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Erol M, Tezcan H, Duran M, Uygun T, Kurtipek E, Önner H. The role of myocardial perfusion imaging in predicting myocardial ischemia in patients diagnosed with long COVID. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2023; 39:2279-2284. [PMID: 37665487 DOI: 10.1007/s10554-023-02928-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Accepted: 08/06/2023] [Indexed: 09/05/2023]
Abstract
OBJECTIVE Incomplete recovery with long-term complications weeks beyond the acute coronavirus disease 2019 (COVID-19) infection is referred to as long COVID. Among the well-known long-term complications of COVID-19, myocardial damage is a frequently encountered side effect. Yet there is a lack of data for identifying high-risk patients who are more likely to develop long-term cardiovascular complications following COVID-19. Myocardial perfusion imaging (MPI) is the primary functional imaging modality in evaluating myocardial ischemia This study aimed to investigate the role of MPI in predicting myocardial ischemia in patients diagnosed with long COVID. METHODS Subjects were selected from eligible long COVID patients and control subjects without a prior history of COVID-19 who were referred to the nuclear medicine department for stress and rest single-photon emission computed tomography (SPECT) MPI. All participants' past medical records and clinical, and demographic characteristics were scanned. In addition, patients undergoing coronary angiography (CAG) following SPECT MPI were documented and patients with critical coronary stenosis were identified. RESULTS Our results revealed that long COVID patients had higher rates of abnormal summed stress scores compared to the control subjects (p < 0.05). Additionally, serum CRP level, SPECT lung-to-heart ratio (LHR), and the presence of long COVID were independent predictors of ischemia. The presence of long COVID was the best predictor of ischemia among the aforementioned parameters (p < 0.001). CONCLUSION Our data indicate that SPECT MPI provides comprehensive information on myocardial perfusion and left ventricular function in long COVID patients.
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Affiliation(s)
- Mustafa Erol
- Department of Nuclear Medicine, Konya City Hospital, Konya, Turkey
| | - Hüseyin Tezcan
- Department of Cardiology, Konya City Hospital, Konya, Turkey.
| | - Mustafa Duran
- Department of Cardiology, Konya City Hospital, Konya, Turkey
| | - Turgut Uygun
- Department of Cardiology, Konya City Hospital, Konya, Turkey
| | - Ercan Kurtipek
- Department of Pulmonology, Konya City Hospital, Konya, Turkey
| | - Hasan Önner
- Department of Nuclear Medicine, Konya City Hospital, Konya, Turkey
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Bian J, Herzog CA, Rangaswami J, Wald R, Stratman JA, Asif A, Sidhu MS, Bangalore S, Mathew RO. Lung Sestamibi Uptake on Myocardial Perfusion Imaging and Outcomes in Chronic Kidney Disease. Cardiorenal Med 2021; 11:67-76. [PMID: 33494087 DOI: 10.1159/000511801] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 09/19/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND AND OBJECTIVES In patients with CKD and end-stage kidney disease (ESKD), cardiac stress testing has low sensitivity and specificity for coronary disease. Alternate markers that are derived during the stress testing may enhance the predictive characteristic of stress testing. The objective was to examine the predictive characteristic of lung-to-heart ratio (LHR) in patients with CKD and ESKD. DESIGN, SETTING, PARTICIPANTS, AND MEASUREMENTS Retrospective parallel cohort of ESKD and CKD not on dialysis (CKD-ND) who underwent stress testing with nuclear myocardial perfusion imaging utilizing sestamibi tracer and regadenoson. Stress LHR was calculated by the processing software and reported. Patients were analyzed by tertile of LHR (≤0.28, 0.29-0.32, ≥0.33). The primary outcome was a composite of all-cause mortality, hospitalization for myocardial infarction or unstable angina, or revascularization. RESULTS There were 144 CKD-ND and 145 ESKD patients. Patients with ESKD had greater comorbidity burden than CKD-ND. Stress tests were more often performed for pre-operative risk assessment among ESKD versus CKD-ND (53.8 vs. 5.6%, p < 0.001). ESKD patients more likely had ischemia identified on stress testing (19.3 vs. 8.3%, p = 0.001). Mean LHR was 0.31 (Standard deviation - SD: 0.09) and was similar across CKD-ND stages and ESKD. Primary outcome in the lowest (23%) and highest (33.3%) LHR tertile was higher than the middle tertile (12.8%); p = 0.005. This finding was similar between CKD-ND and ESKD and persisted in multivariable analysis. CONCLUSIONS LHR ≤0.28 and ≥0.33 are independently associated with higher risk for death in patients with CKD-ND and ESKD. Future studies are warranted to understand the association of extreme LHR values and outcomes in this high-risk population.
