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Schenone AL, Hutt E, Cremer P, Jaber WA. Utility of nuclear cardiovascular imaging in the cardiac intensive care unit. J Nucl Cardiol 2023; 30:553-569. [PMID: 34109502 DOI: 10.1007/s12350-021-02665-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 03/25/2021] [Indexed: 10/21/2022]
Abstract
The contemporary Cardiac Intensive Care Unit (CICU) has evolved into a complex unit that admits a heterogeneous mix of patients with a wide range of acute cardiovascular diseases often complicated by multi-organ failure. Although electrocardiography (ECG) and echocardiography are well-established as first-line diagnostic modalities for assessing patients in the CICU, nuclear cardiology imaging has emerged as a useful adjunctive diagnostic modality. The versatility, safety and accuracy of nuclear imaging (e.g., perfusion, metabolism, inflammation) for the assessment of patient with coronary artery disease, ventricular arrhythmias, infiltrative cardiomyopathies, infective endocarditis and inflammatory aortopathies has been proven useful and now often incorporated into the best practices for the management of critically ill cardiac patients. Thus, clinicians must familiarize themselves with the value and current and future applications of nuclear imaging in the management of the cardiac patient in the CICU.
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Affiliation(s)
- Aldo L Schenone
- Cleveland Clinic Heart, Thoracic, Institute Cleveland Clinic, 9500 Euclid Ave. J1-5, Cleveland, OH, 44195, USA
| | - Erika Hutt
- Cleveland Clinic Heart, Thoracic, Institute Cleveland Clinic, 9500 Euclid Ave. J1-5, Cleveland, OH, 44195, USA
| | - Paul Cremer
- Cleveland Clinic Heart, Thoracic, Institute Cleveland Clinic, 9500 Euclid Ave. J1-5, Cleveland, OH, 44195, USA
| | - Wael A Jaber
- Cleveland Clinic Heart, Thoracic, Institute Cleveland Clinic, 9500 Euclid Ave. J1-5, Cleveland, OH, 44195, USA.
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Bautz J, Stypmann J, Reiermann S, Pavenstädt HJ, Suwelack B, Stegger L, Rahbar K, Reuter S, Schäfers M. Prognostic implication of myocardial perfusion and contractile reserve in end-stage renal disease: A direct comparison of myocardial perfusion scintigraphy and dobutamine stress echocardiography. J Nucl Cardiol 2022; 29:2988-2999. [PMID: 34750727 PMCID: PMC9834353 DOI: 10.1007/s12350-021-02844-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 08/25/2021] [Indexed: 01/22/2023]
Abstract
BACKGROUND We aimed to compare the prognostic value of myocardial perfusion scintigraphy (MPS) and dobutamine stress echocardiography (DSE) in patients with end-stage renal disease (ESRD) without known coronary artery disease. METHODS Two-hundred twenty-nine ESRD patients who applied for kidney transplantation at our centre were prospectively evaluated by MPS and DSE. The primary endpoint was a composite of myocardial infarction (MI) or all-cause mortality. The secondary endpoint included MI or coronary revascularization (CR) not triggered by MPS or DSE at baseline. RESULTS MPS detected reversible ischemia in 31 patients (13.5%) and fixed perfusion defects in 13 (5.7%) patients. DSE discovered stress-induced wall motion abnormalities (WMAs) in 28 (12.2%) and at rest in 18 (7.9%) patients. MPS and DSE results agreed in 85.6% regarding reversible defects (κ = 0.358; P < .001) and in 90.8% regarding fixed defects (κ = 0.275; P < .001). Coronary angiography detected relevant stenosis > 50% in only 15 of 38 patients (39.5%) with pathological findings in MPS and/or DSE. At a median follow-up of 8 years and 10 months, the primary endpoint occurred in 70 patients (30.6%) and the secondary endpoint in 24 patients (10.5%). The adjusted Cox hazard ratios (HRs) for the primary endpoint were 1.77 (95% CI 1.02-3.08; P = .043) for perfusion defects in MPS and 1.36 (95% CI 0.78-2.37; P = ns) for WMA in DSE. The secondary endpoint was significantly correlated with the findings of both modalities, MPS (HR 3.21; 95% CI 1.35-7.61; P = .008) and DSE (HR 2.67; 95% CI 1.15-6.20; P = .022). CONCLUSION Perfusion defects in MPS are a stronger determinant of all-cause mortality, MI and the need for future CR compared with WMAs in DSE. Given the complementary functional information provided by MPS vs DSE, results are sometimes contradictory, which may indicate differences in the underlying pathophysiology.
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Affiliation(s)
- Joachim Bautz
- Department of Nuclear Medicine, University Hospital Münster, Albert-Schweitzer-Campus 1, Building A1, 48149, Münster, Germany
- Department of Internal Medicine D, Nephrology, University Hospital Münster, Münster, Germany
| | - Jörg Stypmann
- Department of Cardiology, University Hospital Münster, Münster, Germany
| | - Stefanie Reiermann
- Department of Internal Medicine D, Nephrology, University Hospital Münster, Münster, Germany
| | | | - Barbara Suwelack
- Department of Internal Medicine D, Nephrology, University Hospital Münster, Münster, Germany
| | - Lars Stegger
- Department of Nuclear Medicine, University Hospital Münster, Albert-Schweitzer-Campus 1, Building A1, 48149, Münster, Germany
| | - Kambiz Rahbar
- Department of Nuclear Medicine, University Hospital Münster, Albert-Schweitzer-Campus 1, Building A1, 48149, Münster, Germany
| | - Stefan Reuter
- Department of Internal Medicine D, Nephrology, University Hospital Münster, Münster, Germany
| | - Michael Schäfers
- Department of Nuclear Medicine, University Hospital Münster, Albert-Schweitzer-Campus 1, Building A1, 48149, Münster, Germany.
- European Institute for Molecular Imaging, University of Münster, Münster, Germany.
- DFG EXC 1003 'Cells in Motion' Cluster of Excellence, University of Münster, Münster, Germany.
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Salvarese N, Carta D, Marzano C, Gerardi G, Melendez-Alafort L, Bolzati C. [99mTc][Tc(N)(DASD)(PNPn)]+ (DASD = 1,4-Dioxa-8-azaspiro[4,5]decandithiocarbamate, PNPn = Bisphosphinoamine) for Myocardial Imaging: Synthesis, Pharmacological and Pharmacokinetic Studies. J Med Chem 2018; 61:11114-11126. [DOI: 10.1021/acs.jmedchem.8b01191] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Affiliation(s)
- Nicola Salvarese
- Institute of Condensed Matter Chemistry and Technologies for Energy (ICMATE)-CNR, Corso Stati Uniti, 4, 35127 Padova, Italy
| | - Davide Carta
- Department of Pharmaceutical and Pharmacological Sciences, University of Padua, Via Marzolo, 5, 35131 Padova, Italy
| | - Cristina Marzano
- Department of Pharmaceutical and Pharmacological Sciences, University of Padua, Via Marzolo, 5, 35131 Padova, Italy
| | - Gabriele Gerardi
- Department of Veterinary Clinical Science, University of Padua, Viale dell’Università 16, 35020 Legnaro, Padua, Italy
| | | | - Cristina Bolzati
- Institute of Condensed Matter Chemistry and Technologies for Energy (ICMATE)-CNR, Corso Stati Uniti, 4, 35127 Padova, Italy
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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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