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Naghshtabrizi B, Alvandi M, Shaghaghi Z, Hadei SK, Fariba F, Moradi M, Rabie MAS. Transient ischemic dilation or transient RV visualization in patients with normal SPECT stress myocardial perfusion imaging: Correlation with CT coronary artery calcium scoring and coronary angiography. J Nucl Cardiol 2022; 29:2149-2156. [PMID: 34228333 DOI: 10.1007/s12350-021-02704-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 05/17/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Ancillary findings on MPI, such as transient ischemic dilation (TID) and transient right ventricular visualization (TRV), are recognized as markers of extensive CAD and predictive of adverse outcomes. They usually occur in association with stress-induced regional MPI abnormalities. However, the clinical significance of these ancillary markers in the presence of normal stress MPI is incompletely understood. METHODS From a cohort of 564 consecutive patients referred for clinical SPECT stress MPI, 44 patients had normal stress SPECT MPI and either TID (n = 28) or TRV (n = 16). These imaging findings were correlated with CT coronary calcium (CAC), CT coronary angiography (CTA), and invasive coronary angiography (ICA) in patients with severe CAC ≥ 1000 HU. TID and TRV were quantified as stress/rest ratios. Severe CAD was defined as > 70% luminal stenosis on CTA or ICA. RESULTS The median TID ratio was 1.23, with a range of 1.13-1.48; the median TRV ratio was 1.30, with a range of 1.20-1.48. Of 44 patients with TID or TRV, only 9 patients (20.5%) had severe obstructive > 70% CAD by angiography (6 of 28 patients (21.5%) with TID and 3 of 16 patients (19%) with TRV). Severe multi-vessel CAD occurred in only 2 of 44 patients (4.5%). In contrast, of 9 patients with CAC > 1000 HU, 6 (67%) had severe obstructive CAD. CONCLUSION In patients with normal stress SPECT MPI and TID or TRV, the incidence of severe obstructive CAD was relatively low and predominantly single-vessel CAD. These findings do not support the concept that TID or TRV with normal stress MPI is predictive of high-risk CAD.
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Affiliation(s)
- Behshad Naghshtabrizi
- Department of Cardiology, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Maryam Alvandi
- Department of Nuclear Medicine and Molecular Imaging, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran.
| | - Zahra Shaghaghi
- Department of Nuclear Medicine and Molecular Imaging, Clinical Development Research Unit of Farshchian Heart Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Seyed Kamaledin Hadei
- Department of Radiology, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Farnaz Fariba
- Department of Cardiology, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Mehdi Moradi
- Department of Cardiology, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
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Hämäläinen H, Corovai A, Laitinen J, Laitinen TM, Hedman M, Hedman A, Kivelä A, Laitinen TP. Myocardial ischemia and previous infarction contribute to left ventricular dyssynchrony in patients with coronary artery disease. J Nucl Cardiol 2021; 28:3010-3020. [PMID: 32869165 PMCID: PMC8709814 DOI: 10.1007/s12350-020-02316-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Accepted: 07/14/2020] [Indexed: 11/24/2022]
Abstract
AIMS The aim of this study was to characterize determinants of left ventricular mechanical dyssynchrony (LVMD) in patients with coronary artery disease (CAD). METHODS Medical records and results of myocardial perfusion SPECT/CT studies were evaluated in 326 patients with previously diagnosed CAD. LVMD was assessed with the phase analysis of ECG-gated myocardial SPECT. Dyssynchrony was described with phase histogram bandwidth (PHBW), standard deviation (PHSD) or entropy (PHE) values above limit of the highest normal. RESULTS Prevalence of LVMD was 29% in CAD patients. Size of the infarction scar and ischemia extent correlated significantly with PHBW, PHSD and PHE (P < 0.001 for all). Independent predictors of LVMD were myocardial infarction scar (P = 0.004), ischemia extent (P = 0.003), and QRS duration (P = 0.003). Previous percutaneous coronary intervention and coronary artery bypass grafting did not independently predict dyssynchrony. CONCLUSIONS Almost one-third of CAD patients had significant LVMD. Dyssynchrony was associated with earlier myocardial infarction and presence of myocardial ischemia. Previous percutaneous coronary intervention and coronary artery bypass grafting did not independently predict dyssynchrony.
