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Othman MOM, Moustafa HM, El-Ghany MMA, El-Mon’em El-Rasad SAA. The value of myocardial MIBI washout rate in risk stratification of coronary artery disease. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2021; 52:73. [DOI: 10.1186/s43055-020-00382-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 12/06/2020] [Indexed: 09/01/2023] Open
Abstract
Abstract
Background
Although it is well established that MIBI does not redistribute as thallium within the myocardium, it showed a reverse redistribution phenomenon that can be expressed by the rate of myocardial MIBI washout. The aim in this study was calculating the global myocardial washout of the MIBI (GWR) in patients diagnosed with coronary artery disease (CAD) of different risk stratifications.
Results
This prospective study included 100 patients. All patients were stratified into low-, intermediate-, and high-risk groups according to clinical evaluation using Framingham score, stress ECG results using Duke’s score and finally myocardial perfusion imaging prognostic findings. GWR was estimated in each of these groups. GWR mean was 9.5%, 13%, and 18% within clinically stratified patients into low-, intermediate-, and high-risk patients respectively with correlation coefficient 0.4. In addition, GWR mean was 9.7%, 15.4%, and 18.7% within patients stratified according to exercise ECG findings into low-, intermediate-, and high-risk patients respectively with correlation coefficient 0.6. Combining all myocardial perfusion findings, GWR mean was 7.9%, 15.1%, and 19.3% in patient with low-, intermediate-, and high-risk imaging findings respectively with correlation coefficient 0.71.
Conclusion
GWR is positively correlated with the risk stratifications of the CAD patients. GWR can be used as an additional parameter to assess the risk of CAD patients.
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Aaty A, Al Fattah AA, Allam AH. Each Nuclear Cardiology lab should have its own lower limit of normal for functional parameters: True or False? J Nucl Cardiol 2018; 25:661-664. [PMID: 28236216 DOI: 10.1007/s12350-017-0830-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Accepted: 02/10/2017] [Indexed: 10/20/2022]
Affiliation(s)
- Ahmed Aaty
- Cardiology, Alexandria University, Alexandria, Egypt
| | - Alia Abd Al Fattah
- Faculty of Medicine, Critical Care Medicine, Cairo University Kasr Alainy, Cairo, Egypt
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Bom MJ, Manders JMB, Uijlings R, Badings EA, Martens FMAC. Negative predictive value of SPECT for the occurrence of MACE in a medium-sized clinic in the Netherlands. Neth Heart J 2014; 22:151-7. [PMID: 24574313 PMCID: PMC3954933 DOI: 10.1007/s12471-014-0524-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background Single-photon emission computed tomography (SPECT) is an important prognostic tool in evaluating coronary artery disease (CAD), with a high negative predictive value (NPV) for the occurrence of major adverse cardiac events (MACE). The prognostic value of SPECT is disputed in women, patients with atrial fibrillation (AF), diabetes, left bundle branch block (LBBB) and renal impairment. Methods Seven hundred sixty-two patients without prior history of CAD who had SPECT without perfusion deficits were followed for 2 years for MACE. Predictive variables for the occurrence of MACE were reviewed by Cox proportional hazard regression, considering clinical information, resting-ECG data and SPECT data. Results The NPV of SPECT for the occurrence of MACE within 2 years was 95.8 %. Multivariate Cox regression revealed male gender as the only significant predictor for the occurrence of MACE, besides a positive stress ECG at SPECT and a low LVEF. AF, LBBB, renal impairment and diabetes had no significant effect on the prognosis after normal SPECT. Conclusion SPECT with normal perfusion images has great NPV in a medium-sized clinic in the Netherlands, even in patients with LBBB, AF, diabetes and renal impairment. MACE-free survival, however, was negatively influenced by male gender; we therefore propose more caution in men.
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Affiliation(s)
- M J Bom
- Department of Cardiology, Deventer Hospital, N. Bolkesteinlaan 75, 7416 SE, Deventer, the Netherlands,
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Lairez O, Cognet T, Dercle L, Méjean S, Berry M, Bastié D, Richaud R, Gautier M, Fouilloux A, Galinier M, Carrié D, Massabuau P, Berry I. Prediction of all-cause mortality from gated-SPECT global myocardial wall thickening: comparison with ejection fraction and global longitudinal 2D-strain. J Nucl Cardiol 2014; 21:86-95. [PMID: 24170624 DOI: 10.1007/s12350-013-9813-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2013] [Accepted: 10/16/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND The aim of this study was to assess the correlation between global wall thickening (GWT) obtained by gated-single photon emission computed tomography (SPECT) and echocardiographic measures [ejection fraction (EF), global longitudinal strain (GLS), and strain rate (GLSR)] and to compare their prognostic value for all-cause mortality. METHODS AND RESULTS Seventy-four patients with referral for dipyridamole myocardial perfusion SPECT were prospectively included and underwent transthoracic echocardiography to measure left ventricular EF, GLS, and GLSR. The strongest correlation with GWT was for EF (R = 0.63, P < .001), followed by GLSR (R = -0.57, P < .001) and GLS (R = -0.53, P < .001). There were ten deaths over a period of 14.6 ± 5.7 months. Using the multivariate Cox analysis, summed stress score (HR 1.108; P = .023), EF (HR 1.01, P = .031), GLS (HR 1.593, P = .001), and GWT (HR 0.898, P = .034) remained independent predictors of mortality. Mean survival rate evaluated by Kaplan-Meier analysis was longer in patients with GWT ≥ 24% (21.9 ± 0.6 months) than those with GWT < 24% (13.6 ± 2.7 months; P < .001). CONCLUSIONS GWT assessed is a highly sensitive tool to detect early myocardial systolic dysfunction and may bring additional prognostic information.
