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Giubbini R, Paghera B, Dondi M, Estrada Lobato E, Peix A, Paez D. Critical Appraisal of the Current Role of Myocardial Perfusion Imaging in the Management of Acute Chest Pain. Semin Nucl Med 2023; 53:733-742. [PMID: 37722928 DOI: 10.1053/j.semnuclmed.2023.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 08/14/2023] [Accepted: 08/17/2023] [Indexed: 09/20/2023]
Abstract
This paper describes the evolution of nuclear cardiology techniques in the setting of acute coronary syndromes. Since the 1970s, the contribution of nuclear cardiology has been fundamental in delineating the physiopathology and diagnosis of acute myocardial infarction, when electrocardiogram (ECG) did not provide the diagnosis and when cardiac enzyme assessments were at a very early stage. In this clinical situation, at that time the role of pyrophosphate scintigraphy and antimyosin antibodies was important in ensuring diagnostic precision. However, these methods showed limitations and were abandoned in the late 80s and early 90s when therapeutic applications such as thrombolytic therapy, and primary-and rescue-percutaneous coronary intervention (PCI) were introduced. Beginning in the mid-80s, the introduction and widespread use of perfusion tracers such as 99mTc labelled compounds and technological advances such as SPECT, allowed to assess the efficacy of thrombolysis and early revascularization, as well as to assess in depth myocardial salvage. Currently, perfusion SPECT, especially using fast imaging techniques and dedicated cardiac SPECT with solid-state detectors, allows a quick confirmation or exclusion of acute coronary syndromes, particularly in low-to-intermediate likelihood of coronary artery disease (CAD), especially when there are absolute or relative contraindications to the use of coronary computed tomographic angiography (CCTA).
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Affiliation(s)
- Raffaele Giubbini
- Department of Nuclear Medicine, University of Brescia, Brescia, Italy
| | - Barbara Paghera
- Department of Nuclear Medicine, Nuclear Medicine Unit, University of Brescia, Brescia, Italy
| | - Maurizio Dondi
- Department of Nuclear Medicine, Nuclear Medicine and Diagnostic Imaging Section, Division of Human Health, Department of Nuclear Sciences and Applications, International Atomic Energy Agency, Vienna, Austria
| | - Enrique Estrada Lobato
- Department of Nuclear Medicine, Nuclear Medicine and Diagnostic Imaging Section, Division of Human Health, Department of Nuclear Sciences and Applications, International Atomic Energy Agency, Vienna, Austria
| | - Amalia Peix
- Department of Nuclear Medicine, Institute of Cardiology, Havana, Cuba
| | - Diana Paez
- Department of Nuclear Medicine, Nuclear Medicine and Diagnostic Imaging Section, Division of Human Health, Department of Nuclear Sciences and Applications, International Atomic Energy Agency, Vienna, Austria.
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Sood A, Singh D, Dutta U, Mittal BR, Parmar M, Kaur G, Kaur K. Effect of ursodeoxycholic acid in facilitating early hepatic clearance of radiotracer among patients undergoing 99mTc-sestamibi myocardial perfusion scintigraphy: A randomized double blind placebo controlled parallel trial. J Nucl Cardiol 2020; 27:2337-2348. [PMID: 30697661 DOI: 10.1007/s12350-019-01597-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 12/27/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Infra-cardiac tracer activity due to persistent hepatic activity interferes in inferior and infero-septal wall assessment during 99mTc-MIBI SPECT/CT myocardial perfusion scintigraphy (MPS) in evaluation of patients with coronary artery disease. It affects image interpretation with increased study duration. Ursodeoxycholic acid (UDCA) is known to enhance hepatic excretion of bilirubin and bile salts, though its role in enhancing the hepatic tracer clearance in facilitating cardiac imaging is not known. METHODS This prospective, randomized double-blind, placebo controlled clinical trial of 120 patients, referred for adenosine stress or viability MPS studies were randomized 1:1 to receive either UDCA or placebo. Outcome was quantitative & qualitative improvement in imaging for better interpretation and to reduce the waiting time for scan. RESULTS 118 participants (59 ± 11.9 years; 84 men) underwent adenosine stress MPS or viability MPS. Sixty participants had UDCA while 58 had placebo intervention. The study showed significant decrease in liver counts with improved myocardial to liver ratio at 30 and 60 minutes in adenosine stress MPS group, and marginally significant alteration in liver counts at 60 minutes in viability MPS group receiving UDCA, resulting in better images. CONCLUSION UDCA intervention in MPS provides early and better image due to faster hepatic tracer clearance.
