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Sample records for acid myocardial scintigraphy

  1. Dynamic myocardial scintigraphy with 123I-labelled free fatty acids

    In this thesis, long-chain radioiodinated free fatty acids (123I-FFA), 16-iodo-123I-cis-Δ9-hexadecenoic acid (123I-HA) and 17-iodo-123I-heptade-canoic acid (123I-Hsup(o)A), were employed for myocardial scintigraphy in patients with coronary artery disease. The results indicate that clearance of 123I-FFA from the myocardium is dependent on the nature of ischemic injury. Clearance is delayed if the injury is reversible and accelerated in case of irreversible ischemia. Mechanisms responsible for divergent behaviour of FFA in patients with acute myocardial infarction versus patients with angina pectoris are purely speculative. This differential clearance from normally perfused, transiently ischemic and infarcted myocardium has practical application. The test provides a means to assess the nature of ischemic injury rapidly. These findings may have major consequences for logical management of patients presenting with chest pain and suspected coronary artery disease. (Auth.)

  2. Assessment of myocardial fatty acid metabolism in patients with angina pectoris and diabetes mellitus using {sup 123}I-BMIPP myocardial scintigraphy

    Ito, Kazuki; Tanabe, Takuji; Yuba, Tatsuya; Doue, Tomoki; Adachi, Yoshihiko; Katoh, Shuuji [Asahi Univ., Gifu (Japan). Murakami Memorial Hospital; Sugihara, Hiroki; Azuma, Akihiro; Nakagawa, Masao

    2001-11-01

    We studied the effect of myocardial ischemia and diabetes mellitus (DM) on the myocardial fatty acid metabolism using {sup 123}I-BMIPP myocardial scintigraphy. We performed {sup 123}I-BMIPP myocardial scintigraphy in 50 patients with myocardial ischemia and without DM (AP), in 30 patients with myocardial ischemia and DM (AP+DM), 12 patients with DM and without myocardial ischemia (DM), and in 10 normal subjects (N). Myocardial uptake rate of {sup 123}I-BMIPP was obtained using the time activity curve. Myocardial washout rate of {sup 123}I-BMIPP was calculated using the polar images of early and delayed SPECT images. Myocardial uptake rate of {sup 123}I-BMIPP (%) were AP: 4.9{+-}0.6, AP+DM: 5.5{+-}0.5, DM 5.7{+-}0.5 and N: 5.0{+-}0.4. {sup 123}I-BMIPP myocardial uptake rate was increased in AP+DM and DM. {sup 123}I-BMIPP myocardial washout rate (%) were AP: 30.2{+-}4.3, AP+DM: 24.5{+-}3.9, DM: 16.1{+-}2.8 and N: 19.4{+-}3.2. {sup 123}I-BMIPP myocardial washout rate was increased in AP and AP+DM. {sup 123}I-BMIPP myocardial washout rate was increased particularly in patients with multi-vessels disease. {sup 123}I-BMIPP myocardial washout rate was decreased in DM. The present study suggested that diabetes mellitus increased myocardial fatty acid uptake and decreased myocardial fatty acid washout, and that myocardial ischemia increased myocardial fatty acid washout. (author)

  3. Assessment of myocardial fatty acid metabolism in patients with angina pectoris and diabetes mellitus using 123I-BMIPP myocardial scintigraphy

    We studied the effect of myocardial ischemia and diabetes mellitus (DM) on the myocardial fatty acid metabolism using 123I-BMIPP myocardial scintigraphy. We performed 123I-BMIPP myocardial scintigraphy in 50 patients with myocardial ischemia and without DM (AP), in 30 patients with myocardial ischemia and DM (AP+DM), 12 patients with DM and without myocardial ischemia (DM), and in 10 normal subjects (N). Myocardial uptake rate of 123I-BMIPP was obtained using the time activity curve. Myocardial washout rate of 123I-BMIPP was calculated using the polar images of early and delayed SPECT images. Myocardial uptake rate of 123I-BMIPP (%) were AP: 4.9±0.6, AP+DM: 5.5±0.5, DM 5.7±0.5 and N: 5.0±0.4. 123I-BMIPP myocardial uptake rate was increased in AP+DM and DM. 123I-BMIPP myocardial washout rate (%) were AP: 30.2±4.3, AP+DM: 24.5±3.9, DM: 16.1±2.8 and N: 19.4±3.2. 123I-BMIPP myocardial washout rate was increased in AP and AP+DM. 123I-BMIPP myocardial washout rate was increased particularly in patients with multi-vessels disease. 123I-BMIPP myocardial washout rate was decreased in DM. The present study suggested that diabetes mellitus increased myocardial fatty acid uptake and decreased myocardial fatty acid washout, and that myocardial ischemia increased myocardial fatty acid washout. (author)

  4. Myocardial rest iodine-123-β-methyl-iodophenyl-pentadecanoic acid scintigraphy compared with dipyridamole stress thallium-201 scintigraphy in unstable angina

    Twelve patients with stable angina and 12 patients with unstable angina underwent rest iodine-123-β-methyl-iodophenyl-pentadecanoic acid (BMIPP), dipyridamole stress thallium scintigraphy and delayed thallium scintigraphy. In stable angina, sensitivity for detecting ischemic segments was higher in dipyridamole thallium (74%) than rest BMIPP (48%) images (p<0.05), but there was no significant difference between the 2 images in unstable angina. In unstable angina, the incidence of segments with higher defect scores on BMIPP images than on delayed thallium images and the opposite pattern was 27 and 5 (p<0.01). In stable angina, there was no difference. The mean defect score on BMIPP (6.3±5.6) was higher than that on delayed thallium scintigraphy (2.9±2.7) and it was almost the same as on the initial dipyridamole stress test (6.5±5.2). In conclusion, BMIPP scintigraphy is safer and may be as useful in detecting myocardial ischemia in patients with unstable angina as thallium scintigraphy. (author)

  5. Myocardial scintigraphy with 131I-hexadecene-9 oique acid. Study of reproducibility on the dog

    After I.V. injection to dogs of 16 123I-hexadecene-9-oique acid, the decreasing part of the myocardial activity curve is fitted with an exponential which period is calculated. The measurement of the period value is reproducible when the dog stays in a stable physiologic state, meanwhile the value of the period can be very different from dog to dog

  6. Perfusion scintigraphy in acute myocardial infarction

    The Tc-99m sestamibi perfusion SPECT scintigraphy in acute myocardial infarction is a feasible method to assess the size of area at risk and the residual blood flow to this area as the most important determinants of final infarct size without any delay in treatment. In combination with a follow-up study final infarct size as well as myocardial salvage can be quantified. Clinical indications for the use of Tc-99m sestamibi scintigraphy are the noninvasive identification of arterial occlusion in patients suspected to acute myocardial infarction without electrocardiographic ST-elevation and the assessment of reperfusion success. In clinical trials Tc-99m sestamibi scintigraphy has proven to be a useful method to assess the impact of varying reperfusion therapies. The present review article discusses the indication, the study protocol, the interpretation of results and the clinical and scientifically importance of this method. (orig.)

  7. Relationship between evaluation by quantitative fatty acid myocardial scintigraphy and response to {beta}-blockade therapy in patients with dilated cardiomyopathy

    Ito, Tatsuo; Hoshida, Shiro; Nishino, Masami; Aoi, Toshiyuki; Egami, Yasuyuki; Takeda, Toshihiro; Kawabata, Masayoshi; Tanouchi, Jun; Yamada, Yoshio; Kamada, Takenobu [Div. of Cardiology, Osaka Rosai Hospital (Japan)

    2001-12-01

    Predicting the effect of {beta}-blockade therapy on the clinical outcome of patients with dilated cardiomyopathy (DCM) is difficult prior to the initiation of therapy. Myocardial fatty acid metabolism has been shown to be impaired in patients with DCM. We examined whether the extent of myocardial injury, as assessed by iodine-123 15-(p-iodophenyl)-3-R,S-methylpentadecanoic acid (BMIPP) myocardial scintigraphy, is related to the response of patients with DCM to {beta}-blockade therapy. Thirty-seven patients with DCM were examined using BMIPP myocardial scintigraphy before and after 6 months of treatment with metoprolol. Myocardial BMIPP uptake (%BM uptake) was estimated quantitatively as a percentage of the total injected count ratio. The left ventricular end-diastolic and end-systolic dimensions (LVDd, LVDs) and ejection fraction (LVEF) were also evaluated. The patients were divided into two groups according to their functional improvement (>10% elevation of LVEF) after 6 months of metoprolol therapy. Twenty-eight patients responded to the therapy, while nine did not. Prior to the therapy, no significant differences in LVDd, LVDs or LVEF were observed between the responders and non-responders. However, the %BM uptake was significantly lower in the non-responders than in the responders (1.0%{+-}0.2% vs 2.1%{+-}0.5%, P<0.001). The %BM uptake could be used to distinguish the responders from the non-responders with a sensitivity of 0.93 and a specificity of 1.00 at a threshold value of 1.4. After the metoprolol therapy, the %BM uptake improved significantly in the responders (2.5%{+-}0.5%, P<0.01) but did not change in the non-responders. These results indicate that myocardial BMIPP uptake could predict the response of DCM patients to {beta}-blockade therapy. (orig.)

  8. Relationship between evaluation by quantitative fatty acid myocardial scintigraphy and response to β-blockade therapy in patients with dilated cardiomyopathy

    Predicting the effect of β-blockade therapy on the clinical outcome of patients with dilated cardiomyopathy (DCM) is difficult prior to the initiation of therapy. Myocardial fatty acid metabolism has been shown to be impaired in patients with DCM. We examined whether the extent of myocardial injury, as assessed by iodine-123 15-(p-iodophenyl)-3-R,S-methylpentadecanoic acid (BMIPP) myocardial scintigraphy, is related to the response of patients with DCM to β-blockade therapy. Thirty-seven patients with DCM were examined using BMIPP myocardial scintigraphy before and after 6 months of treatment with metoprolol. Myocardial BMIPP uptake (%BM uptake) was estimated quantitatively as a percentage of the total injected count ratio. The left ventricular end-diastolic and end-systolic dimensions (LVDd, LVDs) and ejection fraction (LVEF) were also evaluated. The patients were divided into two groups according to their functional improvement (>10% elevation of LVEF) after 6 months of metoprolol therapy. Twenty-eight patients responded to the therapy, while nine did not. Prior to the therapy, no significant differences in LVDd, LVDs or LVEF were observed between the responders and non-responders. However, the %BM uptake was significantly lower in the non-responders than in the responders (1.0%±0.2% vs 2.1%±0.5%, P<0.001). The %BM uptake could be used to distinguish the responders from the non-responders with a sensitivity of 0.93 and a specificity of 1.00 at a threshold value of 1.4. After the metoprolol therapy, the %BM uptake improved significantly in the responders (2.5%±0.5%, P<0.01) but did not change in the non-responders. These results indicate that myocardial BMIPP uptake could predict the response of DCM patients to β-blockade therapy. (orig.)

  9. Myocardial scintigraphy with 16 123I hexadecene 9 oique acid: influence of plasma concentrations of fatty acids and glucose

    After I.V. injection of 123I hexadecene-9 oic acid to dogs, the decreasing part of the myocardial activity curve is fitted with an exponential which period is calculated. Then the procedure is repeated after I.V. injection of heparin alone (6 dogs), of heparin during an intralipid perfusion (6 dogs) and lastly during a perfusion of a solution of glucose, insulin and potassium (7 dogs). In the two last protocols only, the period of the curve is significantly increased. The increase of the period means perhaps an increase of the intracellular accumulation of fatty acids. Patients must be in the same nutritional state to allow comparison between periods and a measure of the plasma level of NEFA is necessary before each injection of the labelled fatty acid

  10. Myocardial scintigraphy with 16 /sup 123/I hexadecene 9 oique acid: influence of plasma concentrations of fatty acids and glucose

    Comet, M.; Pilichowski, P.; Wolf, J.E.; Busquet, G.; Dubois, F.; Mathieu, J.P.; Pernin, C.; Riche, F. (C.H.R.U. de Grenoble (France)); Vidal, M. (U.S.M.G., 38 - Grenoble (France))

    1983-01-01

    After I.V. injection of /sup 123/I hexadecene-9 oic acid to dogs, the decreasing part of the myocardial activity curve is fitted with an exponential which period is calculated. Then the procedure is repeated after I.V. injection of heparin alone (6 dogs), of heparin during an intralipid perfusion (6 dogs) and lastly during a perfusion of a solution of glucose, insulin and potassium (7 dogs). In the two last protocols only, the period of the curve is significantly increased. The increase of the period means perhaps an increase of the intracellular accumulation of fatty acids. Patients must be in the same nutritional state to allow comparison between periods and a measure of the plasma level of NEFA is necessary before each injection of the labelled fatty acid.

  11. Tomographic scintigraphy of regional myocardial perfusion

    Estimation of the extent of regional ischemia by scintigraphic methods has been hampered by the geometric constraints of two-dimensional imaging. Myocardial perfusion scintigraphy was performed using the Fresnel zone-plate tomographic camera after the injection of Tc-99m microspheres (20 to 40 μ) into a coronary artery. Coronary artery occlusion was performed in six dogs by embolization via a catheter guidewire system. Twenty millicuries of Tc-99m microspheres were injected into the left main coronary artery of the six occluded and three unoccluded dogs. Scintigraphy was performed in multiple projections in the living animal. Optical reconstruction of the holographic image provided tomographic gamma images of the heat. Scintigraphy was also performed with an Anger camera for comparison. The extent of the perfusion defect was measured by planimetry and expressed as a percentage of the ventricular area in that projection. The average of the right and left anterior oblique projections provided the most accurate estimate of the size of the perfusion defect (average error: 13.6 percent; range: 0 to 38.2 percent). Fresnel zone-plate imaging provided an accurate in vivo assessment of the extent of altered myocardial perfusion

  12. Stress myocardial scintigraphy in coronary artery disease

    To evaluate the clinical significance of asymptomatic ischemic heart disease, exercise electrocardiography and stress myocardial scintigraphy were performed. These were correlated with symptoms during exercise tests and histories of myocardial infarction (MI). The study subjects consisted of 70 patients with coronary artery disease, including 34 with MI, and 36 without MI but with angina pectoris. Stress tests were performed using bicycle ergometer under electrocardiographic monitoring throughout the test. Transient myocardial ischemia was confirmed by perfusion defects on thallium myocardial imaging demonstrated immediately after exercise, but not 3 hours after the stress test. Asymptomatic ST depression was observed in 18 of 34 patients with MI (53%) and in 21 of the 36 patients with angina (58%); however, transient myocardial perfusion defects were confimred in 61% of the patients with MI (11 of 18 patients), but in only 33% of those with angina (7 of 21 patients). The difference was statistically significant (p<0.05). It was suggested that there are some differences in the clinical significance of asymptomatic ST depression between the patients with MI and those without MI but with angina pectoris. (author)

  13. Myocardial scintigraphy with 16 123I hexadecene-9 oic acid. Study of the influence of isoproterenol, propranolol, dipyridamole and isoptine

    After I.V. injection of 123I hexadecene-9 oic acid to dogs, the decreasing part of the myocardial activity curve is fitted with an exponential which period is calculated. Tacking the anesthetized dogs as his own reference, we study the influence of isoproterenol, propranolol, dipyridamole and isoptine on value of the period. None of the drugs modify significatively the period. Nevertheless, propranolol and isoptine and to a lesser extent dipyridamole have a tendancy to increase the value of the period

  14. Myocardial scintigraphy with /sup 131/I-hexadecene-9 oique acid. Study of reproducibility on the dog

    Comet, M.; Wolf, J.E.; Pilichowski, P.; Dubois, F.; Busquet, G.; Mathieu, J.P.; Pernin, C.; Riche, F. (C.H.R.U. de Grenoble, 38 (France)); Vidal, M. (Laboratoire d' Etudes Dynamiques et Structurales de la Selectivite, U.S.M.G., 38 - Grenoble (France))

    1983-01-01

    After I.V. injection of /sup 123/I-hexadecene-9-oique acid to 16 dogs, the decreasing part of the myocardial activity curve is fitted with an exponential whose period is calculated. The measurement of the period value is reproducible when the dog stays in a stable physiologic state, meanwhile the value of the period can be very different from dog to dog.

  15. Myocardial scintigraphy - 25 years after start

    The development of myocardial scintigraphy (MS) reflects the clinical success of a representative procedure in nuclear medicine. Radiopharmaceuticals for visualizing vital and damaged myocardium and techniques (planar-qualitative, planar-quantitative, SPECT-qualitative-quantitative with comparative sensitivities) are briefly reviewed with the main focus on their clinical application in coronary (CHD) and noncoronary heart disease, where recent literature from the United States and Europe is considered. The limited value of MS for screening of CHD is outlined and its present and future role in detecting asymptomatic (silent) ischemia/infarction and asymptomatic patients at professional risk is stressed. The present state of MS in coronary heart disease is discussed for single and multivessel disease, previous infarction, and risk stratification (myocardial washout, pulmonary uptake, ischemic dilation, absent heart sign), reflecting the importance of the procedure in exercise-induced ischemia as well as in ischemia at rest for prognostication of the natural and therapeutic course, i.e., therapy control (angioplasty, bypass, lysis, cardiac drugs). More marginal but upcoming clinical indications are mentioned, such as progressive systemic sclerosis cardiac transplantation, pediatric cardiology, and problems of nephrology/urology. The ''normal'' values and the impact of digital radiology and of contrast cardiography are touched upon. Preliminary cases with 111In-antimyosin and 99mTC-Isonitriles are presented including correlative results between globla ejection fraction determination according to gated 99mTc-isonitrile and conventional 99mTc-erythrocyte ventriculogram (r=0,75; n=10). (orig.)

  16. Myocardial scintigraphy using iodine-123 15-(p-Iodophenyl)-3-R, S-methylpentadecanoic acid predicts the response to beta-blocker therapy in patients with dilated cardiomyopathy but does not reflect therapeutic effect

    Myocardial fatty acid metabolism is disturbed in patients with idiopathic dilated cardiomyopathy. Myocardial scintigraphy using iodine-123 15-(p-iodophenyl)-3-R, S-methylpentadecanoic acid (BMIPP) was used to assess the response to β-blocker therapy in 19 patients with dilated cardiomyopathy. BMIPP myocardial scintigraphy was performed before and 6 months after initiating β-blocker therapy with metoprolol. Cardiac BMIPP uptake was assessed as the total defect score (TDS) and heart-to-mediastinum activity (H/M) ratio. Patients were classified retrospectively as responders with an improvement of at least one functional class (New York Heart Association) or an increase in ejection fraction of ≥0.10 at 6 months, or as nonresponders meeting neither criterion. Responders had a significantly better pretreatment TDS (p<0.005) and H/M ratio (p<0.0001) than nonresponders. TDS exhibited no significant changes over 6 months in either group (responders: 13.2±3.7 vs 12.5±3.3; nonresponders: 20.8±6.5 vs 20.5±3.0). Responders showed no significant changes in H/M ratio (2.47±0.28 vs 2.43±0.42); paradoxically, nonresponders showed a significant increase from 1.82±0.11 to 2.10±0.19 (p<0.05), suggesting that β-blocker therapy protected the myocardial fatty acid metabolism even in the absence of clinical improvement. BMIPP myocardial scintigraphy provides a prediction of response to β-blocker treatment, but does not reflect the therapeutic effect in responders at 6 months. (author)

  17. Myocardial scintigraphy using iodine-123 15-(p-Iodophenyl)-3-R, S-methylpentadecanoic acid predicts the response to beta-blocker therapy in patients with dilated cardiomyopathy but does not reflect therapeutic effect

    Yoshinaga, Keiichiro; Tahara, Minoru; Torii, Hiroyuki; Akimoto, Masaki [Kagoshima City Medical Association Hopital (Japan); Kihara, Koichi; Tei, Chuwa

    2000-05-01

    Myocardial fatty acid metabolism is disturbed in patients with idiopathic dilated cardiomyopathy. Myocardial scintigraphy using iodine-123 15-(p-iodophenyl)-3-R, S-methylpentadecanoic acid (BMIPP) was used to assess the response to {beta}-blocker therapy in 19 patients with dilated cardiomyopathy. BMIPP myocardial scintigraphy was performed before and 6 months after initiating {beta}-blocker therapy with metoprolol. Cardiac BMIPP uptake was assessed as the total defect score (TDS) and heart-to-mediastinum activity (H/M) ratio. Patients were classified retrospectively as responders with an improvement of at least one functional class (New York Heart Association) or an increase in ejection fraction of {>=}0.10 at 6 months, or as nonresponders meeting neither criterion. Responders had a significantly better pretreatment TDS (p<0.005) and H/M ratio (p<0.0001) than nonresponders. TDS exhibited no significant changes over 6 months in either group (responders: 13.2{+-}3.7 vs 12.5{+-}3.3; nonresponders: 20.8{+-}6.5 vs 20.5{+-}3.0). Responders showed no significant changes in H/M ratio (2.47{+-}0.28 vs 2.43{+-}0.42); paradoxically, nonresponders showed a significant increase from 1.82{+-}0.11 to 2.10{+-}0.19 (p<0.05), suggesting that {beta}-blocker therapy protected the myocardial fatty acid metabolism even in the absence of clinical improvement. BMIPP myocardial scintigraphy provides a prediction of response to {beta}-blocker treatment, but does not reflect the therapeutic effect in responders at 6 months. (author)

  18. Myocardial scintigraphy in the diagnosis of myocardial contusion

    To assess the clinical value of a new fatty acid imaging tracer, 123I-β-methyl iodophenyl pentadecanoic acid (BMIPP), I-BMIPP and thallium-201 (Tl) dual imaging was performed at rest in fifteen patients with mild blunt chest trauma (mean AIS thoracic 1.4±0.51, mean ISS 6.47±3.50, mean RTS 7.69±0.43). All patients were prospectively evaluated on the basis of serial electrocardiograms (ECG) and cardiac enzyme studies (total CPK). Tl and BMIPP dual scintigrams were performed within 10 days following admission. SPECT images were divided into seven segments, and the segmental images were visually scored according to tracer uptake on a 3 (severely decreased tracer uptake) to 0 (normal) scale. Nine patients had scintigraphic defects and were considered to have a myocardial contusion. ECG findings, AIS, ISS, and CPK levels failed to distinguish between scintigraphically positive patients and scintigraphically negative patients. Five of the 14 hypoperfused segments on BMIPP imaging, showed normal Tl uptake, one showed lower BMIPP uptake than Tl, and the remaining eight showed similar distribution of both tracers. The mismatch between tracer uptake on BMIPP images and Tl images was thought to reflect impaired myocardial fatty acid metabolism. Thus, mild blunt chest trauma results in a higher frequency of traumatic myocardial injury than previously recognized, and BMIPP is a promising radio-pharmaceutical for evaluating impaired myocardial fatty acid metabolism in patients with myocardial contusion. (author)

  19. Machine learning improves the accuracy of myocardial perfusion scintigraphy results

    Objective: Machine learning (ML) an artificial intelligence method has in last decade proved to be an useful tool in many fields of decision making, also in some fields of medicine. By reports, its decision accuracy usually exceeds the human one. Aim: To assess applicability of ML in interpretation of the stress myocardial perfusion scintigraphy results in coronary artery disease diagnostic process. Patients and methods: The 327 patient's data of planar stress myocardial perfusion scintigraphy were reevaluated in usual way. Comparing them with the results of coronary angiography the sensitivity, specificity and accuracy of the investigation were computed. The data were digitized and the decision procedure repeated by ML program 'Naive Bayesian classifier'. As the ML is able to simultaneously manipulate with whatever number of data, all reachable disease connected data (regarding history, habitus, risk factors, stress results) were added. The sensitivity, specificity and accuracy of scintigraphy were expressed in this way. The results of both decision procedures were compared. Conclusion: Using ML method, 19 more patients out of 327 (5.8%) were correctly diagnosed by stress myocardial perfusion scintigraphy. In this way ML could be an important tool for myocardial perfusion scintigraphy decision making

  20. 123I-metaiodobenzylguanidine myocardial scintigraphy in Parkinson's disease

    Orimo, S; Ozawa, E; Nakade, S; Sugimoto, T.; Mizusawa, H

    1999-01-01

    OBJECTIVES—123I-metaiodobenzylguanidine (MIBG) myocardial scintigraphy is clinically used to estimate local myocardial sympathetic nerve damage in some forms of heart disease, autonomic nerve disturbance in diabetic neuropathy, and disturbance of the autonomic nervous system in neurodegenerative disease. In the present study, examinations were performed to clarify (1) the proportion of cardiac sympathetic nerve disturbance in Parkinson's disease, (2) the usefulness of 123...

  1. Sensitivity and related factors in iodine-123-β-methyl-p-iodophenyl-pentadecanoic acid myocardial scintigraphy to detect stable effort angina pectoris

    This study evaluated the sensitivity and the related factors in iodine-123-β-methyl-p-iodophenyl-pentadecanoic acid (BMIPP) scintigraphy to detect stable angina. The subjects were 198 patients with stable angina who underwent BMIPP before percutaneous coronary intervention or coronary bypass graft surgery. Patients with unstable angina, myocardial infarction, congestive heart failure, cardiomyopathy and vasospastic angina were excluded. After investigation of the sensitivity of BMIPP, the patients with single-vessel disease without collateral flow were classified into the normal 123I-BMIPP uptake group (normal group) or decreased 123I-BMIPP uptake group (decreased group), and various factors were compared between the two groups. Sensitivity was 61% overall, 58% in single-vessel disease, 69% in double-vessel disease, 53% in triple-vessel disease, 43% in only left main vessel disease, and 89% in left main and other vessel disease (NS). In single-vessel disease, the sensitivity was 40% in 75% coronary artery stenosis, 58% in 90% stenosis, 89% in 99% stenosis, and 69% in total occlusion (p=0.003). Comparing the decreased and normal groups, diabetes mellitus was more frequent in the normal group (14.6% vs 39.5%), minimal lumen diameter was smaller (0.75±0.37 vs 0.98±0.49 mm) and lesion length was longer in the decreased group (15.4±4.9 vs 11.6±5.5 mm). Logistic multivariate analysis showed that the independent factors were diabetes mellitus [odds ratio 0.20, 95% confidence interval (CI) 0.04-0.87, p=0.03], minimal lumen diameter (odds ratio 0.10, 95% CI 0.02-0.48, p=0.003) and lesion length (odds ratio 1.12, 95% CI 1.00-1.25, p=0.03). BMIPP is useful in stable angina patients because of the acceptable sensitivity. Diabetes mellitus, minimal lumen diameter and lesion length were independent factors associated with decreased BMIPP uptake. (author)

  2. Thallium-199 myocardial scintigraphy for assessing the efficacy of drug and surgical treatment of coronary disease

    Potentialities of thallium-199 myocardial scintigraphy in evaluation of the effects of surgical and drug treatment of myocardial perfusion in coronary patients are studied. It is shown that thallium-199 myocardial scintigraphy helps assess the effect of treatment on myocardial perfusion. Positive effect of treatment manifests by decrease of myocardial perfusion defects. The method permits imaging the coronary microcirculation over the course of treatment and predicting a further course of disease

  3. Paradoxical hypotension during dobutamine infusion for myocardial perfusion scintigraphy

    Dobutamine as a predominant beta-1 agonist increases heart rate and myocardial contractility and at sufficient high doses, it also increases systolic blood pressure. This study was undertaken to describe instances of paradoxical hypotension during dobutamine infusion for Tl-201 myocardial perfusion SPECT study and the relationship between scintigraphic findings and hypotension occurred during dobutamine infusion. Methods: In 201 consecutive patients unable to perform adequate exercise, dobutamine Tl-201 myocardial SPECT was performed. Dobutamine was infused starting from 10 μg/kg/min increasing to 40 μ/kg/min. Paradoxical hypotension was defined as a decrease in systolic blood pressure ≥ 20 mmHg compared with baseline study. Paradoxical hypotension was observed in 40 patients (Group A) out of 201 (19.9%) while no significant change in systolic blood pressure was detected in the remaining 161 patients (Group B). Mean maximum fall in systolic blood pressure was 39±18 mmHg (range: 20-90). In 33 of 40 patients (83%) with paradoxical hypotension, scintigraphy was normal compared to 131 (81%) of the remaining 161 patients. In patients of Group A, angiography, echocardiography and tilt table tests were performed in 13, 11 and 6 patients respectively. Nine of 13 angiographic evaluations (69%), 10 of 11 echocardiographic evaluations (91%), all of the tilt table tests were normal. Additionally, all of the patients of Group A were clinically followed up at least 6 months after the myocardial perfusion scintigraphy. None of the patients had a cardiac event except one patient during the follow-up period. Conclusion: Paradoxical hypotension during dobutamine infusion for myocardial scintigraphy is not an uncommon finding and up to 19.9% patients may develop such hypotension. To maximize test safety, precautions should be taken during dobutamine myocardial stress test, since remarkable decrease in systolic blood pressure may occur. Unlike hypotension occurring with exercise

  4. Myocardial perfusion scintigraphy with exercise and pharmacological stress

    Cardiac studies including myocardial perfusion scintigraphy was begun in the Singapore General Hospital, nuclear medicine department in 1983. From a few patients per year using planar imaging, we have in 1994 studied 1500 patients for myocardial perfusion, using mainly SPECT (single-photon emission computerised tomography) and radionuclides such as Thallium-201, Technetium-99m sestamibi and Tc-99m tetrofosmin. Patients have been stressed using treadmill exercise or pharmacological agents; we have used dipyridamole, and dobutamine for pharmacological stress but have no experience with intravenous adenosine

  5. Insulin-augmented Thallium myocardial scintigraphy in animals: First results

    The aim of this experimental study was to establish whether or not insulin administration one hour before administration of Thallium-201 improves its myocardial uptake. Fifty mCi of Thallium-201 per Kg of body weight was injected in control mice (Group A, n=6) and in test mice [preceded one hour by 200 milliunits/kg of insulin (with glucose cover) given intraperitoneally (Group B, n=3), or intramuscularly (Group C, n=3), or with inactivated insulin (Group D, n=6)]. Percent myocardial uptake of the injected dose was calculated after sacrificing the mice at one hour post-injection. Further, serial thallium-201 scintigraphy was done in three rabbits, two of which were injected intravenously with insulin (200 milliunits/kg) one hour before Thallium-201 administration. Mean myocardial uptake in Group A, B, C, and D mice was 1.2, 2.7, 2.8, and 1.6 respectively. Mean myocardial uptake of test rabbits at 0,1 and 4 hours of scintigraphy was 9%, 40%, and 85% higher than the control rabbit. It was concluded that insulin intervention significantly augments myocardial uptake of Thallium-201. (author)

  6. The clinical value of planar thallium-201 myocardial perfusion scintigraphy

    The clinical value of planar thalium-201 myocardial perfusion scintigraphy was examined, using visual and quantitative analysis, for the detection of presence, localization and extent of coronary disease, using coronary arteriography as gold standard. The indremental diagnostic yield of different noninvasive tests for the diagnosis and the severity of coronary artery disease was quantified by using multivariate discriminant analysis. (author). 284 refs.; 14 figs.; 37 tabs

  7. The feasibility of long-term outcome prediction in acute myocardial infarction using the discordance between early and delayed image on 123I-BMIPP myocardial scintigraphy

    The feasibility of long-term outcome prediction using Beta-methyliodophenylpentadecanoic acid (BMIPP) myocardial scintigraphy was evaluated in cases of acute myocardial infarction. BMIPP myocardial scintigraphy was performed on 165 patients with first acute myocardial infarction at the time of discharge from the hospital (average of 27 days after disease on set). Discordance between early and delayed image was checked and its relation to later cardiac events (during the mean follow up period of 64.2±9.8 months) was analyzed. In 82 of these 165 cases TlCl scintigraphy was simultaneously performed (Tl/BMIPP dual SPECT) to examine mismatch form BMIPP scintigraphy and discordance between early and images. Discordance between early and delayed images was observed in 86 cases (52%). Among patients for whom dual SPECT was performed, mismatch between TlCl and BMIPP scintigraphy was observed in 30 cases (37%). When the relation between mismatch and discordance was analyzed, mismatch was accompanied by washout. The incidence of later cardiac events was significantly higher for cases showing discordance accompanied by washout and cases showing mismatch on dual SPECT scintigraphy than cases without these findings. When multivariate analysis was conducted, involving age, sex, infarction related artery, left ventricular end-diastolic volume index, left ventricular ejection fraction, severity of disturbed fatty acid metabolism, washout and fill-in, washout was identified as an independent predictor of cardiac events. Mismatch on Tl/BMIPP dual SPECT is important for predicting long-term prognosis of acute myocardial infarction. Furthermore, washout on BMIPP scintigraphy is also useful as a predictor of cardiac events. (author)

  8. Diagnosis of ventricular aneurysm on Tl-201 myocardial scintigraphy

    Author has proposed ''open beak sign'' (outward extension of left ventricular wall at the edge of scintigraphic hypoperfusion) and ''double chamber sign'' (division of left ventricular cavity) as new observations on planar images of Tl-201 myocardial scintigraphy for diagnosis of ventricular aneurysm. Open beak sign and/or double chamber sign could be detectable in 55 of the 60 myocardial infarctions with ventricular aneurysm, while, 4 of the 162 myocardial infarctions without ventricular aneurysm showed these signs. Thus both open beak sign and double chamber sign for the detection of ventricular aneurysm had a sensitivity of 91.7 %, a specificity of 97.5 %, and an accuracy of 95.9 %. Open beak sign was well demonstrated in middle-sized ventricular aneurysm (17 of the 18 aneurysms, 94.4 %). Detectability of double chamber sign was poor in small ventricular aneurysm (4 of the 10 aneurysms, 40.0 %), and good in large ventricular aneurysm (11 of the 13 aneurysms, 84.6 %). In comparison of rest scan with exercise scan, rest scan was more sensitive for open beak sign and detectability of open beak sign correlated with ischemia at the edge of scintigraphic hypoperfusion based on analysis of coronary arteriography. This report has revealed diagnostic efficacy of Tl-201 myocardial scintigraphy for the detection of ventricular aneurysm. (author)

  9. Clinical use of 201Tl myocardial scintigraphy

    Myocardial imaging with 201Tl and scinticamera was studied experimentally using specially designed phantoms and clinically in 23 patients with myocardial infarction or other heart disease. In the phantom experiment, quality of image, accumulative count rate, and detectability of the defect were compared to obtain the best technique for their detection, using four different collimators, i.e., converging, pin-hole, 4000-hole, and 140 keV high-resolution, at two photopeak levels of 201Tl of 75 and 167 keV, and combining a radiation absorber. In patient examination, myocardial images taken at different periods after injection, different detecting conditions of the scinticamera, and various detecting projections were compared. Images of the converging collimator at the 75 keV photopeak revealed considerably higher accumulative counts and relatively higher quality than those of other detecting conditions. It was necessary to take as many images as possible in various projections, in order to detect the location and size of the myocardial ischemic lesion because the lesion was demonstrated as a clear defect only in profile. It became evident that images taken between about 25 and 90 min delineated the myocardium more clearly than those taken in other periods. Normal images taken in 8 patients without ischemic heart disease appeared in the shape of a doughnut of horseshoe, demonstrating mainly the left venticular myocardium. The image was faint in the region of the aortic or mitral valve and thin in the region of the apical wall. A faint image of the right ventricular myocardium was sometimes seen. In 3 patients with valvular heart disease, findings suggested changes in the thickness of myocardium and the distribution of coronary blood flow. In 11 of 12 patients with old myocardial infarction, the location and size of the lesion was detected. (Evans, J.)

  10. Myocardial scintigraphy with 16 /sup 123/I hexadecene-9 oic acid. Study of the influence of isoproterenol, propranolol, dipyridamole and isoptine

    Comet, M.; Wolf, J.E.; Pilichowski, P.; Busquet, G.; Dubois, F.; Mathieu, J.P.; Pernin, C.; Riche, F.; Vidal, M. ( Grenoble Universite, 38 - (France))

    1983-01-01

    After I.V. injection of /sup 123/I hexadecene-9 oic acid to dogs, the decreasing part of the myocardial activity curve is fitted with an exponential which period is calculated. Taking the anesthetized dog as reference, we study the influence of isoproterenol, propranolol, dipyridamole and isoptine on value of the period. None of the drugs modify significantly the period. Nevertheless, propranolol and isoptine and to a lesser extent dipyridamole have a tendancy to increase the value of the period.

  11. ST segment elevation after myocardial infarction: Viability or ventricular dysfunction? Comparison with myocardial scintigraphy

    The detection of viable myocardium after myocardial infarction is an important indication for revascularization. We compared exercise-induced ST segment elevation with reversibility at Thallium-201 SPECT scintigraphy and regional wall motion assessment by ventriculography. Thirty two patients with previous myocardial infarction and with left ventricular ejection fraction of < 50% were studied. Patients underwent coronary angiography and Thallium-201 SPECT scintigraphy with re-injection protocol before and after coronary artery bypass graft surgery. Group I comprised 11 patients with ST segment elevation during treadmill stress testing. Group II comprised 21 patients without ST segment elevation. Minimal or moderate hypokinesis was present in 2 patients of Group I and in 4 patients of Group II. Nine patients of Group I and 17 patients of Group II had severe hypokinetic, akinetic or dyskinetic myocardium. Scintigraphy revealed reversibility in the myocardial infarction area in 4 patients from Group I (36.4%) and 11 (52.4%) patients from Group II. Improvement in perfusion after coronary artery bypass grafting was observed in 4 patients from Group I and 8 patients from Group II. Sensitivity, specificity, accuracy, and positive and negative predictive values of ST segment elevation were 33.3, 70.6, 55.2, 44.5 and 60% respectively. It was concluded that exercise-induced ST segment elevation after myocardial infarction is present more frequently in cases of severe regional myocardial dysfunction. (author)

  12. Thallium-201 myocardial scintigraphy on coronary vasodilator, dipyridamole

    Thallium-201 myocardial scintigraphy on coronary vasodilator, dipyridamole was done to assess their coronary perfusion reserves in 51 patients with suspected angina pectoris. In comparison with coronary arteriography (CAG), sensitivity, specificity and accuracy of this method for 75% coronary stenosis were 0.70, 0.89 and 0.76 respectively. For further analysis, stenotic lesions on CAG were classified into the groups of three coronary vessels and were compared with myocardial scintigrams. Sensitivity was 0.48, however specificity was 0.98, which was very high. From this result, it can be said that a decrease in thallium uptake on scintigram reflects the reduction of regional coronary perfusion reserve accurately. To assess individual stenotic lesion, detectability of the stenoses of left distal coronary artery was low, which could be due to the limitation of spatial resolution of γ-camera. In 33 patients with 75% coronary stenosis, 36% of them had chest pain and 57% had ST-T change on ECG. These side effects disappeared rapidly with intravenous injection of aminophylline, antagonist of dipyridamole. In conclusion, thallium-201 myocardial scintigraphy on dipyridamole is safe and accurate method to assess regional coronary perfusion reserve. (author)

  13. Assessment of myocardial damage in hypertrophic cardiomyopathy using cardiac enzymes, myosin light chain and myocardial scintigraphy

    To assess myocardial damage in hypertrophic cardiomyopathy (HCM), CPK-MB, %LDH 1, myoglobin (Mb), and myosin light chain (MLC) were determined in 45 HCM patients. Of these patients, 10 also underwent Tl-201 myocardial scintigraphy and In-111-antimyosin antibody (In-111 Fab-DTPA)(In-AM) myocardial scintigraphy. MLC was 0.56±0.55 ng/ml. An increase in CPK-MB, %LDH 1, and Mb was seen in 6 (14%), 19 (44%), and 7 (18%) patients, respectively. There was no correlation between MLC and any of CPK-MB, %LDH1 or Mb. Perfusion defects were seen on Tl-201 myocardial scintigrams in 4 patients. All of these patients had diffuse tracer uptake on In-AM myocardial scintigrams. The degree of In-AM uptake was not correlated with MLC; however, of 4 patients with intense In-AM uptake, 3 had perfusion defects on Tl-201 myocardial scintigrams and decreased left ventricular function. In 3 patients in whom CPK-MB and %LDH 1 were increased but MLC was not increased, diffuse tracer uptake was seen on In-AM myocardial scintigrams. Because diffuse uptake of In-AM was seen in spite of the lack of increased MLC, In-111-Fab-DTPA is likely to be incorporated by the myocardial damaged cells, as well as necrotic cells. HCM seems to be associated with a high likelihood of myocardial damage. Integrated assessment of myocardial damage is required, including an increase of MLC, CPK-MB, %LDH 1, and Mb, perfusion defects on Tl-201 scintigrams, and tracer uptake on In-AM scintigrams. (N.K.)

  14. Use of resting myocardial scintigraphy during chest pain to exclude diagnosis of acute myocardial infarction

    Barbirato, Gustavo Borges; Azevedo, Jader Cunha de; Felix, Renata Christian Martins; Correa, Patricia Lavatori; Volschan, Andre; Viegas, Monica; Pimenta, Lucia; Dohmann, Hans Fernando Rocha; Mesquita, Evandro Tinoco; Mesquita, Claudio Tinoco [Centro de Estudos do Hospital Pro-Cardiaco (Procep), Rio de Janeiro, RJ (Brazil)

    2009-04-15

    Background: Images of myocardial perfusion taken during an episode of chest pain have been used for patients in the emergency department. Objective: To evaluate the operating characteristics of {sup 99m}Tc-Tetrofosmin scintigraphy during an episode of chest pain to exclude the diagnosis of cute myocardial infarction. Methods: One hundred and eight patients admitted with chest pain, or up to four hours after the end of symptoms and non diagnostic electrocardiogram, underwent resting scintigraphy and measurement of troponin I concentrations. Patients with a history of myocardial infarction (MI) were not excluded (24 patients). Troponin I concentrations were determined at admission and 6 hours later. Nuclear physicians performed a blind analysis of the images, and myocardial infarction was confirmed whenever troponin I level increase was three times that of the control. Results: Resting perfusion image was abnormal in all 6 patients with MI. Only 1 patient had a normal image and increased troponin levels. Fifty-five patients had positive images without MI, and 46 patients had normal images and troponin levels. The prevalence of the disease was 6.5%. The sensitivity and specificity of the resting images during an episode of chest pain to diagnose MI was 85.7% and 45.5%, respectively. The negative predictive value was 97.7%. Conclusion: Patients undergoing chest pain protocol with SPECT showed an excellent negative predictive value to exclude diagnosis of myocardial infarction. These results suggest that resting perfusion image is an important tool at the chest pain unit. (author)

  15. Quantification analysis in Tc-99m MIBI myocardial perfusion scintigraphy

    Aims: Technetium-99-MIBI myocardial perfusion scintigraphy is a routinely employed nuclear medicine procedure. This study was carried out to get additional information in terms of Lung-heart ratio (LHR), Right ventricular index (RVI) by computer assisted quantification analysis of this procedure. Material and Methods: Fifty diagnosed cases of coronary artery disease (CAD) underwent 99mTc-MIBI planar studies at stress and rest. A group of 15 subjects with low pre-test likelihood of CAD and normal exercise and rest 99mTc-MIBI images was used as control. LHR was calculated from the static images in the anterior view. A circular region of interest (ROI) of about 8 pixel in diameter was selected in left lung area at maximal count density as assessed visually. Similar ROI was drawn on left ventricular wall at maximal count density area, as assessed visually. Ratio of the counts in the lung ROI to the counts in the myocardial ROI was expressed as Lung Heart ratio or 'lung index. LHR = Average counts in Lung ROI/Average counts in Left Myocardial ROI. Right ventricular index (RVI) was determined from the static images in LAO 450 views. ROIs were drawn on the right ventricle (RV) with maximal counts and on the left ventricle (LV) with maximal counts as assessed visually. The ratio of the counts in the two ROIs gave the right ventricular index. RVI = Average counts in RV ROI/ Average counts in LV ROI. Results: A close correlation was noted in the findings of three independent observers. In patients or coronary artery disease group (CAD Group), stress was induced by treadmill exercise or dipyridamole infusion. The CAD Group showed higher LHR at stress and at rest than controls. Student's t-test comparison of patients versus controls. p99mTc-MIBI myocardial perfusion images provides reproducible and clinically useful information regarding left ventricular function in CAD patients

  16. A decision support system for stress only myocardial perfusion scintigraphy may save unnecessary rest studies

    Tägil, K; Jakobsson, D; Lomsky, M;

    2013-01-01

    The aim of this study was to investigate the influence of a computer-based decision support system (DSS) on performance and inter-observer variability of interpretations regarding ischaemia and infarction in myocardial perfusion scintigraphy (MPS).......The aim of this study was to investigate the influence of a computer-based decision support system (DSS) on performance and inter-observer variability of interpretations regarding ischaemia and infarction in myocardial perfusion scintigraphy (MPS)....

  17. Myocardial scintigraphy with 201Tl and quantitative assessment of myocardial blood flow

    A newly introduced radionuclide for myocardial imaging, 201-Tl, was studied. Twenty-two subjects consisting of 7 normals, 12 with ischemic heart disease and 3 with hypertrophic cardiomyopathy (HCM) were selected. On intravenous administration of 201-Tl(1.5 - 20. mCi), initial transit of the tracer through the heart, as well as subsequent uptake by the myocardium, were recorded by a scintillation camera. The later process showed the distribution of the myocardial blood flow (MBF). A normal myocardial scintigraphy revealed the left-sided myocardial mass predominantly, whereas the right side or the septum predominated in the case of tetralogy of fallot (T/F) or idiopathic hypertrophic subuaortic stenosis (IHSS). An ischemic or infarcted area of the myocardium in ischemic heart disease (IHD) was compatible with electrocardiographic findings, and revealed defects even in an equivocal case on ECG. Since the ratio of radioactivity taken up by the myocardium (U) to the total injected dosis (I) is assumed to be proportional to the fractional MBF of cardiac output (CO), MBF/CO is calculated by ratio of the radioactivity selected from myocardial region on the later recording to that from the entire region on the initial transit of the tracer bolus. The average MBF/CO of normals was 4.4 +- 0.5%, IHD 4.0 +- 0.8% and HCM 5.5 +- 1.2%. On exercise loading, a significant increase of this value was observed in normals, whereas no change was observed in IHD. (auth.)

  18. Thallium-201 scintigraphy perfusion defect with dipyridamole in a patient with a myocardial bridge

    A patient with myocardial bridging and a thallium-201 scintigraphy perfusion defect after the administration of intravenous dipyridamole is presented. The same patient had a normal perfusion study on exercise stress testing. The effects of coronary vasodilators and dipyridamole on coronary artery flow patterns in patients with myocardial bridging are discussed. We suggest that coronary vasodilators may induce perfusion defects in patients with myocardial bridging and should be avoided in such patients

  19. Myocardial Scintigraphy in the Evaluation of Cardiac Events in Patients without Typical Symptoms

    Smanio, Paola Emanuela Poggio, E-mail: pgmsmanio@gmail.com; Silva, Juliana Horie; Holtz, João Vitor; Ueda, Leandro; Abreu, Marilia; Marques, Carlindo; Machado, Leonardo [Instituto Dante Pazzanese de Cardiologia, São Paulo, SP - Brazil Mailing (Brazil)

    2015-08-15

    Cardiovascular disease is a leading cause of death in the world and in Brazil. Myocardial scintigraphy is an important noninvasive method for detecting ischemia in symptomatic patients, but its use in asymptomatic ones or those with atypical symptoms is yet to be defined. To verify the presence of major cardiac events in asymptomatic patients or those with atypical symptoms (atypical chest pain or dyspnea) that underwent myocardial scintigraphy (MS), over a period of 8 years. Secondary objectives were to identify cardiac risk factors associated with myocardial scintigraphy abnormalities and possible predictors for major cardiac events in this group. This was a retrospective, observational study using the medical records of 892 patients that underwent myocardial scintigraphy between 2005 and 2011 and who were followed until 2013 for assessment of major cardiac events and risk factors associated with myocardial scintigraphy abnormalities. Statistical analysis was performed by Fisher’s exact test, logistic regression and Kaplan-Meyer survival curves, with statistical significance being set at p ≤ 0.05. Of the total sample, 52.1% were men, 86.9% were hypertensive, 72.4% had hyperlipidemia, 33.6% were diabetic, and 12.2% were smokers; 44.5% had known coronary artery disease; and 70% had high Framingham score, 21.8% had moderate and 8% had low risk. Of the myocardial scintigraphies, 58.6% were normal, 26.1% suggestive of fibrosis and 15.3% suggestive of ischemia. At evolution, 13 patients (1.5%) had non-fatal myocardial infarction and six individuals (0.7%) died. The group with normal myocardial scintigraphy showed longer period of time free of major cardiac events, non-fatal myocardial infarction (p = 0.036) and death. Fibrosis in the myocardial scintigraphy determined a 2.4-fold increased risk of non-fatal myocardial infarction and five-fold higher risk of death (odds ratio: 2.4 and 5.7, respectively; p = 0.043). The occurrence of major cardiac events in 8 years

  20. Myocardial Scintigraphy in the Evaluation of Cardiac Events in Patients without Typical Symptoms

    Cardiovascular disease is a leading cause of death in the world and in Brazil. Myocardial scintigraphy is an important noninvasive method for detecting ischemia in symptomatic patients, but its use in asymptomatic ones or those with atypical symptoms is yet to be defined. To verify the presence of major cardiac events in asymptomatic patients or those with atypical symptoms (atypical chest pain or dyspnea) that underwent myocardial scintigraphy (MS), over a period of 8 years. Secondary objectives were to identify cardiac risk factors associated with myocardial scintigraphy abnormalities and possible predictors for major cardiac events in this group. This was a retrospective, observational study using the medical records of 892 patients that underwent myocardial scintigraphy between 2005 and 2011 and who were followed until 2013 for assessment of major cardiac events and risk factors associated with myocardial scintigraphy abnormalities. Statistical analysis was performed by Fisher’s exact test, logistic regression and Kaplan-Meyer survival curves, with statistical significance being set at p ≤ 0.05. Of the total sample, 52.1% were men, 86.9% were hypertensive, 72.4% had hyperlipidemia, 33.6% were diabetic, and 12.2% were smokers; 44.5% had known coronary artery disease; and 70% had high Framingham score, 21.8% had moderate and 8% had low risk. Of the myocardial scintigraphies, 58.6% were normal, 26.1% suggestive of fibrosis and 15.3% suggestive of ischemia. At evolution, 13 patients (1.5%) had non-fatal myocardial infarction and six individuals (0.7%) died. The group with normal myocardial scintigraphy showed longer period of time free of major cardiac events, non-fatal myocardial infarction (p = 0.036) and death. Fibrosis in the myocardial scintigraphy determined a 2.4-fold increased risk of non-fatal myocardial infarction and five-fold higher risk of death (odds ratio: 2.4 and 5.7, respectively; p = 0.043). The occurrence of major cardiac events in 8 years

  1. Scintigraphy for the detection of myocardial damage in the indeterminate form of Chagas disease

    Pedroso, Enio Roberto Pietra; Rezende, Nilton Alves de, E-mail: narezende@terra.com.b [Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG (Brazil). Faculdade de Medicina; Abuhid, Ivana Moura [Instituto de Medicina Nuclear e Diagnostico Molecular, Belo Horizonte, MG (Brazil)

    2010-07-15

    Background: non-invasive cardiological methods have been used for the identification of myocardial damage in Chagas disease. Objective: to verify whether the rest/stress myocardial perfusion scintigraphy is able to identify early myocardial damage in the indeterminate form of Chagas disease. Methods: eighteen patients with the indeterminate form of Chagas Disease and the same number of normal controls, paired by sex and age, underwent rest/stress myocardial scintigraphy using sestamibi-99mTc, aiming at detecting early cardiac damage. Results: the results did not show perfusion or ventricular function defects in patients at the indeterminate phase of Chagas disease and in the normal controls, except for a patient who presented signs of ventricular dysfunction in the myocardial perfusion scintigraphy with electrocardiographic gating. Conclusion: the results of this study, considering the small sample size, showed that the rest/stress myocardial scintigraphy using sestamibi-99mTc is not an effective method to detect early myocardial alterations in the indeterminate form of Chagas disease (author)

  2. An autopsied case of cardiomyopathy demonstrated specific findings by thallium-201 myocardial scintigraphy

    A few cases showing dilatation and decreased contraction of the left ventricle at the terminal stage of hypertrophic cardiomyopathy (dilated-HCM) have been reported. Recently, we experienced a case of dilated-HCM and compared thallium-201 myocardial scintigraphic findings with histological findings. Thallium-201 myocardial scintigraphic findings resembled that of dilated cardiomyopathy (dilated biventricle and large perfusion defect). But, histological findings revealed large fibrosis and disarray of myocardial cells. These observation from thallium-201 myocardial scintigraphy was useful for the assessment of myocardial fibrosis of hypertrophic cardiomyopathy. (author)

  3. Applicability of the Appropriate use Criteria for Myocardial Perfusion Scintigraphy

    Oliveira, Anderson de [Universidade Federal Fluminense - UFF, Niterói, RJ (Brazil); Comissão Nacional de Energia Nuclear - CNEN (Brazil); Rezende, Maria Fernanda [Universidade Federal Fluminense - UFF, Niterói, RJ (Brazil); Hospital Pró-Cardíaco, Rio de Janeiro, RJ (Brazil); Corrêa, Renato; Mousinho, Rodrigo [Hospital Pró-Cardíaco, Rio de Janeiro, RJ (Brazil); Azevedo, Jader Cunha [Universidade Federal Fluminense - UFF, Niterói, RJ (Brazil); Hospital Pró-Cardíaco, Rio de Janeiro, RJ (Brazil); Miranda, Sandra Marina; Oliveira, Aline Ribeiro [Universidade Federal Fluminense - UFF, Niterói, RJ (Brazil); Gutterres, Ricardo Fraga [Comissão Nacional de Energia Nuclear - CNEN (Brazil); Mesquita, Evandro Tinoco; Mesquita, Cláudio Tinoco [Universidade Federal Fluminense - UFF, Niterói, RJ (Brazil); Hospital Pró-Cardíaco, Rio de Janeiro, RJ (Brazil)

    2014-11-15

    Appropriateness Criteria for nuclear imaging exams were created by American College of Cardiology (ACC) e American Society of Nuclear Cardiology (ASNC) to allow the rational use of tests. Little is known whether these criteria have been followed in clinical practice. To evaluate whether the medical applications of myocardial perfusion scintigraphy (MPS) in a private nuclear medicine service of a tertiary cardiology hospital were suitable to the criteria of indications proposed by the American medical societies in 2005 and 2009 and compare the level of indication of both. We included records of 383 patients that underwent MPS, November 2008 up to February 2009. Demographic characteristics, patient's origin, coronary risk factors, time of medical graduation and appropriateness criteria of medical applications were studied. The criteria were evaluated by two independent physicians and, in doubtful cases, defined by a medical expert in MPS. Mean age was 65 ± 12 years. Of the 367 records reviewed, 236 (64.3%) studies were performed in men and 75 (20.4%) were internee. To ACC 2005, 255 (69.5%) were considered appropriate indication and 13 (3.5%) inappropriate. With ACC 2009, 249 (67.8%) were considered appropriate indications and 13 (5.2%) inappropriate. We observed a high rate of adequacy of medical indications for MPS. Compared to the 2005 version, 2009 did not change the results.

  4. Assessment of myocardial damage in cardiomyopathy using 111In-antimyosin Fab myocardial scintigraphy

    111In-antimyosin Fab (AM) myocardial scintigraphy was carried out in (A) 10 patients with idiopathic dilated cardiomyopathy, (B) 7 with dilated phase of hypertrophic cardiomyopathy and (C) 8 with normal (control) individuals. Imaging was taken 48 hours after intravenous injection of 74 MBq of AM. Myocardial uptake of AM was evaluated qualitatively and quantitatively. Positive uptake was observed in 9/10 (90%), 7/7 (100%) and 0/8 (0%) in groups A, B and C, respectively. AM index (heart/lung ratio) in groups A and B were 2.04±0.24 and 2.46±0.49, Values significantly higher than that obtained in the control patient without cardiomyopathy (1.51±0.13)(p<0.01). Positive monoclonal antimyosin antibody studies were highly prevalent in dilated cardiomyopathic and dilated phase of hypertrophic cardiomyopathic patients, even in the presence of negative right ventricular biopsy. It is suggested that this method was useful for the noninvasive assessment of active myocardial damage in these patients. (author)

  5. Improving the accuracy of myocardial perfusion scintigraphy results by machine learning method

    Full text: Machine learning (ML) as rapidly growing artificial intelligence subfield has already proven in last decade to be a useful tool in many fields of decision making, also in some fields of medicine. Its decision accuracy usually exceeds the human one. To assess applicability of ML in interpretation the results of stress myocardial perfusion scintigraphy for CAD diagnosis. The 327 patient's data of planar stress myocardial perfusion scintigraphy were reevaluated in usual way. Comparing them with the results of coronary angiography the sensitivity, specificity and accuracy for the investigation was computed. The data were digitized and the decision procedure repeated by ML program 'Naive Bayesian classifier'. As the ML is able to simultaneously manipulate of whatever number of data, all reachable disease connected data (regarding history, habitus, risk factors, stress results) were added. The sensitivity, specificity and accuracy for scintigraphy were expressed in this way. The results of both decision procedures were compared. With ML method 19 patients more out of 327 (5.8 %) were correctly diagnosed by stress myocardial perfusion scintigraphy. ML could be an important tool for decision making in myocardial perfusion scintigraphy. (author)

  6. Diagnosis of myocardial ischaemia using exercise ST mapping and afterload 201Tl scintigraphy

    Two non-invasive methods are compared used in the diagnosis of myocardial ischaemia, i.e. precordial exercise mapping of the ST segment and after load 201Tl scintigraphy of the myocardium.High sensitivity of mapping (89.3%) and of 201Tl scan (92.9%) was found compared to the findings on the coronary arteries. The specificity of both methods was lower (57.1%). Both methods give similar results in diagnosis of myocardial ischaemia; for localization the affection site thallium scintigraphy of the myocardium is preferably used. (author). 2 figs., 2 tabs., 23 refs

  7. Clinical significance of I-123 MIBG myocardial scintigraphy for evaluating the severity of congestive heart failure

    We studied the significance of I-123 MIBG (metaiodobenzylguanidine) myocardial scintigraphy for evaluating the severity of congestive heart failure (CHF). I-123 MIBG scintigraphy was performed in 7 patients with CHF of NYHA class I-III (6 with dilated cardiomyopathy and 1 with adriamycine cardiomyopathy) and in 2 normals. The SPECT and anterior planar myocardial images were obtained 15 minutes after (initial images) and 4 hours after (delayed images) an injection of I-123 MIBG (111 MBq). Compared with normals, patients with CHF demonstrated (1) low myocardial uptake and (2) rapid myocardial washout of I-123 MIBG, indicating myocardial sympathetic disarrangement. Then, quantitating these abnormalities with the heart to upper mediastinum uptake ratio (H/B) and the percent washout rate (%WR) during 4 hours, respectively, we compared these two indices with LV ejection fraction (EF) at rest measured by echocardiography and exercise capacity (max VO2 and VO2 at anaerobic threshold (AT)) determined with respiratory gas exchange analysis during maximal bicycle exercise. H/B was lower and %WR was greater in patients with CHF than in normals. H/B correlated with EF (r=0.77, p2 (r=-0.74, p<0.05) and AT (r=-0.81, p<0.05). Thus, H/B and %WR were closely related to the severity of CHF. These results suggest that I-123 MIBG myocardial scintigraphy and the quantitative analysis of I-123 MIBG myocardial uptake provide useful information about the severity of CHF. (author)

  8. Up to date examination protocols for myocardial perfusion scintigraphy; Aktuelle Untersuchungsprotokolle der Myokardperfusionsszintigrafie

    Kammeier, Annett; Lindner, O.; Burchert, W. [Inst. fuer Radiologie, Nuklearmedizin und Molekulare Bildgebung, Herz- und Diabeteszentrum NRW, Univ. der Ruhr-Univ. Bochum (Germany)

    2010-06-15

    Myocardial perfusion scintigraphy is a noninvasive imaging procedure for diagnosis and risk stratification of patients with coronary artery disease therapeutic decisions. In the last decades advances in technology, radiopharmaceuticals, pharmacologic stress testing and acquisition protocols have led to further improvement of diagnostic accuracy. This paper provides an overview of radiopharmaceuticals, stress testing protocols, acquisition strategies and recommendations for the preparation of patients for myocardial perfusion SPECT. (orig.)

  9. Clinical studies on diabetic myocardial disease using exercise testing with myocardial scintigraphy and endomyocardial biopsy

    Genda, A.; Mizuno, S.; Nunoda, S.; Nakayama, A.; Igarashi, Y.; Sugihara, N.; Namura, M.; Takeda, R.; Bunko, H.; Hisada, K.

    1986-08-01

    Nine diabetics without significant coronary stenosis participated in an exercise testing protocol with thallium-201 myocardial scintigraphy. Endomyocardial biopsy of right ventricle was also obtained. There were 4 patients with abnormal perfusion (positive group) and 5 patients with normal perfusion (negative group). All cases of the positive group were familial diabetics and there was only one case of dietary treatment, whereas in the negative group, there were only 2 cases of familial diabetics and 3 cases receiving dietary treatment. No statistical differences between the positive and negative groups were observed for the data of exercise performance and hemodynamic parameters in cardiac catheterization at rest. However, the mean ejection fraction in the positive group (62 +/- 13%) was significantly lower than in the negative group (77 +/- 4%). In both groups, the mean diameter of myocardial cells and the mean percent fibrosis of biopsy specimens showed significant increases compared with the control group. The mean percent fibrosis in the positive group (24.1 +/- 8.5%) compared with that in the negative group (16.5 +/- 5.9%) showed a tendency to increase. It is suggested that the abnormal perfusion of thallium-201 in the positive group indicates subclinically a pathological change of microcirculation caused by diabetes mellitus.

  10. Incremental predictive value of myocardial scintigraphy with {sup 123}I-BMIPP in patients with acute myocardial infarction treated with primary percutaneous coronary intervention

    Nanasato, Mamoru; Hirayama, Haruo [Nagoya Daini Red Cross Hospital, Cardiovascular Center, Nagoya (Japan); Ando, Akitada; Isobe, Satoshi; Nonokawa, Makoto; Murohara, Toyoaki [Nagoya University Graduate School of Medicine, Department of Cardiology, Nagoya (Japan); Kinoshita, Yoshimi; Nanbu, Ichiro [Nagoya Daini Red Cross Hospital, Department of Radiology, Nagoya (Japan); Yokota, Mitsuhiro [Nagoya University Graduate School of Medicine, Cardiovascular Division, Department of Clinical Pathophysiology, Nagoya (Japan)

    2004-11-01

    It is unclear whether {sup 123}I-labelled {beta}-methyl iodophenyl pentadecanoic acid ({sup 123}I-BMIPP) myocardial scintigraphy adds further predictive value for future cardiac events compared with the variables obtained during cardiac catheterisation in patients with acute myocardial infarction (AMI) treated with primary percutaneous coronary intervention (PCI). We therefore investigated whether {sup 123}I-BMIPP imaging in patients with AMI treated by primary PCI was useful in predicting future cardiac events. One hundred and fifty-nine patients with AMI who were treated with primary PCI and underwent left ventriculography (LVG) on admission underwent {sup 201}Tl and {sup 123}I-BMIPP myocardial scintigraphy. Scintigrams were visually classified, and the total defect score (TDS) was calculated. Major adverse cardiac events (MACE) were defined as cardiac death including sudden death, congestive heart failure and recurrence of acute coronary syndrome. Patients were followed up for a mean of 34.5 months (12-63 months). Twenty-six patients had MACE. Kaplan-Meier analysis indicated that patients with the top 50% of {sup 123}I-BMIPP TDSs had a significantly higher rate of MACE (P=0.007). Patients with mismatch between {sup 201}Tl and {sup 123}I-BMIPP images also had significantly more MACE (P=0.02). In the prediction of MACE, the global chi-square value was 5.2 (P=0.001) based on LVEF (<45%) and the number of diseased vessels (two or three). Adding {sup 123}I-BMIPP TDS and the mismatch improved the global chi-square value ({chi}{sup 2}=7.2) Myocardial scintigraphy using {sup 201}Tl and {sup 123}I-BMIPP predicts future cardiac events in patients with AMI treated with primary PCI, and provides additional predictive value compared with the variables obtained with cardiac catheterisation alone. (orig.)

  11. Assessment of myocardial viability by 24-hour imaging after stress thallium-201 scintigraphy

    Taki, Junichi; Nakajima, Kenichi; Bunko, Hisashi; Taniguchi, Mitsuru; Kawasuji, Michio; Tonami, Norihisa; Hisada, Kinichi (Kanazawa Univ. (Japan). School of Medicine)

    1991-12-01

    Twenty-four-hour delayed imaging after stress thallium-201 scintigraphy was assessed for more accurate detection of viable myocardium. Thirty-two patients with coronary artery disease who showed fixed perfusion abnormality (FPA) at 3 hr imaging after stress Tl study were evaluated with 24 hr delayed imaging. Of 37 areas with FPA, 19 areas (51%) showed redistribution (RD) at 24 hr imaging. After successful coronary artery bypass grafting (n=19) or transluminal coronary angioplasty (n=3), stress Tl scintigraphy was performed. Of 13 areas with RD at 24 hr imaging, 12 revealed improvement of Tl uptake after revascularization. On the other hand, of 12 areas with FPA until 24 hr, 8 showed no improvement. In conclusion, conventional stress Tl-201 scintigraphy underestimates myocardial viability, and additional 24 hr imaging permits more accurate assessment of myocardial viability. (author).

  12. Normal stress databases in myocardial perfusion scintigraphy – how many subjects do you need?

    Trägårdh, Elin; Sjöstrand, Karl; Edenbrandt, Lars

    2012-01-01

    Commercial normal stress databases in myocardial perfusion scintigraphy (MPS) commonly consist of 30–40 individuals. The aim of the study was to determine how many subjects are needed. Four normal stress databases were developed using patients who underwent 99mTc MPS: non‐corrected images (NC) fo...