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Affiliation(s)
- Julia Bian
- University of South Carolina School of Medicine, Columbia, South Carolina, USA
| | - Charles A Herzog
- Cardiology Division, Department of Internal Medicine, Hennepin Healthcare/University of Minnesota, Minneapolis, Minnesota, USA
| | - Janani Rangaswami
- Division of Nephrology, Department of Medicine, Einstein Medical Center, Philadelphia, Pennsylvania, USA
| | - Ron Wald
- Division of Nephrology and Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Ontario, Québec, Canada
| | - Jennifer A Stratman
- Education & Research, Columbia VA Health Care System, Columbia, South Carolina, USA
| | - Arif Asif
- Department of Medicine, Jersey Shore University Medical Center, Hackensack-Meridian School of Medicine at Seton Hall University, Hackensack-Meridian Health, Neptune, New Jersey, USA
| | - Mandeep S Sidhu
- Division of Cardiology, Department of Medicine, Albany Medical College & Albany Medical Center, Albany, New York, USA
| | - Sripal Bangalore
- Division of Cardiology, Department of Medicine, NYU Grossman School of Medicine, New York, New York, USA
| | - Roy O Mathew
- University of South Carolina School of Medicine, Columbia, South Carolina, USA, .,Division of Nephrology, Department of Medicine, Columbia VA Health Care System, Columbia, South Carolina, USA,
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Katsikis A, Theodorakos A, Papaioannou S, Kalkinis A, Kolovou G, Konstantinou K, Koutelou M. Adenosine stress myocardial perfusion imaging in octogenarians: Safety, tolerability, and long-term prognostic implications of hemodynamic response and SPECT-related variables. J Nucl Cardiol 2019; 26:250-262. [PMID: 28447283 DOI: 10.1007/s12350-017-0893-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Accepted: 04/05/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Evaluation of tolerability, safety, and prognostic implications of adenosine stress myocardial perfusion imaging (MPI) in octogenarians. METHODS 370 octogenarians (49% known coronary artery disease) were studied. Hemodynamic response, MPI-related data, and rest-left ventricular ejection fraction (LVEF) based on echocardiography were registered per patient, and prospective follow-up was performed to document all-cause death (ACD), cardiac death (CD), myocardial infarction (MI), and late revascularization. RESULTS No deaths or MIs were observed during adenosine infusion or the short-term post-infusion period. 86% of patients were able to tolerate a 6-minute infusion. All side effects terminated spontaneously after infusion cessation, except for one case of pulmonary oedema. After 9.3 years, there were 124 ACDs, 62 CDs, 16 MIs, and 35 revascularizations. Differences between survival curves of summed stress score (SSS)-based risk groups were significant for all end points (P < .001). SSS and LVEF were independent predictors of all end points (P ≤ .01) and lung uptake of cardiac end points. ΔHR <10 bpm (OR = 1.78, P = .004) and inability to increase HR by >10 bpm and decrease systolic blood pressure by >10 mmHg (OR = 2, P = .02) during adenosine infusion were independent predictors of ACD and CD, respectively. Hemodynamic response variables, SSS, and lung uptake provided incremental prognostic value over pre-test data for ACD and CD. CONCLUSIONS In octogenarians, adenosine stress MPI is well tolerated and provides effective long-term risk stratification.