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Affiliation(s)
- Ashwani Sood
- Post Graduate Institute of Medical Education and Research (PGIMER), Nuclear Medicine, Chandigarh, India
| | - Deepa Singh
- Post Graduate Institute of Medical Education and Research (PGIMER), Nuclear Medicine, Chandigarh, India
| | - Usha Dutta
- Post Graduate Institute of Medical Education and Research (PGIMER), Gastroenterology, Chandigarh, India
| | - Bhagwant Rai Mittal
- Post Graduate Institute of Medical Education and Research (PGIMER), Nuclear Medicine, Chandigarh, India.
| | - Madan Parmar
- Post Graduate Institute of Medical Education and Research (PGIMER), Nuclear Medicine, Chandigarh, India
| | - Gurvinder Kaur
- Post Graduate Institute of Medical Education and Research (PGIMER), Nuclear Medicine, Chandigarh, India
| | - Komalpreet Kaur
- Post Graduate Institute of Medical Education and Research (PGIMER), Nuclear Medicine, Chandigarh, India
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Mastrocola LE, Amorim BJ, Vitola JV, Brandão SCS, Grossman GB, Lima RDSL, Lopes RW, Chalela WA, Carreira LCTF, Araújo JRND, Mesquita CT, Meneghetti JC. Update of the Brazilian Guideline on Nuclear Cardiology - 2020. Arq Bras Cardiol 2020; 114:325-429. [PMID: 32215507 PMCID: PMC7077582 DOI: 10.36660/abc.20200087] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Affiliation(s)
| | - Barbara Juarez Amorim
- Universidade Estadual de Campinas (Unicamp), Campinas, SP - Brazil
- Sociedade Brasileira de Medicina Nuclear (SBMN), São Paulo, SP - Brazil
| | | | | | - Gabriel Blacher Grossman
- Hospital Moinhos de Vento, Porto Alegre, RS - Brazil
- Clínica Cardionuclear, Porto Alegre, RS - Brazil
| | - Ronaldo de Souza Leão Lima
- Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ - Brazil
- Fonte Imagem Medicina Diagnóstica, Rio de Janeiro, RJ - Brazil
- Clínica de Diagnóstico por Imagem (CDPI), Grupo DASA, Rio de Janeiro, RJ - Brazil
| | | | - William Azem Chalela
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brazil
| | | | | | | | - José Claudio Meneghetti
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brazil
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Gutierrez-Villamil C, Peix A, Orellana P, Berrocal I, Ramirez R, Estrada-Lobato E, Paez D. Impact of International Atomic Energy Agency support to the development of nuclear cardiology in low-and-middle-income countries: Case of Latin America and the Caribbean. J Nucl Cardiol 2019; 26:2048-2054. [PMID: 31286416 PMCID: PMC6908563 DOI: 10.1007/s12350-019-01805-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Accepted: 06/17/2019] [Indexed: 11/26/2022]
Abstract
Cardiovascular diseases (CVDs) are the leading cause of death in Latin America and the Caribbean (LAC) region as well as worldwide. Lifestyle, nutritional habits and the upsurge of obesity have contributed to the increase in the prevalence of CVDs in the region. The role of nuclear cardiology in the management of patients with CVDs is well established. Particularly, myocardial perfusion imaging is widely used in LAC countries and has been increasingly integrated into the healthcare systems in the region for the diagnosis of coronary artery disease, risk stratification and to guide patient management. In its role to support countries around the world to address their health needs through the peaceful applications of nuclear techniques, the International Atomic Energy Agency (IAEA) has provided assistance to the LAC region for the establishment and strengthening of the nuclear cardiology practice. To that extent, the IAEA provides support in building capacities of multidisciplinary teams of professionals, the provision of medical equipment and the promotion of communication and exchange of knowledge among the different stakeholders. In addition, the IAEA encourages the participation of nuclear medicine centers in international multi-center research studies. In this paper, we present some of the projects through which the IAEA has supported the LAC region, including regional technical cooperation projects and coordinated research projects related to cardiology within the current multimodality approach to cardiac imaging.
