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Valaiyapathy NC, Rallapeta RP, Hemalatha DS, Krishna Mohan VS, Rajasekhar D, Kalawat T. Technetium-99m Methoxyisobutyl Isonitrile Stress MPI in Suspected Coronary Artery Disease Patients: A Prospective Study to Evaluate Clinical Significance of Adenosine-induced ECG Changes. Indian J Nucl Med 2024; 39:2-9. [PMID: 38817727 PMCID: PMC11135371 DOI: 10.4103/ijnm.ijnm_71_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 06/27/2023] [Accepted: 11/01/2023] [Indexed: 06/01/2024] Open
Abstract
Purpose The purpose of this study is to evaluate the adenosine pharmacological stress-induced electrocardiogram (ECG) changes and their association with stress-induced ischemic defects on myocardial perfusion scintigraphy (MPS) in the evaluation of coronary artery disease (CAD) and to evaluate event-free survival among patients with positive and negative ECG/MPS image findings. Methods A total of 100 patients were examined using stress MPS from March 2020 to August 2021. Stress-induced ECG changes during adenosine infusion were evaluated. The summed stress score (SSS) was evaluated to identify ischemic defects in myocardium. Association of stress ECG changes and scintigraphic results was evaluated. Results Out of 100 patients, stress ECG changes during adenosine infusion were seen among 34 patients, whereas 66 patients had normal ECG findings. Positive stress MPS findings with SSS >3 were seen in 22 patients, whereas 78 patients had SSS ≤3. There was no agreement between stress ECG changes and MPS findings with Cohen's kappa coefficient (κ) = -0.023, whereas there was mild agreement between stress ECG changes and SSS >7 with κ = 0.105. Median follow-up of 11 months showed more events among patients with positive ECG changes than negative ECG changes. Conclusion Adenosine, pharmacological stress is safe to use, but few patients might experience some minor and transient symptoms. Adenosine may induce ECG changes in patients with or without positive MPS findings. Patients with concordant positive findings need aggressive cardiac care, whereas patients with small or no defects on MPS need close monitoring.
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Affiliation(s)
- N C Valaiyapathy
- Department of Nuclear Medicine, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India
| | - Ramya Priya Rallapeta
- Department of Nuclear Medicine, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India
| | - D S Hemalatha
- Department of Nuclear Medicine, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India
| | - VS Krishna Mohan
- Department of Nuclear Medicine, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India
| | - D Rajasekhar
- Department of Cardiology, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India
| | - Tekchand Kalawat
- Department of Nuclear Medicine, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India
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El Harake J, Sayseng V, Grondin J, Weber R, Einstein AJ, Konofagou E. Preliminary Feasibility of Stress Myocardial Elastography for the Detection of Coronary Artery Disease. ULTRASOUND IN MEDICINE & BIOLOGY 2023; 49:549-559. [PMID: 36435662 PMCID: PMC9789187 DOI: 10.1016/j.ultrasmedbio.2022.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 10/09/2022] [Accepted: 10/11/2022] [Indexed: 06/16/2023]
Abstract
Myocardial elastography (ME) is a cardiac strain imaging technique that has been found capable of detecting a decrease in radial strain caused by ischemia or infarction in patients with coronary artery disease (CAD) as well as in a canine model. Prior studies have focused on rest imaging, but stress testing can reveal functional deficits caused by stenoses that are asymptomatic at rest. Therefore, it has been proposed that stress ME (S-ME) improves the detection of CAD. A novel strain difference (Δε) metric is presented and investigated in a canine model of induced ischemia, as well as in a study in human patients with CAD validated by myocardial perfusion imaging. In the canine model study, flow-limiting stenosis was induced by partial ligation in n = 2 canines, and stenosis was found to consistently reduce Δε in the affected myocardial regions compared with baseline, as well as compared to myocardial regions that are remote to the induced stenosis. In the clinical study, the median Δε was significantly lower (p < 0.05) in infarcted myocardial regions (-6.29%) than in those with normal perfusion (4.62%), with Δε in ischemic regions falling in between (-2.91%). The same trend was observed when considering radial strain during stress and, to a lesser degree, at rest alone. The results indicate that S-ME may be more sensitive to mild cases of CAD that are functionally asymptomatic at rest.
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Affiliation(s)
- Jad El Harake
- Department of Biomedical Engineering, Columbia University, New York, New York, USA
| | - Vincent Sayseng
- Department of Biomedical Engineering, Columbia University, New York, New York, USA
| | - Julien Grondin
- Department of Radiology, Columbia University Irving Medical Center and New York-Presbyterian Hospital, New York, New York, USA
| | - Rachel Weber
- Department of Biomedical Engineering, Columbia University, New York, New York, USA
| | - Andrew J Einstein
- Department of Radiology, Columbia University Irving Medical Center and New York-Presbyterian Hospital, New York, New York, USA; Division of Cardiology, Columbia University Irving Medical Center and New York-Presbyterian Hospital, New York, New York, USA; Department of Medicine, Columbia University Irving Medical Center and New York-Presbyterian Hospital, New York, New York, USA
| | - Elisa Konofagou
- Department of Biomedical Engineering, Columbia University, New York, New York, USA; Department of Radiology, Columbia University Irving Medical Center and New York-Presbyterian Hospital, New York, New York, USA.
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The Use of Stress Cardiovascular Imaging in Pediatric Population. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10020218. [PMID: 36832347 PMCID: PMC9954485 DOI: 10.3390/children10020218] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 01/21/2023] [Accepted: 01/23/2023] [Indexed: 01/28/2023]
Abstract
Although not frequent in the pediatric population, ischemia could occur in children due to several congenital and acquired disease. Stress imaging is key for the non-invasive evaluation of myocardial abnormalities and perfusion defect in this clinical setting. Moreover, beyond ischemia assessment, it can provide complementary diagnostic and prognostic information in valvular heart disease and cardiomyopathies. When performed using cardiovascular magnetic resonance, it could detect, in addition, myocardial fibrosis and infarction, increasing the diagnostic yield. Several imaging modalities are currently available for the evaluation of stress myocardial perfusion. Advances in technologies have also increased the feasibility, safety and availability of these modalities in the pediatric age group. However, despite the established role of stress imaging and its increasing use in daily clinical practice, there are currently no specific guidelines, and little data are available in the literature on this topic. The aim of this review is to summarize the most recent evidence on pediatric stress imaging and its clinical application with a focus on the advantages and limitations of each imaging modality currently available.