  13. Myocardial perfusion scintigraphy in a case of dextrocardia: Doing it “right”

    We present the challenges in performing the stress test and acquisition of images in myocardial scintigraphy in a 54-year-old female patient with dextrocardia. Dextrocardia and situs inversus were documented on prior investigations including a chest roentgenogram and sonography

  14. Myocardial stunning in hypertrophic cardiomyopathy: recovery predicted by single photon emission computed tomographic thallium-201 scintigraphy

    A young woman with hypertrophic cardiomyopathy confirmed by echocardiography and cardiac catheterization presented with chest pain and features of a large left ventricular aneurysm. The initial diagnosis was myocardial ischemia with either an evolving or an ancient myocardial infarction. Subsequently, verapamil therapy was associated with complete resolution of the extensive left ventricular wall motion abnormalities, normalization of left ventricular ejection fraction and a minimal myocardial infarction. Normal thallium uptake on single photon emission computed tomographic scintigraphy early in the hospital course predicted myocardial viability in the region of the aneurysm. Thus, orally administered verapamil may reverse spontaneous extensive myocardial ischemia in hypertrophic cardiomyopathy and possibly limit the extent of myocardial infarction in such circumstances

  15. Coronary artery disease detected noninvasively by dipyridamole-loading 201Tl myocardial scintigraphy in elderly patients

    To evaluate the usefulness in diagnosing coronary artery disease (CAD), dipyridamole-loading 201Tl myocardial scintigraphy was performed for 52 elderly patients (65 - 92 years, mean: 72 years), and the results were compared with data from the treadmill exercise tests. 1. Thirty-five patients could not tolerate adequate exercise tests. Seven of them had reversible defects; six, fixed (irreversible) ones. Dipyridamole scintigraphy is therefore applicable in detecting CAD among patients with suspected CAD who are unable to perform adequate exercise tests. 2. Four of 16 patients with positive exercise tests had no reversible defects; the exercise results in three were regarded as false positives. 3. Seventeen patients experienced chest pain; 12 had ST depression during dipyridamole loading. There were no serious complications, but seven patients required aminophylline. 4. We demonstrated previously that the sensitivity and specificity of dipyridamole scintigraphy in detecting CAD were 90 % and 92 %, respectively, in patients with chest pain undergoing coronary angiography. These results were superior to those of conventional exercise myocardial scintigraphy. Therefore, dipyridamole scintigraphy is regarded as a safe and useful method for detecting CAD, particulary in elderly patients who have ST and T wave abnormalities but cannot tolerate exercise test adequately. (author)

  16. Usefulness of {sup 99m}Tc-tetrofosmin myocardial scintigraphy before and after coronary intervention

    Adachi, Itaru; Hou, Nobuyoshi; Komori, Tsuyoshi; Tabuchi, Koujiro; Matsui, Ritsuo; Sueyoshi, Kouzou; Narabayashi, Isamu; Matsuda, Shigeki; Tamoto, Shigemi [Osaka Medical Coll., Takatsuki (Japan)

    1997-06-01

    Dipyridamole-loading {sup 99m}Tc-tetrofosmin myocardial scintigraphy was performed for patients with coronary artery disease who underwent percutaneous transluminal coronary angiography (PTCA) in order to examine whether SPECT imaging prior to treatment is useful for the determination of prognosis after coronary intervention. Thirty-six patients including 9 with angina pectoris (AP), 22 with old myocardial infarction (OMI) and 5 OMI with AP were underwent dipyridamole-loading {sup 99m}Tc-tetrofosmin myocardial SPECT before and after coronary intervention. The length of follow-up was 185{+-}107 days after PTCA. Improvement of myocardial uptake was observed on myocardial SPECT in all cases with AP. Improvement of the myocardial uptake was observed 50% (4/8) of patients with OMI who had no myocardial viability. It was suggested that the improvement of myocardial uptake after PTCA was due to incomplete fill-in in cases with AP and that presence of fill-in was important for level of fill-in in patients with AP. The improvement of myocardial uptake in the scar tissue in patients with OMI contributed to the hibernating myocardium. We concluded that correct detection of hibernating myocardium was difficult despite the superior imaging capacity of {sup 99m}Tc-tetrofosmin myocardial SPECT. (author)

  17. Reproducibility of planar 123I-meta-iodobenzylguanidine (MIBG) myocardial scintigraphy in patients with heart failure

    Despite its high prognostic value, widespread clinical implementation of 123I-meta-iodobenzylguanidine (MIBG) myocardial scintigraphy is hampered by a lack of validation and standardization. The purpose of this study was to assess the reliability of planar 123I-MIBG myocardial scintigraphy in patients with heart failure (HF). Planar myocardial MIBG images of 70 HF patients were analysed by two experienced and one inexperienced observer. The reproducibility of early and delayed heart-to-mediastinum (H/M) ratios, as well as washout rate (WR) calculated by two different methods, was assessed using the intraclass correlation coefficient (ICC) and the Bland-Altman analysis. In addition, a subanalysis in patients with a very low H/M ratio (delayed H/M ratio 123I-MIBG images (the ICCs for the delayed H/M ratios were 0.98, 0.96 and 0.90, respectively). In addition, the WR without background correction resulted in higher reliability than the WR with background correction (the interobserver Bland-Altman 95 % limits of agreement were -2.50 to 2.16 and -10.10 to 10.14, respectively). Furthermore, the delayed H/M ratio measurements remained reliable in a subgroup of patients with a very low delayed H/M ratio (ICC 0.93 for the inter-observer analysis). Moreover, a fixed-size cardiac ROI could be used for the assessment of delayed H/M ratios, with good reliability of the measurement. The present study showed a high reliability of planar 123I-MIBG myocardial scintigraphy in HF patients, confirming that MIBG myocardial scintigraphy can be implemented easily for clinical risk stratification in HF. (orig.)

  18. Application of radionuclide infarct scintigraphy to diagnose perioperative myocardial infarction following revascularization

    To evaluate the application of radionuclide infarct scintigraphy to diagnose myocardial infarction after revascularization, we obtained postoperative technetium 99m pyrophosphate myocardial scintigrams, serial electrocardiograms and CPK-MB isoenzymes in ten control and 51 revascularized patients. All control patients had negative electrocardiograms and scintigrams, but eight had positive isoenzymes. Eight revascularized patients had positive electrocardiograms, images and enzymes and two had positive scintigrams and enzymes with negative electrocardiograms. Thirty-four patients with negative electrocardiograms and scintigrams had positive isoenzymes; in only seven patients were all tests negative. Our data suggest radionuclide infarct scintigraphy is a useful adjunct to the electrocardiogram in diagnosing perioperative infarction. The frequent presence of CPK-MB in postoperative patients without other evidence of infarction suggests that further studies are required to identify all factors responsible for its release

  19. Functional significance of coronary collateral circulation during dynamic exercise evaluated by thallium-201 myocardial scintigraphy.

    Wainwright, R J; Maisey, M N; Edwards, A. C.; Sowton, E

    1980-01-01

    Sixty-five patients with angiographically documented coronary artery disease were investigated by thallium-201 (201Tl) scintigraphy to determine the role of the collateral circulation during dynamic exercise. Fifty-three patients had complete proximal occlusion of at least one major coronary artery. One patient had total occlusion of all three major coronary arteries. Sixty-four collateral channels were identified, graded, and compared with corresponding regions of the myocardial scintigram. ...

  20. Myocardial scintigraphy with gallium-67 in the detection of cardiac acute rejection

    In order to evaluate the myocardial scintigraphy with Gallium-67 potentiality in the detection of acute rejection phenomenon, 105 studies were performed in 20 patients after they had a heart transplantation. The scintigraphic images were obtained by a conventional camera-computer system. These images were acquired 48 hours after all the patients were given an intravenous injection of 111 MBq of Gallium-67 Citrate. The biopsies were done according to the Mason technique and the histological analysis followed the Billingham standards. (author)

  1. Segmental analysis of thallium 201 myocardial perfusion scintigraphy: its value in a community hospital.

    Tendera, M; Campbell, W B; Moyers, J R

    1984-08-01

    In a community hospital, we correlated results of thallium 201 myocardial scintigraphy with coronary arteriographic data in 79 patients. Scintigraphy was 92% sensitive and 85% specific in detecting coronary artery disease. There were no false-negative scintigrams in patients with double or triple vessel disease. The most important factors determining sensitivity of the method in detecting individual coronary stenoses were (1) location of the stenosis in the coronary tree, (2) number of vessels involved, and (3) degree of obstruction. Higher prevalence of perfusion defects in areas of 90% to 99% stenosis as compared with 50% to 89% lesions was of borderline statistical significance (86% vs 59%; P = .06). Myocardial perfusion scintigraphy was unable to predict the number of significantly narrowed coronary vessels. Predictive value of a perfusion defect for a significant coronary stenosis was 87% for anterior, 88% for septal, 90% for lateral, 89% for posterior, and 78% for inferior segment. We conclude that segmental analysis of myocardial scintigrams may be of value in a community hospital. PMID:6463700

  2. Exercise thallium-201 myocardial scintigraphy in left main coronary artery disease

    To detect left main (LM) coronary artery disease (CAD), exercise thallium-201 myocardial scintigraphy was analyzed in 24 patients (LM stenosis > 50 %) without myocardial infarction and 10 normal controls. A high risk myocardial scintigraphy was defined as follows; (1) a LMCAD scintigraphic pattern reported by Dash, (2) nonuniform diffuse slow washout, (3) increased lung thallium uptake on the initial anterior image. Twenty-three (96 %) patients had an abnormal scintigraphic findings. The LMCAD scintigraphic pattern was found in seven (29 %) patients, all of whom had LM stenosis more than 90 %. Remaining 17 patients with LM stenosis less than 90 % didn't show this pattern. In the 10 LMCAD patients without right coronary artery (RCA) lesion, four (40 %) patients showed this pattern. But in the 14 LMCAD patients with RCA lesion, three (21 %) patients showed this pattern. In this study, a high risk exercise electrocardiography was also defined as follows; (1) > 2 mm ST depression, (2) appearance of ST depression at 50 watt or less exercise load, (3) 10 mmHg or more decrease in systolic blood pressure during exercise. Detection of high risk CAD with exercise electrocardiography, exercise thallium scintigraphy and either were 46, 67, 83 %, respectively. (author)

  3. Dilated cardiomyopathy - approach made simplified with myocardial perfusion scintigraphy and cardiac viability studies

    Full text: To differentiate the ischemic vs nonischemic dilated cardiomyopathy and to assess myocardial viability in the ischemic cardiomyopathy. Materials and Methods: 34 patients (24 males and 10 females) with dilated cardiomyopathy diagnosed on echocardiography with reduced left ventricular ejection fraction and global hypokinesia were included between the period of Jan 2009 and July 2010. All the patients underwent rest myocardial perfusion scintigraphy first; 45 minutes after intravenous injection of 7 mCi of 99mTc MIBI. The stress myocardial perfusion imaging (after physical stress or gm/kg/min; 6 min infusion) was pharmacological stress with adenosine; 140 performed in the patients with normal perfusion at rest. The 18F FDG (5 mCi) cardiac viability studies were performed in patient with abnormal rest myocardial perfusion. The images were acquired on GE Infinia systems and processed on Emory toolbox (ECT) to study the ischemia and viability. Results: The mean left ventricular ejection fraction was found to be 27.38% at rest. The stress and rest perfusion scintigraphy was carried out in 20/34(58%) patients in whom 9(45%) patients underwent pharmacological stress with Inj adenosine and 11(55%) patients underwent physical stress. The stress induced ischemia was diagnosed in 12(60%) patients and infarct in 2(10%) patients with mixed ischemia and infarct pattern in 2(10%) patients. The nonischemic cause was diagnosed in 4 patients. The cardiac viability study was carried out in 14/34 (42%) patients with 6(42%) viable, 5(35%) nonviable and 3(21%) mixed viable and nonviable patterns were identified. Conclusion: The myocardial perfusion scintigraphy was the simplified approach for differentiating ischemic verses nonischemic dilated cardiomyopathy with addition of cardiac viability study (18FDG) made it one stop shop for the complete work-up of patients for further management

  4. Contamination of clothing and other items by sweat during exercise 201Tl myocardial perfusion scintigraphy

    We measured the radioactivity on patient's upper and lower garments, towels, broad sashes for the bust, and electrodes contaminated by sweat due to exercise 201Tl myocardial perfusion scintigraphy. In measuring activity, a scintillation survey meter adjusted to the energy of 201Tl was used. In measuring the radioactivity of clothing, more than 4 Bq/cm2 was considered to be a significant level of contamination. We detected contamination in 30% of upper garments and towels, 19% of broad sashes, 8% of lower garments and 4% of electrodes. Among these materials, several items of clothing and other items showed contamination exceeding 40 Bq/cm2. Towels were remarkably contaminated, with one towel showing a maximum contamination level of 420 Bq/cm2. Examinations done by exercise 201Tl myocardial perfusion scintigraphy often result in the contamination of clothing and other items through sweating. This contamination is especially common in summer, particularly in upper garments and towels. The contamination ratio for towels was over 50%. The contamination ratio increased as the level of exercise became more difficult. When the exercise load was more than 100 W, the contamination ratio was 50%. In cases of extreme contamination, images of contaminated upper garments could be obtained by the scintigraphy camera. The areas of high activity on the images seemed to correspond to areas of the body where sweating was profuse. Based on these results, we should pay close attention to the handling of clothing and other items used in exercise testing by 201Tl myocardial perfusion scintigraphy and the points used in measuring contaminated clothing and other items after testing. (author)

  5. Myocardial ischemia detected by isoproterenol stress cardiac blood-pool scintigraphy

    It is well known that left ventricular regional contraction abnormality (hypokinesis: hypo) occurs during myocardial ischemia. However, it is uncertain whether left ventricular asynchronous contraction (asynchrony) is an index of myocardial ischemia. To validate asynchrony as an index of myocardial ischemia, isoproterenol infusion stress (ISP) cardiac blood-pool scintigraphy (RI angiography) was performed in patients with ischemic heart disease. The subjects were classified into 2 groups: (1) 15 patients with coronary artery disease (CAD) and (2) 8 patients with 'normal' coronary arteries (NC). None had any electrical ventricular conduction disturbance. ISP was administered with increasing doses of 0.02, 0.04, 0.08 μg/kg/min at 3-min intervals, and it was terminated in the event of angina, significant ST changes or target heart rate. Symptom-limited ergometer exercise testing (EX) was also administered in 14 patients. Regional decrease in amplitude and phase delay identified by phase analysis was diagnosed as hypo and asynchrony, respectively. ISP myocardial scintigraphy was also performed in 15 patients. ISP and EX induced asynchrony in 14 (93%) and 13 patients (93%), respectively, while did hypo in 4 (27%) and 9 (64%), respectively. Ten (67%) of 15 patients had asynchrony without hypo in ISP; whereas only 4 (28%) of 14 patients did in EX. ISP-induced asynchrony occurred in one of 8 patients with NC. The locations of ISP-induced asynchrony and those of EX-induced asynchrony were concordant in 11 (79%) of 14 patients. Asynchrony on the ISP RI angiogram was observed at the same sites of redistribution on the ISP myocardial scintigram. We concluded that asynchrony itself is a sensitive and specific index of myocardial ischemia. (author)

  6. Arm exercise testing with myocardial scintigraphy in asymptomatic patients with peripheral vascular disease

    Arm exercise with myocardial scintigraphy and oxygen consumption determinations was performed by 33 men with peripheral vascular disease, 40 to 74 years of age (group 2). None had evidence of coronary disease. Nineteen age-matched male control subjects (group 1) were also tested to determine the normal endurance and oxygen consumption during arm exercise in their age group and to compare the results with those obtained during a standard treadmill performance. The maximal heart rate, systolic blood pressure, pressure rate product, and oxygen consumption were all significantly lower for arm than for leg exercise. However, there was good correlation between all these parameters for both types of exertion. The maximal heart rate, work load and oxygen consumption were greater for group 1 subjects than in patients with peripheral vascular disease despite similar activity status. None of the group 1 subjects had abnormal arm exercise ECGs, while six members of group 2 had ST segment changes. Thallium-201 scintigraphy performed in the latter group demonstrated perfusion defects in 25 patients. After nine to 29 months of follow-up, three patients who had abnormal tests developed angina and one of them required coronary bypass surgery. Arm exercise with myocardial scintigraphy may be an effective method of detecting occult ischemia in patients with peripheral vascular disease. Those with good exercise tolerance and no electrocardiographic changes or 201T1 defects are probably at lower risk for the development of cardiac complications, while those who develop abnormalities at low exercise levels may be candidates for invasive studies

  7. Noninvasive detection of coronary artery disease by dipyridamole-loading 201thallium myocardial scintigraphy

    Fifty patients with suspected coronary artery disease (CAD) were given i.v. infusion of 0.568 mg/kg of dipyridamole (DP) for 4 min in the supine position, and were loaded by stepping. Myocardial DP scanning (DP scintigraphy) was then performed with i.v. injection of 3 mCi of Tl-201 chloride. Findings were compared with those of coronary angiography and treadmill ECG. DP scintigraphy had higher sensitivity (90 %) and specificity (95 %) than treadmill ECG (76 % and 67 %) in diagnosing a ≥ 75 % coronary stenosis. Twenty nine patients had significant CAD: Reversible defects were associated with chest pain in 79 %, and with ST depression in 76 %. Not only relative differences in blood flow between the normal and diseased sites but also ischemia was suggested to be responsible for these defects. Increased rate pressure product by DP scintigraphy was slight (34 %) compared with that by treadmill ECG (105 %), suggesting a strong involvement of redistribution of coronary blood flow in the occurrence of ischemia. Increased myocardial oxygen consumption due to stepping was considered as the cause of ischemia as well, because the incidence of chest pain and ST depression was higher than previously reported. Chest pain and ST depression improved by i.v. injection of aminophylline. (Namekawa, K.)

  8. Screening for silent myocardial ischemia caseof diabetics : interest of myocardial perfusion scintigraphy

    Silent myocardial ischemia is a major cause of morbidity and mortality in diabetic patients. Its diagnosis by noninvasive means such as myocardial SPECT would improve the management of these patients. The purpose of this study is to assess the frequency of silent myocardial ischemia in asymptomatic diabetics and their evolution. As a result, the myocardial SPECT is a reliable tool for screening for silent myocardial ischemia in diabetic patients. Its prognostic value allows to stratify the cardiac risk and guide therapeutic management. Its integration into a screening strategy in Tunisia seems limited by its low availability and cost. The latter could be reduced by better patient selection.

  9. Prognostic value of intravenous dipyridamole thallium scintigraphy after an acute myocardial ischemic event

    Seventy-seven patients recovering from an acute coronary event were studied by intravenous dipyridamole thallium scintigraphy to evaluate the prognostic value and safety of the test in this patient subset. Forty-four patients (58%) had unstable angina and 33 (42%) had an acute myocardial infarction. One death occurred within 24 hours of testing. Sixty-eight patients were followed for an average of 12 months; 25, 31 and 23% had a fixed, reversible or combined thallium defect on their predischarge thallium scan. During follow-up, 10 patients died or had a nonfatal myocardial infarction; in each case, a reversible or combined myocardial thallium defect was present. Univariate analysis of 17 clinical, scintigraphic and angiographic variables showed that a reversible thallium defect and the angiographically determined extent of coronary artery disease were predictors of future cardiac events. The extent of coronary disease and global left ventricular ejection fraction were predictors of subsequent reinfarction or death. Logistic regression analyses revealed that a reversible thallium defect (p less than 0.001) and the extent of coronary disease (p less than 0.009) were the only significant predictors of a cardiac event. When death or reinfarction were the outcome variables, the extent of coronary disease (p less than 0.02) and left ventricular ejection fraction (p less than 0.06) were the only variables selected. Thus, intravenous dipyridamole thallium scintigraphy after an acute coronary ischemic syndrome is a useful and relatively safe noninvasive test to predict subsequent cardiac events

  10. Cardiac morphology in left ventricular hypertrophy using thallium-201 myocardial scintigraphy

    To evaluate cardiac morphology in the patients with various cases of hypertrophy, we measured left ventricular (LV) size using thallium-201 myocardial scintigraphy in 29 normal subjects and in 90 patients. Cardiac shape and dimension were assessed by measuring the wall thickness and external length in the short and long axis of LV image in LAO projection. In aortic stenosis and hypertensive heart disease the shape was spherical and the wall was thickened. In both mitral (MR) and aortic (AR) regurgitations, LV dilatation were shown; spherical shape in chronic MR but ellipsoid shape in acute MR and AR. Decreased LV size but normal shape was observed in mitral stenosis and cor pulmonale. In hypertrophic cardiomyopathy the LV wall was asymmetrically hypertrophied, while in congestive cardiomyopathy the wall is thin with marked LV dilatation and the shape was spherical. We concluded that the heart had characteristic configuration which might reflect cardiac performance or compensate for the load to the heart, and that thallium-201 myocardial scintigraphy is useful in the evaluation of cardiac morphology as well as in diagnosis of myocardial ischemia. (author)

  11. Myocardial perfusion scintigraphy with technetium99m-MIBI in the diagnosis of coronary artery disease in women

    Aim: To assess the value of myocardial perfusion scintigraphy for coronary artery disease (CAD) in women, we compared the results of a technetium99m-methoxy-isobutyl-isonitrile (99mTc-MIBI) scintigraphy with those of a coronary angiography in a group of women referred for evaluation of chest pain. Material and Methods: Twenty women, 15 of them postmenopausal, were included. A 99mTc-MIBI myocardial scintigraphy with one-day protocol (rest-stress) was performed. When needed, a combined stress (ergometric plus dipyridamole) was used. Both qualitative and quantitative regional uptake analysis was done. In patients with normal coronary arteries and positive myocardial scintigraphies, measurements were made of serum cholesterol and triglycerides (CHOD-PAD enzymatic colorimetric test), and lipoprotein(a) -Lp(a)- (BioSCREEN Lp(a) method). Results: Change in regional uptake (stress/rest) was as follows: during stress 99mTc-MIBI, 116 segments had normal uptake (from 93±9% to 94±7%), 52 had moderately reduced uptake (from 67±9% to 75±17%), and 12 had severely reduced uptake (from 33±9% to 64±28%). Qualitative and quantitative analysis coincided in 18 cases. The two non-coincident cases were patients in whom qualitative analysis and coronary angiography were normal, but on quantitative analysis it appeared a reversible defect in one case and a 'reverse redistribution' pattern in the other. Breast attenuation defects were detected in four cases. Myocardial scintigraphy and coronary angiography coincided in 70% cases (figure). The remainder 30% was constituted by patients with positive scintigraphy and normal coronary arteries; among these cases, the 71% were postmenopausal and had systolic hypertension, chest pain at rest, positive ergometric test and hypercholesterolemia (table). Conclusion: We concluded that 99mTc-MIBI myocardial scintigraphy can help in the CAD diagnosis in postmenopausal women

  12. Evaluation of myocardial perfusion and ventricular shape in hypertrophic cardiomyopathy using 99mTc-tetrofosmin scintigraphy

    Hypertrophic cardiomyopathy (HCM) is known to have the impairment of myocardial perfusion as well as irregularly hypertrophic myocardium. To evaluate myocardial perfusion and ventricular shape in HCM, 99mTc-Tetrofosmin scintigraphy was performed after exercise (Ex) and at resting state (Re) in 10 patients with HCM and was compared with early image (Ea) and delayed image (De) of 201Tl scintigraphy performed after exercise. SPECT images of both 99mTc-Tetrofosmin and 201Tl scintigraphy were analyzed with five scaled visual scores set in 18 segments. The complete concordance ratio between 99mTc-Tetrofosmin (Ex and Re) and 201Tl(Ea and De) images in segmental analysis was 75%. Image quality of 99mTc-Tetrofosmin was seemed to be superior to that of 201Tl scintigraphy. In 9 patients with HCM, 99mTc-Tetrofosmin scintigraphy was performed under the ECG gating and the thickness of septal and free wall was measured. Good correlation was observed with the data by ultrasound cardiography (r=0.79, p99mTc-Tetrofosmin scintigraphy is useful for the evaluation of myocardial morphology as well as perfusion abnormality. (author)

  13. Attenuation correction for myocardial scintigraphy: state-of-the-art

    Myocardial perfusion imaging has been proved as an accurate, noninvasive method for diagnosis of coronary artery disease with a high prognostic value. However image artifacts, which decrease sensitivity and in particular specificity, degrade the clinical impact of this method. Soft tissue attenuation is regarded as one of the most important factors of impaired image quality. Different approaches to correct for tissue attenuation have been implemented by the camera manufacturers. The principle is to derive an attenuation map from the transmission data and to correct the emission data for nonuniform photon attenuation with this map. There have been several reports published demonstrating an improved specificity with no substantial change in sensitivity by this method. To accurately perform attenuation correction quality control measurements and adequate training of technologists and physicians are mandatory. (orig.)

  14. Acute myocardial infarction. Clinical application of technetium 99m stannous pyrophosphates infarct scintigraphy

    Acute myocardial infarction is being recognized as a spectrum of clinical subsets. This appreciation has been brought about to a large degree by the development of several new tools that can be applied clinically to aid in evaluation of patients with acute infarction, and in some cases to provide short- and long-term prognostic information. In the realm of noninvasive methods, several tests utilizing radiopharmaceuticals and scintillation cameras have emerged and are rapidly becoming reliable diagnostic parameters in patients with coronary disease and infarction. Technetium-99m (stannous) pyrophosphate (TcPYP) scintigraphy, one of the first of these techniques to find clinical use, has been shown to be an accurate indicator of acute transmural myocardial infarction and provides added sensitivity and specificity to the diagnosis. Increased diagnostic accuracy, the dimension of visible localization, and the potential for infarct sizing promise physicians better understanding of a patient's clinical presentation and a more rational approach to management

  15. Angina and exertional myocardial ischemia in diabetic and nondiabetic patients: assessment by exercise thallium scintigraphy

    Patients with diabetes mellitus and coronary artery disease are thought to have painless myocardial ischemia more often than patients without diabetes. We studied 50 consecutive patients with diabetes and 50 consecutive patients without diabetes, all with ischemia, on exercise thallium scintigraphy to show the reliability of angina as a marker for exertional ischemia. The two groups had similar clinical characteristics, treadmill test results, and extent of infarction and ischemia, but only 7 patients with diabetes compared with 17 patients without diabetes had angina during exertional ischemia. In diabetic patients the extent of retinopathy, nephropathy, or peripheral neuropathy was similar in patients with and without angina. Angina is an unreliable index of myocardial ischemia in diabetic patients with coronary artery disease. Given the increased cardiac morbidity and mortality in such patients, periodic objective assessments of the extent of ischemia are warranted

  16. Quantitative analysis of 201Tl myocardial scintigraphy in ischemic heart disease

    Seventy two patients with myocardial infarction (MI), 13 with angina pectoris (AP), and 10 without ischemic heart disease were investigated by the quantitative analysis of Tl-201 myocardial scintigraphy. In the group of MI patients, defects of Tl-201 uptake was observed in 89.7% on planar images and 91.2% on SPECT images. Patients without Tl defect had no evidence of abnormal Q wave. For 62 patients undergoing coronary angiography and left ventriculography, defect size was well consistent with culprit lesions, particularly in the left anterior descending artery. Both extent score (ES) and severity score (SS), obtained by planar images and bull's-eye SPECT images, were significantly correlated with peak creatine phosphokinase (CPK) in plasma and ejection fraction. Redistribution magnitudes of Tl-201 uptake (ΔES and ΔSS) 3 hr after exercise were much greater in patients with exercise-induced ST depression than those with either unchanged or elevated ST segments. Some of the patients with no evidence of ST depression had high ΔES and ΔSS. Similarly, these indices were high in patients with residual stenosis of culprit coronary artery. Six MI patients treated with percutaneous transluminal coronary angioplasty (PTCA) were found to have the decrease in both ΔES and ΔSS. Decreased % Tl-201 uptake and % washout rate were also improved by PTCA. Similar improvement in these indices was seen in 15 AP patients successfully treated with PTCA. Reverse redistribution (RR) was seen in 5 patients with no significant stenosis of culprit coronary artery. Three other MI patients had also RR after PTCA. Areas corresponding to RR had higher washout rate than the other areas. In conclusion, quantitative analysis of Tl-201 myocardial scintigraphy seems to be useful in estimating infarction size and viable myocardium, as well as in evaluating the improvement of myocardial ischemia after PTCA. (N.K.)

  17. Quantitative evaluation of regional myocardial blood flow by digital subtraction angiography. Correlations with exercise electrocardiography and Tl-201 myocardial scintigraphy

    Ikeda, Hisao; Shibao, Keigo; Yamaguchi, Ryutaro and others

    1987-04-01

    The study subjects consisted of 25 patients with angina pectoris and 14 patients with normal coronary arteries. Following the manual injection of contrast media into the left anterior descending coronary artery (LAD), a time-density curve was generated in the sectors of the myocardium which were perfused by the LAD and the T/sub 1/2/ was calculated. T/sub 1/2/ values correlated closely with double product (r = -0.73). They were significantly greater in patients with exercise-induced ST depression (8.3 +- 1.0 vs 5.8 +- 0.7, p < 0.005). In addition, there was a good correlation between T/sub 1/2/ values and washout ratio as determined by exercise thallium-201 myocardial scintigraphy, with r = -0.83. Although T/sub 1/2/ values were within the normal range (mean +- 2SD of control subjects) in all patients with LAD stenosis of 50 percent or less, these values were abnormally increased, exceeding the normal range, in 11 of the 12 patients with stenosis of 90 percent or more. Compared with exercise electro-cardiography, T/sub 1/2/ values were abnormally prolonged in 11 of the 13 patients with exercise-induced ST depression. Compared with exercise thallium-201 myocardial scintigraphy, T/sub 1/2/ values were abnormally prolonged in seven of the nine patients with transient perfusion defects. When an arteriographically significant degree of stenosis was assumed to be 75 percent or more, the accuracies of T/sub 1/2/ were; sensitivity, 80 %, specificity, 100 %, and diagnostic accuracy, 88 %. The results were comparable to those of exercise electrocardiography or exercise thallium-201 myocardial scintigraphy. In five patients with angina pectoris who underwent percutaneous translumial angioplasty (PTCA), T/sub 1/2/ values were significantly decreased after PTCA (from 8.5 +- 0.9 to 5.9 +- 0.9, p < 0.005), associated with an increase in double product. (J.P.N.).

  18. Clinical estimation of acute myocardial infarct size with /sup 99m/technetium pyrophosphate scintigraphy

    We evaluated scintigraphic techniques in estimating infarct size. In 26 patients with acute transmural myocardial infarction, /sup 99m/Technetium pyrophosphate (TcPYP) infarct scintigraphy, gated cardiac blood pool scintigraphy and 201-Thallium (201-Tl) perfusion scintigraphy were performed. Invasive hemodynamic measurements were obtained and serial venous blood specimens taken for measurement of total and MB creatine phosphokinase (CPK). Infarct size was estimated from the area of abnormal TcPYP uptake, the extent of reduced 101-Tl uptake, the percentage of abnormally contracting segments, and serial enzyme measurements. Left ventricular ejection fraction (LVEF) and stroke work index (LVSWI) were calculated. TcPYP infarct area was associated with the extent of reduced 201-Tl uptake (r = 0.66), the percentage of abnormally contracting segments (r = 0.64), and with both LVSWI (r = 0.73) and LVEF (r = -0.58). TcPYP infarct area did not correlate with cumulative total or MB-CPK release or the integrated total CPK-time curve, nor did the enzyme estimates of infarct size correlate with LVSWI or LVEF. Variable perfusion of infarcts of different sizes may explain the lack of correlation between TcPYP infarct area and enzyme estimates of infarct size. A combination of anatomic and functional indices derived from scintigraphic and hemodynamic measurements may provide the best assessment of infarct size

  19. Myocardial perfusion scintigraphy in the detection of silent ischemia in asymptomatic diabetic patients

    Oki, Glaucia Celeste Rossatto [Clinica Diagnoson and Hospital Aristides Maltez, Salvador, BA (Brazil). Servicos de Medicina Nuclear; Pavin, Elizabeth Joao; Parisi, Maria Candida R. [Universidade Estadual de Campinas (Unicamp), Campinas, SP (Brazil). Department of Internal Medicine. Service of Endocrinology; Coelho, Otavio Rizzi; Almeida, Raitany C. [Universidade Estadual de Campinas (Unicamp), Campinas, SP (Brazil). Department of Internal Medicine. Service of Cardiology; Etchebehere, Elba Cristina Sa de Camargo; Ramos, Celso Dario, E-mail: cdramos@unicamp.br [Universidade Estadual de Campinas (Unicamp), Campinas, SP (Brazil). Department of Radiology. Service of Nuclear Medicine; Camargo, Edwaldo Eduardo [Hospital Sirio-Libanes, Campinas, SP (Brazil). Service of Nuclear Medicine

    2013-01-15

    Objective: This study was aimed to evaluate myocardial perfusion in asymptomatic patients with type 1 (DM1) and type 2 diabetes mellitus (DM2) without previous diagnoses of coronary artery disease (CAD) or cerebral infarction. Materials and Methods: Fifty-nine consecutive asymptomatic patients (16 DM1, 43 DM2) underwent myocardial perfusion scintigraphy with {sup 99m}Tc-sestamibi (MPS). They were evaluated for body mass index, metabolic control of DM, type of therapy, systemic arterial hypertension, dyslipidemia, nephropathy, retinopathy, peripheral neuropathy, smoking, and familial history of CAD. Results: MPS was abnormal in 15 patients (25.4%): 12 (20.3%) with perfusion abnormalities, and 3 with isolated left ventricular dysfunction. The strongest predictors for abnormal myocardial perfusion were: age 60 years and above (p = 0.017; odds ratio [OR] = 6.0), peripheral neuropathy (p = 0.028; OR = 6.1), nephropathy (p = 0.031; OR = 5.6), and stress ECG positive for ischemia (p = 0.049; OR = 4.08). Conclusion: Silent myocardial ischemia occurs in more than one in five asymptomatic diabetic patients. The strongest predictors of ischemia in this study were: patient age, peripheral neuropathy, nephropathy, retinopathy and a stress ECG positive for ischemia. (author)

  20. Myocardial perfusion scintigraphy in the detection of silent ischemia in asymptomatic diabetic patients

    Objective: This study was aimed to evaluate myocardial perfusion in asymptomatic patients with type 1 (DM1) and type 2 diabetes mellitus (DM2) without previous diagnoses of coronary artery disease (CAD) or cerebral infarction. Materials and Methods: Fifty-nine consecutive asymptomatic patients (16 DM1, 43 DM2) underwent myocardial perfusion scintigraphy with 99mTc-sestamibi (MPS). They were evaluated for body mass index, metabolic control of DM, type of therapy, systemic arterial hypertension, dyslipidemia, nephropathy, retinopathy, peripheral neuropathy, smoking, and familial history of CAD. Results: MPS was abnormal in 15 patients (25.4%): 12 (20.3%) with perfusion abnormalities, and 3 with isolated left ventricular dysfunction. The strongest predictors for abnormal myocardial perfusion were: age 60 years and above (p = 0.017; odds ratio [OR] = 6.0), peripheral neuropathy (p = 0.028; OR = 6.1), nephropathy (p = 0.031; OR = 5.6), and stress ECG positive for ischemia (p = 0.049; OR = 4.08). Conclusion: Silent myocardial ischemia occurs in more than one in five asymptomatic diabetic patients. The strongest predictors of ischemia in this study were: patient age, peripheral neuropathy, nephropathy, retinopathy and a stress ECG positive for ischemia. (author)

  1. Myocardial perfusion as assessed by thallium-201 scintigraphy during the discontinuation of mechanical ventilation in ventilator-dependent patients

    Patients who cannot be separated from mechanical ventilation (MV) after an episode of acute respiratory failure often have coexisting coronary artery disease. The authors hypothesized that increased left ventricular (LV) wall stress during periods of spontaneous ventilation (SV) could alter myocardial perfusion in these patients. Using thallium-201 (201TI) myocardial scintigraphy, the authors studied the occurrence of myocardial perfusion abnormalities during periods of SV in 15 MV-dependent patients (nine women, six men; aged 71 ± 7 yr, mean ± SD). Fourteen of these patients were studied once with 201TI myocardial scintigraphy during intermittent mechanical ventilation (IMV) and again on another day, after at least 10 min of SV through a T-piece. One patient was studied during SV only. Thirteen of 14 of the patients (93%) studied during MV had abnormal patterns of initial myocardial 201TI uptake, but only 1 patient demonstrated redistribution of 201TI on delayed images. The remainder of the abnormalities observed during MV were fixed defects. SV produced significant alterations of myocardial 201TI distribution or transient LV dilation, or both, in 7 of the 15 patients (47%). Four patients demonstrated new regional decreases of LV myocardial thallium concentration with redistribution of the isotope on delayed images. The patient studied only during SV also had myocardial 201TI defects with redistribution. Five patients (3 also having areas of 201TI redistribution) had transient LV dilation during SV

  2. Correlation of left ventricular dyssynchrony with myocardial stunning using dual single photon emission computed tomography of 123iodine-β-methyl iodophenyl pentadecanoic acid and 201thallium scintigraphy after reperfusion therapy

    Left ventricular (LV) dyssynchrony after reperfusion therapy has been closely examined as a cause of chronic remodeling, but the details have not been clarified. The present study measured LV dyssynchrony appearing immediately after reperfusion therapy using real-time three-dimensional echocardiography (RT-3DE), and assessed the significance of this phenomenon in relation to dual single photon emission computed tomography (SPECT) of 123iodine β methyliodophenyl pentadecanoic acid (123I-BMIPP) and 201thallium (201Tl). Subjects comprised 58 patients with first-time acute myocardial infarction who received reperfusion therapy and underwent RT-3DE and dual SPECT of 123I-BMIPP and 201Tl within two weeks of onset. Two dyssynchrony parameters were measured using RT-3DE in the acute phase and six months later. After evaluating the correlation of these dyssynchrony parameters to resting 201Tl uptake, 201Tl washout, 123I-BMIPP uptake, and 201Tl-123I-BMIPP discrepancy (Tl-BMIPP discrepancy), we compared scintigraphic parameters in the chronic phase between groups with improved dyssynchrony and those without. Acute dyssynchrony exhibited a significant positive correlation to Tl-BMIPP discrepancy and it was significantly increased in the group with improved dyssynchrony in the chronic phase, revealing close relationship between dyssynchrony and Tl-BMIPP discrepancy. Then the subjects were divided into positive Tl-BMIPP discrepancy and negative discrepancy groups, and the parameters of cardiac function were compared between them. In the chronic phase, improved cardiac function was observed in the group with positive Tl-BMIPP discrepancy compared to negative discrepancy. LV dyssynchrony after reperfusion therapy correlates positively with Tl-BMIPP discrepancy, reflecting acute myocardial stunning, in which ventricular contraction improves during the chronic phase. (author)

  3. Evaluation of myocardial abnormalities in collagen diseases by thallium-201 myocardial scintigraphy

    Yamano, Shigeru; Kagoshima, Tadashi; Sugihara, Kiyotaka (Nara Medical Univ., Kashihara (Japan)) (and others)

    1993-12-01

    This study was performed to evaluate myocardial abnormalities in patients with collagen diseases by exercise and rest thallium-201 myocardial scintigrams. A total of 65 patients without ischemic ECG changes, consisting of 18 with systemic lupus erythematosus (SLE), 18 with polymyositis (PM), 8 with progressive systemic sclerosis (PSS), and 21 with Sjoegren's syndrome (SjS), was enrolled in this study. Reversible exercise-induced defects scintigraphically suggesting myocardial ischemia were noted in 8 cases of SLE, 4 cases of PM, 4 cases of PSS, and 3 cases of SjS. Nineteen patients had exercise-induced defects and underwent cardiac catheterization, 8 of whom had normal coronary angiograms. Fixed hypoperfusion areas were observed in one case of SLE, 6 cases of PM and 3 cases of SjS. Rest thallium-201 myocardial scintigram disclosed hypoperfusion areas which were not induced by exercise in 2 cases of SLE, 3 cases of PM, one case of PSS and 5 cases of SjS. Echocardiogram showed no significant differences in ejection fraction and % fractional shortening between the disease groups and healthy control group. These findings suggest that patients with collagen diseases have abnormalities of coronary circulation at the level of the intramural vasculature before cardiac function impairment, myocardial fibrosis and functional abnormalities at the cell membrane. (author).

  4. Assessment of myocardial fatty acid metabolism in patients with vasospastic angina using {sup 123}I-BMIPP myocardial SPECT

    Ito, Kazuki; Sugihara, Hiroki; Terada, Kouji [Kyoto Prefectural Univ. of Medicine (Japan)] [and others

    1995-10-01

    Myocardial perfusion and fatty acid metabolism may be unpaired in the patients of vasospastic angina (VSA), because abnormal regional wall motion of left ventricle has been shown in some cases of VSA without apparent history of myocardial infarction. To study the clinical utility of {sup 123}I-BMIPP scintigraphy in diagnosis of myocardial ischemia in VSA, both {sup 123}I-BMIPP (rest) and {sup 201}Tl (exercise) SPECT were performed in the 20 patients of VSA diagnosed by coronary angiography. Defect scores were calculated visually from the 17 segments of myocardial images and were compared with patient`s anginal history, period from last attack, numbers of attack, left ventricular (LV) ejection fraction and severity of regional LV wall motion abnormality. {sup 123}I-BMIPP SPECT images showed decreased tracer uptake in 14 cases of 20 (70%) VSA patients. Exercise {sup 201}Tl SPECT images showed decreased tracer uptake in 3 cases of 20 (15%) of patients. Severity of regional LV wall motion abnormality was correlated with defect score of BMIPP. Though total defect score of BMIPP did not correlate with patient`s anginal history, number of symptoms and LV ejection fraction, correlated inversely with period from last attack. It was suggested that {sup 123}I-BMIPP myocardial SPECT images in VSA patients showed `memories` of myocardial ischemic damages induced by vasospasm. In summary, {sup 123}I-BMIPP myocardial SPECT images could be a useful test for diagnosis and evaluation of VSA. (author).

  5. 123I-meta-iodo-benzyl-guanidine myocardial scintigraphy and congestive heart failure: current data and perspective

    Congestive heart failure is often associated with an impairment of the sympathetic nervous system, i.e., global hyperactivity and regional impairment of the adrenergic system. Cardiac 123I-MIBG scintigraphy is a radionuclide technique which can explore the presynaptic adrenergic function. Myocardial MIBG fixation is decreased in congestive heart failure, reflecting a reduction of norepinephrine uptake by the myocardial presynaptic nerve endings. The impairment of presynaptic function occurs early in the disease and is actually involved in the pathogenesis of cardiac failure. Cardiac MIBG scintigraphy is a useful tool to explore the myocardial adrenergic stores in patients with congestive heart failure. It could be proposed in patients with severe ventricular dysfunction in order to assist physicians in setting-up the timing of heart transplantation. (authors)

  6. The importance of sex-specific quantitative criteria in thallium-201 myocardial scintigraphy

    Breast attenuation is an important cause of artifactual cold spots on visually interpreted TL-201 myocardial images. This study was undertaken to determine the need for sex-specific criteria in the quantitative analysis of exercise-redistribution TL-201 myocardial scintigraphy (SCINT). The studies of 13 normal females (F) and 12 normal males (M) were processed according to the method of a previous study. Significant sexual differences were found in 7/12 regional uptake (U) proportions, 9/11 regional washout (WO) percentages, 0/3 image redistribution indices, and 0/1 lung to heart ratio. The differences primarily reflected a proportionately decreased anterior and septal uptake in F, a proportionately decreased inferior and inferoapical U in M, and faster WO in F. Sex-specific and total population normal boundaries were set a +- 3SD of the mean for each parameter. Sex-specific boundaries were narrower, and, for 5 parameters (4U and 1WO), contained within the total population boundaries. It was estimated that these differences in boundaries would result in a 6 to 25% discrepancy in patient classification. These results predict that a subset of M and F with coronary artery stenoses could be misclassified as normal by total population criteria, while properly classified as abnormal by sex-specific criteria. The authors conclude that since important differences exist between M and F in the detected pattern of TL-201 myocardial U and WO, sex-specific cr4iteria may enhance the predictive accuracy of SCINT

  7. Prediction of cardiac events after uncomplicated myocardial infarction: a prospective study comparing predischarge exercise thallium-201 scintigraphy and coronary angiography

    The ability of predischarge quantitative exercise thallium-201 (201T1) scintigraphy to predict future cardiac events was evaluated prospectively in 140 consecutive patients with uncomplicated acute myocardial infarction; the results were compared with those of submaximal exercise treadmill testing and coronary angiography. High risk was assigned if scintigraphy detected 201T1 defects in more than one discrete vascular region, redistribution, or increased lung uptake, if exercise testing caused ST segment depression greater than or equal to 1 mm or angina or if angiography revealed multivessel disease. Low risk was designated if scintigraphy detected a single-region defect, no redistribution, or no increase in lung uptake, if exercise testing caused no ST segment depression or angina, or if angiography revealed single-vessel disease or no disease. By 15 +/- 12 months, 50 patients had experienced a cardiac event; seven died (five suddenly), nine suffered recurrent myocardial infarction, and 34 developed severe class III or IV angina pectoris. Compared with that of patients at low risk, the cumulative probability of a cardiac event was greater in high-risk patients identified by scintigraphy, exercise testing, or angiography. Scintigraphy predicted low-risk status better than exercise testing or angiography. Each predicted mortality with equal accuracy. These results indicate that (1) submaximal exercise 201T1 scintigraphy can distinguish high- and low-risk groups after uncomplicated acute myocardial infarction before hospital discharge; (2) 201T1 defects in more than one discrete vascular region, presence of delayed redistribution, or increased lung thallium uptake are more sensitive predictors of subsequent cardiac events than ST segment depression, angina, or extent of angiographic disease; and (3) low-risk patients are best identified by a single-region 201T1 defect without redistribution and no increased lung uptake

  8. 201Tl myocardial scintigraphy correlation with TMT and coronary angiography - a preliminary report

    Full text: This study analyses 60 patients of suspected ischemic heart disease who underwent myocardial perfusion studies with 201Tl SPECT from June 1998 - September 1998. Thirty six patients were tested positive on TMT, thallium scintigraphy was positive in 21 (58%) patients and negative in 15 (41%) cases. Coronary angiography results were available in 35 patients, of which there were 5 cases with LBBB where TMT was not done due to high unpredictability. The 5 cases were tested negative, both angiographically and stress thallium showing 100% correlation. Out of remaining 30 patients, angiography was positive in 22 patients. Stress thallium was positive in 19 patients (87%). Of the 8 cases which showed normal coronary angiography, stress thallium was positive in 3 cases (13%) and negative in 5 patients (87%). Statistical analysis of this small group showed a sensitivity of 86%, specificity of 63%, false negative rate 14% and false positive rate of 37%. Overall accuracy is 80%

  9. Importance of 201Tl scintigraphy during exercise for diagnosis of silent myocardial ischemia

    Using thallium scintigraphy during exercise (TSE), suspect silent myocardial ischemia (SIM) was diagnosed in subjects without angina pectoris. 21 active pilots with suspect SIM were examined after previous exercise ECG as well as 33 patients with diabetes type I and II. In six pilots (28.6%) TSE showed accumulation defects suggesting ischemic disorders of the large coronary arteries. Five pilots showed obvious depressions of the ST segment in ECG during submaximal exercise TSE. In another group of five pilots small depressions of the ST segment were associated with normal TSE. Twelve diabetic patients (36.4%) had minor accumulation defects on TSE. Only two showed a ST depression under 2 mm in ECG during TSE. Based on data in the literature suggesting higher sensitivity and specificity of exercise thallium scintigraphy as compared with exercise ECG and the possibility of a false positive diagnosis of SIM from exercise ECG alone, it is recommended to also use TSE. A more detailed diagnosis of SIM is essential not only with regard to the assessment of work capacity but also for a long-term follow-up of patients with SIM for assessment of its incidence, impact and prognosis in the population. (author). 4 figs., 4 tabs., 25 refs

  10. Dipyridamole combined with symptom-limited exercise for myocardial perfusion scintigraphy: Image characteristics and clinical role

    Although dipyridamole can be used with myocardial scintigraphy to demonstrate reversible perfusion defects, combining exercise with the pharmacologic tool could improve image quality and information yield. The incidence of perfusion defects and the quality of thallium 201 images were reviewed in a series of 820 patients who had been assigned to a specific stress-test mode. Supine bicycle exercise alone was used (group I) where no pharmacologic or physical factors (e.g., beta-blockers, arthritis) limited performance; otherwise, intravenous dipyridamole was followed by sympton-limited exercise (group II). Angiographic correlation was available in 57 patients in group I, and in 158 in group II; of these, 109 performed significant exercise (≤3 min at increasing workloads) following dipyridamole (group IIA), whereas in 49 (group IIB) the exercise phase following dipyridamole was truncated. All test-mode groups were similar with respect to the incidence of (ST) depression during testing, patient throughput, and the sensitivity of perfusion defects. Chest pain and reversible defects were induced more frequently in group II than in group I. In group IIA, splanchnic background activity was lower (P<0.001) than in group IIB, and the false-positive rate tended to be lower. Thus, combining exercise with dipyridamole in patients with non-cardiac limitations to exercise enabled the achievement of optimal results by perfusion scintigraphy. (orig.)

  11. Usefulness of low- and medium-energy collimators in 123I-MIBG myocardial scintigraphy

    The heart-to-mediastinum (H/M) ratio on myocardial scintigraphy with 123I-metaiodobenzylguanidine (MIBG) is used as a semi-quantitative index. However, the scatter from a photopeak of 529 keV on 123I is thought to affect the H/M ratio, and collimator selection is important as well. We attempted to determine the usefulness of low- and medium-energy general purpose (LME) collimators by comparing them with low-energy high-resolution (LEHR) and medium-energy low-penetration (MELP) collimators in phantom and clinical studies. In the phantom study, we used a thoracic phantom and plastic bottles filled with 123I-MIBG solution as upper limbs. Phantom images were acquired with LEHR, LME, and MELP collimators. Regions of interest were placed on the lung, mediastinum, heart, and liver. The average counts in the lung, coefficient of variation (CV%) in the heart, mediastinum, and liver, and H/M ratio were calculated. The H/M ratios obtained with the LEHR collimator and LME collimator were compared in a clinical study. We found that the average count in the lung measured with the LME collimator was reduced to about 30% of that obtained with the LEHR collimator in the phantom study. CV% measured with the LME collimator improved about 10% compared with that determined with the MELP collimator. The H/M ratio measured with the LME collimator was close to that measured with the MELP collimator. In the clinical study, the H/M ratios measured with the LEHR and LME collimators showed a positive relationship (y=2.1 x-1.3, x; H/M with LEHR, y; H/M with LME). LME collimators provided improved contrast and signal-to-noise ratio in evaluation of the H/M ratio on 123I-MIBG myocardial scintigraphy. (author)

  12. Myocardial perfusion: Comparison between 99mTc-MIBI scintigraphy and microbubbles- Pesda and Levovist-echocardiography

    Myocardial perfusion scintigraphy has been used for the last 25 years. Recently echocardiography is trying to realize the same kind of test with microbubbles injected intravenously. Aim: Comparison of the results of myocardial perfusion scintigraphy with 99mTc-MIBI and microbubbles - Pesda and Levovist-echocardiography. The nuclear medicine is considered the gold standard. Material and method: We studied 27 patients, 15 male, aging 58+/- 12.5 years with angina unstable or myocardial infarction (19 pts ) and normal (8 pts ). All patients received 740 MBq of 99mTc-MIBI during the echo examination. The SPECT scintigraphies were performed in an ADAC Vertex Plus scintillation camera. The echo were performed in a HDI 3000/5000 ATL, P3-2 transducer, intermittent harmonic image, VHS and 2 independent observers. During the echo examination the patients received Pesda- 2-7 ml/min- and Levovist- 400mg/ml 2-4 min. Results: NM versus Pesda and NM versus Levovist are presented. Concordance 87% (K=0.42). Concordance 89% (K0.57). Conclusion: Despite of the feasibility, echocardiography can detect myocardial perfusion defects with a good concordance of 87-89 % of these cases. The learning curve, the qualitative analysis is jeopardized by fibrotic areas, and the attenuation are problems that they need to solve

  13. Functional significance of coronary collateral circulation during dynamic exercise evaluated by thallium-201 myocardial scintigraphy

    Sixty-five patients with angiographically documented coronary artery disease were investigated by thallium-201 (201Tl) scintigraphy to determine the role of the collateral circulation during dynamic exercise. Fifty-three patients had complete proximal occlusion of at least one major coronary artery. One patient had total occlusion of all three major coronary arteries. Sixty-four collateral channels were identified, graded, and compared with corresponding regions of the myocardial scintigram. Tracer uptake was also graded and classified as various degrees of protection from ischaemia. A significant correlation between good collaterals with complete protection and poor or absent collaterals with no protection was noted. Seventeen patients (20 occluded vessels) had total coronary occlusion without myocardial infarction. Collaterals conferred protection in 9/15 occlusions whereas no protection was seen in five occlusions without collaterals. There was no difference in the protective role of homocoronary and heterocoronary collateral vessels. Hypertrophy of the first septal left anterior descending perforator conferred significant protection from ischaemia in contrast to bridging collaterals and ghosting. During exercise the right coronary bed is preferentially protected from ischaemia, in contrast to the left anterior descending territory. This probably reflects the direction of a transmural flow gradient between left and right ventricles during exercise. (author)

  14. Significance of decreased washout rate in hypertrophic cardiomyopathy by exercise Tl-201 myocardial scintigraphy

    A clinical significance of decreased washout rate (WR) in hypertrophic cardiomyopathy by exercise thallium-201 myocardial scintigraphy was evaluated. Thirty-six patients with hypertrophic cardiomyopathy and normal coronary angiogram were categorized into 3 groups according to initial distribution (ID) and WR: decreased ID group (17 patients, ID group), normal ID but decreased WR group (9 patients, WR group) and normal ID and normal WR group (10 patients, N group). Results: (1) Cardio-thoracic-ratio and left ventricular end-diastolic pressure were higher in WR group than in other 2 groups. (2) Resting ejection fraction and left ventricular end-diastolic volume index did not differ in three groups. (3) Exercise ejection fraction was increased in N group, whereas it was not increased in ID or WR groups. It was increased in 47% of ID group, but were decreased or not changed in all patients of WR group. In conclusion, decreased WR in patients with hypertrophic cardiomyopathy may strongly suggest left ventricular myocardial damage. (author)

  15. Chronic pulmonary embolism presenting with right ventricular dilatation on thallium myocardial scintigraphy

    Full text: A 61 year old male presented to the Nuclear Medicine Department for an exercise thallium study with a three month history of exertional dyspnoea for investigation. Patient history included PTCA to LAD and pulmonary embolism 16 years previously. The patient underwent 5.24 minutes of a standard treadmill Bruce protocol which was terminated due to his usual dyspnoea. The patient was injected with 120 MBq of 201-Thallous Chloride at peak exercise and prone SPECT imaging performed 8 minutes later with a dual head gamma camera. Reconstructed images demonstrated normal myocardial perfusion at a moderate level of haemodynamic stress. However, moderate night ventricular dilatation was noted raising the possibility of respiratory disease as cause for symptoms. Echocardiography confirmed right ventricular dilatation and moderate to severe pulmonary hypertension while subsequent respiratory function tests were unremarkable. The patient was then referred to Nuclear Medicine for a ventilation and perfusion lung scan. A six view ventilation study was performed following inhalation of 99mTc Technegas and corresponding perfusion images were acquired following intravenous administration of 99mTc MAA. The ventilation and perfusion images demonstrated multiple matched segmental defects bilaterally, suggestive of chronic thrombo-embolism. The patient was subsequently anti-coagulated with improvement of symptoms. In conclusion, our study has demonstrated how right ventricular dilatation on myocardial scintigraphy can alert the clinician to alternative causes for dyspnoea, and in our case resulted subsequently in a diagnosis of chronic pulmonary embolism

  16. Myocardial perfusion scintigraphy: utilization patterns and impact on patient management at the Philippine Heart Center

    The clinical use of SPECT myocardial perfusion scintigraphy in 101 patients referred to the nuclear medicine department of a tertiary care hospital was evaluated. The most common indications for requesting the test were for assessment of myocardial viability after infarction, determination of the size of the infarcted or ischemic area, and confirmation of the presence or absence of suspected coronary artery disease (CAD). Using the chest symptoms and demographic data to calculate pretest likelihood for CAD, it was determined that 10 had high probability, 34 had intermediate probability and 8 had low probability for the disease. The rest (49 patients) had proven CAD. The test result contributed to a modest degree of stratification into the extremes of CAD likelihood. There was a change in the decision to catheterize in 17 of the 101 patients, planned catheterization being reduced by 25% (16/64) as a result of the scan findings. A normal scan had greater impact however, with the perceived need for catheterization going down by 80%. A change in whether to proceed with surgical procedures (angioplasty or bypass) or not was also noted in 17 patients. Finally, the results contributed to a change in medical management in 29 patients. Our data indicate that perfusion scanning is used more often for the functional information it gives, rather than simply for CAD detection, and has substantial impact on subsequent clinical decision-making. (author). 25 refs.; 3 tabs

  17. Variation in heart rate influences the assessment of transient ischemic dilation in myocardial perfusion scintigraphy

    Transient arrhythmias can affect transient ischemic dilation (TID) ratios. This study was initiated to evaluate the frequency and effect of normal heart rate change on TID measures in routine clinical practice. Consecutive patients undergoing stress/rest sestamibi gated myocardial perfusion scintigraphy were studied (N = 407). Heart rate at the time of stress and rest imaging were recorded. TID ratios were analyzed in relation to absolute change in heart rate (stress minus rest) for subjects with normal perfusion and systolic function (Group 1, N = 169) and those with abnormalities in perfusion and/or function (Group 2, N = 238). In Group 1, mean TID ratio was inversely correlated with the change in heart rate (r = -0.47, P < 0.0001). For every increase of 10 BPM in heart rate change, the TID ratio decreased by approximately 0.06 (95% confidence interval 0.04–0.07). In Group 2, multiple linear regression demonstrated that the change in heart rate (beta = -0.25, P < 0.0001) and the summed difference score (beta = 0.36, P < 0.0001) were independent predictors of the TID ratio. Normal variation in heart rate between the stress and rest components of myocardial perfusion scans is common and can influence TID ratios in patients with normal and abnormal cardiac scans

  18. Evaluation of left ventricular hypertrophy using thallium-201 myocardial scintigraphy, echocardiography and vectorcardiography

    Thallium-201 (201Tl) myocardial scintigraphy was performed in 40 patients with left ventricular hypertrophy(LVH). Twelve out of 40 patients had pressure overloading (Aortic stenosis: 5, Hypertension: 7), 14 patients had volume overloading (Aortic regurgitation: 9, Mitral regurgitation: 5) and 14 had idiopathic cardiomyopathy (Hypertrophic type (HCM): 8, Congestive type (CCM): 6), respectively. LV area, LV uptake index and Wall uptake ratio were calculated from left anterior oblique view of 201Tl myocardial images. These three indices of both pressure overloading and volume overloading were significantly higher than those of controls. The degree of LVH was indicated by both LV area and LV uptake index. LV area was significantly larger in volume overloading than in pressure overloading. In idiopathic cardiomyopathy, these three indices of HCM and LV area and LV uptake index of CCM were significantly increased compared with those of controls. LV area of CCM was significantly larger than that of HCM, while Wall uptake ratio of HCM was significantly higher than that of CCM. LV uptake index and Wall uptake ratio of HCM became higher according as left ventricular cavity became smaller. LV area of CCM became larger in proportion as left ventricular cavity became larger and as left ventricular wall thickness became thinner. (author)

  19. Exercise myocardial perfusion scintigraphy is useful for evaluating myocardial ischemia even in the elderly

    Pharmacologic stress testing is recommended to elderly patients as a valuable alternative to exercise testing. We examined whether exercise testing is as useful for evaluating myocardial ischemia in the elderly as in the young. The consecutive 1,508 patients who underwent exercise 201Tl single-photon emission computed tomography (SPECT) were divided into six age groups: 6-29 years (n=56), 30-44 (n=143), 45-54 (n=311), 55-64 (n=498), 65-74 (n=402), and 75-88 (n=98). Both heart rate and rate-pressure product at peak exercise were significantly lower in patients aged 75-88 than in the other five groups. The frequency of ischemic ST depression was higher in patients aged 75-88 than in those aged 6-74, although the difference was not significant. Moreover, the frequency of 201Tl transient defect was significantly higher in patients aged 75-88 than in those aged 6-74. On the other hand, the sensitivity of ischemic ST depression for 201Tl transient defect was similar among the six groups, but the specificity was significantly lower in patients aged 75-88 than in those aged 6-74. In conclusion, exercise 201Tl SPECT is useful for evaluating myocardial ischemia even in the elderly, but exercise electrocardiography has limitations such as lower specificity in the elderly than 201Tl SPECT. (author)

  20. 123I-MIBG Myocardial sympathetic innervation scintigraphy and Parkinson's disease

    Aim: Dysfunction of the autonomic nervous system is an under-recognised but important aspect of the aetiological and clinical manifestation of primary degenerative dysautonomias such as Parkinson's disease (PD). Functional imaging studies suggest that selective cardiac sympathetic denervation may occur early in PD but not in other parkinsonian syndromes. The clinical implication of this apparently disease specific peripheral dysautonomia is unknown and would be the subject of much interest in future years. Scintigraphy with radiolabeled metaiodobenzylguanidine (123I-MIBG) enables the visualization and quantification of cardiac sympathetic function. Materials and Methods: We prospectively performed 73 123I-MIBG myocardial studies in two groups of patients: 61 patients (30 male/31 female) diagnosed of PD without any autonomic dysfunction (PD group) and 12 patients (7 male/4 female) were studied for a suspicion of pheochromocytoma (nonPD group). Severity of PD was evaluated by Hoehn-Yahr scale. Myocardial imaging with 123I-MIBG was performed to evaluate cardiac sympathetic function. Early and delayed images of the anterior view were obtained 15min and 4h after injection of 111 MBq iv of 123I-MIBG. Quantification of 123I-MIBG uptake using a heart-to-mediastinum ratio (H/M) and washout ratio (W) and comparison between groups were carried out. Results: The 123I-MIBG heart uptake was: a) reduced in 16 PD patients (26.2% of PD), b) absent in 42 PD patients (62.8% of PD) and c) normal in 3 PD (4.9% of PD) and in all of the 12 nonPD patients. H/M was significantly smaller in PD patients than nonPD patients (P 123I-MIBG uptake is a valuable and sensitive tool to identify early cardiac sympathetic dysfunction in patients with PD. As this finding could be characteristic of PD patients, the 123I-MIBG myocardial scintigraphy would be useful to discriminate them from other neurodegenerative disorders early in the course of the disease

  1. Adenosine stress myocardial perfusion scintigraphy in pediatric patients after arterial switch operation

    Arterial switch operation (ASO) has become the established treatment for correction of transposition of great arteries (TGA). Despite the immediate correction of abnormal hemodynamics, acute and delayed complications related to the coronaries may cause morbidity and mortality. We evaluated the incidence of perfusion abnormalities and safety of adenosine by stress–rest myocardial perfusion single-photon emission computed tomography (SPECT) [myocardial perfusion scintigraphy (MPS)] using Tc-99m Sestamibi (MIBI) in asymptomatic children post-ASO. Prospective study. We conducted a prospective, single-institutional study where stress–rest MPS was performed on 10 children of age between 1.25 and 6 years. Two of the patients had additional ventricular septal defect, one patient had left ventricular outflow tract obstruction, and another had Taussig–Bing anomaly. All the patients underwent corrective surgery as a single-stage procedure at the age of 176 ± 212 days (range 9-560 days). Adenosine was administered at a rate of 140 μg/kg/min intravenously as continuous infusion for duration of 6 min. All the continuous variables were summarized as mean ± standard deviation, or range and median. Mann–Whitney test for unpaired data and Wilcoxon Rank test for paired samples were used. The average increase in heart rate over the basal heart rate after adenosine stress was 59.7 ± 17.0%. No acute or remote complications were observed in any case. None of the patients demonstrated myocardial perfusion defects, either at rest or after adenosine stress. MPS post-adenosine induced vasodilatation is safe and feasible in patients of ASO for transposition of great arteries. One-stage repair, implantation of excised coronary buttons within neo-aortic sinus, and minimal or no mobilization of proximal coronaries may eliminate the occurrence of perfusion defects in patients of corrected TGA

  2. Comparison Between Postprocessing Software and Repeated Scanning to Eliminate Subdiaphragmatic Activity in Myocardial Perfusion Scintigraphy

    Theerakulpisut, Daris; Chotipanich, Chanisa

    2016-01-01

    Myocardial perfusion single photon emission computed tomography (SPECT) is a powerful test of evaluation for coronary artery disease, but subdiaphragmatic radiotracer activity often interferes with the interpretation of inferior wall findings. This study aims to evaluate the effectiveness of using software elimination of the subdiaphragmatic activity for the assessment of its efficacy in the correctness of image interpretation and the overall image quality of myocardial perfusion scintigraphy (MPS). MPS studies from January 2010 to October 2012 at our institution were reviewed. Thirty-two SPECT studies were included, all of which had significant subdiaphragmatic activity in the first scan and needed to be delayed to let the activity clear. Each scan was interpreted by using semiquantitative scoring in 17 segments according to the degree of radiotracer uptake. The first scan, which had interfering activity, was manipulated by masking out the unwanted activity with software native to our image processing software suite. The manipulated images were then compared with delayed images of the same patient, of which the subdiaphragmatic activity was spontaneously cleared with time. The first scan masked by software correlated with the delayed scan for myocardial regions supplied by the left circumflex (LCx) and right coronary artery (RCA), but not the left anterior descending (LAD). However, the quality of the masked scans was perceived by the observer to be better in terms of quality and ease of interpretation. Using software to mask out unwanted subdiaphragmatic activity has no detrimental effect on the interpretation of MPS images when compared with delayed scanning, but it can improve subjective scan quality and ease of interpretation. PMID:27134559

  3. Myocardial perfusion scintigraphy with technetium 99m-MIBI in the diagnosis of coronary artery disease in women

    The results of technetium 99m - methoxy-isobutyl-isonitrile scintigraphy in a one-day protocol: rest - physical or combined stress bicycle plus endovenoous dipyridamole were compared with those of coronary angiography in 20 women referred for the evaluation of pre cordial pain and of the usefulness of myocardial perfusion scintigraphy. The uptake of the radio drug under stress and at rest varied from 93 +-9 to 94 +- 7 % in the 204 segments with normal uptake under stress, from 67 He articulates it analyzes the reasons or utility of the employment of the radioactive iodine in the diagnosis and treatment of the thyroid affections +- 9 to 75 +- 17 % in the 89 with moderate reduction, and from 33 +- 9 to 64 +-28 % in the 27 with severe reduction. The qualitative and quantitative uptake analyses coincided in 18 patients. The perfusion scintigraphy and the angiography agreed in 70 % of the patients. It was concluded that the myocardial perfusion scintigraphy with technetium 99-MIBI contributes to the diagnosis of the coronary artery disease in women

  4. Cardiac autonomic neuropathy in patients with diabetes and no symptoms of coronary artery disease: comparison of {sup 123}I-metaiodobenzylguanidine myocardial scintigraphy and heart rate variability

    Scholte, Arthur J.H.A.; Schuijf, Joanne D.; Delgado, Victoria; Kok, Jurriaan A.; Bus, Mieke T.J.; Maan, Arie C.; Wall, Ernst E. van der; Bax, Jeroen J. [Leiden University Medical Center, Department of Cardiology, Albinusdreef 2, PO Box 9600, Leiden (Netherlands); Stokkel, Marcel P.; Dibbets-Schneider, Petra [Leiden University Medical Center, Nuclear Medicine, Leiden (Netherlands); Kharagitsingh, Antje V. [Medisch Centrum Haaglanden, Department of Internal Medicine, The Hague (Netherlands)

    2010-09-15

    The purpose of this study was to evaluate the prevalence of cardiac autonomic neuropathy (CAN) in a cohort of patients with type 2 diabetes, truly asymptomatic for coronary artery disease (CAD), using heart rate variability (HRV) and {sup 123}I-metaiodobenzylguanidine ({sup 123}I-mIBG) myocardial scintigraphy. The study group comprised 88 patients with type 2 diabetes prospectively recruited from an outpatient diabetes clinic. In all patients myocardial perfusion scintigraphy, CAN by HRV and {sup 123}I-mIBG myocardial scintigraphy were performed. Two or more abnormal tests were defined as CAN-positive (ECG-based CAN) and one or fewer as CAN-negative. CAN assessed by {sup 123}I-mIBG scintigraphy was defined as abnormal if the heart-to-mediastinum ratio was <1.8, the washout rate was >25%, or the total defect score was >13. The prevalence of CAN in patients asymptomatic for CAD with type 2 diabetes and normal myocardial perfusion assessed by HRV and {sup 123}I-mIBG scintigraphy was respectively, 27% and 58%. Furthermore, in almost half of patients with normal HRV, {sup 123}I-mIBG scintigraphy showed CAN. The current study revealed a high prevalence of CAN in patients with type 2 diabetes. Secondly, disagreement between HRV and {sup 123}I-mIBG scintigraphy for the assessment of CAN was observed. (orig.)

