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Comparison of empagliflozin and sitagliptin therapy on myocardial perfusion reserve in diabetic patients with coronary artery disease. Nucl Med Commun 2021; 42:972-978. [PMID: 34397987 DOI: 10.1097/mnm.0000000000001429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Sodium-glucose co-transporter 2 inhibitors reduce the risk of cardiovascular events in type 2 diabetic patients with coronary artery disease (CAD); however, the underlying mechanisms remain unclear. OBJECTIVES We compared the effects of empagliflozin vs. sitagliptin therapy on myocardial perfusion reserve (MPR) using dynamic single-photon emission computed tomography (SPECT) imaging. METHODS In total, 100 patients with type 2 diabetes, CAD and an MPR <2.5 were randomized to receive either empagliflozin (10 mg once daily) or sitagliptin (100 mg once daily). Dynamic SPECT examinations were performed at baseline and at 6 months. The primary endpoint was the percent change of global MPR. Evaluable SPECT data were available for 98 patients. RESULTS Baseline clinical characteristics and SPECT data were well balanced between the two groups. At a 6-month follow-up, the fasting glucose and glycated hemoglobin levels significantly decreased in both groups. Hematocrit and hemoglobin levels significantly increased in the empagliflozin group but not in the sitagliptin group. The global MPR significantly improved after treatment in both groups (34.5 ± 70.6%; P = 0.005 for empagliflozin vs. 22.4 ± 45.7%; P = 0.024 for sitagliptin). However, there was no significant difference in the global MPR between the two groups (P = 0.934). Similar findings were detected with regard to the regional MPR. CONCLUSION Among patients with type 2 diabetes and CAD, both empagliflozin and sitagliptin significantly improved the global MPR with no significant difference between the groups.
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Fang W, Liu S. New 99mTc Radiotracers for Myocardial Perfusion Imaging by SPECT. Curr Radiopharm 2019; 12:171-186. [PMID: 30727939 DOI: 10.2174/1874471012666190206102214] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 01/04/2019] [Accepted: 01/08/2019] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Myocardial Perfusion Imaging (MPI) with radiotracers is an integral component in evaluation of the patients with known or suspected coronary artery diseases (CAD). 99mTc-Sestamibi and 99mTc-Tetrofosmin are commercial radiopharmaceuticals for MPI by single photon-emission computed tomography (SPECT). Despite their widespread clinical applications, they do not meet the requirements of an ideal perfusion imaging agent due to their inability to linearly track the regional myocardial blood flow rate at >2.5 mL/min/g. With tremendous development of CZT-based SPECT cameras over the past several years, the nuclear cardiology community has been calling for better perfusion radiotracers with improved extraction and biodistribution properties. METHODS This review will summarize recent research efforts on new cationic and neutral 99mTc radiotracers for SPECT MPI. The goal of these efforts is to develop a 99mTc radiotracer that can be used to detect perfusion defects at rest or under stress, determine the regional myocardial blood flow, and measure the perfusion and left ventricular function. RESULTS The advantage of cationic radiotracers (e.g. 99mTc-Sestamibi) is their long myocardial retention because of the positive molecular charge and fast liver clearance kinetics. 99mTc-Teboroxime derivatives have a high initial heart uptake (high first-pass extraction fraction) due to their neutrality. 99mTc- 3SPboroxime is the most promising radiotracer for future clinical translation considering its initial heart uptake, myocardial retention time, liver clearance kinetics, heart/liver ratios and SPECT image quality. CONCLUSION 99mTc-3SPboroximine is an excellent example of perfusion radiotracers, the heart uptake of which is largely relies on the regional blood flow. It is possible to use 99mTc-3SPboroximine for detection of perfusion defect(s), accurate quantification and determination of regional blood flow rate. Development of such a 99mTc radiotracer is of great clinical benefit for accurate diagnosis of CAD and assessing the risk of future hard events (e.g. heart attack and sudden death) in cardiac patients.
