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Møller MB, Schuijf JD, Oyama-Manabe N, Linde JJ, Kühl JT, Lima JAC, Kofoed KF. Technical Considerations for Dynamic Myocardial Computed Tomography Perfusion as Part of a Comprehensive Evaluation of Coronary Artery Disease Using Computed Tomography. J Thorac Imaging 2023; 38:54-68. [PMID: 36044617 DOI: 10.1097/rti.0000000000000673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Dynamic myocardial computed tomography perfusion (DM-CTP) has good diagnostic accuracy for identifying myocardial ischemia as compared with both invasive and noninvasive reference standards. However, DM-CTP has not yet been implemented in the routine clinical examination of patients with suspected or known coronary artery disease. An important hurdle in the clinical dissemination of the method is the development of the DM-CTP acquisition protocol and image analysis. Therefore, the aim of this article is to provide a review of critical parameters in the design and execution of DM-CTP to optimize each step of the examination and avoid common mistakes. We aim to support potential users in the successful implementation and performance of DM-CTP in daily practice. When performed appropriately, DM-CTP may support clinical decision making. In addition, when combined with coronary computed tomography angiography, it has the potential to shorten the time to diagnosis by providing immediate visualization of both coronary atherosclerosis and its functional relevance using one single modality.
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Affiliation(s)
- Mathias B Møller
- Department of Cardiology, Rigshospitalet, University of Copenhagen, The Heart Centre
| | - Joanne D Schuijf
- Global Research and Development Center, Canon Medical Systems Europe, Zoetermeer, The Netherlands
| | - Noriko Oyama-Manabe
- Department of Radiology, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Jesper J Linde
- Department of Cardiology, Rigshospitalet, University of Copenhagen, The Heart Centre
| | - Jørgen T Kühl
- Department of Cardiology, Rigshospitalet, University of Copenhagen, The Heart Centre
| | - Joao A C Lima
- Departments of Medicine and Radiology, Johns Hopkins Hospital and School of Medicine, Baltimore, MD
| | - Klaus F Kofoed
- Department of Cardiology, Rigshospitalet, University of Copenhagen, The Heart Centre
- Department of Radiology, Rigshospitalet, University of Copenhagen
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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2
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Smith P, Farag A, Bhambhvani P, Iskandrian A, Hage FG. Prognostic value of absent left ventricular ejection fraction reserve with regadenoson SPECT MPI. J Nucl Cardiol 2022; 29:978-986. [PMID: 33089878 DOI: 10.1007/s12350-020-02390-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 09/07/2020] [Indexed: 01/18/2023]
Abstract
BACKGROUND An absent left ventricular ejection fraction (LVEF) reserve with vasodilator stress with PET cardiac imaging has been shown to provide significant independent and incremental value to the perfusion images for prediction of future cardiovascular adverse events. However, the prognostic value of LVEF reserve has not been well characterized with SPECT myocardial perfusion imaging (MPI). METHODS We studied 858 consecutive patients with normal and abnormal perfusion pattern with regadenoson SPECT MPI. Change in LVEF was calculated as post-stress LVEF-rest LVEF. Absent LVEF reserve was defined as a drop in LVEF by 5% or more on the post-stress images. The primary outcome was a composite of cardiac death, non-fatal myocardial infarction and late coronary revascularization. RESULTS An absent LVEF reserve was more common in patients with abnormal vs normal MPI (31% vs 19%, P = .001). During a median follow-up of 32 months, the primary outcome was experienced by 31% of the study population. An absent LVEF reserve was not associated with an increased risk of the primary outcome in patients with normal (hazard ratio 1.1, 95% CI .4-2.7, P = .8) or abnormal (.75, .56-1.00, P = .05) MPI. There was no significant correlation between extent of ischemia and post-stress change in LVEF (Pearson r = - .072, P = .07). CONCLUSIONS In patients undergoing regadenoson SPECT MPI, absent LVEF reserve is not associated with worse cardiac outcomes. Thus, routine reporting of both post-stress and rest LVEF measurements in this setting may not be necessary.