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Affiliation(s)
- Olivier Lairez
- Department of Nuclear Medicine, Toulouse University Hospital, 1, Avenue Jean Poulhès, TSA 50032, 31059, Toulouse Cedex 9, France,
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Fihn SD, Gardin JM, Abrams J, Berra K, Blankenship JC, Dallas AP, Douglas PS, Foody JM, Gerber TC, Hinderliter AL, King SB, Kligfield PD, Krumholz HM, Kwong RYK, Lim MJ, Linderbaum JA, Mack MJ, Munger MA, Prager RL, Sabik JF, Shaw LJ, Sikkema JD, Smith CR, Smith SC, Spertus JA, Williams SV. 2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS guideline for the diagnosis and management of patients with stable ischemic heart disease: executive summary: a report of the American College of Cardiology Foundation/American Heart Association task force on practice guidelines, and the American College of Physicians, American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. Circulation 2012. [PMID: 23182125 DOI: 10.1016/j.jacc.2012.07.013] [Citation(s) in RCA: 1227] [Impact Index Per Article: 102.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Fihn SD, Gardin JM, Abrams J, Berra K, Blankenship JC, Dallas AP, Douglas PS, Foody JM, Gerber TC, Hinderliter AL, King SB, Kligfield PD, Krumholz HM, Kwong RYK, Lim MJ, Linderbaum JA, Mack MJ, Munger MA, Prager RL, Sabik JF, Shaw LJ, Sikkema JD, Smith CR, Smith SC, Spertus JA, Williams SV, Anderson JL. 2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS guideline for the diagnosis and management of patients with stable ischemic heart disease: a report of the American College of Cardiology Foundation/American Heart Association task force on practice guidelines, and the American College of Physicians, American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. Circulation 2012; 126:e354-471. [PMID: 23166211 DOI: 10.1161/cir.0b013e318277d6a0] [Citation(s) in RCA: 465] [Impact Index Per Article: 38.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Prognostic Implications of the Difference Between Left Ventricular Ejection Fractions After Stress and at Rest in Addition to the Quantification of Myocardial Perfusion Abnormalities Obtained With Gated SPECT. Clin Nucl Med 2012; 37:748-54. [DOI: 10.1097/rlu.0b013e31825ae755] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Coelho-Filho OR, Seabra LF, Mongeon FP, Abdullah SM, Francis SA, Blankstein R, Di Carli MF, Jerosch-Herold M, Kwong RY. Stress myocardial perfusion imaging by CMR provides strong prognostic value to cardiac events regardless of patient's sex. JACC Cardiovasc Imaging 2011; 4:850-61. [PMID: 21835377 DOI: 10.1016/j.jcmg.2011.04.015] [Citation(s) in RCA: 97] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2011] [Revised: 04/11/2011] [Accepted: 04/21/2011] [Indexed: 02/09/2023]
Abstract
OBJECTIVES The major aim of this study is to test the hypothesis that stress cardiac magnetic resonance (CMR) imaging can provide robust prognostic value in women presenting with suspected ischemia, to the same extent as in men. BACKGROUND Compelling evidence indicates that women with coronary artery disease (CAD) experience worse outcomes than men owing to a lack of early diagnosis and management. Numerous clinical studies have shown that stress CMR detects evidence of myocardial ischemia and infarction at high accuracy. Compared to nuclear scintigraphy, CMR is free of ionizing radiation, has high spatial resolution for imaging small hearts, and overcomes breast attenuation artifacts, which are substantial advantages when imaging women for CAD. METHODS We performed stress CMR in 405 patients (168 women, mean age 58 ± 14 years) referred for ischemia assessment. CMR techniques included cine cardiac function, perfusion imaging during vasodilating stress, and late gadolinium enhancement imaging. All patients were followed for major adverse cardiac events (MACE). RESULTS At a median follow-up of 30 months, MACE occurred in 36 patients (9%) including 21 cardiac deaths and 15 acute myocardial infarctions. In women, CMR evidence of ischemia (ISCHEMIA) demonstrated strong association with MACE (unadjusted hazard ratio: 49.9, p < 0.0001). While women with ISCHEMIA(+) had an annual MACE rate of 15%, women with ISCHEMIA(-) had very low annual MACE rate (0.3%), which was not statistically different from the low annual MACE rate in men with ISCHEMIA(-) (1.1%). CMR myocardial ischemia score was the strongest multivariable predictor of MACE in this cohort, for both women and men, indicating robust cardiac prognostication regardless of sex. CONCLUSIONS In addition to avoiding exposure to ionizing radiation, stress CMR myocardial perfusion imaging is an effective and robust risk-stratifying tool for patients of either sex presenting with possible ischemia.