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Affiliation(s)
- Athanasios Katsikis
- Nuclear Medicine Department, Onassis Cardiac Surgery Center, Athens, Greece.
- Cardiology Department, 401 General Military Hospital of Athens, Athens, Greece.
- , Zoodochou Pigis 54, Melissia, Athens, Greece.
| | | | | | - Antonios Kalkinis
- Nuclear Medicine Department, Onassis Cardiac Surgery Center, Athens, Greece
| | - Genovefa Kolovou
- Cardiology Department, Onassis Cardiac Surgery Center, Athens, Greece
| | - Konstantinos Konstantinou
- Cardiology Department, 401 General Military Hospital of Athens, Athens, Greece
- Cardiology Department, Ipokration Hospital of Athens, Athens, Greece
| | - Maria Koutelou
- Nuclear Medicine Department, Onassis Cardiac Surgery Center, Athens, Greece
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Katsikis A, Theodorakos A, Manira V, Papaioannou S, Kolovou G, Voudris V, Koutelou M. Long-term prognostic implications of myocardial perfusion imaging in octogenarians: an all-comer, cohort study. Eur J Nucl Med Mol Imaging 2017; 44:1547-1558. [DOI: 10.1007/s00259-017-3739-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 05/22/2017] [Indexed: 11/28/2022]
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Sareen N, Ananthasubramaniam K. Left main coronary artery disease: A review of the spectrum of noninvasive diagnostic modalities. J Nucl Cardiol 2016; 23:1411-1429. [PMID: 26487011 DOI: 10.1007/s12350-015-0152-1] [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: 02/15/2015] [Accepted: 04/15/2015] [Indexed: 11/29/2022]
Abstract
Medically managed significant left main (LM) stem disease has been considered a determinant of increased cardiac mortality approaching 50% at 3-year follow-up. Despite the clinical significance of LM disease, studies comparing the various diagnostic modalities, especially noninvasive, are sparse. Clinicians, particularly imagers, should be aware of the strengths and weaknesses of existing modalities to diagnose LM disease as integrating many clues (history, symptoms, electrocardiogram, and stress hemodynamics are essential to suspect this diagnosis and proceed to the next step). Here we review the existing data on the current role of electrocardiography, nuclear myocardial perfusion imaging (single photon emission computed tomography and positron emission tomography), stress echocardiography, cardiac computed tomography, and cardiac magnetic resonance imaging in diagnostic evaluation of LM disease. Wherever applicable we have extended our discussion to multivessel coronary artery disease encompassing scenarios where LMS can present as LM equivalent with or without extensive multivessel coronary artery disease.
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Affiliation(s)
- Nishtha Sareen
- Department of Cardiology, St. Joseph Mercy Oakland Hospital, Pontiac, MI, USA
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Bajaj NS, Singh S, Farag A, El-Hajj S, Heo J, Iskandrian AE, Hage FG. The prognostic value of non-perfusion variables obtained during vasodilator stress myocardial perfusion imaging. J Nucl Cardiol 2016; 23:390-413. [PMID: 26940574 DOI: 10.1007/s12350-016-0441-3] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Accepted: 01/21/2016] [Indexed: 11/25/2022]
Abstract
Myocardial perfusion imaging (MPI) is an established diagnostic test that provides useful prognostic data in patients with known or suspected coronary artery disease. In more than half of the patients referred for stress testing, vasodilator stress is used in lieu of exercise. Unlike exercise, vasodilator stress does not provide information on exercise and functional capacity, heart rate recovery, and chronotropy, and ECG changes are less frequent. These non-perfusion data provide important prognostic and patient management information. Further, event rates in patients undergoing vasodilator MPI are higher than in those undergoing exercise MPI and even in those with normal images probably due to higher pretest risk. However, there are a number of non-perfusion variables that are obtained during vasodilator stress testing, which have prognostic relevance but their use has not been well emphasized. The purpose of this review is to summarize the prognostic values of these non-perfusion data obtained during vasodilator MPI.