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Dilsizian V, Chandrashekhar Y. Molecular Imaging: New Promises. JACC Cardiovasc Imaging 2022; 15:2019-2021. [PMID: 36357149 DOI: 10.1016/j.jcmg.2022.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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5
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Antonios L, Chen W, Dilsizian V. The Impact of COVID-19 on Nuclear Medicine Operations Including Cardiovascular Manifestations in the USA. Semin Nucl Med 2022; 52:11-16. [PMID: 34246451 PMCID: PMC8214997 DOI: 10.1053/j.semnuclmed.2021.06.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
The pandemic of coronavirus 2019 disease (COVID-19) not only directly causes high morbidity and mortality of the disease, but also indirectly affects patients with pre-existing medical conditions, particularly cardiovascular diseases, with delayed or deferred outpatient care and procedure including nuclear medicine studies because of concerns about exposure to the virus. In this article, the impact of COVID-19 on hospital operation and nuclear medicine practice in the United States along with recommendations and guidance from major academic organizations are presented. Safe operation of specific nuclear medicine scans, such as lung scintigraphy and nuclear cardiac imaging, are reviewed in the context of balancing benefits to patients against the risk of exacerbating the spread of the virus. Thoughtful reintroduction of nuclear medicine services are discussed based on ethical considerations that maximize benefits to those who are likely to benefit most, taking into consideration baseline health inequities, and ensuring that all decisions reflect best available evidence with transparent communication. Finally, potential correlation between decreased volume of nuclear cardiac studies performed during the pandemic and corresponding increased deaths from ischemic and hypertensive cardiac disease is discussed.
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Affiliation(s)
| | | | - Vasken Dilsizian
- Address reprint requests to Vasken Dilsizian, MD, Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland Medical Center, 22 S. Greene Street, Room N2W78, Baltimore, MD 21201-1595
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Dilsizian V, Budde RPJ, Chen W, Mankad SV, Lindner JR, Nieman K. Best Practices for Imaging Cardiac Device-Related Infections and Endocarditis: A JACC: Cardiovascular Imaging Expert Panel Statement. JACC Cardiovasc Imaging 2021; 15:891-911. [PMID: 34922877 DOI: 10.1016/j.jcmg.2021.09.029] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 09/01/2021] [Accepted: 09/13/2021] [Indexed: 12/13/2022]
Abstract
The diagnosis of cardiac device infection and, more importantly, accurate localization of the infection site, such as defibrillator pocket, pacemaker lead, along the peripheral driveline or central portion of the left ventricular assist device, prosthetic valve ring abscesses, and perivalvular extensions, remain clinically challenging. Although transthoracic and transesophageal echocardiography are the first-line imaging tests in suspected endocarditis and for assessing hemodynamic complications, recent studies suggest that cardiac computed tomography (CT) or CT angiography and functional imaging with 18F-fluoro-2-deoxyglucose (FDG) positron emission tomography (PET) with CT (FDG PET/CT) may have an incremental role in technically limited or inconclusive cases on echocardiography. One of the key benefits of FDG PET/CT is in its detection of inflammatory cells early in the infection process, before morphological damages ensue. However, there are many unanswered questions in the literature. In this document, we provide consensus on best practices among the various imaging studies, which includes the detection of cardiac device infection, differentiation of infection from inflammation, image-guided patient management, and detailed recommendations on patient preparation, image acquisition, processing, interpretation, and standardized reporting.
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Affiliation(s)
- Vasken Dilsizian
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA.
| | - Ricardo P J Budde
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Wengen Chen
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Sunil V Mankad
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Jonathan R Lindner
- Knight Cardiovascular Institute and the Oregon National Primate Research Center, Oregon Health & Science University, Portland, Oregon, USA
| | - Koen Nieman
- Department of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California, USA
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7
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Chen W, Dilsizian V. Diagnosis and Image-guided Therapy of Cardiac Left Ventricular Assist Device Infections. Semin Nucl Med 2020; 51:357-363. [PMID: 33280782 DOI: 10.1053/j.semnuclmed.2020.11.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Due to limited availability of donor hearts, more and more end stage heart failure patients are dependent on left ventricular assist device (LVAD) as their destination therapy rather than the original intended use as a bridge for heart transplantation. While LVADs improve life expectancy in these patients, infection emerges as one of the major adverse events. Early and accurate localization of LVAD infection is critical, as it can significantly influence clinical management decisions and ultimately impact patient outcome. Although the International Society of Heart and Lung Transplantation has defined 3 categories for LVAD infection: (1) LVAD-specific infection, (2) LVAD-related infection, and (3) non-LVAD infection, there is still lack of standardized criteria for diagnosing these 3 types of LVAD infections. Morphologically based imaging tools such as transesophageal echocardiogram and cardiac computed tomography (CT) or CT angiogram have limited roles in diagnosing LVAD infections due to their nonspecific findings, often affected by significant streaking and beam hardening artifacts from the metal device. In contrast, 18F-fluorodeoxyglucose (FDG) Positron Emission Tomography (PET)/CT has repeatedly shown a high sensitivity and specificity for LVAD infection diagnosis, albeit in small number of subjects. Beyond its accuracy for detecting infection, FDG PET/CT can predict clinical outcome based on the location of LVAD infection. As a functional imaging tool, FDG PET/CT can demonstrate the extent and severity of LVAD infection, as well as infectious embolism and potential extra-cardiac source of infection, which are all critical for providing optimal patient care, justifying its judicious and precise use in the workup of LVAD infection.
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Affiliation(s)
- Wengen Chen
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - Vasken Dilsizian
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Maryland.
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8
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Perez-Liva M, Yoganathan T, Herraiz JL, Porée J, Tanter M, Balvay D, Viel T, Garofalakis A, Provost J, Tavitian B. Ultrafast Ultrasound Imaging for Super-Resolution Preclinical Cardiac PET. Mol Imaging Biol 2020; 22:1342-1352. [PMID: 32602084 PMCID: PMC7497458 DOI: 10.1007/s11307-020-01512-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 04/13/2020] [Accepted: 05/27/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE Physiological motion and partial volume effect (PVE) significantly degrade the quality of cardiac positron emission tomography (PET) images in the fast-beating hearts of rodents. Several Super-resolution (SR) techniques using a priori anatomical information have been proposed to correct motion and PVE in PET images. Ultrasound is ideally suited to capture real-time high-resolution cine images of rodent hearts. Here, we evaluated an ultrasound-based SR method using simultaneously acquired and co-registered PET-CT-Ultrafast Ultrasound Imaging (UUI) of the beating heart in closed-chest rodents. PROCEDURES The method was tested with numerical and animal data (n = 2) acquired with the non-invasive hybrid imaging system PETRUS that acquires simultaneously PET, CT, and UUI. RESULTS We showed that ultrasound-based SR drastically enhances the quality of PET images of the beating rodent heart. For the simulations, the deviations between expected and mean reconstructed values were 2 % after applying SR. For the experimental data, when using Ultrasound-based SR correction, contrast was improved by a factor of two, signal-to-noise ratio by 11 %, and spatial resolution by 56 % (~ 0.88 mm) with respect to static PET. As a consequence, the metabolic defect following an acute cardiac ischemia was delineated with much higher anatomical precision. CONCLUSIONS Our results provided a proof-of-concept that image quality of cardiac PET in fast-beating rodent hearts can be significantly improved by ultrasound-based SR, a portable low-cost technique. Improved PET imaging of the rodent heart may allow new explorations of physiological and pathological situations related with cardiac metabolism.