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Affiliation(s)
- Wei Fang
- Department of Nuclear Medicine, Fuwai Hospital, the National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No.167 North Lishi Road, Xicheng District, Beijing, China
| | - Shuang Liu
- School of Health Sciences, Purdue University, Beijing, IN 47907, United States
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Yoshinaga K, Manabe O, Tamaki N. Absolute quantification of myocardial blood flow. J Nucl Cardiol 2018; 25:635-651. [PMID: 27444500 DOI: 10.1007/s12350-016-0591-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Revised: 07/01/2016] [Indexed: 12/22/2022]
Abstract
With the increasing availability of positron emission tomography (PET) myocardial perfusion imaging, the absolute quantification of myocardial blood flow (MBF) has become popular in clinical settings. Quantitative MBF provides an important additional diagnostic or prognostic information over conventional visual assessment. The success of MBF quantification using PET/computed tomography (CT) has increased the demand for this quantitative diagnostic approach to be more accessible. In this regard, MBF quantification approaches have been developed using several other diagnostic imaging modalities including single-photon emission computed tomography, CT, and cardiac magnetic resonance. This review will address the clinical aspects of PET MBF quantification and the new approaches to MBF quantification.
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Affiliation(s)
- Keiichiro Yoshinaga
- Diagnostic and Therapeutic Nuclear Medicine, National Institute of Radiological Sciences, 4-9-1 Anagawa, Inage-Ku, Chiba, 263-8555, Japan
| | - Osamu Manabe
- Department of Nuclear Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Nagara Tamaki
- Department of Nuclear Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
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4
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Zhao ZQ, Liu M, Fang W, Liu S. Sulfonyl-Containing Boronate Caps for Optimization of Biological Properties of 99mTc(III) Radiotracers [99mTcCl(CDO)(CDOH)2B-R] (CDOH2 = Cyclohexanedione Dioxime). J Med Chem 2017; 61:319-328. [PMID: 29186661 DOI: 10.1021/acs.jmedchem.7b01412] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Zuo-Quan Zhao
- Department of
Nuclear Medicine, Fuwai Hospital, National Center for Cardiovascular
Diseases, Chinese Academy of Medical Sciences, and Peking Union Medical
College, No.167 North Lishi Road, Xicheng District, Beijing 100037, China
| | - Min Liu
- School
of Health Sciences, Purdue University, 550 Stadium Mall Drive, West Lafayette, Indiana 47907, United States
| | - Wei Fang
- Department of
Nuclear Medicine, Fuwai Hospital, National Center for Cardiovascular
Diseases, Chinese Academy of Medical Sciences, and Peking Union Medical
College, No.167 North Lishi Road, Xicheng District, Beijing 100037, China
| | - Shuang Liu
- School
of Health Sciences, Purdue University, 550 Stadium Mall Drive, West Lafayette, Indiana 47907, United States
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Assessment of coronary flow reserve using a combination of planar first-pass angiography and myocardial SPECT: Comparison with myocardial (15)O-water PET. Int J Cardiol 2016; 222:209-212. [PMID: 27497096 DOI: 10.1016/j.ijcard.2016.07.183] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Accepted: 07/28/2016] [Indexed: 11/20/2022]
Abstract
UNLABELLED Coronary flow reserve (CFR), defined as the ratio of maximum coronary flow increase from baseline resting blood flow, is one of the most sensitive parameters to detect early signs of coronary arteriosclerosis at the microvascular level. Myocardial perfusion PET is a well-established technology for CFR measurement, however, availability is still limited. The aim of this study is to introduce and validate myocardial flow reserve measurement by myocardial perfusion SPECT. METHODS Myocardial perfusion SPECT at rest and ATP stress (0.16mg/Kg/min) was performed in 10 patients with known coronary artery disease. Immediately after the injection of Tc-99m sestamibi (MIBI), left ventricular (LV) dynamic planar angiographic data were obtained for 90s. Coronary flow reserve index as measured by MIBI SPECT (CFRMIBI) was calculated as follows: CFRMIBI=CmsSbmb/CmbSbms, where subscripts b, s, Cm, and Sbm indicate baseline, during stress, myocardial counts with MIBI SPECT, and integral of LV counts with first pass angiography, respectively. Additionally, standard stress/rest (15)O-water PET to estimate CFR was performed in all patients as standard of reference. RESULTS CFRMIBI increased in conjunction with CFR, but underestimated blood flow at high flow rates. The relationship between CFRMIBI (Y) and CFRPET (X) was well fitted as follows: Y=1.40x(1-exp(1.79/x)) (r=0.84). CONCLUSIONS The index of CFRMIBI reflects the CFR by (15)O-water PET but underestimates flow at high flows, maybe as a reflection of pharmacokinetic limitations of MIBI.