  5. Cardiac autonomic neuropathy in patients with diabetes and no symptoms of coronary artery disease: comparison of 123I-metaiodobenzylguanidine myocardial scintigraphy and heart rate variability

    The purpose of this study was to evaluate the prevalence of cardiac autonomic neuropathy (CAN) in a cohort of patients with type 2 diabetes, truly asymptomatic for coronary artery disease (CAD), using heart rate variability (HRV) and 123I-metaiodobenzylguanidine (123I-mIBG) myocardial scintigraphy. The study group comprised 88 patients with type 2 diabetes prospectively recruited from an outpatient diabetes clinic. In all patients myocardial perfusion scintigraphy, CAN by HRV and 123I-mIBG myocardial scintigraphy were performed. Two or more abnormal tests were defined as CAN-positive (ECG-based CAN) and one or fewer as CAN-negative. CAN assessed by 123I-mIBG scintigraphy was defined as abnormal if the heart-to-mediastinum ratio was 25%, or the total defect score was >13. The prevalence of CAN in patients asymptomatic for CAD with type 2 diabetes and normal myocardial perfusion assessed by HRV and 123I-mIBG scintigraphy was respectively, 27% and 58%. Furthermore, in almost half of patients with normal HRV, 123I-mIBG scintigraphy showed CAN. The current study revealed a high prevalence of CAN in patients with type 2 diabetes. Secondly, disagreement between HRV and 123I-mIBG scintigraphy for the assessment of CAN was observed. (orig.)

  6. Incidentally detected large diaphragmatic hernia in Tl-201 myocardial perfusion scintigraphy; no substantial effect on the study results

    Özdemir, Semra; Erselcan, Taner; Hasbek, Zekiye; Tandoğan, İzzet; GÜMÜŞ, CESUR

    2011-01-01

    AbstractA case of diaphragmatic hernia, detected incidentally by Thallium 201 (Tl-201) myocardial perfusion scintigraphy (MPS), was presented. We recognized a large photon deficient area in the right lung and middle mediastinum regions, also attenuating cardiac activity in the first 10 projections during the evaluation of stress and rest single-photon emission computed tomography (SPECT) projections of the subject. Computed tomography (CT) examination of the mass revealed a diaphragmatic hern...

  7. The results of questionnaire on quantitative assessment of 123I-metaiodobenzylguanidine myocardial scintigraphy in heart failure

    This study was done by working group under the cooperation between Japanese Society of Nuclear Medicine and Japanese Circulation Society. We evaluated the usefulness of quantitative assessment of 123I-metaiodobenzylguanidine (MIBG) myocardial scintigraphy in heart failure by the results of questionnaire. Forty-nine (72.1%) of 68 selected institutions participated in this study. The incidence of MIBG myocardial scintigraphy used in heart failure was 41.1%. The imaging protocol was mostly done by both planar and SPECT at 15 min and 3.6 hr after intravenous injection of 111 MBq of MIBG. The quantitative assessment was mostly done by heart/mediastinum (H/M) ratio and washout rate analysis based on planar imaging. The mean normal value of H/M ratio were 2.34±0.36, and 2.49±0.40, at early and delayed images, respectively. The normal value of washout rate was 27.74±5.34%. On the other hand, those of H/M ratio in heart failure were 1.87±0.27, and 1.75±0.24, at early and delayed images, respectively. That of washout rate was 42.30±6.75%. These parameters were very useful for the evaluation of heart failure. In conclusion, MIBG myocardial scintigraphy was widely used for not only early detection and severity assessment, but also indication for therapy and prognosis evaluation in heart failure patients. (author)

  8. Evaluation of sympathetic activity by 123I-metaiodobenzylguanidine myocardial scintigraphy in dilated cardiomyopathy patients with sleep breathing disorder

    Because increased sympathetic nervous activity (SNA) in patients with dilated cardiomyopathy (DCM) associated with sleep breathing disorder (SBD) is known to deteriorate the prognosis of cardiac failure, 123I-metaiodobenzylguanidine (MIBG) myocardial scintigraphy was used as the investigative tool in the present study. The study group comprised 53 patients (47 men, 6 women; mean age 56±3 years) with chronic stable DCM. Patients were divided into SBD(+) or SBD(-) group according to 24-h pulse oximetry results. SBD(+) was defined when the 3% oxygen desaturation index was more than 15/h during sleep. In total, 32 patients were SBD(-) and 21 were SBD(+). In both groups, pulse oximetry were performed during sleep and awakening pulse rate, and measurement of the blood levels of catecholamines and B-type natriuretic peptide was performed. MIBG myocardial scintigraphy and echocardiography were performed at the same time. No significant difference was found between the 2 groups in catecholamine levels or left ventricular ejection fraction. However, MIBG had a significantly increased washout rate and a significantly decreased delayed heart to mediastinum ratio in the SBD(+) group compared with the SBD(-) group. SNA is increased in DCM patients when associated with SBD. MIBG myocardial scintigraphy may be a sensitive method of detecting increased SNA. (author)

  9. Regional myocardial free fatty acid metabolism

    Experimental evidence to date has confirmed the potential value of radioactive labelled free fatty acid (FFA) and their analogs for the assessment of regional myocardial FFA metabolism despite a number of current limitations. It is emphasized that with these agents only one specific aspect of myocardial metabolism, that of FFA, can be tested and that with these compounds information on the overall metabolic state cannot always be obtained. (WU)

  10. Myocardial perfusion scintigraphy in identification and localization of individual coronary lesions

    Baškot Branislav

    2004-01-01

    Full Text Available The aim of this study was to evaluate the accuracy of myocardial perfusion scintigraphy with technetium-99m tetrofosmin by single-photon emission computed tomography (SPECT, using one-day protocol in the identification and localization of individual stenosed coronary vessels. Sixty-eight patients with suspected coronary artery disease (CAD were studied. In thirty of them coronary angiography showed significant stenosis (³50%. Nine patients were with one-vessel disease, 11 were with two-vessel disease, and 10 were with three-vessel disease. All the patients were administered two i.v. injections of 99mTc tetrofosmin, one at peak pharmacologic exercise (1-3 min after i.v. administration of dipiridamol 0.56 mg per kg during 4 min 370 MBq, and the other 740 MBq at rest 3 hrs after the exercise test (acquisition was obtained 15-30 min after injections for both studies. Overall sensitivity, specificity, and diagnostic accuracy in the identification of individual stenosed coronary vessels were 90%, 86%, and 88%, respectively. Sensitivity, specificity, and accuracy in each of the individual vascular territories were not significantly different: LAD (96% 64%, and 75%, ACx (73%, 100%, and 94%, RCA (95%, 93%, and 94%. The results of this study demonstrated one-day 99mTc-tetrofosmin SPECT scintigraphy to be suitable and accurate technique for the identification and localization of individual stenosed coronary vessels, as well as a highly sensitive method in the recognition of one- and multiple-vessel diseases of coronary arteries.

  11. Role of myocardial perfusion scintigraphy in type II diabetic patients: a multicentre study

    Coronary artery disease (CAD) is a major cause of morbidity and mortality in patients with diabetes and this population has high incidence of silent cardiac events. Objective: We evaluated the role of myocardial perfusion scintigraphy (MPS) in detection of coronary artery disease (CAD) in patients with type II diabetes mellitus in correlation with presenting complaints. Methods: This study was conducted at six Nuclear Medicine Institutes of Pakistan as an IAEA sponsored technical Co-operation project from January to December 2003. We conducted stress-redistribution SPECT MPS with intravenous injection of 111 MBq (3mCi) 201Tl-thallous chloride in 288 subjects with type II diabetes mellitus, 186 male and 92 female (age range 20 to 77 years). Average duration since diagnosis of diabetes mellitus was 4.61 + 4.56 years. Upon the bases of clinical history, diabetic patients were divided into six groups, Asym= asymptomatic subjects (n=46), Esob=exertional SOB (n=27), Acp=atypical chest pain without dyspnea (n=61), AcpD= atypical chest pain with dyspnea (n=57), Tcp=typical chest pain without dyspnea (n=36), TcpD=typical chest pain with dyspnea (n=61). We conducted visual analysis on reconstructed tomographic slices. Results: Considering all diabetic patients together 61.45% were having CAD (inducible ischemia 45.48%, myocardial infarction 15.97%). Overall incidence of CAD was higher in Esob group than Asym (55.55% vs. 34.78%), AcpD group than Acp (71.92% vs. 49.18%) and TcpD group than Tcp (83.61% vs. 66.67%). Incidence of stress induced ischemia (SII) and myocardial infarction (MI) in Asym group was 23.91% and 10.87%, in Acp Group 36.07% and 13.11%, and in Tcp group 47.22% and 19.44% respectively. Incidence of SII and MI in Esob group was 44.44% and 11.11%, in AcpD roup 56.14% and 15.79%, and in TcpD group 60.66% and 22.95% respectively. Conclusion: Our study concludes that incidence of silent myocardial ischemia and infarction is quite high in patients with type

  12. The influence of lactate and dipyridamole on myocardial fatty acid metabolism in man, traced with 123I-17-iodoheptadecanoic acid

    Changes in myocardial metabolism can be detected externally by registration of time-activity curves after administration of radioiodinated fatty acids. In this scintigraphic study the influence of lactate on fatty acid metabolism was investigated in the normal human myocardium, traced with 123I-17-iodoheptadecanoic acid (123I-17-HDA). In patients (paired, n=7) lactate loading decreased the uptake of 123I-17-HDA significantly from 27 (control:22-36) to 20 counts/min/pixel (16-31; p 123I-17-HDA scintigraphy of the heart. (orig.)

  13. Assessment of coronary hemodynamics and myocardial perfusion in patients with syndrome X by digital subtraction angiography and 201Tl-myocardial scintigraphy

    To evaluate coronary hemodynamics and myocardial perfusion, left coronary digital subtraction angiography (DSA) and Tl-201 myocardial scintigraphy were performed in patients with syndrome X. The coronary circulation time (CCT) was significantly prolonged after the injection of isosorbide dinitrate and contrast medium i.c. Apical T1/2 was also prolonged on ergonovine malate provocation test. We suspected that the vascular response of the coronary peripheral artery was impaired, and microvascular spasm probably existed in patients with syndrome X. The prevalence of abnormal myocardial perfusion defect on exercise Tl-201 SPECT in syndrome X was very high, and coronary hemodynamics was significantly disturbed in the group of syndrome X with abnormal Tl-201 SPECT. Tl-201 lung/heart count ratio significantly increased in syndrome X on treadmill test. Because of this, exercise induced left ventricular dysfunction was suspected. We concluded that the main pathophysiological finding of impaired coronary circulation in syndrome X was microvascular spasm. (author)

  14. Three-dimensional display of 99mTc-MIBI myocardial scintigraphy

    One of 99mTc-hexakis, 99mTc-methoxyisobutyl isonitrile (MIBI), has been demonstrated to have a myocardial uptake proportional to regional coronary blood flow. In this study, 99mTc-MIBI myocardial scintigraphy was performed for 16 patients with ischemic heart disease. After injection of 740 MBq of 99mTc-MIBI, 64 projection images were collected during a 360-degree rotation. Three-dimensional (3D) display of the left ventricle was reconstructed with depth-shading method from 99mTc-MIBI SPECT images, which were reconstructed by filtered back projection method. In 9 of the patients, left ventricular cineangiography were performed as diagnostic gold standard. Four physicians blinded to patients' clinical information interpreted 3D images and SPECT images on separate occasions. Diagnosis of hypoperfusion by 3D displays agreed with those of SPECT in 92.9% (104/112 segments), and disagreed in 7.1% (8 segments). Sensitivity and specificity of 3D images were 87.0% and 93.9%, which were not statistically different (p<0.05) from that of SPECT images (91.3%, 97.0%). Receiver operating characteristic (ROC) analysis revealed nearly identical curves for the two. Although 3D display had nearly identical diagnostic ability with SPECT, observers reported that 3D images were easier to diagnose than SPECT images. An advantage of the 3D display is that the display gives a more realistic impression of the left ventricle to an observer than tomography or planar imaging. Another advantage is that 3D display can reduce the amount of data storage compared with that of SPECT. In conclusion, 3D images may be useful for diagnosis of hypoperfusion of left ventricle. (author)

  15. BNP was Associated with Ischemic Myocardial Scintigraphy and Death in Patients at Chest Pain Unit

    Azevedo, Jader Cunha de, E-mail: jadercazevedo@gmail.com [Universidade Federal Fluminense, Niterói, Rio de Janeiro, RJ (Brazil); Hospital Pró-Cardíaco, Rio de Janeiro, RJ (Brazil); Centro Universitário de Volta Redonda, Rio de Janeiro, RJ (Brazil); Reis, Bruno Cezario Costa; Barreto, Nathalia Monerat P.B. [Centro Universitário de Volta Redonda, Rio de Janeiro, RJ (Brazil); F, Diogenes S. Junior; Prezotti, Lais S. [Universidade Federal Fluminense, Niterói, Rio de Janeiro, RJ (Brazil); Procaci, Victor Rebelo; Octaviano, Vivian Werneck [Centro Universitário de Volta Redonda, Rio de Janeiro, RJ (Brazil); Volschan, Andre [Hospital Pró-Cardíaco, Rio de Janeiro, RJ (Brazil); Mesquita, Evandro Tinoco; Mesquita, Claudio Tinoco [Universidade Federal Fluminense, Niterói, Rio de Janeiro, RJ (Brazil); Hospital Pró-Cardíaco, Rio de Janeiro, RJ (Brazil)

    2015-01-15

    Recent studies have suggested that B-type Natriuretic Peptide (BNP) is an important predictor of ischemia and death in patients with suspected acute coronary syndrome. Increased levels of BNP are seen after episodes of myocardial ischemia and may be related to future adverse events. To determine the prognostic value of BNP for major cardiac events and to evaluate its association with ischemic myocardial perfusion scintigraphy (MPS). This study included retrospectively 125 patients admitted to the chest pain unit between 2002 and 2006, who had their BNP levels measured on admission and underwent CPM for risk stratification. BNP values were compared with the results of the MPS. The chi-square test was used for qualitative variables and the Student t test, for quantitative variables. Survival curves were adjusted using the Kaplan-Meier method and analyzed by using Cox regression. The significance level was 5%. The mean age was 63.9 ± 13.8 years, and the male sex represented 51.2% of the sample. Ischemia was found in 44% of the MPS. The mean BNP level was higher in patients with ischemia compared to patients with non-ischemic MPS (188.3 ± 208.7 versus 131.8 ± 88.6; p = 0.003). A BNP level greater than 80 pg/mL was the strongest predictor of ischemia on MPS (sensitivity = 60%, specificity = 70%, accuracy = 66%, PPV = 61%, NPV = 70%), and could predict medium-term mortality (RR = 7.29, 95% CI: 0.90-58.6; p = 0.045) independently of the presence of ischemia. BNP levels are associated with ischemic MPS findings and adverse prognosis in patients presenting with acute chest pain to the emergency room, thus, providing important prognostic information for an unfavorable clinical outcome.

  16. Myocardial perfusion scintigraphy in Germany. Results of the 2005 query and current status

    The working group Cardiovascular Nuclear Medicine of the German Society of Nuclear Medicine (DGN), in cooperation with the working group Nuclear Cardiology of the German Cardiac Society (DGK), decided to conduct a national survey on myocardial perfusion scintigraphy (MPS). Method: a questionnaire to evaluate MPS for the year 2005 was sent. Results: 346 completed questionnaires had been returned (213 private practices, 99 hospitals and 33 university hospitals). MPS of 112 707 patients were reported with 110 747 stress and 95 878 rest studies. The majority (> 75%) was performed with 99mTc-MIBI or tetrofosmin. 201Tl stress-redistribution was used in 22 637 patients (20%). The types of stress were exercise in 78%, vasodilation with adenosine or dipyridamol in 21% and dobutamine in 1%. 99.97% of all MPS were SPECT studies. Gated SPECT was performed in 36% of the stress and in 32% of the rest studies. An attenuation correction was used in 21%. 29 institutions (8%) performed gated SPECT (stress and rest) and attenuation correction. 47% of all MPS were requested by ambulatory care cardiologists, 17% by internists, 12% by primary care physicians, 21% by hospital departments and 2% by others. Conclusion: in Germany, MPS is predominantly performed with 99mTc-perfusion agents. The common type of stress is ergometry. Gated SPECT and attenuation correction do not yet represent standards of MPS practice in Germany, which indicates some potential of optimization. (orig.)

  17. Myocardial perfusion scintigraphy 2006 in Germany. Results of the query and current status

    Aim: this second survey was to deliver further information on myocardial perfusion scintigraphy (MPS) in Germany in 2006. Method: 351 questionnaires were evaluated: 207 private practices (PP), 117 hospitals (HO), 27 from university hospitals (UH). Results: MPS of 106 331 patients were reported, 85% were investigated with 99mTc-perfusion tracers. 74% [2005 = 72%] were performed in PP, 17% [2005 = 15%] in HO and 9% [2005 = 13%] in UH. PP, which participated in 2005 and 2006, demonstrated an increase by 3,9% (HO 0%, UH -13,0%). The type of stress was pharmacological in 27% [2005 = 22%]; 54% adenosine (of these 29% with exercise), 37% dipyridamole (of these 56% with exercise), and 9% dobutamine. Gated SPECT was performed in 42% [2005 = 36%] of all rest- and in 39% [2005 32%] of all stress MPS. An attenuation correction was used by 69 [2005 = 78] institutions. 40% of all MPS were performed in patients suspected to have CAD. 24% of all institutions reported changes in the use of MPS by competing methods. Conclusion: there is a small increase of MPS between 2005 and 2006 despite competing methods. Gated SPECT has experienced more acceptance. Suspicion of CAD is an important indication of MPS. In order to tap the full potential of MPS a gated SPECT should be performed routinely. (orig.)

  18. Myocardial perfusion scintigraphy in Germany. Results of the 2005 query and current status

    Lindner, O. [Inst. fuer Radiologie, Nuklearmedizin und Molekulare Bildgebung, Herz- und Diabeteszentrum NRW, Bad Oeynhausen (Germany); Burchert, W. [Inst. fuer Radiologie, Nuklearmedizin und Molekulare Bildgebung, Herz- und Diabeteszentrum NRW, Bad Oeynhausen (Germany); Arbeitsgemeinschaft ' ' Kardiovaskulaere Nuklearmedizin' ' der Deutschen Gesellschaft fuer Nuklearmedizin (Germany); Bengel, F.M. [Cardiovascular Nuclear Medicine, Johns Hopkins Medical Insts., Baltimore (United States); Arbeitsgruppe ' ' Nuklearkardiologische Diagnostik' ' der Deutschen Gesellschaft fuer Kardiologie (Germany); Zimmermann, R. [Arbeitsgruppe ' ' Nuklearkardiologische Diagnostik' ' der Deutschen Gesellschaft fuer Kardiologie (Germany); Medizinische Klinik, Klinikum Pforzheim GmbH (Germany); Dahl, J. vom [Klinik fuer Kardiologie, Kliniken Maria Hilf GmbH, Moenchengladbach (Germany); Schaefer, W.; Buell, U. [Klinik fuer Nuklearmedizin, Universitaetsklinikum Aachen (Germany); Schober, O. [Klinik und Poliklinik fuer Nuklearmedizin, Universitaetsklinikum Muenster (Germany); Schwaiger, M. [Nuklearmedizinische Klinik, Klinikum Rechts der Isar, Muenchen (Germany); Kluge, R. [Klinik und Poliklinik fuer Nuklearmedizin, Univ. Leipzig (Germany); Schaefers, M. [Arbeitsgemeinschaft ' ' Kardiovaskulaere Nuklearmedizin' ' der Deutschen Gesellschaft fuer Nuklearmedizin (Germany); Klinik und Poliklinik fuer Nuklearmedizin, Universitaetsklinikum Muenster (Germany)

    2007-07-01

    The working group Cardiovascular Nuclear Medicine of the German Society of Nuclear Medicine (DGN), in cooperation with the working group Nuclear Cardiology of the German Cardiac Society (DGK), decided to conduct a national survey on myocardial perfusion scintigraphy (MPS). Method: a questionnaire to evaluate MPS for the year 2005 was sent. Results: 346 completed questionnaires had been returned (213 private practices, 99 hospitals and 33 university hospitals). MPS of 112 707 patients were reported with 110 747 stress and 95 878 rest studies. The majority (> 75%) was performed with {sup 99m}Tc-MIBI or tetrofosmin. {sup 201}Tl stress-redistribution was used in 22 637 patients (20%). The types of stress were exercise in 78%, vasodilation with adenosine or dipyridamol in 21% and dobutamine in 1%. 99.97% of all MPS were SPECT studies. Gated SPECT was performed in 36% of the stress and in 32% of the rest studies. An attenuation correction was used in 21%. 29 institutions (8%) performed gated SPECT (stress and rest) and attenuation correction. 47% of all MPS were requested by ambulatory care cardiologists, 17% by internists, 12% by primary care physicians, 21% by hospital departments and 2% by others. Conclusion: in Germany, MPS is predominantly performed with {sup 99m}Tc-perfusion agents. The common type of stress is ergometry. Gated SPECT and attenuation correction do not yet represent standards of MPS practice in Germany, which indicates some potential of optimization. (orig.)

  19. Myocardial perfusion scintigraphy 2006 in Germany. Results of the query and current status

    Lindner, O. [Inst. fuer Radiologie, Nuklearmedizin und Molekulare Bildgebung, Herz- und Diabeteszentrum NRW, Bad Oeynhausen (Germany); Burchert, W. [Inst. fuer Radiologie, Nuklearmedizin und Molekulare Bildgebung, Herz- und Diabeteszentrum NRW, Bad Oeynhausen (Germany); Arbeitsgemeinschaft Kardiovaskulaere Nuklearmedizin der Deutschen Gesellschaft fuer Nuklearmedizin (Germany); Bengel, F.M. [Cardiovascular Nuclear Medicine, Johns Hopkins Medical Institutions, Baltimore, MD (United States); Arbeitsgruppe Nuklearkardiologische Diagnostik der Deutschen Gesellschaft fuer Kardiologie (Germany); Zimmermann, R. [Arbeitsgruppe Nuklearkardiologische Diagnostik der Deutschen Gesellschaft fuer Kardiologie (Germany); Medizinische Klinik, Klinikum Pforzheim GmbH (Germany); Dahl, J. vom [Klinik fuer Kardiologie, Kliniken Maria Hilf GmbH, Moenchengladbach (Germany); Schaefer, W. [Klinik fuer Nuklearmedizin, Universitaetsklinikum Aachen (Germany); Schober, O. [Klinik und Poliklinik fuer Nuklearmedizin, Universitaetsklinikum Muenster UKM (Germany); Kluge, R. [Klinik und Poliklinik fuer Nuklearmedizin, Univ. Leipzig (Germany); Schaefers, M. [Arbeitsgemeinschaft Kardiovaskulaere Nuklearmedizin der Deutschen Gesellschaft fuer Nuklearmedizin (Germany); Klinik und Poliklinik fuer Nuklearmedizin, Universitaetsklinikum Muenster UKM (Germany)

    2008-07-01

    Aim: this second survey was to deliver further information on myocardial perfusion scintigraphy (MPS) in Germany in 2006. Method: 351 questionnaires were evaluated: 207 private practices (PP), 117 hospitals (HO), 27 from university hospitals (UH). Results: MPS of 106 331 patients were reported, 85% were investigated with {sup 99m}Tc-perfusion tracers. 74% [2005 = 72%] were performed in PP, 17% [2005 = 15%] in HO and 9% [2005 = 13%] in UH. PP, which participated in 2005 and 2006, demonstrated an increase by 3,9% (HO 0%, UH -13,0%). The type of stress was pharmacological in 27% [2005 = 22%]; 54% adenosine (of these 29% with exercise), 37% dipyridamole (of these 56% with exercise), and 9% dobutamine. Gated SPECT was performed in 42% [2005 = 36%] of all rest- and in 39% [2005 = 32%] of all stress MPS. An attenuation correction was used by 69 [2005 = 78] institutions. 40% of all MPS were performed in patients suspected to have CAD. 24% of all institutions reported changes in the use of MPS by competing methods. Conclusion: there is a small increase of MPS between 2005 and 2006 despite competing methods. Gated SPECT has experienced more acceptance. Suspicion of CAD is an important indication of MPS. In order to tap the full potential of MPS a gated SPECT should be performed routinely. (orig.)

  20. Decreased accumulation of 123I-metaiodobenzylguanidine myocardial scintigraphy in Parkinson's disease

    123I-metaiodobenzylguanidine (MIBG) is an analog of norepinephrine and a tracer for sympathetic neuron integrity and function. MIBG myocardial scintigraphy was performed in 11 patients with Parkinson's disease (PD) and 8 control subjects to investigate the cardiac sympathetic nerve function of PD. On the SPECT images, while normal accumulation was observed in control subjects, low or no uptake was observed in all patient with PD. In planar imaging studies, heart to mediastinum average count ratio (H/M) was calculated on both early and delayed images. The mean value of H/M in patients with PD reveals significant difference from that in the control subjects. In patients with PD, there was no significant correlation between H/M and 'stage of Hoehn and Yahr' or between H/M and intensity of drug treatment. It was estimated that decreased H/M and absent accumulation of MIBG in PD may be due to the cardiac sympathetic nerve dysfunction or the down regulation of norepinephrine transporter. (author)

  1. Clinical course of cor pulmonale investigated after an interval of one year by thallium-201 myocardial SPECT scintigraphy

    Cor pulmonale was evaluated in 13 patients with chronic lung disease by thallium-201 myocardial SPECT scintigraphy together with pulmonary function tests and right heart catheterization. One year later, we performed this scintigraphy again to investigate the clinical course of the cor pulmonale. In 6 of 13 patients with respiratory failure (Pao2 less than 60 Torr), a remarkable progression in cor pulmonale was noted after one year, despite outpatient oxygen therapy. If the patients were admitted because of acute exacerbation of respiratory failure, the cor pulmonale was found to have worsened. In contrast, patients with acute exacerbation due to respiratory infection or causes other than respiratory failure, showed little change in cor pulmonale. Although patients with a marked progression of cor pulmonale tended to have poor pulmonary function data and elevated pulmonary arterial pressure, the clinical course of cor pulmonale could not be predicted from the initial pulmonary function tests or right heart catheterization. (author)

  2. Utility of the combination of DAT SPECT and MIBG myocardial scintigraphy in differentiating dementia with Lewy bodies from Alzheimer's disease

    Shimizu, Soichiro; Hirao, Kentaro; Kanetaka, Hidekazu; Namioka, Nayuta; Hatanaka, Hirokuni; Hirose, Daisuke; Fukasawa, Raita; Umahara, Takahiko; Sakurai, Hirohumi; Hanyu, Haruo [Tokyo Medical University, Department of Geriatric Medicine, Shinjuku-ku, Tokyo (Japan)

    2016-01-15

    {sup 123}I-2β-Carbomethoxy-3β-(4-iodophenyl)-N-(3-fluoropropyl) nortropane ({sup 123}I-FP-CIT) dopamine transporter single photon emission computed tomography (DAT SPECT) and {sup 123}I-metaiodobenzylguanidine (MIBG) myocardial scintigraphy can be used to assist in the diagnosis of patients with dementia with Lewy bodies (DLB). We compared the diagnostic value of these two methods in differentiating DLB from Alzheimer's disease (AD). Furthermore, we evaluated whether a combination of DAT SPECT and MIBG myocardial scintigraphy would provide a more useful means of differentiating between DLB and AD. Patients with AD (n = 57) and patients with DLB (n = 76) who underwent both DAT SPECT and MIBG myocardial scintigraphy were enrolled. The sensitivity, specificity, and accuracy of both methods as well as their combination for differentiating DLB from AD were calculated. Moreover, we examined whether symptoms of the patients with DLB were associated with the patterns of the abnormalities displayed on DAT SPECT and MIBG myocardial scintigraphy. The sensitivity and specificity of differentiating DLB from AD were 72.4 and 94.4 % by the heart to mediastinum ratio of MIBG uptake, 88.2 and 88.9 % by the specific binding ratio on DAT SPECT, and 96.1 and 90.7 % by their combination, respectively. The combined use of DAT SPECT and MIBG myocardial scintigraphy enabled more accurate differentiation between DLB and AD compared with either DAT SPECT or MIBG myocardial scintigraphy alone. There was a significantly higher frequency of parkinsonism in the abnormal DAT SPECT group than the normal DAT SPECT group. On the other hand, there was a higher frequency of the appearance of rapid eye movement (REM) sleep behavior disorder in the abnormal MIBG uptake group than the normal MIBG uptake group. These results suggested that using a combination of these scintigraphic methods is a useful and practical approach to differentiate DLB from AD. (orig.)

  3. Prevalence of myocardial ischaemia as assessed with myocardial perfusion scintigraphy in patients with diabetes mellitus type 2 and mild anginal symptoms

    Wiersma, Jacobijne J.; Trip, Mieke D.; Piek, Jan J.; Tijssen, Jan G.P. [Academic Medical Center, Department of Cardiology, Amsterdam (Netherlands); Verberne, Hein J.; Eck-Smit, Berthe L.F. van [Academic Medical Center Amsterdam, Department of Nuclear Medicine, Amsterdam (Netherlands); Holt, Wik L. ten [Amstelland Hospital, Department of Cardiology, Amstelveen (Netherlands)

    2006-12-15

    To determine the prevalence and predictors of reversible myocardial perfusion defects, indicative of myocardial ischaemia, in patients with mild, stable anginal complaints [Canadian Cardiovascular Society classification (CCS) I-II/IV] and diabetes mellitus type 2 (T2DM). A total of 329 patients with T2DM and stable, mild anginal symptoms (CCS I-II/IV) underwent myocardial perfusion scintigraphy. Perfusion images were assessed using a five-point (semi)-quantitative scoring system according to a 17-segment myocardial model. One-hundred and fifty-six (47%) patients showed reversible myocardial perfusion defects defined as a summed difference score of {>=}3. Male gender [odds ratio (OR) 2.28, 95% CI 1.4-3.71, p=0.001], previous myocardial infarction (MI) without revascularisation (OR 3.04, 95% CI 1.28-7.24, p=0.01), and the use of two or more classes of anti-anginal medication (OR 2.36, 95% CI 1.48-3.76, p<0.001) were independent predictors for the presence of reversible defects. By contrast, lipid-lowering therapy reduced the possibility of reversible perfusion defects (OR 0.56, 95% CI 0.33-0.95, p=0.03). Approximately half of the patients with mild, stable angina pectoris and T2DM showed evidence of myocardial ischaemia. Male gender, previous MI and the use of anti-anginal medication were positive predictors and lipid-lowering therapy was a negative predictor for the results of the scintigraphic stress test. (orig.)

  4. Prevalence of myocardial ischaemia as assessed with myocardial perfusion scintigraphy in patients with diabetes mellitus type 2 and mild anginal symptoms

    To determine the prevalence and predictors of reversible myocardial perfusion defects, indicative of myocardial ischaemia, in patients with mild, stable anginal complaints [Canadian Cardiovascular Society classification (CCS) I-II/IV] and diabetes mellitus type 2 (T2DM). A total of 329 patients with T2DM and stable, mild anginal symptoms (CCS I-II/IV) underwent myocardial perfusion scintigraphy. Perfusion images were assessed using a five-point (semi)-quantitative scoring system according to a 17-segment myocardial model. One-hundred and fifty-six (47%) patients showed reversible myocardial perfusion defects defined as a summed difference score of ≥3. Male gender [odds ratio (OR) 2.28, 95% CI 1.4-3.71, p=0.001], previous myocardial infarction (MI) without revascularisation (OR 3.04, 95% CI 1.28-7.24, p=0.01), and the use of two or more classes of anti-anginal medication (OR 2.36, 95% CI 1.48-3.76, p<0.001) were independent predictors for the presence of reversible defects. By contrast, lipid-lowering therapy reduced the possibility of reversible perfusion defects (OR 0.56, 95% CI 0.33-0.95, p=0.03). Approximately half of the patients with mild, stable angina pectoris and T2DM showed evidence of myocardial ischaemia. Male gender, previous MI and the use of anti-anginal medication were positive predictors and lipid-lowering therapy was a negative predictor for the results of the scintigraphic stress test. (orig.)

  5. Prevalence of Ischemia on Myocardial Perfusion Scintigraphy of Pre- and Postmenopausal Women

    In postmenopausal women, the presence of risk factors for coronary artery disease (CAD) increases. However, the difference in prevalence of ischemia between pre- and postmenopausal women with multiple risk factors for CAD has not been well established. To compare the prevalence of ischemia on Tc99m-sestamibi myocardial perfusion scintigraphy (MPS) in pre-and postmenopausal women, and to evaluate whether menopause can be considered an independent risk predictor of ischemia in women with multiple risk factors for CAD. This study retrospectively assessed 500 MPS of pre- and postmenopausal women with multiple risk factors for CAD. Statistical analysis was performed by using Fisher exact test and univariate and multivariate analysis, a p value ≤ 0.05 being considered significant. Postmenopausal women represented 55.9% of the sample; 83.3% were hypertensive; 28.9%, diabetic; 32.1%, smokers; 25%, obese; 61.2% had high cholesterol levels; and 34.3% had known CAD. Postmenopausal women were more often hypertensive, diabetic and dyslipidemic, and had lower functional capacity on exercise testing (p = < 0.005). The presence of ischemia on MPS did not significantly differ between the pre- and postmenopausal groups (p = 0.395). The only variable associated with ischemia on MPS was known CAD (p = 0.004). The results suggest that, in women with multiple risk factors for CAD, menopause was not an independent predictor of ischemia on MPS. Those data support the idea that the investigation of ischemia via MPS in women with multiple risk factors for CAD should begin prior to menopause

  6. Myocardial perfusion scintigraphy 2007 in Germany. Results of the query and current status

    Lindner, O. [Inst. fuer Radiologie, Nuklearmedizin und Molekulare Bildgebung, Herz- und Diabeteszentrum NRW, Bad Oeynhausen (Germany); Burchert, W. [Inst. fuer Radiologie, Nuklearmedizin und Molekulare Bildgebung, Herz- und Diabeteszentrum NRW, Bad Oeynhausen (Germany); Arbeitsgemeinschaft Kardiovaskulaere Nuklearmedizin der Deutschen Gesellschaft fuer Nuklearmedizin (Germany); Bengel, F.M. [Cardiovascular Nuclear Medicine, Johns Hopkins Medical Institutions, Baltimore (United States); Arbeitsgruppe Nuklearkardiologische Diagnostik der Deutschen Gesellschaft fuer Kardiologie (Germany); Zimmermann, R. [Arbeitsgruppe Nuklearkardiologische Diagnostik der Deutschen Gesellschaft fuer Kardiologie (Germany); Medizinische Klinik, Klinikum Pforzheim GmbH, Pforzheim (Germany); Dahl, J. vom [Klinik fuer Kardiologie, Kliniken Maria Hilf GmbH, Moenchengladbach (Germany); Schaefer, W. [Klinik fuer Nuklearmedizin, Universitaetsklinikum Aachen (Germany); Schober, O. [Klinik und Poliklinik fuer Nuklearmedizin, Universitaetsklinikum Muenster UKM (Germany); Schaefers, M. [Arbeitsgemeinschaft Kardiovaskulaere Nuklearmedizin der Deutschen Gesellschaft fuer Nuklearmedizin (Germany); Klinik und Poliklinik fuer Nuklearmedizin, Universitaetsklinikum Muenster UKM (Germany)

    2009-07-01

    Aim: This third survey of the working group Cardiovascular Nuclear Medicine of the German Society of Nuclear Medicine in cooperation with the working group Nuclear Cardiology of the German Cardiac Society was to deliver information on the procedures and in particular on the development of myocardial perfusion scintigraphy (MPS) from 2005 to 2007. Method: 370 questionnaires (222 private practices (PP), 117 hospitals (HO), 31 university hospitals (UH)) were evaluated. Results: MPS of 114,374 patients were reported, 83% were investigated with {sup 99m}Tc-perfusion tracers. 76% [2006=74%] were performed in PP, 15% [2006=17%] in HO and 9% [2006=9%] in UH. Diabetics represented 21% of all MPS patients in 2007. Data of 215 institutions which participated all from 2005 to 2007 showed an increase in MPS of 2.3% (PP +6.8%, HO -4.5%, UH -18.2%). The type of stress was pharmacological in 27% [2006 = 27%]; 67% adenosine (of these 25% with exercise), 31% dipyridamole (of these 55% with exercise), and 2% dobutamine. Gated SPECT was performed in 47% [2006 = 42%] of all rest and in 44% [2006 = 39%] of all stress MPS. 61% [2006 = 83%] of all institutions did not apply perfusion scores. 20% [2006 = 24%] of the institutions reported changes in the use of MPS by competing methods. Conclusion: There is a small increase of MPS between 2005 and 2007 despite competing methods. Gated SPECT has experienced more acceptance, but is still underrepresented. As compared to the European average and general standards of MPS a considerable backlog accounts to pharmacological stress tests, gated SPECT and perfusion scores. (orig.)

  7. Myocardial perfusion scintigraphy 2008 in Germany. Results of the fourth query

    Aim: The working group Cardiovascular Nuclear Medicine of the German Society of Nuclear Medicine in cooperation with the working group Nuclear Cardiology of the German Cardiac Society herewith present the results of the 4th survey on myocardial perfusion scintigraphy (MPS) of the year 2008. Method: 310 questionnaires (191 private practices (PP), 93 hospitals (HO), 31 university hospitals (UH)) were evaluated. Results: MPS of 98 947 patients were reported. 15% of them were younger than 50 y, 57% between 50 and 70 y and 28% older than 70 y. 88% [2007: 83%] of all were studied with Tc-99m perfusion tracers. The patient radiation exposure of a stress and rest protocol considering German standard recommended doses was 8.5 mSv, of a stress-only protocol 1.9 mSv. 77% [2007: 76%] of the MPS were performed in PP, 15% [2007: 15%] in HO and 8% [2007: 9%] in UH. From 2005 to 2008 there was a mild increase in the MPS numbers by 1.2% (PP +7.1%, HO -5.5%, UH -31.4%). The type of stress was pharmacological in 30% [2007: 27%]; 68% adenosine (of these 22% with exercise), 29% dipyridamole (of these 64% with exercise), and <1% dobutamine. Gated SPECT was performed in 46% [2007: 47%] of all rest and in 42% [2007: 44%] of all stress MPS. 62% [2007: 61%] of all institutions did not use perfusion scores. Conclusion: The MPS numbers from 2005 to 2008 in Germany can be regarded as stable. However, there are considerable shifts from HO and UH to PP. The well known potential of MPS considering risk stratification and functional analysis has not been tapped so far. Both gated SPECT and a quantitative perfusion analysis should be performed routinely in every patient.

  8. Prevalence of Ischemia on Myocardial Perfusion Scintigraphy of Pre- and Postmenopausal Women

    Santos, Daniel Augusto Message dos, E-mail: danielmessage@cardiol.br; Navarro, Wendy Yasdin Sierraalta; Alexandre, Leonardo Machado; Cestari, Priscila Feitosa; Smanio, Paola Emanuela Poggio [Instituto Dante Pazzanese de Cardiologia, São Paulo, SP (Brazil)

    2013-12-15

    In postmenopausal women, the presence of risk factors for coronary artery disease (CAD) increases. However, the difference in prevalence of ischemia between pre- and postmenopausal women with multiple risk factors for CAD has not been well established. To compare the prevalence of ischemia on Tc{sup 99m}-sestamibi myocardial perfusion scintigraphy (MPS) in pre-and postmenopausal women, and to evaluate whether menopause can be considered an independent risk predictor of ischemia in women with multiple risk factors for CAD. This study retrospectively assessed 500 MPS of pre- and postmenopausal women with multiple risk factors for CAD. Statistical analysis was performed by using Fisher exact test and univariate and multivariate analysis, a p value ≤ 0.05 being considered significant. Postmenopausal women represented 55.9% of the sample; 83.3% were hypertensive; 28.9%, diabetic; 32.1%, smokers; 25%, obese; 61.2% had high cholesterol levels; and 34.3% had known CAD. Postmenopausal women were more often hypertensive, diabetic and dyslipidemic, and had lower functional capacity on exercise testing (p = < 0.005). The presence of ischemia on MPS did not significantly differ between the pre- and postmenopausal groups (p = 0.395). The only variable associated with ischemia on MPS was known CAD (p = 0.004). The results suggest that, in women with multiple risk factors for CAD, menopause was not an independent predictor of ischemia on MPS. Those data support the idea that the investigation of ischemia via MPS in women with multiple risk factors for CAD should begin prior to menopause.

  9. Three minute versus six minute adenosine infusion in myocardial perfusion scintigraphy

    Pharmacological stress imaging techniques are used widely in clinical nuclear cardiology for evaluation of ischemic heart disease. Adenosine is often used but is expensive and causes significant side effects .The aim of this retrospective review was to study the tolerance and efficacy, of adenosine infusion of a 3 minute (min) versus the conventional 6 min stress protocol and to assess the cost efficiency of the 3 min protocol. Three hundred thirty one patients had myocardial scintigraphy using adenosine as a stressing agent. Blood pressure, heart rate and ECG were recorded at baseline and during the test. Symptoms (flushing, headache, chest pain, dyspnoea, neck pain) were recorded throughout the adenosine infusion. All the patients had had either 6 min or 3 min adenosine infusion at 140 mg/kg per minute. 169 of them had side effects. Flushing (32% at 3 min vs 50 % at 6 min, p<0.05), headache (11.5% at 3 min vs 7 % at 6 min p-not significant-ns), chest pain (8% at 3 min vs 13 % at 6 min, ns), dyspnoea (7% at 3 min vs %10 at 6 min, ns), ECG changes (10% at 3 min vs 28% at 6 min, p<0.05), neck pain (4.5% at 3 min vs 9% at 6 min, ns), abdominal discomfort (3% at 3 min vs 3% at 6 min, ns) and fall in blood pressure (6% at 3 min vs 8.5% at 6 min, ns). The change in heart rate was not significant with either protocol. The 6 min and 3 min infusions of adenosine had similar accuracy (73% vs 70%) for the detection of coronary artery disease. The patients tolerated the 3 min protocol better with only 40% of the patients having minimal side effects compared with 60% for the 6 mon protocol. The 3 min protocol is also cost effective as it uses less adenosine and therefore reduces total costs by 40 US$ per patient. (author)

  10. Interest of 123I-mibg cardiac tomo-scintigraphy coupled with myocardial perfusion in diagnosis of multiple system atrophy

    Objective: The aim of this prospective study is to assess the pertinence of using 123I-mibg myocardial tomo-scintigraphy coupled with perfusion scintigraphy as a diagnostic tool, to discriminate between multiple system atrophy (M.S.A.) and idiopathic Parkinson's disease (P.D.) at first guided by clinical data and L-DOPA tests. Material and methods: Forty patients, aged from 43 to 78 years (median 62 years) with Parkinson's syndrome were studied. Nineteen had a diagnosis of P.D. (criteria of brain bank) and 21 A.M.S. (Gibbs criteria). All were given test to acute L-DOPA. Chest-centered planar imaging (128 x 128 matrix, 5 minutes of duration) is performed at 1 hour and 4 hours after injection of 220 MBq of 123I-mibg, in addition a non-synchronized tomo-scintigraphy (64 x 64 matrix, 32 images of 50 seconds, zoom 1.45) was performed after the 4. hour and 15 minutes after injection of 200 to 400 MBq of 99mTc-tetrofosmin. Besides neurological data, the parameters retained for comparison purposes with 123I-mibg cardiac tomo-scintigraphy were patients age, duration of disease and L-DOPA test results. Two regions of interest (R.O.I.) identical in size and in shape are used for 123I-mibg uptake quantifications (H/M and washout [W.o.]). The first one was placed in projection of mediastinum (M) and the other one in projection of heart (H). Results: We found an overall decreased uptake of the myocardial 123I-mibg without perfusion abnormality in 15 of 19 patients with P.D. and 11 among them were L-DOPA sensitive (L-DOPA test greater than 30%). Normal tracer uptake with 123I-mibg associated with an almost quite normal perfusion was seen in 15 of 21 patients with M.S.A. and they were little or not L-DOPA sensitive (L-DOPA test less than 30%). Therefore, 10 discordant cases (25%) between cardiac scintigraphy and clinical evolution of disease with also discordant L-DOPA tests were observed. In the P.D. group, quantification of data enhanced the diagnostic decision with low heart to

  11. Indications for myocardial-perfusion-scintigraphy according to the appropriateness criteria; Indikationen zur Myokardperfusionsszintigrafie unter Beruecksichtigung der Appropriateness-Kriterien

    Lindner, Oliver [Inst. fuer Radiologie, Nuklearmedizin und Molekulare Bildgebung, Herz- und Diabeteszentrum NRW, Univ. der Ruhr-Univ. Bochum (Germany)

    2010-06-15

    The German National Care Guideline (Nationale Versorgungsleitlinie) for chronic CAD provides diagnostic algorithms with indications for the use of cardiac radionuclide imaging. In addition, the Appropriateness Criteria of the American College of Cardiology Foundation (ACCF) provide evidence-medicine based and expert rated indications for the appropriate use of myocardial-perfusion-scintigraphy performed as SPECT or PET. They may serve as a guide for clinicians asking for a cardiac radionuclide study and for nuclear physicians to check for appropriate use. An appropriate imaging test provides an incremental information and a clinical benefit with respect to health outcomes and survival. A total of 67 indications was reviewed, 33 were classified as appropriate while uncertain and inappropriate designations were assigned for 9 and 25 indications, respectively. This paper gives an overview of the appropriate and the uncertain indications for myocardial perfusion imaging. (orig.)

  12. The new method of evaluation for the regional myocardial function using the regional wall thickening curve obtained by ECG-gated 201Tl planar myocardial scintigraphy

    A new method was developed for obtaining an increase rate of regional myocardial systolic wall thickness (%WT) in ECG-gated Tl-201 myocardial scintigraphy. Its value was assessed in the clinical setting in comparison with %WT obtained by echocardiography. The subjects were a total of 18 patients with cardiac diseases, including angina pectoris (7), hypertension (3), dilated cardiomyopathy (4), aortic valve stenosis (2), aortic valve regurgitation (one) and sick sinus syndrome (one). Left ventricular septal and posterolateral segments were defined as regions of interest (ROI) on LAO 45deg planar images to correspond to the sites on echocardiographic left ventricular short axial M mode images. In addition, rectangular ROI, which directly crossed the ventricular wall, was assigned to determine changes in myocardial wall thickness, whereby time-activity curve (TAC) was prepared. TAC obtained so far was analogous to that obtained by ultrasound crystal method in an animal experiment. Thus the TAC was supposed to reflect changes in regional myocardial wall thickness. Furthermore, enddiastolic count (EDC) and endsystolic count (ESC) were obtained. %WT was obtained by a formula of (ESC - EDC)/EDC*100. %WT obtained in this way correlated positively with that obtained by echocardiography, for both septal segment (r=0.78) and posterolateral segment (r=0.77). These findings suggested that the regional wall thickening curve can be used in the clinical setting. (N.K.)

  13. Myocardial scintigraphy using 99m-Tc-methoxyisobutylisonitrile (Tc-MIBI): A full substitution of 201-Tl?

    The results of selective coronary angiography, myocardial 201-Tl scintigraphy (stress and redistribution) and after 99m-Tc-methoxyisobutylisonitrile stress and rest injections (Tc-MIBI, Cardiolite, DuPont de Nemours, USA) were compared in 19 patients with manifest ischemic heart disease in identical three projections and after same ergometric load. 16 patients had significant stenoses of 1-3 main coronary arteries inclusive of left coronary artery main stem, insignificant stenoses (<50%) were present in the remaining 3 patients. Scintigraphic localizations of accumulation defects in both Tc-MIBI and 201-Tl stress scintigraphy were in agreement in 70.6% of evaluated left ventricular wall segments. A positive 201-Tl redistribution and rest-stress Tc-MIBI scintigraphic difference agreed in 52.6% of images of all three projections with verified accumulation defects. The sensitivity of ischemic area detection in reference to coronary angiography was nearly identical in 201-Tl (75%) and Tc-MIBI scintigraphy (81.2%). Better physical properties of 99m-Tc from the point of view of a gamma camera detection, a possibility to get markedly higher counting rate and sufficient accumulation of the radiopharmaceutical in the perfused myocardium enable to reach scintigraphic pictures with a high contrast after labelled Tc-MIBI injection, even in case of sequential impulse summation during heart cycle (gating). (author) 1 tab., 1 fig., 14 refs

  14. The value of the Duke Activity Status Index (DASI) in predicting ischaemia in myocardial perfusion scintigraphy - a prospective study

    Background: Functional capacity assessment may be a useful tool to stratify patients according to risk of coronary artery disease (CAD). The Duke Activity Status Index (DASI) is a functional assessment based on activities of daily living and cardiovascular fitness, assessed using a self-administered questionnaire. MATERIAL AND METHODS: We assessed the relationship between established clinical risk factors for CAD and the DASI with results of myocardial perfusion scintigraphy (MPS). The MPS results used in the analysis were the presence of reversible ischaemia and the resting left ventricular ejection fraction (LVEF). A DASI self-administered questionnaire was completed by 117 consecutive participants, and a patient history was taken to ascertain established risk factors. All participants underwent a stress test, and myocardial perfusion scintigraphy was performed. Statistical analysis consisted of logistic and linear regression using a statistical software package. RESULTS: The DASI was the only factor that correlated significantly with reversible ischaemia on MPS. None of the previously established risk factors had a significant association with reversible ischaemia within the model. Our study found a potential relationship between the DASI score and the left ventricular ejection fraction (LVEF) although this was not statistically significant. CONCLUSIONS: Our study findings suggest that the DASI may represent a powerful tool for risk stratification prior to investigation of CAD. A further study with a larger sample size will be required to investigate the predictive value of the DASI and the association with LVEF. (authors)

  15. I-Metaiodobenzylguanidine Myocardial Scintigraphy in Lewy Body-Related Disorders: A Literature Review

    Eun Joo Chung

    2015-05-01

    Full Text Available Lewy body-related disorders are characterized by the presence of Lewy bodies and Lewy neurites, which have abnormal aggregations of α-synuclein in the nigral and extranigral areas, including in the heart. 123I-metaiodobenzylguanidine (MIBG scintigraphy is a well-known tool to evaluate cardiac sympathetic denervation in the Lewy body-related disorders. MIBG scintigraphy showed low uptake of MIBG in the Lewy body-related disorders, including Parkinson’s disease, dementia with Lewy bodies, pure autonomic failure and rapid eye movement sleep behavior disorder. This review summarizes previous results on the diagnostic applications of MIBG scintigraphy in Lewy body-related disorders.

  16. Myocardial perfusion scintigraphy in Germany in 2009: utilization and state of the practice

    Lindner, Oliver; Burchert, Wolfgang [University Hospital of the Ruhr University Bochum, Institute of Radiology, Nuclear Medicine and Molecular Imaging, Heart and Diabetes Centre North Rhine-Westphalia, Bad Oeynhausen (Germany); Bengel, Frank M. [Hanover University School of Medicine, Department of Nuclear Medicine, Hannover (Germany); Zimmermann, Rainer [Klinikum Pforzheim GmbH, Cardiology Department, Pforzheim (Germany); Dahl, Juergen vom [Kliniken Maria Hilf GmbH, Cardiology Department, Moenchengladbach (Germany); Schaefers, Michael [Westfaelische Wilhelms Universitaet Muenster, European Institute of Molecular Imaging, Muenster (Germany)

    2011-08-15

    Since 2006, the working group Cardiovascular Nuclear Medicine of the German Society of Nuclear Medicine, in cooperation with the working group Nuclear Cardiology of the German Cardiac Society, has been surveying the utilization and technical realization of myocardial perfusion scintigraphy (MPS) in Germany. This paper presents the results of the reporting year 2009. A total of 291 centres participated in the inquiry, including 179 private practices (PP), 86 hospitals (HO) and 26 university hospitals (UH). MPS of 98,103 patients were reported. The MPS numbers per million population (pmp) were estimated at 2,360; 76% of the MPS were performed in PP, 17% in HO and 7% in UH. The ratio of MPS to coronary angiography to revascularization was 0.5 to 2.3 to 1. Data from 134 centres which participated in the surveys from 2005 to 2009 showed a decrease in MPS utilization of 2.2%. Nearly half of the MPS were requested by ambulatory care cardiologists. Of all MPS studies, 89% were conducted with {sup 99m}Tc perfusion tracers. Ergometry was the preferred stress test (69%). Adenosine was used in 16%, adenosine + exercise in 7%, dipyridamole in 3%, dipyridamole + exercise in 5% and dobutamine in <1%. Gated single proton emission computed tomography (SPECT) acquisition was performed in 56% of all rest MPS and in 56% of all stress MPS. Both rest and stress MPS were ECG gated in 41%. Only 33% of the centres always performed a quantification of the perfusion studies, whereas 51% did not apply any quantification; 4% of the MPS studies were corrected for attenuation, and 17 centres used transmission sources of 12 CT-based systems. A scan activity of 2,380 MPS pmp is in the upper third of the European range. The ratios to coronary angiography and to revascularization suggest that angiography dominates diagnosis and management of coronary artery disease (CAD). The clinical and technical realizations reveal that the predominant goals of further trainings to optimize MPS are in the field

  17. Detection of residual jeopardized myocardium 3 weeks after myocardial infarction by exercise testing with thallium-201 mycardial scintigraphy

    The usefulness of thallium-201 (Tl-201) exercise myocardial scintigraphy in identifying patients with multivessel coronary artery disease (MVCAD) and residual jeopardized myocardium after myocardial infarction (MI) was evaluated in 32 patients 3 weeks after MI. All patients underwent (1) limited multilead submaximal treadmill testing, (2) thallium-201 (Tl) myocardial scintigraphy at end-exercise and at rest, and (3) coronary and left ventricular angiography. Tl-201 perfusion defects were categorized as either reversible (ischemia) or irreversible (scar). The conventional exercise test was designated positive if there was ST depression > = 1mm and/or angina. Jeopardized myocardium (JEP) was defined angiographically as a segment of myocardium with normal or hypokinetic wall motion supplied by a significantly stenotic major coronary artery. MVCAD was defined as two or more significantly stenotic coronary arteries. Significant coronary stenosis was categorized as either 50 to 69% diameter narrowing or > = 70% diameter narrowing, thereby yielding, respectively, two subgroups each of jeopardized myocardium (JEP-50 and JEP-70) and MVCAD (MV-50 and MV-70). Clinical findings of angina, heart failure or ventricular arrhythmias during the late convalescent period after MI occurred in four of 10 patients (40%) with MV-50, five of 16 (31%) with MV-70, four of 10 (40%) with JEP-50 and five of 18 (28%) with JEP-70, and thus were insensitive for detecting MVCAD and JEP. Reversible ischemia and/or a positive conventional exercise test occurred in five of 10 patients (50%) with MV-50, 13 of 16 (81%) with MV-70, four of 10 (40%) with JEP-50 and 15 of 18 (83%) with JEP-70. All eight patients with both Tl-201 reversible ischemia and a positive conventional exercise test had JEP-70. In 30 of 31 patients (97%) with angiographic asynergy, Tl-201 scar was detected. No complications were associated with exercise testing

  18. Prospective assessment of regional myocardial perfusion before and after coronary revascularization surgery by quantitative thallium-201 scintigraphy

    Because thallium-201 uptake relates directly to the amount of viable myocardium and nutrient blood flow, the potential for exercise scintigraphy to predict response to coronary revascularization surgery was investigated in 47 consecutive patients. All patients underwent thallium-201 scintigraphy and coronary angiography at a mean (+/- standard deviation) of 4.3 +/- 3.1 weeks before and 7.5 +/- 1.6 weeks after surgery. Thallium uptake and washout were computer-quantified and each of six segments was defined as normal, showing total or partial redistribution or a persistent defect. Persistent defects were further classified according to the percent reduction in regional thallium activity; PD25-50 denoted a 25 to 50% constant reduction in relative thallium activity and PD greater than 50 denoted a greater than 50% reduction. Of 82 segments with total redistribution before surgery, 76 (93%) showed normal thallium uptake and washout postoperatively, versus only 16 (73%) of 22 with partial redistribution (probability [p] . 0.01). Preoperative ventriculography revealed that 95% of the segments with total redistribution had preserved wall motion, versus only 74% of those with partial redistribution (p . 0.01). Of 42 persistent defects thought to represent myocardial scar before surgery, 19 (45%) demonstrated normal perfusion postoperatively. Of the persistent defects that showed improved thallium perfusion postoperatively, 75% had normal or hypokinetic wall motion before surgery, versus only 14% of those without improvement (p less than 0.001). Whereas 57% of the persistent defects that showed a 25 to 50% decrease in myocardial activity demonstrated normal thallium uptake and washout postoperatively, only 21% of the persistent defects with a decrease in myocardial activity greater than 50% demonstrated improved perfusion after surgery (p . 0.02)

  19. Evaluation of coronary hemodynamics and exercise sup 201 Tl-myocardial scintigraphy in patients with vasospastic angina

    Matsumura, Kentaro; Nakase, Emiko; Haiyama, Tohru; Hasegawa, Akira; Saito, Takayuki (Kyoto Minami Hospital (Japan))

    1992-05-01

    To clarify the coronary hemodynamics and myocardial perfusion in patients with vasospastic angina, we performed exercise {sup 201}Tl-myocardial scintigraphy (planar and SPECT) in 72 patients and left coronary digital subtraction angiography (DSA) in 37 patients without significant organic coronary artery stenosis. Coronary artery spasm was documented by coronary angiography in all patients. Fifty-four patients (75%) developed exercise-induced {sup 201}Tl-myocardial perfusion defect on SPECT. {sup 201}Tl pulmonary uptake (L/H) was significantly increased in patients with vasospastic angina. Especially, L/H was higher in patients with multiple small perfusion defect on {sup 201}Tl-SPECT, so that exercise-induced left ventricular dysfunction existed in patients with vasospastic angina and especially in cases of multiple small perfusion defect on {sup 201}Tl-SPECT. The left coronary circulation time (CCT) was prolonged in patients with vasospastic angina. The mechanism of prolonged CCT is still unknown, but we suspected that prolonged CCT was induced by increased peripheral coronary vascular resistance in patients with vasospastic angina. It was concluded that the peripheral coronary circulation was disturbed in patients with vasospastic angina, but its abnormal coronary circulation had no relation to location of spasm-induced vessels. We concluded that impaired coronary microcirculation was taken a part of pathophysiology in vasospastic angina. (author).

  20. Perfusion vector - a new method to quantify myocardial perfusion scintigraphy images: a simulation study with validation in patients

    Minarik, David; Senneby, Martin; Wollmer, Per;

    2015-01-01

    for further assisting the visual interpretation and to test the concept using simulated MPS images as well as patients. Methods The perfusion vector is based on calculating the difference between the anatomical centroid and the perfusion center of gravity of the left ventricle. Simulated MPS images were...... obtained using the SIMIND Monte Carlo program together with XCAT phantom. Four different-sized anterior and four lateral defects were simulated, and perfusion vector components x-, y-, and z-axes were calculated. For the patient study, 40 normal and 80 abnormal studies were included. Perfusion vectors were......Background The interpretation of myocardial perfusion scintigraphy (MPS) largely relies on visual assessment by the physician of the localization and extent of a perfusion defect. The aim of this study was to introduce the concept of the perfusion vector as a new objective quantitative method...

  1. Serial change in 123I-MIBG myocardial scintigraphy in non-insulin-dependent diabetes mellitus

    We performed 123I-MIBG (MIBG) myocardial scintigraphy twice in patients with non-insulin-dependent diabetes mellitus (NIDDM) to investigate whether MIBG distribution was improved by pertinent clinical control. To determine the influential factors for MIBG distribution, we investigated the association between various clinical parameters and the serial change in MIBG uptake parameters. Twenty NIDDM patients with no cardiac disorders were evaluated. Planar images were taken at 30 minutes (early) and 3 hours (delayed) after MIBG injection. The heart-to-upper-mediastinum uptake ratio (H/M) and washout ratio (WR) were calculated as parameters for estimating cardiac sympathetic function. Patients were divided into two groups, eight in the improved group and twelve in the unimproved group, according to the serial change in H/M. The mean interval between the baseline and the follow up study was 2.1±0.6 year. Differences between the means of the laboratory data in patients in both groups were compared for the baseline and the follow up study by using the paired t-test. As a means of determining the influential factors for a serial change of MIBG uptake, Fisher's exact test was performed to evaluate the association between the serial change in cardiac MIBG parameters and changes in other clinical parameters, such as blood sugar (BS) control, BS control method (insulin therapy), serum cholesterol control, and severity of diabetic complications. We also analyzed the association between the changes in CVR-R (coefficient variance of R-R intervals at rest ECG) or NCV (velocity of posterior tibial nerve) and those of other clinical parameters. Associations among these neurological parameters (MIBG parameters, CVR-R and NCV) were also analyzed. Paired t-tests showed a significant decrease in fasting blood sugar and fructosamine in the improved group in the follow up study compared to those in the baseline study. Nevertheless, Fisher's exact test showed no significant association

  2. A new protocol of dual energy acquisition on stress 201Tl and rest 99mTc-tetrofosmin myocardial scintigraphy

    We carried out stress 201Tl (Tl) and rest 99mTc-tetrofosmin (TF) myocardial scintigraphy with dual energy acquisition in 24 patients with suspected ischemic heart disease performed coronary arteriography and elucidated the sensitivity of this method. One hour after light meal eating, TF (555 MBq) was injected intravenously at rest and after 3 minutes from injection of TF exercise or pharmacologic stress was performed. During stress Tl (111 MBq) was injected intravenously before end-point or at adequate point of pharmacologic stress. Dual energy acquisition using triple energy windows (TEW) was started after 5 minutes (early) and 4 hours (delayed) from stress. The sensitivity (Sn), specificity (Sp) and accuracy (Ac) in diagnosis of non-infarcted branches by using Tl (early)-TF (rest) and Tl (early)-Tl (delayed) were 79% vs. 53% (Sn), 78% vs. 96% (Sp) and 79% vs. 71% (Ac) respectively. Accordance of uptake score of infarcted region between TF (rest) and Tl (delayed) was 70%. In conclusion, this protocol is seemed to be useful as usual protocol for detection of myocardial ischemia and viability during about only 1 hour. (author)

  3. Clinical implications of increased lung uptake of 201Tl during exercise scintigraphy 2 weeks after myocardial infarction

    To determine the prevalence and clinical significance of increased lung 201Tl uptake during submaximal exercise myocardial scintigraphy performed 2 weeks after acute myocardial infarction, 61 patients underwent submaximal exercise testing (target heart rate, 120 beats/min), multigated blood pool imaging at rest and coronary angiography before hospital discharge. Thallium lung uptake on the initial anterior projection image was graded qualitatively by comparing the intensity of 201Tl activity in the lungs with that in the mediastinum. In 39 patients (64 percent), it was normal (equal to mediastinal activity) and in 22 (36 percent), it was increased (greater than mediastinal activity). Compared with patients with normal lung uptake, those with increased uptake had a greater prevalence of prior infarction (13 versus 36 percent, probability [p] less than 0.05), less global cardiac reserve as assessed by the four level New York Heart Association classification (p less than 0.05), more advanced Killip class in the coronary care unit (p less than 0.05), a higher Norris coronary prognostic index (2.6 +/- 1.9 versus 4.6 +/- 2.3 [mean +/- standard deviation], p less than 0.01), failure to achieve the target heart rate because of dyspnea, fatigue or angina (36 versus 86 percent, p less than 0.01), a greater prevalence of exercise-induced S-T segment depression (18 versus 45 percent, p less than 0.05), a greater number of anterior 201Tl myocardial defects (p less than 0.05); a lower radionuclide ejection fraction at rest (50.4 +/- 6.1 versus 39.6 +/- 9.3 percent, p less than 0.01) and a greater number of asynergic left ventricular segments (p less than 0.05). Thus, the occurrence of increased lung 201Tl uptake during submaximal exercise scintigraphy in the early postinfarction period is frequent and appears to be a marker of severe and functionally more important coronary artery disease associated with left ventricular dysfunction

  4. Detection of myocardial infarction with dual energy CT myocardial iodine maps and perfusion myocardial single photon emission computed tomography scintigraphy: an experimental study in canine

    Objective: To investigate the feasibility and accuracy of dual energy CT myocardial iodine maps in detecting acute myocardial infarction in canine model. Methods: Myocardial ischemia model was made by ligaturing left anterior descending coronary arteries (LAD) after thoracotomy in six dogs, while another 3 dogs undergoing thoracotomy not ligaturing LAD as control group. Before and three hours after operation, dual-source CT (DSCT) was performed, followed by resting 99Tcm-MIBI single photon emission computed tomography myocardial perfusion imaging. Then, dogs were sacrificed, and the hearts were removed, triphenyketrazolium chloride staining and conventional HE staining were performed. CT number of non-ischemic and ischemic regions were measured and analyzed. The wall of the left ventricle in the short axis was divided into 17 segments, the segments of myocardial perfusion defect in DSCT myocardial iodine maps, SPECT, and pathology were determined. Student t test was used to analyze the difference of CT number between infarcted and non-infarcted myocardium. Kappa test was used for the accuracy of DSCT myocardial iodine maps and SPECT in detecting myocardial ischemia according to the pathological results. Results: No abnormal regions were detected using DSCT myocardial iodine maps in preoperative control and infarction group. After thoracotomy, partial sparse or defective perfusion was consistently noted in six dogs' apical anterior and partition wall in both DSCT myocardial iodine maps and SPECT. In the infarcted group, the attenuation of infarction region (34.75±16.66) HU was significantly decreased compared with preoperative measurements (123.18±15.38 ) HU (t=10.526, P<0.01); decreased perfusion in the infarcted region was also noted in the DSCT myocardial iodine maps and SPECT. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of DSCT myocardial iodine maps and SPECT were 85.0% (34/40), 84.1% (95/113), 65.4% (34

  5. Thallium-201 myocardial scintigraphy in coronary triple-vessel disease: An attempt to increase sensitivity using quantitative methods

    In order to increase the sensitivity of thallium-201 exercise scintigraphy in patients with triple vessel coronary disease (TVD), we first examined retrospectively myocardial scintigrams of 179 patients with TVD, as documented subsequently by cardiac catheterization. Ischemia had been diagnosed visually in 141 (79%), scar without ischemia in 25 (14%) and no apparent perfusion defect in 13 (7%) cases. The subset of TVD patients without scintigraphic ischemia (i.e. those with scar or no perfusion defect) was then compared to a control group with normal coronary angiography using four quantitative criteria: (1) in preset-count analog images, a quotient of the exposure times rest image/stress image; (2) in preset-time digital images, a quotient of counts/pixel in stress image/rest image using two different myocardial regions of interest (ROI); (3) a similar quotient using paracardial lung ROIs of three different sizes; (4) the absolute values of stress lung uptake. Quotients (1) and (2) were expected to be lower in TVD patients than in normal controls due to exercise-induced global ischemia, quotient (3) and value (4) were expected to be higher due to exercise-induced left ventricular dysfunction with increased lung uptake of thallium-201. All results showed a tendency to confirm these hypotheses; significant differences (P<0.05) between patients and controls were obtained in all lung quotients and in 3 of 12 myocardial quotients. No significant differences were observed in the exposure time quotients of preset-count images and in the stress lung uptake. Due to overlapping values, it was not possible to fix normal and pathological ranges of any quotient. It is concluded that the increased of ratio of stress/rest lung uptake reflecting exercise-induced pulmonary venous congestion seems to indicate TVD in apparently normal thallium-201 scintigrams in a large number of patients. (orig.)

  6. Thallium 201 scintigraphy in an infant with myocardial infarction following mucocutaneous lymph node syndrome

    A 4-month old boy with myocardial infarction following mucocutaneous lymph node syndrome is described. Angiocardiogram revealed multiple aneurysms of the right and left main coronary arteries, complete occlusion of the left anterior descending and left circumflex coronary arteries, and post-infarction aneurysm of the left ventricle. Thallium 201 scintigram demonstrated the infarcted area precisely and repeat examinations showed the improvement of the myocardial perfusion, which was probably due to the development of the collateral circulation. (orig.)