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Affiliation(s)
- Mailyn Perez-Liva
- Université de Paris, PARCC, INSERM, 56, rue Leblanc, 75015, Paris, France.
| | | | - Joaquin L Herraiz
- Nuclear Physics Group and IPARCOS, Complutense University of Madrid, Plaza de las Ciencias, 1, 28020, Madrid, Spain
- Health Research Institute of the Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Jonathan Porée
- Physics for Medicine Paris, Inserm/ESPCI Paris-PSL/PSL-University/CNRS, 17 rue Moreau, 75012, Paris, France
- Engineering physics department, Polytechnique Montréal, Montréal, Canada
| | - Mickael Tanter
- Physics for Medicine Paris, Inserm/ESPCI Paris-PSL/PSL-University/CNRS, 17 rue Moreau, 75012, Paris, France
| | - Daniel Balvay
- Université de Paris, PARCC, INSERM, 56, rue Leblanc, 75015, Paris, France
| | - Thomas Viel
- Université de Paris, PARCC, INSERM, 56, rue Leblanc, 75015, Paris, France
| | | | - Jean Provost
- Engineering physics department, Polytechnique Montréal, Montréal, Canada
- Montreal Heart Institute, Montréal, Canada
| | - Bertrand Tavitian
- Université de Paris, PARCC, INSERM, 56, rue Leblanc, 75015, Paris, France
- Service de Radiologie, APHP Centre, Hôpital Européen Georges Pompidou, Paris, France
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9
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Perez-Liva M, Yoganathan T, Herraiz JL, Porée J, Tanter M, Balvay D, Viel T, Garofalakis A, Provost J, Tavitian B. Ultrafast Ultrasound Imaging for Super-Resolution Preclinical Cardiac PET. Mol Imaging Biol 2020. [DOI: https://doi.org/10.1007/s11307-020-01512-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abstract
Purpose
Physiological motion and partial volume effect (PVE) significantly degrade the quality of cardiac positron emission tomography (PET) images in the fast-beating hearts of rodents. Several Super-resolution (SR) techniques using a priori anatomical information have been proposed to correct motion and PVE in PET images. Ultrasound is ideally suited to capture real-time high-resolution cine images of rodent hearts. Here, we evaluated an ultrasound-based SR method using simultaneously acquired and co-registered PET-CT-Ultrafast Ultrasound Imaging (UUI) of the beating heart in closed-chest rodents.
Procedures
The method was tested with numerical and animal data (n = 2) acquired with the non-invasive hybrid imaging system PETRUS that acquires simultaneously PET, CT, and UUI.
Results
We showed that ultrasound-based SR drastically enhances the quality of PET images of the beating rodent heart. For the simulations, the deviations between expected and mean reconstructed values were 2 % after applying SR. For the experimental data, when using Ultrasound-based SR correction, contrast was improved by a factor of two, signal-to-noise ratio by 11 %, and spatial resolution by 56 % (~ 0.88 mm) with respect to static PET. As a consequence, the metabolic defect following an acute cardiac ischemia was delineated with much higher anatomical precision.
Conclusions
Our results provided a proof-of-concept that image quality of cardiac PET in fast-beating rodent hearts can be significantly improved by ultrasound-based SR, a portable low-cost technique. Improved PET imaging of the rodent heart may allow new explorations of physiological and pathological situations related with cardiac metabolism.
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10
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Pelletier-Galarneau M, Dilsizian V. Microvascular Angina Diagnosed by Absolute PET Myocardial Blood Flow Quantification. Curr Cardiol Rep 2020; 22:9. [DOI: 10.1007/s11886-020-1261-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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11
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Dilsizian V, Erario M. Is Exercise Treadmill Time or Reduction in Myocardial Ischemia the Appropriate Primary Endpoint to Assess Success of Percutaneous Coronary Intervention in Stable Angina (ORBITA)? J Nucl Med 2017; 59:1-2. [PMID: 29217737 DOI: 10.2967/jnumed.117.206334] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Accepted: 11/30/2017] [Indexed: 11/16/2022] Open
Affiliation(s)
- Vasken Dilsizian
- University of Maryland School of Medicine, Baltimore, Maryland; and
| | - Madeline Erario
- Department of Medicine, Inova Fairfax Hospital, Falls Church, Virginia
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12
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Ziegler M, Alt K, Paterson BM, Kanellakis P, Bobik A, Donnelly PS, Hagemeyer CE, Peter K. Highly Sensitive Detection of Minimal Cardiac Ischemia using Positron Emission Tomography Imaging of Activated Platelets. Sci Rep 2016; 6:38161. [PMID: 27909290 PMCID: PMC5133579 DOI: 10.1038/srep38161] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Accepted: 11/04/2016] [Indexed: 01/12/2023] Open
Abstract
A reliable method for the diagnosis of minimal cardiac ischemia would meet a strong demand for the sensitive diagnosis of coronary artery disease in cardiac stress testing and risk stratification in patients with chest pain but unremarkable ECGs and biomarkers. We hypothesized that platelets accumulate early on in ischemic myocardium and a newly developed technology of non-invasive molecular PET imaging of activated platelets can thus detect minimal degrees of myocardial ischemia. To induce different degrees of minimal cardiac ischemia, the left anterior descending artery (LAD) was ligated for 10, 20 or 60 min. Mice were injected with a newly generated scFvanti-GPIIb/IIIa-64CuMeCOSar radiotracer, composed of a single-chain antibody that only binds to activated integrin GPIIb/IIIa (αIIbβIII) and thus to activated platelets, and a sarcophagine cage MeCOSar complexing the long half-life PET tracer copper-64. A single PET/CT scan was performed. Evans Blue/TTC staining to detect necrosis as well as classical serological biomarkers like Troponin I and heart-type fatty acid-binding protein (H-FABP) were negative, whereas PET imaging of activated platelets was able to detect small degrees of ischemia. Taken together, molecular PET imaging of activated platelets represents a unique and highly sensitive method to detect minimal cardiac ischemia.