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Affiliation(s)
- Phillip Smith
- Division of Cardiovascular Disease, Dept. of Medicine, University of Alabama in Birmingham, Birmingham, United States
| | - Ayman Farag
- Division of Cardiovascular Disease, Dept. of Medicine, University of Alabama in Birmingham, Birmingham, United States
| | - Pradeep Bhambhvani
- Dept. of Radiology, University of Alabama in Birmingham, Birmingham, United States
| | - Ami Iskandrian
- Division of Cardiovascular Disease, Dept. of Medicine, University of Alabama in Birmingham, Birmingham, United States
| | - Fadi G Hage
- Division of Cardiovascular Disease, Dept. of Medicine, University of Alabama in Birmingham, Birmingham, United States.
- Division of Cardiovascular disease, Birmingham VA Medical Center, Birmingham, United States.
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Asif T, Lee Chuy K, Malhotra S. Asystole following Regadenoson administration: Review of literature, risk factors and management. J Nucl Cardiol 2021; 28:2046-2055. [PMID: 32462632 DOI: 10.1007/s12350-020-02136-x] [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] [Accepted: 04/06/2020] [Indexed: 11/30/2022]
Abstract
Regadenoson, a selective A2A receptor agonist, is widely used for vasodilator stress myocardial perfusion imaging and has a superior adverse effect profile when compared with other agents. However, with widespread use, there have been several reported cases of Regadenoson induced bradyarrhythmias and even asystole in patients with no known conduction system disease. In this article, we report a case of asystole following Regadenoson administration, evaluate mechanisms and risk factors for Regadenoson induced bradyarrhythmias to better identify patients at risk. We also review the available treatment options and propose recommendations for limiting its risk.
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Affiliation(s)
- Talal Asif
- Division of Cardiology, Cook County Health, Chicago, IL, USA
| | | | - Saurabh Malhotra
- Division of Cardiology, Cook County Health, Chicago, IL, USA.
- Division of Cardiology, Rush Medical College, Chicago, IL, USA.
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Hage FG, AlJaroudi WA. Review of cardiovascular imaging in the Journal of Nuclear Cardiology 2019: Single-photon emission computed tomography. J Nucl Cardiol 2020; 27:1171-1179. [PMID: 32410057 DOI: 10.1007/s12350-020-02167-4] [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: 04/15/2020] [Accepted: 04/16/2020] [Indexed: 02/07/2023]
Abstract
In 2019, the Journal of Nuclear Cardiology published excellent articles pertaining to imaging in patients with cardiovascular disease. In this review, we will summarize a selection of these articles to provide a concise review of the main advancements that have recently occurred in the field and provide the reader with an opportunity to review a wide selection of articles. In the first article of this 2-part series, we focused on publications dealing with positron emission tomography, computed tomography, and magnetic resonance. This review will place emphasis on myocardial perfusion imaging using single-photon emission computed tomography summarizing advances in the field including in diagnosis and prognosis, non-perfusion variables, safety of testing, imaging in patients with heart failure and renal disease.
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Affiliation(s)
- Fadi G Hage
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Lyons Harrison Research Building 306, 1900 University BLVD, Birmingham, AL, 35294, USA.
- Section of Cardiology, Birmingham Veterans Affairs Medical Center, Birmingham, AL, USA.
| | - Wael A AlJaroudi
- Division of Cardiovascular Medicine, Clemenceau Medical Center, Beirut, Lebanon
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Assen MV, Vonder M, Pelgrim GJ, Von Knebel Doeberitz PL, Vliegenthart R. Computed tomography for myocardial characterization in ischemic heart disease: a state-of-the-art review. Eur Radiol Exp 2020; 4:36. [PMID: 32548777 PMCID: PMC7297926 DOI: 10.1186/s41747-020-00158-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 03/30/2020] [Indexed: 12/21/2022] Open
Abstract
This review provides an overview of the currently available computed tomography (CT) techniques for myocardial tissue characterization in ischemic heart disease, including CT perfusion and late iodine enhancement. CT myocardial perfusion imaging can be performed with static and dynamic protocols for the detection of ischemia and infarction using either single- or dual-energy CT modes. Late iodine enhancement may be used for the analysis of myocardial infarction. The accuracy of these CT techniques is highly dependent on the imaging protocol, including acquisition timing and contrast administration. Additionally, the options for qualitative and quantitative analysis and the accuracy of each technique are discussed.