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Affiliation(s)
- Hanna Hämäläinen
- Department of Clinical Physiology and Nuclear Medicine, Kuopio University Hospital, PO BOX 100, Kuopio, 70029, KYS, Finland.
| | - Alisa Corovai
- Department of Clinical Physiology and Nuclear Medicine, Kuopio University Hospital, PO BOX 100, Kuopio, 70029, KYS, Finland
| | - Jussi Laitinen
- Department of Clinical Physiology and Nuclear Medicine, Kuopio University Hospital, PO BOX 100, Kuopio, 70029, KYS, Finland
| | - Tiina M Laitinen
- Department of Clinical Physiology and Nuclear Medicine, Kuopio University Hospital, PO BOX 100, Kuopio, 70029, KYS, Finland
| | - Marja Hedman
- Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
- Department of Cardiothoracic Surgery, Kuopio University Hospital, Kuopio, Finland
| | - Antti Hedman
- Heart Center, Kuopio University Hospital, Kuopio, Finland
| | - Antti Kivelä
- Heart Center, Kuopio University Hospital, Kuopio, Finland
| | - Tomi P Laitinen
- Department of Clinical Physiology and Nuclear Medicine, Kuopio University Hospital, PO BOX 100, Kuopio, 70029, KYS, Finland
- Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
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3
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Bekendam MT, Mommersteeg PMC, Kop WJ, Widdershoven JW, Vermeltfoort IAC. Anxiety and hemodynamic reactivity during cardiac stress testing: The role of gender and age in myocardial ischemia. J Nucl Cardiol 2021; 28:2581-2592. [PMID: 32112295 PMCID: PMC8709819 DOI: 10.1007/s12350-020-02079-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 02/10/2020] [Indexed: 01/11/2023]
Abstract
BACKGROUND The prevalence of myocardial ischemia is associated with anxiety. State and trait anxiety are more common in younger women compared to men, and high anxiety levels could affect hemodynamic reactivity during cardiac stress testing. The aim is to examine whether anxiety plays a role in gender differences in patients ≤ 65 and > 65 years in hemodynamic reactivity and ischemia during cardiac stress testing. METHODS AND RESULTS Included were 291 patients (66.8 ± 8.7 years, 45% women) with suspect ischemia undergoing myocardial perfusion single-photon emission computed tomography (MPI-SPECT). Primary outcomes were semi-quantitative summed difference score (SDS) and summed stress score (SSS), as continuous indicators of myocardial ischemia. Analyses were stratified by age. Trait anxiety was measured using a validated questionnaire (GAD-7) and state anxiety using facial expression analyses software. Overall, trait and state anxiety were not associated with the prevalence of ischemia (N = 107, 36%). A significant interaction was found between gender and trait anxiety in women ≤ 65 years for SDS (F(1,4) = 5.73, P = .019) and SSS (F(1,10) = 6.50, P = .012). This was not found for state anxiety. CONCLUSION SDS and SSS were significantly higher in women younger than 65 years with high trait anxiety. This interaction was not found in men and women over 65 years.
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Affiliation(s)
- Maria T Bekendam
- Department of Medical and Clinical Psychology, Center of Research on Psychology in Somatic Diseases (CoRPS), Tilburg University, Warandelaan 2, P.O. Box 90153, 5037 AB, Tilburg, The Netherlands
| | - Paula M C Mommersteeg
- Department of Medical and Clinical Psychology, Center of Research on Psychology in Somatic Diseases (CoRPS), Tilburg University, Warandelaan 2, P.O. Box 90153, 5037 AB, Tilburg, The Netherlands.