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Mochula AV, Zavadovsky KV, Lishmanov YB. Method for Studying the Myocardial Blood Flow Reserve by Load Dynamic Single-Photon Emission Computed Tomography. Bull Exp Biol Med 2016; 160:864-6. [PMID: 27165060 DOI: 10.1007/s10517-016-3328-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Indexed: 10/21/2022]
Abstract
We developed a method for collection and processing of scintigraphic data to estimate myocardial reserve in a gamma-chamber with cadmium-zinc-telluride detectors. Dynamic single-photon emission computed tomography of the heart with (99m)Tc-Technetril was performed in 16 coronary heart disease patients at rest and during pharmacological load. During data processing, regions of interest from the cavity and the myocardium of the left ventricle were formed and activity-time curves were constructed. The index of myocardial blood fl ow reserve was calculated as the difference between two ratios of the mean gamma-count from the myocardial area to the area under the left ventricle cavity curve (peak) during load and at rest. The mean indices of myocardial reserve in healthy volunteers and patients with coronary artery atherosclerosis were 1.86 (1.59; 2.20) and 1.39 (1.12; 1.69), respectively. The development of the method for studying myocardial reserve by single-photon emission computed tomography is an urgent problem and requires further investigations.
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Affiliation(s)
- A V Mochula
- Laboratory for Radionuclide Research Methods, Research Institute of Cardiology, Tomsk, Russian Federation.
| | - K V Zavadovsky
- Laboratory for Radionuclide Research Methods, Research Institute of Cardiology, Tomsk, Russian Federation.,Laboratory No. 31, Physical-Technical Institute, National Research Tomsk Polytechnic University, Tomsk, Russia
| | - Yu B Lishmanov
- Laboratory for Radionuclide Research Methods, Research Institute of Cardiology, Tomsk, Russian Federation.,Laboratory No. 31, Physical-Technical Institute, National Research Tomsk Polytechnic University, Tomsk, Russia
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Shiraishi S, Sakamoto F, Tsuda N, Yoshida M, Tomiguchi S, Utsunomiya D, Ogawa H, Yamashita Y. Prediction of left main or 3-vessel disease using myocardial perfusion reserve on dynamic thallium-201 single-photon emission computed tomography with a semiconductor gamma camera. Circ J 2015; 79:623-31. [PMID: 25746547 DOI: 10.1253/circj.cj-14-0932] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Myocardial perfusion imaging (MPI) may fail to detect balanced ischemia. We evaluated myocardial perfusion reserve (MPR) using Tl dynamic single-photon emission computed tomography (SPECT) and a novel cadmium zinc telluride (CZT) camera for predicting 3-vessel or left main coronary artery disease (CAD). METHODS AND RESULTS: A total of 55 consecutive patients with suspected CAD underwent SPECT-MPI and coronary angiography. The MPR index was calculated using the standard 2-compartment kinetic model. We analyzed the utility of MPR index, other SPECT findings, and various clinical variables. On multivariate analysis, MPR index and history of previous myocardial infarction (MI) predicted left main and 3-vessel disease. The area under the receiver operating characteristic curve was 0.81 for MPR index, 0.699 for history of previous MI, and 0.86 for MPR index plus history of previous MI. MPR index ≤1.5 yielded the highest diagnostic accuracy. Sensitivity, specificity, and accuracy were 86%, 78%, and 80%, respectively, for MPR index, 64%, 76%, 73% for previous MI, and 57%, 93%, and 84% for MPR index plus history of previous MI. CONCLUSIONS Quantification of MPR using dynamic SPECT and a novel CZT camera may identify balanced ischemia in patients with left main or 3-vessel disease.