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Affiliation(s)
- Melanie Ziegler
- Atherothrombosis and Vascular Biology, Baker IDI Heart &Diabetes Institute, Melbourne, Australia
| | - Karen Alt
- Atherothrombosis and Vascular Biology, Baker IDI Heart &Diabetes Institute, Melbourne, Australia.,Vascular Biotechnology, Baker IDI Heart &Diabetes Institute, Melbourne, Australia
| | - Brett M Paterson
- School of Chemistry and Bio21 Molecular Science and Biotechnology Institute, The University of Melbourne, Melbourne, Australia
| | - Peter Kanellakis
- Vascular Biology &Atherosclerosis, Baker IDI Heart &Diabetes Institute, Melbourne, Australia
| | - Alex Bobik
- Vascular Biology &Atherosclerosis, Baker IDI Heart &Diabetes Institute, Melbourne, Australia
| | - Paul S Donnelly
- School of Chemistry and Bio21 Molecular Science and Biotechnology Institute, The University of Melbourne, Melbourne, Australia
| | - Christoph E Hagemeyer
- Vascular Biotechnology, Baker IDI Heart &Diabetes Institute, Melbourne, Australia.,Central Clinical School, Monash University, Melbourne, Australia.,RMIT University, Melbourne, Australia
| | - Karlheinz Peter
- Atherothrombosis and Vascular Biology, Baker IDI Heart &Diabetes Institute, Melbourne, Australia.,Central Clinical School, Monash University, Melbourne, Australia.,RMIT University, Melbourne, Australia
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14
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Taqueti VR, Di Carli MF. Radionuclide myocardial perfusion imaging for the evaluation of patients with known or suspected coronary artery disease in the era of multimodality cardiovascular imaging. Prog Cardiovasc Dis 2015; 57:644-53. [PMID: 25770849 PMCID: PMC5926794 DOI: 10.1016/j.pcad.2015.03.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Over the last several decades, radionuclide myocardial perfusion imaging (MPI) with single photon emission tomography and positron emission tomography has been a mainstay for the evaluation of patients with known or suspected coronary artery disease (CAD). More recently, technical advances in separate and complementary imaging modalities including coronary computed tomography angiography, computed tomography perfusion, cardiac magnetic resonance imaging, and contrast stress echocardiography have expanded the toolbox of diagnostic testing for cardiac patients. While the growth of available technologies has heralded an exciting era of multimodality cardiovascular imaging, coordinated and dispassionate utilization of these techniques is needed to implement the right test for the right patient at the right time, a promise of "precision medicine." In this article, we review the maturing role of MPI in the current era of multimodality cardiovascular imaging, particularly in the context of recent advances in myocardial blood flow quantitation, and as applied to the evaluation of patients with known or suspected CAD.
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Affiliation(s)
- Viviany R Taqueti
- Noninvasive Cardiovascular Imaging Program, Departments of Medicine and Radiology, Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Marcelo F Di Carli
- Noninvasive Cardiovascular Imaging Program, Departments of Medicine and Radiology, Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
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15
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Ohira H, Dowsley T, Dwivedi G, deKemp RA, Chow BJ, Ruddy TD, Davies RA, DaSilva J, Beanlands RSB, Hessian R. Quantification of myocardial blood flow using PET to improve the management of patients with stable ischemic coronary artery disease. Future Cardiol 2014; 10:611-31. [DOI: 10.2217/fca.14.44] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
ABSTRACT Cardiac PET has been evolving over the past 30 years. Today, it is accepted as a valuable imaging modality for the noninvasive assessment of coronary artery disease. PET has demonstrated superior diagnostic accuracy for the detection of coronary artery disease compared with single-photon emission computed tomography, and also has a well-established prognostic value. The routine addition of absolute quantification of myocardial blood flow increases the diagnostic accuracy for three-vessel disease and provides incremental functional and prognostic information. Moreover, the characterization of the vasodilator capacity of the coronary circulation may guide proper decision-making and monitor the effects of lifestyle changes, exercise training, risk factor modification or medical therapy for improving regional and global myocardial blood flow. This type of image-guided approach to individualized patient therapy is now attainable with the routine use of cardiac PET flow reserve imaging.
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Affiliation(s)
- Hiroshi Ohira
- MFI program, National Cardiac PET Center, Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Taylor Dowsley
- MFI program, National Cardiac PET Center, Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Girish Dwivedi
- MFI program, National Cardiac PET Center, Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Robert A deKemp
- MFI program, National Cardiac PET Center, Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Benjamin J Chow
- MFI program, National Cardiac PET Center, Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Terrence D Ruddy
- MFI program, National Cardiac PET Center, Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Ross A Davies
- MFI program, National Cardiac PET Center, Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Jean DaSilva
- MFI program, National Cardiac PET Center, Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Rob SB Beanlands
- MFI program, National Cardiac PET Center, Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Renee Hessian
- MFI program, National Cardiac PET Center, Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, ON, Canada
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17
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Schindler TH, Quercioli A, Valenta I, Ambrosio G, Wahl RL, Dilsizian V. Quantitative Assessment of Myocardial Blood Flow—Clinical and Research Applications. Semin Nucl Med 2014; 44:274-93. [DOI: 10.1053/j.semnuclmed.2014.04.002] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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18
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Underwood SR, de Bondt P, Flotats A, Marcasa C, Pinto F, Schaefer W, Verberne HJ. The current and future status of nuclear cardiology: a consensus report. Eur Heart J Cardiovasc Imaging 2014; 15:949-55. [DOI: 10.1093/ehjci/jeu060] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Technical Considerations of Phosphorous-32 Bremsstrahlung SPECT Imaging after Radioembolization of Hepatic Tumors: A Clinical Assessment with a Review of Imaging Parameters. Radiol Res Pract 2014; 2014:407158. [PMID: 24800073 PMCID: PMC3985385 DOI: 10.1155/2014/407158] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Revised: 02/15/2014] [Accepted: 02/19/2014] [Indexed: 12/12/2022] Open
Abstract
Background. Bremsstrahlung (BS) imaging during radioembolization (RE) confirms the deposition of radiotracer in hepatic/extrahepatic tumors. The aim of this study is to demonstrate (32)P images and to optimize the imaging parameters. Materials and Methods. Thirty-nine patients with variable types of hepatic tumors, treated with the intra-arterial injection of (32)P, were included. All patients underwent BS SPECT imaging 24-72 h after tracer administration, using low energy high resolution (LEHR) (18 patients) or medium energy general purpose (MEGP) (21 patients) collimators. A grading scale from 1 to 4 was used to express the compatibility of the (32)P images with those obtained from CT/MRI. Results. Although the image quality obtained with the MEGP collimator was visually and quantitatively better than with the LEHR (76% concordance score versus 71%, resp.), there was no statistically significant difference between them. Conclusion. The MEGP collimator is the first choice for BS SPECT imaging. However, if the collimator change is time consuming (as in a busy center) or an MEGP collimator is not available, the LEHR collimator could be practical with acceptable images, especially in a SPECT study. In addition, BS imaging is a useful method to confirm the proper distribution of radiotherapeutic agents and has good correlation with anatomical findings.