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Affiliation(s)
- Navkaranbir S Bajaj
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Lyons Harrison Research Building 306, 701 19th Street South, Birmingham, AL, 35294-0007, USA
| | - Siddharth Singh
- Division of Cardiovascular Disease, Cedars Sinai Heart Institute, Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - Ayman Farag
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Lyons Harrison Research Building 306, 701 19th Street South, Birmingham, AL, 35294-0007, USA
| | - Stephanie El-Hajj
- Division of Cardiovascular Disease, Medical University of South Carolina, Charleston, SC, USA
| | - Jack Heo
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Lyons Harrison Research Building 306, 701 19th Street South, Birmingham, AL, 35294-0007, USA
| | - Ami E Iskandrian
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Lyons Harrison Research Building 306, 701 19th Street South, Birmingham, AL, 35294-0007, USA
| | - Fadi G Hage
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Lyons Harrison Research Building 306, 701 19th Street South, Birmingham, AL, 35294-0007, USA.
- Section of Cardiology, Birmingham Veteran's Administration Medical Center, Birmingham, AL, USA.
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Hallioglu O, Ceylan Gunay E, Unal S, Erdogan A, Balci S, Citirik D. Gated myocardial perfusion scintigraphy in children with sickle cell anemia: correlation with echocardiography. ACTA ACUST UNITED AC 2011; 30:354-9. [PMID: 21458111 DOI: 10.1016/j.remn.2011.02.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2010] [Revised: 12/25/2010] [Accepted: 02/01/2011] [Indexed: 10/18/2022]
Abstract
OBJECTIVES The heart is one of the organs affected by sickle cell anemia (SCA). This prospective study has aimed to evaluate myocardial perfusion and left ventricle (LV) function in children with SCA by gated myocardial perfusion scintigraphy (G-MPS) and to compare the results with echocardiographic parameters. METHODS Forty-three patients with SCA were evaluated by G-MPS and echocardiography. Myocardial perfusion and motion with thickening function were analyzed both visually and quantitatively. End-diastolic (EDV), end-systolic volumes (ESV), ejection fraction (EF), lung-to-heart (L/H) ratio were also calculated. RESULTS None of the patients showed stress perfusion impairment in G-MPS. LV dilatation in 15 patients was observed both by G-MPS and echocardiography. EF values were within normal limits. Correlation between EF values calculated by two methods was not statistically significant. However, LV dilatation detected by both methods and EDV-ESV values in G-MPS were correlated to end-diastolic and end-systolic diameters calculated in echocardiography (p<0.05). M-Mode echocardiography revealed higher myocardial performance index (LV-MPI) in patients with LV dilatation. There was also a significant relationship between LV dilatation and frequent blood transfusions (>5/years) and acute chest syndrome (p<0.05). CONCLUSION Myocardial perfusion impairment in children with SCA is not frequently observed. Thus, performing the scintigraphy only in patients with cardiac symptoms should be considered. Since EF values of the children with SCA are not deteriorated in early stages, LV-MPI and LV dilatation should be considered as a significant parameter other than EF or perfusion data.