  7. Usefulness of 123I-Meta-iodobenzylguanidine (MIBG) myocardial scintigraphy for evaluation of cardiac sympathetic nervous system function in diabetic patients

    The cardiac sympathetic nervous system function of diabetic patients with no definite cardiovascular complications other than hypertension was evaluated by 123I -MIBG myocardial scintigraphy. The subjects consisted of 82 diabetic patients, 59 men, 23 women, mean age 57 years, 17 with hypertension and 65 with normal blood pressure, and they were compared with normal controls (8 men and 3 women, mean age 54 years). Myocardial scintigraphy was performed 10 minutes and 4 hours after administration of MIBG. The superior mediastinum and whole myocardium were set as regions of interest, and the heart-to-mediastinum ratio (H/M ratio) and the washout rate (%WR) were calculated. The mean observation period was 18±12 months, and 17 of the 65 diabetic patients with normal blood pressure before the study developed hypertension during the observation period. There were significant differences in H/M ratio and %WR between the diabetic patients and normal controls (H/M ratio; 1.96±0.34 vs 2.27±0.20, %WR; 24.71±16.99% vs 12.89±11.94). The diabetic patients with hypertension had higher morbidity with diabetic retinopathy and a lower H/M ratio. The 17 patients who developed hypertension during the observation period showed an increase in %WR and a reduction in the H/M ratio. Five patients who died during the observation period had a reduced H/M ratio and increased of %WR. 123I-MIBG myocardial scintigraphy in diabetic patients was shown to be useful for detecting cardiac sympathetic nervous system dysfunction, predicting the development of hypertension, and identifying patients who had a poor outcome. Diabetic patients with abnormal signals on MIBG myocardial scintigraphy need to be monitored much more carefully. (K.H.)

  8. Is quantitative analysis superior to visual analysis of planar thallium 201 myocardial exercise scintigraphy in the evaluation of coronary artery disease? - Analysis of a prospective clinical study

    Niemeyer, Menco; Laarman, GertJan; Wall, Ernst; Cramer, Maarten-Jan; Verzijlbergen, Fred; Zwindermans, Aelko; Ascoop, Carl; Pauwels, Ernest K.J.

    1990-01-01

    textabstractQuantitative analysis of myocardial exercise scintigraphy has been previously reported to be superior to visual image interpretation for detection of the presence and extent of coronary artery disease. Computer analysis of perfusion defects and washout rate of thallium 201 was performed on scintigrams from a group of 131 consecutive patients (prospective group), using criteria defined from a previous group of 72 patients (initial group), and compared with visual interpretation of ...

  9. Radiation dose difference between state of the art myocardial perfusion scintigraphy and computed tomography coronary angiography in patients undergoing evaluation for suspected coronary artery disease.

    Tsay, I M; Subiakto, I; Asrar Ul Haq, M; Castles, A V; Allman, K; Hayat, U; Rudd, N; Barlis, P; van Gaal, W

    2016-02-01

    Minimisation of radiation exposure with cardiac imaging reduces the potential of secondary side effects. Radiation exposure from myocardial perfusion scintigraphy and computed tomography coronary angiography (CTCA) was compared. Overall doses were low with both modalities. Doses were lower in the CTCA group, but by only a small difference of 1.1 mSv. Radiation exposure should not be the primary consideration when choosing between these two modalities. PMID:26899890

  10. Usefulness of {sup 123}I-Meta-iodobenzylguanidine (MIBG) myocardial scintigraphy for evaluation of cardiac sympathetic nervous system function in diabetic patients.

    Tamura, Koji; Nakatani, Yuko; Doi, Kenji; Adachi, Gakuji; Takada, Kou

    2001-11-01

    The cardiac sympathetic nervous system function of diabetic patients with no definite cardiovascular complications other than hypertension was evaluated by {sup 123}I -MIBG myocardial scintigraphy. The subjects consisted of 82 diabetic patients, 59 men, 23 women, mean age 57 years, 17 with hypertension and 65 with normal blood pressure, and they were compared with normal controls (8 men and 3 women, mean age 54 years). Myocardial scintigraphy was performed 10 minutes and 4 hours after administration of MIBG. The superior mediastinum and whole myocardium were set as regions of interest, and the heart-to-mediastinum ratio (H/M ratio) and the washout rate (%WR) were calculated. The mean observation period was 18{+-}12 months, and 17 of the 65 diabetic patients with normal blood pressure before the study developed hypertension during the observation period. There were significant differences in H/M ratio and %WR between the diabetic patients and normal controls (H/M ratio; 1.96{+-}0.34 vs 2.27{+-}0.20, %WR; 24.71{+-}16.99% vs 12.89{+-}11.94). The diabetic patients with hypertension had higher morbidity with diabetic retinopathy and a lower H/M ratio. The 17 patients who developed hypertension during the observation period showed an increase in %WR and a reduction in the H/M ratio. Five patients who died during the observation period had a reduced H/M ratio and increased of %WR. {sup 123}I-MIBG myocardial scintigraphy in diabetic patients was shown to be useful for detecting cardiac sympathetic nervous system dysfunction, predicting the development of hypertension, and identifying patients who had a poor outcome. Diabetic patients with abnormal signals on MIBG myocardial scintigraphy need to be monitored much more carefully. (K.H.)

  11. Comparative value of brain perfusion SPECT and [123I]MIBG myocardial scintigraphy in distinguishing between dementia with Lewy bodies and Alzheimer's disease

    Both decreased occipital perfusion on brain single-photon emission computed tomography (SPECT) and reduction in cardiac 123I-metaiodobenzylguanidine (MIBG) uptake are characteristic features of dementia with Lewy bodies (DLB), and potentially support the clinical diagnosis of DLB. The aim of this study was to compare the diagnostic value of these two methods for differentiation of DLB from Alzheimer's disease (AD). The study population comprised 19 patients with probable DLB and 39 patients with probable AD who underwent both SPECT with N-isopropyl-p-[123I]iodoamphetamine and MIBG myocardial scintigraphy. Objective and quantitative measurement of perfusion in the medial occipital lobe, including the cuneus and lingual gyrus, was performed by the use of three-dimensional stereotactic surface projections. Medial occipital perfusion was significantly decreased in the DLB group compared with the AD group. The mean heart/mediastinum ratios of MIBG uptake were significantly lower in the DLB group than in the AD group. Although SPECT failed to demonstrate significant hypoperfusion in the medial occipital lobe in five patients with DLB, marked reduction of MIBG uptake was found in all patients with DLB. Receiver operating characteristic analysis revealed that MIBG myocardial scintigraphy enabled more accurate discrimination between DLB and AD than was possible with perfusion SPECT. MIBG myocardial scintigraphy may improve the sensitivity in the detection of DLB. In particular, this method may provide a powerful differential diagnostic tool when it is difficult to distinguish cases of DLB from AD using brain perfusion SPECT. (orig.)

  12. Clinical evaluation of serial thallium-201 myocardial scintigraphy in special reference to left ventricular function in patients with acute myocardial infarction

    In 20 patients with acute myocardial infarction (AMI), serial Tl-201 myocardial scintigraphy was performed and scintigraphic infarct size (SIS) was determined 1 (or less), 2 and 8 weeks after AMI. Hemodynamic indices were determined with a Swan-Ganz catheter at a mean of 27.7 hours after AMI. Left ventricular ejection fraction (EF) was determined with Tc-99m HSA cardiac blood pool scintigram at 8 weeks after AMI. Mapping ECG was also observed serially. Of 20 patients, SIS decreased in 12, was unchanged in 2 and increased in 5. No image defect was observed on the initial scintigram in one case. When the patients were classified into two groups, i.e. those with initial SIS more than 25% and those with initial SIS less than 25%, hemodynamic indices were demonstrated to be more markedly impaired in the former than in the latter. However, when all patients were pooled, correlations between the initial SIS and hemodynamic indies (CI, SI, SWI, PADP) were poor. There was a good correlation between SIS and EF both determined 8 weeks after AMI. When the patients were clasified into the improved and unimproved groups according to the per cent change of SIS (CIS), both hemodynamic indices on admission and EF at 8 weeks were better in the improved than in the unimproved group, and especially significant correlation was found between CIS and each of SI and PADP. There was a good correlation between maximum ΣST in mapping ECG and SIS at 1 week after AMI. (author)

  13. Diagnosis of occlusion site in the left anterior descending coronary artery in patients with anterior myocardial infarction. Comparison of thallium-201 myocardial scintigraphy and 12-lead electrocardiography

    Yang, Xinchun; Imai, Kamon; Saito, Satoshi; Ozawa, Yukio; Kan-matuse, Katuo [Nihon Univ., Tokyo (Japan). School of Medicine

    1995-03-01

    To evaluate whether the site of occlusion/stenosis in the left anterior descending coronary artery (LAD) could be diagnosed by noninvasive techniques, thallium-201 myocardial scintigraphy (TMS), 12-lead electrocardiography (ECG), and coronary arteriography were performed in 33 patients with anterior acute myocardial infarction (AMI). The subjects were divided into two groups according to the location of stenosis: ie, either proximal to the first diagonal branch (PRO, n=18), or beyond the first diagonal branch (NON-PRO, n=15). The location of the anterior interventricular groove was defined as 0 degrees. The extent of persistent perfusion defect was greater in the PRO group than in the NON-PRO group (0.43{+-}0.12 vs 0.31{+-}0.14, p<0.01). The left margin of the defect in the basal short-axis layer was at 75{+-}30deg in the PRO group and at -19{+-}43deg in the NON-PRO group (p<0.001). A defect with a left margin at >30deg in the basal layer was found in 94% (17/18) of the patients in the PRO group and in 6% (1/15) of the patients in the NON-PRO group (p<0.001). An abnormal Q wave in leads aVL/I was found in 78% (14/18) of the patients in the PRO group and in 20% (3/15) of the patients in the NON-PRO group (p<0.001). The sensitivity, specificity and total predictive accuracy of detection of proximal lesions of the LAD were 94%, 93% and 94% by TMS, and 78%, 80% and 79% by ECG, respectively. A significant difference in accuracy existed between TMS and ECG (p<0.05). These data suggest that it is possible to diagnose the site of occlusion/stenosis of the LAD as either proximal or non-proximal in patients with anterior AMI by TMS and ECG. (author).

  14. Alternating myocardial sympathetic neural function of athlete's heart in professional cycle racers examined with iodine-123-MIBG myocardial scintigraphy

    Myocardial sympathetic neural function in professional athletes who had the long-term tremendous cardiac load has not been fully investigated by myocardial iodine-123-metaiodobenzylguanidine (MIBG) uptake in comparison with power spectral analysis (PSA) in electrocardiography. Eleven male professional cycle racers and age-matched 11 male healthy volunteers were enrolled in this study. The low frequency components in the power spectral density (LF), the high frequency components in the power spectral density (HF), the LF/HF ratio and mean R-R interval were derived from PSA and time-domain analysis of heart rate variability in electrocardiography. The mean heart-to-mediastinum uptake ratio (H/M ratio) of the MIBG uptake, in professional cycle racers was significantly lower than that in healthy volunteers (p<0.01) and HF power in professional cycle racers was significantly higher than that in healthy volunteers (p<0.05). In the group of professional cycle racers, the H/M ratio showed a significant correlation with the R-R interval, as indices of parasympathetic nerve activity (r=0.80, p<0.01), but not with the LF/HF ratio as an index of sympathetic nerve activity. These results may indicate that parasympathetic nerve activity has an effect on MIBG uptake in a cyclist's heart. (author)

  15. Assessment of myocardial damage in dilated-phase hypertrophic cardiomyopathy by using indium-111-antimyosin Fab myocardial scintigraphy

    For the detection of myocardial cell damage, an 111In-antimyosin Fab study was carried out on seven patients (Group A) in the dilated phase of hypertrophic cardiomyopathy, seven patients (Group B) with dilated cardiomyopathy, and eight control patients (Group C). Imaging was done 48 hr after intravenous injection of 74 MBq of 111In-antimyosin Fab. Myocardial antimyosin uptake was visually graded as 0, +1, +2 or +3. A score of +2 or +3 was considered positive. The heart/lung ratio of antimyosin uptake (antimyosin index) also was determined. Antimyosin uptake was positive in seven (100%), nine (90%) and no (0%) patients in Groups A, B, and C, respectively. The antimyosin index in Groups A and B was 2.46 ± 0.49 and 2.04 ± 0.24, respectively, findings were significantly higher than that in Group C (1.51 ± 0.13) (p less than 0.01). Positive biopsy findings were noted in only two patients in Group A. Thus, antimyosin uptake was increased in dilated phase hypertrophic cardiomyopathy and dilated cardiomyopathy, which suggests ongoing necrotic changes in these patients

  16. Myocardial imaging using thallium 201 scintigraphy after dipyridamole infusion: A case history

    Coronary artery disease frequently occurs in combination with peripheral vascular disorders and is an important cause of morbidity and mortality during or after peripheral vascular surgery. However, the detection of coronary artery disease in patients with peripheral vascular disease may be complicated, since most of these patients are unable to perform conventional exercise testing. The authors report a sixty-two-year-old man with an infrarenally located aneurysm of the abdominal aorta who underwent thallium 201 scintigraphy combined with dipyridamole infusion as an alternative exercise test. The subsequent thallium 201 images showed perfusion defects indicative of severe coronary artery disease. Coronary angiography showed an occluded right coronary artery and a significant proximal stenosis in the left anterior descending coronary artery. The patient underwent successful aortocoronary bypass surgery, and two months later, the aortic aneurysm was operated on without complications. As a result, dipyridamole thallium 201 scintigraphy should be considered as a valuable diagnostic test to detect coronary artery disease in patients with peripheral vascular disorders

  17. Method for preparing 99mTc-labelled radiopharmaceuticals for myocardial scintigraphy

    Radiopharmaceuticals which preferably concentrate in myocardial tissue are prepared, in particular technetium compounds with the reducing ligand molecule DMPE. A method is introduced to convert pertechnetate in one step into the proposed compound by means of a saline, slow-oxidizing and lyophilized form of the reducing ligand DMPE, preferably DMPE x 2HCl

  18. Usefulness of thallium-201 myocardial scintigraphy during hyperventilation and accelerated exercise test in patients with vasospastic angina and nearly normal coronary artery

    The usefulness of thallium-201 (201Tl) myocardial scintigraphy was studied in 109 patients with vasospastic angina who had nearly normal coronary arteries (degree of stenosis 201Tl myocardial scintigraphy was compared between four groups, 34 patients performing graded bicycle ergometer exercise starting at a work load of 50 W with increments of 25 W every 3 min (Ergo(3) group), 14 patients performing hyperventilation for 5 min (HV(5) group), 31 patients performing bicycle ergometer exercise with increments of 25 W every 1 min after 5 min hyperventilation (HV(5)+Ergo(1) group), and 30 patients at rest (Rest group). The value of the visual redistribution rate on 201Tl myocardial scintigrams in the HV(5)+Ergo(l) group (65%) was higher than that in the patients of other groups (Ergo(3) 41%, HV(5) 43%, Rest 33%). However, there were no significant differences between the four groups. Stress 201Tl imaging after hyperventilation and accelerated exercise is useful to disclose ischemic evidence in about two thirds of patients with vasospastic angina and nearly normal coronary arteries, whereas about 40% of patients had visual redistribution on 201Tl myocardial scintigrams by performing standard procedures. (author)

  19. Mapping of the image quality in myocardial scintigraphy: A national study

    The aim of this study was to make a survey over the physical parameters and how they affect the image quality and the final diagnosis for myocardial perfusion SPECT in Sweden. Another aim was to evaluate the need for standardized acquisition and processing protocols for myocardial perfusion SPECT. All thirty nuclear medicine departments in Sweden that perform myocardial perfusion SPECT participated in the study. A thorax heart phantom was used to simulate two patients. All studies were acquired and processed with the parameters used clinically in each hospital respectively. A quantitative and a qualitative evaluation were performed. At each hospital, the local nuclear medicine physician interpreted the images as if they were true patient images. There are great differences in the acquiring and processing parameters used in myocardial perfusion SPECT studies in Sweden. The image quality varies greatly for the different hospital but was approved for the majority of the hospitals. Images from two hospitals were considered to be too poor to be diagnosed. The interpretations of the local nuclear medicine physicians differ but the majority has reported an adequate diagnosis. One third of the hospitals have reported false positive defects. All steps in the chain from the acquisition to the evaluation of the medicine physician must be performed with high quality. The determinative factors are the noise reduction filter, the orientation of the slices in the heart and the judgement of the local medicine physician. The acquiring and processing parameters proposed by EANM should be used. The hospitals are also recommended to investigate in the time and resources available, in order to educate all staff involved in the evaluation of myocardial studies

  20. Assessment of cardiac outcome in pancreas kidney transplant recipients using 99mTc-MIBI myocardial perfusion scintigraphy

    Full text: Simultaneous pancreas-kidney transplantation (SPK) in diabetic patients (patients) 99mTc-MIBI myocardial perfusion scintigraphy (MPI) in predicting cardiac outcome post SPK. One hundred and forty patients underwent SPK at our institution over a 15-year period. Sixty-six subjects were excluded because of incomplete follow-up (n=54) or death from non-cardiac causes (n=12). Seventy-four patients (44 men, 30 women) with age 44.3+/-7.4 yrs (range: 31-62yrs) were followed for up to 14 yrs post SPK. The mean interval between SPK and MPI was 48.1+/-37.1 months (median: 37.5, range: 6-132 months). MPI was performed using a standard two-day protocol with Adenosine or Dipyridamole and a dual-head gamma camera using 900 configuration, attenuation and scatter correction and resolution recovery. Images were reported by at least one experienced observer using standard software. MPI were classified as normal (n=33), infarct (n=4), small (n=32) or large (n=2) areas of impaired coronary flow reserve (CFR) or a combination of infarct and impaired CFR (n=3). Cardiac events were considered if infarct, angina, death or coronary revascularisation occurred. Two patients underwent coronary artery bypass surgery five yrs post SPK (both two yrs post MPI) and one patient developed angina six yrs post SPK (three yrs post MPI). In these patients, MPI showed only small areas of impaired CFR. The negative and positive predictive values for MPI were 100 and 9%, respectively. In summary, MPI has excellent NPV post SPK. The PPV is poor, suggesting that myocardial perfusion defects correlate only weakly with overall atherosclerotic risk profile post SPK. Copyright (2002) The Australian and New Zealand Society of Nuclear Medicine Inc

  1. Small average differences in attenuation corrected images between men and women in myocardial perfusion scintigraphy: a novel normal stress database

    The American Society of Nuclear Cardiology and the Society of Nuclear Medicine state that incorporation of attenuation-corrected (AC) images in myocardial perfusion scintigraphy (MPS) will improve image quality, interpretive certainty, and diagnostic accuracy. However, commonly used software packages for MPS usually include normal stress databases for non-attenuation corrected (NC) images but not for attenuation-corrected (AC) images. The aim of the study was to develop and compare different normal stress databases for MPS in relation to NC vs. AC images, male vs. female gender, and presence vs. absence of obesity. The principal hypothesis was that differences in mean count values between men and women would be smaller with AC than NC images, thereby allowing for construction and use of gender-independent AC stress database. Normal stress perfusion databases were developed with data from 126 male and 205 female patients with normal MPS. The following comparisons were performed for all patients and separately for normal weight vs. obese patients: men vs. women for AC; men vs. women for NC; AC vs. NC for men; and AC vs. NC for women. When comparing AC for men vs. women, only minor differences in mean count values were observed, and there were no differences for normal weight vs. obese patients. For all other analyses major differences were found, particularly for the inferior wall. The results support the hypothesis that it is possible to use not only gender independent but also weight independent AC stress databases

  2. Homocysteine levels are associated with the results of 123I-metaiodobenzylguanidine myocardial scintigraphy in type 2 diabetic patients

    Elevated total plasma homocysteine (tHcy) levels and cardiovascular autonomic dysfunction are associated with a high mortality in type 2 diabetic patients. We tested the hypothesis that hyperhomocysteinemia is associated with insulin resistance and cardiovascular autonomic dysfunction in type 2 diabetic patients not receiving insulin treatment. The study group consisted of 17 type 2 diabetic patients with high tHcy levels (>15 mmol/l, age 58±5 years, high tHcy group). The control group consisted of 23 age-matched type 2 diabetic patients with normal tHcy levels (≤15 mmol/l, age 58±9 years, normal tHcy group). Cardiovascular autonomic function was assessed by baroreflex sensitivity, heart rate variability, plasma norepinephrine concentrations, and cardiac 123I-metaiodobenzylguanidine (MIBG) scintigraphy. Early and delayed 123I-MIBG myocardial uptake values were lower (p123I-MIBG was higher (p123I-MIBG at the delayed phase. Our results demonstrate that high levels of tHcy are associated with depressed cardiovascular autonomic function and insulin resistance in patients with type 2 diabetes mellitus. (orig.)

  3. Influence of hypertensive left ventricular hypertrophy on detection of ischemic area with exercise thallium-201 myocardial scintigraphy

    Sixty-four patients with single left anterior descending artery disease having effort angina (group A: 40 patients with hypertrophic hypertension, group B: 10 patients with hypertrophic hypertension, group C: 14 patients with non-hypertrophic hypertension) were assessed to determine the influence of hypertensive left ventricular (LV) hypertrophy on detection of ischemic area. The criterion of hypertrophy by two-dimensional echocardiography was >12 mm in the wall thickness of interventricular septal or posterior wall. Population in Group B might show low detectability in ischemic area by 201Tl myocardial scintigraphy (positive thallium rate 60%, defect score 2.7±3.6), and high lung thallium uptake and high frequence of ECG positive among three groups. In semiquantitative analysis, the washout rate of the posterolateral wall and %RD (delayed %uptake-initial %uptake) of the septal wall in patients with Group B were lowest among three groups. However, the washout rate in the septal wall against the posterior wall, and the initial %uptake and the delayed %uptake of the septal wall were not significantly different among three groups. We could conclude that the decreased washout rate in nonischemic area with hypertensive LV hypertrophy might make the ischemic area masked. (author)

  4. Scintigraphy with technetium dimercaptosuccinic acid (99m Tc DMSA)

    Renal uptake of 99m Tc DMSA was used to evaluate the renal function of 16 healthy subjects (controls) and 115 patients with various urinary tract diseases. Scintigraphic examination was carried out 6 hours after an intravenous injection of the product. In the 16 controls Tc DMSA uptake was 25.7+-2.48% in the right kidney and 24.4+-2.86% in the left kidney. In 36 patients with one single hypertrophied kidney, there was a correlation (r=0.850) between creatinine clearance and Tc DMSA uptake, which was higher than in normal subjects (39.23+-9.9%). In the group of 68 patients with unilateral (31) or bilateral (37) renal disease, a significant correlation (r=0,725) was observed between kidney-to-kidney ratios of urea clearance and Tc DMSA uptake, so that renal impairment could be quantified. Quantitative scintigraphy did not appear to be of assistance in the remaining 11 patients with obstructive uropathy, as it overestimated renal function. The results obtained with 99 m Tc DMSA scintigraphy should be helpful in choosing between nephrectomy and conservative surgery and in assessing the degree of compensatory hypertrophy in single kidneys

  5. Evaluation of false-positive results on Tc myocardial scintigraphy in patients with coronary artery bypass grafting including left internal thoracic artery-left anterior descending artery grafting

    Stress myocardial scintigraphy in patients who have undergone coronary artery bypass grafting (CABG) frequently shows false-positive results. To investigate the reason for these false-positive results, two different stress tests-adenosine triphosphate (ATP) stress testing and ergometer exercise testing, and Tc-tetrofosmin myocardial scintigraphy were performed with a 1-day stress/rest protocol. The subjects were 6 patients with a history of myocardial infarction (MI) and 14 patients with a history of angina pectoris (AP) who had undergone CABG that included left internal thoracic artery-left anterior descending artery grafting. Graft patency was confirmed with coronary angiography. Short-axis images were reconstructed with single photon emission tomography. The severity of perfusion defects on short-axis images was evaluated quantitatively with a normal database as severity score, and the difference in severity score between stress and rest was defined as fill-in. Fill-in on the ATP stress test was 3.1±7.0 in the AP group and 16.3±13.2 in the MI group (p<0.01). Fill-in on the exercise stress test was 2.7±8.3 in the AP group and 34.8±20.6 in the MI group (p<0.01). In the MI group, fill-in on the exercise stress test was significantly greater than that on the ATP stress test (p<0.05). The exercise time and the amount of exercise stress in patients with MI were significantly greater than those in patients with AP. In conclusion, coronary flow reserve may play a role in false positive-finding on myocardial perfusion scintigraphy in patients who have undergone CABG. (author)

  6. Detection of myocardial lesions by dipyridamole thallium-201 scintigraphy in patients with rheumatoid arthritis

    Momose, Shigeki [Saint Marianna Univ., Kawasaki, Kanagawa (Japan). School of Medicine

    1995-06-01

    Dipyridamole thallium-201 (Tl) scintigraphic studies to evaluate microcirculation of the heart were performed in 54 patients with rheumatoid arthritis (RA) who had neither cardiac complaints nor myocardial damages on ECG. Twenty seven of 54 RA patients showed some perfusion defects in this study. The values of ESR, CRP and rheumatoid factors of IgM and IgG classes were significantly higher in these patients with perfusion defect compared with those in the rest of RA patients with normal perfusion. The scintigraphic perfusion defects improved relating with the reduction of inflammatory activities of RA. The histological specimens of heart in 12 RA autopsy cases were reviewed to study the etiology of these perfusion defects. In 7 of 12 cases, microvasculitis and microthrombosis were observed without any macroscopic findings compatible with myocardial infarction. Our results suggest that RA patients have frequently microcirculatory disturbances in the heart due to microvasculitis without any clinical symptoms of ECG changes. (author).

  7. Metastatic thyroid cancer appearing as increased lung uptake on myocardial 99Tcm-sestamibi scintigraphy

    Full text: A 61-year-old female presented to the Nuclear Medicine Department with shortness of breath and central chest pain for the previous 2 months, for investigation of reversible myocardial ischaemia. The patient was administered 259 MBq of 99Tcm-sestamibi (MIBI) at rest, and SPET images of myocardial perfusion were acquired using a Siemens Multispect3 gamma camera, at 45 min post-administration. The patient then underwent 3 min of exercise on a bicycle, achieving a peak workload of 25 W and a peak heart rate of 161 beats-min-1 The exercise was terminated due to the patient's usual shortness of breath. The ECG was normal at rest and peak stress. The patient was injected with 777 MBq of 99Tcm-MIBI 2 min prior to peak exercise. SPET images were again acquired at 45 min post-administration. Gated images could not be performed. Reconstructed images showed no scintigraphic evidence of reversible myocardial ischaemia, but there was a fixed anterior wall defect. Review of the raw planar images demonstrated markedly increased lung uptake in a heterogeneous distribution. Further questioning confirmed a history of follicular thyroid cancer with pulmonary metastases, which were confirmed on current chest X-ray, in a distribution identical to the scintigraphic images. The fixed anterior defect may be a reconstruction artefact, rather than a prior infarct. In conclusion, we have demonstrated an unusual cause for increased lung uptake on routine myocardial perfusion imaging with 99Tcm-MIBI; thyroid cancer should be included in the differential diagnosis of such an appearance

  8. Thallium scintigraphy in human transplants: A way to detect myocardial damage

    An original index has been derived from thallium images to detect histopathologic changes in heart transplant patients. One hundred eighty-four static and end-diastolic images with thallium were recorded 5 minutes after injection in the left anterior oblique projection. Twenty patients and 14 healthy volunteers were studied. The epicardial and endocardial borders were determined, and the difference of these values was considered the myocardial area. The results in heart transplants were compared with the results of endomyocardial biopsies (N = 142). A significant decrease (p less than 0.01) was found in the index of the myocardial area between normal biopsy results and mild and moderate rejection. Differences were not detected between studies performed in several postoperative periods in the absence of rejection. The results in healthy volunteers prove that the index does not change between studies performed at different times in the same subject, although the value obtained from the end-diastolic image was more constant. On the basis of these results, it is possible to suggest that the decrease in the myocardial area during rejection is the result of a fall of thallium uptake by the myocardium. Capillary endothelial hyperplasia, perivascular infiltration, and myocytolysis can justify these changes, although the presence of other histologic findings, such as intramyocardial edema, could influence the value of this index. We conclude that the uptake of thallium decreases during acute rejection episodes; the results obtained from the images, in this work, are an expression of this event

  9. Clinical usefulness of 123I-MIBG myocardial scintigraphy as a marker of the severity and prognosis of congestive heart failure

    To evaluate the clinical usefulness of 123I-MIBG myocardial scintigraphy in patients with congestive heart failure. Myocardial dynamic imaging was performed immediately after 123I-MIBG administration at 1 frame/sec for 500 sec in 52 patients with or without congestive heart failure. The %uptake/ROI, dynamic heart to mediastinum uptake ratio (H/M) and dynamic washout rate (WR) were calculated from their time activity curves to assess the relationship between the NYHA functional class and these values. In 52 other patients with heart failure, the initial and delayed MIBG anterior planar images were obtained, and H/M in delayed images and WR between initial and delayed images were measured. The patients were followed up for 31.8±16.8 months, and their survival rates were compared among three groups, H/M123I-MIBG myocardial scintigraphy is very useful to diagnose the severity and prognosis in patients with congestive heart failure. (K.H.)

  10. The development of radioiodinated fatty acids for myocardial imaging

    Since free fatty acids are the principal energy source for the normally oxygenated myocardium, the use of iodine-123-labeled fatty acid analogues is an attractive approach for myocardial imaging. Interest in the use of these substances results from divergent fatty acid metabolic pathways in ischemic (triglyceride storage) versus normoxic tissue (β-oxidative clearance), following flow-dependent delivery. Iodine-123-labeled fatty acids may offer a unique opportunity to identity myocardial viability using single photon emission tomography. The development of structurally-modified fatty acids became of interest because of the relatively long acquisition periods required for SPECT. The significant time required by early generation single- or dual-head SPECT systems for data acquisition requires minimal redistribution during the acquisition period to ensure accurate evaluation of the regional fatty acid distribution pattern after re-construction. Research has focussed on the evaluation of structural modifications which can be introduced into the fatty acid chain which would inhibit the subsequent β-oxidative catabolism which normally results in rapid myocardial clearance. Introduction of a methyl group in position-3 of the fatty acid carbon chain has been shown to significantly delay myocardial clearance and iodine-123-labeled 15-(p-iodophenyl)-3- R,S-methylpentadecanoic acid (BMIPP) is a new tracer based on this strategy

  11. Potential and limitation of myocardial perfusion scintigraphy for detection of viability

    Scintigraphic detection of myocardial viability is required for treatment planning and prognostication in patients with contractile dysfunction. There are four pathophysiological entities of dysfunction in coronary artery disease; one of them, ''hibernating'' myocardium, cannot be differentiated from scar or necrosis by mere perfusion imaging. Due to the determinants of delayed activity distribution after 201Tl injection, optimized imaging protocols using this tracer allow for adequate differentiation in many instants. Differentiation between ''stunned'' and ''hibernating'' myocardium or scar is achieved with all perfusion indicators actually available. Though 201Tl imaging with optimized protocols is almost as efficacious in viability detection as 18F-FDG positron emission tomography, the latter actually remains the reference method particularly in patients with severe left ventricular dysfunction at coronary occlusions. (orig.)

  12. Attenuation correction for myocardial scintigraphy: state-of-the-art; Schwaechungskorrektur bei der Myokardszintigraphie: Aktueller Stand

    Lindner, O.; Kammeier, A.; Fricke, E. [Inst. fuer Molekulare Biophysik, Radiopharmazie und Nuklearmedizin, Herz- und Diabeteszentrum NRW, Universitaetsklinik der Ruhr-Univ. Bochum, Bad Oeynhausen (Germany)

    2004-09-01

    Myocardial perfusion imaging has been proved as an accurate, noninvasive method for diagnosis of coronary artery disease with a high prognostic value. However image artifacts, which decrease sensitivity and in particular specificity, degrade the clinical impact of this method. Soft tissue attenuation is regarded as one of the most important factors of impaired image quality. Different approaches to correct for tissue attenuation have been implemented by the camera manufacturers. The principle is to derive an attenuation map from the transmission data and to correct the emission data for nonuniform photon attenuation with this map. There have been several reports published demonstrating an improved specificity with no substantial change in sensitivity by this method. To accurately perform attenuation correction quality control measurements and adequate training of technologists and physicians are mandatory. (orig.)

  13. Myocardial scintigraphy. Clinical use and consequence in a non-invasive cardiological department

    Dümcke, Christine Elisabeth; Graff, J; Rasmussen, SPL;

    2006-01-01

    INTRODUCTION: Myocardial perfusion imaging (MPI) is increasingly used for the diagnosis of ischaemic heart disease. The method is particularly applied as a gate keeper before coronary angiography (CAG) in patients with intermediate probability for ischaemic heart disease. This study aimed to...... analyse the clinical use of MPI in a university hospital without invasive cardiological laboratory. MATERIAL AND METHODS: In the period 01.01.2002 to 31.12.2003, 259 patients (141 women, 118 men) were referred to MPI from our department of cardiology. RESULTS: Normal MPI was seen in 111 patients (43......%), whereas reversible ischaemia was seen in 88 patients (34%) and led to referral of 52 patients (59%) to CAG. 17 patients (19%) continued clinical control, and 19 cases (22%) were closed. Correlating results between MPI and all performed CAGs were found in 42 patients (61%), and divergent results were seen...

  14. Development of a new technic for breast attenuation correction in myocardial perfusion scintigraphy using computational methods

    Introduction: One of the limitations of nuclear medicine studies are false-positive results that lead to unnecessary exams and procedures associated to morbidity and costs to the individual and society. One of the most frequent causes for reducing the specificity of myocardial perfusion imaging (MPI) is photon attenuation, especially by breast in women. Objective: To develop a new technique to compensate the photon attenuation by women breasts in myocardial perfusion imaging with 99mTc-sestamibi, using computational methods. Materials and methods: A procedure was proposed which integrates Monte Carlo simulation, computational methods and experimental techniques. Initially, were obtained the chest attenuation correction percentages using a phantom Jaszczak and breast attenuation percentages by Monte Carlo simulation method, using the EGS4 program. The percentages of attenuation correction were linked to individual patients' characteristics by an artificial neural network and a multivariate analysis. A preliminary technical validation was done by comparing the results of the MPI and catheterism (CAT), before and after applying the technique to 4 patients. The t test for parametric data, Wilcoxon, Mann-Whitney and X2 for the others were used. Probability values less than 0.05 were considered statistically significant. Results: Each increment of 1 cm in the thickness of breast was associated to an average increment of 6% on photon attenuation, while the maximum increase related to breast composition was about 2%. The average chest attenuation percentage per unit was 2.9%. Both, the artificial neural network and linear regression, showed an error less than 3% as predictive models for percentage of female attenuation. The anatomical-functional correlation between MPI and CAT was maintained after the use of the technique. Conclusion: Results suggest that the proposed technique is promising and could be a possible alternative to other conventional methods employed

  15. Quantitative analysis of SPECT imaging parameters in patients with resting perfusion defects on myocardial perfusion scintigraphy

    Functional status/contractile behaviour of hibernating myocardium was analyzed objectively by analyzing the available quantitative parameters obtained on gated SPECT myocardial perfusion imaging (MPI) using Emory cardiac toolbox (ECTB) software. Materials and Methods: In this retrospective study, 70 patients with perfusion defects on 99Tc-Sestamibi MPI (12 females, 58 males) who also underwent 18F-FDG Cardiac PET study for assessment of hibernating myocardium were included for analysis. Patients were divided in three categories based on summed rest score (SRS) obtained from ECTB software, depicting the extent of perfusion defects. In a study population matched for extent of perfusion defects, quantitative parameters obtained from ECTB software such as left ventricular ejection fraction (LVEF), left ventricular end diastolic volume (EDV), left ventricular end systolic volume (ESV) and left ventricular stroke volume (SV) were compared between patients showing evidence of hibernating myocardium and patients showing no evidence of hibernating myocardium. Student 't' test was applied on the given observations and a P-value <0.05 was considered as a significant difference between the means in two categories. Results: There was no significant difference in LVEF, EDV, ESV and SV measurements between those who demonstrate hibernating myocardium and those who show no evidence of hibernating myocardium across all the categories of patients. Few trends were evident in the present study in LVEF, EDV and ESV measurements i.e., fall in mean LVEF with increasing SRS and rise in mean EDV and ESV with increasing SRS. Conclusions: The findings were consistent with the nature of hibernating myocardium i.e., non-contractile and dysfunctional. The fall in the LVEF was suggestive of deteriorating myocardial function with increasing extent of perfusion defects. The increasing left ventricular EDV and ESV with increasing extent of perfusion defects was suggestive of rising incidence of

  16. Increased accuracy of single photon emission computed tomography (SPECT myocardial perfusion scintigraphy using iterative reconstruction of images

    Stević Miloš

    2016-01-01

    Full Text Available Background/Aim. Filtered back projection (FBP is a common way of processing myocardial perfusion imaging (MPI studies. There are artifacts in FBP which can cause falsepositive results. Iterative reconstruction (IR is developed to reduce false positive findings in MPI studies. The aim of this study was to evaluate the difference in the number of false positive findings in MPI studies, between FBP and IR processing. Methods. We examined 107 patients with angina pectoris with MPI and coronary angiography (CAG, 77 man and 30 woman, aged 32−82. MPI studies were processed with FBP and with IR. Positive finding at MPI was visualization of the perfusion defect. Positive finding at CAG was stenosis of coronary artery. Perfusion defect at MPI without coronary artery stenosis at CAG was considered like false positive. The results were statistically analyzed with bivariate correlation, and with one sample t-test. Results. There were 20.6% normal, and 79.4% pathologic findings at FBP, 30.8% normal and 69.2% pathologic with IR and 37.4% normal and 62.6% pathologic at CAG. FBP produced 19 false-positive findings, at IR 11 false positive findings. The correlation between FBP and CAG was 0.658 (p < 0.01 and between IR and CAG 0.784 (p < 0.01. The number of false positive findings at MPI with IR was significantly lower than at FBP (p < 0.01. Conclusion. Our study shows that IR processing MPI scintigraphy has less number of false positive findings, therefore it is our choice for processing MPI studies.

  17. Diagnostic cutoff points for 123I-MIBG myocardial scintigraphy in a Caucasian population with Parkinson's disease

    Molecular imaging with 123I-metaiodobenzylguanidine (MIBG) has been used in Parkinson's disease (PD), but there is no consensual index to discriminate between normal and PD patients in the Caucasian population. The purpose of this study was to determine diagnostic cutoff points in the quantification of MIBG cardiac uptake in our population of PD patients. We have also calculated the reproducibility over a range of interpretation expertise. The study included 14 PD patients and 14 normal age- and sex-matched controls. Heart to mediastinum ratios (H/M) were calculated at 15 min (H/M15m) and 4 h (H/M4h) post-injection by three observers with different interpretation expertise, one of whom drew the regions of interest at three different times. The intraobserver and interobserver reliability was calculated (interclass correlation coefficient and coefficient of variability). Diagnosis was estimated by maximizing the Youden index for H/M and washout ratios. Discrimination ability was assessed by the area under the curve (AUC). Sensitivity and specificity were reported, using our thresholds. The parameter with the best diagnostic accuracy was the H/M4h ratio, with a major AUC (0.976 area under the receiver-operating characteristic curve). The threshold was 1.43 with a 95% confidence interval of 1.37-1.50. Using this threshold, the sensitivity and specificity were 93 and 100%. The interobserver and intraobserver variabilities measuring this ratio were 3.2 and 3.1%, respectively. The diagnostic cutoff point for 123I-MIBG myocardial scintigraphy in a Caucasian population with PD was 1.43 for the H/M4h index, with a good sensitivity and specificity. The technique is easy to use, with a good reproducibility over a range of interpretation expertise. (orig.)

  18. The safety of anginine in patients undergoing myocardial perfusion scintigraphy (MPS)- a nurses' perspective

    Full text: Anginine-augmented MPS improves detection rate of myocardial viability and reversible ischaemia. However, anginine can cause significant hypotension. The aims of this study were to determine i) safety of anginine in patients with an intermediate to high risk of myocardial ischaemia undergoing MPS; ii) frequency and degree of fall in systolic blood pressure (SBP); iii) BP monitoring requirements; and iv) type of patient(s) prone to side effects. 63 patients (33M, 30F, mean age-67.2y) were included. Each was cannulated, drank two glasses of water, and lay supine prior to administration of anginine (1 x puff sublingually). 99Tcm-MIBI was administered 3-5 minutes later. BP measurements were obtained every five minutes for 20 minutes. SBP fell in 46/63 patients (range 5 - 40mmHg, mean 1 6mmHg, in 14 fall >20mmHg), and rose in 14/63. Maximal fall occurred 5-15 minutes post-administration of anginine (14 at 5min, 15 at 10min, 17 at 15min), returning toward baseline by 20 minutes in all patients. Seven patients developed a headache and two light-headedness; in all SBP fell >10mmHg. The quality of the scans was unaffected. There were 22(35%) abnormal studies - 14 reversible defects, two fixed defects, six cardiomyopathy (mean SBP tall 8.1mmHg, 8.6mmHg with normal study). LVEF was obtained in 33 patients; SBP fell in 24 (mean LVEF 57.8%), and rose in nine (mean LVEF 56.8%). The frequency and extent of hypotension in relation to age, sex, LVEF, or scan findings was not statistically significant. Anginine is sate to administer to patients undergoing MPS. Careful monitoring of the BP is recommended during the initial 20 minutes post-administration. No particular patient type was identified at higher risk. Copyright (2000) The Australian and New Zealand Society of Nuclear Medicine Inc

  19. Optimization of a protocol for myocardial perfusion scintigraphy by using an anthropomorphic phantom

    Ramos, Susie Medeiros Oliveira; Sa, Lidia Vasconcellos de, E-mail: susie@ird.gov.br [Instituto de Radioprotecao e Dosimetria (IRD/CNEN-RJ), Rio de Janeiro, RJ (Brazil); Glavam, Adriana Pereira; Kubo, Tadeu Takao Almodovar [Clinica de Diagnostico Por Imagem (CDPI/DASA), Rio de Janeiro, RJ (Brazil)

    2014-07-15

    Objective: to develop a study aiming at optimizing myocardial perfusion imaging. Materials and Methods: imaging of an anthropomorphic thorax phantom with a GE SPECT Ventri gamma camera, with varied activities and acquisition times, in order to evaluate the influence of these parameters on the quality of the reconstructed medical images. The {sup 99m}Tc-sestamibi radiotracer was utilized, and then the images were clinically evaluated on the basis of data such as summed stress score, and on the technical image quality and perfusion. The software ImageJ was utilized in the data quantification. Results: the results demonstrated that for the standard acquisition time utilized in the procedure (15 seconds per angle), the injected activity could be reduced by 33.34%. Additionally, even if the standard scan time is reduced by 53.34% (7 seconds per angle), the standard injected activity could still be reduced by 16.67%, without impairing the image quality and the diagnostic reliability. Conclusion: the described method and respective results provide a basis for the development of a clinical trial of patients in an optimized protocol. (author)

  20. Clinical study of right ventricular visualization by 201Tl myocardial scintigraphy

    Thallium-201 myocardial scans of 65 patients were retrospectively reviewed to evaluate the ability to detect right ventricular (RV) overloading. The degree of right ventricular visualization (RVV) was graded as a scale of (-)-(+++) according to RV uptake of the tracer: (-) = none; (+-) = slight RVV; (+) = less than left ventricular visualization (LVV); (++) = equal to LVV; (+++) = greater than LVV. Increased RV uptake was frequently seen in patients with chronic lung disease or congenital heart disease. The best projection angle for RVV was 60 deg in patients with grades (+-) and (+). The degree of RVV was compared with the data from cardiac catheterization performed in 25 of the patients. More increased uptake of the tracer was significantly associated with higher values of RV systolic pressure, pulmonary arterial systolic pressure, mean pulmonary arterial pressure, and pulmonary arterial resistant index. RV end-diastolic pressure, cardiac index, RV work index, RV stroke-work index, and heart rate were independent of the intensity of tracer uptake. The ratio of the RV to the left ventricle was significantly higher with increasing tracer uptake, although there was no significant difference between the groups with (+-) and grade (+). It was also correlated well with RV hemodynamic parameters. (Namekawa, K.)

  1. Initial experience with myocardial perfusion scintigraphy (MPS) in patients awaiting lung volume reduction surgery (LVRS)

    Full text: LVRS is an effective therapeutic option for patients with end-stage chronic airway limitation (CAL). Pre-operative cardiac assessment in such patients is vital for a favourable outcome. We reviewed the role of MPS in the pre-operative cardiac risk stratification of patients undergoing LVRS. Of 37 patients who underwent LVRS, 25 patients (11M/14F; mean age 59.9 yrs) were evaluated pre-operatively with a MPS. Two had a history of ischaemic heart disease. 17 patients were given dipyridamole (IV - 0.05mg/kg), and eight patients were given dobutamine (IV). The LVEF was determined in 11/25 patients (range - 54-79%, mean 65.5%). Reversible defects were reported in two patients; one involving the antero-lateral wall, confirmed with coronary catheterisation (C/C) (100% LAD lesion) and treated successfully with angioplasty, and 1 involving the inferior wall (false positive on C/C). Two fixed defects were reported, each involving the inferior wall and consistent with a history of prior inferior wall myocardial infarction. The post-operative course was favourable in all patients who had a MPS, except in one who died from sepsis, while another developed mild biventricular failure three months post-operatively. Both these patients had a normal MPS. In those who did not have a MPS study, 2/12 patients died in the post-operative period; one from sepsis (normal C/C), and the other from biventricular failure. No other cardiac complications were documented. Although the population size was small, MPS assisted in the pre-operative cardiac risk stratification and management of patients undergoing LVRS. Copyright (2000) The Australian and New Zealand Society of Nuclear Medicine Inc

  2. The accuracy and side effects of pharmacologic stress thallium myocardial scintigraphy with adenosine triphosphate disodium (ATP) infusion in the diagnosis of coronary artery disease

    The diagnostic accuracy and side effects of pharmacologic stress thallium myocardial scintigraphy with ATP infusion were studied in 172 patients with or without coronary artery disease. ATP was infused for five minutes at a rate of 0.16 mg/kg/min (group A) or 0.18 mg/kg/min (group B) via antecubital vein. One hundred and eleven (67 of group A, 44 of group B) of 172 patients underwent coronary arteriography (CAG). In 111 patients received CAG, overall sensitivity, specificity and accuracy of this method were 88%, 84% and 87%, respectively. In 67 patients of group A, these were 92%, 81% and 90%. In 44 patients of group B, 79%, 87% and 82% were documented (NS, between groups A and B). Chest pain, flushing, bradycardia and ST depression were included in side effects caused by ATP infusion. At least one of these side effects were observed in 84% of the all 172 patients, 89% of group A and 75% of group B (NS). But, all of the side effects were spontaneously alleviated within two minutes without any therapy. In conclusion, pharmacologic stress myocardial scintigraphy with ATP infusion is very accurate and safe, and infusion rate of 0.16 mg/kg/min is optimal for this purpose. (author)

  3. Noninvasive diagnostic test choices for the evaluation of coronary artery disease in women: a multivariate comparison of cardiac fluoroscopy, exercise electrocardiography and exercise thallium myocardial perfusion scintigraphy

    Several diagnostic noninvasive tests to detect coronary and multivessel coronary disease are available for women. However, all are imperfect and it is not yet clear whether one particular test provides substantially more information than others. The aim of this study was to evaluate clinical findings, exercise electrocardiography, exercise thallium myocardial scintigraphy and cardiac fluoroscopy in 92 symptomatic women without previous infarction and determine which tests were most useful in determining the presence of coronary disease and its severity. Univariate analysis revealed two clinical, eight exercise electrocardiographic, seven myocardial scintigraphic and seven fluoroscopic variables predictive of coronary or multivessel disease with 70% or greater stenosis. The multivariate discriminant function analysis selected a reversible thallium defect, coronary calcification and character of chest pain syndrome as the variables most predictive of presence or absence of coronary disease. The ranked order of variables most predictive of multivessel disease were cardiac fluoroscopy score, thallium score and extent of ST segment depression in 14 electrocardiographic leads. Each provided statistically significant information to the model. The estimate of predictive accuracy was 89% for coronary disease and 97% for multivessel coronary disease. The results suggest that cardiac fluoroscopy or thallium scintigraphy provide significantly more diagnostic information than exercise electrocardiography in women over a wide range of clinical patient subsets

  4. Cardiac resynchronization therapy evaluated by myocardial scintigraphy with 99mTc-MIBI: changes in left ventricular uptake, dyssynchrony, and function

    99mTc-MIBI gated myocardial scintigraphy (GMS) evaluates myocyte integrity and perfusion, left ventricular (LV) dyssynchrony and function. Cardiac resynchronization therapy (CRT) may improve the clinical symptoms of heart failure (HF), but its benefits for LV function are less pronounced. We assessed whether changes in myocardial 99mTc-MIBI uptake after CRT are related to improvement in clinical symptoms, LV synchrony and performance, and whether GMS adds information for patient selection for CRT. A group of 30 patients with severe HF were prospectively studied before and 3 months after CRT. Variables analysed were HF functional class, QRS duration, LV ejection fraction (LVEF) by echocardiography, myocardial 99mTc-MIBI uptake, LV end-diastolic volume (EDV) and end-systolic volume (ESV), phase analysis LV dyssynchrony indices, and regional motion by GMS. After CRT, patients were divided into two groups according to improvement in LVEF: group 1 (12 patients) with increase in LVEF of 5 or more points, and group 2 (18 patients) without a significant increase. After CRT, both groups showed a significant improvement in HF functional class, reduced QRS width and increased septal wall 99mTc-MIBI uptake. Only group 1 showed favourable changes in EDV, ESV, LV dyssynchrony indices, and regional motion. Before CRT, EDV, and ESV were lower in group 1 than in group 2. Anterior and inferior wall 99mTc-MIBI uptakes were higher in group 1 than in group 2 (p99mTc-MIBI uptake. (orig.)

  5. Dual myocardial single photon emission computed tomography (SPECT) using thallium-201 and I-123-β-methyl-i-pentadecanoic acid in patients with Duchenne's progressive muscular dystrophy

    Dual single photon emission computed tomography (SPECT) was performed in 31 patients with Duchenne's progressive muscular dystrophy (DMD) using 123I-β-methyl pentadecanoic acid (BMIPP) for myocardial fatty acid metabolism and 201thallium (Tl)-chloride for myocardial perfusion. The left ventricle was divided into 9 segments, and accumulation of the radiotracers was assessed visually for each segment to calculate defect score for each tracer. There was some degree of decrease in myocardial accumulation of both tracers in all DMD patients. Reduced accumulation was most common at the apex (BMIPP: 67%, Tl: 63%), followed by the posterior wall, lateral wall, and anterior wall. On the other hand, reduced accumulation was less common at the septum. BMIPP showed a higher accumulation than Tl in all segments but the septum. When BMIPP defect score was larger than Tl defect score, BMIPP defect score tended to increase during 4 years follow-up (p Tl defect score revealed a slight fibrosis or normal myocardium. It can be concluded that the dual SPECT myocardial scintigraphy using BMIPP and Tl provides accurate information about disease progression of the heart in patients with DMD by detecting abnormalities of the myocardial metabolism of each substance, thereby enabling the assessment of left ventricular function. (author)

  6. Serial change in {sup 123}I-MIBG myocardial scintigraphy in non-insulin-dependent diabetes mellitus

    Nagamachi, Shigeki; Jinnouchi, Seishi; Kurose, Takeshi; Nishii, Ryuichi; Futami, Shigemi; Tamura, Shozo; Matsukura, Shigeru [Miyazaki Medical Coll., Kiyotake (Japan); Kawai, Keiichi

    2002-02-01

    We performed {sup 123}I-MIBG (MIBG) myocardial scintigraphy twice in patients with non-insulin-dependent diabetes mellitus (NIDDM) to investigate whether MIBG distribution was improved by pertinent clinical control. To determine the influential factors for MIBG distribution, we investigated the association between various clinical parameters and the serial change in MIBG uptake parameters. Twenty NIDDM patients with no cardiac disorders were evaluated. Planar images were taken at 30 minutes (early) and 3 hours (delayed) after MIBG injection. The heart-to-upper-mediastinum uptake ratio (H/M) and washout ratio (WR) were calculated as parameters for estimating cardiac sympathetic function. Patients were divided into two groups, eight in the improved group and twelve in the unimproved group, according to the serial change in H/M. The mean interval between the baseline and the follow up study was 2.1{+-}0.6 year. Differences between the means of the laboratory data in patients in both groups were compared for the baseline and the follow up study by using the paired t-test. As a means of determining the influential factors for a serial change of MIBG uptake, Fisher's exact test was performed to evaluate the association between the serial change in cardiac MIBG parameters and changes in other clinical parameters, such as blood sugar (BS) control, BS control method (insulin therapy), serum cholesterol control, and severity of diabetic complications. We also analyzed the association between the changes in CV{sub R-R} (coefficient variance of R-R intervals at rest ECG) or NCV (velocity of posterior tibial nerve) and those of other clinical parameters. Associations among these neurological parameters (MIBG parameters, CV{sub R-R} and NCV) were also analyzed. Paired t-tests showed a significant decrease in fasting blood sugar and fructosamine in the improved group in the follow up study compared to those in the baseline study. Nevertheless, Fisher's exact test showed

  7. Thallium-201 perfusion scintigraphy in the evaluation of late myocardial damage in left-side breast cancer treated with adjuvant radiotherapy

    Purpose: To evaluate late myocardial damage after adjuvant radiotherapy using a mixed-beam (photons plus electrons) technique to treat the internal mammary lymph nodes in left-side breast cancer. Methods and Materials: A bicycle ergometer stress test coupled with thallium-201 perfusion scintigraphy and analysis by single-photon computed tomography (CT) was performed on 19 patients treated with left-side breast/chest wall and internal mammary radiation for breast cancer between 1987 and 1993. To be sure that we would evaluate late toxicity caused by the irradiation, patients had to fulfill the following eligibility criteria: left-side breast cancer, treatment between 1987 and 1993 and no recurrence during follow-up, age ≤75 years, no known risk for coronary artery disease, no previous chemotherapy, internal mammary field treated with an association of photons and electrons, and CT scan-based treatment planning. Results: Median age at scintigraphy was 59 years. Two patients did not reach optimal exercise level and were not evaluable. Among the 17 evaluable patients representing 91.6 patient years of follow-up, there were no perfusion defects by visual or quantitative analysis. Conclusion: The mixed-beam technique seemed to spare the heart from harmful irradiation and to protect the myocardium. Results need to be confirmed on the long-term use of this technique

  8. Angiography-based prediction of outcome after coronary artery bypass surgery versus changes in myocardial perfusion scintigraphy

    Eckardt, Rozy; Kjeldsen, Bo Juel; Haghfelt, Torben; Grupe, Peter; Johansen, Allan; Andersen, Lars Ib; Hesse, Birger

    2011-01-01

    scintigraphy before and 6 months after CABG, the results being kept secret from the surgeon. Based on clinical and angiographic findings, the surgeons filled in a questionnaire indicating the predicted changes in coronary blood flow in each of the three coronary artery territories and in the LVEF. Symptomatic...

  9. Relation between serum PAP (prostate acid phosphatase) and bone scintigraphy in prostatic cancer

    Seventy-seven patients with prostatic cancer were treated at our department in the last 5 years. Of these patients 30 cases were followed by bone scintigraphy and serum PAP. In 27 follow-up scintigraphy procedures changes of bone scintigraphy corresponded to changes in serum PAP levels. Changes of PAP levels did not always correspond to changes of scintigraphy, but almost all cases in which the level of PAP increased in a short period showed progression of bone metastasis. A 3-month interval between bone scintigraphy procedure in stage D2 prostatic cancer patients is generally recommended. However, we think that in prostatic cancer patients follow-up bone scintigraphy at regular short intervals is unnecessary if there is no change in serum PAP levels, symptoms or physical condition. Bone scintigraphy should be performed when the tumor marker changes rapidly or when any physical symptom appears. (author)

  10. The use of I-123 metaiodobenzylguanidine myocardial scintigraphy to evaluate the efficacy of olprinone hydrochloride in an experimental adriamycin-induced cardiomyopathy

    Adriamycin (ADR) has a strong antitumor effect on a number of malignant diseases, however, it can cause serious adverse effects, such as cardiac failure and fatal myocardial disorder. We evaluated the therapeutic effectiveness of olprinone hydrochloride (OH) and its ability to protect myocardium during ADR administration in a rabbit cardiomyopathy model. Twenty-seven 3-month-old male New Zealand white rabbits weighing 2.3-2.8 kg were placed in 4 groups: Group A (control group) received intravenous saline solution, 3 times a week for 8 weeks; Group B (cardiomyopathy model group) received intravenous injection of ADR 3 times per week for 8 weeks; Group C received daily ADR administration concurrently with OH intravenous administration for 8 weeks; and Group D received daily intravenous administration of OH which was begun 3 weeks after starting daily ADR administration. Electrocardiography, hematologic and biochemical examination, echocardiography, myocardial scintigraphy (123I-m-iodobenzylguanidine (MIBG)) and histopathological examination were used to evaluate each group and the results were compared. The incidence of myocardical disorder caused by ADR was lower in Group C, as compared with Group B. However, there were no differences between groups D and B. Our findings show that when OH administration began at the same time as ADR administration, it inhibited ADR-induced cardiomyopathy, and possibly prevented heart failure, thanks to its protective effect on the myocardium. (author)

  11. Evaluation of the quality of the radiopharmaceutical 99mTc-MIBI and its influence on image quality in myocardial perfusion scintigraphy

    This study evaluated the quality of the 99mTc-MIBI radiopharmaceutical from different manufacturers, used in three nuclear medicine services (NMS) in Recife-PE, through labeling procedure of each service. It was observed their biodistribution by quantifying the activity present in the organs of interest (heart / liver), the influence and interference in image quality and in myocardial scintigraphy diagnosis exam. In these NMS (A, B and C) were done quality controls in the eluates of 99Mo/99mTc generators (radionuclidic, chemical and radiochemical purity and pH) and of the 99mTc-MIBI radiopharmaceutical (radiochemical purity and pH) used in myocardial scintigraphy exam. In the case of radiochemical purity (RCP), was used the thin layer chromatography technique; after the chromatographic ran on, the plates were analyzed both in the dose calibrator, and in scintillation camera of each NMS. The radiopharmaceutical biodistribution was evaluated through the activities present in the heart and liver images in 60 patients, using the technique of combined images counting. Five nuclear physicians analyzed 24 images through myocardial perfusion visual interpretation during stress, it was verified the agreement degree among them. The results of the quality control showed that all eluate samples were in agreement with the manufacturers in relation to radionuclidic purity and pH. In relation to chemical purity, 10% of the services samples B and C showed Al+3 values above 10 ppm. In the RCP, it was observed that using the scintillation camera, only 22% of the samples would be discarded, while with dose calibrator would be 78%, indicating that the scintillation camera is more sensitive in chromatographic pale analysis. For the labeled radiopharmaceutical, the services B and C presented respectively one and three samples with RCP percentage below 90%. However, C service presented the lowest medium to liver/heart proportions, showing that this factor does not depends on the labeling

  12. Effect of beta-blockade on low-dose dobutamine-induced changes in left ventricular function in healthy volunteers: assessment by gated SPET myocardial perfusion scintigraphy

    Everaert, H.; Vanhove, C.; Franken, P.R. [Division of Nuclear Medicine, University Hospital, Free University of Brussels (AZ VUB), Brussels (Belgium)

    2000-04-01

    Viability studies are often performed in patients receiving beta-blocking agents. However, the intake of beta-blocking agents could influence the identification of viable myocardium when low-dose dobutamine is used to demonstrate inotropic reserve. The aim of this study was to quantify the effect of beta-blockade on global and regional left ventricular function in healthy volunteers using low-dose dobutamine gated single-photon emission tomographic (SPET) myocardial perfusion scintigraphy. Ten subjects were studied once ''on'' and once ''off'' beta-blocker therapy (metoprolol succinate, 100 mg day{sup -1}). On each occasion four consecutive gated SPET acquisitions (of 7 min duration) were recorded after injection of 925 MBq technetium-99m tetrofosmin on a triple-headed camera equipped with focussing (Cardiofocal) collimators. Acquisitions were made at rest (baseline 1 and 2) and 5 min after the beginning of the infusion of 5 and 10 {mu}g kg{sup -1} min{sup -1} dobutamine. Wall thickening (WT) was quantified using a method based on circumferential profile analysis. Left ventricular ejection fraction (LVEF) was obtained using the Cedars-Sinai algorithm. Blood pressure (BP) and heart rate (HR) were recorded at the end of each acquisition. At baseline LVEF, WT and systolic BP values under beta-blockade were not significantly different from those obtained in the non-beta-blocked state. The mean HR and diastolic BP at baseline were lower under beta-blockade. Dobutamine administration (at 5 and 10 {mu}g kg{sup -1} min{sup -1}) induced a significant increase in WT, LVEF and systolic BP in all subjects both on and off beta-blockade. The increases in WT, LVEF and systolic BP in the beta-blocked state were less pronounced but not significantly different. HR increased significantly at 10 {mu}g kg{sup -1} min{sup -1} dobutamine without beta-blocker administration, while no increase in HR was observed in the beta-blocked state. Beta

  13. Effect of beta-blockade on low-dose dobutamine-induced changes in left ventricular function in healthy volunteers: assessment by gated SPET myocardial perfusion scintigraphy

    Viability studies are often performed in patients receiving beta-blocking agents. However, the intake of beta-blocking agents could influence the identification of viable myocardium when low-dose dobutamine is used to demonstrate inotropic reserve. The aim of this study was to quantify the effect of beta-blockade on global and regional left ventricular function in healthy volunteers using low-dose dobutamine gated single-photon emission tomographic (SPET) myocardial perfusion scintigraphy. Ten subjects were studied once ''on'' and once ''off'' beta-blocker therapy (metoprolol succinate, 100 mg day-1). On each occasion four consecutive gated SPET acquisitions (of 7 min duration) were recorded after injection of 925 MBq technetium-99m tetrofosmin on a triple-headed camera equipped with focussing (Cardiofocal) collimators. Acquisitions were made at rest (baseline 1 and 2) and 5 min after the beginning of the infusion of 5 and 10 μg kg-1 min-1 dobutamine. Wall thickening (WT) was quantified using a method based on circumferential profile analysis. Left ventricular ejection fraction (LVEF) was obtained using the Cedars-Sinai algorithm. Blood pressure (BP) and heart rate (HR) were recorded at the end of each acquisition. At baseline LVEF, WT and systolic BP values under beta-blockade were not significantly different from those obtained in the non-beta-blocked state. The mean HR and diastolic BP at baseline were lower under beta-blockade. Dobutamine administration (at 5 and 10 μg kg-1 min-1) induced a significant increase in WT, LVEF and systolic BP in all subjects both on and off beta-blockade. The increases in WT, LVEF and systolic BP in the beta-blocked state were less pronounced but not significantly different. HR increased significantly at 10 μg kg-1 min-1 dobutamine without beta-blocker administration, while no increase in HR was observed in the beta-blocked state. Beta-blocker therapy in healthy subjects attenuates the inotropic and chronotropic myocardial

  14. Tc99m- hepatobiliary iminodiacetic acid (HIDA) scintigraphy in clinical practice

    There have been evolutionary changes in the management of pathological conditions of the hepatobiliary system over recent years, particularly with an increasing emphasis on modern hepatobiliary surgical techniques. Concurrent advances have occurred in imaging technology and availability, leading to a greater use of ultrasound, multidetector computed tomography (CT), and magnetic resonance imaging (MRI) in the primary evaluation of hepatobiliary disease. Radionuclide imaging using technetium99m (Tc99m) hepatobiliary iminodiacetic acid (HIDA) derivatives is an established technique that complements morphological imaging, providing valuable functional information in both pre- and postoperative evaluation of patients with suspected or known hepatobiliary disease. This review discusses the current clinical indications for Tc99m HIDA scintigraphy using clinical cases to demonstrate how this technique continues to play a valuable diagnostic role in the assessment of the functional integrity of the hepatobiliary system.

  15. Myocardial perfusion defects and the left ventricular ejection fraction disclosed by scintigraphy in patients with primary hyperparathyroidism

    Ogard, Christina Gerlach; Søndergaard, Susanne Bonnichsen; Jakobsen, Henrik;

    2005-01-01

    Patients with primary hyperparathyroidism (PHPT) have increased risk of cardiovascular disease. For patients undergoing preoperative parathyroid imaging with 99mTc-sestamibi single photon emission computed tomography (SPECT), we combined cervical SPECT and gated cardiac SPECT to achieve information...... about the localization of parathyroid adenomas, myocardial perfusion, and the left ventricular ejection fraction (LVEF) at rest. A series of 22 patients with PHPT and no history of myocardial infarction or angina pectoris were recruited consecutively. At 60 minutes after injection of 700 MBq 99m......Tc-sestamibi, SPECT of the neck and gated myocardial perfusion SPECT were performed at the same time. All of the patients who underwent parathyroidectomy had the parathyroid adenoma localized as predicted from the SPECT. Five patients (23%) had myocardial perfusion defects extending more than 15% (range 15-25%), and...

  16. Prona positioning in patients submitted to myocardial perfusion scintigraphy; Posicao prona em pacientes submetidos a cintilografia de perfusao miocardica

    Cunha, C.J.; Ferreira, F.C.L.; Dullius, M.A.; Souza, S.O.; Souza, D.N. [Universidade Federal de Sergipe (UFS), Sao Cristovao, SE (Brazil). Dept. de Fisica; Carvalho, C.R.A. [Clinica de Medicina Nuclear Endocrinologia e Diabetes, Aracaju, SE (Brazil)

    2011-10-26

    The myocardium perfusion scintigraphy corresponds at the nuclear medicine to one of best diagnostic methods for myocardium diseases. However, artefacts generated by the diaphragmatic tissue can induce to false positive diagnostic when does not occurs association of the image in supine position with the prone position. Images acquired at the two positions were analysed and the evaluation of tomographic images were estimation and consequently, a more completed diagnostic

  17. GAMMAGRAFÍA DE PERFUSIÓN MIOCÁRDICA EN MUJERES POSMENOPÁUSICAS CON ANGINA Y CORONARIAS EPICÁRDICAS ANGIOGRÁFICAMENTE NORMALES / Myocardial perfusion scintigraphy in postmenopausal women with angina and angiographically normal epicardial coronary

    Sherien Sixto Fernández

    2011-03-01

    Full Text Available Introduction and Objectives: Microvascular angina is common in postmenopausal women. Myocardial ischemia was induced by stress testing, and reports have been published about the relationship between endothelial dysfunction and myocardial perfusion. The objective of this research was to determine whether myocardial ischemia can be evidenced by abnormalities in perfusion and function, as detected by myocardial scintigraphy in women with typical angina, normal coronary angiography and endothelial dysfunction. Methods: 59 women underwent lipid and endothelial function measurements by brachial artery ultrasound, in addition, a 24-hour ECG study (Holter. During the scintigraphy a stress-rest protocol was applied. Patients were divided into two groups according to presence (group I or absence (group II of myocardial perfusion defects. Results: 21 patients showed perfusion defects. 57 % of group I exhibited greater endothelial dysfunction. Only twelve patients showed reversible perfusion defects, and 75 % of the cases was associated with a reduction of post-stress left ventricular ejection fraction, greater than 5 %, and regional abnormalities of wall motion. Three patients in group I showed evidence of ischemia compared with four in Group II. Conclusions: The stress-induced ischemia was associated with a reduced post-stress ejection fraction and endothelial dysfunction in the studied women, and no ischemic changes in the Holter were found.