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Chowdhury FU, Vaidyanathan S, Bould M, Marsh J, Trickett C, Dodds K, Clark TPR, Sapsford RJ, Dickinson CJ, Patel CN, Thorley PJ. Rapid-acquisition myocardial perfusion scintigraphy (MPS) on a novel gamma camera using multipinhole collimation and miniaturized cadmium-zinc-telluride (CZT) detectors: prognostic value and diagnostic accuracy in a 'real-world' nuclear cardiology service. Eur Heart J Cardiovasc Imaging 2013; 15:275-83. [DOI: 10.1093/ehjci/jet149] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
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Carlier T, Eugène T, Bodet-Milin C, Garin E, Ansquer C, Rousseau C, Ferrer L, Barbet J, Schoenahl F, Kraeber-Bodéré F. Assessment of acquisition protocols for routine imaging of Y-90 using PET/CT. EJNMMI Res 2013; 3:11. [PMID: 23414629 PMCID: PMC3614476 DOI: 10.1186/2191-219x-3-11] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2012] [Accepted: 12/08/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite the early theoretical prediction of the 0+-0+ transition of 90Zr, 90Y-PET underwent only recently a growing interest for the development of imaging radioembolization of liver tumors. The aim of this work was to determine the minimum detectable activity (MDA) of 90Y by PET imaging and the impact of time-of-flight (TOF) reconstruction on detectability and quantitative accuracy according to the lesion size. METHODS The study was conducted using a Siemens Biograph® mCT with a 22 cm large axial field of view. An IEC torso-shaped phantom containing five coplanar spheres was uniformly filled to achieve sphere-to-background ratios of 40:1. The phantom was imaged nine times in 14 days over 30 min. Sinograms were reconstructed with and without TOF information. A contrast-to-noise ratio (CNR) index was calculated using the Rose criterion, taking partial volume effects into account. The impact of reconstruction parameters on quantification accuracy, detectability, and spatial localization of the signal was investigated. Finally, six patients with hepatocellular carcinoma and four patients included in different 90Y-based radioimmunotherapy protocols were enrolled for the evaluation of the imaging parameters in a clinical situation. RESULTS The highest CNR was achieved with one iteration for both TOF and non-TOF reconstructions. The MDA, however, was found to be lower with TOF than with non-TOF reconstruction. There was no gain by adding TOF information in terms of CNR for concentrations higher than 2 to 3 MBq mL-1, except for infra-centimetric lesions. Recovered activity was highly underestimated when a single iteration or non-TOF reconstruction was used (10% to 150% less depending on the lesion size). The MDA was estimated at 1 MBq mL-1 for a TOF reconstruction and infra-centimetric lesions. Images from patients treated with microspheres were clinically relevant, unlike those of patients who received systemic injections of 90Y. CONCLUSIONS Only one iteration and TOF were necessary to achieve an MDA around 1 MBq mL-1 and the most accurate localization of lesions. For precise quantification, at least three iterations gave the best performance, using TOF reconstruction and keeping an MDA of roughly 1 MBq mL-1. One and three iterations were mandatory to prevent false positive results for quantitative analysis of clinical data. TRIAL REGISTRATION http://IDRCB 2011-A00043-38 P101103.
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Affiliation(s)
- Thomas Carlier
- Nuclear Medicine Department, University Hospital of Nantes, Place Alexis Ricordeau, Nantes, 44093, France.
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Friedman M, Spalding J, Kothari S, Wu Y, Gatt E, Boulanger L. Myocardial perfusion imaging laboratory efficiency with the use of regadenoson compared to adenosine and dipyridamole. J Med Econ 2013; 16:449-60. [PMID: 23363331 DOI: 10.3111/13696998.2013.772057] [Citation(s) in RCA: 7] [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
OBJECTIVE Adenosine, dipyridamole, and regadenoson are pharmacologic stress agents used in myocardial perfusion imaging (MPI), to diagnose and monitor coronary artery disease. Clinical studies suggest that regadenoson has pharmacologic properties that simplify the MPI procedure through availability to a wider range of patients and easier administrative requirements. This study assesses the operational advantages and laboratory efficiency associated with the use of regadenoson compared to adenosine and dipyridamole. METHODS A web-based survey of 141 nuclear medicine technologists working in US-based cardiovascular imaging laboratories from June-July 2009. MAIN OUTCOME MEASURES Descriptive statistics measured the adenosine, dipyridamole, and regadenoson cohorts. Bivariate analyses compared the overall and staff-specific time to conduct an MPI test. The site-specific sub-groups were defined by hospital vs non-hospital setting, hours of operation, number of SPECT cameras, and number of full-time equivalent staff, including nurses, nuclear technologists, physicians, and nurse practitioners/physician assistants. RESULTS The total time to conduct an MPI test was shortest with regadenoson 156 (46) min compared to adenosine and dipyridamole 182 (63) and 191 (61) min, respectively. Time from regadenoson administration to the start of the imaging session, including dose calculation and infusion time, was 14.2 min less than adenosine, and 12.0 min less than dipyridamole. The time to manage adverse events was shortest if it occurred with regadenoson compared to adenosine and dipyridamole, with minor exceptions. Due to the nature of survey implementation, possible recall bias may limit the results. Some differences in procedures times may be attributable to differences in laboratories' protocols. CONCLUSIONS Overall time savings and time savings stratified by operational ability (number of staff, number of SPECT cameras, hours of operation) translate to a more efficient utilization of laboratory resources when using regadenoson compared to adenosine and dipyridamole. Regadenoson is the most efficient pharmacologic stress agent compared to adenosine and dipyridamole.
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Nguyen AL, Haas F, Evens J, Breur JMPJ. Sudden cardiac death after repair of anomalous origin of left coronary artery from right sinus of Valsalva with an interarterial course : Case report and review of the literature. Neth Heart J 2012; 20:463-71. [PMID: 23055055 PMCID: PMC3491136 DOI: 10.1007/s12471-012-0324-4] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Anomalous aortic origin of the coronary artery from the opposite sinus with interarterial course (AAOCA) is a rare condition with a high risk of sudden cardiac death (SCD) during or after strenuous exertion. SCD after repair of this anomaly is extremely rare. Here we present a 15-year-old athlete who collapsed on the basketball court in whom an anomalous origin of the left coronary artery from the right sinus of Valsalva with interarterial course (ALCA) was diagnosed. In spite of extensive pre-sport participation testing, SCD occurred shortly after surgical correction. We reviewed the literature to establish an evidence-based recommendation to aid physicians in conducting the optimal pre-sport participation management for the prevention of SCD in patients with a surgically corrected AAOCA/ALCA, especially for those who participate in strenuous exercise. Review of the literature (60 articles with 325 patients) reveals that post-surgical, pre-sport participation testing varies greatly but that mortality after surgical repair is extremely low (1.5 %). In conclusion, SCD can still rarely occur after repair of AAOCA despite extensive pre-sport participation testing. This should raise awareness among physicians treating these patients and raises the question whether or not return-to-play guidelines need to be revised.