| | - Willem J Kop
- Department of Medical and Clinical Psychology, Center of Research on Psychology in Somatic Diseases (CoRPS), Tilburg University, Warandelaan 2, P.O. Box 90153, 5037 AB, Tilburg, The Netherlands
| | - Jos W Widdershoven
- Department of Medical and Clinical Psychology, Center of Research on Psychology in Somatic Diseases (CoRPS), Tilburg University, Warandelaan 2, P.O. Box 90153, 5037 AB, Tilburg, The Netherlands
- Department of Cardiology, Elizabeth-TweeSteden Hospital, Tilburg, The Netherlands
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Peix A, Padrón K, Cabrera LO, Pardo L, Sánchez J. Left ventricular mechanical dyssynchrony in patients with chest pain and normal epicardial coronary arteries. J Nucl Cardiol 2021; 28:1055-1063. [PMID: 31267412 DOI: 10.1007/s12350-019-01804-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 06/15/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND To detect ischemia in patients with angina and normal coronaries frequently represents a complex diagnosis. METHODS To investigate whether left ventricular mechanical dyssynchrony by phase analysis contributes in the evaluation of patients with chest pain and normal coronaries, gated-SPECT myocardial perfusion imaging (MPI) at rest and 30 minutes post-stress was performed in 218 patients with normal epicardial coronaries, who were divided into two groups: those with summed difference score (SDS) ≥ 4 (54 patients, Group 1), and those with SDS < 4 (164 patients, Group 2). Intraventricular synchronism-phase standard deviation (PSD) and histogram bandwidth (HBW)-was evaluated by phase analysis. RESULTS Women were significantly more frequent in Group 2 (those without ischemia in SPECT MPI): 113 (69%) vs 25 (46%), P = .00001. In males, left ventricular ejection fraction (LVEF) and ventricular volumes were not significantly different between patients with or without ischemia. However, ischemic females showed significantly higher ventricular volumes, minor post-stress LVEF and more negative delta LVEF (- 3.9 vs 0.34, P = .0008) than the non-ischemic ones. There was a significant post-stress increase of PSD and HBW among males, although not among females. According to SSS (≥ 4, with ischemia/necrosis; < 4, without ischemia/necrosis), post-stress PSD and HBW significantly increase both in male and female, and PSD and HBW were significantly higher in females with SSS ≥ 4 compared to those with SSS < 4 (PSD rest: 19.04° vs 11.72°, P < .0001; HBW rest: 58.85° vs 38.21°, P < .0001). PSD and HBW were also higher among males with SSS ≥ 4 compared to those with SSS < 4, although not significantly. CONCLUSION Higher ventricular volumes in females and dyssynchrony are associated with inducible ischemia in MPI in patients with chest pain and normal coronaries. Stress-induced ischemia increases degree of dyssynchrony.
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Affiliation(s)
- Amalia Peix
- Institute of Cardiology and Cardiovascular Surgery, Havana, Cuba.
- Nuclear Medicine Department, Institute of Cardiology, 17 No. 702, Vedado, CP 10 400, Havana, Cuba.
| | - Kenia Padrón
- Institute of Cardiology and Cardiovascular Surgery, Havana, Cuba
- Nuclear Medicine Department, Institute of Cardiology, 17 No. 702, Vedado, CP 10 400, Havana, Cuba
| | - Lázaro O Cabrera
- Institute of Cardiology and Cardiovascular Surgery, Havana, Cuba
- Nuclear Medicine Department, Institute of Cardiology, 17 No. 702, Vedado, CP 10 400, Havana, Cuba
| | - Leticia Pardo
- Institute of Cardiology and Cardiovascular Surgery, Havana, Cuba
- Nuclear Medicine Department, Institute of Cardiology, 17 No. 702, Vedado, CP 10 400, Havana, Cuba
| | - Jesús Sánchez
- Institute of Cybernetics, Mathematics and Physics, Havana, Cuba
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Cortés CM, Aramayo G EN, Barboza PE, Crottogini A, Embon MA. Impact of early post-stress 99mTc sestamibi ECG-gated SPECT myocardial perfusion imaging on the detection of ischemic LV dyssynchrony: an early step in the stunning cascade. Int J Cardiovasc Imaging 2021; 37:1789-1798. [PMID: 33442855 DOI: 10.1007/s10554-020-02145-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 12/23/2020] [Indexed: 11/26/2022]
Abstract
Transient alterations in ventricular conduction and synchronized cardiac performance have been reported in experimental models of myocardial ischemia. In post-stress 99mTc-sestamibi-gated-SPECT myocardial perfusion imaging (MPI), the time elapsed between tracer injection and image acquisition could influence the detection of ischemic left ventricular mechanical dyssynchrony (LVMD). We aimed at evaluating whether early vs. delayed post-stress MPI improve ischemic LVMD detection using the phase analysis parameters standard deviation (SD) and histogram bandwidth (HB) and to assess the correlation between stress-induced changes in SD and HB and other functional parameters. We prospectively studied 32 control subjects (Group-1) and 60 ischemic patients (Group-2). Stress-induced changes were calculated as stress minus rest (Δ). LVMD was defined as post-stress increases of either SD or HB. Group-2 showed higher ΔSD and ΔHB in early than in delayed images: early ΔSD: 1.63 (- 0.37 to 4.83) vs. delayed ΔSD: - 0.39 (- 3.82 to 1.74); early ΔHB: 2.50 (- 4 to 12) vs. ΔHB delayed: - 4 (- 15.75 to 4), all p < 0.01. ΔSD and ΔHB correlated linearly with ΔLV-ejection-fraction (EF) and ΔLV-end systolic-volume (ESV) in early images, all p < 0.01. Early images detected LVMD in more patients than delayed scans (78% vs. 38%; p < 0.01) All patients with LVEF drop in early post-stress evaluation had LVMD. Early post-stress images improve ischemic LVMD detection. Ischemic LVEF and LVESV changes correlate with ΔSD and ΔHB.