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Affiliation(s)
- C Gutierrez-Villamil
- Servicio de Medicina Nuclear, Fundación Cardioinfantil - Instituto de Cardiología, Bogotá, Colombia
- Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá, Colombia
| | - A Peix
- Nuclear Medicine Department, Institute of Cardiology, 17 No. 702, Vedado, CP 10 400, Havana, Cuba.
| | - P Orellana
- Nuclear Medicine Unit, Radiology Department, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - I Berrocal
- Hospital San Juan de Dios, San Jose, Costa Rica
| | - R Ramirez
- Technical Cooperation Section for Latin America and the Caribbean, International Atomic Energy Agency, Vienna, Austria
| | - E Estrada-Lobato
- Nuclear Medicine and Diagnostic Imaging Section, International Atomic Energy Agency, Vienna, Austria
| | - D Paez
- Nuclear Medicine and Diagnostic Imaging Section, International Atomic Energy Agency, Vienna, Austria
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Purbhoo K, Vangu MDTW. Efficacy of full-fat milk and diluted lemon juice in reducing infra-cardiac activity of (99m)Tc sestamibi during myocardial perfusion imaging. Cardiovasc J Afr 2016; 26:171-6. [PMID: 26407218 PMCID: PMC4683295 DOI: 10.5830/cvja-2015-033] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2013] [Accepted: 03/25/2015] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND When using (99m)Tc sestamibi for myocardial perfusion imaging, increased splanchnic activity creates a problem in the visual and quantitative interpretation of the inferior and infero-septal walls of the left ventricle. We sought to determine whether the administration of diluted lemon juice or full-fat milk would be effective in reducing interfering infra-cardiac activity and therefore result in an improvement in image quality. We compared the administration of full-fat milk and diluted lemon juice to a control group that had no intervention. METHODS The study was carried out prospectively. All patients referred to our institution for myocardial perfusion imaging from November 2009 to May 2012 were invited to be enrolled in the study. A total of 630 patients were randomised into three groups. Group 0 (G0), 246 patients, were given diluted lemon juice, group 1 (G1), 313 patients, were given full-fat milk, and group 2 (G2), 71 patients, had no intervention (control group). A routine two-day protocol was used and the patients were given the same intervention on both days. Raw data of both the stress and rest images were visually assessed for the presence of infra-cardiac activity, and quantitative grading of the relative intensity of myocardial activity to infra-cardiac activity was determined. The physicians were blinded to the intervention received and the data were reviewed simultaneously. RESULTS The overall incidence of interfering infra-cardiac activity at stress was 84.1, 84.5 and 96.6% in G0, G1 and G2, respectively (p = 0.005). At rest it was 91.7, 90.1 and 100% in G0, G1 and G2, respectively (p = 0.0063). The visual and quantitative results favoured both milk and lemon juice in reducing the amount of interfering infra-cardiac activity versus no intervention. CONCLUSION The administration of milk or lemon juice resulted in a significant decrease in the intensity of infra-cardiac activity compared to the control group. This reduction in intensity was even more significant in the milk group for patients assessed during rest myocardial perfusion imaging.
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Affiliation(s)
- Khushica Purbhoo
- Department of Nuclear Medicine and Molecular Imaging, Chris Hani Baragwanath Academic Hospital and Charlotte Maxeke Johannesburg Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa.
