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Okada M, Kashiwase K, Hirata A, Nishio M, Takeda Y, Nemoto T, Amiya R, Ueda Y, Higuchi Y, Yasumura Y. Evaluation of Need for Implantable Cardioverter-Defibrillator by Thallium-201 Scintigraphy Among Japanese Patients With Prior Myocardial Infarction. Circ J 2018; 83:56-66. [PMID: 30381700 DOI: 10.1253/circj.cj-17-1436] [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: 11/09/2022]
Abstract
BACKGROUND Identifying who among current Japanese patients with prior myocardial infarction (MI) would benefit from an implantable cardioverter-defibrillator (ICD) is imperative. Accordingly, this study seeks to determine whether single-photon emission computed tomography (SPECT) can help identify such patients. Methods and Results: This retrospective study enrolled 60 consecutive patients with prior MI who underwent stress thallium-201 SPECT and ICD implantation from February 2000 to October 2014. Occurrence of arrhythmic death and/or or appropriate ICD therapy, defined as shock or antitachycardia pacing for ventricular fibrillation or tachycardia, was identified until November 2016. During the median follow-up interval of 6.6 years, 18 (30%) patients experienced arrhythmic death and/or appropriate ICD therapy. Multivariate Cox proportional hazard regression analysis revealed that the summed stress score (SSS) [hazard ratio (HR)=1.14; P=0.005] and left ventricular ejection fraction (LVEF) at rest (HR=0.92; P=0.038) were significantly associated with the occurrence of arrhythmic events. Patients with SSS ≥21 and LVEF ≤30%, which were determined to be the best cutoff points, had significantly higher incidence of the arrhythmic events than the other patients (64% vs. 11%; HR=7.18; log-rank P=0.001). CONCLUSIONS SSS using stress thallium-201 SPECT in combination with LVEF can help determine the need for ICD therapy among current Japanese patients with prior MI.
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Affiliation(s)
| | | | - Akio Hirata
- Cardiovascular Division, Osaka Police Hospital
| | - Mayu Nishio
- Division of Cardiovascular Medicine, Saiseikai Senri Hospital
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2
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Usefulness of scintigraphy to predict electrical storms in severe idiopathic dilated cardiomyopathy. Ann Nucl Med 2013; 27:407-15. [DOI: 10.1007/s12149-013-0699-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2012] [Accepted: 02/04/2013] [Indexed: 10/27/2022]
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Wong VW, Mardini M, Cheung NW, Mihailidou AS. High-dose insulin in experimental myocardial infarction in rabbits: protection against effects of hyperglycaemia. J Diabetes Complications 2011; 25:122-8. [PMID: 20206553 DOI: 10.1016/j.jdiacomp.2010.01.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2009] [Revised: 12/20/2009] [Accepted: 01/27/2010] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Hyperglycaemia at the time of acute myocardial infarction (AMI) is a predictor of survival and is associated with increased mortality and morbidity in patients with or without diabetes mellitus. On the other hand, insulin has been shown to reduce myocardial injury in experimental studies but its benefits have not been confirmed in clinical studies. METHODS The isolated perfused heart model was used to examine the direct effect of incremental doses of insulin and varying degrees of hyperglycaemia on infarct size and cardiomyocyte apoptosis in rabbit hearts. The rabbit hearts were subjected to 30-min ischaemia and 2.5-h reperfusion. RESULTS Insulin, given alone just before reperfusion, dramatically reduced infarct size in a dose-dependent manner (75-300 μU/ml) during experimental myocardial infarction (46%±2% to 10.9%±3%, P<.001). Acutely elevated glucose levels (33 mmol/L) induced a significantly greater infarct size and cardiomyocyte apoptosis compared to hearts subjected to normal glucose levels. On the other hand, high-dose insulin (300 μU/ml) given 5 min before reperfusion attenuated the extent of infarction and reduced apoptosis in hearts that were exposed to high glucose levels. CONCLUSION Acutely elevated levels of glucose induced larger infarct area during ischaemia-reperfusion, and this is mediated through proapoptotic pathways. Insulin, when given just before reperfusion, confers cardioprotection in a dose-dependent manner and reverses the detrimental effect of acute hyperglycaemia. High-dose insulin as well as maintaining normoglycaemia remain important factors that improve outcomes following myocardial infarction.