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Affiliation(s)
- Claudia Mariana Cortés
- Service of Nuclear Medicine, Favaloro Foundation University Hospital, Buenos Aires, Argentina.
| | - E Natalia Aramayo G
- Service of Nuclear Medicine, Favaloro Foundation University Hospital, Buenos Aires, Argentina
| | - Paula Elizabeth Barboza
- Service of Nuclear Medicine, Favaloro Foundation University Hospital, Buenos Aires, Argentina
| | | | - Mario Alberto Embon
- Department of Images, Favaloro Foundation University Hospital, Buenos Aires, Argentina
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Massardo T. Auxiliary ischemic markers, the role of left ventricular dyssynchrony. J Nucl Cardiol 2020; 27:2269-2272. [PMID: 30701445 DOI: 10.1007/s12350-019-01606-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 01/11/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Teresa Massardo
- Sección Medicina Nuclear, Departamento de Medicina, Hospital Clínico Universidad de Chile, Santos Dumont 999 1E, Independencia, PO Box 6531063, Santiago, Chile.
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7
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Padrón K, Peix A, Cabrera L, Garcia J, Rodriguez L, Carrillo R, Mena E, Fernandez Y. Could myocardial viability be related to left ventricular dyssynchrony? Simultaneous evaluation by gated SPECT-MPI. J Nucl Cardiol 2020; 27:1158-1167. [PMID: 32246407 DOI: 10.1007/s12350-020-02047-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] [Received: 06/19/2018] [Accepted: 11/08/2019] [Indexed: 10/24/2022]
Abstract
BACKGROUND Left ventricular contraction dyssynchrony (LVCD) has been related to induced ischemia and transmural scar but the interplay of myocardial viability and dyssynchrony is unknown. The aim of the present study was to establish the role of dyssynchrony in the context of a viability study performed with nitrate augmentation gated single photon emission computed tomography (GSPECT) myocardial perfusion imaging (MPI). METHODS Fifty-four consecutive patients with ischemic dilated cardiomyopathy (IDC) and depressed left ventricular ejection fraction (LVEF) were included. They underwent a two-day rest/nitroglycerine (NTG) study GSPECT MPI to determine the myocardial viability. Patients with a nitrate-induced uptake increase of > 10% vs baseline, in at least, two consecutive dysfunctional segments were considered viable as well as those who showed no improvement in the uptake but the uptake was > 50% on post NTG study. Patients with no nitrate-induced uptake increase of > 10% and the uptake of < 50% were considered non-viable. Perfusion, function and LVCD were compared in 25 viable patients vs 29 non-viable patients at baseline and after NTG administration. RESULTS After NTG administration, in the viable group, the LVEF increased (36.44 ± 6.64% vs 39.84 ± 6.39%) and the end-systolic volume decreased significantly (119.28 ± 31.77 mL vs 109.08 ± 33.17 mL) (P < 0.01). These patients also experienced a significant reduction in the LVCD variables: phase standard deviation was reduced in the post NTG study (57.77° ± 19.47° vs 52.02° ± 17.09°) as well as the phase histogram bandwidth (190.20° ± 78.83° vs 178.0° ± 76.14°) (P < 0.05). Functional and LVCD variables remained similar in the non-viable patients (P > 0.05). CONCLUSION In patients with IDC and depressed LVEF, the myocardial viability detected by rest/ NTG GSPECT MPI, might determine LVCD improvement.
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Affiliation(s)
- Kenia Padrón
- National Institute of Cardiology, Havana City, Cuba.
| | - Amalia Peix
- National Institute of Cardiology, Havana City, Cuba
| | | | | | | | | | - Erick Mena
- National Institute of Cardiology, Havana City, Cuba
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8
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Jiang Z, Zhou W. Left ventricular mechanical dyssynchrony for CAD diagnosis: Does it have incremental clinical values? J Nucl Cardiol 2020; 27:251-253. [PMID: 30218216 DOI: 10.1007/s12350-018-1440-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 08/31/2018] [Indexed: 12/01/2022]
Affiliation(s)
- Zhixin Jiang
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, Jiangsu, China.
| | - Weihua Zhou
- School of Computing, University of Southern Mississippi, Long Beach, MS, 39560, USA.