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Affiliation(s)
- A. L. Nguyen
- Department of Paediatric Cardiology, Wilhelmina Children’s Hospital, University Medical Centre Utrecht, PO Box 85090, 3508 AB Utrecht, the Netherlands
| | - F. Haas
- Department of Paediatric Cardiothoracic Surgery, Wilhelmina Children’s Hospital, University Medical Centre Utrecht, PO Box 85090, 3508 AB Utrecht, the Netherlands
| | - J. Evens
- Department of Paediatric Cardiothoracic Surgery, Wilhelmina Children’s Hospital, University Medical Centre Utrecht, PO Box 85090, 3508 AB Utrecht, the Netherlands
| | - J. M. P. J. Breur
- Department of Paediatric Cardiology, Wilhelmina Children’s Hospital, University Medical Centre Utrecht, PO Box 85090, 3508 AB Utrecht, the Netherlands
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Miner R. Factors Influencing Non-cardiac Side Effects of Dipyridamole When Used for Myocardial Perfusion Stress Testing. J Med Imaging Radiat Sci 2012; 43:43-51. [PMID: 31052020 DOI: 10.1016/j.jmir.2011.12.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2011] [Revised: 12/06/2011] [Accepted: 12/14/2011] [Indexed: 10/14/2022]
Abstract
PURPOSE This study evaluates whether patient demographic information can be used to predict the non-cardiac side effects experienced during myocardial perfusion imaging (MPI) procedures using dipyridamole. BACKGROUND Heart disease is a major cause of death in the industrialized world. MPI of coronary blood flow using radiopharmaceuticals is frequently used to assess coronary artery disease. Pharmacological methods can be used to increase coronary blood flow with vasodilators such as dipyridamole or adenosine, or inotropic and chronotropic agents such as dobutamine or arbutamine. The side effects of these agents are recognized, but little is known about the factors that influence their frequency and severity. METHODS One hundred and nineteen patients scheduled for myocardial perfusion pharmacological stress testing using dipyridamole participated in the study. Patient demographic data, which included age, sex, body mass index (BMI), diabetic status, smoker status, and daily aspirin usage, were collected before the start of the procedure. Patients underwent a 1-day rest and stress MPI procedure. The radiopharmaceuticals used were 99mTc-Myoview or 201Tl. The pharmacological stress procedure used dipyridamole injections based on body weight. Aminophylline was injected at the end of the stress session. Gated single photon emission computed tomography was performed for both rest and stress images. Once the patients completed the procedure, they were given a questionnaire that asked them to report the severity of any side effects experienced from the dipyridamole. Specific data types determined the statistical test best suited for analysis. The Chi-square test was used to evaluate the nominal scale data (sex, diabetic status, aspirin usage, and smoker status), Mann-Whitney test was used to compare nominal scale data and ordinal scale data (side effect severity), Student's t-test r was used for ratio scale data (age, BMI, and percent of population), and multiple linear regression and multiple logistic regression tests were used to evaluate multiple variables. RESULTS A total of 119 patients were surveyed (58 male, 61 female). The average age was 67.7 years (10.7 year standard deviation). There were no statistically significant differences in the male and female demographics except for daily aspirin usage (more common with males). Headaches were the most common side effect (50% of all patients), followed by dizziness (26%), flushing (24%), chest pain (19%), and nausea (18%). Correlations were found between patients experiencing no side effects with age (r = -0.607) and sex (P = .034); headaches with age (r = -0.706) and BMI (r = 0.464); chest pain with diabetic status (P = .017); dizziness with diabetic status (P = .039); and nausea with age (r = -0.612). CONCLUSION Side effects of dipyridamole are generally known, but the factors influencing incidence and severity are not. This study has shown that patient demographic information normally gathered before MPI procedures can help determine the frequency and severity of some side effects. Providing more accurate information to a patient on the possible side effects could help reduce patient anxiety and improve patient cooperation.
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Affiliation(s)
- Robert Miner
- The Ottawa Cardiovascular Centre, Ottawa, Ontario, Canada
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Abstract
PURPOSE OF REVIEW Heart failure is an important problem after surgical correction of congenital heart disease. Timely recognition may be difficult. Recent developments in exercise testing and stress-imaging may change the management of patients with congenital heart disease. RECENT FINDINGS Exercise tests are commonly used in the follow-up of patients with congenital heart disease. Maximal exercise studies are not always feasible in this patient population. Variables of submaximal exercise and ventilator efficiency have shown a good correlation with variables of maximal exercise and have been suggested to relate to long-term cardiac function.For evaluation of submaximal exercise, stress imaging may reveal abnormal responses unrecognized at rest. Both physical exercise as well as pharmacological stress may be used in combination with various imaging modalities. For practical reasons, dobutamine is most widely used to generate and mimic stress and is well tolerated in low doses. Particularly in lesions affecting the right ventricle and with single ventricular physiology after the Fontan operation, magnetic resonance stress imaging has provided additional insight into the cardiac function. SUMMARY The abnormal stress responses can potentially be used for risk assessment in the follow-up of patients with congenital cardiac disease. Further studies are required to provide common protocols for stress imaging.
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Schindler TH, Schelbert HR, Quercioli A, Dilsizian V. Cardiac PET imaging for the detection and monitoring of coronary artery disease and microvascular health. JACC Cardiovasc Imaging 2010; 3:623-40. [PMID: 20541718 DOI: 10.1016/j.jcmg.2010.04.007] [Citation(s) in RCA: 278] [Impact Index Per Article: 19.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2010] [Revised: 04/21/2010] [Accepted: 04/26/2010] [Indexed: 12/11/2022]
Abstract
Positron emission tomography (PET) myocardial perfusion imaging in concert with tracer-kinetic modeling affords the assessment of regional myocardial blood flow (MBF) of the left ventricle in absolute terms (milliliters per gram per minute). Assessment of MBF both at rest and during various forms of vasomotor stress provides insight into early and subclinical abnormalities in coronary arterial vascular function and/or structure, noninvasively. The noninvasive evaluation and quantification of MBF and myocardial flow reserve (MFR) extend the scope of conventional myocardial perfusion imaging from detection of end-stage, advanced, and flow-limiting, epicardial coronary artery disease (CAD) to early stages of atherosclerosis or microvascular dysfunction. Recent studies have shown that impaired hyperemic MBF or MFR with PET, with or without accompanying CAD, is predictive of increased relative risk of death or progression of heart failure. Quantitative approaches that measure MBF with PET identify multivessel CAD and offer the opportunity to monitor responses to lifestyle and/or risk factor modification and to therapeutic interventions. Whether improvement or normalization of hyperemic MBF and/or the MFR will translate to improvement in long-term cardiovascular outcome remains clinically untested. In the meantime, absolute measures of MBF with PET can be used as a surrogate marker for coronary vascular health, and to monitor therapeutic interventions. Although the assessment of myocardial perfusion with PET has become an indispensable tool in cardiac research, it remains underutilized in clinical practice. Individualized, image-guided cardiovascular therapy may likely change this paradigm in the near future.