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Affiliation(s)
- M van Assen
- University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 EZ, Groningen, The Netherlands.
| | - M Vonder
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - G J Pelgrim
- Department of Radiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - P L Von Knebel Doeberitz
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - R Vliegenthart
- Department of Radiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Performance of Coronary Risk Scores Among Patients With Chest Pain in the Emergency Department. J Am Coll Cardiol 2019; 71:606-616. [PMID: 29420956 DOI: 10.1016/j.jacc.2017.11.064] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Revised: 10/30/2017] [Accepted: 11/27/2017] [Indexed: 12/22/2022]
Abstract
BACKGROUND Both the modified History, Electrocardiogram, Age, Risk factors and Troponin (HEART) score and the Emergency Department Assessment of Chest pain Score (EDACS) can identify patients with possible acute coronary syndrome (ACS) at low risk (<1%) for major adverse cardiac events (MACE). OBJECTIVES The authors sought to assess the comparative accuracy of the EDACS (original and simplified) and modified HEART risk scores when using cardiac troponin I (cTnI) cutoffs below the 99th percentile, and obtain precise MACE risk estimates. METHODS The authors conducted a retrospective study of adult emergency department (ED) patients evaluated for possible ACS in an integrated health care system between 2013 and 2015. Negative predictive values for MACE (composite of myocardial infarction, cardiogenic shock, cardiac arrest, and all-cause mortality) were determined at 60 days. Reclassification analyses were used to assess the comparative accuracy of risk scores and lower cTnI cutoffs. RESULTS A total of 118,822 patients with possible ACS were included. The 3 risk scores' accuracies were optimized using the lower limit of cTnI quantitation (<0.02 ng/ml) to define low risk for 60-day MACE, with reclassification yields ranging between 3.4% and 3.9%, while maintaining similar negative predictive values (range 99.49% to 99.55%; p = 0.27). The original EDACS identified the largest proportion of patients as low risk (60.6%; p < 0.0001). CONCLUSIONS Among ED patients with possible ACS, the modified HEART score, original EDACS, and simplified EDACS all predicted a low risk of 60-day MACE with improved accuracy using a cTnI cutoff below the 99th percentile. The original EDACS identified the most low-risk patients, and thus may be the preferred risk score.
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Andrikopoulou E, Morgan CJ, Brice L, Bajaj NS, Doppalapudi H, Iskandrian AE, Hage FG. Incidence of atrioventricular block with vasodilator stress SPECT: A meta-analysis. J Nucl Cardiol 2019; 26:616-628. [PMID: 29043556 PMCID: PMC5904011 DOI: 10.1007/s12350-017-1081-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Accepted: 07/25/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND Adenosine or regadenoson are often used with pharmacologic stress testing. Adenosine may trigger atrioventricular block (AVB). Despite its higher selectivity, regadenoson has also been associated with AVB. We studied the incidence of de novo AVB with these agents. METHODS A comprehensive search of SCOPUS was performed from inception to March 2016. Studies of at least 10 patients, using adenosine and/or regadenoson with SPECT-MPI, reporting rates of AVB were selected for further review. RESULTS Thirty four studies were pooled including 22,957 patients. Adenosine was used in 21 studies and regadenoson in 15. Both were administered in two studies. The estimated incidence of overall and high-grade AVB was 3.81% (95% CI 1.99%-6.19%) and 1.93% (95% CI 0.77%-3.59%), respectively. The incidence of AVB (8.58%; 95% CI 5.55%-12.21% vs 0.30%; 95% CI 0.04%-0.82%, respectively, P < .001) and high-grade AVB (5.21%; 95% CI 2.81%-8.30% vs 0.05%; 95% CI < .001%-0.19% respectively, P < .001) were higher with adenosine compared to regadenoson. CONCLUSION AVB is seen in about 4% of patients undergoing vasodilator stress test. Both overall and high-grade AVB are more frequent with adenosine compared to regadenoson.
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Affiliation(s)
- Efstathia Andrikopoulou
- University of Alabama at Birmingham, Birmingham, AL, USA.