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Affiliation(s)
- Shinya Shiraishi
- Department of Diagnostic Radiology, Graduate School of Life Sciences, Kumamoto University
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Petretta M, Storto G, Pellegrino T, Bonaduce D, Cuocolo A. Quantitative Assessment of Myocardial Blood Flow with SPECT. Prog Cardiovasc Dis 2015; 57:607-14. [PMID: 25560327 DOI: 10.1016/j.pcad.2014.12.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The quantitative assessment of myocardial blood flow (MBF) and coronary flow reserve (CFR) may be useful for the functional evaluation of coronary artery disease, allowing judgment of its severity, tracking of disease progression, and evaluation of the anti-ischemic efficacy of therapeutic strategies. Quantitative estimates of myocardial perfusion and CFR can be derived from single-photon emission computed tomography (SPECT) myocardial perfusion images by use of equipment, tracers, and techniques that are available in most nuclear cardiology laboratories. However, this method underestimates CFR, particularly at high flow rates. The recent introduction of cardiac-dedicated gamma cameras with solid-state detectors provides very fast perfusion imaging with improved resolution, allowing fast acquisition of serial dynamic images during the first pass of a flow agent. This new technology holds great promise for MBF and CFR quantification with dynamic SPECT. Future studies will clarify the effectiveness of dynamic SPECT flow imaging.
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Affiliation(s)
- Mario Petretta
- Department of Translational Medical Sciences, University Federico II, Naples, Italy
| | - Giovanni Storto
- Nuclear Medicine Unit, IRCCS Regional Cancer Hospital CROB, Rionero in Vulture, Italy
| | - Teresa Pellegrino
- Institute of Biostructure and Bioimaging, National Council of Research, Naples, Italy
| | - Domenico Bonaduce
- Department of Translational Medical Sciences, University Federico II, Naples, Italy
| | - Alberto Cuocolo
- Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy.
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Naya M, Tsutsui H. Assessment of Coronary Flow Reserve by Dynamic Single-Photon Emission Computed Tomography. Circ J 2015; 79:515-6. [DOI: 10.1253/circj.cj-15-0106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Masanao Naya
- Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine
| | - Hiroyuki Tsutsui
- Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine
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Shimada S, Harada K, Toyono M, Tamura M, Takada G. Using transthoracic Doppler echocardiography to diagnose reduced coronary flow velocity reserve in the posterior descending coronary artery in children with elevated right ventricular pressure. Circ J 2008; 71:1912-7. [PMID: 18037745 DOI: 10.1253/circj.71.1912] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Advances in transthoracic Doppler echocardiography enable noninvasive measurements of coronary flow velocity and coronary flow velocity reserve (CFVR) in the posterior descending coronary artery (PD). METHODS AND RESULTS To evaluate CFVR in the PD of children with elevated right ventricular (RV) pressure, 19 children with RV pressure overload and 13 age-matched controls with normal RV pressure were studied using transthoracic Doppler echocardiography. Average peak flow velocity (APV) was measured at rest and in hyperemic conditions (intravenous administration of adenosine of 0.16 mg.kg(-1).min(-1)). Compared with controls, the PD CFVR was significantly reduced in the patients with elevated RV pressure (1.87+/-0.42 vs 2.49+/-0.55, p<0.01) because their mean baseline APV was significantly greater (27+/-6 vs 19+/-4 cm/s, p<0.01), although hyperemic APV was not significantly different (49+/-10 vs 48+/-14 cm/s, p=NS). CONCLUSIONS PD CFVR is limited in patients with elevated RV pressure because of elevation of the baseline resting flow velocity.
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Affiliation(s)
- Shunsuke Shimada
- Department of Pediatrics, Akita University School of Medicine, Japan.
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Abstract
Noninvasive quantitative measurement of myocardial perfusion has played an important role in cardiac research and also has potential applications in clinical imaging. Positron emission tomography (PET) methods for measuring absolute perfusion are well established, although the need for an on-site cyclotron has restricted its use to a limited number of centers. Single-photon emission CT (SPECT) also has potential for quantifying myocardial perfusion and has more widespread availability. In this article we review the basic principles of absolute myocardial perfusion quantification and the radiopharmaceuticals that are available for both PET and SPECT. We also examine the extent to which recent developments in instrumentation have increased the practicality of absolute perfusion quantification in PET and the potential for absolute quantification in SPECT.