  18. Clinical significance of exercise-induced ST segment depression in patients with lateral myocardial infarction involving the left circumflex artery. Evaluation by exercise 99mTc-MIBI myocardial scintigraphy

    The aim of this study is to clarify the causes of exercise-induced ST-segment depression in patients with broad lateral old myocardial infraction involving left circumflex branch (LCX) (LCX-OMI) without ischemia on exercise scintigraphy. Twenty one patients (M/F=11/10, age=62±19 years) with myocardial infraction involving LCX (LCX-MI), but without fill-in on exercise and rest MIBI quantitative gated SPECT (QGS), were selected. They were divided into two groups of Group ST(+) (n=11, with significant ST depression (max-2.8±0.4 mm), Group ST (-) (n=10) without ST depression. On 20 SPECT segments of both exercise and rest SPECT, we scored uptake score as defect score (DS) (0=normal to 3=defect) and wall motion as wall motion score (WMS) (0=normal to -5=dyskinesis) and summed DS (TDS) and WMS (TWMS) in LCX region, furthermore, calculated the difference of TWMS (ΔTWMS {exercise-rest}), end diastolic volume (EDV) and ejection fraction (EF) during exercise were compared between the two groups. Group ST(+) showed significantly (p2-4 without ischemia in LCX-MI was observed in patients with broad LCX-MI, low EF, and was related to impaired wall motion in LCX region. ST depression in V2-4 was considered to appear as miller image of ST elevation at postero-inferior wall due to disturbed wall motion on exercise. (author)

  19. Evaluation of hemodynamic significance of coronary fistulae. Diagnostic integration between coronary angiography and stress/rest myocardial scintigraphy

    It is here reported on the importance of the integration of data obtained from digital coronary angiography and stress/rest 99mTc sestamibi myocardial perfusion single photon emission tomography in evaluationing the hemodynamic significance of coronary arteriovenous fistulae. Coronary fistulae were detected with coronary angiography in 9 patients. All patients underwent clinical examination, trans thoracic echocardiography, stress electrocardiogram and stress/rest 99mTc sestamibi myocardial perfusion single photon emission tomography. Stress/rest 99mTc sestamibi myocardial perfusion single photon tomography and stress electrocardiogram showed stress-induced myocardial ischemia in 2 patients. The first patient with familial predisposition and risk factors for ischemic heart disease presented a mesocardic heart murmur on clinical examination. At stress ECG (125 Watt, 153 b/m max frequency 93%, arterial pressure 230 mmHg, max frequency pressure product 35200) ischemic alterations were recorded at the first minute of the second stage of the Bruce protocol. Coronary angiography detected a circumflex artery fistula in the coronary sinus. Stress/rest 99mTc sestamibi myocardial perfusion single photon emission tomography for the evaluation of stress/rest perfusion detected a reversible perfusion defect of the proximal portion of the posterolateral and lateral walls, thus confirming the hemodynamic importance of the flow through the fistula during stress cycloergometric testing. In the second patient familial predisposition to ischemic heart disease and previous inferior wall myocardial infarction and non-significant stress ECG, coronary angiography identified a seclusive stenosis of the right coronary artery and anomaly between the anterior interventricular artery and the left pulmonary artery. The presence of the contrast medium in the left pulmonary artery identified a flow from the left ventricle to the left pulmonary artery. Good angiographic results were obtained

  20. Radio-isotopic myocardial study

    The non invasive study of the myocardium with radio-isotopes is effected either with radio-elements labeling on recently infarcted myocardium, such as PYP Tc 99m, or after I.V. injection of Tl 201 extracted by normal myocardium or after I.V. injection of radio-element which study the myocardial metabolism. The fixation of PYP Tc 99m, bordering that of calcium, appears 24 hours after the onset of the myocardial infarction; then it reduces and disappears a week later; its persistency gives evidence of an evolution to ventricular anevrism. The relatively low sensitivity and specificity of this test should induce to reserve if for precise cases. 201 Tl realizes a map of the myocardial flow because this radio-isotope reflects with damping the variations of coronary flow. The scintigraphy is made either after stress test or after I.V. injection of dipyridamole, and the sensitivity and specificity of the test is better than electrocardiographic exercise stress test. The predictive value of the test for a patient highly depends of the prevalence of the coronary disease for this patient; however the results of Tl scintigraphy are far from an ideal test; quantitative or semi-quantitative analysis of the image compared to the analogical image seems to improve sensitivity for detection of coronary disease. After myocardial infarction, its best use is to detect a left anterior descending stenosis after posterior or inferior infarction. Among the possible radio-elements of myocardial metabolism, scintigraphy with fatty acids opens interesting prospects for the study of the myocardial clearance of the radio-isotope, that reflects the global or regional myocardial metabolism

  1. A comparative study between TL-201 SPECT myocardial perfusion scintigraphy and dobutamine stress echocardiography in the detection of coronary artery disease at the Philippine Heart Center

    Although thallium-201 SPECT myocardial perfusion scintigraphy (MPS) has shown considerable accuracy for the detection of coronary artery disease (CAD), dobutamine stress echocardiography (DSE), a relatively new method for the detection of CAD had been recently utilized at the Philippine Heart Center. To assess its diagnostic worth versus that of thallium-201 spect myocardial scintigraphy (MPS), we studied 18 patients who underwent both procedures. Coronary angiography (CA) was used as the gold standard. MPS was performed with maximal treadmill exercise or with dipyridamole (0.568 mg/kg over 4 minutes) and Tl-201 was injected at peak stress. DSE was performed by infusing dobutamine at an increment of 5 μg/kg/min up to a maximum of 40. Atropine (0.01%) was added when 85% of maximum predicted heart rate is not achieved. Significant stenosis (>70%) was found in 16 out of 18 patients by CA. The sensitivity for the presence of CAD was 88% (14/16) and 69% (11/16) for MPS and DSE respectively. Specificity was 100% (2/2) for both. PPV was 100% for both while NPV was 50% and 29% for MPS and DSE respectively. Diagnostic accuracies were 89% and 72% for MPS and DSE respectively (P>0.05). Sensitivity for detecting left anterior descending artery (LAD) lesion was 71% 64% for MPS and DSE respectively; specificity was 75% and 100% respectively. For the left circumplex artery (LCX) lesion, both MPS and DSE had a sensitivity of 62% and specificity of 60%. Likewise for the right coronary artery (RCA) lesion, both had a sensitivity of 66% and specificity of 50%. Diagnostic accuracies were equal for both tests at 72% for LAD; 61% for LCX; and 61% for RCA. Kappa tests for association shows ρ values of >0.05 for overall and individual CAD detection suggesting no significant difference between MPS and DSE. Although there is a trend showing better detection of CAD with MPS, this particular study shows that both tests are comparable with regards to detection of the presence of CAD and of

  2. The effect of β-blocker on hamster model BIO 53.58 with dilated cardiomyopathy determined using 123I-MIBG myocardial scintigraphy

    123I-metaiodobenzylguanidine (MIBG) myocardial scintigraphy is currently used to evaluate cardiac sympathetic nerve function, but MIBG also has the capacity to evaluate dilated cardiomyopathy (DCM) severity and therapeutic effectiveness. In this study, we administered β-blockers to a DCM hamster model and evaluated the effect of therapy using MIBG. We also pathologically compared the effects of myocardial fibrosis suppression. BIO 53.58 hamsters were divided into the following five groups based on β-blocker administration: vehicle (COT), 2 mg/kg/day carvedilol (CLT), 20 mg/kg/day (CHT) carvedilol, 4 mg/kg/day (MLT) metoprolol, 40 mg/kg/day (MHT) metoprolol. F1B hamsters were administered a vehicle (COF). Plasma catecholamine, noradrenaline (p-NADR), adrenaline (p-ADR), and dopamine (p-DOPA) were assayed, and MIBG was performed. The count ratio of the heart to the mediastinum (H/M) and left ventricle myocardial washout ratio (WR) were calculated. We then performed an autopsy and calculated the percent change in fibrotic area from myocardial sections. H/M of the initial image in the COT group was significantly lower at 2.4±0.2 than the 2.9±0.7 in the COF group (p<0.05). The CLT and CHT groups had higher H/M values compared to the COT group (3.1±0.6, 3.0±0.6 versus 2.4±0.2: p<0.05). Significant correlations were evident between the H/M of the delayed image and p-NADR and p-DOPA (p<0.05, p<0.01, respectively) as well as between WR and p-NADR and p-DOPA (p<0.05). Percent change in fibrotic area was significantly lower in the β-blocker groups than in the COT group (p<0.05). Significant negative correlations were seen between the H/M of the delayed image and the percent change in fibrosis area. The delayed image H/M and WR acutely reflected cardiac disorder and sympathetic nerve function disorder in BIO 53.58 hamsters. In the carvedilol-administered groups, there was improvement compared to the initial H/M image, indicating the efficacy of the β-blocker in DCM

  3. Evaluation of the therapeutic effect of hyperbaric oxygenation and erythropoietin in the treatment of chronic heart failure using myocardial perfusion scintigraphy G-SPECT

    Baškot Branislav

    2009-01-01

    Full Text Available Background. The most important predictors of longterm survival in patients with cardiac ischemic disease are left ventricular ejection fraction, left ventricular volumes, infarction size, presence and extent of residual myocardial ischemia. One of the most important recent developments in single photon emission computed tomography (SPECT myocardial perfusion imaging is the ability to acquire these studies in conjunction with electrocardiogram (ECG gating (G-SPECT. The ability to asses radionuclide myocardial perfusion and function with ECG G-SPECT imaging has revolutionized this field of nuclear cardiology. Study with G-SPECT development algorithms permits to quantify measures of left ventricular (LV volume, ejection fraction (LVEF and even regional myocardial wall motion and thickening. The American Society of Nuclear Cardiology (ASNC in its position paper from March 1999 recommends the routine incorporation of G-SPECT during cardiac perfusion scintigraphy. Case report. We presented a 70-year-old male with ischemic heart disease (dilatative, cardiomyopathy and absolute arrhythmia. He was few times hospitally treated by medicamentous therapy with no evidence of improvement. After hospital treatment, we included hyperbaric oxygenation (HBO and erythropoietin injections. Hyperbaric oxygenation was carried out in a monoplace hyperbaric chamber, BLK S-303, by a graduated protocol for patients with severe heart insufficiency, totally 15 treatments. Recombinant erythropoietin beta (RecormonR F. Hoffmann-La Roche was applied deeply subcutaneously, every second day from 2 000 IU to totally 16 000 IU. Before the therapy G-SPECT study was performed with 99m technetium-MIBI, and we obtained the functional parameters and perfusion of the left ventricle to follow-up the therapy effects. The study was performed by an ADAC-VERTEX PLUS-EPIC two-head gamma camera with dedicated quantitatively algorithm Auto-QUANT. The results of LVEF were 15%, with severity

  4. Evaluation of viability of infarcted myocardium by low dose dobutamine stress echocardiography. Comparison with exercise stress 201Tl myocardial scintigraphy

    Exercise stress 201Tl myocardial single-photon emission computed tomography (SPECT) is recognized to be a excellent method for identifying viability after myocardial infarction, but it is expensive and needs a longer time for data acquisition than echocardiography. We therefore performed this study to evaluate the effectiveness of low dose (5-10 μg/kg/min) dobutamine stress echocardiography (DSE) in 30 patients (61±8 years old: 24 men and 6 women) within 4 weeks after myocardial infarction in identifying viable myocardium, compared to results obtained by SPECT. Defining an akinetic or dyskinetic segment obtained by rest echocardiography as a definite infarct area, altogether 96 segments out of 716 segments were shown to be infarct areas. Of these, 75 (78%) segments were identified as viable by DSE, and 77 (80%) by SPECT. Only 2 segments were shown to be discrepant on DSE and SPECT. Subsequently, the sensitivity, specificity and accuracy rates for DSE were 96%, 100% and 96%, respectively. In conclusion, DSE is as effective and useful as SPECT in the evaluation of viability after myocardial infarction. (author)

  5. Mapping of the image quality in myocardial scintigraphy: A national study; Kartlaeggning av bildkvalitet vid myokardscintigrafi: en nationell studie

    Ohlson, Maria; Gustafsson, Agnetha (Radiofysikavd., Universitetssjukhuset, Linkoeping (SE)); Gretarsdottir, Jakobina (Diagnostik, Sahlgrenska Universitetssjukhuset, Goeteborg (SE)); Olsson, Eva (Fysiologiska kliniken, Universitetssjukhuset, Linkoeping (SE)); Johansson, Lena (Klinisk Fysiologi, Sahlgrenska Universitetssjukhuset, Goeteborg (SE))

    2008-04-15

    The aim of this study was to make a survey over the physical parameters and how they affect the image quality and the final diagnosis for myocardial perfusion SPECT in Sweden. Another aim was to evaluate the need for standardized acquisition and processing protocols for myocardial perfusion SPECT. All thirty nuclear medicine departments in Sweden that perform myocardial perfusion SPECT participated in the study. A thorax heart phantom was used to simulate two patients. All studies were acquired and processed with the parameters used clinically in each hospital respectively. A quantitative and a qualitative evaluation were performed. At each hospital, the local nuclear medicine physician interpreted the images as if they were true patient images. There are great differences in the acquiring and processing parameters used in myocardial perfusion SPECT studies in Sweden. The image quality varies greatly for the different hospital but was approved for the majority of the hospitals. Images from two hospitals were considered to be too poor to be diagnosed. The interpretations of the local nuclear medicine physicians differ but the majority has reported an adequate diagnosis. One third of the hospitals have reported false positive defects. All steps in the chain from the acquisition to the evaluation of the medicine physician must be performed with high quality. The determinative factors are the noise reduction filter, the orientation of the slices in the heart and the judgement of the local medicine physician. The acquiring and processing parameters proposed by EANM should be used. The hospitals are also recommended to investigate in the time and resources available, in order to educate all staff involved in the evaluation of myocardial studies

  6. Abdominal visceral fat accumulation is associated with the results of {sup 123}I-metaiodobenzylguanidine myocardial scintigraphy in type 2 diabetic patients

    Anan, Futoshi [Oita Red Cross Hospital, Department of Cardiology, Oita (Japan); Oita University, Department of Internal Medicine I, Oita (Japan); Masaki, Takayuki; Takahashi, Naohiko; Yoshimatsu, Hironobu [Oita University, Department of Internal Medicine I, Oita (Japan); Yonemochi, Hidetoshi; Nakagawa, Mikiko; Saikawa, Tetsunori [Oita University, Department of Cardiovascular Science, Oita (Japan); Eshima, Nobuoki [Oita University, Department of Biostatistics, School of Medicine, Oita (Japan)

    2007-08-15

    We tested the hypothesis that increased abdominal visceral accumulation (VFA) is associated with insulin resistance and cardiovascular autonomic dysfunction in type 2 diabetic patients not receiving insulin treatment. The fat distribution was evaluated by measuring the VFA by abdominal computed tomography at the umbilical level. The study group consisted of 24 type 2 diabetic patients with high VFA ({>=}100 cm{sup 2}, age 60 {+-} 8 years, high VFA group). The control group consisted of 19 age-matched type 2 diabetic patients with normal VFA (<100 cm{sup 2}, age 60 {+-} 7 years, normal VFA group). Cardiovascular autonomic function was assessed by baroreflex sensitivity, heart rate variability, plasma norepinephrine concentrations, and cardiac {sup 123}I-metaiodobenzylguanidine (MIBG) scintigraphy. Early and delayed {sup 123}I-MIBG myocardial uptake values were lower (p < 0.005 and p < 0.0001, respectively) and the percent washout rate of {sup 123}I-MIBG was higher (p < 0.0005) in the high VFA group than in the normal VFA group. The fasting plasma insulin concentrations (p < 0.005) and the homeostasis model assessment (HOMA) index values (p < 0.0005) were higher in the high VFA group than in normal VFA group. Multiple regression analysis revealed that the level of VFA was independently predicted by the HOMA index values and the myocardial uptake of {sup 123}I-MIBG during the delayed phase. Our results demonstrate that the level of VFA is associated with depressed cardiovascular autonomic function and insulin resistance in patients with type 2 diabetes mellitus. (orig.)

  7. Usefulness and limitations of {sup 99m}Tc-3,3-diphosphono-1,2-propanodicarboxylic acid scintigraphy in the aetiological diagnosis of amyloidotic cardiomyopathy

    Rapezzi, Claudio; Quarta, Candida Cristina; Longhi, Simone; Gallo, Pamela; Gagliardi, Christian; Branzi, Angelo [University of Bologna and Policlinico S. Orsola-Malpighi Hospital, Institute of Cardiology, Bologna (Italy); Guidalotti, Pier Luigi; Pettinato, Cinzia [S. Orsola-Malpighi Hospital, Nuclear Medicine Unit, Bologna (Italy); Leone, Ornella [University of Bologna and S. Orsola-Malpighi Hospital, Department of Pathology, Bologna (Italy); Ferlini, Alessandra [University of Ferrara, Department of Diagnostic and Experimental Medicine, Section of Medical Genetics, Ferrara (Italy); Salvi, Fabrizio [Ospedale Bellaria, Department of Neurology, Bologna (Italy)

    2011-03-15

    We previously reported in a small series of patients that {sup 99m}Tc-3,3-diphosphono-1,2-propanodicarboxylic acid ({sup 99m}Tc-DPD) scintigraphy tested positive in transthyretin-related (TTR) (both mutant and wild-type) but not in primary (AL) amyloidotic cardiomyopathy (AC). We extended our study to a larger cohort of patients with AC. We evaluated (1) 45 patients with TTR-related AC (28 mutant and 17 wild-type), (2) 34 with AL-related AC and (3) 15 non-affected controls. Myocardial uptake of {sup 99m}Tc-DPD (740 MBq i.v.) was semiquantitatively and visually assessed at 5 min and at 3 h. Heart retention (HR) and heart to whole-body retention ratio (H/WB) of late {sup 99m}Tc-DPD uptake were higher among TTR-related AC (HR 7.8%; H/WB 10.4) compared with both unaffected controls (HR 3.5%; H/WB 5.7; p < 0.0001) and AL-related AC (HR 4.0%; H/WB 6.1; p < 0.0001). For the diagnosis of TTR-related AC, positive and negative predictive accuracy of visual scoring of cardiac retention were: 80 and 100% (visual score {>=}1); 88 and 100% (visual score {>=}2); and 100 and 68% (visual score = 3). At adjusted linear regression analysis, TTR aetiology turned out to be the only positive predictor of increasing {sup 99m}Tc-DPD uptake in terms of both HR [{beta} 2.5, 95% confidence interval (CI) 1.5-3.5; p < 0.0001] and H/WB ({beta} 3.5, 95% CI 2.1-4.9; p < 0.0001). While {sup 99m}Tc-DPD scintigraphy was confirmed to be useful for differentiating TTR from AL-related AC, diagnostic accuracy was lower than previously reported due to a mild degree of tracer uptake in about one third of AL patients. {sup 99m}Tc-DPD scintigraphy can provide an accurate differential diagnosis in cases of absent or intense uptake evaluated by visual score. (orig.)

  8. Selection of patients for myocardial perfusion scintigraphy based on fuzzy sets theory applied to clinical-epidemiological data and treadmill test results

    P.S. Duarte

    2006-01-01

    Full Text Available Coronary artery disease (CAD is a worldwide leading cause of death. The standard method for evaluating critical partial occlusions is coronary arteriography, a catheterization technique which is invasive, time consuming, and costly. There are noninvasive approaches for the early detection of CAD. The basis for the noninvasive diagnosis of CAD has been laid in a sequential analysis of the risk factors, and the results of the treadmill test and myocardial perfusion scintigraphy (MPS. Many investigators have demonstrated that the diagnostic applications of MPS are appropriate for patients who have an intermediate likelihood of disease. Although this information is useful, it is only partially utilized in clinical practice due to the difficulty to properly classify the patients. Since the seminal work of Lotfi Zadeh, fuzzy logic has been applied in numerous areas. In the present study, we proposed and tested a model to select patients for MPS based on fuzzy sets theory. A group of 1053 patients was used to develop the model and another group of 1045 patients was used to test it. Receiver operating characteristic curves were used to compare the performance of the fuzzy model against expert physician opinions, and showed that the performance of the fuzzy model was equal or superior to that of the physicians. Therefore, we conclude that the fuzzy model could be a useful tool to assist the general practitioner in the selection of patients for MPS.

  9. Selection of patients from myocardial perfusion scintigraphy based on fuzzy sets theory applied to clinical-epidemiological data and treadmill test results

    Coronary artery disease (CAD) is a worldwide leading cause of death. The standard method for evaluating critical partial occlusions is coronary arteriography, a catheterization technique which is invasive, time consuming, and costly. There are noninvasive approaches for the early detection of CAD. The basis for the noninvasive diagnosis of CAD has been laid in a sequential analysis of the risk factors, and the results of the treadmill test and myocardial perfusion scintigraphy (MPS). Many investigators have demonstrated that the diagnostic applications of MPS are appropriate for patients who have an intermediate likelihood of disease. Although this information is useful, it is only partially utilized in clinical practice due to the difficulty to properly classify the patients. Since the seminal work of Lotfi Zadeh, fuzzy logic has been applied in numerous areas. In the present study, we proposed and tested a model to select patients for MPS based on fuzzy sets theory. A group of 1053 patients was used to develop the model and another group of 1045 patients was used to test it. Receiver operating characteristic curves were used to compare the performance of the fuzzy model against expert physician opinions, and showed that the performance of the fuzzy model was equal or superior to that of the physicians. Therefore, we conclude that the fuzzy model could be a useful tool to assist the general practitioner in the selection of patients for MPS. (author)

  10. Administration of endo venous dipyridamole in myocardial scintigraphy with tetrofosmin-Tc99m in patients with complete left bundle branch block. Preliminary results

    The partial results of the administration of endovenous dipyridamole are compared with physical effort in 7 patients with complete left bundle branch block (CLBB) during myocardial scintigraphy with Tetrofosmin-TC99m. Exercise was undertaken according to the habitual protocol of our laboratory. The following segments were analyzed: septum, apex, inferoapical, posterolateral, anterolateral, anterior, inferior, postero-inferior and postero-basal. The highest heart rate (HR) on exertion was 90 n8 % and the maximum load was 61n 24 W. Heart rate, systolic and diastolic blood pressure under basal conditions had no significant changes, but when the stresses were compared they did (p<0.05). The global concordance for the reversibility or not of the uptake defect of the radiopharmaceutical was 96 %, k=0.83, whereas for identifying the type of defect it was 92 %, k=0.84. The worst concordance was for the septum 85 %, k=0.80; however, it was not significant in relation to other analyzed segments. Congruency was 71 % in the diagnostic result. Due probably to the unsuitability of the sample of studied patients, our results show a good concordance between the use of dipyridamole and physical effort with stress methods when only the images obtained are evaluated

  11. Abdominal visceral fat accumulation is associated with the results of 123I-metaiodobenzylguanidine myocardial scintigraphy in type 2 diabetic patients

    We tested the hypothesis that increased abdominal visceral accumulation (VFA) is associated with insulin resistance and cardiovascular autonomic dysfunction in type 2 diabetic patients not receiving insulin treatment. The fat distribution was evaluated by measuring the VFA by abdominal computed tomography at the umbilical level. The study group consisted of 24 type 2 diabetic patients with high VFA (≥100 cm2, age 60 ± 8 years, high VFA group). The control group consisted of 19 age-matched type 2 diabetic patients with normal VFA (2, age 60 ± 7 years, normal VFA group). Cardiovascular autonomic function was assessed by baroreflex sensitivity, heart rate variability, plasma norepinephrine concentrations, and cardiac 123I-metaiodobenzylguanidine (MIBG) scintigraphy. Early and delayed 123I-MIBG myocardial uptake values were lower (p 123I-MIBG was higher (p 123I-MIBG during the delayed phase. Our results demonstrate that the level of VFA is associated with depressed cardiovascular autonomic function and insulin resistance in patients with type 2 diabetes mellitus. (orig.)

  12. Synthesis, formulation and quality control of methoxy isobutyl isonitrile as a 99m Tc radiopharmaceutical kit for myocardial perfusion scintigraphy

    99m Tc - MIBI is a lipophile cationic 99m Tc complex which has been found to accumulate in viable myocardial tissue. The chemical structure of Isonitriles in particular Methoxy Isobutyl Isonitrile (MIBI) as well as the procedures of synthesis, formulation of kit and labelling with 99m Tc is discussed. Investigation of effective factors and finding the optimum parameters to obtain the highest labelling efficiency and radiochemical purity of 99m Tc - MIBI complex is also included in this research work

  13. Improvement of myocardial perfusion detected by 201Tl scintigraphy on cardiac rehabilitation for patients with coronary artery disease

    The effect of cardiac rehabilitation (mean 70±48 months) on myocardial perfusion was assessed using thallium-201 (201Tl) exercise study in 63 patients with coronary artery disease (CAD). Subjects were those in a rehabilitation group (Rh=42) participating in supervised sports training two to three times per week and the control group (Ct=21) not taking active daily exercise. The interval between two 201Tl SPECT studies was 19±16 months. After physical training, total duration of the exercise test increased from 443±112 to 536±121 seconds (+19%) in the Rh group, and from 484±129 to 432±115 seconds in the Ct group (-10.7%) (p2 to 269.8±58 x 102 in the Rh group and decreased from 218.7±40 x 102 to 216.6±76 x 102 (p201Tl myocardial perfusion defect on exercise improved more in 54.8% (stress 59.5%, rest 35.7%) in the Rh group than in the Ct group (9.5%, p201Tl perfusion defect decreased from 68 (23.1%) to 49 regions (16.7%) of 294 total myocardial regions in the Rh group on exercise. However. it increased from 39 (26.5%) to 44 (29.9%) regions of 147 regions in the Ct group (p<0.01). Thus, cardiac rehabilitation increases exercise tolerance with improvement of myocardial perfusion. suggesting that cardiac rehabilitation is an advisable and effective treatment for patients with ischemic heart disease. (author)

  14. Prediction of single versus multivessel disease following myocardial infarction using 201-thallium scintigraphy and electrocardiographic stress testing

    Fifty patients were evaluated who suffered a single myocardial infarction with graded electrocardiographic stress testing, 201-thallium myocardial perfusion imaging and coronary angiography to assess the role of noninvasive indices as predictors of single versus multivessel coronary artery disease. Multivessel involvement was defined angiographically as the presence of two or more major coronary arteries with at least a 70% intraluminal diameter narrowing. Multivessel disease was defined scintigraphically as the presence of stress and/or redistribution perfusion defects in the distribution of more than one coronary artery. The results of stress electrocardiography were not useful in differentiating patients with single (9/16 positive) versus multivessel (22/34 positive) disease. The degree of exercise-induced ST-segment depression was also not helpful. Stress 201-thallium imaging did offer limited additional information with correct predictions of multivessel disease in 21 of 26 patients. Predictions of single-vessel disease were accurate in 11 of 24 patients. Eleven of these 13 incorrect predictions of single-vessel disease were due to the relative insensitivity of the thallium stress image to perceive defect in the anterior wall when the left anterior descending artery had significant obstruction at catheterization. Further refinements of stress perfusion imaging are needed before this method can be used to reliably separate patients with single and multivessel disease after myocardial infarction

  15. The safety of dipyridamole myocardial perfusion scintigraphy (MPS) in patients with end-stage chronic airways limitations (CAL)

    Full text: Dipyridamole MPS is a well-established investigative technique in the diagnosis and pre-operative risk stratification of patients with possible coronary artery disease. However, there remains a concern of its use in patients with end-stage chronic airways limitations (CAL). Lung volume reduction surgery (LVRS) is a recent therapeutic option for such patients. The options for non-invasive pre-operative cardiac assessment in such patients are limited. This study reviewed the safety of dipyridamole use in such a clinical setting. 20 patients (10M, 10F, mean age 64.8 yrs) were evaluated. None had any history of ischaemic heart disease. Dipyridamole was administered intravenously at a dose of 0.05 mg/kg. Six patients remained asymptomatic throughout the procedure, while none experienced any chest pain. Two patients experienced moderate dyspnoea, which was rapidly relieved with aminophylline (100mg IV) during the recovery phase of the study. Two others developed mild dyspnoea; one settled spontaneously, while the other responded promptly to aminophylline. Aminophylline was administered to nine other patients to reverse minor symptoms (headache, flushing sensation). One other patient developed marked hypotension (SBP fell >20mmHg) and bradycardia, but no ECG changes for myocardial ischaemia. He responded well to aminophylline. His myocardial perfusion scan demonstrated extensive reversible myocardial ischaemia. Although the population size was small, dipyridamole appears safe to use in patients with end-stage CAL. Copyright (2000) The Australian and New Zealand Society of Nuclear Medicine Inc

  16. 14C octanoic acid breath tests correlate with scintigraphy in the critically ill

    Full text: Gastric stasis is common in the critically ill and reduces tolerance to nasogastric feeding. Scintigraphic measurement of gastric emptying is rarely used in the critically ill for practical reasons. Breath testing would be a more convenient way of determining gastric emptying. The purpose of this study was to validate 14C octanoic acid breath tests against scintigraphy in ventilated patients. 21 unselected mechanically ventilated patients receiving enteral nutrition via a nasogastric tube (14M, mean age 58yrs) were fed a dual radiolabelled nutrient meal consisting of 100ml Ensure, 74KBq 14C octanoic acid and 20MBq 99Tc sulphur colloid. 12 normal volunteers (9M mean age 38yrs) were also studied to establish normal ranges. Dynamic scintigraphic images were collected with subjects in 20 deg LAO position over 4 hours utilising a GE Starcam 300M mobile gamma camera. Breath samples were collected using the RAH 'Rapid-14' collection methodology at baseline and every 10 -15 minutes for 4 hours. Gastric emptying parameters were calculated and correlated. Normal breath test mean t- = 117min (SD=46). Delayed gastric emptying was seen in some of the critically ill patients, mean t- - 143 mm (SD=86). Strongest correlations were between normals scintigraphic t- (t-s) and breath test t- (t-B), r=0.96 (p-B, r=0.75 (p-s and t-B, n=16, r=0.73 (p14C octanoic acid breath tests in normal subjects and the critically ill. This may be a useful alternative for measurement of gastric emptying in the critically ill. Copyright (2002) The Australian and New Zealand Society of Nuclear Medicine Inc

  17. Tc-99m p-aminohippuric acid renal scintigraphy: results of preliminary animal and human studies

    Purpose: Tc-99m p-aminohippuric acid (PAH) is a new radiopharmaceutical labeled with Tc-99m in presence of calcium three sodium salt of DTPA by use of Sn(II) - reduction method. Tc-99m PAH is rapidly secreted by the kidneys in a manner consistent with tubular secretion, as confirmed by rat probenecid studies. The present study aimed at evaluating Tc-99m PAH as renal imaging agent. Methods: After bolus injection of radiopharmaceutical in a Wister rat (17 MBq) and in 10 healthy subjects - 2 normal volunteers and 8 potential kidney. donors (111 MBq) dynamic images were acquired for 20 min in three frame groups. In all patients Tc-99m MAG3 and Tc-99m DTPA studies were also performed several days later, in l day intervals to acquire renal studies for comparison. The scintigraphic images and time/activity curves were analyzed. Results: Rat study gave typical three-phase renogram and satisfactory renal functional images with no significant extrarenal background. During Tc-99m PAH scintigraphy in humans rapid disappearance of radiopharmaceutical from the vascular system and high uptake in kidneys followed by its very fast elimination and low residual activity at the end of the study were registered. Anterior whole body images obtained at 40 min and 3 h post injection to evaluate the distribution of 99mTc-PAH within the body showed neither gallbladder nor liver activity. Mean values of the following semi-quantitative parameters were calculated; time to peak (Tmax): 3.65±0.91, time from peak to 50% of peak activity (T1/2): 6.91±2.71, percentage of residual activity in each kidney at the end of the study: 26±2.71 and split renal function: 51.26±3.92. Mean values of Tmax and T1/2 obtained with Tc-99m PAH were significantly lower in comparison with Tc-99m DTPA. Mean values of relative function did not show any significant difference between three tracers. Conclusion: Our preliminary results confirmed good biological characteristics of 99mTc-PAH, indicating its potential

  18. Evaluation of the therapeutic effect of percutaneous nephroureterolithotomy by Tc-99m diethylenetriaminepentaacetic acid (DTPA) renal scintigraphy

    To evaluate the therapeutic effects of percutaneous nephroureterolithotomy, the renal function of eleven patients with renal calculi was studied, pre- and post-intervention. Renal function was determined, by renal scintigraphy with the renal agent, Tc-99m diethylenetriaminepentaacetic acid (DTPA). In each renal scintigram the renogram curve was analyzed and the following was determined by deconvolution analysis; the renal fraction of blood flow (RFBF), DTPA-glomerular filtration ratio (GFR) and the renal mean transit time (MTT). The successful results in percutaneous nephroureterolithotomy (PNL) was proven using the radionuclide technique in most cases. From these results it can be concluded that renal scintigraphy is an effective procedure to evaluate the effect of PNL for treating renal calculi and secondary hydronephrosis. (author)

  19. Estimation of acute myocardial infarct size in patients with successful coronary reperfusion by counts-based method (mirror image ROI method) using technetium-99m pyrophosphate myocardial scintigraphy

    The present study was to assess the usefulness of counts-based method in myocardial planar imaging with Tc-99m pyrophosphate (PYP) in determining myocardial infarct (MI) size. The subjects were 39 patients successfully treated with coronary thrombolytic therapy 6 hours after the onset of MI. Four to 6 days after the onset of MI, Tc-99m PYP images were obtained 4 hrs after iv injection of Tc-99m PYP (740 MBq). MI counts obtained by counts-based method in an anterior view (mirror image ROI method) were compared with the total serum concentration of creatine kinase (CK) and left ventricular ejection fraction (EF). There was a significant correlation between MI counts and the total serum concentration of CK. Similar findings were obtained for both anterior and inferior MI. MI counts showed a negative correlation with EF calculated from both blood pool scintiscanning and left ventriculography during the chronic stage. For patients with successful coronary perfusion, MI counts obtained by counts-based method are considered to become an indicator for MI size and chronic left ventricular function. (N.K.)

  20. {sup 123}I-MIBG myocardial scintigraphy in diabetic patients. Relationship with {sup 201}Tl uptake and cardiac autonomic function

    Nagamachi, Shigeki; Jinnouchi, Seishi; Kurose, Takeshi; Ohnishi, Takashi; Flores, L.G. II; Nakahara, Hiroshi; Futami, Shigemi; Tamura, Shozo; Matsukura, Shigeru [Miyazaki Medical Coll., Kiyotake (Japan)

    1998-12-01

    The purpose of this paper is to investigate the influence of diabetic myocardial damage (suspected myocardial damage; SMD) diagnosed by {sup 201}Tl-SPECT and diabetic cardiac autonomic neuropathy (AN) on myocardial MIBG uptake in patients with NIDDM. Eighty-seven diabetic patients divided into four subgroups: 23 with SMD (+) AN (+); 19 with SMD (+) AN (-); 27 with SMD (-) AN (+); 18 with SMD (-) AN (-), and 10 controls were studied. Both planar and SPECT images were taken at 30 minutes (early) and 3 hours (delayed) after {sup 123}I-MIBG injection. The heart to mediastinum uptake ratio (H/M) and washout ratio of {sup 123}I-MIBG (WR) were obtained from both planar images. Similarly, the difference between the {sup 201}Tl image and the {sup 123}I-MIBG image in the total uptake score (TUS) was taken as the difference in the total uptake score ({Delta}TUS) representing cardiac sympathetic denervation without SMD. On both early and delayed planar images, the mean H/M value in the subgroups of diabetic patients was significantly lower in the SMD (+) AN (+) group than in the control group, but among those subgroups, there was statistically significant difference between the SMD (+) AN (+) and SMD (-) AN (-) groups only on the delayed images. Regarding the WR value, there was no statistically significant difference among subjects. On SPECT image analysis, the diabetic subgroup with AN or SMD had statistically significant lower values for TUS than those of the control group. Among diabetics, there was a statistically significant differences between SMD [+] AN [+] and SMD [-] AN [-] on both early and delayed images. Similarly, the SMD [+] AN [-] group also had significantly lower values than those of SMD [-] AN [-] on early images. Regarding {Delta}TUS, there was a statistically significant differences between AN [+] subgroups and controls. Similarly, the mean value for {Delta}TUS was much higher in AN [+] subgroups than in AN [-] subgroups with or without SMD in diabetes

  1. [sup 123]I-MIBG myocardial scintigraphy in diabetic patients. Relationship with [sup 201]Tl uptake and cardiac autonomic function

    Nagamachi, Shigeki; Jinnouchi, Seishi; Kurose, Takeshi; Ohnishi, Takashi; Flores, L.G. II; Nakahara, Hiroshi; Futami, Shigemi; Tamura, Shozo; Matsukura, Shigeru (Miyazaki Medical Coll., Kiyotake (Japan))

    1998-12-01

    The purpose of this paper is to investigate the influence of diabetic myocardial damage (suspected myocardial damage; SMD) diagnosed by [sup 201]Tl-SPECT and diabetic cardiac autonomic neuropathy (AN) on myocardial MIBG uptake in patients with NIDDM. Eighty-seven diabetic patients divided into four subgroups: 23 with SMD (+) AN (+); 19 with SMD (+) AN (-); 27 with SMD (-) AN (+); 18 with SMD (-) AN (-), and 10 controls were studied. Both planar and SPECT images were taken at 30 minutes (early) and 3 hours (delayed) after [sup 123]I-MIBG injection. The heart to mediastinum uptake ratio (H/M) and washout ratio of [sup 123]I-MIBG (WR) were obtained from both planar images. Similarly, the difference between the [sup 201]Tl image and the [sup 123]I-MIBG image in the total uptake score (TUS) was taken as the difference in the total uptake score ([Delta]TUS) representing cardiac sympathetic denervation without SMD. On both early and delayed planar images, the mean H/M value in the subgroups of diabetic patients was significantly lower in the SMD (+) AN (+) group than in the control group, but among those subgroups, there was statistically significant difference between the SMD (+) AN (+) and SMD (-) AN (-) groups only on the delayed images. Regarding the WR value, there was no statistically significant difference among subjects. On SPECT image analysis, the diabetic subgroup with AN or SMD had statistically significant lower values for TUS than those of the control group. Among diabetics, there was a statistically significant differences between SMD [+] AN [+] and SMD [-] AN [-] on both early and delayed images. Similarly, the SMD [+] AN [-] group also had significantly lower values than those of SMD [-] AN [-] on early images. Regarding [Delta]TUS, there was a statistically significant differences between AN [+] subgroups and controls. Similarly, the mean value for [Delta]TUS was much higher in AN [+] subgroups than in AN [-] subgroups with or without SMD in diabetes

  2. Prognostic Utility of Calcium Scoring as an Adjunct to Stress Myocardial Perfusion Scintigraphy in End-Stage Renal Disease.

    Moody, William E; Lin, Erica L S; Stoodley, Matthew; McNulty, David; Thomson, Louise E; Berman, Daniel S; Edwards, Nicola C; Holloway, Benjamin; Ferro, Charles J; Townend, Jonathan N; Steeds, Richard P

    2016-05-01

    Coronary artery calcium score (CACS) is a strong predictor of adverse cardiovascular events in the general population. Recent data confirm the prognostic utility of single-photon emission computed tomographic (SPECT) imaging in end-stage renal disease, but whether performing CACS as part of hybrid imaging improves risk prediction in this population is unclear. Consecutive patients (n = 284) were identified after referral to a university hospital for cardiovascular risk stratification in assessment for renal transplantation. Participants underwent technetium-99m SPECT imaging after exercise or standard adenosine stress in those unable to achieve 85% maximal heart rate; multislice CACS was also performed (Siemens Symbia T16, Siemens, Erlangen, Germany). Subjects with known coronary artery disease (n = 88) and those who underwent early revascularization (n = 2) were excluded. The primary outcome was a composite of death or first myocardial infarction. An abnormal SPECT perfusion result was seen in 22% (43 of 194) of subjects, whereas 45% (87 of 194) had at least moderate CACS (>100 U). The frequency of abnormal perfusion (summed stress score ≥4) increased with increasing CACS severity (p = 0.049). There were a total of 15 events (8 deaths, and 7 myocardial infarctions) after a median duration of 18 months (maximum follow-up 3.4 years). Univariate analysis showed diabetes mellitus (Hazard ratio [HR] 3.30, 95% CI 1.14 to 9.54; p = 0.028), abnormal perfusion on SPECT (HR 5.32, 95% CI 1.84 to 15.35; p = 0.002), and moderate-to-severe CACS (HR 3.55, 95% CI 1.11 to 11.35; p = 0.032) were all associated with the primary outcome. In a multivariate model, abnormal perfusion on SPECT (HR 4.18, 95% CI 1.43 to 12.27; p = 0.009), but not moderate-to-severe CACS (HR 2.50, 95% CI 0.76 to 8.20; p = 0.130), independently predicted all-cause death or myocardial infarction. The prognostic value of CACS was not incremental to clinical and SPECT perfusion data (global chi

  3. Contributions of myocardial scintigraphy in coronary heart disease in chronic hemodialysis: A prospective study of 52 cases

    We propose in this work to assess the prevalence of cardiovascular risk factors in the chronic hemodialysis as well as diagnostic and prognostic performance of myocardial SPECT. We conducted a prospective study over a period of 5 years (1999-2004) assemble 52 chronic hemodialysis patients, 73 pour cent were treated at the hemodialysis unit of the principal Hospital Military - Tunis and 27 pour cent the hemodialysis unit of the polyclinic CNSS El Khadhra. The conventional periodic hemodialysis bicarbonate was the dialysis technique used in all our patients.

  4. Development of a computer-aided diagnosis system using fuzzy inference in 201TlCl exercise myocardial scintigraphy

    We have been working on the development of a computer-aided diagnosis system for images in nuclear medicine by using artificial neural networks. A physician's diagnosis of coronary artery disease in nuclear cardiology is performed not only on the basis of imaging data but also includes other factors such as measurement data from exercise scintigraphy. Therefore, we propose an expert system that uses fuzzy inference to estimate the number of abnormal vessels in cases of single- or multi-vessel disease (including normal vessels) of the coronary arteries. The main characteristic of this system is that it integrates information from various sources, including the physician's impressions. In this study, we investigated the system's clinical effectiveness. Results indicated a rate of agreement between the system's confidence level of inference and the physician's diagnosis of 62.2% and a rate of sensitivity of 83% for coronary artery disease. The computer made it possible to utilize vague factors such as a physician's assessment based on experience and intuition. These results demonstrate the usefulness of our proposed technique. (author)

  5. Comparison of 123I-MIBG myocardial scintigraphy, brain perfusion SPECT, and voxel-based MRI morphometry for distinguishing between dementia with Lewy bodies and Alzheimer's disease

    This study aimed to compare the diagnostic value of 123I-metaiodobenzylguanidine (MIBG) myocardial scintigraphy, N-isopropyl-p[123I]iodoamphetamine (IMP) brain perfusion single-photon emission computed tomography (SPECT), and brain magnetic resonance imaging (MRI) voxel-based morphometry (VBM) for the differentiation of dementia with Lewy bodies (DLB) and Alzheimer's disease (AD). Thirty-five and 34 patients with probable DLB and probable AD, respectively, were enrolled. All patients underwent 123I-MIBG myocardial scintigraphy, 123I-IMP brain perfusion SPECT, and brain MRI. For 123I-MIBG imaging, we calculated early and delayed heart-to-mediastinum (H/M) uptake ratios. Three-dimensional stereotactic surface projections (3D-SSP) were used to analyze the results of 123I-IMP SPECT. VBM with statistical parametric mapping 8 plus diffeomorphic anatomical registration using exponentiated Lie algebra (DARTEL) was used to analyze the brain MRI data. The area under the receiver operating characteristic curves (AUC) for discriminating DLB and AD was highest (0.882) for the delayed H/M ratio on 123I-MIBG scintigraphy. AUC for z-score measurement in the occipital lobe was 0.818 and that for the extent of gray matter (GM) atrophy in the whole brain was 0.788. AUC for the combination of 3D-SSP and VBM analysis was 0.836. The respective sensitivities and specificities for distinguishing DLB from AD were 97.1 and 100% for the delayed H/M ratio using 123I-MIBG scintigraphy; 88.6 and 73.5% for the occipital lobe z-score using 3D-SSP analysis; 85.7 and 64.7% for the extent of whole brain GM atrophy using voxel-based MRI morphometry; and 91.4 and 76.5% for the combination of 3D-SSP analysis and VBM. 123I-MIBG myocardial scintigraphy was superior to brain perfusion SPECT and brain MRI using an advanced statistical technique to differentiate DLB and AD. (author)

  6. Effect of isosorbide-5-mononitrate on the mean pulmonary artery pressure and parameters of endocardial scintigraphy following uncomplicated myocardial infarction

    It was the aim of the study described here to find out whether it would be possible to validate the effects that isosorbide-5-mononitrate has on patients having suffered uncomplicated myocardial infarction, when given shortly after continuous infusions of glycerol trinitrate, which are generally withdrawn just before the infarct patient is transferred from the intensive care unit to a peripheral ward. In this connection it was also of interest, if an effect would be detectable after three to four weeks of treatment using a 3x20 mg regimen or if the effects of continuous treatment would be abolished by the development of tachyphylaxis. An unbiased evaluation of efficacy was achieved on the basis of determinations of the mean pulmonary artery pressure, of the enddiastolic volume of the left ventricle using technetium-99m and of the left-ventricular ejection fraction at rest. (Vhe)

  7. Prevalence of symptomatic and silent stress-induced perfusion defects in diabetic patients with suspected coronary artery disease referred for myocardial perfusion scintigraphy

    Prior, John O.; Calcagni, Maria-Lucia; Bischof Delaloye, Angelika [Centre Hospitalier Universitaire Vaudois (CHUV University Hospital), Division of Nuclear Medicine, Lausanne (Switzerland); Monbaron, David; Ruiz, Juan [Centre Hospitalier Universitaire Vaudois (CHUV University Hospital), Division of Endocrinology, Diabetology and Metabolism, Lausanne (Switzerland); Koehli, Melanie [Centre Hospitalier Universitaire Vaudois (CHUV University Hospital), Division of Nuclear Medicine, Lausanne (Switzerland); Centre Hospitalier Universitaire Vaudois (CHUV University Hospital), Division of Endocrinology, Diabetology and Metabolism, Lausanne (Switzerland)

    2005-01-01

    Silent myocardial ischaemia - as evaluated by stress-induced perfusion defects on myocardial perfusion scintigraphy (MPS) in patients without a history of chest pain - is frequent in diabetes and is associated with increased rates of cardiovascular events. Its prevalence has been determined in asymptomatic diabetic patients, but remains largely unknown in diabetic patients with suspected coronary artery disease (CAD) in the clinical setting. In this study we therefore sought (a) to determine the prevalence of symptomatic and silent perfusion defects in diabetic patients with suspected CAD and (b) to characterise the eventual predictors of abnormal perfusion. The patient population comprised 133 consecutive diabetic patients with suspected CAD who had been referred for MPS. Studies were performed with exercise (41%) or pharmacological stress testing (1-day protocol, {sup 99m}Tc-sestamibi, {sup 201}Tl or both). We used semi-quantitative analysis (20-segment polar maps) to derive the summed stress score (SSS) and the summed difference score (SDS). Abnormal MPS (SSS{>=}4) was observed in 49 (37%) patients (SSS=4.9{+-}8.4, SDS=2.4{+-}4.7), reversible perfusion defects (SDS{>=}2) in 40 (30%) patients [SSS=13.3{+-}10.9; SDS=8.0{+-}5.6; 20% moderate to severe (SDS>4), 7% multivessel] and fixed defects in 21 (16%) patients. Results were comparable between patients with and patients without a history of chest pain. Of 75 patients without a history of chest pain, 23 (31%, 95% CI=21-42%) presented reversible defects (SSS=13.9{+-}11.3; SDS=7.4{+-}1.2), indicative of silent ischaemia. Reversible defects were associated with inducible ST segment depression during MPS stress (odds ratio (OR)=3.2, p<0.01). Fixed defects were associated with erectile dysfunction in males (OR=3.7, p=0.02) and lower aspirin use (OR=0.25, p=0.02). Silent stress-induced perfusion defects occurred in 31% of the patients, a rate similar to that in patients with a history of chest pain. MPS could identify

  8. Brain Natriuretic Peptide, Atrial Natriuretic Peptide and Endothelin-1 response to peak exercise in patients with coronary artery disease and correlation with myocardial perfusion scintigraphy abnormalities

    Aim: Plasma Brain Natriuretic Peptide (BNP) has been known as a promising marker of ventricular dysfunction in cardiac patients. There are conflicting reports about its response to exercise testing. Therefore, this study was performed to investigate the exercise induced changes in BNP, Atrial Natriuretic Peptide (ANP) and Endothelin-1 (E) levels and their correlation with perfusion abnormalities on myocardial perfusion scintigraphy (MPS). Materials and Methods: Study group consisted of 35 patients (mean age=53.9+11.8) who underwent MPS with suspicion or diagnosis of coronary artery disease. Plasma levels of BNP, ANP, and E were measured at rest and after symptom-limited ergometry. Patients were divided into two groups according to the presence of perfusion abnormality (i.e. ischemia or infarction) on MPS. Results: BNP, ANP and E levels did not change significantly with exercise, however baseline levels of BNP, ANP levels and peak-exercise level of BNP in patients with perfusion abnormalities were significantly higher. Hypertensive patients with or without perfusion abnormalities had higher baseline BNP, ANP levels, and peak-exercise BNP levels compared to normotensives. BNP levels at rest and after exercise had a significant correlation with age (r=0.57, p=0.04; r=0.58, p=0.04), as well as baseline ANP values (r=0.37, p=0.033). Highest baseline BNP, ANP and exercise BNP levels were observed in patients with infarction. Conclusion: Exercise-testing did not induce significant changes in plasma levels of BNP, ANP and E. Higher BNP levels had correlation with the presence of ischemia, infarction and hypertension, as well as, increasing age

  9. Effect of the reverse redistribution pattern on the left ventricular ejection fraction in the Tc- 99m MIBI SPECT myocardial perfusion scintigraphy

    Bekir Taşdemir

    2015-09-01

    Full Text Available Objective: The causes and prognostic significance of the reverse redistribution pattern (RRP is not clear yet. In this study, we aimed to evaluate the RRP effect on the left ventricular ejection fraction (EF. Methods: Imaging of the patients whose technetium-99m sestamibi myocardial perfusion scintigraphy was carried out and reported as normal were retrospectively examined. One-day protocol and/or pharmacologic stress testing applied patients were excluded. 21 patients with RRP met the inclusion criteria. All of these patients were included in the study as RRP group. Randomly selected 21 patients with non-RRP were included in the study as control group. Transient ischemic dilation (TID scores and EF values were automatically calculated with the Quantitative Gated SPECT (QGS program. Results: While a statistically significant difference was not found between the RRP and control groups in terms of age, sex, hypertension, family history, hyperlipidemia, and diabetes (p>0.05, there was a statistically significant difference in terms of smoking (p=0.019. TID scores in the RRP group were significantly lower compared to the control group (p<0.001. In addition, a statistically significant decrease was determined in the EF values in the rest images compared to the stress images in the RRP group (p=0.002. Furthermore, this decrease was significantly higher than in the control group (p= 0.034. Conclusion: The results related to the TID scores and EF values are suggesting the existence of an ischemic cause in the background of the RRP. Additionally, the relationship found between smoking and RRP may be associated with the tachycardia and / or coronary spasm-inducing effect of smoking. J Clin Exp Invest 2015; 6 (3: 286-290

  10. Myocardial perfusion scintigraphy 2008 in Germany. Results of the fourth query; Myokard-Perfusions-Szintigraphie 2008 in Deutschland. Ergebnisse der vierten Erhebung

    Lindner, O. [Herz- und Diabeteszentrum NRW, Bad Oeynhausen (Germany). Inst. fuer Radiologie, Nuklearmedizin und Molekulare Bildgebung; Burchert, W. [Herz- und Diabeteszentrum NRW, Bad Oeynhausen (Germany). Inst. fuer Radiologie, Nuklearmedizin und Molekulare Bildgebung; Deutsche Gesellschaft fuer Nuklearmedizin (Germany). Arbeitsgemeinschaft ' Kardiovaskulaere Nuklearmedizin' ; Bengel, F.M. [Johns Hopkins Medical Institutions, Baltimore (United States). Cardiovascular Nuclear Medicine; Deutsche Gesellschaft fuer Nuklearmedizin (Germany). Arbeitsgruppe ' Nuklearkardiologische Diagnostik' ; Zimmermann, R. [Deutsche Gesellschaft fuer Nuklearmedizin (Germany). Arbeitsgruppe ' Nuklearkardiologische Diagnostik' ; Klinikum Pforzheim GmbH, Pforzheim (Germany). Medizinische Klinik; Dahl, J. vom [Kliniken Maria Hilf GmbH, Moenchengladbach (Germany). Klinik fuer Kardiologie; Schaefer, W. [Kliniken Maria Hilf GmbH, Moenchengladbach (Germany). Klinik fuer Nuklearmedizin; Schober, O. [Muenster Univ. (Germany). Inst. of Molecular Imaging; Schaefers, M. [Deutsche Gesellschaft fuer Nuklearmedizin (Germany). Arbeitsgemeinschaft ' Kardiovaskulaere Nuklearmedizin' ; Muenster Univ. (Germany). Inst. of Molecular Imaging

    2010-07-01

    Aim: The working group Cardiovascular Nuclear Medicine of the German Society of Nuclear Medicine in cooperation with the working group Nuclear Cardiology of the German Cardiac Society herewith present the results of the 4{sup th} survey on myocardial perfusion scintigraphy (MPS) of the year 2008. Method: 310 questionnaires (191 private practices (PP), 93 hospitals (HO), 31 university hospitals (UH)) were evaluated. Results: MPS of 98 947 patients were reported. 15% of them were younger than 50 y, 57% between 50 and 70 y and 28% older than 70 y. 88% [2007: 83%] of all were studied with Tc-99m perfusion tracers. The patient radiation exposure of a stress and rest protocol considering German standard recommended doses was 8.5 mSv, of a stress-only protocol 1.9 mSv. 77% [2007: 76%] of the MPS were performed in PP, 15% [2007: 15%] in HO and 8% [2007: 9%] in UH. From 2005 to 2008 there was a mild increase in the MPS numbers by 1.2% (PP +7.1%, HO -5.5%, UH -31.4%). The type of stress was pharmacological in 30% [2007: 27%]; 68% adenosine (of these 22% with exercise), 29% dipyridamole (of these 64% with exercise), and <1% dobutamine. Gated SPECT was performed in 46% [2007: 47%] of all rest and in 42% [2007: 44%] of all stress MPS. 62% [2007: 61%] of all institutions did not use perfusion scores. Conclusion: The MPS numbers from 2005 to 2008 in Germany can be regarded as stable. However, there are considerable shifts from HO and UH to PP. The well known potential of MPS considering risk stratification and functional analysis has not been tapped so far. Both gated SPECT and a quantitative perfusion analysis should be performed routinely in every patient.

  11. Diagnostic cutoff points for {sup 123}I-MIBG myocardial scintigraphy in a Caucasian population with Parkinson's disease

    Muxi, Africa; Paredes, Pilar [Hospital Clinic, Universitat de Barcelona, Nuclear Medicine Department, Barcelona (Spain); Institut d' Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona (Spain); RECAVA, Instituto de Salud Carlos III, Barcelona (Spain); Agencia de Gestio d' Ajuts Universitaris i de Recerca (AGAUR 2009 SGR 1049), Barcelona (Spain); Navales, Ignacio; Sola, Oriol; Domenech, Beatriz [Hospital Clinic, Universitat de Barcelona, Nuclear Medicine Department, Barcelona (Spain); Valldeoriola, Francesc; Gaig, Carles; Cerda, Andres de la; Tolosa, Eduardo [Hospital Clinic, Universitat de Barcelona, Movement Disorders Unit, Neurology Department, Barcelona (Spain); Institut d' Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona (Spain); Lomena, Francisco [Hospital Clinic, Universitat de Barcelona, Nuclear Medicine Department, Barcelona (Spain); Institut d' Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona (Spain); Pons, Francesca [Hospital Clinic, Universitat de Barcelona, Nuclear Medicine Department, Barcelona (Spain); Institut d' Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona (Spain); Agencia de Gestio d' Ajuts Universitaris i de Recerca (AGAUR 2009 SGR 1049), Barcelona (Spain)

    2011-06-15

    Molecular imaging with {sup 123}I-metaiodobenzylguanidine (MIBG) has been used in Parkinson's disease (PD), but there is no consensual index to discriminate between normal and PD patients in the Caucasian population. The purpose of this study was to determine diagnostic cutoff points in the quantification of MIBG cardiac uptake in our population of PD patients. We have also calculated the reproducibility over a range of interpretation expertise. The study included 14 PD patients and 14 normal age- and sex-matched controls. Heart to mediastinum ratios (H/M) were calculated at 15 min (H/M15m) and 4 h (H/M4h) post-injection by three observers with different interpretation expertise, one of whom drew the regions of interest at three different times. The intraobserver and interobserver reliability was calculated (interclass correlation coefficient and coefficient of variability). Diagnosis was estimated by maximizing the Youden index for H/M and washout ratios. Discrimination ability was assessed by the area under the curve (AUC). Sensitivity and specificity were reported, using our thresholds. The parameter with the best diagnostic accuracy was the H/M4h ratio, with a major AUC (0.976 area under the receiver-operating characteristic curve). The threshold was 1.43 with a 95% confidence interval of 1.37-1.50. Using this threshold, the sensitivity and specificity were 93 and 100%. The interobserver and intraobserver variabilities measuring this ratio were 3.2 and 3.1%, respectively. The diagnostic cutoff point for {sup 123}I-MIBG myocardial scintigraphy in a Caucasian population with PD was 1.43 for the H/M4h index, with a good sensitivity and specificity. The technique is easy to use, with a good reproducibility over a range of interpretation expertise. (orig.)

  12. Myocardial perfusion scintigraphy in the detection of silent ischemia in asymptomatic diabetic patients Cintilografia de perfusão miocárdica na detecção da isquemia silenciosa em pacientes diabéticos assintomáticos

    Gláucia Celeste Rossatto Oki; Elizabeth João Pavin; Otávio Rizzi Coelho; Maria Cândida R. Parisi; Raitany C. Almeida; Elba Cristina Sá de Camargo Etchebehere; Edwaldo Eduardo Camargo; Celso Dario Ramos

    2013-01-01

    OBJECTIVE: This study was aimed to evaluate myocardial perfusion in asymptomatic patients with type 1 (DM1) and type 2 diabetes mellitus (DM2) without previous diagnoses of coronary artery disease (CAD) or cerebral infarction. MATERIALS AND METHODS: Fifty-nine consecutive asymptomatic patients (16 DM1, 43 DM2) underwent myocardial perfusion scintigraphy with 99mTc-sestamibi (MPS). They were evaluated for body mass index, metabolic control of DM, type of therapy, systemic arterial hypertension...

  13. Gastroesophageal reflux: the acid test, scintigraphy or the pH probe

    Seibert, J.J.; Byrne, W.J.; Euler, A.R.; Latture, T.; Leach, M.; Campbell, M.

    1983-06-01

    The best established technique for diagnosing gastroesophageal reflux in children is the 24 hr esophageal pH probe test. No simultaneous comparison of this technique with radionuclide scans has been reported. Therefore, simultaneous 1 hr pH monitoring and gastroesophageal scintigraphy were performed in 49 infants and children with suspected gastroesophageal reflux. Forty-seven of these patients also were later monitored by the 24 hr pH probe test. Upper gastrointestinal series were performed on all patients. All patients with a positive 1 hr pH monitoring also had positive simultaneous scintigraphy. All patients with positive scintigraphy and pH probe monitoring also had a positive upper gastrointestinal series for reflux. The sensitivity of gastroesophageal scintigraphy, when compared to the 24 hr probe as a standard, was 79%; its specificity was 93%. The sensitivity of the upper gastrointestinal series was 86%, when compared to the 24 hr pH probe test. However, its specificity was only 21%.

  14. Gastroesophageal reflux: the acid test, scintigraphy or the pH probe

    The best established technique for diagnosing gastroesophageal reflux in children is the 24 hr esophageal pH probe test. No simultaneous comparison of this technique with radionuclide scans has been reported. Therefore, simultaneous 1 hr pH monitoring and gastroesophageal scintigraphy were performed in 49 infants and children with suspected gastroesophageal reflux. Forty-seven of these patients also were later monitored by the 24 hr pH probe test. Upper gastrointestinal series were performed on all patients. All patients with a positive 1 hr pH monitoring also had positive simultaneous scintigraphy. All patients with positive scintigraphy and pH probe monitoring also had a positive upper gastrointestinal series for reflux. The sensitivity of gastroesophageal scintigraphy, when compared to the 24 hr probe as a standard, was 79%; its specificity was 93%. The sensitivity of the upper gastrointestinal series was 86%, when compared to the 24 hr pH probe test. However, its specificity was only 21%

  15. Serum fatty acid in patients with acute myocardial infarction in Gorgan

    Abdoljalal Marjani

    2012-01-01

    Introduction: The present study aimed to assess serum fatty acid in patients with acute myocardial infarction in Gorgan, Iran. Material and Methods: The study conducted on the thirty and five subjects with acute myocardial infarction who were referred to the intensive Coronary Care Unit in 5th Azar in Gorgan. Results: The content of palmitoleic acid (16:1) was significantly higher in serum fatty acid of the patients than of the control groups (P=0.019), whereas oleic acid (18:1), linoleic aci...

  16. Myocardial uptake of radioiodinated fatty acids under influence of beta-adrenoceptor antagonists in the dog

    The metabolic effects of Pindolol and Metoprolol on myocardial uptake and distribution of radioiodinated free fatty acids (131I-heptadecanoic acid) in the normal and acutely ischemic dog heart, are investigated. The study shows a decrease in uptake of 131I-heptadecanoic acid in the myocardium after administration of beta-blocking agents, which could have major implications: 1) for the administration of beta-blocking agents in the acute stage of myocardial infarction in clinical practice and 2) for the use of 131I-heptadecanoic acid as cardiac imaging agent in patients with or suspect for coronary artery disease whom are on beta-blocker therapy

  17. Serum fatty acid in patients with acute myocardial infarction in Gorgan

    Abdoljalal Marjani

    2012-10-01

    Full Text Available Introduction: The present study aimed to assess serum fatty acid in patients with acute myocardial infarction in Gorgan, Iran. Material and Methods: The study conducted on the thirty and five subjects with acute myocardial infarction who were referred to the intensive Coronary Care Unit in 5th Azar in Gorgan. Results: The content of palmitoleic acid (16:1 was significantly higher in serum fatty acid of the patients than of the control groups (P=0.019, whereas oleic acid (18:1, linoleic acid (18:2, _-linolenic acid (18:3, arachidonic acid (20:4 and Eicosapentaenoic acid (EPA were significantly higher in the control groups than the patients (P<0.0001, P=0.013, P=0.042, P=0,001 and P=0.022 respectively. Conclusion: This study showed that the content of polyunsaturated fatty acids in serum fatty acid component was decreased in acute myocardial infarction patients. These results suggest that there may be some protective effects of poly unsaturated fatty acid against myocardial infarction.

  18. Myocardial fatty acid imaging using iodine-123-BMIPP in patients with hypertensive intracranial hemorrhage

    An evaluation of myocardial fatty acid metabolism in hypertensive patients with major complication has not been previously established. To assess the myocardial fatty acid metabolism in hypertensive patients with intracranial hemorrhage (IH), we performed myocardial image using 123I-15-p-iodophenyl-3-methyl pentadecanoic acid (BMIPP). Seventeen hypertensive patients with IH (HIH) and 27 hypertensive patients without IH (HT) were studied. A dose of 111 MBq of BMIPP was injected intravenously at rest, and a myocardial image was recorded 30 minutes after the injection. Myocardial perfusion image using Thallium-201 (Tl) was also performed within 2 weeks after BMIPP study. The regional myocardial uptakes of BMIPP and Tl were visually assessed in 17 segments with a four-point scoring system (0=absent to 3=normal uptake). Cardiac hypertrophy was evaluated by electrocardiogrpahy (ECG) and two-dimensional ultrasonic cardiography (UCG). Sum of uptake scores of Tl was similar in both groups (45.1±5.4 vs. 47.9±4.2), but that of BMIPP in HIH was lower than HT (35.9±7.9 vs 45.6±4.8, p<0.001). Evaluation of cardiac hypertrophy using ECG and UCG revealed no significant difference between two groups. HIH have much more eccentric hypertrophy in UCG study than HT (53% vs. 37%). These data suggest that hypertensive patients with intracranial hemorrhage have a more impaired myocardial fatty acid metabolism compared to the hypertensive patients with similar cardiac hypertrophy. BMIPP imaging might be useful to evaluate the severity of myocardial fatty acid metabolism in hypertensive patients. (author)

  19. Ascorbic acid improves embryonic cardiomyoblast cell survival and promotes vascularization in potential myocardial grafts in vivo

    Martinez, E. C.; Wang, J; Gan, S U; Singh, R.; Lee, C. N.; Kofidis, T

    2010-01-01

    Organ restoration via cell therapy and tissue transplantation is limited by impaired graft survival. We tested the hypothesis that ascorbic acid (AA) reduces cell death in myocardial grafts both in vitro and in vivo and introduced a new model of autologous graft vascularization for later transplantation. Luciferase (Fluc)- and green fluorescent protein (GFP)-expressing H9C2 cardiomyoblasts were seeded in gelatin scaffolds to form myocardial artificial grafts (MAGs). MAGs were supplemented wit...

  20. Adrenal scintigraphy

    The exact localization of adrenal lesions can be achieved by noninvasive procedures. Whereas radiological methods reflect morphological changes, scintigraphy of adrenal cortex and medulla depends on function. - Radiolabeled 6β-methyl-19-norcholesterol is used for adrenocortical scintigraphy in primary aldosteronism, Cushing's syndrome and hyperandrogenism. By dexamethasone suppression a correct classification of adrenocortical lesions by scintigraphy can be observed in about 89% with a specificity of 86%. 123-I- and 131-I-metaiodobenzylguanidine is used for specific scintigraphy of the adrenal medulla. This method is a safe and reliable method for localization of adrenal and extraadrenal pheochromocytomas. (orig.)

  1. Adrenal scintigraphy

    Fischer, M.; Vetter, H.

    1986-04-01

    The exact localization of adrenal lesions can be achieved by noninvasive procedures. Whereas radiological methods reflect morphological changes, scintigraphy of adrenal cortex and medulla depends on function. - Radiolabeled 6..beta..-methyl-19-norcholesterol is used for adrenocortical scintigraphy in primary aldosteronism, Cushing's syndrome and hyperandrogenism. By dexamethasone suppression a correct classification of adrenocortical lesions by scintigraphy can be observed in about 89% with a specificity of 86%. 123-I- and 131-I-metaiodobenzylguanidine is used for specific scintigraphy of the adrenal medulla. This method is a safe and reliable method for localization of adrenal and extraadrenal pheochromocytomas.