- Brigham and Women's Hospital, Boston, MA, USA.
| | | | - Lizbeth Brice
- University of Alabama at Birmingham, Birmingham, AL, USA
| | - Navkaranbir S Bajaj
- University of Alabama at Birmingham, Birmingham, AL, USA
- Brigham and Women's Hospital, Boston, MA, USA
| | - Harish Doppalapudi
- University of Alabama at Birmingham, Birmingham, AL, USA
- Birmingham Veterans Affairs Medical Center, Birmingham, AL, USA
| | | | - Fadi G Hage
- University of Alabama at Birmingham, Birmingham, AL, USA
- Birmingham Veterans Affairs Medical Center, Birmingham, AL, USA
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Andrikopoulou E, Hage FG. Adverse effects associated with regadenoson myocardial perfusion imaging. J Nucl Cardiol 2018; 25:1724-1731. [PMID: 29468467 DOI: 10.1007/s12350-018-1218-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Accepted: 01/18/2018] [Indexed: 12/20/2022]
Affiliation(s)
- Efstathia Andrikopoulou
- Sub-division of Non-Invasive Cardiovascular Imaging, Division of Cardiovascular Disease, Department of Medicine, Brigham and Women's Hospital, 75 Francis street, ABI L1-027, Boston, MA, 02115, USA.
| | - Fadi G Hage
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
- Section of Cardiology, Birmingham Veterans Affairs Medical Center, Birmingham, AL, USA
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Hage FG, AlJaroudi WA. Review of cardiovascular imaging in the Journal of Nuclear Cardiology in 2017. Part 2 of 2: Myocardial perfusion imaging. J Nucl Cardiol 2018; 25:1390-1399. [PMID: 29663117 DOI: 10.1007/s12350-018-1266-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 03/21/2018] [Indexed: 12/28/2022]
Abstract
In 2017, the Journal of Nuclear Cardiology published many high-quality articles. In this review, we will summarize a selection of these articles to provide a concise review of the main advancements that have recently occurred in the field. In the first article of this 2-part series, we focused on publications dealing with positron emission tomography, computed tomography, and magnetic resonance. This review will place emphasis on myocardial perfusion imaging using single-photon emission computed tomography summarizing advances in the field including prognosis, safety and tolerability, the impact of imaging on management, and the use of novel imaging protocols.
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Affiliation(s)
- Fadi G Hage
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.
- Section of Cardiology, Birmingham Veterans Affairs Medical Center, Birmingham, AL, USA.
| | - Wael A AlJaroudi
- Division of Cardiovascular Medicine, Cardiovascular Imaging, Clemenceau Medical Center, P.O.Box 11-2555, Beirut, Lebanon
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10
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Daya HA, Hage FG. Effect of aminophylline administration on the diagnostic yield of vasodilator myocardial perfusion imaging. J Nucl Cardiol 2017; 24:1579-1582. [PMID: 27259883 DOI: 10.1007/s12350-016-0553-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Accepted: 05/19/2016] [Indexed: 12/01/2022]
Affiliation(s)
- Hussein Abu Daya
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Fadi G Hage
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Lyons Harrison Research Building 306, 1900 University BLVD, Birmingham, AL, 35294, USA.
- Section of Cardiology, Birmingham Veterans Affairs Medical Center, Birmingham, AL, USA.
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Rai M, Ahlberg AW, Marwell J, Chaudhary W, Savino JA, Alter EL, Henzlova MJ, Duvall WL. Safety of vasodilator stress myocardial perfusion imaging in patients with elevated cardiac biomarkers. J Nucl Cardiol 2017; 24:724-734. [PMID: 26902485 DOI: 10.1007/s12350-016-0448-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Revised: 01/27/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND While adenosine and dipyridamole as myocardial perfusion imaging (MPI) stress agents have literature supporting their safety in the setting of myocardial infarction (MI), regadenoson does not. Studying a high risk cohort of patients with elevated cardiac biomarkers may shed light on potential safety issues of these agents which might also affect lower risk cohorts. METHODS All patients who had undergone a clinically indicated stress MPI study at two academic centers from 1/1/2010 through 12/31/2012 with elevated troponin ≤7 days prior to testing were included. The primary endpoint was a composite of death, non-fatal MI, congestive heart failure (CHF), stroke, ventricular arrhythmias, atrial fibrillation/flutter, or atrioventricular block requiring intervention within 24 h of testing. RESULTS Of the 703 stress MPI studies that met inclusion criteria, 360 (51.2%), 199 (28.3%), 74 (10.5%), 9 (1.3%), and 61 (8.7%) underwent regadenoson, dipyridamole, adenosine, dobutamine, and exercise stress, respectively. The primary endpoint occurred in 11 (1.6%) patients with an incidence of 1.4% (n = 5), 1.0% (n = 2), 1.4% (n = 1), 11.1% (n = 1), and 3.3% (n = 2) following regadenoson, dipyridamole, adenosine, dobutamine, and exercise stress, respectively (P = 0.137). The adverse events included non-fatal MI in 7 (1.0%) patients, death in 1 (0.1%) patient, CHF in 1 (0.1%) patient, ventricular arrhythmia in 1 (0.1%) patient, and atrial arrhythmia in 1 (0.1%) patient. CONCLUSION In the setting of elevated troponin, serious complications associated with either exercise or vasodilator stress testing appear to be relatively rare with no increased risk attributable to a particular vasodilator agent.