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Affiliation(s)
- Vincent W Wong
- Department of Cardiology, Royal North Shore Hospital, Sydney, NSW 2065, Australia
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Heidary S, Patel H, Chung J, Yokota H, Gupta SN, Bennett MV, Katikireddy C, Nguyen P, Pauly JM, Terashima M, McConnell MV, Yang PC. Quantitative tissue characterization of infarct core and border zone in patients with ischemic cardiomyopathy by magnetic resonance is associated with future cardiovascular events. J Am Coll Cardiol 2010; 55:2762-8. [PMID: 20538171 DOI: 10.1016/j.jacc.2010.01.052] [Citation(s) in RCA: 86] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2009] [Revised: 12/09/2009] [Accepted: 01/02/2010] [Indexed: 10/19/2022]
Abstract
OBJECTIVES This study evaluates how characterization of tissue heterogeneity of myocardial infarction by cardiovascular magnetic resonance (CMR) is associated with cardiovascular events (CVE) in patients with ischemic cardiomyopathy (ICM). BACKGROUND Prior studies demonstrated that the quantification of myocardial scar volume by CMR is superior to left ventricular end-diastolic volume, left ventricular end-systolic volume, and left ventricular ejection fraction (LVEF) in predicting future CVE in ICM patients. Evaluation of infarct heterogeneity by measuring infarct core and border zones through CMR might have a higher association with CVE. METHODS Seventy patients (mean LVEF: 25 +/- 11%) considered for revascularization or medical management +/- implantable cardiac defibrillator were enrolled. A 1.5-T GE MRI (Signa, GE Healthcare, Milwaukee, Wisconsin) was used to acquire cine and delayed enhancement images. The patients' core and border zones of infarcted myocardium were analyzed and followed for CVE. RESULTS Larger infarct border zone and its percentage of myocardium were found in the 29 patients (41%) who had CVE (median 13.3 g [interquartile range (IQR) 8.4 to 25.1 g] vs. 8.0 g [IQR 3.0 to 14.5 g], p = 0.02 and 7.8% [IQR 4.9% to 17.0%] vs. 4.1% [IQR 1.9% to 9.3%], p = 0.02, respectively). The core infarct zone and its percentage of myocardium, left ventricular end-diastolic volume, left ventricular end-systolic volume, and LVEF were not statistically significant. Sub-analysis of the medical management and revascularization patients with CVE demonstrated that the medically managed patients had a larger border zone, whereas there was no difference between border and core zones in the revascularization group (p < 0.05). CONCLUSIONS Quantification of core and border zones and their percentages of myocardium through CMR is associated with future CVE and might assist in the management of patients with ICM.
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Affiliation(s)
- Shahriar Heidary
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University, Stanford, California 94305-5233, USA
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Yokota H, Heidary S, Katikireddy CK, Nguyen P, Pauly JM, McConnell MV, Yang PC. Quantitative characterization of myocardial infarction by cardiovascular magnetic resonance predicts future cardiovascular events in patients with ischemic cardiomyopathy. J Cardiovasc Magn Reson 2008; 10:17. [PMID: 18400089 PMCID: PMC2322993 DOI: 10.1186/1532-429x-10-17] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2008] [Accepted: 04/09/2008] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Cardiovascular magnetic resonance (CMR) can provide quantitative data of the myocardial tissue utilizing high spatial and temporal resolution along with exquisite tissue contrast. Previous studies have correlated myocardial scar tissue with the occurrence of ventricular arrhythmia. This study was conducted to evaluate whether characterization of myocardial infarction by CMR can predict cardiovascular events in patients with ischemic cardiomyopathy (ICM). RESULTS We consecutively studied 86 patients with ICM (LVEF < 50%, mean LVEF: 26 +/- 12%) with CMR before revascularization or medication therapy +/- implantable cardiac defibrillator, determined the amount of myocardial scar, and followed for development of cardiovascular events. Thirty-three patients (38%) had cardiovascular events (mean follow-up: 20 +/- 16 months). Patients who developed cardiovascular events had larger scar volume and scar percentage of the myocardium than those who did not develop cardiovascular events (16.8 +/- 12.4 cm3 vs. 11.7 +/- 12.6 cm3, p = 0.023 and 10.2 +/- 6.9% vs. 7.2 +/- 6.7%, p = 0.037, respectively). There were no significant differences in LVEDV, LVESV and LVEF between the patients with and without cardiovascular events (231 +/- 76 ml vs. 230 +/- 88 ml; 180 +/- 73 ml vs. 175 +/- 90 ml; and 25 +/- 10% vs. 27 +/- 13%, respectively). CONCLUSION Quantification of the scar volume and scar percentage by CMR is superior to LVEDV, LVESV, and LVEF in prognosticating the future likelihood of the development of cardiovascular events in patients with ICM.