  2. Serial assessment of myocardial thallium perfusion and fatty acid utilization in spontaneously hypertensive rats

    To evaluate the advantage of free fatty acid imaging on the detection of hypertrophied myocardium, we compared sequentially myocardial thallium and BMIPP (15-(p-iodophenyl)-3-(R,S)-methyl pentadecanoic acid) distribution in spontaneously hypertensive rat (SHR) using dual tracer autoradiography and in vivo pin-hole imaging. Autoradiography and pin-hole imaging showed uniform myocardial distribution of BMIPP and thallium within less than 27 weeks age SHR. In 40 weeks age SHR, thallium myocardial distribution showed uniform, however, BMIPP had focal decrease. Quantitative analysis of pin-hole images showed that myocardial BMIPP and thallium uptake ratio decreased according to the ages of SHR. Our data suggest that hypertension is associated with uniform myocardial perfusion and focal alternation in the substrate used for the performance of myocardial work. Based on the above autoradiographic and in vivo pin-hole imagings, I-123 BMIPP imaging may have a potential for early detection on hypertrophic myocardium compared to thallium perfusion in clinically hypertensive patients. (author)

  3. Comparison of myocardial thallium and β-methyl iodophenyl pentadecanoic acid (BMIPP) distribution in cardiomyopathy hamster

    The usefulness of fatty acid imaging in the detection of cardiomyopathy was evaluated by comparing thallium and BMIPP myocardial distribution in Bio 14.6 Syrian Hamster (25 week ages). Autoradiography was performed in 3 using 3.7 MBq (100 μCi) of 125I-BMIPP and 37 MBq (1 mCi) of 201TlCl. In vivo pin-hole imaging was performed in 3 using 37 MBq (1 mCi) of 123I-BMIPP and 37 MBq (1 mCi) of 201TlCl. In all cardiomyopathy hamsters, decreased uptake of BMIPP compared to that of thallium was demonstrated. These findings suggest dilated cardiomyopathy is associated with severe focal alternation in the substrate used for the performance of myocardial work. In conclusion, myocardial imaging using BMIPP may be useful for early detection of myocardial degeneration compared to thallium in patients with dilated cardiomyopathy. (author)

  4. Gated equilibrium bloodpool scintigraphy

    This thesis deals with the clinical applications of gated equilibrium bloodpool scintigraphy, performed with either a gamma camera or a portable detector system, the nuclear stethoscope. The main goal has been to define the value and limitations of noninvasive measurements of left ventricular ejection fraction as a parameter of cardiac performance in various disease states, both for diagnostic purposes as well as during follow-up after medical or surgical intervention. Secondly, it was attempted to extend the use of the equilibrium bloodpool techniques beyond the calculation of ejection fraction alone by considering the feasibility to determine ventricular volumes and by including the possibility of quantifying valvular regurgitation. In both cases, it has been tried to broaden the perspective of the observations by comparing them with results of other, invasive and non-invasive, procedures, in particular cardiac catheterization, M-mode echocardiography and myocardial perfusion scintigraphy. (Auth.)

  5. Adrenal scintigraphy

    The following items are discussed:anatomy and physiology of adrenal glands, clinical indications of scintigraphy, radiobiology and radiochemistry, scintigraphic imaging, adrenocortical hyperfunction, aldosteronism and hypertension associated with low renin level, excess of androgen, adrenocortical hyperfunction and future perspectives of adrenal scintigraphy. (M.A.)

  6. Lung scintigraphy

    A review of lung scintigraphy, perfusion scintigraphy with SPECT, lung ventilation SPECT, blood pool SPECT. The procedure of lung perfusion studies, radiopharmaceutical, administration and clinical applications, imaging processing .Results encountered and evaluation criteria after Biello and Pioped. Recommendations and general considerations have been studied about relation of this radiopharmaceutical with other pathologies

  7. Myocardial fatty acid utilisation during exercise induced ischemia in patients with coronary artery disease

    Aim: Reversible or irreversible myocardial damage due to ischemia correlates with altered membrane functions of the cells. To compare myocardial free fatty acid (FFA) metabolism and flow during exercise induced ischemia we studied ten patients with coronary artery disease but without previous myocardial infarction. Methods: A series of post-exercise single-photon emission computed tomography (SPECT) measurements was performed after injection of 123I labelled heptadecanoic acid (HDA). Myocardial perfusion was estimated from the separately performed exercise-redistribution thallium study. Fatty acid metabolic rate, thallium uptake and washout were calculated for anterior, lateral, posterior and septal segments. Results: The more reduced post-exercise FFA metabolic rate (-63±18%, mean ±1 SD) compared to flow (-36±16%) was related to the severity of myocardial ischemia and wall motion abnormalities. Conclusion: In this small group of patients, the reduced post-exercise FFA metabolic rate tentatively suggests a parsimonious workload of the exercising myocardium by reducing oxygen consumption in patients with coronary artery disease. (orig.)

  8. Dual myocardial single photon emission computed tomography (SPECT) using thallium-201 and I-123-{beta}-methyl-i-pentadecanoic acid in patients with Duchenne's progressive muscular dystrophy

    Shimoyama, Katsuya [Kyorin Univ., Mitaka, Tokyo (Japan). School of Medicine

    1999-10-01

    Dual single photon emission computed tomography (SPECT) was performed in 31 patients with Duchenne's progressive muscular dystrophy (DMD) using {sup 123}I-{beta}-methyl pentadecanoic acid (BMIPP) for myocardial fatty acid metabolism and {sup 201}thallium (Tl)-chloride for myocardial perfusion. The left ventricle was divided into 9 segments, and accumulation of the radiotracers was assessed visually for each segment to calculate defect score for each tracer. There was some degree of decrease in myocardial accumulation of both tracers in all DMD patients. Reduced accumulation was most common at the apex (BMIPP: 67%, Tl: 63%), followed by the posterior wall, lateral wall, and anterior wall. On the other hand, reduced accumulation was less common at the septum. BMIPP showed a higher accumulation than Tl in all segments but the septum. When BMIPP defect score was larger than Tl defect score, BMIPP defect score tended to increase during 4 years follow-up (p<0.042). However, when Tl defect score was larger than BMIPP defect score, an increase in Tl defect score was slight. A significant negative correlation was found between the sum of the BMIPP and Tl defect scores and the left ventricular ejection fraction (LVEF) (r=0.66, p<0.0001). According to the histo-pathological study of two autopsied hearts, severe myocardial fibrosis was seen in segments with fixed perfusion defect. In addition, the mismatched segments of BMIPP defect score > Tl defect score revealed a slight fibrosis or normal myocardium. It can be concluded that the dual SPECT myocardial scintigraphy using BMIPP and Tl provides accurate information about disease progression of the heart in patients with DMD by detecting abnormalities of the myocardial metabolism of each substance, thereby enabling the assessment of left ventricular function. (author)

  9. Myocardial imaging with radioiodinated beta-methyl-branched fatty acid in cardiomyopathy

    The purpose of our experimental and clinical studies was to examine whether myocardial distribution of beta-methyl iodophenyl pentadecanoic acid (BMIPP) is different from that of thallium in cardiomyopathic hamsters and how single photon emission computed tomography (SPECT) delineate the different between thallium and BMIPP distributions in patients with cardiomyopathy. Quantitative dual tracer autoradiography demonstrated an uncoupling of myocardial thallium and [I-125]BMIPP distributions as well as a regional heterogeneity of [I-125]BMIPP distribution in cardiomyopathic hamsters. In patients with septal or apical hypertrophy and normal contractility, SPECT showed reduced [I-123]BMIPP uptake in the thickened myocardium with normal or high thallium uptake. In patients with hypertrophy and systolic dysfunction as well as those with dilated cardiomyopathy, SPECT with thallium and [I-123]BMIPP showed similar heterogeneous distributions. In conclusion, SPECT with [I-123]BMIPP may provide unique features different from thallium imaging and may delineate regional abnormalities of myocardial fatty acid metabolism in cardiomyopathy. (author)

  10. Myocardial perfusion scintigraphy in patients with mitral valve prolapse: its advantage over stress electrocardiography in diagnosing associated coronary artery disease and its implications for the etiology of chest pain

    Patients with mitral valve prolapse (MVP) frequently experience chest pain which may, especially in older subjects and males, be difficult to differentiate from angina pectoris. Electrocardiographic (ECG) changes, ventricular arrhythmias, metabolic abnormalities and rare reports of myocardial infarction and sudden death further suggest the presence of an ischemic process in these patients. The recognition of accompanying coronary artery disease (CAD) and exclusion of other causes of ischemia, therefore, may be important in determining the prognosis and appropriate therapy for such patients. We performed stress ECGs and perfusion scintigrams in 25 patients with confirmed MVP who underwent cardiac catheterization for evaluation of chest pain. Stress ECGs were not helpful in diagnosing assosiated CAD, primarily because of a high incidence (53%, 10/19) of false positive tests, and had only a 48% overall accuracy. Scintigraphy was more accurate (p < 0.001), correctly classifying all patients. Scintigraphy was uniformly negative in patients with normal coronary arteriograms, suggesting that ischemia, if present as the cause of chest pain and ECG changes, must be either very localized or generalized

  11. Adrenal scintigraphy

    The visualization of functioning adrenocortical tissue by scintigraphy became possible with the introduction of radioiodinated cholesterol derivatives. According to the literature, there is evidence that one of these iodinated cholesterols, 6-β-iodomethyl-nor-cholesterol, concentrates in the adrenal cortex to a much greater extent than 131I-19-odocholesterol. Results comparing both radiopharmaceuticals are described. The authors investigated the possibility of increasing the uptake of iodinated cholesterol using simultaneous ACTH and the 'cholesterol side-chain cleavage enzymeblocker': aminoglutethimide. The results of adrenal scintigraphy performed in 37 patients are described. Finally, the literature on adrenal scintigraphy is reviewed, and results reported in various studies are compared. (Auth.)

  12. Technetium Tc 99m Dimercaptosuccinic Acid Renal Scintigraphy in Diagnosis of Urinary Tract Infections in Children with Negative Culture

    Mehdi Fazel

    2006-02-01

    Full Text Available

    Introduction: The aim of this study was to evaluate the accuracy of Technetium Tc 99m dimercaptosuccinic acid (99mTc-DMSA renal scintigraphy in the diagnosis of urinary tract infection (UTI in children with suspected infection but with a negative urine culture.

    Materials and Methods: The records of all children with suspected or definite diagnosis of UTI presented during a 2-year period were reviewed in this study. Abnormal findings on renal scintigraphy, voiding cystourethrography (VCUG, and ultrasonography were evaluated and compared between the patients with the definite diagnosis of UTI and those with suspected UTI and negative urine cultures.

    Results: Of 210 patients, 86 had a definite diagnosis of UTI (group 1 and 124 had suspected UTI without a positive culture (group 2. Abnormal findings on DMSA scans were seen in 76 patients (88.4% in group 1 and 84 (67.7% in group 2. Vesicoureteral reflux was detected by VCUG in 50% and 32.3% of the patients in groups 1 and 2, respectively. In group 2, vesicoureteral reflux was seen in 40.5% of the patients with abnormal DMSA scan. Ultrasonography findings were abnormal in 51.3% and 39.8% of the patients with abnormal DMSA scan findings in groups 1 and 2, respectively.

    Conclusion: According to our findings, in children with a negative urine

  13. Regulatory role of free fatty acids in maintain of membrane homeostasis in heart mitochondria at experimental myocardial ischaemia

    M. V. Egorova; S. A. Afanasiyev

    2016-01-01

    The rate of oxygen uptake by heart mitochondria (Mch) at different heart pathologies (myocardial infarction, diabetes mellitus and their combination) was studied polarographically. The rate of oxygen uptake of damaged heart Mch and content of free fatty acids (FFA) were increased. Change of these parameters was increased with the development of pathologies that is most pronounced in the groups «diabetes» and «diabetes + myocardial infarction». In the group of «myocardial infarction + diabetes...

  14. Impact of arterial occlusion during partial nephrectomy on residual renal function. An evaluation with 99mtechnetium-dimercaptosuccinic acid scintigraphy

    Partial nephrectomy (PNx) has been performed with temporary renal arterial occlusion and in situ renal hypothermia (conventional PNx). However, the impact of temporary renal arterial occlusion on residual renal function has not been well assessed. To address this question, we performed renal scintigraphy with 99mtechnetium-dimercaptosuccinic acid (DMSA) for the quantitative measurement of postoperative residual renal function after conventional PNx and partial nephrectomy without arterial occlusion (non-clamping PNx). Thirty-four patients underwent postoperative DMSA scintigraphy after PNx for renal cell carcinoma. No obvious difference in preoperative renal function between the diseased kidney and the contralateral kidney was found in any of the patients. Of these patients, 24 underwent conventional PNx, and 10 underwent non-clamping PNx. Residual renal function was evaluated using the relative DMSA uptake of the operated kidney. The relative DMSA uptake of the operated kidney was 39.9±7.3% (25.1-58.8) after conventional PNx compared to 34.8±8.9% (13.5-45.5) after non-clamping PNx. This difference was not statistically significant (P=0.15). Total ischemic time during conventional PNx had no adverse influence on the residual renal function. In the analysis of the other determinant factors influencing residual renal function, tumor size was the only significant factor that inversely correlated with the relative DMSA uptake. Our results showed that arterial clamping during PNx has no negative impact on the functional residual capacity as long as in situ renal hypothermia is adequately performed. (author)

  15. n-3 Fatty Acids and Cardiovascular Events after Myocardial Infarction

    Kromhout, D.; Giltay, E.J.; Geleijnse, J.M.

    2010-01-01

    Background - Results from prospective cohort studies and randomized, controlled trials have provided evidence of a protective effect of n-3 fatty acids against cardiovascular diseases. We examined the effect of the marine n-3 fatty acids eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) and

  16. Usefulness of {sup 123}I-MIBG and {sup 123}I-BMIPP myocardial scintigraphy for detecting coronary artery disease and for evaluating left ventricular function

    Toyama, Takuji; Suzuki, Yasushi; Tsukagoshi, Joichi [Gunma Univ., Maebashi (Japan). School of Medicine] [and others

    1995-02-01

    We evaluated the diagnostic value of {sup 123}I-metaiodobenzylguanidine (MIBG) and {sup 123}I-labeled beta-methyliodophenyl pentadecanoic acid (BMIPP) myocardial SPECTs for evaluating coronary artery disease and left ventricular function, in comparison with the diagnostic value of {sup 201}Tl (Tl) SPECT. For forty-nine patients with coronary artery disease, resting MIBG and BMIPP SPECTs were performed to detect coronary artery stenosis, compared with the diagnostic value of exercise Tl. Left ventricular ejection fraction and regional wall motion were compared with the total US (TUS) and regional US (RUS) of resting MIBG and BMIPP SPECTs, and in turn, compared with resting Tl SPECT. The sensitivity of resting BMIPP SPECT for detecting coronary artery stenosis was lower, and the specificity of resting MIBG SPECT was lower than the other two methods. The accuracy of resting MIBG SPECT for evaluating coronary lesions was nearly the same as the accuracy of exercise Tl, but higher than that of BMIPP SPECT. Left ventricular ejection fraction was well correlated with TUS of resting MIBG SPECT (r=0.80), resting BMIPP SPECT (r=0.77), and resting Tl SPECT (r=0.68). Regional wall motion was most correlated with RUS of resting BMIPP SPECT, compared with that of resting Tl and MIBG SPECTs. These data suggest that resting MIBG SPECT is useful for detecting coronary artery disease and that resting BMIPP SPECT is valuable in evaluating regional left ventricular function. (author).

  17. Cardioprotective effects of gallic acid in diabetes-induced myocardial dysfunction in rats

    Patel, Snehal S.; Goyal, Ramesh K.

    2011-01-01

    Background: Normalization of hyperglycemia, hyperlipidemia, and oxidative stress is an important objective in preventing diabetes-induced cardiac dysfunction. Objective: This study was undertaken to examine the effects of gallic acid in myocardial dysfunctions associated with type-1 diabetes. Materials and Methods: Diabetes was induced by single intravenous injection of streptozotocin (STZ, 50 mg/kg i.v.). Gallic acid was administered daily at three different doses (100, 50, and 25 mg/kg p.o....

  18. Fatty Acid Desaturase Gene Variants, Cardiovascular Risk Factors, and Myocardial Infarction in the Costa Rica Study

    Aslibekyan, S.; Jensen, M K; Campos, H.; Linkletter, C. D.; Loucks, E. B.; Ordovas, J. M.; Deka, R.; Rimm, E. B.; Baylin, A

    2012-01-01

    Genetic variation in fatty acid desaturases (FADS) has previously been linked to long-chain polyunsaturated fatty acids (PUFAs) in adipose tissue and cardiovascular risk. The goal of our study was to test associations between six common FADS polymorphisms (rs174556, rs3834458, rs174570, rs2524299, rs174589, rs174627), intermediate cardiovascular risk factors, and non-fatal myocardial infarction (MI) in a matched population based case–control study of Costa Rican adults (n = 1756). Generalized...

  19. Serum uric acid level in hypertensive patients with acute myocardial infarction

    To estimate serum uric acid level in hypertensive patients with acute myocardial infarction and hypertensive patients without myocardial infarction. Study Design Cross-sectional study. Setting Department of Medicine, Mayo Hospital, Lahore. Duration of study with dates Study was carried over a period of six months from 01-01-2007 to 30-06-2007. Subjects and methods Eighty hypertensive patients were included in the study out of which 40 patients with acute myocardial infarction were put in MI group and 40 patients without any history of myocardial infarction were labeled as non-MI group. Results Mean age of the patients in MI group and non-MI was found to be 50.0+-12.4 and 51.8+-10.1 years, respectively. Results of Serum uric acid level in MI group were 6.9+-1.0 mg/dl (0.407 +- 0.059 mmol/L ) and in non-MI group were 5.8+-1.5 mg/dl (0.342 +- 0.088 mmol/L) (p<0.001). (where 1 mmol/L = 16.78 mg/dl or 1 mg/dl = 0.059 mmol/L). Conclusion The present study proved that raised serum uric acid level can cause hypertension and further rise can lead to MI. (author)

  20. Evaluation of the therapeutic effect of hyperbaric oxygenation and erythropoietin in the treatment of chronic heart failure using myocardial perfusion scintigraphy G-SPECT

    Baškot Branislav; Živković Miodrag; Tepić Sandra; Obradović Slobodan

    2009-01-01

    Background. The most important predictors of longterm survival in patients with cardiac ischemic disease are left ventricular ejection fraction, left ventricular volumes, infarction size, presence and extent of residual myocardial ischemia. One of the most important recent developments in single photon emission computed tomography (SPECT) myocardial perfusion imaging is the ability to acquire these studies in conjunction with electrocardiogram (ECG) gating (G-SPECT). The ability to asses radi...

  1. Myocardial perfusion scintigraphy: the evidence. A consensus conference organised by the British Cardiac Society, the British Nuclear Cardiology Society and the British Nuclear Medicine Society, endorsed by the Royal College of Physicians of London and the Royal College of Radiologists

    This review summarises the evidence for the role of myocardial perfusion scintigraphy (MPS) in patients with known or suspected coronary artery disease. It is the product of a consensus conference organised by the British Cardiac Society, the British Nuclear Cardiology Society and the British Nuclear Medicine Society and is endorsed by the Royal College of Physicians of London and the Royal College of Radiologists. It was used to inform the UK National Institute of Clinical Excellence in their appraisal of MPS in patients with chest pain and myocardial infarction. MPS is a well-established, non-invasive imaging technique with a large body of evidence to support its effectiveness in the diagnosis and management of angina and myocardial infarction. It is more accurate than the exercise ECG in detecting myocardial ischaemia and it is the single most powerful technique for predicting future coronary events. The high diagnostic accuracy of MPS allows reliable risk stratification and guides the selection of patients for further interventions, such as revascularisation. This in turn allows more appropriate utilisation of resources, with the potential for both improved clinical outcomes and greater cost-effectiveness. Evidence from modelling and observational studies supports the enhanced cost-effectiveness associated with MPS use. In patients presenting with stable or acute chest pain, strategies of investigation involving MPS are more cost-effective than those not using the technique. MPS also has particular advantages over alternative techniques in the management of a number of patient subgroups, including women, the elderly and those with diabetes, and its use will have a favourable impact on cost-effectiveness in these groups. MPS is already an integral part of many clinical guidelines for the investigation and management of angina and myocardial infarction. However, the technique is underutilised in the UK, as judged by the inappropriately long waiting times and by

  2. Investigations into the myocardial metabolism of 123-I-ω-HDA in patients showing the clinical signs and symptoms of mitral valve prolapse and previously proven to have no coronary heart disease

    In 53 patients showing the clinical signs and symptoms of mitral valve prolapse (MVP) where coronary heart disease (CHD) had previously been excluded by angiography the myocardial metabolism of fatty acids was examined at rest using metabolic myocardial scintigraphy (MMS) and 123-I-ω-HDA as tracer substance. The results were correlated with those obtained by other methods of investigation (findings at rest and during exercise from ECG recordings, tests using a flow-guided catheter and radionuclide ventriculography, further from echocardiography as well as myocardial Tl redistribution scintiscanning during exercise). For purposes of reference, MMS was additionally carried out in twelve normal individuals subjected to coronary angiography to exclude both MVP and CHD. The results of this study would appear to suggest that the pathological findings revealed by myocardial Tl scintigraphy in patients showing symptoms of MVP cannot invariably be classified as 'false' but are at least to some extent attributable to impaired myocardial perfusion, vitality or metabolism. (orig./MG)

  3. Cardioprotective effects of gallic acid in diabetes-induced myocardial dysfunction in rats

    Snehal S Patel

    2011-01-01

    Full Text Available Background: Normalization of hyperglycemia, hyperlipidemia, and oxidative stress is an important objective in preventing diabetes-induced cardiac dysfunction. Objective: This study was undertaken to examine the effects of gallic acid in myocardial dysfunctions associated with type-1 diabetes. Materials and Methods: Diabetes was induced by single intravenous injection of streptozotocin (STZ, 50 mg/kg i.v.. Gallic acid was administered daily at three different doses (100, 50, and 25 mg/kg p.o. for 8 weeks at the end of which blood samples were collected and analyzed for various biochemical parameters. Results: Injection of STZ produced significant loss of body weight (BW, polyphagia, polydypsia, hyperglycemia, hypoinsulinemia, hyperlipidemia, hypertension, bradycardia, and myocardial functional alterations. Treatment with gallic acid significantly lowered fasting glucose, the AUC glucose level in a dose-dependent manner; however, the insulin level was not increased significantly at same the dose and prevented loss of BW, polyphagia, and polydypsia in diabetic rats. It also prevented STZ-induced hyperlipidemia, hypertension, bradycardia, structural alterations in cardiac tissue such as increase in force of contraction, left ventricular weight to body weight ratio, collagen content, protein content, serum lactate dehydrogenase, and creatinine kinase levels in a dose-dependent manner. Further, treatment also produced reduction in lipid peroxidation and increase in antioxidant parameters in heart of diabetic rats. Conclusion: The results of this study suggest that gallic acid to be beneficial for the treatment of myocardial damage associated with type-1 diabetes.

  4. The role of dietary fatty acids in predicting myocardial structure in fat-fed rats

    Miller Melissa L

    2011-06-01

    Full Text Available Abstract Background Obesity increases the risk for development of cardiomyopathy in the absence of hypertension, diabetes or myocardial ischemia. Not all obese individuals, however, progress to heart failure. Indeed, obesity may provide protection from cardiovascular mortality in some populations. The fatty acid milieu, modulated by diet, may modify obesity-induced myocardial structure and function, lending partial explanation for the array of cardiomyopathic phenotypy in obese individuals. Methods Adult male Sprague-Dawley rats were fed 1 of the following 4 diets for 32 weeks: control (CON; 50% saturated fat (SAT; 40% saturated fat + 10% linoleic acid (SAT+LA; 40% saturated fat + 10% α-linolenic acid (SAT+ALA. Serum leptin, insulin, glucose, free fatty acids and triglycerides were quantitated. In vivo cardiovascular outcomes included blood pressure, heart rate and echocardiographic measurements of structure and function. The rats were sacrificed and myocardium was processed for fatty acid analysis (TLC-GC, and evaluation of potential modifiers of myocardial structure including collagen (Masson's trichrome, hydroxyproline quantitation, lipid (Oil Red O, triglyceride quantitation and myocyte cross sectional area. Results Rats fed SAT+LA and SAT+ALA diets had greater cranial LV wall thickness compared to rats fed CON and SAT diets, in the absence of hypertension or apparent insulin resistance. Treatment was not associated with changes in myocardial function. Myocardial collagen and triglycerides were similar among treatment groups; however, rats fed the high-fat diets, regardless of composition, demonstrated increased myocyte cross sectional area. Conclusions Under conditions of high-fat feeding, replacement of 10% saturated fat with either LA or ALA is associated with thickening of the cranial LV wall, but without concomitant functional changes. Increased myocyte size appears to be a more likely contributor to early LV thickening in response to

  5. GSPECT myocardial perfusion scintigraphy with 99mTc-MIBI for the diagnosis of severe coronary artery disease - an alternative to MUGA test

    The aim of the presented study is to compare the possibilities of two radionuclide methods: GSPECT MS and MUGA for diagnosis of severe chronic CAD with myocardial dysfunction. 12 patients with coronarographically proven CAD with regional myocardial dysfunction are included in the study. GSPECT MS and MUGA are performed using Siemens DIACAM gamma camera and standard protocols. The myocardial perfusion and function are assessed applying semiquantitative methods. The results show mean EF and standard deviation 51% σ 15% and 52% σ 13% respectively. There is no significant difference between the two methods P > 0,5. GSPECT MS defined hypo-perfused defects (n20) corresponding to the areas with significantly stenosed coronary vessels and they are hypo-kinetic in 12 areas and normo-kinetic in 8 areas. MUGA defined 11 hypo-kinetic areas matched with GSPECT MS and 2 mismatched areas. The comparing between the two methods reveals that there are no significant differences in the assessment of myocardial function. GSPECT MS enables the assessment of myocardial perfusion besides function. It is more sensitive method and allows earlier diagnosis

  6. The development of iodine-123-labeled-methyl-branched fatty acids for myocardial SPECT imaging

    Iodine-123-labeled fatty acids represent unique metabolic probes for correlation of energy substrate metabolism with regional myocardial viability. Interest in the use of these agents results from differences which are often observed in various types of heart disease between regional myocardial fatty acid uptake patterns and flow tracer distribution. Although the physiological basis is not completely understood, differences between regional fatty acid and flow tracer distribution may reflect alterations in important parameters of metabolism which can be useful for patient management or therapeutic strategy decision making. The iodine-123-labeled 15-(p-iodophenyl)-3-R,S-methylpentadecanoic acid (BMIPP) fatty acid analogue was developed at the Oak Ridge National Laboratory and was recently introduced as ''Cardiodine trademark'' in 1993 by Nihon Medi-Physics for commercial distribution in Japan. Iodine-123-BMPP is also being used in clinical studies on an institutional approval basis at several institutions in Europe and the US. This paper describes the development of the concept of fatty acid ''metabolic trapping'' of methyl-branched fatty acids and their use for single photon emission computerized tomographic cardiac imaging

  7. [Antithrombotic therapy after myocardial infarction: arguments for the use of acetylsalicylic acid and coumarin derivatives].

    Waskowsky, W M; Brouwer, A; Verheugt, F W A

    2005-01-01

    Patients who survived myocardial infarction and who are being treated with the current optimal therapy (antithrombotics, statins and beta-blockers), have a 10-20% chance of death, re-infarction and stroke within in the first year. A possible explanation for this could be an increased activation and generation ofthrombin for at least 6 months following the cardiovascular event preceding preventative therapy. Acetylsalicylic acid and clopidogrel do not affect activation by thrombin of the platelet aggregation and the clotting cascade. The additional use of cumarin derivatives could therefore reduce the chance of recurring thrombotic events, and subsequently improve prognosis. Since the nineteen-nineties several randomised trials have been conducted to study the clinical relevance ofcumarin derivatives both with and without acetylsalicylic acid, in patients who had had a myocardial infarction. The conclusions of these studies were not unambiguous. If the international normalized ratio (INR) was kept > 2 for a long period, by means of frequent check-ups and effective dosage adjustment, the chance of death, recurrent myocardial infarction or stroke was 30-50% lower than when acetylsalicylic acid only was used. The risk of bleeding was raised by 2-4 times, but there were no life-threatening episodes of bleeding. In view of the recent development of anticoagulant agents, for which monitoring seems to be becoming unnecessary, identification of patients who would benefit most from a combined antithrombotic strategy is warranted. PMID:15688836

  8. Planar myocardial imaging in the baboon model with iodine-123-15-(iodophenyl)pentadecanoic acid (IPPA) and iodine-123-15-(p-iodophenyl)-3-R,S-methylpentadecanoic acid (BMIPP), using time-activity curves for evaluation of metabolism

    Dormehl, I.C.; Hugo, N.; Rossouw, D.; White, A.; Feinendegen, L.E

    1995-10-01

    The purpose of this study was to compare by planar myocardial scintigraphy the kinetics of iodine-123-15-(iodophenyl)pentadecanoic acid ({sup 123}I-pPPA and {sup 123}I-oPPA), and of iodine-123-(p-iodophenyl)-3-R,S-methyl-pentadecanoic acid (BMIPP), firstly in normal baboons, and subsequently after blocking fatty acid oxidation by a carnitine palmitoyl transferase I(CPT1) inhibitor. The induced changes in myocardial metabolism were reflected in the dynamic behaviour of the three tracers. pPPA and oPPA to a large extent, provided information on {beta}-oxidation changes in the myocardium: {beta}-oxidation participation changed from 47% and 50%, respectively to 17% and 23% after inhibition. BMIPP provided better images and reflected largely on changed tracer incorporation into the neutral lipid pools. The {beta}-oxidation contributed only about 10% towards the metabolic pathway of BMIPP. The information obtained in this study could help determine the tracer of choice for SPECT, whereby myocardial viability could optimally be revealed.

  9. Regional myocardial extraction of a radioiodinated branched chain fatty acid during right ventricular pressure overload due to acute pulmonary hypertension

    To determine whether branched chain fatty acid extraction is reduced during right ventricular (RV) dysfunction due to acute pulmonary artery hypertension, studies were done in 6 anesthetized dogs. Regional branched chain fatty acid extraction was measured by comparing the myocardial uptake of I-125 labeled 15-[p-(iodophenyl)]-3-methylpentadecanoic acid (I-PDA) to myocardial blood flow. Acute pulmonary hypertension was induced by incremental intravenous injection of 100 micron diameter glass beads into six pentobarbital anesthetized, mechanically ventilated dogs. Myocardial blood flow was measured by radiolabeled microspheres both under baseline conditions and during pulmonary hypertension. Mean RV pressure rose from 12 +- 2 (mean +- SEM) to 30 +-3mmHg resulting in a 225 +- 16% increase in RV stroke work. RV ejection fraction, as assessed by gated blood pool scans fell from 39 +- 2 to 18 +- 2%. Left ventricular (LV) pressures, stroke work and ejection fraction were unchanged. Myocardial blood flow increased 132 + 59% in the RV free wall and 67 +- 22% in the RV septum. LV blood flow was unchanged. Despite increased RV work and myocardial blood flow, no differences were noted in the branched chain fatty acid extraction ratios among LV or RV free walls or septum. The authors conclude that early RV dysfunction associated with pulmonary artery hypertension is not due to inadequate myocardial blood flow or branched chain fatty acid extraction

  10. Myocardial metabolism of pantothenic acid in chronically diabetic rats.

    Beinlich, C J; Naumovitz, R D; Song, W O; Neely, J R

    1990-03-01

    Transport and metabolism of [3H]pantothenic acid ([3H]Pa) was investigated in hearts from control and streptozotocin-induced diabetic rats. In isolated perfused hearts from control animals, the transport of [3H]Pa was linear over 3 h of perfusion when 11 mM glucose was the only exogenous substrate. The in vitro transport of [3H]Pa by hearts from 48-h diabetic rats was reduced by 65% compared to controls and was linear over 2 h of perfusion with no further accumulation of Pa during the third hour. The defect in transport observed in vitro could be corrected by in vivo treatment with 4 U Lente insulin/day for 2 days. In vitro addition of insulin in the presence of 11 mM glucose or 11 mM glucose plus 1.2 mM palmitate had no effect on [3H]Pa transport in hearts from 48-h diabetic rats during 3 h of perfusion. Accumulation of [3H]Pa was not inhibited by inclusion of 0.7 mM amino acids, 1 mM carnitine, 50 microM mersalic acid or 1 mM panthenol, pantoyllactone or pantoyltaurine. Uptake was inhibited by 1 mM nonanoic, octanoic or heptanoic acid, 0.1 mM biotin or 0.25 mM probenecid, suggesting a requirement for the terminal carboxyl group for transport. Transport of pantothenic acid was reduced in hearts from diabetic rats within 24 h of injection of streptozotocin. In vitro accumulation of [3H]Pa decreased to 10% of control 1 week after streptozotocin injection and then remained at 30% of the control value over 10 weeks.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:2141362

  11. Abnormal myocardial fatty acid metabolism in dilated cardiomyopathy detected by iodine-123 phenylpentadecanoic acid and tomographic imaging

    The radioidinated synthetic fatty acid iodine-123 phenylpentadecanoic acid (IPPA) has proven useful in the identification of regional abnormalities of cardiac metabolism in patients with myocardial ischemia. The present study was performed to test the hypothesis that the myocardial distribution and turnover of fatty acids, assessed noninvasively with IPPA, are altered in patients with cardiomyopathy. Nine normal volunteers and 19 patients with dilated cardiomyopathy of various etiologies underwent cardiac imaging with single-photon emission computed tomography (SPECT) after intravenous injection of IPPA. Apical short-axis and basal short-axis sections were reconstructed and quantitatively analyzed for relative IPPA activity distribution and washout. Patients with congestive cardiomyopathy demonstrated significantly greater heterogeneity of IPPA uptake than normal subjects (maximal percent variation of activity 27 +/- 11 vs 18 +/- 4, p less than 0.01). They also demonstrated a more rapid percent washout rate than control subjects (24 +/- 8 vs 17 +/- 6 for the apical short-axis section, p less than 0.05; 26 +/- 7 vs 18 +/- 5 for the basal short-axis section, p less than 0.01). These abnormalities of fatty acid distribution and turnover were independent of the etiology of the cardiomyopathy. The degree of heterogeneity of IPPA uptake was significantly related to the patients' New York Heart Association functional class (r = 0.64, p less than 0.01). Thus, compared with normal myocardium, the myocardium of patients with congestive cardiomyopathy demonstrates a more heterogeneous distribution of fatty acid uptake, which parallels the clinical severity of the disease. Furthermore, patients with congestive cardiomyopathy demonstrate a more rapid myocardial clearance of the labeled fatty acid, as assessed with SPECT imaging

  12. Myocardial damage assessed by indium-111-antimyosin: correlation with persistent enteroviral ribonucleic acid in dilated cardiomyopathy

    The persistence of enteroviral ribonucleic acid (RNA) in the myocardium has been implicated as a pathogenetic factor in idiopathic dilated cardiomyopathy. Enteroviral persistence may lead to myocardial cell membrane damage, resulting in increased uptake of antimyosin antibodies. To further evaluate this hypothesis, a direct comparison of myocardial antimyosin uptake with the presence of enteroviral RNA was performed in ten patients (one female, nine male; 53±8 years) with chronic dilated cardiomyopathy. Planar antimyosin images were obtained 48 h after the injection of indium-111-labelled antimyosin Fab. Using a region of interest technique, the heart to lung uptake ratio (HLR) was calculated as a semiquantitative parameter of myocardial tracer uptake. Cardiac catheterization was performed to assess left ventricular function and to obtain myocardial biopsy samples. In the biopsy samples, gene amplification by polymerase chain reaction (PCR) was used to specifically detect enteroviral RNA. In the ten patients, the left ventricular ejection fraction was 39%±11% and the end-diastolic volume 131±46 ml/m2. The HLR was 1.72±0.21 and showed no correlation with functional parameters. In two patients with a positive PCR consistent with persisting enteroviral RNA, the HLR was not higher than that in eight patients with a negative PCR (1.46±0.18 vs 1.78±0.18, respectively). These results suggest that increased uptake of 111In-antimyosin in chronic idiopathic dilated cardiomyopathy cannot be explained by pure persistence of enteroviral RNA. Other pathogenetic factors such as myocardial autoantibodies or microvascular spasm may be responsible for myocyte membrane damage detected by antimyosin. (orig.). With 3 figs., 1 tab

  13. Myocardial distribution of I131-labeled hexadecenoic acid in relation to the dog local coronary flow

    20 anesthetized and thoracotomized dogs are studied. The local myocardial blood flow is measured with sup(99m)Tc human albumin microspheres. The intramyocardial distribution of the 16-I(131)-9-hexadecenoic acid in relation to local blood flow is studied in basal conditions (7 dogs), after experimental infarction (6 dogs) and postischemic reactive hyperhemia (7 dogs). We conclude that during basal condition, after infarction but not during reactive hyperhemia, the distribution of the labeled fatty acid reflect the local variations of blood flow

  14. A Novel Fatty Acid Profile Index—the Lipophilic Index—and Risk of Myocardial Infarction

    Toledo, Estefania; Campos, Hannia; Ding, Eric L.; Wu, Hongyu; Hu, Frank B.; Sun, Qi; Baylin, Ana

    2013-01-01

    The lipophilic index (LI), a mean measure of fatty acid melting points, has been proposed to capture overall fatty acid profile and may play an important role in the etiology of coronary heart disease. We aimed to determine the association between LI in diet and in adipose tissue and metabolic risk factors for myocardial infarction (MI) and risk of MI. We used a population-based, matched case-control study of nonfatal first acute MI conducted in Costa Rica between 1994 and 2004, with 1,627 ca...

  15. Usefulness of {sup 123}I-metaiodobenzylguanidine myocardial scintigraphy for predicting the effectiveness of {beta}-blockers in patients with dilated cardiomyopathy from the standpoint of long-term prognosis

    Fujimoto, Shinichiro; Inoue, Aritomo; Hisatake, Shinji; Yamashina, Shohei; Yamashina, Hisayo; Nakano, Hajime; Yamazaki, Junichi [Toho University School of Medicine, Division of Cardiovascular Medicine, Department of Internal Medicine, Ohmori Hospital, Tokyo (Japan)

    2004-10-01

    The usefulness of {sup 123}I-metaiodobenzylguanidine (MIBG) myocardial scintigraphy in predicting the effectiveness of {beta}-blocker therapy in dilated cardiomyopathy (DCM) was investigated from the standpoint of long-term prognosis. The subjects were 53 DCM patients in whom {beta}-blockers had been successfully introduced and used for 6 months or longer. When symptoms were stable before the introduction of {beta}-blockers and for up to 1 year thereafter, MIBG myocardial single-photon emission computed tomography was performed and the images analysed to obtain the extent score (EXT), severity score (SEV) and washout rate (WR). At the same time, echocardiography was performed to measure left ventricular ejection fraction (LVEF). Thereafter, patients were placed under observation for an average of 1,314{+-}986 days, with the occurrence of cardiac events as the endpoint. The degree of improvement in WR after introduction of {beta}-blockers was a significant predictor of cardiac events. In fact, none of the patients whose improvement in WR was valued at 10 or higher had cardiac events. Accordingly, using improvement in WR of 10 as the cut-off value, the patients were divided into two groups, ''improved'' and ''unimproved''. There were significant differences between the groups in respect of early EXT, early SEV and WR before the introduction of {beta}-blockers. As regards predictors of WR improvement, multivariate logistic regression analysis demonstrated that early EXT, WR and LVEF were significant predictors. This study shows that, from the standpoint of long-term prognosis, DCM patients who would benefit the most from {beta}-blocker therapy are those with low early EXT and early SEV and high WR before {beta}-blocker introduction regardless of LVEF values. (orig.)

  16. Usefulness of 99mTc(V)-dimercaptosuccinic acid scintigraphy in the assessment of response to external radiation therapy in soft tissue sarcoma in Giant Schnauzer dog

    A nine-year-old male black Giant Schnauzer dog was referred for the scintigraphic evaluation with a history of malignant fibrosarcoma with a rapidly growing non painful mass on the left shoulder region quite near to the site of an operation performed four months ago. We carried out oncological scintigraphy using pentavalent 99mTechnetium labelled dimercaptosuccinic acid [99mTc(V)-DMSA], a tumour localising radiopharmaceutical agent. The study was performed to assess the margins, vascularity of the tumour and response to the cancer therapy. Uniform intense radiopharmaceutical uptake was observed in the lesion indicating its margins, vascularity and malignant nature. The dog was subjected to external radiation therapy to control the growth of the cancer and to bring the tumour mass to an operable size. The dog was followed up with 99mTc(V)-DMSA scintigraphy pre-irradiation and post-irradiation. Immediately after the post-irradiation scintigraphy, the dog was operated on. During the surgery, resection of the tumour margins was performed carefully using a hand held gamma probe to assure that no tumour tissue was left inside. In conclusion, the authors would like to state that 99mTc(V)-DMSA oncoscintigraphy is valuable in the assessment and evaluation of therapy in canine soft tissue cancer. (author)

  17. Effect of low dose acetylsalicylic acid on the frequency and hematologic activity of left ventricular thrombus in anterior wall acute myocardial infarction

    Kuepper, A.J.V.; Verheugt, F.W.; Peels, C.H.; Galema, T.W.; den Hollander, W.; Roos, J.P.

    1989-04-15

    In this prospective, randomized, placebo-controlled trial the effect of 100 mg acetylsalicylic acid (ASA) once daily on the incidence, hematologic activity and embolic potential of left ventricular (LV) thrombosis was studied in 100 consecutive patients with a first anterior wall acute myocardial infarction (AMI). Patients were randomized to ASA or placebo less than 12 hours after onset of symptoms. Heparin, 5,000 IU subcutaneously twice daily, was given to all patients during immobilization. Echocardiography was performed less than 24 hours, 48 to 72 hours and 1, 2, and 12 weeks after AMI. LV thrombosis was detected by echocardiography in 30 (33%) of the 92 evaluable patients (15 patients given ASA and 15 given placebo). Indium-111 platelet scintigraphy was done in 17 of the 22 patients with an LV thrombus at the second week echocardiogram. Among 7 ASA-treated patients, 4 had positive images; among 10 placebo patients, 5 had positive images. LV thrombus resolution was noted in 3 of 9 patients with a positive scan and in 5 of 8 patients with a negative platelet scan. In 7 of 10 ASA-treated patients and 5 of 12 placebo-treated patients thrombus resolution was observed (difference not significant). Systemic embolism occurred in 2 patients, both given ASA, during the first week after AMI. Thus, low dose ASA has no effect on the incidence, hematologic activity and embolic potential of LV thrombosis in anterior wall AMI.

  18. Evaluation of renal function in children with vesicoureteral reflux; Changes in renal uptake rate using [sup 99m]Tc-dimercaptosuccinic acid scintigraphy

    Hioki, Takuichi (Mie Univ., Tsu (Japan). School of Medicine)

    1993-09-01

    Renal uptake rate was calculated by [sup 99m]Tc-dimercaptosuccinic acid (DMSA) scintigraphy in 100 kidneys from 58 patients with pediatric vesicoureteral reflux (VUR) to assess kidney function quantitatively for treatment selection and surgical timing. The conservatively treated group consisted of 42 patients (75 kidneys) who underwent DMSA renal scintigraphy twice at intervals of 2 years during their management. The surgically treated group consisted of 16 patients (25 kidneys) who underwent DMSA renal scintigraphy before and 2 years after surgery, Urine samples were collected at the time of initial DMSA renal scintigraphy for the simultaneous measurement of [beta][sub 2]-microglobulin ([beta][sub 2]-MG), [alpha][sub 1]-microglobulin and N-acetyl-[beta]-glucosaminidase. Renal uptake ratio of DMSA did not differ in VUR grades during a 2-year follow-up period in the conservative group. In the age group of patients aged 2 or less, renal uptake ratio decreased 2 years later, with significant difference with that in the other age groups. According to VUR grade, there was no significant difference in DMSA renal kidney ratios between the conservative group and the surgical group. According to age, significant difference in renal uptake ratio was observed between the two groups; i.e., patients aged 2 or less had a significantly decreased renal uptake ratio in the conservative group than the surgical group. However, the renal uptake ratio did not differ in the other age groups. For patients aged 2 or less, surgery was considerd necessary to prevent reflux when urinary [beta][sub 2]-MG indexes are increased. For those aged 3 years or more, on the other hand, conservative treatment was considered optimal regardless of VUR grades; surgery was considered recommended in the case of repeated urinary infection and decreased renal function. (N.K.).

  19. Serum Fatty Acids, Traditional Risk Factors, and Comorbidity as Related to Myocardial Injury in an Elderly Population with Acute Myocardial Infarction

    Laake, Kristian; Seljeflot, Ingebjørg; Schmidt, Erik B; Myhre, Peder; Tveit, Arnljot; Arnesen, Harald; Solheim, Svein

    2016-01-01

    ), and peak Troponin T (TnT) levels in elderly patients with an acute myocardial infarction (AMI). Materials and Methods. Patients (n = 299) consecutively included in the ongoing Omega-3 fatty acids in elderly patients with myocardial infarction (OMEMI) trial were investigated. Peak TnT was registered...... during the hospital stay. Serum fatty acid analysis was performed 2-8 weeks later. Results. No significant correlations between peak TnT levels and any of the n-3 PUFAs were observed. However, patients with a history of atrial fibrillation had significantly lower docosahexaenoic acid levels than patients...... without. Significantly lower peak TnT levels were observed in patients with a history of hyperlipidemia, angina, MI, atrial fibrillation, intermittent claudication, and previous revascularization (all p < 0.02). Conclusions. In an elderly population with AMI, no association between individual serum fatty...

  20. Altered maternal thyroid function: Effect of L-carnitine supplementation on fetal and neonatal myocardial free fatty acid oxidation,in vitro

    Kumar, Ratan

    1998-01-01

    Effect of L-carnitine supplementation on myocardial free fatty acid oxidation,in vitro, in offsprings born of hypothyroid and hyperthyroid mothers was studied in rats. L-carnitine supplementation stimulated myocardial fatty acid oxidation during gestational period in offspring born of control and hyperthyroid mothers. In contrast L-carnitine supplementation induced stimulation in myocardial fatty acid oxidation was very less in fetuses born of hypothyroid mothers. However, in neonates born of...

  1. Evaluation of interobserver variability of parenchymal phase of Tc-99m mercaptoacetyltriglycine and Tc-99m dimercaptosuccinic acid renal scintigraphy

    The aim of this study was to investigate the variability in the interpretation of parenchymal abnormalities and to assess the differences in interpretation of routine renal scintigraphic findings on posterior view of technetium-99m dimercaptosuccinic acid (pvDMSA) scans and parenchymal phase of technetium-99m mercaptoacetyltriglycine (ppMAG3) scans by using standard criterions to make standardization and semiquantitative evaluation and to have more accurately correlation. Two experienced nuclear medicine physicians independently interpreted pvDMSA scans of 204 and ppMAG3 scans of 102 pediatric patients, retrospectively. Comparisons were made by visual inspection of pvDMSA scans, and ppMAG3 scans by using a grading system modified from Itoh et al. According to this, anatomical damage of the renal parenchyma was classified into six types: Grade 0-V. In the calculation of the agreement rates, Kendall correlation (tau-b) analysis was used. According to our findings, excellent agreement was found for DMSA grade readings (DMSA-GR) (tau-b = 0.827) and good agreement for MAG3 grade readings (MAG3-GR) (tau-b = 0.790) between two observers. Most of clear parenchymal lesions detected on pvDMSA scans and ppMAG3 scans identified by observers equally. Studies with negative or minimal lesions reduced correlation degrees for both DMSA-GR and MAG3-GR. Our grading system can be used for standardization of the reports. We conclude that standardization of criteria and terminology in the interpretations may result in higher interobserver consistency, also improve low interobserver reproducibility and objectivity of renal scintigraphy reports

  2. Parathyroid scintigraphy

    Geatti, O. [Azienda Ospedali Riuniti di Trieste, Trieste (Italy). Div. of Nulcear Medicine

    1999-09-01

    The paper discusses the role of parathyroid scintigraphy in the preoperative location of enlarged parathyroid tissues. Various modified acquisition and processing protocols have been reported and {sup 201}Thallium still continues to be used, but other radiopharmaceuticals, such as {sup 99m}Tc-methoxy isobutyl isonitrile and {sup 99m}Tc-tetrofosmin are now often preferred, especially because of the more favourable physical properties of the Technetium labelling.

  3. Liver scintigraphy

    Liver scintigraphy can be classified into 3 major categories according to the properties of the radiopharmaceuticals used, i.e., methods using radiopharmaceuticals which are (1) incorporated by hepatocytes, (2) taken up by reticulo endothelial cells, and (3) distributed in the blood pool of the liver. Of these three categories, the liver scintigraphy of the present research falls into category 2. Radiopharmaceuticals which are taken up by endothelial cells include 198Au colloids and 99mTc-labelled colloids. Liver scintigraphy takes advantage of the property by which colloidal microparticles are phagocytosed by Kupffer cells, and reflect the distribution of endothelial cells and the intensity of their phagocytic capacity. This examination is indicated in the following situations: (i) when you suspect a localized intrahepatic lesion (tumour, abscess, cyst, etc.), (ii) when you want to follow the course of therapy of a localized lesion, (iii) when you suspect liver cirrhosis, (iv) when you want to know the severity of liver cirrhosis or hepatitis, (v) when there is hepatomegaly and you want to determine the morphology of the liver, (vi) differential diagnosis of upper abdominal masses, and (vii) when there are abnormalities of the right diaphragm and you want to know their relation to the liver

  4. Myocardial Perfusion Spect Imaging in Dextrocardia: A Case Report

    Semra Özdemir

    2013-08-01

    Full Text Available The myocardial perfusion scintigraphy acquisition and analysis present some technical differences in the rare dextrocardia cases. Here we report a case of a 38 year-old woman with dextrocardia who had been applied myocardial perfusion scintigraphy. Presented case showed that the thoracic and abdominal organs had a mirror image with situs inversus totalis type dextrocardia. The incidence of coronary heart disease and life span of people with situs inversus totalis are the same as the normal population. So we may apply myocardial perfusion scintigraphy to this patient group. The current case is presented in order to remind the special applications of myocardial perfusion SPECT imaging in patients with dextrocardia.

  5. Relation between human myocardial acidic isoferritin and hepatoma

    Acid iso ferritin (AIF), a ferritin isomer with a high proposition of H subunit, is different from basic iso ferritin (BIF) biochemically and immunologically. AIF was isolated and purified from human myocardium and the antiserum was obtained by immunizing the rabbits. A radioimmunoassay (RIA) of AIF and an immunoradiometric assay of AIF-H subunit were established by preparing 125I-AIF and 125I-AIF-H McAb using the chloramine-T method. The intra-and inter-assay CV of AIF RIA were 1.65% and 9.71%, respectively. The recovery rate was 102%. The antiserum provided a linear response from 7.0∼369.6μg/L, with ED50 of 27.50 μg/L. AIF-H IRMA methodological study found that the intra- and inter- assay CV were 2.44% and 10.16%, respectively. The sensitivity was 0.74 μg/L, the recovery rate was 92.29% and ED50 was 23.05 μg/L. The cross-reactivity of the two assays with AFP, CEA and lactoferrin was negligible, while that with BIF was 1.74% and 3.13%, respectively. The serum AIF concentration showed a considerable variation in different sexes and age groups. Its sensitivity for diagnosis of hepatic cancer was 73.05%, independent on the severity of hepatic injury. In eight kinds of malignant tumors studied, AIF was found to be most valuable in diagnosis of hepatic cancer, with its positive, negative false-positive and false-negative rates being all ideal. The patients with hepatoma had increased concentration of serum AIF-H subunit, so measuring the ratio of H/L subunits was valuable for studying the diseases. These results suggest that AIF may turn to be a rather specific index of hepatic cancer. Combination of monitoring both AIF and AFP would raise the rate of detection of positive cases and improve the specificity of method for the diagnosis of hepatic cancer. (15 refs., 4 figs., 6 tabs.)

  6. Assessment of prognostic value of semiquantitative parameters on gated single photon emission computed tomography myocardial perfusion scintigraphy in a large middle eastern population

    Coronary artery disease is the leading cause of mortality worldwide. The goal of this study is to determine the prognostic value of semiquantitative parameters of electrocardiogram-gated single photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) in a large Middle Eastern (Iranian) population. This study was a prospective study including all patients referred to our center for myocardial perfusion scan. The patients were followed annually up to 24 months and their survival information was collected. From 1148 patients, 473 (41.2%) men and 675 (58.8%) women, 40.6% had normal MPI, 13.3% near normal and 46.1% abnormal MPI. After follow-up of 929 patients, 97.4% of patients were alive, and 2.6% succumbed to cardiac deaths. Abnormal ejection fraction was related with cardiac events (P = 0.001), but neither transient ischemic dilation (TID) (P = 0.09) nor lung/heart ratio (P = 0.92) showed such relationship. Association between summed difference score (SDS) and soft cardiac events (P < 0.001) was significant. Summed motion score (SMS) and summed thickening score (STS) showed a significant relation with hard cardiac events, including myocardial infarction and cardiac death (P < 0.001 and P = 0.001, respectively). Totally, risk of all cardiac events was significantly higher in abnormal MPI group than normal group (P < 0.001, 0.02, and 0.025, respectively). No significant relationship was found between TID and total cardiac events (P = 0.478). Semiquantitative variables derived from gated SPECT MPI have independent prognostic value. Rate of total cardiac events is higher in patients with higher summed stress score and SDS. Total and hard cardiac events are higher in upper scores of functional parameters (SMS and STS). Total cardiac events are higher in patients with lower left ventricular ejection fraction

  7. NT-proBNP and Circulating Inflammation Markers in Prediction of a Normal Myocardial Scintigraphy in Patients with Symptoms of Coronary Artery Disease

    Rathcke, C.N.; Kjøller, Erik; Fogh-Andersen, N.;

    2010-01-01

    an intermediate risk of CAD or with known CAD with renewed suspicion of ischemia were referred to MPI. Blood samples were analyzed for N-terminal fragment of the prohormone brain natriuretic peptide (NT-proBNP), YKL-40, IL-6, matrix metalloproteinase 9 (MMP-9) and high sensitive C-reactive protein...... (hsCRP). Patients with myocardial perfusion defects had elevated levels of NT-proBNP (p95% regardless of existing CAD. Conclusions: 20-25% of patients suspected of CAD could have been spared a MPI by using a NT-proBNP cut-off concentration at 25 ng/l with a negative predictive value >95%. NT...

  8. Comparison of renal ultrasonography and dimercaptosuccinic acid renal scintigraphy in febrile urinary tract infection.

    Ayazi, Parviz; Mahyar, Abolfazl; Noroozian, Elham; Esmailzadehha, Neda; Barikani, Ameneh

    2015-12-01

    Accurate and early diagnosis and appropriate treatment of patient with urinary tract infection (UTI) are essential for the prevention or restriction of permanent damage to the kidneys in children. The aim of this study was to compare renal ultrasonography (US) and dimercaptosuccinic acid (DMSA) renal scan in the diagnosis of patients with febrile urinary tract infection. This study involved the medical records of children with febrile urinary tract infection who were admitted to the children's hospital in Qazvin, Iran. Pyelonephritis was diagnosed on the basis of clinical symptoms, laboratory tests and abnormal DMSA renal scans. The criteria for abnormality of renal US were an increase or a decrease in diffuse or focal parenchymal echogenicity, loss of corticomedullary differentiation, kidney position irregularities, parenchymal reduction and increased kidney size. Of the 100 study patients, 23% had an abnormal US and 46% had an abnormal DMSA renal scan. Of the latter patients, 15 had concurrent abnormal US (P value ≤ 0.03, concordance rate: 18%). Renal US had a sensitivity of 32%, specificity of 85%, positive predictive value of 65% and negative predictive value of 60%. Of the 77 patients with normal US, 31 (40.2%) had an abnormal DMSA renal scan. Despite the benefits and accessibility of renal US, its value in the diagnosis of pyelonephritis is limited. PMID:26700082

  9. Significance of technetium-99m human serum albumin diethylenetriamine pentaacetic acid scintigraphy in patients with nephrotic syndrome.

    Tsuyoshi Takashima

    Full Text Available It is thought that a large amount of albumin leaking from the glomerulus in nephrotic syndrome (NS is reabsorbed at the proximal tubule and catabolized. Therefore, it is possible the final quantity of urinary protein does not always reflect the amount of leakage of protein from the glomerulus. We experienced two cases without nephrotic range proteinuria thought to involve hypoproteinemia due to the same pathophysiology as NS. On these patients, we performed protein leakage scintigraphy with technetium-99m human serum albumin diethylenetriamine pentaacetic acid (99mTc-HSAD to exclude a diagnosis of protein-losing gastroenteropathy and observed diffuse positive accumulation in the kidneys with more intense uptake in the kidney than the liver on the anterior view 24 hours after 99mTc-HSAD administration. In healthy adults intravenously given 99mTc-HSAD, the same dynamics are observed as in albumin metabolism, and the organ radioactivity of the liver and kidneys after 24 hours is equal. Therefore, we thought it was possible that the renal uptake 24 hours after 99mTc-HSAD administration was a characteristic finding of NS. In order to confirm it, the subjects were divided into two groups: the NS group (n = 10 and the non-NS group (n = 7. We defined more intense uptake in the kidney than the liver on the anterior view 24 hours after 99mTc-HSAD administration as Dense Kidney (+. Furthermore, we designed regions of interest in the right and left kidneys and liver on anterior and posterior images, then calculated the kidney-liver ratio. Nine of the ten patients had Dense Kidney (+ in the NS group, compared to none in the non-NS group. And the kidney-liver ratio was significantly higher in the NS group than in the non-NS group on each view in the bilateral kidneys. In conclusion, our results suggest that the renal uptake 24 hours after 99mTc-HSAD administration is a characteristic finding of NS.

  10. Clinical significance of scintigraphy in pulmonary aspergilloma

    In order to study the scintigraphic findings related to the pathophysiology of pulmonary aspergilloma, chest scintigraphy with Tl-201 chloride and perfusion lung scintigraphy were performed in 18 and 19 patients with pulmonary aspergilloma, respectively. In Tl-201 scintigraphy, accumulation of Tl-201 in the diseased areas related to Aspergillus infection was observed in 18 of 19 foci. Roentgenographic findings related to the accumulation of Tl-201 in the lesion were thickness of the cavity wall and pleural thickening adjacent to the cavity, but they showed no relation to the size of the fungus ball, and 2 cases without fungus ball showed positive results. Moreover, in Tl-201 single photon emission computed tomography, accumulation of Tl-201 was demonstrated in the area surrounding fungus ball. In addition, findings of inflammation such as leukocytosis, elevated erythrocyte sedimentation rate, positive CRP and fever were observed in more than 50% of all cases. These results suggest that tissues surrounding the fungus ball, including the cavity wall and thickned pleura undergo inflammatory process secondary to infection by Aspergillus. Perfusion lung scintigrams showed decreased perfusion in all of 19 cases, which was more marked than that expected from the chest radiograph in many cases. In Tl-201 myocardial scintigraphy, visualization of the right ventricle was observed in 15 of 18 cases. Tl-201 chest scintigraphy and perfusion lung scintigraphy are useful for evaluation of the activity of the disease process, right ventricular overloading, and regional perfusion in pulmonary aspergilloma. (author)

  11. NT-proBNP and Circulating Inflammation Markers in Prediction of a Normal Myocardial Scintigraphy in Patients with Symptoms of Coronary Artery Disease

    Rathcke, C.N.; Kjøller, Erik; Fogh-Andersen, N.;

    2010-01-01

    with an intermediate risk of CAD or with known CAD with renewed suspicion of ischemia were referred to MPI. Blood samples were analyzed for N-terminal fragment of the prohormone brain natriuretic peptide (NT-proBNP), YKL-40, IL-6, matrix metalloproteinase 9 (MMP-9) and high sensitive C-reactive protein (hs......CRP). Patients with myocardial perfusion defects had elevated levels of NT-proBNP (p95% regardless of existing CAD. Conclusions: 20-25% of patients suspected of CAD could have been spared a MPI by using a NT-proBNP cut-off concentration at 25 ng/l with a negative predictive value >95%. NT-proBNP has...

  12. Impaired myocardial fatty acid metabolism detected by {sup 123}I-BMIPP in patients with unstable angina pectoris. Comparison with perfusion imaging by {sup 99m}Tc-sestamibi

    Takeishi, Yasuchika; Sukekawa, Hiroyasu; Saito, Haruo; Nishimura, Shozo; Shibu, Takayuki; Sasaki, Yasuhiko; Tomoike, Hitonobu [Yamagata Univ. (Japan). School of Medicine

    1995-08-01

    The present study was undertaken to determine the potential diagnostic value of {sup 123}I-BMIPP scintigraphy for the detection of altered myocardial fatty acid metabolism in patients with unstable angina. Both myocardial metabolic imaging with {sup 123}I-BMIPP and perfusion imaging with {sup 99m}Tc-sestamibi were performed at rest in 28 patients with unstable angina in the pain-free state. The regional uptakes of {sup 123}I-BMIPP or {sup 99m}Tc-sestamibi were scored semiquantitatively (0=normal, 4=no activity) and compared with the coronary arteriographic findings. Decreased uptakes of {sup 123}I-BMIPP were observed in 18 patients, and 11 patients had abnormal {sup 99m}Tc-sestamibi images. Defect scores of {sup 123}I-BMIPP were larger than those of {sup 99m}Tc-sestamibi (7.8{+-}2.1 vs. 5.2{+-}1.9, p<0.01). The sensitivity for the detection of patients with unstable angina was higher in {sup 123}I-BMIPP than in {sup 99m}Tc-sestamibi (77% vs. 45%, p<0.01). The site of the decreased {sup 123}I-BMIPP uptake corresponded to the most stenotic coronary artery lesion in all patients. Fatty acid metabolic imaging with {sup 123}I-BMIPP was more sensitive for detecting myocardial ischemia than perfusion imaging with {sup 99m}Tc-sestamibi. {sup 123}I-BMIPP may be a clue to define the culprit lesion in unstable angina and be helpful to decide the best treatment and guide coronary angioplasty. (author).

  13. Clinical efficacy of efonidipine hydrochloride, a T-type calcium channel inhibitor, on sympathetic activities. Examination using spectral analysis of heart rate/blood pressure variabilities and 123I-Metaiodobenzylguanidine myocardial scintigraphy

    Dihydropyridine Ca antagonists cause reflex tachycardia related to their hypotensive effects. Efonidipine hydrochloride has inhibitory effects on T-type Ca channels, even as it inhibits reflex tachycardia. In the present study, the influence of efonidipine hydrochloride on heart rate and autonomic nervous function was investigated. Using an electrocardiogram and a tonometric blood pressure measurement, autonomic nervous activity was evaluated using spectral analysis of heart rate/systolic blood pressure variability. Three protocols were used: a single dose of efonidipine hydrochloride was administered orally to healthy subjects with resting heart rate values of 75 beats/min or more (high-heart rate (HR) group) and to healthy subjects with resting heart rate values less than 75 beats/min (low-HR group); efonidipine hydrochloride was newly administered to untreated patients with essential hypertension, and autonomic nervous activity was investigated after a 4-week treatment period; and patients with high heart rate values (≥75 beats/min) who had been treated with a dihydropyridine L-type Ca channel inhibitor for 1 month or more were switched to efonidipine hydrochloride and any changes in autonomic nervous activity were investigated. In all protocols, administration of efonidipine hydrochloride decreased the heart rate in patients with a high heart rate, reduced sympathetic nervous activity, and enhanced parasympathetic nervous activity. In addition, myocardial scintigraphy with 123I-metaiodobenzylguanidine showed significant improvement in the washout rate and heart to mediastinum (H/M) ratio of patients who were switched from other dihydropyridine Ca antagonists to efonidipine hydrochloride. Efonidipine hydrochloride inhibits increases in heart rate and has effects on the autonomic nervous system. It may be useful for treating hypertension and angina pectoris, and may also have a cardiac protective function. (author)

  14. Iodine-123 BMIPP Scintigraphy in the Evaluation of Patients with Heart Failure

    Nakae, I.; Matsuo, S.; Koh, T.; Mitsunami, K.; Horie, M. [Shiga Univ. of Medical Science, Otsu (Japan). Depts. of Cardiovascular and Respiratory Medicine, and of General Medicine

    2006-10-15

    Purpose: To investigate whether cardiac parameters obtained by I-123 15-(p-iodophenyl)-3-methyl pentadecanoic acid (BMIPP, a radioactive fatty acid analogue) myocardial scintigraphy are useful as indicators of disease severity and predictors of cardiac events in congestive heart failure (CHF). Material and Methods: Thirty-two CHF patients (functional class: 17 in NYHA II and 15 in NYHA III at the time of this study) were compared with 18 normal control subjects. Myocardial scintigraphy was performed 15 min and 3 hours after I-123 BMIPP injection. The heart-to-mediastinum count ratio of I-123 BMIPP on the initial (H/Mi) and delayed (H/Md) images and the washout rate (WR) were calculated. Results: Both H/Mi and H/Md were lower in CHF than in controls (H/Mi 1.96{+-}0.18 vs. 2.30{+-}0.29; H/Md 1.72{+-}0.15 vs. 1.97{+-}0.21; both P <0.001), but WR was higher in CHF than in controls (WR (%) 23.7{+-}5.7 vs. 18.2{+-}6.0, P <0.01). Both H/Mi (R = 0.42, P <0.05) and H/Md (R = 0.45, P <0.05) correlated positively with the left ventricular (LV) ejection fraction (EF), estimated by echocardiography. The WR correlated positively with the plasma B-type natriuretic peptide (BNP) level (R = 0.47, P <0.01). Kaplan-Meier analysis showed an earlier CHF progression for patients with a lower H/Mi (<1.94). Conclusion: Myocardial metabolic abnormality evaluated by I-123 BMIPP scintigraphy is related to the severity of CHF. Furthermore, it may be useful as a predictor for cardiac events.

  15. Clinical study on myocardial imaging with β-methyl-p-(123I)-iodophenyl-pentadecanoic acid in patients with mitochondrial myopathy

    Myocardial imaging with β-methyl-p-(123I)-iodophenyl-pentadecanoic acid (123I-BMIPP), a new radiopharmaceutical designed to evaluate myocardial fatty acid metabolism, was performed in 7 patients with mitochondrial myopathy to detect their myocardial damages in comparison with 201Tl myocardial imaging. These patients were divided into 4 chronic progressive external ophthalmoplegia (CPEO) cases, 2 mitochondrial myopathy, encephalopathy, lactic acidosis, and stroke-like episodes (MELAS) cases and 1 myoclonus epilepsy with ragged-red fibers (MERRF). In visual assessment, we observed more myocardial segments with decreased uptake of 123I-BMIPP compared to 201Tl in MELAS cases than in CPEO cases. The mean myocardial uptake of 123I-BMIPP was higher than that of 201Tl in CPEO cases. On the other hand, in MELAS and MERRF cases, the mean myocardial uptake of 123I-BMIPP was lower than that of 201Tl. Abnormal findings suggesting myocardial damages were observed in echocardiogram and/or in electrocardiogram in MELAS and MERRF cases, while no such abnormal findings were observed in CPEO cases. Along with the previously reported experimental result that the impairment of rat myocardial mitochondria decreased myocardial uptake of 123I-BMIPP, these results suggest that 123I-BMIPP may be useful to detect myocardial damages in patients with mitochondrial myopathy. (author)

  16. Clinical study on myocardial imaging with. beta. -methyl-p-( sup 123 I)-iodophenyl-pentadecanoic acid in patients with mitochondrial myopathy

    Kihara, Koichi; Nakajo, Masayuki; Shono, Hirohisa (Kagoshima Univ. (Japan). Faculty of Medicine) (and others)

    1992-04-01

    Myocardial imaging with {beta}-methyl-p-({sup 123}I)-iodophenyl-pentadecanoic acid ({sup 123}I-BMIPP), a new radiopharmaceutical designed to evaluate myocardial fatty acid metabolism, was performed in 7 patients with mitochondrial myopathy to detect their myocardial damages in comparison with {sup 201}Tl myocardial imaging. These patients were divided into 4 chronic progressive external ophthalmoplegia (CPEO) cases, 2 mitochondrial myopathy, encephalopathy, lactic acidosis, and stroke-like episodes (MELAS) cases and 1 myoclonus epilepsy with ragged-red fibers (MERRF). In visual assessment, we observed more myocardial segments with decreased uptake of {sup 123}I-BMIPP compared to {sup 201}Tl in MELAS cases than in CPEO cases. The mean myocardial uptake of {sup 123}I-BMIPP was higher than that of {sup 201}Tl in CPEO cases. On the other hand, in MELAS and MERRF cases, the mean myocardial uptake of {sup 123}I-BMIPP was lower than that of {sup 201}Tl. Abnormal findings suggesting myocardial damages were observed in echocardiogram and/or in electrocardiogram in MELAS and MERRF cases, while no such abnormal findings were observed in CPEO cases. Along with the previously reported experimental result that the impairment of rat myocardial mitochondria decreased myocardial uptake of {sup 123}I-BMIPP, these results suggest that {sup 123}I-BMIPP may be useful to detect myocardial damages in patients with mitochondrial myopathy. (author)

  17. Effect of myocardial perfusion and metabolic interventions on cardiac kinetics of phenylpentadecanoic acid (IPPA) I 123

    Reske, S.N.; Schoen, S.; Schmitt, W.; Knopp, R.; Winkler, C.; Machulla, H.J.