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Affiliation(s)
- O Hallioglu
- Mersin University, Department of Pediatric Cardiology, Turkey
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Practical considerations for 1-day stress-only myocardial perfusion protocol. J Am Coll Cardiol 2010; 55:2610-1; author reply 2612-3. [PMID: 20513607 DOI: 10.1016/j.jacc.2010.02.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2010] [Accepted: 02/15/2010] [Indexed: 11/27/2022]
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Gated myocardial perfusion scintigraphy in children with myocarditis: can it be considered as an indicator of clinical outcome? Nucl Med Commun 2009; 29:907-14. [PMID: 18769309 DOI: 10.1097/mnm.0b013e328303359f] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE Myocarditis is an inflammation of the heart muscle and represents a challenge for diagnosis and treatment. On account of the lack of sensitivity and specificity of routine cardiac tests, there is a need for accurate diagnostic imaging. The aim of this study is to review the role of gated 99Tc-methoxyisobutylisonitrile myocardial perfusion scintigraphy (G-MPS) in the diagnosis and follow-up of the patients with myocarditis in comparison with gallium scintigraphy. MATERIALS AND METHODS Thirteen patients with a clinical diagnosis of myocarditis were included in the study. All underwent rest G-MPS and the images were then evaluated by quantitative perfusion single-photon emission computed tomography and quantitative gated single photon emission computed tomography software program. Visual evaluation of perfusion was performed as well as analysis of motion with thickening function [expressed as summed rest score, summed motion score, and summed thickening score (STS)] with calculation of ejection fraction (EF) and lung-to-heart (L/H) ratio. Eight patients underwent 67Ga scintigraphy. Clinical, echocardiography, and cardiac enzymes (creatinine kinase-MB, myoglobulin, troponin T, brain natriuretic peptide) data were gathered from the patients' charts. Clinical outcome was grouped according to prognosis. Spearman's correlation (SC) test was used for comparison analysis. RESULTS Myocardial perfusion defects were observed in eight patients. Perfusion defects in the left ventricle involve a mean of 7.25% (range: 1-11%), whereas wall motion abnormality on G-MPS was more prominent, which showed to be a better marker for myocardial inflammation and necrosis. The 67Ga scintigraphy findings were normal in all, but two. The G-MPS EF (33+/-21%) was slightly lower than the echocardiography EF (40+/-15%), but with close correlation (SC coefficient: 0.635). Comparison of scintigraphic findings with clinical parameters showed that summed motion score with G-MPS EF and STS with L/H ratios were highly correlated (0.932 and 0.622, respectively). The maximum brain natriuretic peptide and L/H ratio with STS were highly correlated with the patients' outcomes (SC coefficient: -0.621, 0.821, and 0.579, respectively), as well. CONCLUSION Tc-methoxyisobutylisonitrile G-MPS is therefore helpful in providing additional diagnostic and prognostic information in patients with myocarditis.
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Higgins JP, Higgins JA, Williams G. Stress-induced abnormalities in myocardial perfusion imaging that are not related to perfusion but are of diagnostic and prognostic importance. Eur J Nucl Med Mol Imaging 2006; 34:584-95. [PMID: 17103165 DOI: 10.1007/s00259-006-0293-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2006] [Accepted: 09/20/2006] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Certain stress-induced ancillary findings on myocardial perfusion scintigraphy increase the likelihood that the patient has coronary artery disease (CAD); furthermore, among CAD patients, they indicate more severe and extensive disease, placing these patients at higher risk for future cardiac events. Indeed, in studies with no obvious perfusion defect yet with serious CAD--for example, balanced ischemia--it can be these high-risk findings that necessitate invasive intervention. DISCUSSION Besides reversible perfusion defects, such findings include increased pulmonary radiotracer uptake, transient cavity dilatation, increased end-diastolic or end-systolic volume, decreased post-stress ejection fraction, and increased right ventricular tracer uptake on stress images. The pathophysiology underlying these findings is clearly different as they do not always occur together, and each independently predicts more severe and extensive CAD. In the current review, these findings are defined and their significance in diagnosing patients with suspected or known CAD is discussed.
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Affiliation(s)
- John P Higgins
- Cardiology Section, Nuclear Medicine, VA Boston Healthcare System and Harvard Medical School, 2C-120, 1400 VFW Parkway, Boston, MA 02132, USA.
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