| | - Mboyo Di Tamba Willy Vangu
- Department of Nuclear Medicine and Molecular Imaging, Chris Hani Baragwanath Academic Hospital and Charlotte Maxeke Johannesburg Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa
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Evaluation of the diagnostic and prognostic use of gated myocardial perfusion single-photon emission computed tomography in patients with acute chest pain. Nucl Med Commun 2015; 36:945-51. [DOI: 10.1097/mnm.0000000000000336] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Feitosa-Filho GS, Baracioli LM, Barbosa CJDG, Franci A, Timerman A, Soares Piegas L, Marin-Neto JA, Nicolau JC. SBC guidelines on unstable angina and non-ST-elevation myocardial infarction: executive summary. Arq Bras Cardiol 2015; 105:214-27. [PMID: 26466071 PMCID: PMC4592169 DOI: 10.5935/abc.20150118] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Affiliation(s)
- Gilson Soares Feitosa-Filho
- Hospital Santa Izabel da Santa Casa de Misericórdia da Bahia – Escola
Bahiana de Medicina e Saúde Publica, Salvador, BA, Brazil
| | | | | | - André Franci
- Instituto do Coração (InCor/HCFMUSP), São Paulo, SP, Brazil
| | - Ari Timerman
- Instituto Dante Pazzanese de Cardiologia, São Paulo, SP, Brazil
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Updates on Coronary CTA in the Emergency Department. CURRENT RADIOLOGY REPORTS 2015. [DOI: 10.1007/s40134-015-0096-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Abstract
This article presents a description of tele-nuclear medicine and, after outlining its history, a wide, representative range of its applications. Tele-nuclear medicine has benefited greatly from technological progress, which for several decades has provided greater data transfer rates and storage capacity at steadily decreasing cost. Differences in the practice of nuclear medicine between developed and developing countries arise mainly from disparities in their available infrastructure, funding and education levels of personnel involved. Consequently there are different emphases in their tele-nuclear medicine, which are elaborated. It is concluded that tele-nuclear medicine is important for all countries, but the emphasis on its application may differ between developed and developing nations, with an emphasis on distance learning in the latter.
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Dave DM, Ferencic M, Hoffmann U, Udelson JE. Imaging techniques for the assessment of suspected acute coronary syndromes in the emergency department. Curr Probl Cardiol 2014; 39:191-247. [PMID: 24952880 PMCID: PMC8323766 DOI: 10.1016/j.cpcardiol.2014.05.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Jain R, Sharma A, Uliel L, Mellnick V, McConathy J. An overview of nuclear medicine studies for urgent and emergent indications. Semin Roentgenol 2014; 49:210-24. [PMID: 24836495 DOI: 10.1053/j.ro.2014.02.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Rashmi Jain
- Mallinckrodt Institute of Radiology, St. Louis, MO
| | - Akash Sharma
- Mallinckrodt Institute of Radiology, St. Louis, MO
| | - Livnat Uliel
- Mallinckrodt Institute of Radiology, St. Louis, MO
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New SPECT and PET radiopharmaceuticals for imaging cardiovascular disease. BIOMED RESEARCH INTERNATIONAL 2014; 2014:942960. [PMID: 24901002 PMCID: PMC4034657 DOI: 10.1155/2014/942960] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Accepted: 03/16/2014] [Indexed: 01/08/2023]
Abstract
Nuclear cardiology has experienced exponential growth within the past four decades with converging capacity to diagnose and influence management of a variety of cardiovascular diseases. Single photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) with technetium-99m radiotracers or thallium-201 has dominated the field; however new hardware and software designs that optimize image quality with reduced radiation exposure are fuelling a resurgence of interest at the preclinical and clinical levels to expand beyond MPI. Other imaging modalities including positron emission tomography (PET) and magnetic resonance imaging (MRI) continue to emerge as powerful players with an expanded capacity to diagnose a variety of cardiac conditions. At the forefront of this resurgence is the development of novel target vectors based on an enhanced understanding of the underlying pathophysiological process in the subcellular domain. Molecular imaging with novel radiopharmaceuticals engineered to target a specific subcellular process has the capacity to improve diagnostic accuracy and deliver enhanced prognostic information to alter management. This paper, while not comprehensive, will review the recent advancements in radiotracer development for SPECT and PET MPI, autonomic dysfunction, apoptosis, atherosclerotic plaques, metabolism, and viability. The relevant radiochemistry and preclinical and clinical development in addition to molecular imaging with emerging modalities such as cardiac MRI and PET-MR will be discussed.
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Dondi M. Guest editorial: IAEA approach to meet nuclear medicine needs of the emerging world. Semin Nucl Med 2013; 43:159-60. [PMID: 23561451 DOI: 10.1053/j.semnuclmed.2012.11.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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