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Affiliation(s)
- Martin A Lodge
- Department of Radiology, The Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA.
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Naya M, Tsukamoto T, Inubushi M, Morita K, Katoh C, Furumoto T, Fujii S, Tsutsui H, Tamaki N. Elevated Plasma Plasminogen Activator Inhibitor Type-1 is an Independent Predictor of Coronary Microvascular Dysfunction in Hypertension. Circ J 2007; 71:348-53. [PMID: 17322633 DOI: 10.1253/circj.71.348] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Elevated plasma plasminogen activator inhibitor-1 (PAI-1) is related to cardiovascular events, but its role in subclinical coronary microvascular dysfunction remains unknown. Thus, in the present study it was investigated whether elevated plasma PAI-1 activity is associated with coronary microvascular dysfunction in hypertensive patients. METHODS AND RESULTS Thirty patients with untreated essential hypertension and 10 age-matched healthy controls were studied prospectively. Myocardial blood flow (MBF) was measured by using (15)O-water positron emission tomography. Clinical variables associated with atherosclerosis (low-density lipoprotein-cholesterol, high-density lipoprotein (HDL)-cholesterol, triglyceride, homeostasis model assessment (HOMA-IR), and PAI-1 activity) were assessed to determine their involvement in coronary microvascular dysfunction. Adenosine triphosphate (ATP)-induced hyperemic MBF and coronary flow reserve (CFR) were significantly lower in hypertensive patients than in healthy controls (ATP-induced MBF: 2.77+/-0.82 vs 3.49+/-0.71 ml x g(-1) x min(-1); p<0.02 and CFR: 2.95 +/-1.06 vs 4.25+/-0.69; p<0.001). By univariate analysis, CFR was positively correlated with HDL-cholesterol (r=0.46, p<0.02), and inversely with HOMA-IR (r=-0.39, p<0.05) and PAI-1 activity (r=-0.61, p<0.001). By multivariate analysis, elevated PAI-1 activity remained a significant independent determinant of diminished CFR. CONCLUSIONS Elevated plasma PAI-1 activity was independently associated with coronary microvascular dysfunction, which suggests that plasma PAI-1 activity is an important clue linking hypofibrinolysis to the development of atherosclerosis.
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Affiliation(s)
- Masanao Naya
- Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
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Kataoka Y, Nakatani S, Tanaka N, Kanzaki H, Yasuda S, Morii I, Kawamura A, Miyazaki S, Kitakaze M. Role of Transthoracic Doppler-Determined Coronary Flow Reserve in Patients With Chest Pain. Circ J 2007; 71:891-6. [PMID: 17526986 DOI: 10.1253/circj.71.891] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The assessment of patients with chest pain is an important step to make a diagnosis and clinical decision. Coronary flow reserve (CFR) can be used for the screening of significant coronary stenosis. However, the feasibility and limitation of CFR in those patients remains unknown. METHODS AND RESULTS A total of 100 patients with chest pain were examined. CFR was measured in all 3 major coronary arteries by using transthoracic Doppler echocardiography (TTDE). Coronary angiography was performed 1 to 3 days after TTDE. CFR in all 3 major coronary arteries could be measured in 83 (83%) of 100 patients. The echo-contrast agent was useful in 32 of 49 patients who had unclear color Doppler images. When CFR <2.0 was regarded as the cut-off point, the overall agreement rate between CFR and the results of coronary angiography was 83% (69 of the 83 patients). In addition, CFR could predict the presence of coronary artery disease satisfactorily (sensitivity 85%, specificity 81%, positive predictive value 89%, negative predictive value 93%). CONCLUSIONS TTDE seems to be a promising tool for screening patients with chest pain. Moreover, an echo-contrast agent seems to be an effective and supportive tool for patients who have poor visualization of coronary flow.