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Crosland W, Aggarwal H, Farag A, Mehta S, Mannon RB, Heo J, Iskandrian AE, Hage FG. The effect of renal transplantation on left ventricular function, electrocardiography, and mechanical synchrony by gated myocardial perfusion imaging. J Nucl Cardiol 2019; 26:1962-1970. [PMID: 30350267 DOI: 10.1007/s12350-018-1411-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2017] [Accepted: 05/14/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Depressed left ventricular ejection fraction (LVEF), LV mechanical dyssynchrony (LVMD), and prolonged QTc interval predict poor outcomes in end-stage renal disease (ESRD). Renal transplantation improves mortality in ESRD patients but the effects of transplantation on these indices remain undefined. METHODS We identified patients with myocardial perfusion imaging (MPI) before and after renal transplantation. A control group consisted of ESRD patients who underwent 2 MPIs but did not receive a transplant. Changes in LVEF, LVMD indices [phase standard deviation (SD) and bandwidth (BW)] by MPI, and electrocardiogram (ECG) indices were determined. RESULTS The study population consisted of 32 ESRD patients (53% male, 50 ± 11 years, 59% African American, 65% diabetic). The second MPI was performed 31 months (13-59 months) after renal transplantation. LVEF (72 ± 10% vs. 67 ± 10%, P < 0.001) but not SD (22 ± 15° vs. 22 ± 11°, P = 0.9) or BW (58 ± 35° vs. 57 ± 29°, P = 0.9) improved after transplantation. There were no changes in these indices in the control group. QTc (425 ± 30 ms vs. 447 ± 32 ms, P = <0.001) but not QRS (90 ± 21 ms vs. 90 ± 21 ms, P = 0.9) improved significantly after renal transplantation. CONCLUSIONS LVEF and QTc improved after renal transplantation but LVMD indices and QRS did not change, which suggests that LVMD and electrical dyssynchrony may be irreversible in ESRD.
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Affiliation(s)
- William Crosland
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Himanshu Aggarwal
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Ayman Farag
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Shikha Mehta
- Division of Nephrology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Roslyn B Mannon
- Division of Nephrology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jaekyeong Heo
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Ami E Iskandrian
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Fadi G Hage
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, AL, USA.
- Division of Cardiovascular Disease, Birmingham Veterans Affairs Medical Center, Birmingham, AL, USA.
- 1900 University BLVD, 306 Lyons Harrison Research Building, Birmingham, AL, 35294, USA.
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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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Jiang Z, Tang H, Shi J, Zhou Y, Wang C, Li D, Shan Q, Zhou W. Myocardial stunning-induced left ventricular dyssynchrony on gated single-photon emission computed tomography myocardial perfusion imaging. Nucl Med Commun 2018; 39:725-731. [PMID: 29794947 PMCID: PMC10960236 DOI: 10.1097/mnm.0000000000000870] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Myocardial stunning provides additional nonperfusion markers of coronary artery disease (CAD), especially for severe multivessel CAD. The purpose of this study is to assess the influence of myocardial stunning to the changes of left ventricular mechanical dyssynchrony (LVMD) parameters between stress and rest gated single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI). PATIENTS AND METHODS A total of 113 consecutive patients (88 males and 25 females) who had undergone both stress and rest Tc-sestamibi gated SPECT MPI were retrospectively enrolled. Suspected or known patients with CAD were included if they had exercise stress MPI and moderate to severe myocardial ischemia. Segmental scores were summed for the three main coronary arteries according to standard myocardial perfusion territories, and then regional perfusion, wall motion, and wall thickening scores were measured. Myocardial stunning was defined as both ischemia and wall dysfunction within the same coronary artery territory. Patients were divided into the stunning group (n=58) and nonstunning group (n=55). RESULTS There was no significant difference of LVMD parameters between stress and rest in the nonstunning group. In the stunning group, phase SD and phase histogram bandwidth of contraction were significantly larger during stress than during rest (15.05±10.70 vs. 13.23±9.01 and 46.07±34.29 vs. 41.02±32.16, P<0.05). Phase SD and phase histogram bandwidth of relaxation were also significantly larger during stress than during rest (21.21±13.91 vs. 17.46±10.52 and 59.03±37.82 vs. 52.38±36.89, P<0.05). CONCLUSION Both systolic and diastolic LVMD parameters deteriorate with myocardial stunning. This kind of change may have incremental values to diagnose CAD.
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Affiliation(s)
- Zhixin Jiang
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Haipeng Tang
- School of Computing, University of Southern Mississippi, Hattiesburg, Mississippi, USA
| | - Jianzhou Shi
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Yanli Zhou
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Cheng Wang
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Dianfu Li
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Qijun Shan
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Weihua Zhou
- School of Computing, University of Southern Mississippi, Hattiesburg, Mississippi, USA
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