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Affiliation(s)
- Hajime Yokota
- Division of cardiovascular medicine, department of medicine, Stanford university, Stanford, CA, USA
| | - Shahriar Heidary
- Division of cardiovascular medicine, department of medicine, Stanford university, Stanford, CA, USA
| | - Chandra K Katikireddy
- Division of cardiovascular medicine, department of medicine, Stanford university, Stanford, CA, USA
| | - Patricia Nguyen
- Division of cardiovascular medicine, department of medicine, Stanford university, Stanford, CA, USA
| | - John M Pauly
- Department of electrical engineering, Stanford university, Stanford, CA, USA
| | - Michael V McConnell
- Division of cardiovascular medicine, department of medicine, Stanford university, Stanford, CA, USA
| | - Phillip C Yang
- Division of cardiovascular medicine, department of medicine, Stanford university, Stanford, CA, USA
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Weinsaft JW, Klem I, Judd RM. MRI for the assessment of myocardial viability. Magn Reson Imaging Clin N Am 2008; 15:505-25, v-vi. [PMID: 17976589 DOI: 10.1016/j.mric.2007.08.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Accurate distinction between viable and infarcted myocardium is important for assessment of patients who have cardiac dysfunction. Through the technique of delayed-enhancement MRI (DE-MRI), viable and infarcted myocardium can be simultaneously identified in a manner that closely correlates with histopathology findings. This article provides an overview of experimental data establishing the physiologic basis of DE-MRI-evidenced hyperenhancement as a tissue-specific marker of myocardial infarction. Clinical data concerning the utility of transmural extent of hyperenhancement for predicting response to medical and revascularization therapy are reviewed. Studies directly comparing DE-MRI to other viability imaging techniques are presented, and emerging applications for DE-MRI are discussed.
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Affiliation(s)
- Jonathan W Weinsaft
- Greenberg Division of Cardiology, Weill Medical College of Cornell University, 525 East 68th Street, Starr-4, New York, NY 10021, USA.
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Abstract
Accurate distinction between viable and infarcted myocardium is important for assessment of patients who have cardiac dysfunction. Through the technique of delayed-enhancement MRI (DE-MRI), viable and infarcted myocardium can be simultaneously identified in a manner that closely correlates with histopathology findings. This article provides an overview of experimental data establishing the physiologic basis of DE-MRI-evidenced hyperenhancement as a tissue-specific marker of myocardial infarction. Clinical data concerning the utility of transmural extent of hyperenhancement for predicting response to medical and revascularization therapy are reviewed. Studies directly comparing DE-MRI to other viability imaging techniques are presented, and emerging applications for DE-MRI are discussed.
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Affiliation(s)
- Jonathan W Weinsaft
- Greenberg Division of Cardiology, Weill Medical College of Cornell University, 525 East 68th Street, Starr-4, New York, NY 10021, USA.
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Kwong RY, Chan AK, Brown KA, Chan CW, Reynolds HG, Tsang S, Davis RB. Impact of unrecognized myocardial scar detected by cardiac magnetic resonance imaging on event-free survival in patients presenting with signs or symptoms of coronary artery disease. Circulation 2006; 113:2733-43. [PMID: 16754804 DOI: 10.1161/circulationaha.105.570648] [Citation(s) in RCA: 523] [Impact Index Per Article: 29.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Contrast-enhanced cardiac magnetic resonance imaging (CMR) can determine the extent of myocardial scar from infarction (MI). However, the prognostic significance of unrecognized myocardial scar by CMR in patients without a history of MI is unknown. METHODS AND RESULTS One hundred ninety-five patients without a known prior MI underwent CMR for assessment of left ventricular (LV) function and late gadolinium enhancement (LGE). We assessed the prognostic value of LGE and other CMR variables beyond the strongest clinical predictors and built the best overall models for major adverse cardiac events (MACE) and cardiac mortality. During a median follow-up of 16 months, 31 patients (18%) experienced MACE, including 17 deaths. LGE demonstrated the strongest unadjusted associations with MACE and cardiac mortality (hazard ratios of 8.29 and 10.9, respectively; both P<0.0001). Patients in the lowest tertile of LGE-involved myocardium (mean LV mass, 1.4%) experienced a >7-fold increased risk for MACE. By multivariable analyses, LGE was independently associated with MACE beyond the clinical model (P<0.0001) or the clinical model combined with angiographically significant coronary stenosis (P=0.0007), LV ejection fraction (P=0.001), LV end-systolic volume index (P=0.0006), or segmental WMA (P=0.002). LGE remained the strongest predictor selected in the best overall models for MACE and cardiac mortality. CONCLUSIONS Among patients with a clinical suspicion of coronary artery disease but without a history of MI, LGE involving a small amount of myocardium carries a high cardiac risk. In addition, LGE provides incremental prognostic value to MACE and cardiac mortality beyond common clinical, angiographic, and functional predictors.