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Affiliation(s)
- Thomas H Schindler
- Nuclear Cardiology and Cardiac Imaging, Division of Cardiology, Department of Medicine, University Hospitals of Geneva, Geneva, Switzerland.
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Preamputation evaluation of lower-limb skeletal muscle perfusion with H(2) (15)O positron emission tomography. Am J Phys Med Rehabil 2010; 89:473-86. [PMID: 20357647 DOI: 10.1097/phm.0b013e3181d89b08] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To establish whether muscle blood flow (MBF) measurements with O-water positron emission tomography could reliably identify patients with critical limb ischemia and detect and quantify a distal deficit in skeletal MBF in these cases. DESIGN O-water positron emission tomography scans were performed at rest or during unloaded ankle plantar and dorsiflexion exercise of the diseased leg in 17 subjects with leg ischemia or on a randomly selected leg of 18 age-matched healthy control subjects. TcPO2 was evaluated with Novametrix monitors and perfusion of skin topically heated to 44 degrees C and adjacent nonheated areas with a Moor Instruments laser Doppler imaging scanner. RESULTS The enhancement of MBF induced by exercise was significantly lower in ischemic than in normal legs, and the sensitivity and specificity of this phenomenon were similar to those of laser Doppler imaging or TcPO2 in identifying ischemia subjects. In addition, the exercise MBF deficit was predominant at the distal-leg levels, indicating the ability of the technique to help determine the correct level of amputation. CONCLUSIONS Skeletal MBF of legs with severe ischemia can be detected accurately with O-water positron emission tomography and could add valuable information about viability of skeletal muscle in the residual limb when deciding the level of an amputation.
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Flu WJ, van Kuijk JP, Hoeks S, Bax JJ, Poldermans D. Preoperative Evaluation of Patients with Possible Coronary Artery Disease. Curr Cardiol Rep 2010; 12:286-94. [DOI: 10.1007/s11886-010-0116-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Kirschner R, Toth L, Varga-Szemes A, Simor T, Suranyi P, Kiss P, Ruzsics B, Toth A, Baker R, Brott BC, Litovsky S, Elgavish A, Elgavish GA. Differentiation of acute and four-week old myocardial infarct with Gd(ABE-DTTA)-enhanced CMR. J Cardiovasc Magn Reson 2010; 12:22. [PMID: 20377842 PMCID: PMC2867985 DOI: 10.1186/1532-429x-12-22] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2009] [Accepted: 04/07/2010] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Standard extracellular cardiovascular magnetic resonance (CMR) contrast agents (CA) do not provide differentiation between acute and older myocardial infarcts (MI). The purpose of this study was to develop a method for differentiation between acute and older myocardial infarct using myocardial late-enhancement (LE) CMR by a new, low molecular weight contrast agent.Dogs (n = 6) were studied in a closed-chest, reperfused, double myocardial infarct model. Myocardial infarcts were generated by occluding the Left Anterior Descending (LAD) coronary artery with an angioplasty balloon for 180 min, and four weeks later occluding the Left Circumflex (LCx) coronary artery for 180 min. LE images were obtained on day 3 and day 4 after second myocardial infarct, using Gd(DTPA) (standard extracellular contrast agent) and Gd(ABE-DTTA) (new, low molecular weight contrast agent), respectively. Triphenyltetrazolium chloride (TTC) histomorphometry validated existence and location of infarcts. Hematoxylin-eosin and Masson's trichrome staining provided histologic evaluation of infarcts. RESULTS Gd(ABE-DTTA) or Gd(DTPA) highlighted the acute infarct, whereas the four-week old infarct was visualized by Gd(DTPA), but not by Gd(ABE-DTTA). With Gd(ABE-DTTA), the mean +/- SD signal intensity enhancement (SIE) was 366 +/- 166% and 24 +/- 59% in the acute infarct and the four-week old infarct, respectively (P < 0.05). The latter did not differ significantly from signal intensity in healthy myocardium (P = NS). Gd(DTPA) produced signal intensity enhancements which were similar in acute (431 +/- 124%) and four-week old infarcts (400 +/- 124%, P = NS), and not statistically different from the Gd(ABE-DTTA)-induced SIE in acute infarct. The existence and localization of both infarcts were confirmed by triphenyltetrazolium chloride (TTC). Histologic evaluation demonstrated coagulation necrosis, inflammation, and multiple foci of calcification in the four day old infarct, while the late subacute infarct showed granulation tissue and early collagen deposition. CONCLUSIONS Late enhancement CMR with separate administrations of standard extracellular contrast agent, Gd(DTPA), and the new low molecular weight contrast agent, Gd(ABE-DTTA), differentiates between acute and late subacute infarct in a reperfused, double infarct, canine model.