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Affiliation(s)
- Otavio R Coelho-Filho
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA
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Stress Myocardial Perfusion Imaging for Assessing Prognosis: An Update. JACC Cardiovasc Imaging 2011; 4:1305-19. [DOI: 10.1016/j.jcmg.2011.10.003] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2011] [Revised: 10/21/2011] [Accepted: 10/27/2011] [Indexed: 12/25/2022]
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Van Tosh A, Supino PG, Nichols KJ, Garza D, Horowitz SF, Reichek N. Prognosis of a Normal Positron Emission Tomography 82Rb Myocardial Perfusion Imaging Study in Women with No History of Coronary Disease. Cardiology 2011; 117:301-6. [DOI: 10.1159/000323841] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2010] [Accepted: 12/18/2010] [Indexed: 11/19/2022]
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Oprea-Lager DE, Sorgdrager BJ, Jukema JW, Scherptong RWC, Ringers J, Coenraad MJ, van Hoek B, Stokkel MPM. Clinical value of myocardial perfusion scintigraphy as a screening tool in liver transplant candidates. Liver Transpl 2011; 17:261-9. [PMID: 21384508 DOI: 10.1002/lt.22234] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
A cardiac evaluation before orthotopic liver transplantation (OLT) is imperative. Previous investigations have demonstrated that mild to moderate reversible perfusion defects on myocardial perfusion scintigraphy (MPS) in general are associated with a low risk for perioperative cardiac events. The objective of this study was to assess any perfusion defects in consecutive patients with chronic liver disease who were undergoing OLT. OLT candidates underwent extensive cardiovascular screening that included, among other methods, MPS. Patients who had no contraindications for surgery and underwent OLT were followed up. The occurrence and risk of complications and mortality were compared in 3 groups of patients: patients with normal MPS results, patients with any reversible defect, and patients with a fixed perfusion defect on MPS. In all, 156 subsequent patients underwent OLT. One or more reversible segmental perfusion defects on MPS were present in 14 patients (<3 segments, n = 12; 3 segments without obstructive coronary artery disease, n = 2). The risk of complications did not differ significantly between patients with normal MPS findings and patients with a reversible perfusion defect (odds ratio = 3.04, 95% confidence interval = 0.65-14.26, P = 0.16), although the study was not sufficiently powered to show a difference. The presence of 1 or more reversible defects on MPS was significantly associated with an increased incidence of all-cause 1-year mortality (hazard ratio = 3.17, 95% confidence interval = 1.02-9.83, P = 0.046). No significant difference in the outcomes of patients with normal MPS findings and patients with a fixed defect on MPS was found; the study was, however, not adequately powered to do so. In conclusion, the results of this small cohort study indicate that patients with mild to moderate reversible perfusion defects on MPS may have inferior survival characteristics in comparison with patients with normal MPS results. A prospective, adequately powered study is required to confirm the results of this study.
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Affiliation(s)
- Daniela E Oprea-Lager
- Department of Nuclear Medicine, Leiden University Medical Center, Leiden, The Netherlands
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van der Wall EE, Scholte AJ, Bax JJ. Gated myocardial SPECT imaging; true additional value in AMI? Int J Cardiovasc Imaging 2010; 26:893-6. [PMID: 20532632 PMCID: PMC2991157 DOI: 10.1007/s10554-010-9650-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2010] [Accepted: 05/27/2010] [Indexed: 12/01/2022]
Affiliation(s)
- E. E. van der Wall
- Department of Cardiology, Leiden University Medical Center, P.O. Box 9600, Leiden, Netherlands
| | - A. J. Scholte
- Department of Cardiology, Leiden University Medical Center, P.O. Box 9600, Leiden, Netherlands
| | - J. J. Bax
- Department of Cardiology, Leiden University Medical Center, P.O. Box 9600, Leiden, Netherlands
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Mudrick DW, Velazquez E, Borges-Neto S. Does Myocardial Perfusion Imaging Provide Incremental Prognostic Information to Left Ventricular Ejection Fraction? Curr Cardiol Rep 2010; 12:155-61. [DOI: 10.1007/s11886-010-0093-x] [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] [Indexed: 10/19/2022]
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