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Affiliation(s)
- Yu Kataoka
- Division of Cardiology, Department of Internal Medicine, National Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita 565-8565, Japan
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Nishino M, Hoshida S, Egami Y, Kondo I, Shutta R, Yamaguchi H, Tanaka K, Tanouchi J, Hori M, Yamada Y. Coronary Flow Reserve by Contrast Enhanced Transesophageal Coronary Sinus Doppler Measurements Can Evaluate Diabetic Microvascular Dysfunction. Circ J 2006; 70:1415-20. [PMID: 17062963 DOI: 10.1253/circj.70.1415] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND This study was undertaken to investigate whether coronary flow reserve (CFR) using coronary sinus flow (CSF), which can be measured by transesophageal Doppler echocardiography (TEDE), especially when contrast enhanced, is useful in evaluating microvascular dysfunction in patients with diabetes mellitus (DM). METHODS AND RESULTS CSF recordings using contrast enhanced TEDE were performed before and after adenosine triphosphate infusion (0.15 mg x kg(-1) x min(-1)) in 16 patients with type 2 DM and diabetic retinopathy and in 13 non-DM patients (control). Coronary angiography revealed normal epicardial coronary arteries. CFR was defined as the ratio of the antegrade flow velocity time integral in hyperemic conditions and basal levels. Clear envelopes of CSF were obtained in all DM patients using contrast-enhanced TEDE. CFR using CSF in the DM group was significantly decreased compared with the control group (1.4+/-0.4 vs 2.1+/-0.5, p<0.01), but there were no significant differences of age, ejection fraction, rate of hypertension and hypercholesterolemia between the 2 groups. Using 1.7 of CFR as the cut-off value, diabetic microvascular dysfunction could be detected with 82% sensitivity and 83% specificity. CONCLUSIONS CFR calculated by CSF using contrast-enhanced TEDE may be useful for evaluating diabetic microvascular dysfunction.
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Affiliation(s)
- Masami Nishino
- Division of Cardiology, Osaka Rosai Hospital, Sakai 591-8025, Japan.
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Fujimoto S, Wagatsuma K, Uchida Y, Nii H, Nakano M, Toda M, Yamashina S, Yamazaki J. Study of the Predictors and Lesion Characteristics of Ischemic Heart Disease Patients With False Negative Results in Stress Myocardial Perfusion Single-Photon Emission Tomography. Circ J 2006; 70:297-303. [PMID: 16501296 DOI: 10.1253/circj.70.297] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The predictors and lesion morphology of patients with ischemic heart disease testing false negative results in stress myocardial perfusion single-photon emission computed tomography (SPECT) was investigated. METHODS AND RESULTS Subjects were 58 consecutive patients who underwent coronary angiography (CAG), even though they showed normal findings in stress myocardial perfusion SPECT. Age, gender, methods of stress, perfusion agent, coronary risk factors, angina symptoms, and electrocardiographic changes were investigated as predictors by multivariate analysis. For lesion morphology, significant stenotic lesions were studied for morphological characteristics and reference diameter (RD), percentage diameter stenosis (%DS), minimum lumen diameter (MLD), and lesion length (LL) were measured. CAG revealed 30 significant stenotic lesions in 18 patients. Logistic regression analysis revealed significant predictors to be age (odds ratio (OR) 1.118, p<0.05), typical anginal pain (OR 21.09, p<0.01), and hypertension (OR 8.336, p<0.05). For lesion morphology, there were only 2 diffuse lesions and the mean RD, %DS, MLD, and LL were 3.03+/-0.9 mm, 63.1 +/-9.3%, 1.13+/-0.49 mm, and 13.2+/-7.0 mm, respectively. CONCLUSION Sufficient caution is believed necessary in the interpretation of normal findings of stress myocardial perfusion SPECT when the patient is elderly, complains of typical anginal pain, or has hypertension. In regard to characteristics of lesion morphology, there were hardly any diffuse lesions.
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Affiliation(s)
- Shinichiro Fujimoto
- Division of Interventional Cardiology, Cardiovascular Center, Toho University School of Medicine, Tokyo, Japan.
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