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Affiliation(s)
- Robert Kirschner
- Department of Biochemistry and Molecular Genetics, University of Alabama at Birmingham, MCLM 556, Birmingham, AL 35294-0005, USA
- Heart Institute, Faculty of Medicine, University of Pecs, Hungary
- Elgavish Paramagnetics Inc., Birmingham, Alabama, USA
| | - Levente Toth
- Department of Biochemistry and Molecular Genetics, University of Alabama at Birmingham, MCLM 556, Birmingham, AL 35294-0005, USA
- Elgavish Paramagnetics Inc., Birmingham, Alabama, USA
| | - Akos Varga-Szemes
- Department of Biochemistry and Molecular Genetics, University of Alabama at Birmingham, MCLM 556, Birmingham, AL 35294-0005, USA
- Heart Institute, Faculty of Medicine, University of Pecs, Hungary
- Elgavish Paramagnetics Inc., Birmingham, Alabama, USA
| | - Tamas Simor
- Department of Biochemistry and Molecular Genetics, University of Alabama at Birmingham, MCLM 556, Birmingham, AL 35294-0005, USA
- Heart Institute, Faculty of Medicine, University of Pecs, Hungary
- Elgavish Paramagnetics Inc., Birmingham, Alabama, USA
| | - Pal Suranyi
- Department of Biochemistry and Molecular Genetics, University of Alabama at Birmingham, MCLM 556, Birmingham, AL 35294-0005, USA
- Elgavish Paramagnetics Inc., Birmingham, Alabama, USA
| | - Pal Kiss
- Department of Biochemistry and Molecular Genetics, University of Alabama at Birmingham, MCLM 556, Birmingham, AL 35294-0005, USA
- Elgavish Paramagnetics Inc., Birmingham, Alabama, USA
| | - Balazs Ruzsics
- Department of Biochemistry and Molecular Genetics, University of Alabama at Birmingham, MCLM 556, Birmingham, AL 35294-0005, USA
- Elgavish Paramagnetics Inc., Birmingham, Alabama, USA
| | - Attila Toth
- Department of Biochemistry and Molecular Genetics, University of Alabama at Birmingham, MCLM 556, Birmingham, AL 35294-0005, USA
- Elgavish Paramagnetics Inc., Birmingham, Alabama, USA
| | - Robert Baker
- Animal Resources Program, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Brigitta C Brott
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Silvio Litovsky
- Department of Anatomical Pathology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Ada Elgavish
- Division of Clinical Immunology and Rheumatology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Elgavish Paramagnetics Inc., Birmingham, Alabama, USA
| | - Gabriel A Elgavish
- Department of Biochemistry and Molecular Genetics, University of Alabama at Birmingham, MCLM 556, Birmingham, AL 35294-0005, USA
- Elgavish Paramagnetics Inc., Birmingham, Alabama, USA
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Abstract
In patients with coronary arterial disease, stress imaging is able to demonstrate abnormalities in the motion of the ventricular walls, and abnormalities in coronary arterial perfusion not apparent at rest. It can also provide information on prognostic factors. In patients with congenitally malformed hearts, stress imaging is used to determine contractile reserve, abnormalities of mural motion, and global systolic function, but also to assess diastolic and vascular function. In most of these patients, stress is usually induced using pharmacological agents, mainly dobutamine given in varying doses. The clinical usefulness of abnormal responses to the stress induced in such patients has to be addressed in follow-up studies. The abnormal stress might serve as surrogate endpoints, predicting primary endpoints at an early stage, which are useful for stratification of risk in this population of growing patients. We review here the stress imaging studies performed to date in patients with congenitally malformed hearts, with a special emphasis on echocardiography and cardiac magnetic resonance imaging.
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Van Holen R, Staelens S, Vandenberghe S. SPECT imaging of high energy isotopes and isotopes with high energy contaminants with rotating slat collimators. Med Phys 2009; 36:4257-67. [DOI: 10.1118/1.3177312] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Fommei E, Bruselli L, Ripoli A, Gimelli A, Ghione S, Giorgetti A, Kush A, Tagliavia ID, Passino C, Marzullo P. Single-shot cardiorenal scintigraphy with 99mTc-tetrofosmin: a dynamic characterization at rest and during adenosine infusion. J Nucl Med 2009; 50:1288-95. [PMID: 19617333 DOI: 10.2967/jnumed.109.062646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
UNLABELLED Renal function is known to be a strong predictor of cardiovascular prognosis, and cardiorenal disease is increasingly investigated in medical research. In this study, we tested the hypothesis that a single combined cardiorenal scintigraphy examination with the perfusion tracer (99m)Tc-tetrofosmin is feasible and may allow the simultaneous investigation of cardiac and renal pathology in cardiovascular patients. METHODS Thirty patients scheduled for dual-day gated SPECT also gave their informed consent for a renal acquisition after a single injection of 370 MBq of (99m)Tc-tetrofosmin, at rest (30 patients) or with adenosine (21 patients), and to undergo an additional standard renal study with the glomerular tracer (99m)Tc-diethylenetriaminepentaacetic acid (DTPA) (74 MBq) after 1 wk (24 patients). Kidney images and renograms were obtained. Renal uptake index, expressed as the percentage ratio of kidney counts cumulated over the second minute after injection to the administered dose, was calculated as a functional renal parameter. Time to peak activity and separate kidney percentage uptake (as the percentage contribution of each kidney to total renal uptake) were also calculated. RESULTS Compared with (99m)Tc-DTPA, (99m)Tc-tetrofosmin provided better-quality kidney images, with a higher uptake index (13.17% +/- 4.76% vs. 8.33% +/- 2.45%, P < 0.001) and with comparable separate kidney percentage uptake and times to peak activity. (99m)Tc-tetrofosmin uptake index was significantly lower in the patients who were more compromised according to renal and cardiovascular functional parameters, and correlated with (99m)Tc-DTPA uptake index (r = 0.77, P < 0.001), serum creatinine (r = 0.59, P < 0.005), log brain natriuretic peptide N-terminal levels (r = -0.65, P < 0.005), myocardial and carotid intima-media wall thickness (for both, r = -0.61, P < 0.005), and the Doppler index of renal vascular resistance (r = -0.60, P < 0.005). In the 21 patients who underwent the provocative test, adenosine induced a significant decrease in renal (99m)Tc-tetrofosmin uptake index (from 14.12% +/- 4.50% to 11.81% +/- 3.33%, P < 0.005) suggesting a decrement in renal perfusion or function. CONCLUSION (99m)Tc-tetrofosmin cardiorenal scintigraphy is feasible at low cost as a single-shot study and may allow both the evaluation of renal morphology and renograms during a cardiac study and the calculation of renal functional parameters.
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Affiliation(s)
- Enza Fommei
- Gabriele Monasterio Foundation, CNR Institute of Clinical Physiology, Pisa, Italy.
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Hoeks S, Flu WJ, van Kuijk JP, Bax J, Poldermans D. Cardiovascular risk assessment of the diabetic patient undergoing major noncardiac surgery. Best Pract Res Clin Endocrinol Metab 2009; 23:361-73. [PMID: 19520309 DOI: 10.1016/j.beem.2009.01.002] [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: 11/30/2022]
Abstract
Noncardiac surgery is associated with an increased risk for cardiovascular morbidity and mortality. It is important to stratify the risk of these patients for perioperative cardiac events. Diabetes, a presently rapidly expanding disease, is a major risk factor for cardiovascular morbidity and mortality. Importantly, silent ischemia is more common in diabetic patients than in the general population. When preoperative risk assessment identifies an increased risk, further cardiac testing is warranted. The most commonly used stress tests for detecting cardiac ischemia is treadmill or bicycle ergometry. However, patients undergoing noncardiac surgery frequently have limited exercise capacity due to co-morbidities. Pharmacologic testing, such as dobutamine stress echocardiography and dipyridamole myocardial perfusion scintigraphy can be performed in patients with limited exercise capacity. Non-invasive stress testing should be considered, especially in diabetic patients, to detect asymptomatic coronary artery disease. Furthermore, when an increased cardiac risk is assessed, two strategies could be used to reduce the incidence of perioperative cardiac events: 1) prophylactic coronary revascularization from which the value is still controversial, and 2) pharmacological treatment (with beta-blockers, statins and aspirin), associated with improved post-operative outcome.
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Affiliation(s)
- Sanne Hoeks
- Department of Anesthesiology, Erasmus Medical Center, Rotterdam, The Netherlands
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