    1986-08-01

    The effect of regional myocardial perfusion and flow-independent adrenergic stimulation, as well as lactate-mediated inhibition of cardiac lipolysis, on cardiac IPPA uptake and metabolism was examined in canine hearts (flow studies) and in the isolated perfused Langendorff rat heart (metabolic interventions). In both normal and ischaemic myocardium, local perfusion is a major determinant of cardiac IPPA uptake. In pacing-induced hyperaemia, the strict flow-dependence of cardiac IPPA uptake is not preserved. Adrenergic stimulation raises the rate of oxidation of both palmitic acid /sup 14/C and IPPA. This change is reflected by increased metabolite production released into the perfusate and radioactivity clearance recorded externally. Lactate in high concentrations exerts the opposite effect on cardiac free fatty acid oxidation. IPPA is stored in this condition preferentially in tissue phospholipids and triglycerides.

  18. Dietary intake and adipose tissue content of α-linolenic acid and risk of myocardial infarction

    Bork, Christian S; Jakobsen, Marianne U; Lundbye-Christensen, Søren;

    2016-01-01

    content of ALA, and risk of incident myocardial infarction (MI). DESIGN: A total of 57,053 participants, aged 50-64 y, were enrolled in the prospective Danish cohort study Diet, Cancer and Health between 1993 and 1997. Dietary intake of ALA was assessed with the use of a validated semiquantitative food...... factors did not influence the observed associations numerically. CONCLUSION: This study suggests that ALA has no appreciable association with risk of incident MI in either men or women.......BACKGROUND: Intake of the plant-derived ω-3 (n-3) fatty acid α-linolenic acid (ALA, 18:3; n-3) may reduce coronary heart disease (CHD) risk, but the results of previous studies have been inconsistent. OBJECTIVE: We aimed to investigate the association between dietary intake of ALA, adipose tissue...

  19. Quantitative analysis of myocardial kinetics of 15-p-[iodine-125] iodophenylpentadecanoic acid

    Myocardial extraction and the characteristic tissue clearance of radioactivity following bolus injections of a radioiodinated (125I) long chain fatty acid (LCFA) analog 15-p-iodophenylpentadecanoic acid (IPPA) were examined in the isolated perfused working rat heart. Radioactivity remaining in the heart was monitored with external scintillation probes. A compartmental model which included nonesterified tracer, catabolite, and complex lipid compartments successfully fitted tissue time-radioactivity residue curves, and gave a value for the rate of IPPA oxidation 1.8 times that obtained from steady-state release of tritiated water from labeled palmitic acid. The technique was sensitive to the impairment of LCFA oxidation in hearts of animals treated with the carnitine palmitoyltransferase I inhibitor, 2[5(4-chlorophenyl)pentyl]oxirane-2-carboxylate (POCA). IPPA or similar modified fatty acids may be better than 11C-labeled physiological fatty acids such as palmitate in this type of study, because efflux of unoxidized tracer and catabolite(s) from the heart are kinetically more distinct, and their contributions to the early data can be reliably separated. This technique may be suitable for extension to in vivo measurements with position tomography and appropriate modified fatty acids

  20. Protective effect of squalene on certain lysosomal hydrolases and free amino acids in isoprenaline-induced myocardial infarction in rats

    Farvin, Sabeena; Surendraraj, A.; Anandan, R.

    2010-01-01

    This study was aimed to evaluate the preventive role of squalene on free amino acids and lysosomal alterations in experimentally induced myocardial infarction in rats. The levels of lysosomal enzymes (beta-glucuronidase, beta-galactosidase, beta-glucosidase, acid phosphatase and cathepsin D) in...... plasma and lysosomal fractions, hydroxyproline content and free amino acids in heart tissue were determined. Isoprenaline administration to rats resulted in decreased stability of the membranes which was reflected by significantly (p...

  1. Free fatty acid has a negative correlation with myocardial uptake of FDG

    Free fatty acid (FFA) is a marker of insulin resistance. Myocardial uptake of FDG is influenced by insulin resistance. We investigated the correlation of FFA and myocardial uptake of FDG in whole body PET. We measured serum FFA levels in consecutive 112 patients who underwent whole body FDG PET due to malignancy work up. Twelve patients with diabetes. 13 with liver disease, 4 with suspicious ischemic heart disease. 1 with steroid therapy, and 10 with final diagnosis of benign disease were excluded. After fasting of diet or beverages for at least 6 hours, blood was aspirated at peripheral vein for measurement of FFA and glucose in serum. FDG was injected as a dose of 0.14 mCi/kg body weight. Fifty minutes later, whole body PET scan was performed from skull base to upper thigh. Maximum SUV (maxSUV) using lean body weight was obtained in heart. liver, cerebellum, muscle and malignant tissues. Finally 72 patients (M:F 45:27, age 56.9±15.8 years) were enrolled. There were 27 non small cell lung cancer, 14 lymphoma, 10 esophageal cancer, 3 breast cancer, 3 colon cancer, 3 renal cell cancer, 2 melanoma, and 10 other cancers. Serum glucose level was 96.6±14.3 mg/dL. Serum FFA level was 720.0±315.2 uEq/L. MaxSUV of main malignant tissue ranged from 0.7 to 11.5 (mean 4.9±2.6). MaxSUV of each organs were 1.0 to 14.6 (mean 4.0±3.0) in heart, 2.7 to 6.4 (mean 3.9±0.6) in cerebellum, 1.0 to 2.6 (mean 1.9±0.3) in liver, and 0.6 to 1.1 (mean 0.8±0.1) in gluteal muscle. FFA and maxSUV of heart had a negative correlation. The best fitting line was MaxSUV of Heart = -4.4583 x In(FF A) + 32.964. But FFA had no correlation with any other parameters like serum glucose level, and MaxSUV of cerebellum, muscle, liver and malignant tissues. We found a negative correlation between FFA levels and myocardial uptake of FDG. FFA modifying drugs such as nicotinic acid derivatives may have influence on myocardial uptake of FDG

  2. Preoperative and postoperative cortical function of the kidney with staghorn calculi assessed by /sup 99m/technetium-dimercaptosuccinic acid renal scintigraphy

    /sup 99m/Technetium dimercaptosuccinic acid renal scintigraphy, consisting of the cortical image and dimercaptosuccinic acid renal uptake rate, was used to assess preoperative and postoperative renal function in 55 patients with staghorn calculi. In 14 of 20 patients who had undergone extended pyelolithotomy and in 4 of 22 who had undergone nephrolithotomy there was an increase or no change in the postoperative dimercaptosuccinic acid renal uptake in the surgically treated kidney. However, there was no increase in the postoperative dimercaptosuccinic acid renal uptake in the patients who had undergone pyelolithotomy combined with nephrotomy or partial nephrectomy. Eight per cent of the preoperative dimercaptosuccinic acid renal uptake rate in the diseased kidney seems to be the absolute level for predicting the postoperative recovery of renal function. Dimercaptosuccinic acid renal images provide evidence of morphological changes in the cortex of the kidney with stones and the dimercaptosuccinic acid uptake rate is a useful adjunct for quantitative assessments of preoperative and postoperative residual cortical function

  3. Skeletal scintigraphy

    Skeletal scintigraphy, using phosphates or diphosphonates labeled with technetium 99m, is a sensitive method of detecting bone abnormalities. The most important and most frequent role of bone scanning is evaluating the skeletal areas in patients who have a primary cancer, especially a malignant condition that has a tendency to spread to bone areas. The bone scan is superior to bone radiographs in diagnosing these abnormalities; 15 percent to 25 percent of patients with breast, prostate or lung cancer, who have normal roentgenograms, also have abnormal scintigrams due to metastases. The majority of bone metastases appear as hot spots on the scan and are easily recognized. The incidence of abnormal bone scans in patients with early stages (I and II) of breast cancer varies from 6 percent to 26 percent, but almost invariably those patients with scan abnormalities have a poor prognosis and should be considered for additional therapies. Progression or regression of bony lesions can be defined through scanning, and abnormal areas can be identified for biopsy. The incidence of metastases in solitary scan lesions in patients with known primary tumors varies from 20 percent to 64 percent. Bone scintigraphy shows positive uptake in 95 percent of cases with acute osteomyelitis. Stress fractures and trauma suspected in battered babies can be diagnosed by scanning before there is radiological evidence. The procedure is free from acute or long-term side effects and, except in cases of very young patients, sedation is seldom necessary. Although the test is sensitive, it is not specific and therefore it is difficult to overemphasize the importance of clinical, radiographic, biochemical and scanning correlation in each patient

  4. Comparison among patients with hypertrophic cardiomyopathy, hypertrophic cardiomyopathy with hypertension and hypertensive heart disease by 123I-BMIPP myocardial scintigraphy

    The usefulness of 123I-BMIPP myocardial SPECT in discriminating hypertrophic cardiomyopathy (46 patients), hypertrophic cardiomyopathy with hypertension (23 patients), and hypertensive hypertrophic heart (20 patients) was studied. SPECT image was divided into 17 domains, and dimension of decreased accumulation was decided visually at each domain as four classes called defect score (DS). Summation of DS (TDS) of each group was used to compare frequency and dimension of decreased accumulation, and characteristic of each site. Frequency of decreased accumulation and TDS in hypertrophic cardiomyopathy were similar in dimension with those in hypertrophic cardiomyopathy with hypertension, and those data in hypertensive hypertrophic heart were lower than those in above-mentioned 2 groups. In the cases of hypertrophic cardiomyopathy and hypertrophic cardiomyopathy with hypertension, decreased accumulation site was similar and was anterior wall-septum junction, septum-posterior wall junction and apex of heart. In the case of hypertensive hypertrophic heart, decreased accumulation site was only the posterior wall. Frequency, dimension and site of decreased accumulation in hypertrophic cardiomyopathy were different from those in hypertensive hypertrophic heart, and BMIPP was thought to be useful in discriminating these diseases. (K.H.)

  5. Targeting Amino Acid Metabolism for Molecular Imaging of Inflammation Early After Myocardial Infarction.

    Thackeray, James T; Bankstahl, Jens P; Wang, Yong; Wollert, Kai C; Bengel, Frank M

    2016-01-01

    Acute tissue inflammation after myocardial infarction influences healing and remodeling and has been identified as a target for novel therapies. Molecular imaging holds promise for guidance of such therapies. The amino acid (11)C-methionine is a clinically approved agent which is thought to accumulate in macrophages, but not in healthy myocytes. We assessed the suitability of positron emission tomography (PET) with (11)C-methionine for imaging post-MI inflammation, from cell to mouse to man. Uptake assays demonstrated 7-fold higher (11)C-methionine uptake by polarized pro-inflammatory M1 macrophages over anti-inflammatory M2 subtypes (ptranslation of novel image-guided, inflammation-targeted regenerative therapies. PMID:27570549

  6. Genomic and Metabolic Disposition of Non-Obese Type 2 Diabetic Rats to Increased Myocardial Fatty Acid Metabolism

    Devanathan, Sriram; Nemanich, Samuel T.; Kovacs, Attila; Fettig, Nicole; Gropler, Robert J.; Shoghi, Kooresh I.

    2013-01-01

    Lipotoxicity of the heart has been implicated as a leading cause of morbidity in Type 2 Diabetes Mellitus (T2DM). While numerous reports have demonstrated increased myocardial fatty acid (FA) utilization in obese T2DM animal models, this diabetic phenotype has yet to be demonstrated in non-obese animal models of T2DM. Therefore, the present study investigates functional, metabolic, and genomic differences in myocardial FA metabolism in non-obese type 2 diabetic rats. The study utilized Goto-K...

  7. Gallium-67 scintigraphy and the Heart

    Although gallium-67 was initially used for tumor imaging, clinical studies suggested its potential use as a method of detecting occult inflammatory lesions. The demonstration of diffuse myocardial uptake of gallium-67 during Lyme disease myocarditis is consistent with a pattern of diffuse myocarditis as seen in sarcoid myocarditis. Two cases are presented. A critical review of the various applications of gallium-67 scintigraphy to myocardium investigation is carried out

  8. Myocardial perfusion imaging in patients with a recent, normal exercise test

    Bovin, Ann; Klausen, Ib Christian; Petersen, Lars Jelstrup

    2013-01-01

    To investigate the added value of myocardial perfusion scintigraphy imaging (MPI) in consecutive patients with suspected coronary artery disease (CAD) and a recent, normal exercise electrocardiography (ECG).......To investigate the added value of myocardial perfusion scintigraphy imaging (MPI) in consecutive patients with suspected coronary artery disease (CAD) and a recent, normal exercise electrocardiography (ECG)....

  9. Distribution of carbon flux within fatty acid utilization during myocardial ischemia and reperfusion

    Twenty-nine intact, working pig hearts were extracorporeally perfused and divided into two study groups (16 Aerobic and 13 Ischemic/Reflow hearts). Step function, equilibrium labeling with [14C]palmitate was used to develop uptake and washout curves of radioactive fatty acid products contained in coronary effluent during either aerobic perfusion or reperfusion after ischemia (60% reduction in left anterior descending coronary flow for 30 minutes). Left anterior descending control flows were slightly overperfused in Aerobic hearts (18% higher than in Ischemic/Reflow hearts); otherwise, circumflex and right coronary flows, left ventricular pressure, and serum fatty acids and blood sugar levels were comparable between groups. As expected in Ischemic/Reflow hearts, recovery of regional systolic shortening and myocardial oxygen consumption in reperfusion was only modestly impaired (-20% and -19%, respectively, not significant and p less than 0.011 compared with preischemic values, not significant from Aerobic hearts). The only significant metabolized product to be released from labeled fatty acid utilization in either group was 14CO2. A smaller fatty acid pool also was measured and accounted for by that contained in the coronary intravascular volume. The authors could determine no significant back diffusion of fatty acids from myocardium in either perfusion condition. Uptake time constants of the early phase of 14CO2 production also were virtually identical in both groups (19.9 ± 3.2 versus 16.7 ± 3.2 minutes in Aerobic and Ischemic/Reflow hearts, respectively) and strongly correlated with hemodynamics as described by heart rate. In washout studies, tissue radioactivity in the aqueous soluble and fatty acid pools declined in both study groups, and counts in complex lipids and cholesterol/cholesteryl esters remained steady, whereas those in triacylglycerols varied

  10. Distribution of carbon flux within fatty acid utilization during myocardial ischemia and reperfusion

    Nellis, S.H.; Liedtke, A.J.; Renstrom, B. (Cardiovascular Research, University of Wisconsin Hospital and Clinics, Madison (USA))

    1991-09-01

    Twenty-nine intact, working pig hearts were extracorporeally perfused and divided into two study groups (16 Aerobic and 13 Ischemic/Reflow hearts). Step function, equilibrium labeling with (14C)palmitate was used to develop uptake and washout curves of radioactive fatty acid products contained in coronary effluent during either aerobic perfusion or reperfusion after ischemia (60% reduction in left anterior descending coronary flow for 30 minutes). Left anterior descending control flows were slightly overperfused in Aerobic hearts (18% higher than in Ischemic/Reflow hearts); otherwise, circumflex and right coronary flows, left ventricular pressure, and serum fatty acids and blood sugar levels were comparable between groups. As expected in Ischemic/Reflow hearts, recovery of regional systolic shortening and myocardial oxygen consumption in reperfusion was only modestly impaired (-20% and -19%, respectively, not significant and p less than 0.011 compared with preischemic values, not significant from Aerobic hearts). The only significant metabolized product to be released from labeled fatty acid utilization in either group was 14CO2. A smaller fatty acid pool also was measured and accounted for by that contained in the coronary intravascular volume. The authors could determine no significant back diffusion of fatty acids from myocardium in either perfusion condition. Uptake time constants of the early phase of 14CO2 production also were virtually identical in both groups (19.9 {plus minus} 3.2 versus 16.7 {plus minus} 3.2 minutes in Aerobic and Ischemic/Reflow hearts, respectively) and strongly correlated with hemodynamics as described by heart rate. In washout studies, tissue radioactivity in the aqueous soluble and fatty acid pools declined in both study groups, and counts in complex lipids and cholesterol/cholesteryl esters remained steady, whereas those in triacylglycerols varied.

  11. Altered myocardial metabolic adaptation to increased fatty acid availability in cardiomyocyte-specific CLOCK mutant mice.

    Peliciari-Garcia, Rodrigo A; Goel, Mehak; Aristorenas, Jonathan A; Shah, Krishna; He, Lan; Yang, Qinglin; Shalev, Anath; Bailey, Shannon M; Prabhu, Sumanth D; Chatham, John C; Gamble, Karen L; Young, Martin E

    2016-10-01

    A mismatch between fatty acid availability and utilization leads to cellular/organ dysfunction during cardiometabolic disease states (e.g., obesity, diabetes mellitus). This can precipitate cardiac dysfunction. The heart adapts to increased fatty acid availability at transcriptional, translational, post-translational and metabolic levels, thereby attenuating cardiomyopathy development. We have previously reported that the cardiomyocyte circadian clock regulates transcriptional responsiveness of the heart to acute increases in fatty acid availability (e.g., short-term fasting). The purpose of the present study was to investigate whether the cardiomyocyte circadian clock plays a role in adaptation of the heart to chronic elevations in fatty acid availability. Fatty acid availability was increased in cardiomyocyte-specific CLOCK mutant (CCM) and wild-type (WT) littermate mice for 9weeks in time-of-day-independent (streptozotocin (STZ) induced diabetes) and dependent (high fat diet meal feeding) manners. Indices of myocardial metabolic adaptation (e.g., substrate reliance perturbations) to STZ-induced diabetes and high fat meal feeding were found to be dependent on genotype. Various transcriptional and post-translational mechanisms were investigated, revealing that Cte1 mRNA induction in the heart during STZ-induced diabetes is attenuated in CCM hearts. At the functional level, time-of-day-dependent high fat meal feeding tended to influence cardiac function to a greater extent in WT versus CCM mice. Collectively, these data suggest that CLOCK (a circadian clock component) is important for metabolic adaption of the heart to prolonged elevations in fatty acid availability. This article is part of a Special Issue entitled: Heart Lipid Metabolism edited by G.D. Lopaschuk. PMID:26721420

  12. Regulatory role of free fatty acids in maintain of membrane homeostasis in heart mitochondria at experimental myocardial ischaemia

    M. V. Egorova

    2012-01-01

    Full Text Available The rate of oxygen uptake by heart mitochondria (Mch at different heart pathologies (myocardial infarction, diabetes mellitus and their combination was studied polarographically. The rate of oxygen uptake of damaged heart Mch and content of free fatty acids (FFA were increased. Change of these parameters was increased with the development of pathologies that is most pronounced in the groups «diabetes» and «diabetes + myocardial infarction». In the group of «myocardial infarction + diabetes» pathological process was developed less intensively in comparison with individual pathologies. Addition of FFA suppressed the rate of oxygen uptake of Mch. Equally, inhibition of phospholipase A2 suppressed the respiration of Mch. The hypothesis that FFA act as modulators of the activity of phospholipase A2 was discussed.

  13. Detection and Assessment Using Positron Emission Tomography of Genetically Determined Defects in Myocardial Fatty Acid Utilization. Final report, 8/1/93-6/30/97

    Bergmann, Steven R.

    2000-04-09

    An approach using positron emission tomography (PET) was developed, validated and used to measure myocardial fatty acid metabolism in patients with inherited forms of heart failure. Abnormalities were correlated with the severity of the clinical illness. The approach developed was also shown to identify abnormalities in myocardial fatty acid metabolism in some patients with acquired forms of heart failure. The PET technique thus permits identification of abnormal fatty acid metabolism and provides an approach to evaluate the efficacy of interventional strategies.

  14. Dual myocardial scintigraphic imaging using 123I-BMIPP and 201Tl in patients with Duchenne's progressive muscular dystrophy

    Dual single photon emission computed tomography (SPECT) was performed in 30 patients with Duchenne's muscular dystrophy (DMD) using 201 thallium (Tl) for myocardial perfusion 123I-β-methyl-p-iodophenylpentadecanoic acid (BMIPP) for myocardial fatty acid metabolism scintigraphy. The left ventricle was divided into 9 regions, and accumulation of the radiotracers was assessed visually for each region to calculate defect score for each tracer. There was some degree of decrease in the myocardial accumulation of both tracers in all DMD patients. Reduced accumulation was most common at the apex (BMIPP, 70%; Tl, 63%), followed by the posterior wall, lateral wall, and anterior wall. It was less common on the apical side of the ventricular septum for both tracers (BMIPP, 3%; Tl, 17%). Accumulation of Tl was lower than BMIPP in 18/30 patients (60%) and higher in 9 (30%), while both tracers showed equal accumulation in 3 (10%). BMIPP showed higher accumulation than Tl in all regions but the septum. A significant negative correlation was found between the defect scores for both tracers and the left ventricular ejection fraction (LVEF) (r=-0.629 for Tl; r=-0.567 for BMIPP). The strongest negative correlation was that between the sum of the Tl and BMIPP defect scores and the LVEF (r=-0.681). Dual SPECT myocardial scintigraphy with Tl and BMIPP provided an accurate evaluation of the progression of cardiac lesions in DMD by detecting abnormalities of the myocardial metabolism of each substance thereby enabling the assessment of left ventricular function. (author)

  15. Myocardial hypertrophy and the maturation of fatty acid oxidation in the newborn human heart.

    Yatscoff, Michael A; Jaswal, Jagdip S; Grant, Meghan R; Greenwood, Rachel; Lukat, Trish; Beker, Donna L; Rebeyka, Ivan M; Lopaschuk, Gary D

    2008-12-01

    After birth dramatic decreases in cardiac malonyl CoA levels result in the rapid maturation of fatty acid oxidation. We have previously demonstrated that the decrease in malonyl CoA is due to increased activity of malonyl CoA decarboxylase (MCD), and decreased activity of acetyl CoA carboxylase (ACC), enzymes which degrade and synthesize malonyl CoA, respectively. Decreased ACC activity corresponds to an increase in the activity of 5'-AMP activated protein kinase (AMPK), which phosphorylates and inhibits ACC. These alterations are delayed by myocardial hypertrophy. As rates of fatty acid oxidation can influence the ability of the heart to withstand an ischemic insult, we examined the expression of MCD, ACC, and AMPK in the newborn human heart. Ventricular biopsies were obtained from infants undergoing cardiac surgery. Immunoblot analysis showed a positive correlation between MCD expression and age. In contrast, a negative correlation in both ACC and AMPK expression and age was observed. All ventricular samples displayed some degree of hypertrophy, however, no differences in enzyme expression were found between moderate and severe hypertrophy. This indicates that increased expression of MCD, and the decreased expression of ACC and AMPK are important regulators of the maturation of fatty acid oxidation in the newborn human heart. PMID:18614968

  16. Plasma fatty acids, oxylipins, and risk of myocardial infarction: the Singapore Chinese Health Study.

    Sun, Ye; Koh, Hiromi W L; Choi, Hyungwon; Koh, Woon-Puay; Yuan, Jian-Min; Newman, John W; Su, Jin; Fang, Jinling; Ong, Choon Nam; van Dam, Rob M

    2016-07-01

    We aimed to examine the prospective association between plasma FAs, oxylipins, and risk of acute myocardial infarction (AMI) in a Singapore Chinese population. A nested case-control study with 744 incident AMI cases and 744 matched controls aged 47-83 years was conducted within the Singapore Chinese Health Study. Nineteen plasma FAs and 12 oxylipins were quantified using MS. These were grouped into 12 FA clusters and 5 oxylipin clusters using hierarchical clustering, and their associations with AMI risk were assessed. Long-chain n-3 FAs [odds ratio (OR) = 0.67 per SD increase, 95% confidence interval (CI): 0.53-0.84, P stearic acid (OR = 0.65, 95% CI: 0.44-0.97, P = 0.03) were inversely associated with AMI risk, whereas arachidonic acid (AA) was positively associated with AMI risk (OR = 1.25, 95% CI: 1.03-1.52, P = 0.02) in the multivariable model with adjustment for other FAs. Further adjustment for oxylipins did not substantially change these associations. An inverse association was observed between AA-derived oxylipin, thromboxane (TX)B2, and AMI risk (OR = 0.81, 95% CI: 0.71-0.93, P = 0.003). Circulating long-chain n-3 FAs and stearic acid were associated with a lower and AA was associated with a higher AMI risk in this Chinese population. The association between the oxylipin TXB2 and AMI requires further research. PMID:27371261

  17. Characteristics of left ventricular hypertrophy estimated by MIBG and BMIPP cardiac scintigraphy in patients undergoing peritoneal dialysis

    Ohashi, Hiroshige; Oda, Hiroshi; Ohno, Michiya; Watanabe, Sachirow; Kotoo, Yasunori; Matsuno, Yukihiko [Gifu Prefectural Hospital (Japan)

    2002-12-01

    Left ventricular hypertrophy (LVH) has been reported as a major factor in morbidity and mortality in chronic dialysis patients. However, cardiovascular mortality in peritoneal dialysis (PD) patients with LVH is substantially similar to that in hemodialysis (HD) patients. The present study sought to study whether sympathetic nerve activity and fatty acid metabolism of the myocardium estimated by {sup 123}I metaiodobenzylguanidine (MIBG) and {sup 123}I {beta}-methyl-p-iodophenyl-pentadecanoic acid (BMIPP) myocardial scintigraphy are impaired or not in PD patients with LVH. The underlying disease of 45 PD patients enrolled in this study was chronic glomerulonephritis in all cases. Serum levels of natriuretic peptides (arterial natriuretic peptide (ANP), brain natriuretic peptide (BNP)) and free carnitine and MIBG, BMIPP myocardial scintigraphy and 2-dimensional echocardiography were measured in these 45 PD patients. The following results were obtained. The prevalence of increased left ventricular mass index (LVMI) was 84.4%. LVMI correlated with age, and serum levels of ANP and BNP, and inversely correlated with a heart-to-mediastinum ratio (H/M) estimated by MIBG and BMIPP myocardial scintigraphy. Percentages of the normal image of MIBG and BMIPP measured with a single photon emission computed tomography (SPECT) were 37.8% and 62.2%, respectively. The PD patients showing the diffuse defect of MIBG or BMIPP imaging had the decrease in left ventricular ejection fraction (LVEF). Especially, the serum level of free carnitine was reduced in the PD patients with diffuse defect of BMIPP SPECT. From these results, we concluded that PD patients with LVH showed impaired sympathetic nerve activity and fatty acid metabolism of the myocardium. Metabolic and functional disturbances of the myocardium may influence mortality in PD patients. (author)

  18. Characteristics of left ventricular hypertrophy estimated by MIBG and BMIPP cardiac scintigraphy in patients undergoing peritoneal dialysis

    Left ventricular hypertrophy (LVH) has been reported as a major factor in morbidity and mortality in chronic dialysis patients. However, cardiovascular mortality in peritoneal dialysis (PD) patients with LVH is substantially similar to that in hemodialysis (HD) patients. The present study sought to study whether sympathetic nerve activity and fatty acid metabolism of the myocardium estimated by 123I metaiodobenzylguanidine (MIBG) and 123I β-methyl-p-iodophenyl-pentadecanoic acid (BMIPP) myocardial scintigraphy are impaired or not in PD patients with LVH. The underlying disease of 45 PD patients enrolled in this study was chronic glomerulonephritis in all cases. Serum levels of natriuretic peptides (arterial natriuretic peptide (ANP), brain natriuretic peptide (BNP)) and free carnitine and MIBG, BMIPP myocardial scintigraphy and 2-dimensional echocardiography were measured in these 45 PD patients. The following results were obtained. The prevalence of increased left ventricular mass index (LVMI) was 84.4%. LVMI correlated with age, and serum levels of ANP and BNP, and inversely correlated with a heart-to-mediastinum ratio (H/M) estimated by MIBG and BMIPP myocardial scintigraphy. Percentages of the normal image of MIBG and BMIPP measured with a single photon emission computed tomography (SPECT) were 37.8% and 62.2%, respectively. The PD patients showing the diffuse defect of MIBG or BMIPP imaging had the decrease in left ventricular ejection fraction (LVEF). Especially, the serum level of free carnitine was reduced in the PD patients with diffuse defect of BMIPP SPECT. From these results, we concluded that PD patients with LVH showed impaired sympathetic nerve activity and fatty acid metabolism of the myocardium. Metabolic and functional disturbances of the myocardium may influence mortality in PD patients. (author)

  19. /sup 13/N-labeled L-amino acids for in vivo assessment of local myocardial metabolism

    Baumgartner, F.J.; Barrio, J.R.; Henze, E.; Schelbert, H.R.; MacDonald, N.S.; Phelps, M.E.; Kuhl, D.E.

    1981-06-01

    The hot cell synthesis of sterile, pyrogen-free /sup 13/N-labeled L-amino acids was accomplished by employing the appropriate immobilized enzymes on a CNBr-activated Sepharose support and using remote, semiautomated systems. The syntheses were completed 6-12 min after cyclotron production of (/sup 13/N)ammonia. Myocardial time-activity curves after intracoronary injection of /sup 13/N-labeled L-amino acids in dogs were triexponential in both normal and ischemic myocardium. Higher retention of /sup 13/N activity was observed in ischemic segments. Positron computed tomography imaging also showed increased uptake of /sup 13/N-labeled L-glutamate and L-alanine in ischemic segments compared with normal myocardium when blood flow corrections were made. Myocardial transaminases are primarily responsible for the observed retention fractions. It suggests the participation of the carbon skeletons of these amino acids in the Krebs cycle.

  20. Effects of smoking on myocardial injury in patients with conservatively treated acute myocardial infarction. A study with resting 123I-15-iodophenyl 3-methyl pentadecanoic acid/201Tl myocardial single photon emission computed tomography

    Many reports have demonstrated that smokers who have suffered an acute myocardial infarction (AMI) have a better prognosis than nonsmokers. The present study investigated the effects of current smoking on myocardial injury with resting 123I-15-iodophenyl 3-methyl pentadecanoic acid (BMIPP)/201Tl myocardial single photon emission computed tomography in 103 patients with conservatively treated AMI. The left ventricular myocardium was divided into 9 segments and BMIPP and 201Tl defects were scored using a 5-point grading system (0=normal and 4=no uptake). The sum of the defect scores was defined as the total defect score. There was no significant difference in either the baseline severity of the coronary artery discase or the total defect scores for BMIPP and 201Tl between the current smoker and nonsmoker groups. The difference between the total defect scores for BMIPP and 201Tl tended to be larger in the current smoker group than in the nonsmoker group (2.0±1.9 vs 1.3±1.6, p=0.056). Forty-one (53%) of 77 patients in the current smoker group exhibited a BMIPP/201Tl mismatch, whereas only 8 (31%) of 26 patients in the nonsmoker group did (p=0.047). In conclusion, current smokers had more likelihood of salvageable myocardium in areas at risk, as demonstrated by BMIPP/201Tl mismatch, in AMI than nonsmokers. (author)

  1. Non-invasive analysis of metabolic reactions in body tissues, the case of myocardial fatty acids

    Fatty acid catabolism may be observed in the myocardium by choosing 123I in the ω-position. The kinetics of uptake and release of this tracer, in mouse myocardium, are very similar to that of 1sup(C)-labelled palmitic acid. Because the 123I labels both, the anabolic substrate as well as the final catabolites, which are released into the circulating blood and partially reenter the field of view, they must be separately measured in order to observe the release rate of anabolic tracer as a consequence of fatty acid degradation. 123I in the form of sodium iodide, was chosen to separately observe the catabolic tracer. The catabolic tracer was substracted from the total tracer to yield the anabolically bound tracer. The application of the correction procedure to separately observe the anabolic tracer in the myocardium combined with ECG-triggering of imaging in diastole, gives excellent myocardial scintigrams and permits the construction of metabolic images giving the rates of release of fatty acid labelling for each image segment of the myocardium. There is evidence that in coronary artery disease accumulation defects show a diminished release rate whereas in caridomyopathy the accumulation image does not superimpose the metabolic image. In order to utilize emission computer assisted tomography to its full potential one needs an acceptable speed of imaging for measuring elimination rates of tracer; also ECG triggering to any phase of a cardiac cycle should be applicable in order to improve the image quality; and finally repeated images from one or different tracers should be of interest in order to construct functional images giving metabolic reaction rates in term of elimination half times, besides the image of the initial tracer accumulation. (orig./MG)

  2. Management of gallbladder dyskinesia: patient outcomes following positive 99mtechnetium (Tc)-labelled hepatic iminodiacetic acid (HIDA) scintigraphy with cholecystokinin (CCK) provocation and laparoscopic cholecystectomy

    Aims: To evaluate clinical outcomes in patients with typical biliary pain, normal ultrasonic findings, and a positive 99mtechnetium (Tc)-labelled hepatic iminodiacetic acid analogue (HIDA) scintigraphy with cholecystokinin (CCK) provocation indicating gallbladder dyskinesia, as per Rome III criteria, undergoing laparoscopic cholecystectomy (LC). Methods and materials: Consecutive patients undergoing LC for gallbladder dyskinesia were identified retrospectively. They were followed up by telephone interview and review of the electronic case records to assess symptom resolution. Results: One hundred consecutive patients (median age 44; 80% female) with abnormal gallbladder ejection fraction (GB-EF <35%) were followed up for a median of 12 months (range 2–80 months). Following LC, 84% reported symptomatic improvement and 52% had no residual pain. Twelve percent had persisting preoperative-type pain of either unchanged or worsening severity. Neither pathological features of chronic cholecystitis (87% of 92 incidences when histology available) nor reproduction of pain on CCK injection were significantly predictive of symptom outcome or pain relief post-LC. Conclusion: In one of the largest outcome series of gallbladder dyskinesia patients in the UK with a positive provocation HIDA scintigraphy examination and LC, the present study shows that the test is a useful functional diagnostic tool in the management of patients with typical biliary pain and normal ultrasound, with favourable outcomes following surgery. - Highlights: • Gallbladder dyskinesia (GD) is a challenging condition to diagnose and treat. • This study evaluated clinical outcomes following laparoscopic cholecystectomy (LC). • There was sustained symptomatic benefit in >80% following surgery. • Pre-operative counselling before LC is important

  3. Myocardial Lipid Profiling During Time Course of High Fat Diet and its Relationship to the Expression of Fatty Acid Transporters

    Ewa Harasim

    2015-09-01

    Full Text Available Background/Aims: It is well documented that increased fatty acids (FA supply causes lipid accumulation and insulin resistance in skeletal muscles. Whether the same mechanism is present in the heart is still unclear. Therefore, the goal of our study was to determine the content of specific myocardial lipid fractions during feeding rats a high fat diet (HFD for 5 weeks. Moreover, the relation between changes in myocardial lipid content, whole body insulin resistance and the expression of fatty acid transporters in each week of HFD was established. Methods: Gas liquid chromatography and high performance liquid chromatography were used to determine the content of lipid fractions in the left ventricle. Expression of selected proteins was estimated by Western blot technique. All measurements were made after each week of HFD. Results: As expected, lipid profile in myocardium was altered by HFD in different weeks of the study with the most intense changes in triacylglycerols, long chain fatty acid-CoA and ceramide. Furthermore, there was a significant elevation of plasmalemmal (the 4th and the 5th week and mitochondrial expression (from the 3rd to the 5th week of fatty acid translocase. Conclusion: High fat diet affects myocardial lipid profile in each week of its duration and causes alternations in FA metabolism in cardiomyocytes.

  4. Myocardial protection during elective coronary artery bypasses grafting by pretreatment with omega-3 polyunsaturated fatty acids

    Veljović Milić

    2013-01-01

    Full Text Available Background/Aim. Despite recent advances in coronary artery bypass grafting (CABG, cardioplegic cardiac arrest and cardiopulmonary bypass (CPB are still associated with myocardial injury. Accordingly, the efforts have been made lately to improve the outcome of CPB by glucose-insulinpotassium, adenosine, Ca2+-channel antagonists, L-arginine, N-acetylcysteine, coenzyme Q10, diazoxide, Na+/H+ exchange inhibitors, but with an unequal results. Since omega-3 polyunsatutated fatty acids (PUFAs have shown remarkable cardioprotection in preclinical researches, the aim of our study was to check their effects in prevention of ischemia reperfusion injury in patients with CPB. Methods. This prospective, randomized, placebo-controlled study was performed with parallel groups. The patients undergoing elective CABG were randomized to receive preoperative intravenous omega-3 PUFAs infusion (n = 20 or the same volume of 0.9% saline solution infusion (n = 20. Blood samples were collected simultaneously from the radial artery and the coronary sinus before starting CPB and at 10, 20 and 30 min after the release of the aortic cross clamp. Lactate extraction/excretion and myocardial oxygen extraction were calculated and compared between the two groups. The levels of troponin I (TnT and creatine kinase-myocardial band (CK-MB were determined before starting CPB and 4 and 24 h postoperatively. Results. Demographic and operative characteristics, including CPB and aortic cross-clamp time, were similar between the two groups of patients. The level of lactate extraction 10 and 20 min after aortic cross-clamp time has shown negative values in the control group, but positive values in the PUFAs group with statistically significant differences (-19.6% vs 7.9%; p < 0.0001 and -19.9% vs 8.2%; p < 0.0008, respectively. The level of lactate extraction 30 minutes after reperfusion was not statistically different between the two groups (6.9% vs 4.2%; p < 0.54. Oxygen extraction in the

  5. Conjugated linoleic acid and nitrite attenuate mitochondrial dysfunction during myocardial ischemia.

    Van Hoose, Patrick M; Kelm, Natia Qipshidze; Piell, Kellianne M; Cole, Marsha P

    2016-08-01

    Cardiovascular health is influenced by dietary composition and the western diet is composed of varying types/amounts of fat. Conjugated linoleic acid (cLA) is an abundant dietary unsaturated fatty acid associated with health benefits but its biological signaling is not well understood. Nitrite is enriched in vegetables within the diet and can impact signaling of unsaturated fatty acids; however, its role on cLA signaling is not well understood. Elucidating how nitrite may impact the biological signaling of cLA is important due to the dietary consumption of both cLA and nitrite in the western diet. Since co-administration of cLA and nitrite results in cardioprotection during myocardial infarction (MI), it was hypothesized that cLA and nitrite may affect cardiac mitochondrial respiratory function and complex activity in MI. C57BL/6J mice were treated with cLA and nitrite for either 10 or 13days, where MI was induced on day 3. Following treatment, respiration and complex activity were measured. Among the major findings of this study, cLA treatment (10days) decreases state 3 respiration in vivo. Following MI, nitrite alone and in combination with cLA attenuates increased state 3 respiration and decreases hydrogen peroxide levels. Further, nitrite and cLA co-treatment attenuates increased complex III activity after MI. These results suggest that cLA, nitrite and the combination significantly alter cardiac mitochondrial respiratory and electron transport chain activity in vivo and following MI. Overall, the daily consumption of cLA and nitrite in the diet can have diverse cardiovascular implications, some of which occur at the mitochondrial level. PMID:27156147

  6. Liver scintigraphy in ponies

    Six derivatives of ethylenediamine-N,N'-bis (alpha-2-hydroxy phenyl) acetic acid labeled with /sup 99m/Tc were prepared and their imaging qualities evaluated in ponies. The 6 agents produced good scintigraphic images of certain structures of the liver in the pony. For each agent, 13 different scans were taken. Dorsal views of the left lateral, right lateral, and quadrate lobe were obtained with dorsal scans. Left lateral and left lateral oblique (45 degrees) scans provided a left lateral view of the left lobe and a medial view of the right lateral lobe. Right lateral scans revealed the right lateral and quadrate lobes. Administration of /sup 99m/Tc-labeled colloids which are commonly used in other species for liver scintigraphy resulted in extensive lung uptake in the pony

  7. Dermcidin isoform-2 induced nullification of the effect of acetyl salicylic acid in platelet aggregation in acute myocardial infarction

    Sarbashri Bank; Pradipta Jana; Smarajit Maiti; Santanu Guha; Sinha, A.K.

    2014-01-01

    The aggregation of platelets on the plaque rupture site on the coronary artery is reported to cause both acute coronary syndromes (ACS) and acute myocardial infarction (AMI). While the inhibition of platelet aggregation by acetyl salicylic acid was reported to produce beneficial effects in ACS, it failed to do in AMI. The concentration of a stress induced protein (dermcidin isoform-2) was much higher in AMI than that in ACS. Incubation of normal platelet rich plasma (PRP) with dermcidin showe...

  8. Plasma Free Fatty Acid Concentrations as a Marker for Acute Myocardial Infarction

    Roy, Vijay Kumar; Kumar, Anil; Joshi, Prabal; Arora, Jyoti; Ahanger, Ali Mohammad

    2013-01-01

    Background: Acute myocardial infarction carries a high mortality among cardiac patients.The discovery of the fact that certain enzymes like CPK, LDH liberated into circulation following necrosis of the myocardial cells came as boon for physicians and patients. There has been a constant search of different parameters for the diagnosis and management of CoronaryArtery Diseases (CAD).

  9. The independent value of exercise thallium scintigraphy to physicians

    To determine the effect of exercise myocardial scintigraphy with 201Tl on diagnostic accuracy and the need for coronary angiography, consecutive patients with a variety of clinical presentations were identified. Clinical summaries, including a detailed history, physical examination, and complete data from a standard treadmill exercise test, were presented to 91 cardiologists. The cardiologists assessed the probability of coronary disease and the need for coronary angiography. They were then presented the results of thallium scintigraphy and revised their assessments if warranted. Scintigraphy significantly increased the cardiologists' diagnostic accuracy beyond that attained with other clinical information (p less than 0.0001). The change in accuracy varied from + 4% to + 20% in different patient groups, and was greatest in patients with atypical angina and a positive exercise ECG. Ratings of the need for coronary angiography changed from -13% to +21% in different patient groups. We conclude that exercise thallium scintigraphy can provide independent diagnostic information and influence the need for coronary angiography

  10. Iodine-123-labelled fatty acids for myocardial single-photon emission tomography: current status and future perspectives

    Renewed interest in the clinical use of iodine-123-labelled fatty acids is currently primarily focused on the use of iodine-123-labelled 15-(p-iodophenyl)pentadecanoic acid (IPPA) and ''modified'' fatty acid analogues such as 15-(p-iodophenyl)-3-R,S-methylpentadecanoic acid (BMIPP) which show delayed myocardial clearance, thus permitting single-photon emission tomographic imaging. Interest in the use of BMIPP and similar agents results from the differences which have often been observed in various types of heart disease between regional myocardial uptake patterns of [123I]BMIPP and flow tracer distribution. Although the physiological basis is not completely understood, differences between regional fatty acid and flow tracer distribution may reflect alterations in important parameters of metabolism which can be useful for patient management or therapy planning. These tracers may also represent unique metabolic probes for correlation of energy substrate metabolism with regional myocardial viability. The two agents currently most widely used clinically are 123I-labelled IPPA and BMIPP. While [123I]IPPA is commercially available as a radiopharmaceutical in Europe (Cygne) and Canada (Nordion), multicenter trials are in progress in the United States as a prelude to approval for broad use. [123I]BMIPP was recently introduced as Cardiodine for commercial distribution in Japan (Nihon Medi-Physics, Inc.). [123I]BMIPP is also being used in clinical studies on an institutional approval basis at several institutions in Europe and the United States. In this review, the development of a variety of radioiodinated fatty acids is discussed. The results of clinical trials with [123I]IPPA and [123I]BMIPP are discussed in detail, as are the future prospects for fatty acid imaging. (orig.)

  11. Regional rates of myocardial fatty acid metabolism: Comparison with coronary angiography and ventriculography

    In 50 patients, 1 mCi 123I phenylpentadecanoic acid (IPPA) was injected at peak ergometric stress and 1500 frames were acquired (1 frame/s) with a high count rate gamma camera. Parametric images of rates of decrease and increase for different time intervals after stress were compared with coronary angiography and LV ventriculography, separately evaluating the 3 main coronary territories: 18/150 territories supplied by normal coronaries presented rather homogeneous regional clearing rates, whereas a gradual decrease in clearing rates towards the end of the territory (frequently with peripheral defects) was seen in all 87/150 territories with significant coronary narrowing. In local correspondence to clearing defects, initial IPPA accumulations could be observed with later onset of clearing between 10 and 25 min. In all 44/150 territories presented abnormal clearing rates, mostly with a patchy pattern, with normal coronary anatomy, but all except one had LV dysfunction and a clinical diagnosis of cardiomyopathy, diabetes mellitus or hypertensive disease. Twenty four of the 41 patients with CAD had, in correspondence to a prior myocardial infarction, minimum or missing metabolic activity frequently in circumscribed zones, partly separated by bridges of still viable tissue with preserved but reduced clearing rates. (orig.)

  12. Myocardial distribution of I/sup 131/-labeled hexadecenoic acid in relation to the dog local coronary flow

    Riche, F.; Busquet, G.; Pilichowski, P.; Wolf, J.E.; Mathieu, J.P.; Comet, M.; Pernin, C. (Centre Hospitalier Regional, 38 - Grenoble (France)); Vidal, M.; Vincens, M.; Godart, J. (Grenoble-1 Univ., 38 (France). Inst. des Sciences Nucleaires)

    1981-01-01

    20 anesthetized and thoracotomized dogs are studied. The local myocardial blood flow is measured with sup(99m)Tc human albumin microspheres. The intramyocardial distribution of the 16-I(131)-9-hexadecenoic acid in relation to local blood flow is studied in basal conditions (7 dogs), after experimental infarction (6 dogs) and postischemic reactive hyperhemia (7 dogs). We conclude that during basal condition, after infarction but not during reactive hyperhemia, the distribution of the labeled fatty acid reflect the local variations of blood flow.

  13. Structurally modified fatty acids - clinical potential as tracers of metabolism

    Dudczak, R.; Schmoliner, R.; Angelberger, P.; Knapp, F.F.; Goodman, M.M.

    1985-01-01

    Recently 15-p-iodophenyl-betamethyl-pentadecanoic acid (BMPPA) was proposed for myocardial scintigraphy, as possible probe of metabolic processes other than ..beta..-oxidation. In 19 patients myocardial scintigraphy was done after i.v. BMPPA (2 to 4 mCi). Data were collected (LAO 45/sup 0//14; anterior/5) for 100 minutes in the fasted patients. From heart (H) and liver (L) organ to background (BG) ratios were calculated, and the elimination (E) behavior was analyzed from BG (V. cava region) corrected time activity curves. In 10 patients plasma and urine were examined. By CHCl/sub 3//MeOH extraction of plasma samples (90 min. pi) both in water and in organic medium soluble catabolites were found. TLC fractionation showed that those were co-migrating, compared to standards, with benzoic acid, BMPPA and triglycerides. In urine (0 to 2h pi: 4.1% dose) hippuric acid was found. It is concluded that BMPPA is a useful agent for myocardial scintigraphy. Its longer retention in the heart compared to unbranched radioiodinated fatty acids may facilitate SPECT studies. Rate of elimination and plasma analysis indicate the metabolic breakdown of BMPPA. Yet, the complexity of the supposed mechanism may impede curve interpretation in terms of specific metabolic pathways. 19 refs., 5 tabs.

  14. Seven-Day Caloric and Saturated Fat Restriction Increases Myocardial Dietary Fatty Acid Partitioning in Impaired Glucose-Tolerant Subjects.

    Noll, Christophe; Kunach, Margaret; Frisch, Frédérique; Bouffard, Lucie; Dubreuil, Stéphanie; Jean-Denis, Farrah; Phoenix, Serge; Cunnane, Stephen C; Guérin, Brigitte; Turcotte, Eric E; Carpentier, André C

    2015-11-01

    Subjects with impaired glucose tolerance (IGT) have increased myocardial partitioning of dietary fatty acids (DFAs) with left ventricular dysfunction, both of which are improved by modest weight loss over 1 year induced by lifestyle changes. Here, we determined the effects of a 7-day hypocaloric diet (-500 kcal/day) low in saturated fat (R,S)-[18F]-fluoro-6-thia-heptadecanoic acid positron emission tomography method after 7 days of an ISOCAL diet versus a LOWCAL diet using a randomized crossover design. The LOWCAL diet led to reductions in weight and postprandial insulin area under the curve. Myocardial DFA partitioning over 6 h was increased after the LOWCAL diet (2.3 ± 0.1 vs. 1.9 ± 0.2 mean standard uptake value, P < 0.04). However, the early (90-120 min) myocardial DFA fractional uptake was unchanged after the LOWCAL diet (0.055 ± 0.025 vs. 0.046 ± 0.009 min(-1), P = 0.7). Liver DFA partitioning was unchanged, but liver fractional uptake of DFA tended to be increased. Very short-term caloric and saturated fat dietary restrictions do not lead to the same changes in organ-specific DFA metabolism as those associated with weight loss in subjects with IGT. PMID:26224886

  15. I-123-labelled heptadecanoic acid as myocardial imaging agent: comparison with thallium-201 and first-pass nuclear ventriculography

    Results of the use of 123I-iodoheptadecanoic acid (HA) as a myocardial imaging agent in eight patients and six normals are presented. It was shown that 123I-HA gave comparable results to the widely used radiopharmaceutical 201Tl. However the advantages of using 123I-HA are that the 159 KeV energy is better suited to the conventional gamma camera, it gives a lower radiation dose to the patient and has a lower cost per study. 123I-HA also has an important advantage in its potential for studying regional myocardial metabolic activity; in one patient, a defect due to ischaemia was seen at rest with 123I-HA but required stress to make it evident with 201Tl imaging. (U.K.)

  16. Influence of retinoic acid on TBX1 expression in myocardial cells induced by Shh and Fgf8

    Miao LIU; Xiaoyan WU; Jiawei XU; Runming JIN

    2009-01-01

    The aim of this study was to explore the regulatory mechanism of retinoic acid (RA) on the TBX1 gene expression in myocardial cells. Ventricular cardio-cytes were isolated from neonatal rats and cultured, and then treated with different concentrations of retinoic acid. The expression of Shh and Fgf8 at mRNA and protein levels in neonatal rat myocardial cells were measured by using RT-PCR and Western blot technique, respectively. There was basal expression of Shh and Fgf8 in the control group. When treated with 3×10-7 mol/L RA, we observed that the expression of Shh mRNA and protein in neonatal rat myocardial cells were up-regulated by 1.51 (P<0.05) and 1.10 times (P<0.05), respectively. In comparison with the control group, under the concentra-tion of 5×10-7 mol/L RA, they were up-regulated by 2.21 (P < 0.05) and 2.38 times (P < 0.05) individually. Mean-while, we could detect that the expression of Fgf8 mRNA and protein were up-regulated by 2.50 times (P < 0.05) and 80% (P<0.05) separately compared with the control group after stimulation of 3×10-7 mol/L RA, and they were up-regulated by 3.48 (P< 0.05) and 2.04 times(P < 0.05) individually after stimulation of 5×10-7 mol/LRA. The results indicated that RA could induce the expression of Shh and Fgf8 in neonatal rat myocardial cells. At the same time, it has shown that Shh and Fgf8 were involved in the regulation process of RA on TBX1 expression.

  17. Hepatic scintigraphy for leptospirosis

    Six patients with leptospirosis were investigated. Hepatic scintigraphy showed abnormal radiocolloidal distribution, with non-homogeneous concentration in all of them, and minimum to moderate splenic uptake. Hepatic scintigraphy is proved to be a good function test of the hepatic defeat system

  18. Scintigraphy in equine practice

    The most common use for nuclear medicine in equine practice is bone imaging using technetium 99m as the radionuclide. This article will describe establishment of a facility to perform equine scintigraphy, the peculiarities associated with nuclear medicine and horses and describe a variety of the pathology we identify using scintigraphy. Copyright (2002) The Australian and New Zealand Society of Nuclear Medicine Inc

  19. Effects of exercise training on myocardial fatty acid metabolism in rats with depressed cardiac function induced by transient ischemia

    The effects of exercise training on metabolic and functional recovery after myocardial transient ischemia were investigated in a rat model. Male Wistar Kyoto rats were subjected either to a 30-min left coronary artery occlusion followed by reperfusion or to a sham operation. At 4 weeks after operation, the rats were randomly assigned either to sedentary conditions or to exercise training for 6 weeks. In the ischemic rats, pinhole SPECT (single photon emission computed tomography) imaging with thallium-201 (201Tl) and 123I-(ρ-iodophenyl)-3-R,S-methylpentadecanoic acid (BMIPP) showed a reduction of both myocardial perfusion and fatty acid metabolism in the risk zone of the left ventricle (LV). The LV was dilated and the ejection fraction was decreased after ischemic injury. The severity score showed a significant decrease on both 201Tl and BMIPP (201Tl, from 19.9±2.7 to 17.0±2.2, p<0.05; BMIPP, from 21.5±2.4 to 18.6±1.9, p<0.05) after exercise training in the ischemic trained rats, but did not change significantly in their sedentary counterparts. Plasma levels of free fatty acids normalized in the ischemic trained rats, but elevated in the ischemic sedentary rats (0.53±0.05 vs 0.73±0.06 mmol/L, p<0.05). Furthermore, the trained rats had a significant increase in LV stroke volume (0.25±0.02 vs 0.21±0.01 ml/beat, p<0.05) and adaptive cardiac hypertrophy. These findings demonstrate that adaptive improvements in myocardial perfusion, fatty-acid metabolism and LV function were induced by exercise training after transient ischemia. (author)

  20. Technetium and rhenium complexes with modified fatty acid ligands 4. Evaluation of two new classes of {sup 99m}Tc-labelled fatty acids as potential tracers for myocardial metabolism imaging

    Heintz, A.; Kropp, J.; Deussen, A. [TU Dresden, Medizinische Fakultaet Carl Gustav Carus (Germany); Jung, C.M.; Spies, H.

    2002-01-01

    {sup 99m}Tc-labelled fatty acids were synthesized according to the '3+1' mixed-ligand approach and investigated as potential tracers for myocardial SPECT diagnostics on the model of the isolated guinea pig heart. The results indicate a low but specific myocardial uptake of the {sup 99m}Tc fatty acid derivatives subject to chain length and structure. (orig.)

  1. Evaluation of branched chain fatty acid, BMIPP (. beta. -methyl-. omega. -(p-iodophenyl)-pentadecanoic acid) for the myocardial imaging. Basic experiment

    Kawamura, Yasuaki; Morishita, Takeshi; Yamazaki, Junichi and others

    1988-11-01

    Iodine-123 labeled branched chain fatty acid BMIPP (/sup ..beta../-methyl-..omega..-(p-iodophenyl)-pentadecanoic acid) was evaluated for the myocardial imaging experimentally. /sup 123/I-BMIPP was accumulated in the heart at 2 - 4 minutes after injection and retention in the heart was remarkable at 30 minutes. In the acute canine infarction model, infarcted area was recognized as a defect. Furthermore, in comparison between /sup 123/I-BMIPP and /sup 201/Tl-Cl, discrepancy between these images was recognized in the ischemic and infarcted area. BMIPP is of use in not only cardiomyopathy and hypertension, but ischemic heart desease.

  2. CMR of microvascular obstruction and hemorrhage in myocardial infarction

    Wu Katherine C

    2012-01-01

    Abstract Microvascular obstruction (MO) or no-reflow phenomenon is an established complication of coronary reperfusion therapy for acute myocardial infarction. It is increasingly recognized as a poor prognostic indicator and marker of subsequent adverse LV remodeling. Although MO can be assessed using various imaging modalities including electrocardiography, myocardial contrast echocardiography, nuclear scintigraphy, and coronary angiography, evaluation by cardiovascular magnetic resonance (C...

  3. Evaluation of the quality of the radiopharmaceutical 99mTc-MIBI and its influence on image quality in myocardial perfusion scintigraphy; Avaliacao da qualidade do radiofarmaco {sup 99m}Tc-MIBI e sua influencia na qualidade da imagem em cintilografia de perfusao do miocardio

    Santos, Poliane Angelo de Lucena

    2013-07-01

    This study evaluated the quality of the {sup 99m}Tc-MIBI radiopharmaceutical from different manufacturers, used in three nuclear medicine services (NMS) in Recife-PE, through labeling procedure of each service. It was observed their biodistribution by quantifying the activity present in the organs of interest (heart / liver), the influence and interference in image quality and in myocardial scintigraphy diagnosis exam. In these NMS (A, B and C) were done quality controls in the eluates of {sup 99}Mo/{sup 99m}Tc generators (radionuclidic, chemical and radiochemical purity and pH) and of the {sup 99m}Tc-MIBI radiopharmaceutical (radiochemical purity and pH) used in myocardial scintigraphy exam. In the case of radiochemical purity (RCP), was used the thin layer chromatography technique; after the chromatographic ran on, the plates were analyzed both in the dose calibrator, and in scintillation camera of each NMS. The radiopharmaceutical biodistribution was evaluated through the activities present in the heart and liver images in 60 patients, using the technique of combined images counting. Five nuclear physicians analyzed 24 images through myocardial perfusion visual interpretation during stress, it was verified the agreement degree among them. The results of the quality control showed that all eluate samples were in agreement with the manufacturers in relation to radionuclidic purity and pH. In relation to chemical purity, 10% of the services samples B and C showed Al{sup +3} values above 10 ppm. In the RCP, it was observed that using the scintillation camera, only 22% of the samples would be discarded, while with dose calibrator would be 78%, indicating that the scintillation camera is more sensitive in chromatographic pale analysis. For the labeled radiopharmaceutical, the services B and C presented respectively one and three samples with RCP percentage below 90%. However, C service presented the lowest medium to liver/heart proportions, showing that this factor

  4. Effects of a New Glutamic Acid Derivative on Myocardial Contractility of Stressed Animals under Conditions of Nitric Oxide Synthesis Blockade.

    Tyurenkov, I N; Perfilova, V N; Sadikova, N V; Berestovitskaya, V M; Vasil'eva, O S

    2015-07-01

    Glufimet (glutamic acid derivative) in a dose of 28.7 mg/kg limited the reduction of the cardiac functional reserve in animals subjected to 24-h stress under conditions of nonselective NO synthase blockade with L-NAME (10 mg/kg). Adrenoreactivity and increased afterload tests showed that the increment of myocardial contraction/relaxation rates, left-ventricular pressure, and HR were significantly higher in glufimet-treated stressed animals with NO synthesis blockade than in animals which received no glufimet. The efficiency of glufimet was higher than that of phenibut (the reference drug). PMID:26205724

  5. Association between beta-carotene and acute myocardial infarction depends on polyunsaturated fatty acid status. The EURAMIC Study. European Study on Antioxidants, Myocardial Infarction, and Cancer of the Breast

    Kardinaal, Alwine F; Aro, Antti; Kark, Jeremy D; Riemersma, Rudolph A; van't Veer, Pieter; Gomez-Aracena, Jorge; Kohlmeier, Lenore; Ringstad, Jetmund; Martin, Blaise C; Mazaev, Vladimir P; Delgado-Rodriguez, Miguel; Thamm, Michael; Huttunen, Jussi K; Martin-Moreno, José M; Kok, Frans J.

    1995-01-01

    Because antioxidants may play a role in the prevention of coronary heart disease by inhibiting the peroxidation of polyunsaturated fatty acids (PUFAs), the combined association of diet-derived antioxidants and PUFAs with acute myocardial infarction (MI) was investigated. This multicenter case-control study included 674 patients and 725 control subjects in eight European countries and Israel. Fatty acid composition and alpha-tocopherol and beta-carotene levels were determined in adipose tissue...

  6. Dietary Phenolic Acids of Macrotyloma uniflorum (Horse Gram) Protect the Rat Heart Against Isoproterenol-Induced Myocardial Infarction.

    Panda, Vandana; Laddha, Ankit; Nandave, Mukesh; Srinath, Sudhamani

    2016-07-01

    The present study investigates the cardioprotective activity of the Macrotyloma uniflorum seed extract (MUSE) and its phenolic acids (p-coumaric acid and ferulic acid) in isoproterenol (ISO)-induced myocardial infarction in rats. The previously mentioned phenolic acids were isolated and quantified from MUSE by HPLC. Pretreatment of gemfibrozil (reference standard), MUSE (250 and 500 mg/kg) and the phenolic acids for 30 days to rats treated with ISO (85 mg/kg) on the last 2 days resulted in a significant attenuation of the ISO-elevated levels of serum marker enzymes (aspartate aminotransferase, lactate dehydrogenase and creatine phosphokinase MB), total cholesterol, triglycerides, uric acid, C-reactive protein and malondialdehyde and a restoration of the levels of the ISO-depleted marker enzymes, reduced glutathione and the antioxidant enzymes-superoxide dismutase, catalase, glutathione peroxidase and glutathione reductase in heart. Restoration of the ISO-altered electrocardiogram pattern and haemodynamic parameters (left ventricular end diastolic pressure, heart rate, systolic, diastolic and mean arterial pressure) was also brought about by treatment with MUSE and the phenolic acids. It may be concluded that MUSE treatment to ISO-challenged rats exhibits a significant cardioprotective effect probably because of the potent antioxidant activity of its phenolic acids that salvage the myocardium from the deleterious effects of ISO. Copyright © 2016 John Wiley & Sons, Ltd. PMID:27091200

  7. Improved exercise myocardial perfusion during lidoflazine therapy

    Lidoflazine is a synthetic drug with calcium-channel blocking effects. In a study of 6 patients with severe classic angina pectoris, single-blind administration of lidoflazine was associated with improved myocardial perfusion during exercise as determined by thallium-201 stress scintigraphy. These studies demonstrate that lidoflazine therapy is associated with relief of angina, an increased physical work capacity, and improved regional myocardial perfusion during exercise

  8. Cintilografia para detecção de comprometimento miocárdico na forma indeterminada da doença de Chagas Gammagrafía para detección de compromiso miocárdico en la forma indeterminada de la enfermedad de Chagas Scintigraphy for the detection of myocardial damage in the indeterminate form of Chagas disease

    Ivana Moura Abuhid

    2010-07-01

    ón ventricular en los pacientes en la fase indeterminada de la Enfermedad de Chagas y en los controles normales, excepto en un paciente que presentó signos de disfunción ventricular en el análisis funcional en la gammagrafía miocárdica de perfusión sincronizada con el electrocardiograma (ECG. CONCLUSIÓN: Los resultados de este estudio, en el cual, pese al pequeño número de pacientes, mostraron que la gammagrafía miocárdica de reposo y esfuerzo con sestamibi-99mTc no es un método eficaz para detectar precozmente alteraciones miocárdicas en la forma indeterminada del Mal de Chagas.BACKGROUND: Non-invasive cardiological methods have been used for the identification of myocardial damage in Chagas disease. OBJECTIVE: To verify whether the rest/stress myocardial perfusion scintigraphy is able to identify early myocardial damage in the indeterminate form of Chagas disease. METHODS: Eighteen patients with the indeterminate form of Chagas Disease and the same number of normal controls, paired by sex and age, underwent rest/stress myocardial scintigraphy using sestamibi-99mTc, aiming at detecting early cardiac damage. RESULTS: The results did not show perfusion or ventricular function defects in patients at the indeterminate phase of Chagas disease and in the normal controls, except for a patient who presented signs of ventricular dysfunction in the myocardial perfusion scintigraphy with electrocardiographic gating. CONCLUSION: The results of this study, considering the small sample size, showed that the rest/stress myocardial scintigraphy using sestamibi-99mTc is not an effective method to detect early myocardial alterations in the indeterminate form of Chagas disease.

