007] [Indexed: 10/22/2022]
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Sciagrà R. The expanding role of left ventricular functional assessment using gated myocardial perfusion SPECT: the supporting actor is stealing the scene. Eur J Nucl Med Mol Imaging 2007; 34:1107-22. [PMID: 17384947 DOI: 10.1007/s00259-007-0405-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Gating of single-photon emission computed tomography (SPECT) has significantly improved the reliability and diagnostic accuracy of myocardial perfusion imaging. The functional parameters derived from this technique, mainly left ventricular volumes and ejection fraction, have been demonstrated to be accurate and reproducible. They are able to increase the detection of severe and extensive coronary artery disease and show a significant incremental prognostic power over perfusion abnormalities. Therefore, the importance given to gated SPECT functional data has progressively grown. DISCUSSION This circumstance has further expanded the indications for myocardial perfusion imaging and strengthened its position among the different imaging modalities. Moreover, several studies show that the evaluation of ventricular function may have a leading part in justifying the execution of perfusion scintigraphy in various clinical conditions. AIM Aim of this review is to describe this evolution of gated SPECT functional assessment from a supporting rank with respect to perfusion, to a main actor position in the field of cardiac imaging.
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Affiliation(s)
- Roberto Sciagrà
- Nuclear Medicine Unit, Department of Clinical Physiopathology, University of Florence, Viale Morgagni 85, 50134 Florence, Italy.
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Nakajima K, Kusuoka H, Nishimura S, Yamashina A, Nishimura T. Normal limits of ejection fraction and volumes determined by gated SPECT in clinically normal patients without cardiac events: a study based on the J-ACCESS database. Eur J Nucl Med Mol Imaging 2007; 34:1088-96. [PMID: 17219133 DOI: 10.1007/s00259-006-0321-1] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2006] [Accepted: 10/25/2006] [Indexed: 10/23/2022]
Abstract
PURPOSE Quantitative gated single-photon emission computed tomography (SPECT) is known to have high accuracy and precision for measurement of the principal cardiac functional parameters. We hypothesised that normal values for EF and LV volumes may differ among nationalities, and that optimal threshold values specific to the study population are required. METHODS Among 4,670 consecutively registered patients for a J-ACCESS (Japanese investigation regarding prognosis based on gated SPECT) study from 117 hospitals, a total of 268 (149 women, 119 men) were selected who had no baseline cardiac diseases and had experienced no cardiac events during the preceding 3-year period. A gated SPECT study was performed with 99mTc-tetrofosmin and analysed with Cedars Sinai Medical Center's quantitative gated SPECT (QGS) software. The results in respect of ejection fraction (EF), end-diastolic volume (EDV), end-systolic volume (ESV) and stroke volume (SV), and EDV, ESV and SV normalised by body surface area (EDVI, ESVI and SVI), were calculated and summarised to obtain normal limits. RESULTS EF for women and men was 74 +/- 9% and 63 +/- 7%, respectively (p < 0.0001). EDV, ESV and SV were significantly smaller in women than in men. Based on multiple regressions for linear models, the primary and secondary predictors of EF, EDVI, ESVI were gender and age. By stepwise multiple regression analysis, a statistically significant third predictor for EDV, ESV, SV and SVI was body weight. No colinearity was found between age and body weight. Important factors for the studied Japanese population included a high incidence of small hearts in women and the relatively advanced age of the population (the mean age +/-SD was 64.1 +/- 10.0 years for women and 60.9 +/- 11.7 years for men). CONCLUSION EF and volumes determined by gated SPECT with QGS were significantly affected by gender and age, with body weight as a third predictor for volumes. Moreover, the normal limits were so specific for the population studied that standards appropriate for the study in question should be utilised.
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Affiliation(s)
- Kenichi Nakajima
- Department of Nuclear Medicine, Kanazawa University Hospital, 13-1 Takara-machi, Kanazawa 920-8641, Japan.
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Matsuo S, Nakajima K, Horie M, Nakae I, Nishimura T, The J-ACCESS Investigators. Prognostic Value of Normal Stress Myocardial Perfusion Imaging in Japanese Population A Study Based on the J-ACCESS Study. Circ J 2007; 72:611-7. [DOI: 10.1253/circj.72.611] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Shinro Matsuo
- Department of Nuclear Medicine, Kanazawa University Hospital
| | | | - Minoru Horie
- Department of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science
| | - Ichiro Nakae
- Department of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science
| | - Tsunehiko Nishimura
- Department of Radiology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine
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Nagao T, Chikamori T, Hida S, Igarashi Y, Kuwabara Y, Nishimura S, Yamazaki J, Yamashina A. Quantitative Gated Single-Photon Emission Computed Tomography With 99mTc Sestamibi Predicts Major Cardiac Events in Elderly Patients With Known or Suspected Coronary Artery Disease The QGS-Prognostic Value in the Elderly (Q-PROVE) Study. Circ J 2007; 71:1029-34. [PMID: 17587706 DOI: 10.1253/circj.71.1029] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Although electrocardiogram-gated single-photon emission computed tomography (SPECT) may be useful in risk stratification of elderly patients with coronary artery disease (CAD), few studies have prospectively evaluated its prognostic value in this patient population. METHODS AND RESULTS A total of 175 patients aged 75 years or more with known or suspected CAD were prospectively evaluated by stress gated SPECT using a 20-segment model and an automatic functional analysis. Patients with acute coronary syndrome within the previous 3 months, and those who underwent coronary revascularization within 3 months after the SPECT study were excluded. Outcome assessment included prespecified cardiac events and noncardiac deaths. During a mean follow-up of 3.4 years, there were 18 cardiac events: 2 cardiac deaths, 1 nonfatal myocardial infarction, 3 coronary artery bypass grafting, 5 percutaneous coronary interventions, 1 unstable angina, 4 heart failures, and 2 malignant arrhythmias. Kaplan-Meier survival estimation indicated an event-free survival rate of 98.1% at 3 years in patients without myocardial ischemia, but 79.9% in those with ischemia as documented by gated SPECT (p=0.0001). Multivariate analysis using the Cox proportional hazard model demonstrated that stress-induced myocardial ischemia was the only independent predictor for subsequent cardiac events (p<0.01). CONCLUSIONS Stress gated SPECT predicts cardiac events in patients aged 75 years or more with known or suspected CAD and may have a role in risk stratification of this patient population.
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Affiliation(s)
- Tadashi Nagao
- Department of Cardiology, Tokyo Medical University, Tokyo, Japan
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