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Affiliation(s)
- Mridula Rai
- Division of Cardiology (Henry Low Heart Center), Hartford Hospital, 80 Seymour Street, Hartford, 06102, CT, USA
| | - Alan W Ahlberg
- Division of Cardiology (Henry Low Heart Center), Hartford Hospital, 80 Seymour Street, Hartford, 06102, CT, USA
| | - Julianna Marwell
- Department of Medicine, University of Connecticut, Farmington, CT, USA
| | - Waseem Chaudhary
- Division of Cardiology (Henry Low Heart Center), Hartford Hospital, 80 Seymour Street, Hartford, 06102, CT, USA
| | - John A Savino
- Division of Cardiology (Mount Sinai Heart), Mount Sinai Medical Center, New York, NY, USA
| | - Eric L Alter
- Department of Medicine, Mount Sinai Medical Center, New York, NY, USA
| | - Milena J Henzlova
- Division of Cardiology (Mount Sinai Heart), Mount Sinai Medical Center, New York, NY, USA
| | - W Lane Duvall
- Division of Cardiology (Henry Low Heart Center), Hartford Hospital, 80 Seymour Street, Hartford, 06102, CT, USA.
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Saab R, Hage FG. Vasodilator stress agents for myocardial perfusion imaging. J Nucl Cardiol 2017; 24:434-438. [PMID: 26829956 DOI: 10.1007/s12350-016-0408-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Accepted: 01/06/2016] [Indexed: 01/21/2023]
Affiliation(s)
- Rayan Saab
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Lyons Harrison Research Building 306, 1720 2nd Ave S, Birmingham, AL, 35294-0007, USA.
| | - Fadi G Hage
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Lyons Harrison Research Building 306, 1720 2nd Ave S, Birmingham, AL, 35294-0007, USA
- Section of Cardiology, Birmingham Veterans Affairs Medical Center, Birmingham, AL, USA
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Hage FG, AlJaroudi WA. Review of Cardiovascular Imaging in the Journal of Nuclear Cardiology in 2015-Part 2 of 2: Myocardial perfusion imaging. J Nucl Cardiol 2016; 23:493-8. [PMID: 26892251 DOI: 10.1007/s12350-016-0444-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Accepted: 02/01/2016] [Indexed: 12/24/2022]
Abstract
In 2015, the Journal of Nuclear Cardiology (®) published many high-quality articles. In this series, we will summarize key articles that have appeared in the Journal last year to provide for the interested reader a quick review of the advancements that have recently occurred in the field. In the first article of this 2-part series, we concentrated on publications dealing with plaque imaging, cardiac positron emission tomography, computed tomography, and magnetic resonance. This review will focus on myocardial perfusion imaging summarizing advances in the field including in diagnosis, prognosis, and appropriate use.
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Affiliation(s)
- Fadi G Hage
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, UK
- Section of Cardiology, Birmingham Veterans Affairs Medical Center, Birmingham, AL, UK
| | - Wael A AlJaroudi
- Division of Cardiovascular Medicine, Cardiovascular Imaging, Clemenceau Medical Center, P.O.Box 11-2555, Beirut, Lebanon.