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Affiliation(s)
- Raymond Y Kwong
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, Masssachusetts 02115, USA.
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Isobe S, Ando A, Nanasato M, Nonokawa M, Izawa H, Sobue T, Hirai M, Ito K, Ishigaki T, Murohara T, Yokota M. Combined study with FDG PET and Tl SPECT in patients with idiopathic dilated cardiomyopathy. Nucl Med Commun 2003; 24:1071-80. [PMID: 14508163 DOI: 10.1097/00006231-200310000-00007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This study aimed to determine whether combined examinations of myocardial 2-[18F]fluoro-2-deoxy-D-glucose positron emission tomography (FDG PET) and stress-redistribution 201Tl single-photon emission computed tomography (Tl SPECT) were useful in clarifying myocardial ischaemia and evaluating the prognosis in patients with idiopathic dilated cardiomyopathy (IDCM). Twenty-two patients with IDCM underwent echocardiography, cardiac catheterization, FDG PET, and Tl SPECT. In scintigraphic analysis, the total defect score (TDS) was semiquantitatively determined as the sum of scores of the 17 left ventricular (LV) segments with a 5-point scale (0 as normal to 4 as absent). Patients were classified according to the scintigraphic findings as follows: eight patients with small defects on Tl and FDG (TDS < or = 20) (group I), eight patients with small defects on FDG (TDS < or = 20) with FDG uptake increased relative to Tl or 'mismatch' (group II), and six patients with large defects on FDG and Tl (TDS >20) (group III). Eleven patients (50%) showed reversible defects on Tl and all showed preserved FDG uptake. The patients in group III had significantly lower LV ejection fraction (LVEF) (P<0.05, respectively) and a poorer prognosis as shown by the Kaplan-Meier event-free curve compared with those in groups I and II (P<0.01, respectively). Although patients in group II had significantly greater TDS on Tl compared with those in group I (P<0.01), no significant differences in LVEF and prognosis were found between patients in groups I and II. In multivariate analysis, a TDS on FDG revealed an independent predictor of subsequent cardiac events. In conclusion, such mismatched areas can be assumed to consist of impaired but viable myocardium, and may be associated with ischaemia of the microvasculature. Impaired myocardial glucose metabolism is a more powerful predictor of future cardiac events than perfusion abnormality in patients with IDCM.
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MESH Headings
- Age Factors
- Cardiomyopathy, Dilated/complications
- Cardiomyopathy, Dilated/diagnosis
- Cardiomyopathy, Dilated/diagnostic imaging
- Diagnosis, Differential
- Disease-Free Survival
- Female
- Fluorodeoxyglucose F18
- Humans
- Image Enhancement/methods
- Male
- Middle Aged
- Myocardial Ischemia/complications
- Myocardial Ischemia/diagnosis
- Myocardial Ischemia/diagnostic imaging
- Prognosis
- Radiation-Protective Agents
- Reproducibility of Results
- Risk Assessment/methods
- Sensitivity and Specificity
- Sex Factors
- Tomography, Emission-Computed/methods
- Tomography, Emission-Computed, Single-Photon/methods
- Ventricular Dysfunction, Left/diagnosis
- Ventricular Dysfunction, Left/diagnostic imaging
- Ventricular Dysfunction, Left/etiology
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Affiliation(s)
- S Isobe
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan.
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De Sutter J, Firsovaite V, Tavernier R. Prevention of sudden death in patients with coronary artery disease: do lipid-lowering drugs play a role? PREVENTIVE CARDIOLOGY 2002; 5:177-82. [PMID: 12417826 DOI: 10.1111/j.1520.037x.2002.00731.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Ventricular arrhythmias are the most common cause of sudden cardiac death in patients with coronary artery disease. Since treatment of hypercholesterolemia in patients with coronary artery disease reduces the risk of major coronary events by about 30%, one could speculate that this treatment could also result in a reduction of arrhythmic episodes in high-risk patients. In this review, the importance of myocardial ischemia as a trigger for ventricular arrhythmias, as well as the available data that suggest a possible effect of anti-ischemic treatments, including lipid-lowering drugs, on these arrhythmias are presented. Also, possible mechanisms and future research to test the hypothesis that lipid-lowering drugs can reduce life-threatening ventricular arrhythmias are discussed.
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Affiliation(s)
- John De Sutter
- Department of Cardiology, Ghent University Hospital, 9000 Ghent, Belgium.
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