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Pape M, Zacho HD, Aarøe J, Eggert Jensen S, Petersen LJ. Safety and tolerability of regadenoson for myocardial perfusion imaging - first Danish experience. SCAND CARDIOVASC J 2016; 50:180-6. [PMID: 26956081 DOI: 10.3109/14017431.2016.1163415] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES Evaluating safety and tolerability of the selective A2A receptor agonist, regadenoson, in patients referred for single photon emission computed tomography myocardial perfusion imaging (MPI). DESIGN Observational study of patients referred for MPI stress testing using a 400 μg regadenoson (Rapiscan(®)) bolus. Hemodynamic variables and severity of adverse events (AE) were recorded before, during, and after administration. RESULTS A total of 232 patients were included. One or more AE were reported in 90% of patients; the AEs were graded mostly mild to moderate in severity, resolved spontaneously, and were mainly dyspnea, headache, and chest pain. No advanced heart block or bronchospasm were seen. Transient ST-segment changes developed in 10 patients. The maximum increase in heart rate was 19 ± 11 beats/minute. The mean systolic blood pressure decreased from 144 to 139 mmHg (p < 0.0001). Medical intervention was required in three patients: one case with severe hypotension and two cases with chest pain that was relieved with sublingual nitroglycerin. One patient died the day after stress MPI for reasons considered unrelated to regadenoson. CONCLUSION Regadenoson for MPI is easy to use with a high frequency of AEs, which are generally mild in severity, transient, and resolve spontaneously.
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Affiliation(s)
- Marianne Pape
- a The Department of Cardiology , Aalborg University Hospital , Aalborg , Denmark
| | - Helle D Zacho
- b The Department of Nuclear Medicine , Aalborg University Hospital , Aalborg , Denmark ;,c The Department of Clinical Medicine , Aalborg University , Aalborg , Denmark
| | - Jens Aarøe
- a The Department of Cardiology , Aalborg University Hospital , Aalborg , Denmark
| | - Svend Eggert Jensen
- a The Department of Cardiology , Aalborg University Hospital , Aalborg , Denmark ;,c The Department of Clinical Medicine , Aalborg University , Aalborg , Denmark
| | - Lars J Petersen
- b The Department of Nuclear Medicine , Aalborg University Hospital , Aalborg , Denmark ;,c The Department of Clinical Medicine , Aalborg University , Aalborg , Denmark
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Dilsizian V, Gewirtz H, Paivanas N, Kitsiou AN, Hage FG, Crone NE, Schwartz RG. Serious and potentially life threatening complications of cardiac stress testing: Physiological mechanisms and management strategies. J Nucl Cardiol 2015; 22:1198-213; quiz 1195-7. [PMID: 25975944 DOI: 10.1007/s12350-015-0141-4] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Accepted: 03/25/2015] [Indexed: 01/05/2023]
Affiliation(s)
- Vasken Dilsizian
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD, USA.
| | - Henry Gewirtz
- Department of Medicine (Cardiology Division), Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Nicholas Paivanas
- Department of Medicine (Division of Cardiology), University of Rochester Medical Center, Rochester, NY, USA
| | | | - Fadi G Hage
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham and Birmingham Veterans Affairs Medical Center, Birmingham, AL, USA
| | - Nathan E Crone
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ronald G Schwartz
- Departments of Medicine (Division of Cardiology) and Imaging Sciences (Nuclear Medicine), University of Rochester Medical Center, Rochester, NY, USA
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Verberne HJ, Acampa W, Anagnostopoulos C, Ballinger J, Bengel F, De Bondt P, Buechel RR, Cuocolo A, van Eck-Smit BLF, Flotats A, Hacker M, Hindorf C, Kaufmann PA, Lindner O, Ljungberg M, Lonsdale M, Manrique A, Minarik D, Scholte AJHA, Slart RHJA, Trägårdh E, de Wit TC, Hesse B. EANM procedural guidelines for radionuclide myocardial perfusion imaging with SPECT and SPECT/CT: 2015 revision. Eur J Nucl Med Mol Imaging 2015; 42:1929-40. [PMID: 26290421 PMCID: PMC4589547 DOI: 10.1007/s00259-015-3139-x] [Citation(s) in RCA: 204] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Accepted: 07/08/2015] [Indexed: 01/18/2023]
Abstract
Since the publication of the European Association of Nuclear Medicine (EANM) procedural guidelines for radionuclide myocardial perfusion imaging (MPI) in 2005, many small and some larger steps of progress have been made, improving MPI procedures. In this paper, the major changes from the updated 2015 procedural guidelines are highlighted, focusing on the important changes related to new instrumentation with improved image information and the possibility to reduce radiation exposure, which is further discussed in relation to the recent developments of new International Commission on Radiological Protection (ICRP) models. Introduction of the selective coronary vasodilator regadenoson and the use of coronary CT-contrast agents for hybrid imaging with SPECT/CT angiography are other important areas for nuclear cardiology that were not included in the previous guidelines. A large number of minor changes have been described in more detail in the fully revised version available at the EANM home page: http://eanm.org/publications/guidelines/2015_07_EANM_FINAL_myocardial_perfusion_guideline.pdf.
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Affiliation(s)
- Hein J Verberne
- Department of Nuclear Medicine, F2-238, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
| | - Wanda Acampa
- Institute of Biostructures and Bioimaging, National Council of Research, Naples, Italy
| | - Constantinos Anagnostopoulos
- Center for Experimental Surgery, Clinical and Translational Research, Biomedical Research Foundation, Academy of Athens, Athens, Greece
| | - Jim Ballinger
- Department of Nuclear Medicine, Guy's Hospital - Guy's & St Thomas' Trust Foundation, London, UK
| | - Frank Bengel
- Department of Nuclear Medicine, Hannover Medical School, Hannover, Germany
| | - Pieter De Bondt
- Department of Nuclear Medicine, OLV Hospital, Aalst, Belgium
| | - Ronny R Buechel
- Cardiac Imaging, University Hospital Zurich, Zurich, Switzerland
| | - Alberto Cuocolo
- Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy
| | - Berthe L F van Eck-Smit
- Department of Nuclear Medicine, F2-238, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Albert Flotats
- Nuclear Medicine Department, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Marcus Hacker
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Cecilia Hindorf
- Department of Radiation Physics, Skåne University Hospital, Lund, Sweden
| | | | - Oliver Lindner
- Heart and Diabetes Center North Rhine-Westphalia, Institute for Radiology, Nuclear Medicine and Molecular Imaging, University Hospital of the Ruhr-University Bochum, Bad Oeynhausen, Germany
| | - Michael Ljungberg
- Department of Medical Radiation Physics, Lund University, Lund, Sweden
| | - Markus Lonsdale
- Department of Clinical Physiology and Nuclear Medicine, Bispebjerg Hospital, Copenhagen, Denmark
| | - Alain Manrique
- Department of Nuclear Medicine, Service Commun Investigations chez l'Homme, GIP Cyceron, Caen University Hospital, Caen, France
| | - David Minarik
- Radiation Physics, Skåne University Hospital, Malmö, Sweden
| | - Arthur J H A Scholte
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Riemer H J A Slart
- Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Elin Trägårdh
- Clinical Physiology and Nuclear Medicine, Skåne University Hospital and Lund University, Malmö, Sweden
| | - Tim C de Wit
- Department of Nuclear Medicine, F2-238, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Birger Hesse
- Department of Clinical Physiology and Nuclear Medicine & PET, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark
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Hage FG, AlJaroudi WA. Review of cardiovascular imaging in The Journal of Nuclear Cardiology in 2014: Part 2 of 2: Myocardial perfusion imaging. J Nucl Cardiol 2015; 22:714-9. [PMID: 25920482 DOI: 10.1007/s12350-015-0144-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Accepted: 04/09/2015] [Indexed: 11/25/2022]
Abstract
In this new feature of The Journal of Nuclear Cardiology we will summarize key articles that were published in the Journal in the previous year. In the first article of this 2-part series we concentrated on publications dealing with cardiac positron emission tomography, computed tomography, and neuronal imaging. This review will focus on myocardial perfusion imaging summarizing advances in the field including in diagnosis, prognosis, appropriateness, and safety of testing.
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Affiliation(s)
- Fadi G Hage
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA,
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18
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Hage FG, Iskandrian AE. Serious complications associated with regadenoson administration for myocardial perfusion imaging: a commentary. J Nucl Cardiol 2014; 21:877-9. [PMID: 25156654 DOI: 10.1007/s12350-014-9985-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Fadi G Hage
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Lyons Harrison Research Building 314, 1900 University BLVD, Birmingham, AL, 35294, USA,
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