  9. Co-treatment with conjugated linoleic acid and nitrite protects against myocardial infarction

    Natia Qipshidze-Kelm

    2014-01-01

    Full Text Available According to the CDC, the most common type of heart disease is coronary artery disease, which commonly leads to myocardial infarction (MI. Therapeutic approaches to lessen the resulting cardiovascular injury associated with MI are limited. Recently, MicroRNAs (miRNAs have been shown to act as negative regulators of gene expression by inhibiting mRNA translation and/or stimulating mRNA degradation. A single miRNA can modulate physiological or disease phenotypes by regulating whole functional systems. Importantly, miRNAs can regulate cardiac function, thereby modulating heart muscle contraction, heart growth and morphogenesis. MicroRNA-499 (miRNA-499 is a cardiac-specific miRNA that when elevated causes cardiomyocyte hypertrophy, in turn preventing cardiac dysfunction during MI. Previous studies revealed that combination treatment with conjugated linoleic acid (cLA and nitrite preserved cardiovascular function in mice. Therefore, it was hypothesized that cLA and nitrite may regulate miRNA-499, thus providing cardiac protection during MI. To test this hypothesis, 12-week old mice were treated with cLA (10 mg/kg/d-via osmotic mini-pump or cLA and nitrite (50 ppm-drinking water 3 days prior to MI (ligation of the left anterior descending artery. Echocardiography and pressure–volume (PV-loop analysis revealed that cLA and nitrite-treated MI mice had improved heart function (10 days following MI compared to untreated MI mice. Treatment with cLA and nitrite significantly induced levels of miRNA-499 compared to untreated MI mice. In addition, treatment with cLA and nitrite abolished MI-induced protein expression of p53 and dynamin-related protein-1 (DRP-1. Moreover, the antioxidant enzyme expression of heme oxygenase-1 (HO-1 was elevated in MI mice treated with cLA and nitrite compared to untreated MI mice. Confocal imaging on heart tissue confirmed expression the levels of HO-1 and p53. Taken together, these results suggest that therapeutic

  10. Effects of Polyunsaturated Fatty Acid Treatment on Postdischarge Outcomes After Acute Myocardial Infarction.

    Greene, Stephen J; Temporelli, Pier Luigi; Campia, Umberto; Vaduganathan, Muthiah; Degli Esposti, Luca; Buda, Stefano; Veronesi, Chiara; Butler, Javed; Nodari, Savina

    2016-02-01

    Clinical trials studying the efficacy of n-3 polyunsaturated fatty acids (PUFA) in reducing adverse events after acute myocardial infarction (AMI) have yielded conflicting results, and data regarding the influence of n-3 PUFA treatment after AMI in routine clinical practice are scarce. We conducted a retrospective observational cohort study including patients from 5 Italian Local Health Units who were discharged from the hospital with a primary diagnosis of AMI from January 1, 2010, to December 31, 2011. Using unique patient identifiers, patients were linked across governmental hospital discharge, medication prescription, and mortality databases and followed for 12-months post-index discharge. Patient characteristics and risk of all-cause mortality and repeat AMI were compared by n-3 PUFA prescription after discharge (for outcome analyses, defined as ≥ 2 prescriptions) at a presumed dose of 1 g/day. Overall, 11,269 patients met inclusion criteria, of which 2,425 patients (21.5%) were prescribed n-3 PUFA during follow-up. Patients treated with n-3 PUFA tended to be younger, men, and carry a diagnosis of diabetes and were more likely to be receiving guideline-recommended post-AMI medical therapy, including β blockers, angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers, statins, and antiplatelet therapy (all p <0.001). After adjusting for patient characteristics and concurrent therapies, n-3 PUFA treatment was associated with reduced all-cause mortality (hazard ratio 0.76, 95% CI 0.59 to 0.97) and recurrent AMI (hazard ratio 0.65, 95% CI 0.49 to 0.87) through 12-month follow-up. In conclusion, in this large, contemporary, observational study of "real-world" Italian patients hospitalized for AMI, the use of n-3 PUFA was independently associated with a robust reduction in all-cause mortality and recurrent AMI. These data support further randomized controlled trials with n-3 PUFA therapy in the post-AMI setting. PMID:26708689

  11. Gallium-67 uptake in silent myocardial infarction: a case report

    Scintigrams obtained 24 and 48 hours after the injection of 67Ga in a patient undergoing evaluation for fever of unknown origin revealed positive myocardial uptake. The subsequent clinical course, electrocardiograms, radionuclear studies, and postmortem examination confirmed a silent myocardial infarction in the region of 67Ga localization. No other clinical reports were found of an acute myocardial infarction diagnosed by scintigraphy with 67Ga

  12. Diagnosis of myocardial involvement in patients with systemic myopathies with 15-(p-[I-123]iodophenyl) pentadecanoic acid (IPPA) SPECT

    Involvement of the myocardium in non-infectious myopathies presents in most cases as systolic dysfunction or a disturbed cardiac rhythm. We are interested in exploring how often cardiac involvement can be evaluated with various diagnostic techniques in patients with proven myopathy. We investigated 41 patients with myopathies of various etiology, including mitochondrial and congenital myopathies, Curshmann-Steinert disease, muscular dystrophy, and others. Myopathy was proven by muscular biopsy usually from the bicep. Fatty acid imaging was performed with 15-(p-[I-123]iodophenyl)pentadecanoic acid (IP-PA) and sequential SPECT-scintigraphy with a 180 deg. rotation starting at the 45 deg. RAO position. 190 MBq were injected at the maximal stage of a submaximal exercise. Filtered backprojection and reorientation of the slices were achieved by standard techniques. The quantitative comparison of the oblique slices (bulls-eye technique) of the SPECT-studies revealed turnover-rates as a qualitative measure of β-oxidation. Serum levels of lactate (L), pyruvate (P), glucose (G) and triglycerides (TG) were measured at rest and stress. Ventricular function was investigated by radionuclide ventriculography (MUGA) at rest and under stress with Tc-99m labeled red blood cells. In addition, ECG, 24 hour-ECG, and echocardiography were also performed with standard techniques

  13. Skeleton scintigraphy in trauma

    Skeletal trauma is common and presents both an opportunity and a problem in skeletal scintigraphy. The opportunity arises in the ability of skeletal scintigraphy to demonstrate abnormalities early after direct trauma. It is well recognized that the early detection of fractures in some sites cannot be reliably achieved by standard radiography, especially in the femoral neck and scaphoid bone. The problem comes in recognizing the effects of skeletal trauma when using skeletal scintigraphy for another purpose, such as the detection of metastatic disease. iatrogenic trauma to either the skeleton or soft tissues may be manifest scintigraphic ally. For example Craniotomy typically leaves a rim pattern at the surgical margin. Rib Retraction during thoracotomy can elicit periosteal reaction. Areas of the skeletal receiving curative levels of ionizing radiation (typically 4000 rads or greater) characteristically demonstrate decreased uptake within 6 months to 1 year after therapy. The generally high sensitivity of the skeletal scintigraphy seems to make it an ideal survey test in cases of suspected child abuse especially in which radiographs are unrevealing. Because of difficulties in obtaining a history of trauma from a preschool child or even eliciting a satisfactory description of the location and nature of the pain, skeletal scintigraphy provides a simple and reliable investigation in these children. Subtle trauma, such as that from stress fractures is often difficult to visualize on a plain radiograph. Skeletal scintigraphy is frequently positive at the time of clinical presentation. Skeletal scintigraphy is exquisitely sensitive to the remodeling process and typically shows abnormalities 1 to 2 weeks or more before the appearance of radiographic changes in stress fractures. The periosteal reaction can be visualized within hours of the injury. Insufficiency and fatigue fractures such as vertebral compression fracture, which is probably the most common consequence of

  14. Significance of thymic scintigraphy

    Thymic scintigraphy by 67Ga-citrate and 75Se-methionine was done on 6 cases of thymoma, and 5 cases of myasthenia gravis. Scan was positive on 5 of 6 cases of thymoma. All patients with malignant thymoma were positive. Among the 7 cases of myasthenia gravis, scintigrams revealed 2 thymomas and 1 hyperplasia on whom no thymic mass suspected. Thymic scintigraphy is useful examination when dealing with myasthenia gravis. (auth.)

  15. Poor Tc-99m dimercaptosuccinic acid uptake, re-evaluation with Tc-99m MAG3 scintigraphy in Lowe syndrome

    Koca, Gokhan; Atilgan, Hasan Ikbal; Demirel, Koray; Diri, Akif; Korkmaz, Meliha

    2011-01-01

    Tc-99m dimercaptosuccinic acid (DMSA) is filtered through the glomeruli and reabsorbed by the proximal tubules as low molecular weight proteins. In Lowe syndrome this mechanism is impaired and so poor DMSA uptake is seen. Poor DMSA uptake was shown in very few studies, but none mentioned normal Tc-99m MAG3 uptake. In this case, the patient had poor DMSA uptake, normal MAG3 uptake and a neurogenic bladder in anterior to the left kidney that attenuates left kidney.

  16. Poor Tc-99m dimercaptosuccinic acid uptake, re-evaluation with Tc-99m MAG3 scintigraphy in Lowe syndrome

    99mTc dimercaptosuccinic acid (DMSA) is filtered through the glomeruli and reabsorbed by the proximal tubules as low molecular weight proteins. In Lowe syndrome this mechanism is impaired and so poor DMSA uptake is seen. Poor DMSA uptake was shown in very few studies, but none mentioned normal 99mTc MAG3 uptake. In this case, the patient had poor DMSA uptake, normal MAG3 uptake and a neurogenic bladder in anterior to the left kidney that attenuates left kidney. (author)

  17. Poor Tc-99m dimercaptosuccinic acid uptake, re-evaluation with Tc-99m MAG3 scintigraphy in Lowe syndrome

    Koca, Gokhan; Atilgan, Hasan Ikbal; Demirel, Koray; Diri, Akif; Korkmaz, Meliha

    2011-01-01

    Tc-99m dimercaptosuccinic acid (DMSA) is filtered through the glomeruli and reabsorbed by the proximal tubules as low molecular weight proteins. In Lowe syndrome this mechanism is impaired and so poor DMSA uptake is seen. Poor DMSA uptake was shown in very few studies, but none mentioned normal Tc-99m MAG3 uptake. In this case, the patient had poor DMSA uptake, normal MAG3 uptake and a neurogenic bladder in anterior to the left kidney that attenuates left kidney. PMID:23559713

  18. Co-treatment with conjugated linoleic acid and nitrite protects against myocardial infarction ☆

    Natia Qipshidze-Kelm; Piell, Kellianne M.; Solinger, Jane C.; Cole, Marsha P.

    2013-01-01

    According to the CDC, the most common type of heart disease is coronary artery disease, which commonly leads to myocardial infarction (MI). Therapeutic approaches to lessen the resulting cardiovascular injury associated with MI are limited. Recently, MicroRNAs (miRNAs) have been shown to act as negative regulators of gene expression by inhibiting mRNA translation and/or stimulating mRNA degradation. A single miRNA can modulate physiological or disease phenotypes by regulating whole functional...

  19. Evaluation of myocardial metabolism, with 13N- and 11C-labeled amino acids and positron computed tomography

    To evaluate the utility of labeled L-amino acids (AA) for imaging regional myocardial AA metabolism by positron computed tomography (PCT), the myocardial uptake and clearance of Ala,* Glu, Gln, Asp, Leu tagged with 13N, and of 11C-tagged Asp, and oxaloacetate (Oxal), were examined in 44 experiments at control, during ischemia, and after transaminase inhibition. The myocardial time-activity curves recorded after intracoronary tracer injection had two clearance phases (an early and a late) for all 13N AA, and three (early, intermediate, late) for the two 11C compounds, with significantly different clearance half-times of 18.7 +/- 8.0 (s.d.) sec for the early phase, 141.7 +/- 56.5 sec for the intermediate, and 61.2 +/- 43.5 min for the late phase. The residual fractions ranged from 0.07 to 0.23 in normal myocardium, and consistently increased with ischemia by 0.01-0.07 for 13N-labeled Ala, Glu, Asp, and Leu, but not for 13N Gln and 11C compounds. Transaminase inhibition shortened the half-times of the late phases of 13N-labeled Ala, Glu, Asp, and Leu; had no effect on t1/2 of 13N Gln and 11C Oxal; and resulted in a loss of 11C CO2 production and of the intermediate phase for 11C Asp. On the PCT images, 13N activity from labeled Ala and Glu was not decreased in an ischemic segment despite a significant flow reduction, as demonstrated by 13N NH3 imaging and labeled microspheres. From the results, a three-compartment tracer kinetic model is proposed for the noninvasive quantification of Krebscycle activity, protein synthesis, and metabolic derangements related to ischemia

  20. Synthesis and myocardial kinetics of N-13 and C-11 labeled branched-chain L-amino acids

    Glutamate dehydrogenase (GDH), immobilized on CNBr-activated Sepharose supports, was used with N-13 ammonia to aminate α-ketoisocaproic acid (KIC), and α-ketoisovaleric acid (KIV) to produce N-13-labeled branched-chain L-amino acids with radiochemical yields ranging from 29% to 35%. From kinetic and practical cosiderations, pH 7.5 to 8.0 was established to be optimal for the synthesis of N-13-labeled branched-chain-L-amino acids. Myocardial time-activity curves in dogs at control, during low-flow ischemia, reperfusion, and after transaminase inhibition following intracoronary bolus injection of the N-13 labeled amino acids were biexponential. Higher retention of N-13 activity was observed in ischemic segments both during low-flow ischemia (29.2%) and reperfusion (23.2%) when compared with controls (20.0%), (n-4). On the other hand, transaminase inhibition decreased residue fractions from 21.0% at control to 13.9% (n=4). The residual activity with L-[1-11C]leucine allows for the calculation of protein synthesis rates

  1. Lyme myocarditis diagnosed by indium-111-antimyosin antibody scintigraphy

    Casans, I.; Villar, A.; Almenar, V.; Blanes, A.

    1989-06-01

    We report a new case of Lyme disease with cardiac manifestations, which has been possible to follow during the long period of 12 years. We have detected the usual ECG abnormalities, and concentric hypertrophic myocardiopathy, by echocardiography. The acute myocarditis was demonstrated by /sup 111/In-antimyosin scintigraphy, which showed global myocardial uptake of the tracer, constituting the first report, to our knowledge, of Lyme myocarditis diagnosed by this method.

  2. Lyme myocarditis diagnosed by indium-111-antimyosin antibody scintigraphy

    We report a new case of Lyme disease with cardiac manifestations, which has been possible to follow during the long period of 12 years. We have detected the usual ECG abnormalities, and concentric hypertrophic myocardiopathy, by echocardiography. The acute myocarditis was demonstrated by 111In-antimyosin scintigraphy, which showed global myocardial uptake of the tracer, constituting the first report, to our knowledge, of Lyme myocarditis diagnosed by this method. (orig.)

  3. Attenuation of myocardial apoptosis by alpha-lipoic acid through suppression of mitochondrial oxidative stress to reduce diabetic cardiomyopathy

    LI Chun-jun; ZHANG Qiu-mei; LI Ming-zhen; ZHANG Jing-yun; YU Pei; YU De-min

    2009-01-01

    Background Cardiac failure is a leading cause of the mortality of diabetic patients.In part this is due to a specific cardiomyopathy,referred to as diabetic cardiomyopathy.Oxidative stress is widely considered to be one of the major factors underlying the pathogenesis of the disease.This study aimed to test whether the antioxidant α-lipoic acid(α-LA)could attenuate mitochondrion-dependent myocardial apoptosis through suppression of mitochondrial oxidative stress to reduce diabetic cardiomyopathy.Methods A rat model of diabetes was induced by a single tail intravenous injection of streptozotocin(STZ)45 mg/kg.Experimental animals were randomly assigned to 3 groups:normal control(NC),diabetes(DM)and DM treated with α-LA (α-LA).The latter group was administered with α-LA(100 mg/kg ip per day),the remainder received the same volume vehicle.At weeks 4,8,and 12 after the onset of diabetes,cardiac apoptosis was examined by TUNEL assay.Cardiomyopathy was evaluated by assessment of cardiac structure and function.Oxidative damage was evaluated by the content of malondialdehyde(MDA),reduced glutathione(GSH)and the activity of manganese superoxide diamutase (Mn-SOD)in the myocardial mitochondria.Expression of caspase-9 and caspase-3 proteins was determined by immunohistochemistry and mitochondrial cytochrome c release was detected by Western blottingResults At 4,8,and 12 weeks after the onset of diabetes,significant reductions in TUNEL-positive cells,caspase-9,-3 expression,and mitochondrial cytochrome c release were observed in the α-LA group compared to the DM group.In the DM group,the content of MDA in the myocardial mitochondria was significantly increased,and there was a decrease in both the mitochondrial GSH content and the activities of Mn-SOD.They were significantly improved by α-LA treatment.HE staining displayed structural abnormalities in diabetic hearts,while α-LA reversed this structural derangement.The index of cardiac function(±dp/dtmax)in the diabetes

  4. Thallium-201 scintigraphy in diagnosis of coronary stenosis

    The sensitivity of rest and exercise thallium-201 scintigraphy for the detection of significant coronary artery disease and myocardial ischaemia was compared with rest and exercise electrocardiography in 46 patients with chest pain. Of 26 patients with greater that 70 per cent coronary stenosis, 16 had abnormal rest thallium-201 scintigrams and 13 had Q waves. Myocardial perfusion defects in the resting scintigram correlated very well with evidence of previous myocardial infarction (16 of 17 patients, 94%) significant Q waves were present in 13 of these 17 patients (76%). After exercise, abnormal thallium-201 scintigrams consistent with ischaemia were found in 21 patients (81%). Abnormal exercise electrocardiograms were present in 15 patients (58%). The combination of abnormal exercise thallium-201 scintigrams or exercise electrocardiograms (23/26, 88%) exceeded abnormal exercise electrocardiograms alone (15/26, 58%). The two procedures were thus complementary. Abnormal rest or exercise thallium-201 scintigrams were obtained in 25/26 patients (96%) compared with abnormal rest or exercise electrocardiograms in 21/26 patients (84%). Twenty patients with less than 50 per cent coronary stenosis had normal rest thallium-201 scintigrams and no Q waves. Two had abnormal exercise thallium-201 scintigrams and 7 had abnormal exercise electrocardiograms. Thus,exercise thallium scintigraphy has higher sensitivity than exercise electrocardiography in detecting exercise induced ischaemia and is more specific. Scintigraphy appears to have a higher sensitivity than electrocardiography in detecting coronary artery disease. (author)

  5. Investigation of exercise stress whole-body thallium-201 scintigraphy

    Whole-body thallium-201 scintigraphy using supine and sitting exercise stress testings were performed to study the fractional distribution of cardiac output of the influences on exercise postures and transient myocardial ischemia in sixty-two patients with ischemic heart diseases. These patients were classified into two groups with and without transient myocardial ischemia by findings of exercise thallium-201 myocardial scintigraphy recorded at the same time. The regions of interest (ROI) were drawn over the whole body and each organ (heart, lung, liver and thigh), and then, the percent distribution (%D) was calculated in each organ. The %D of heart was little affected by transient ischemia, postures and duration of exercise, and its value was kept to be nearly 5 - 6 % in any condition. The %D of lung and liver were affected by postures, duration of exercise, transient ischemia, and %D of other organs, especially thigh. The %D of thigh was affected by duration of exercise and postures. The %D of thigh showed a reverse tendency to the %D of lung and liver. We conclude that whole-body thallium-201 scintigraphy is a useful means for evaluation of blood flow distribution induced by exercise and posture change. (author)

  6. Evaluation of patients with metastatic bone lesions from breast carcinoma using whole body scintigraphy with pentavalent technetium-99m dimercaptosuccinic acid: preliminary results

    Pentavalent technetium-99m dimercaptosuccinic acid (DMSA(V)-99mTc) was designed as a tumor-seeking agent, chemically different from its analog trivalent used in renal tubular studies. This radiopharmaceutical was introduced in 1984 and has been used in oncologic application. It was proposed as a new agent for detecting metastases from breast carcinoma in 1992. Aim: To evaluate the sensibility and specificity of the scintigraphic study with DMSA(V)-99mTc in bone metastatic disease from breast carcinoma. Materials and Methods: Prospective study was done in 10 female patients, with average age of 49.8 years (42 to 73) with breast carcinoma and metastatic bone disease. All patients were submitted to whole body scanning with methylene diphosphonate-99mTc (MDP-99mTc) and DMSA(V)-99mTc. The sensibility and the specificity were calculated. Results: A total of one hundred eighty-nine bone lesions were diagnosed clinically and by follow-up, radiographic exams, scintigraphy or biopsy. The presence of 178 metastatic lesions and 11 benign lesions was detected. DMSA(V)-99mTc concentrated in 165 lesions that matched with the MDP-99mTc concentration. Only one benign lesion concentrated the DMSA(V)-99mTc and was established as a false-positive by biopsy. No concentration of DMSA(V)-99mTc was found in other 10 benign lesions that had increased uptake of MDP-99mTc. High accumulation of DMSA(V)-99mTc was observed in liver metastases on one patient with no corresponding concentration of MDP-99mTc. In this study, the use of DMSA(V)-99mTc to detect bone metastases showed 92.1% of sensibility and 90.9% of specificity. Conclusion: High sensibility and specificity to metastatic bone disease from breast carcinoma were found on scintigraphic study with DMSA(V)-99mTc. It suggests that it could be used as an adjuvant technique in scintigraphic bone evaluation in patients with breast carcinoma, improving the specificity of MDP-99mTc bone scans

  7. Studies on clinical significance of exercise-induced ST-segment depression at non-infarct-related leads in the patients with prior myocardial infarction using the stress scintigraphy

    Stress Tl-201 myocardial imaging and stress radionuclide ventriculography were performed in a total of 67 patients with prior myocardial infarction (MI) to assess the clinical significance of exercise induced ST-segment depression at non-infarct-related leads on ECG during the chronic stage. The patients consisted of 12 with inferior MI with single vessel disease (SVD) that showed no precordial ST-segment depression; 7 with inferior MI with SVD accompanied by precordial ST-segment depression; 13 with inferior MI with multivessel disease (MVD); 20 with anterior MI with SVD that showed no inferior ST-segment depression; 4 with anterior MI with SVD accompanied by inferior ST-segment depression; and 11 with anterior MI with MVD. In cases of SVD, the incidence of ST-segment depression at non-infarct-related leads was higher for inferior MI (36.8%) than anterior MI (16.7%). Myocardial imaging revealed large infarct and infarct extending into the inferoseptal wall of the left ventricle (LV) in cases of exercise induced precordial ST-segment depression; and infarct extending into the lateral wall of LV in cases of exercise induced inferior ST-segment depression. In detecting MVD, stress Tl-201 myocardial imaging was superior to exercise electrocardiography and stress radionuclide ventriculography, but this was not statistically significant. Prognostic value of error rate for detecting MVD was significantly improved with a discriminant analysis. Exercise induced ST-segment depression on ECG should be of clinical significance in reflecting myocardial ischemia around an infarcted area. (Namekawa, K)

  8. Ventilation-perfusion scintigraphy

    A historical review of different investigation methods measuring lung function (perfusion and gas exchange) is given. The principles and handling of some ventilation methods using radioxenon, radiokrypton or radiolabelled aerosols, and the injection method of xenon are explained. The clinical applicability of these studies is evaluated considering ventilation and perfusion lung defects and congestive heart failure. The combination of the three principal techniques (perfusion scintigraphy using MAA, ventilation scintigraphy using radioxenon or radiokrypton, perfusion and ventilation scientigraphy after injection of radioxenon) lead to typical patterns of differential diagnosis of perfusion defects. (TRV)

  9. Scintigraphy and thyroid nodules

    The scintigraphy indications are: definition of the functional character in the multi nodules impairments, exploration of low T.S.H. (131I irradiation-therapy, cytological selection of hypo contrasted nodules. The comparison of the 123I fixation and the T.S.H. rate allows to identify the autonomous nodules and the autoimmune nodules hyperplasia. The longitudinal surveillance of nodules (97% of benign pathology) is simplified by scintigraphy: in lack of empowerment, the T.S.H surveillance is useless, in presence of hyper functional areas, the cytology is little useful but a surveillance or an etiologic treatment are required. (IT4, 131I, or surgery). (N.C.)

  10. Bone scintigraphy for horses

    Scintigraphy (bone scan) is being used approximately since 1980 in the horse under general anaesthesia. With the construction of custom-made overhead gantries for gamma-cameras scintigraphy found widespread entry in big equine referral hospitals for bone-scanning of the standing horse. Indications for the use of a bone scan in the horse are inflammatory alterations in the locomotor apparatus. It is primarily used for diagnosis of lameness of unknown origin, suspect of stress fracture or hairline fracture and for horses with bad riding comfort with suspected painful lesions in the spine. (orig.)

  11. Synthesis and preliminary evaluation of 18F-labeled 4-thia palmitate as a PET tracer of myocardial fatty acid oxidation

    Interest remains strong for the development of a noninvasive technique for assessment of regional fatty acid oxidation rate in the myocardium. 18F-labeled 4-thia palmitate (FTP, 16-[18F]fluoro-4-thia-hexadecanoic acid) has been synthesized and preliminarily evaluated as a metabolically trapped probe of myocardial fatty acid oxidation for positron emission tomography (PET). The radiotracer is synthesized by Kryptofix 2.2.2/K2CO3 assisted nucleophilic radiofluorination of an iodo-ester precursor, followed by alkaline hydrolysis and by purification by reverse phase high performance liquid chromatography. Biodistribution studies in rats showed high uptake and long retention of FTP in heart, liver, and kidneys consistent with relatively high fatty acid oxidation rates in these tissues. Inhibition of carnitine palmitoyl-transferase-I caused an 80% reduction in myocardial uptake, suggesting the dependence of trapping on the transport of tracer into the mitochondrion. Experiments with perfused rat hearts showed that the estimates of the fractional metabolic trapping rate (FR) of FTP tracked inhibition of oxidation rate of palmitate with hypoxia, whereas the FR of the 6-thia analog 17-[18F]fluoro-6-thia-heptadecanoic acid was insensitive to hypoxia. In vivo defluorination of FTP in the rat was evidenced by bone uptake of radioactivity. A PET imaging study with FTP in normal swine showed excellent myocardial images, prolonged myocardial retention, and no bone uptake of radioactivity up to 3 h, the last finding suggesting a species dependence for defluorination of the omega-labeled fatty acid. The results support further investigation of FTP as a potential PET tracer for assessing regional fatty acid oxidation rate in the human myocardium

  12. Synthesis and preliminary evaluation of {sup 18}F-labeled 4-thia palmitate as a PET tracer of myocardial fatty acid oxidation

    DeGrado, Timothy R. E-mail: trd@petsparc.mc.duke.edu; Wang Shuyan; Holden, James E.; Nickles, R. Jerome; Taylor, Michael; Stone, Charles K

    2000-04-01

    Interest remains strong for the development of a noninvasive technique for assessment of regional fatty acid oxidation rate in the myocardium. {sup 18}F-labeled 4-thia palmitate (FTP, 16-[{sup 18}F]fluoro-4-thia-hexadecanoic acid) has been synthesized and preliminarily evaluated as a metabolically trapped probe of myocardial fatty acid oxidation for positron emission tomography (PET). The radiotracer is synthesized by Kryptofix 2.2.2/K{sub 2}CO{sub 3} assisted nucleophilic radiofluorination of an iodo-ester precursor, followed by alkaline hydrolysis and by purification by reverse phase high performance liquid chromatography. Biodistribution studies in rats showed high uptake and long retention of FTP in heart, liver, and kidneys consistent with relatively high fatty acid oxidation rates in these tissues. Inhibition of carnitine palmitoyl-transferase-I caused an 80% reduction in myocardial uptake, suggesting the dependence of trapping on the transport of tracer into the mitochondrion. Experiments with perfused rat hearts showed that the estimates of the fractional metabolic trapping rate (FR) of FTP tracked inhibition of oxidation rate of palmitate with hypoxia, whereas the FR of the 6-thia analog 17-[{sup 18}F]fluoro-6-thia-heptadecanoic acid was insensitive to hypoxia. In vivo defluorination of FTP in the rat was evidenced by bone uptake of radioactivity. A PET imaging study with FTP in normal swine showed excellent myocardial images, prolonged myocardial retention, and no bone uptake of radioactivity up to 3 h, the last finding suggesting a species dependence for defluorination of the omega-labeled fatty acid. The results support further investigation of FTP as a potential PET tracer for assessing regional fatty acid oxidation rate in the human myocardium.

  13. Synthesis and evaluation of a tridentate Tc-99m labeled long chain fatty acid analog for myocardial imaging

    Long chain fatty acids serve as the main energy source for the myocardium. As an effort to develop Tc-99m labeled long chain fatty acid analogs due to ideal physical properties and ready availability of Tc-99m, we synthesized and evaluated a tridentate Tc-99m tricarbonyl-N2O-pentadecanoic acid ([Tc-99m]) as a novel radiotracer for myocardial imaging. The pyridinyl precursor of methyl pentadecanoate was prepared in high yield and reacted with [Tc-99m(CO)3(H2O)3]+ at 75 .deg. for 30 min, followed by hydrolysis in 0.4 N NaOH-MeOH. The resulting [Tc-99m] was purified by HPLC and redissolved in 5% ethanol-saline containing 5% bovine serum albumin. In vitro stability of [Tc-99m] was measured in human serum at 37 .deg. for 12 h using radio-TLC. Dynamic images were obtained in SD rats using a gamma camera. Re standard was synthesized as the synthesis of [Tc-99m] using [(NEt4)2[Re(CO)3CI3]. [Tc-99m] was synthesized in 70-78% radiochemical yield and with radiochemical purity higher than 98%. Re counterpart was used to identify the Tc-99m labeled fatty acid analog. [Tc-99m] was shown to be stable (>98%) over 12 h when incubated in human serum. Dynamic images showed rapid accumulation of the radioactivity in the liver, the heart. and the kidneys. ROIs were drawn in the liver and the heart, and their count/pixel ratios were obtained as 2.2:1, 7.5:1, and 16.5:1 at 1, 2 and 5 min postinjection, respectively. There was no significant uptake in the thyroid or salivary gland, indicating that Tc-99m pertechnetate was not regenerated during the time of the study. The results demonstrated that [Tc-99m] may be useful for myocardial imaging. Further studies are warranted to perform tissue distribution of [Tc-99m] in mice

  14. Evaluation of the metabolism in rat hearts of two new radioiodinated 3-methyl-branched fatty acid myocardial imaging agents

    The biological fate of two new radioiodinated 3-methyl-branched fatty acids has been evaluated in rat hearts following intravenous administration. Methyl-branching was introduced in [15-(p-iodophenyl)-3-R,S-methylpentadecanoic acid (BMIPP) and 15-(p-iodophenyl)-3,3-dimethylpentadecanoic acid (DMIPP) to inhibit β-oxidation. The goals of these studies were to correlate the effects of methyl-branching on the incorporation of these agents into the various fatty acid pools and subcellular distribution profiles, and to relate these data to the myocardial retention properties. The properties of BMIPP and DMIPP were compared with the 15-(p-iodophenyl)pentadecanoic acid straight-chain analogue (IPP). Differences in the heart retention of the analogues after intravenous administration in rats correlated with differences observed in subcellular distribution patterns. The dimethyl DMIPP analogue showed the longest retention and the highest association with the mitochondrial and microsomal fractions (34%, 38%) 30 min after injection. These data are in contrast to the rapid clearance of the straight-chain IPP analogue which showed much lower relative association with the mitochondria and microsomes (18%, 15%). The distribution patterns of each analogue in the various lipid pools appeared consistent with the expected capacity of the analogues to be metabolized by β-oxidation. In contrast to the rapid oxidation of the straight-chain IPP analogue, the 3-monomethyl BMIPP analogue appeared to undergo slower oxidation and clearance, whereas the dimethyl-branched DMIPP analogue was apparatently not catabolized by the myocardium. All three analogues showed some incorporation into triglycerides. The metabolism patterns of the branched analogues reported here may provide useful information in the description of the mechanisms by which BMIPP and DMIPP are retained in rat myocardium. (orig.)

  15. Effects of substrate availability and acute ischemia on regional myocardial metabolism demonstrated noninvasively with F-18 deoxyglucose, C-11 palmitic acid and positron computed tomography

    The results indicate that both, F-18 deoxyglucose and C-11 palmitic acid accurately trace different aspects of myocardial metabolism and their changes induced by altered substrate availability and by reduced oxygen supply. Through the pattern of tissue clearance of C-11 palmitic acid, the metabolic fate of Free fatty acids (FFA) can be assessed. Size and turnover rate of the early phase indicate the fraction of C-11 palmitic acid entering immediate oxidation and the rate of oxidation, yet the absence of such a phase does not indicate a metabolic abnormality but merely a shift in myocardial sustrate utilization from FFA to glucose or lactic acid. The normal variability is no longer present when oxygen supply is limited as for example in acute ischemia and this restriction in substrate utilization can be demonstrated with positron computed tomography (PCT). Not only is FFA uptake reduced in proportion to blood flow, but the fraction entering the oxidative pool and its turnover rate are depressed. The regional shift to glucose utilization in acute ischemia is also demonstrated noninvasively by FDG uptake in excess of blood flow and oxygen supply. These studies from the basis for evaluating alternate substrate utilization and tissue viability in myocardial disease

  16. 99Tcm-MIBI hepatobiliary scintigraphy in peadiatric patients with severe cholestatic infant hepatitis syndrome

    Objective: Because of the limited of 99Tcm-diethyl iminodiacetic acid (99Tcm-EHIDA) hepatobiliary scintigraphy in the diagnosis of severe cholestatic infant hepatitis syndrome, trial use 99Tcm-methoxy isobutyl isonitrile (99Tcm-MIBI) as a new hepatobiliary scintigraphy imaging agent to understand its applied basis and primary evaluate value in diagnosis of severe cholestatic infant hepatitis syndrome. Methods: constructed choledochal atresia animal model and investigated the application basis of 99Tcm-MIBI hepatobiliary scintigraphy. Twenty-seven children patients of severe cholestatic who finally confirmed infant hepatitis syndrome were underwent firstly 99Tcm-EHIDIA hepatobiliary scintigraphy. After 24 h delay imaging next day, 99Tcm-MIBI hepatobiliary scintigraphy was underwent after 1 h. Two imaging agents of value in the diagnosis of severe cholestatic infant hepatitis syndrome were compared. Results: It was proved that 99Tcm-MIBI was surely excreted by hepatobiliary and had no intestinal autocrine phenomenon in animal test. So 99Tcm-MIBI can be used to undergo hepatobiliary scintigraphy. The sensitivity of 99Tcm-MIBI hepatobiliary scintigraphy in the diagnosis of severe cholestatic infant hepatitis syndrome was 100% in our primary clinical study. Its sensitivity was higher than which of 99Tcm-EHIDA hepatobiliary scintigraphy (66.67%) by far. Conclusion: With regard to those children patients who suspected highly severe cholestatic infant hepatitis syndrome in clinical, the sensitivity of 99Tcm-MIBI hepatobiliary scintigraphy is obviously superior to conventional 99Tcm-EHIDA hepatobiliary scintigraphy. (authors)

  17. Uso da cintilografia miocárdica em repouso durante dor torácica para descartar infarto agudo do miocárdio Utilización de la centellografía miocárdica en reposo durante dolor torácico para descartar infarto agudo de miocardio Use of resting myocardial scintigraphy during chest pain to exclude diagnosis of acute myocardial infarction

    Gustavo Borges Barbirato

    2009-04-01

    miocardio. MÉTODOS: Un total de 108 pacientes ingresados con dolor torácico, o hasta tras 4 horas del término de los síntomas, con electrocardiograma no diagnostico, realizaron centellografía en reposo y dosificaciones de troponina I. No se excluyeron a los pacientes con pasado de infarto de miocardio (IM (24 pacientes. Se dosificó troponina I al ingreso y tras 6 horas del ingreso. Médicos nucleares realizaron análisis ciego de las imágenes. Se confirmó infarto de miocardio, con elevación de la troponina I mayor que tres veces el control. RESULTADOS: La imagen de perfusión en reposo se mostró anormal en todos los seis pacientes con IM. Sólo un paciente presentó imagen normal y elevación de la troponina. Otros 55 pacientes obtuvieron imagen positiva sin IM y 46 pacientes presentaron imágenes y troponinas normales. La prevalencia de la enfermedad fue de un 6,5%. Fue de un 85,7% la sensibilidad de la imagen de reposo durante dolor torácico para la evidencia de IM, y la especificidad de un 45,5%. El valor predictivo negativo fue de un 97,7%. CONCLUSIÓN: Pacientes sometidos al protocolo de dolor torácico con centellografía de perfusión miocárdica demostraron un excelente valor predictivo negativo para la exclusión del diagnóstico de infarto de miocardio. Estos resultados sugieren que la imagen de perfusión en reposo es una herramienta importante en la unidad de dolor torácico.BACKGROUND: Images of myocardial perfusion taken during an episode of chest pain have been used for patients in the emergency department. OBJECTIVE: To evaluate the operating characteristics of 99mTc-Tetrofosmin scintigraphy during an episode of chest pain to exclude the diagnosis of acute myocardial infarction. METHODS: One hundred and eight patients admitted with chest pain, or up to four hours after the end of symptoms and nondiagnostic electrocardiogram, underwent resting scintigraphy and measurement of troponin I concentrations. Patients with a history of myocardial

  18. A clinical study of thallium-201 scintigraphy in hypertensive patients with and without left ventricular hypertrophy

    Objective: Based on coronary angiography, thallium-201 myocardial scintigraphy was evaluated in hypertensive patients with and without left ventricular hypertrophy, and the causes of its perfusion abnormalities were discussed. Methods: Thallium-201 myocardial scintigraphy was performed on 85 patients with clinically suspected coronary artery disease. Coronary angiography was performed on patients with perfusion abnormalities in one month after scintigraphy. Results: The rate of 201Tl perfusion abnormalities in hypertensive patients with hypertrophy (85.7%) was higher than normal blood pressure (39.3%, P201Tl perfusion abnormalities occur in hypertensive patients with hypertrophy. The perfusion abnormalities may be caused not only by coronary large vessel disease, but also by coronary microvascular disease

  19. Relation Between Red Blood Cell Omega-3 Fatty Acid Index and Bleeding During Acute Myocardial Infarction

    Salisbury, Adam C.; Harris, William S.; Amin, Amit P.; Reid, Kimberly J.; O’Keefe, James H; Spertus, John A.

    2011-01-01

    Omega-3 fatty acids have multiple cardiovascular benefits, but may also inhibit platelet aggregation and increase bleeding risk. If this platelet inhibition is clinically meaningful, patients with the highest omega-3 indices (red blood cell eicosapentaenoic [EPA] plus docosahexaenoic acid [DHA]), which reflect long-term omega-3 fatty acid intake, should be at the greatest bleeding risk. We studied 1,523 patients from 24 US centers who had their omega-3 index assessed at the time of AMI. The r...

  20. THYROID HORMONE REVERSES AGING-INDUCED MYOCARDIAL FATTY ACID OXIDATION DEFECTS AND IMPROVES THE RESPONSE TO ACUTELY INCREASED AFTERLOAD

    Ledee, Dolena; Portman, Michael A.; Kajimoto, Masaki; Isern, Nancy G.; Olson, Aaron

    2013-06-07

    Background: Subclinical hypothyroidism occurs during aging in humans and mice and may contribute to development of heart failure. Aging also impairs myocardial fatty acid oxidation, causing increased reliance on flux through pyruvate dehydrogenase (PDH) to maintain function. We hypothesize that the metabolic changes in aged hearts make them less tolerant to acutely increased work and that thyroid hormone reverses these defects. Methods: Studies were performed on young (Young, 4-6 months) and aged (Old, 22-24 months) C57/BL6 mice at standard (50 mmHg) and high afterload (80 mmHg). Another aged group received thyroid hormone for 3 weeks (Old-TH, high afterload only). Function was measured in isolated working hearts along with substrate fractional contributions (Fc) to the citric acid cycle (CAC) using perfusate with 13C labeled lactate, pyruvate, glucose and unlabeled palmitate and insulin. Results: Cardiac function was similar between Young and Old mice at standard afterload. Palmitate Fc was reduced but no individual carbohydrate contributions differed. CAC and individual substrate fluxes decreased in aged. At high afterload, -dP/dT was decreased in Old versus Young. Similar to low afterload, palmitate Fc was decreased in Old. Thyroid hormone reversed aging-induced changes in palmitate Fc and flux while significantly improving cardiac function. Conclusion: The aged heart shows diminished ability to increase cardiac work due to substrate limitations, primarily impaired fatty acid oxidation. The heart accommodates slightly by increasing efficiency through oxidation of carbohydrate substrates. Thyroid hormone supplementation in aged mice significantly improves cardiac function potentially through restoration of fatty acid oxidation.

  1. Relationship between late ventricular potentials and myocardial {sup 123}I-metaiodobenzylguanidine scintigraphy in patients with dilated cardiomyopathy with mild to moderate heart failure: results of a prospective study of sudden death events

    Kasama, Shu [Gunma University Graduate School of Medicine, Department of Medicine and Biological Science (Cardiovascular Medicine), Gunma (Japan); Cardiovascular Hospital of Central Japan (Kitakanto Cardiovascular Hospital), Department of Cardiovascular Medicine, Gunma (Japan); Toyama, Takuji; Kaneko, Yoshiaki; Kurabayashi, Masahiko [Gunma University Graduate School of Medicine, Department of Medicine and Biological Science (Cardiovascular Medicine), Gunma (Japan); Iwasaki, Toshiya; Sumino, Hiroyuki; Kumakura, Hisao; Minami, Kazutomo; Ichikawa, Shuichi [Cardiovascular Hospital of Central Japan (Kitakanto Cardiovascular Hospital), Department of Cardiovascular Medicine, Gunma (Japan); Matsumoto, Naoya [Nihon University School of Medicine, Department of Cardiology, Tokyo (Japan); Sato, Yuichi [Health Park Clinic, Department of Imaging, Gunma (Japan)

    2012-06-15

    Late ventricular potentials (LPs) are considered to be useful for identifying patients with heart failure at risk of developing ventricular arrhythmias. {sup 123}I-metaiodobenzylguanidine (MIBG) scintigraphy, which is used to evaluate cardiac sympathetic activity, has demonstrated cardiac sympathetic denervation in patients with malignant ventricular tachyarrhythmias. This study was undertaken to clarify the relationship between LPs and {sup 123}I-MIBG scintigraphy findings in patients with dilated cardiomyopathy (DCM). A total of 56 patients with DCM were divided into an LP-positive group (n = 24) and an LP-negative group (n = 32). During the compensated period, the delayed heart/mediastinum count (H/M) ratio, delayed total defect score (TDS), and washout rate (WR) were determined from {sup 123}I-MIBG images and plasma brain natriuretic peptide (BNP) concentrations were measured. Left ventricular end-diastolic volume (LVEDV), left ventricular end-systolic volume (LVESV), and left ventricular ejection fraction (LVEF) were simultaneously determined by echocardiography. LVEDV, LVESV, LVEF and plasma BNP concentrations were similar in the two groups. However, TDS was significantly higher (35 {+-} 8 vs. 28 {+-} 6, p < 0.005), the H/M ratio was significantly lower (1.57 {+-} 0.23 vs. 1.78 {+-} 0.20, p < 0.005), and the WR was significantly higher (60 {+-} 14% vs. 46 {+-} 12%, p < 0.001) in the LP-positive than in the LP-negative group. The average follow-up time was 4.5 years, and there were nine sudden deaths among the 56 patients (16.1%). In logistic regression analysis, the incidences of sudden death events were similar in those LP-negative with WR <50%, LP-negative with WR {>=}50% and LP-positive with WR <50% (0%, 10.0% and 14.3%, respectively), but was significantly higher (41.2%) in those LP-positive with WR {>=}50% (p < 0.01, p < 0.05, and p < 0.05, respectively). The present study demonstrated that the values of cardiac {sup 123}I-MIBG scintigraphic parameters

  2. Bone scintigraphy of decompression sickness

    Value of bone scintigraphy in decompression sickness of 42 patients was retrospectively evaluated. Bone scintigraphy was positive in 30 of 42 patients (83 lesions), while radiography and symptoms were positive in 23 patients (48 lesions), and in 29 patients (44 lesions) respectively. Bone scintigraphy was positive in many lesions with negative radiography or symptoms. However, approximately half of the lesions in which either radiography or symptoms was positive could not be detected by bone scintigraphy. These cases mostly showed radiographic abnormalities such as irregular calcified areas and ''bone island'' in the cervical regions of the humerus, femur and tibia. Both bone scintigraphy and radiography were positive in most of the patients with symptoms of the bends and there seems to be a close relationship between the bends symptoms and bone lesion. We concluded that bone scintigraphy is useful for the evaluation of decompression sickness, but it must be complemented by bone radiography to avoid a significant number of false negative cases. (author)

  3. Kinetics of /sup 13/N-ammonia uptake in myocardial single cells indicating potential limitations in its applicability as a marker of myocardial blood flow

    Rauch, B.; Helus, F.; Grunze, M.; Braunwell, E.; Mall, G.; Hasselbach, W.; Kuebler, W.

    1985-02-01

    To study kinetics and principles of cellular uptake of /sup 13/N-ammonia, a marker of coronary perfusion in myocardial scintigraphy, heart muscle cells of adult rats were isolated by perfusion with collagenase and hyaluronidase. Net uptake of /sup 13/N, measured by flow dialysis, reached equilibrium within 20 sec in the presence of sodium bicarbonate and carbon dioxide (pH 7.4, 37 degrees C). Total extraction, 80 sec after the reaction start, was 786 +/- 159 mumol/ml cell volume. Cells destroyed by calcium overload were unable to extract /sup 13/N-ammonia. Omission of bicarbonate and carbon dioxide reduced total extraction to 36% of control. /sup 13/N-Ammonia uptake could also be reduced by 50 muM 4,4' diisothiocyanostilbene 2,2' disulfonic acid, by 100 micrograms/ml 1-methionine sulfoximine, and by preincubation with 5 muM free oleic acid. These results indicate that in addition to metabolic trapping by glutamine synthetase, the extraction of /sup 13/N-ammonia by myocardial cells is influenced by cell membrane integrity, intracellular-extracellular pH gradient, and possibly an anion exchange system for bicarbonate. For this reason, the uptake of /sup 13/N-ammonia may not always provide a valid measurement of myocardial perfusion.

  4. Effect of dietary omega-3 fatty acids on the heart rate and the heart rate variability responses to myocardial ischemia or submaximal exercise

    George E Billman; William S. Harris

    2011-01-01

    The consumption of omega-3 polyunsaturated fatty acids (n-3 PUFAs) has been reported to decrease resting heart rate (HR) and increase heart rate variability (HRV). However, the effects of n-3 PUFAs on these variables in response to a physiological stress (e.g., exercise or acute myocardial ischemia), particularly in postmyocardial infarction (MI) patients, are unknown. Therefore, HR and HRV (high frequency and total R-R interval variability) were evaluated at rest, during submaximal exercise,...

  5. Early diagnosis of interferon-induced myocardial disorder in patients with chronic hepatitis C. Evaluation by myocardial imaging with 123I-BMIPP

    Interferon (IFN) therapy for chronic hepatitis C is sometimes associated with cardiac complications. In the present study, we performed myocardial imaging with 123I-labeled β-methyl-p-iodophenylpentadecanoic acid (123I-BMIPP) in order to evaluate myocardial disorders caused by IFN. We studied 40 healthy subjects (H group) and 25 patients with chronic hepatitis C who had been treated with IFN (IFN group). A Holter electrocardiogram (ECG) was performed and the autonomic nervous function was assessed by analyzing the spectral variability and 1/f fluctuation of heart rate. Myocardial planner imaging with 123I-BMIPP was performed to obtain the time activity curve for 20 min immediately after administration of 123I-BMIPP (dynamic study). Early and delayed myocardial single photon emission computed tomography (SPECT) images were expressed as Bull's eyes and the myocardium was divided into four segments to calculate the washout rate for each segment on early and late SPECT images (early and late SPECT study). No significant differences in autonomic nervous function were observed between the two groups in heart rate variability. In a dynamic study, the reduction rate from the time activity curve was significantly higher in the IFN group compared with the H group (reduction rate, IFN group, 5.3±3.7% vs H group, 1.2±3.3%; P123I-BMIPP myocardial scintigraphy examination several months after IFN therapy. These results indicate that metabolic disorders of fatty acids caused by IFN therapy can be detected before abnormalities are observed by Holter-ECG or echocardiography. (author)

  6. Tellurium-123m-labeled isosteres of palmitoleic and oleic acids show high myocardial uptake

    These studies were directed at determining if the telluro fatty acids prepared by the isosteric replacement of the Δ9-double bonds of oleic and palmitoleic acids with /sup 123m/Te would show heart uptake in rats. The isostere of palmitoleic acid, 9-tellurapentadecanoic acid(II), was prepared by basic hydrolysis of the product formed by the coupling of /sup 123m/Te-sodium hexyl tellurol with methyl-8-bromooctadecanoate. Similarly, the isostere of oleic acid, 9-telluraheptadecanoic acid(IV), was prepared by the same route beginning with the reaction of /sup 123m/Te-sodium octyl tellurol with methyl-8-bromooctadecanoate. Both /sup 123m/Te-(II) and /sup 123m/Te-(IV) showed remarkably high heart uptake in rats (2 to 3% dose/gm) ten minutes after intravenous administration, and the heart/blood ratios were high (20-30/1). Finally, the hearts of rats injected with /sup 123m/Te-(IV) have been clearly imaged with a rectilinear scanner

  7. Myocardial enhancement on magnetic resonance imaging with gadolinium-diethylenetriamine pentaacetic acid and improvement of left ventricular function in patients with dilated cardiomyopathy

    This study evaluated the significance of myocardial gadolinium-diethylenetriamine pentaacetic acid (Gd-DTPA) enhancement on magnetic resonance imaging for the improvement of left ventricular function in patients with dilated cardiomyopathy. Twenty-seven patients with dilated cardiomyopathy (mean age 59±11 years) were studied. The magnitude of myocardial Gd-DTPA enhancement was quantitatively assessed using signal intensity ratio and compared to changes in left ventricular function and adverse cardiac events during a relatively long follow-up period. Regional high signal intensity ratio, defined as ≥mean+2SD in seven normal subjects, was found in 14 patients: in three or more regions out of five myocardial regions analyzed in six patients (extensive enhancement) and in only one or two regions in eight patients (limited enhancement). The remaining 13 patients had no high signal ratio in any of the five regions analyzed (no enhancement). During the follow-up period of 3.9±1.9 years, four patients died of cardiac causes. The incidence of cardiac death was 33.3% in patients with extensive enhancement, 12.5% in those with limited enhancement and 7.7% in those without enhancement, but there was no statistical difference. Mild improvement in fractional shortening was observed in patients without enhancement during the follow-up (19±4%→27±10%, p=0.03). Evaluation of myocardial Gd-DTPA enhancement on magnetic resonance imaging may provide useful prognostic information for patients with dilated cardiomyopathy. (author)

  8. Nuclear cardiological investigations in patients classified as physically disabled following myocardial infarction

    110 patients classified as physically disabled as a consequence of myocardial infarction were reinvestigated by means of nuclear cardiological methods. Resting 201Tl perfusion scintigraphy showed a normal distribution of radioactivity, while radionuclide ventriculography revealed a normal left ventricular ejection fraction and a normokinetic left ventricle in 20 patients. The investigation of a further 19 patients demonstrated only minimal pathological changes. The results in 34 patients revealed severe myocardial damage, and in a further 19 cases the development of left ventricular aneurysm. The results clearly show the value of 201Tl scintigraphy and radionuclide ventriculography in assessments of the degree of physical disability after myocardial infarction. (author) 15 refs.; 3 tabs

  9. Contemporary adrenal scintigraphy

    High-resolution computed tomography (CT) and magnetic resonance (MR) imaging have replaced scintigraphy as primary imaging modalities for the evaluation of adrenal diseases. Thin-slice CT, CT contrast washout studies and MR pulse sequences specifically designed to identify adrenal lipid content have radically changed the approach to anatomic imaging and provide unique insight into the physical characteristics of the adrenals. With a confirmed biochemical diagnosis, further evaluation is often unnecessary, especially in diagnostic localization of diseases of the adrenal cortex. However, despite the exquisite detail afforded by anatomy-based imaging, there are not infrequently clinical situations in which the functional insight provided by scintigraphy is crucial to identify adrenal dysfunction and to assist in localization of adrenocortical and adrenomedullary disease. The introduction of hybrid PET/CT and SPECT/CT, modalities that directly integrate anatomic and functional information, redefine the radiotracer principle in the larger context of high-resolution anatomic imaging. Instead of becoming obsolete, scintigraphy is an element of a device that combines it with CT or MR to allow a direct correlation between function and anatomy, whereby the combination creates a more powerful diagnostic tool than the separate component modalities. (orig.)

  10. Selective coronary scintigraphy

    Isotopic techniques occupy a leading place amongst examinations practicable on coronary patients because of their reliability and the safety and simplicity of their use. The present work reviews the possible applications of selective coronary scintigraphy in pathology. After a brief discussion on scintigraphy, isotopic techniques for myocardium research, coronarography and other methods to study local myocardium perfusion the theoretical bases for the use of the exploration are studied, the techniques and methods employed are reported and the results discussed. Coronary scintigraphy consists of selective injection in the two coronary arteries previously catheterized during a coronarography, of two different populations of microspheres labelled with two physically short-lived indicators: 15μ 99m Tc-labelled serumalbumin microspheres, 10 to 15μ In-labelled siderophiline microspheres. Various studies have shown the complete harmlessness of the exploration when certain precautions are taken regarding the size and number of the spheres. The microspheres disperse into the downstream arterial territory proportionally to the number of capillaries present in the different parts of the irrigated region, and are temporarily stopped in the precapillaries. The preparation of the different images needed to interpret the Face and OAG examination for the left coronary, then for the right coronary, is carried out at the end of the coronarography and lasts about 45 minutes. It is also possible by selective injection in the aorta-coronary bridges to judge their functional condition by observation of the regions they irrigate. 56 patients of the Necker hospital cardiological clinic have been examined

  11. Bone scintigraphy in psoriasis

    Hahn, K.; Thiers, G.; Eissner, D.; Holzmann, H.

    1980-08-01

    Since 1973 bone scintigraphy using sup(99m)Tc-phosphate-complexes was carried out in 382 patients with psoriasis. For comparison with the results of nuclear medicine, roentgenologic and clinical findings a group af 121 patients with psoriasis aged between 11 and 74 years was compared to a group of 42 patients aged between 20 and 49 years without roentgenologic and clinical signs of psoriasis arthritis. We found by means of isotope investigation that an essentially greater part of the bones adjacent to the joints was involved than was expected according to X-ray and clinical findings. In addition, in 205 patients with psoriasis whole-body scintigraphy, using sup(99m)Tc-MDP, was carried out since 1977/78. In 17 patients we found an increased accumulation of activity in the region of extraarticular structures of the skull as well as of the skeletal thorax. According to these results we conclude that in addition to the clinically and roentgenologically defined psoriatic arthritis in patients with psoriasis an osteopathy may exist, which can only be demonstrated by skeletal scintigraphy and which is localized in bones adjacent to the joints but can also be demonstrated in the region of extraarticular bones.

  12. Bone scintigraphy in psoriasis

    Since 1973 bone scintigraphy using sup(99m)Tc-phosphate-complexes was carried out in 382 patients with psoriasis. For comparison with the results of nuclear medicine, roentgenologic and clinical findings a group af 121 patients with psoriasis aged between 11 and 74 years was compared to a group of 42 patients aged between 20 and 49 years without roentgenologic and clinical signs of psoriasis arthritis. We found by means of isotope investigation that an essentially greater part of the bones adjacent to the joints was involved than was expected according to X-ray and clinical findings. In addition, in 205 patients with psoriasis whole-body scintigraphy, using sup(99m)Tc-MDP, was carried out since 1977/78. In 17 patients we found an increased accumulation of activity in the region of extraarticular structures of the skull as well as of the skeletal thorax. According to these results we conclude that in addition to the clinically and roentgenologically defined psoriatic arthritis in patients with psoriasis an osteopathy may exist, which can only be demonstrated by skeletal scintigraphy and which is localized in bones adjacent to the joints but can also be demonstrated in the region of extraarticular bones. (orig.)

  13. Prevalência de fatores de risco coronarianos e alterações da perfusão miocárdica à cintilografia em pacientes diabéticos assintomáticos ambulatoriais Prevalence of coronary risk factors and myocardial perfusion scintigraphy abnormalities in asymptomatic diabetic outpatients

    Francisco das Chagas Monteiro Júnior

    2007-11-01

    Full Text Available OBJETIVO: Determinar a prevalência de fatores de risco (FR para doença arterial coronariana (DAC e isquemia miocárdica em uma amostra de diabéticos assintomáticos atendidos ambulatorialmente. MÉTODOS: De 80 diabéticos tipo 2 inicialmente recrutados no ambulatório de endocrinologia do nosso Hospital Universitário, sem sintomas e/ou diagnóstico de DAC, apenas 61 completaram o protocolo da pesquisa, sendo 52,5% do sexo feminino, com uma média de idade de 56,3±10,9anos. Os pacientes foram submetidos a entrevista procurando-se identificar os FR e à realização de eletrocardiograma, ecocardiograma e cintilografia miocárdica perfusional (CMP, em repouso e sob estresse. De acordo com o resultado da CMP, foram distribuídos em dois grupos: um isquêmico e outro normal. RESULTADOS: Os FR identificados foram: sexo masculino (48%, idade > 55 anos (51%, história familiar de doença aterosclerótica precoce (16%, passado de tabagismo (46%, hipertensão arterial (44%, sedentarismo (62%, sobrepeso / obesidade (67%, HDL-colesterol 100 mg/dl (85% e triglicérides > 150 mg/dl (54%. A CMP foi positiva para isquemia em 15% dos pacientes. As variáveis associadas a esse diagnóstico foram sexo masculino (p=0,007, HDL baixo (p=0,046, história de tabagismo (p=0,038, hipertrofia ventricular esquerda (HVE (p=0,043 e fração de ejeção do ventrículo esquerdo (FEVE OBJECTIVE: To determine the prevalence of coronary artery disease (CAD risk factors (RF and myocardial ischemia in a sample of asymptomatic diabetic patients treated on an outpatient basis. METHODS: From 80 type 2 diabetic patients initially recruited at an university outpatient endocrinology clinic, with no symptoms and/or CAD diagnosis, only 61 patients completed the study protocol, being 52,5% females, with a mean age of 56.3 ± 10.9 years. The patients were interviewed searching for RF and underwent electrocardiogram, echocardiogram and perfusional myocardial scintigraphy (PMS at rest and

  14. Development of a new technic for breast attenuation correction in myocardial perfusion scintigraphy using computational methods; Desenvolvimento de uma nova tecnica para correcao da atenuacao por tecidos moles em cintilografia de perfusao miocardica utilizando metodos computacionais

    Oliveira, Anderson de

    2015-07-01

    Introduction: One of the limitations of nuclear medicine studies are false-positive results that lead to unnecessary exams and procedures associated to morbidity and costs to the individual and society. One of the most frequent causes for reducing the specificity of myocardial perfusion imaging (MPI) is photon attenuation, especially by breast in women. Objective: To develop a new technique to compensate the photon attenuation by women breasts in myocardial perfusion imaging with {sup 99m}Tc-sestamibi, using computational methods. Materials and methods: A procedure was proposed which integrates Monte Carlo simulation, computational methods and experimental techniques. Initially, were obtained the chest attenuation correction percentages using a phantom Jaszczak and breast attenuation percentages by Monte Carlo simulation method, using the EGS4 program. The percentages of attenuation correction were linked to individual patients' characteristics by an artificial neural network and a multivariate analysis. A preliminary technical validation was done by comparing the results of the MPI and catheterism (CAT), before and after applying the technique to 4 patients. The t test for parametric data, Wilcoxon, Mann-Whitney and X{sup 2} for the others were used. Probability values less than 0.05 were considered statistically significant. Results: Each increment of 1 cm in the thickness of breast was associated to an average increment of 6% on photon attenuation, while the maximum increase related to breast composition was about 2%. The average chest attenuation percentage per unit was 2.9%. Both, the artificial neural network and linear regression, showed an error less than 3% as predictive models for percentage of female attenuation. The anatomical-functional correlation between MPI and CAT was maintained after the use of the technique. Conclusion: Results suggest that the proposed technique is promising and could be a possible alternative to other conventional methods

  15. Microvascular obstruction on delayed enhancement cardiac magnetic resonance imaging after acute myocardial infarction, compared with myocardial {sup 201}Tl and {sup 123}I-BMIPP dual SPECT findings

    Mori, Hiroaki [Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya (Japan); Department of Cardiology, Kainan Hospital, Yatomi (Japan); Isobe, Satoshi, E-mail: sisobe@med.nagoya-u.ac.jp [Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya (Japan); Sakai, Shinichi [Department of Cardiology, Kainan Hospital, Yatomi (Japan); Yamada, Takashi [Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya (Japan); Watanabe, Naoki; Miura, Manabu [Department of Cardiology, Kainan Hospital, Yatomi (Japan); Uchida, Yasuhiro; Kanashiro, Masaaki; Ichimiya, Satoshi [Department of Cardiology, Yokkaichi Municipal Hospital, Yokkaichi (Japan); Okumura, Takahiro; Murohara, Toyoaki [Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya (Japan)

    2015-08-15

    Highlights: • The percentage infarct size (%IS) was significantly greater in the microvascular obstruction (MO) group than in the non-MO group. • The percentage mismatch score (%MMS) on dual scintigraphy significantly correlated with the %IS and the percentage MO. • The %MMS was significantly greater in the non-MO group than in the MO group, and was an independent predictor for MO. - Abstract: Background: The hypo-enhanced regions within the hyper-enhanced infarct areas detected by cardiac magnetic resonance (CMR) imaging reflect microvascular obstruction (MO) after acute myocardial infarction (AMI). The combined myocardial thallium-201 ({sup 201}Tl)/iodine-123-15-(p-iodophenyl)-3-(R,S)-methylpentadecanoic acid ({sup 123}I-BMIPP) dual single-photon emission computed tomography (SPECT) is a useful tool for detecting myocardial reversibility after AMI. We evaluated whether MO could be an early predictor of irreversible myocardial damage in comparison with {sup 201}Tl and {sup 123}I-BMIPP dual SPECT findings in AMI patients. Methods: Sixty-two patients with initial AMI who successfully underwent coronary revascularization were enrolled. MO was defined by CMR imaging. Patients were divided into 2 groups as follows: MO group (n = 32) and non-MO group (n = 30). Scintigraphic defect scores were calculated using a 17-segment model with a 5-point scoring system. The mismatch score (MMS) was calculated as follows: the total sum of (Σ) {sup 123}I-BMIPP defect score minus Σ{sup 201}Tl defect score. The percentage mismatch score (%MMS) was calculated as follows: MMS/(Σ{sup 123}I-BMIPP score) × 100 (%). Results: The percentage infarct size (%IS) was significantly greater in the MO group than in the non-MO group (32.2 ± 13.8% vs. 18.3 ± 12.1%, p < 0.001). The %MMS significantly correlated with the %IS and the percentage MO (r = −0.26, p = 0.03; r = −0.45, p < 0.001, respectively). The %MMS was significantly greater in the non-MO group than in the MO group (45.4

  16. Dermcidin isoform-2 induced nullification of the effect of acetyl salicylic acid in platelet aggregation in acute myocardial infarction

    Bank, Sarbashri; Jana, Pradipta; Maiti, Smarajit; Guha, Santanu; Sinha, A. K.

    2014-01-01

    The aggregation of platelets on the plaque rupture site on the coronary artery is reported to cause both acute coronary syndromes (ACS) and acute myocardial infarction (AMI). While the inhibition of platelet aggregation by acetyl salicylic acid was reported to produce beneficial effects in ACS, it failed to do in AMI. The concentration of a stress induced protein (dermcidin isoform-2) was much higher in AMI than that in ACS. Incubation of normal platelet rich plasma (PRP) with dermcidin showed one high affinity (Kd = 40 nM) and one low affinity binding sites (Kd = 333 nM). When normal PRP was incubated with 0.4 μM dermcidin, the platelets became resistant to the inhibitory effect of aspirin similar to that in the case of AMI. Incubation of PRP from AMI with dermcidin antibody restored the sensitivity of the platelets to the aspirin effect. Incubation of AMI PRP pretreated with 15 μM aspirin, a stimulator of the NO synthesis, resulted in the increased production of NO in the platelets that removed the bound dermcidin by 40% from the high affinity binding sites of AMI platelets. When the same AMI PRP was retreated with 10 μM aspirin, the aggregation of platelets was completely inhibited by NO synthesis. PMID:25055737

  17. Assessment of myocardial viability.

    Travin, Mark I; Bergmann, Steven R

    2005-01-01

    The prevalence of left ventricular (LV) dysfunction and resultant congestive heart failure is increasing. Patients with this condition are at high risk for cardiac death and usually have significant limitations in their lifestyles. Although there have been advances in medical therapy resulting in improved survival and well being, the best and most definitive therapy, when appropriate, is revascularization. In the setting of coronary artery disease, accounting for approximately two thirds of cases of congestive heart failure, LV dysfunction often is not the result of irreversible scar but rather caused by impairment in function and energy use of still viable-myocytes, with the opportunity for improved function if coronary blood flow is restored. Patients with LV dysfunction who have viable myocardium are the patients at highest risk because of the potential for ischemia but at the same time benefit most from revascularization. It is important to identify viable myocardium in these patients, and radionuclide myocardial scintigraphy is an excellent tool for this. Single-photon emission computed tomography perfusion scintigraphy, whether using thallium-201, Tc-99m sestamibi, or Tc-99m tetrofosmin, in stress and/or rest protocols, has consistently been shown to be an effective modality for identifying myocardial viability and guiding appropriate management. Metabolic imaging with positron emission tomography radiotracers frequently adds additional information and is a powerful tool for predicting which patients will have an improved outcome from revascularization, including some patients referred instead for cardiac transplantation. Other noninvasive modalities, such as stress echocardiography, also facilitate the assessment of myocardial viability, but there are advantages and disadvantages compared with the nuclear techniques. Nuclear imaging appears to require fewer viable cells for detection, resulting in a higher sensitivity but a lower specificity than stress

  18. Ressonância magnética vs cintilografia com pirofosfato marcado com tecnécio-99m para a detecção de necrose miocárdica perioperatória Magnetic resonance vs technetium-99m pyrophosphate scintigraphy in the detection of perioperative myocardial necrosis

    Guilherme Urpia Monte

    2008-08-01

    Full Text Available FUNDAMENTO: O infarto do miocárdio perioperatório (IMPO é uma complicação da cirurgia de revascularização miocárdica (CRM com potencial impacto prognóstico. A cintilografia miocárdica (CM com pirofosfato marcado com tecnécio-99m é utilizada no diagnóstico de IMPO, mas demonstra limitada sensibilidade para lesões subendocárdicas. A ressonância magnética cardiovascular (RMC, por sua vez, detém alta acurácia para a detecção de necrose miocárdica. OBJETIVO: Comparar a RMC e a CM para a detecção de IMPO após CRM. MÉTODOS: Foram estudados 24 pacientes portadores de doença arterial coronária crônica, com a técnica de realce tardio pela RMC e com a CM, antes e depois da CRM, analisando-se o surgimento de áreas de necrose miocárdica perioperatória (IMPO. Mensuraram-se também marcadores bioquímicos de lesão miocárdica (CKMB e troponina I, antes e depois da cirurgia. RESULTADOS: Dezenove pacientes completaram o estudo. Desses, 6 (32% apresentaram IMPO à RMC, e 4 (21% à CM (p = NS. Dos 323 segmentos do ventrículo esquerdo avaliados, 17 (5,3% exibiram necrose perioperatória à RMC, e 7 (2,2% à CM (p = 0,013. Observou-se moderada concordância entre os métodos (kappa = 0,46, havendo divergência, quanto ao diagnóstico de IMPO, em 4 (21% casos, a maioria com pequenas áreas de necrose perioperatória à RMC, não visualizadas à CM. Em todos os casos com IMPO à RMC, houve elevação significativa de CKMB e troponina I. CONCLUSÃO: Houve moderada concordância diagnóstica entre os métodos para a detecção de IMPO, mas a RMC permitiu a visualização de pequenas áreas de necrose miocárdica perioperatória, não identificadas pela CM e associadas à elevação de marcadores bioquímicos de lesão miocárdica.BACKGROUND: Perioperative myocardial infarction (POMI is a complication of coronary artery bypass grafting (CABG with a potential prognostic impact. Technetium-99m pyrophosphate myocardial scintigraphy (MS is

  19. sup(99m)Tc-pyrophosphate and 201Tl myocardial scintigrams in a patient with myocarditis

    Myocardial necrosis in acute myocarditis was investigated by scintigraphy. sup(99m)Tc-pyrophosphate (PYP) and 201TI myocardial scintigrams were obtained on a patient with acute myocarditis due to mycoplasma infection. sup(99m)Tc-PYP myocardial scintigrams in the acute stage demonstrated grade 2+ findings, which remained until the chronic stage. 201TI myocardial scintigrams in the acute stage revealed impaired perfusion restricted to the posterolateral wall, and this decrease continued through the chronic stage. It was concluded that both of sup(99m)Tc-PYP and 201TI myocardial scintigrams can reveal abnormality of acute myocarditis. (Ueda, J.)

  20. Exercise thallium-201 scintigraphy in the diagnosis and prognosis of coronary artery disease

    The objective of this study is to determine the discriminant accuracy of exercise thallium-201 myocardial perfusion scintigraphy for the diagnosis and prognosis of patients with known or suspected coronary artery disease. This is a survey of the National Library of Medicine MEDLINE database. The key medical subject headings used were coronary disease, myocardial infarction, radionuclide imaging, and thallium. A total of 122 retrieved studies were considered relevant and were reviewed in depth. Only studies reporting both the sensitivity and specificity of thallium scintigraphy were analyzed. Discriminant accuracy for diagnosis and prognosis was summarized in terms of pooled sensitivity and specificity. Exercise thallium scintigraphy is useful in the noninvasive diagnosis of coronary artery disease, especially in patients with abnormal resting electrocardiograms, restricted exercise tolerance, and intermediate probability of having disease at the time of testing as well as of defining the prognosis of patients with known or suspected coronary artery disease, especially in those with previous myocardial infarction. Because of various shortcomings in the published record, however, the marginal discriminant accuracy and cost effectiveness of thallium scintigraphy compared with conventional clinical assessment and exercise electrocardiography remain controversial. 193 references

  1. Myocardial perfusion modeling using MRI

    Larsson, H B; Fritz-Hansen, T; Rostrup, Egill;

    1996-01-01

    In the present study, it is shown that it is possible to quantify myocardial perfusion using magnetic resonance imaging in combination with gadolinium diethylenetriaminopentaacetic acid (Gd-DTPA). Previously, a simple model and method for measuring myocardial perfusion using an inversion recovery...

  2. Hepatobiliary scintigraphy in children.

    Nadel, H R

    1996-01-01

    Hepatobiliary scintigraphy using iminodiacetic (IDA) radiopharmaceuticals provides clinically useful information on the function of the biliary tract in a variety of pathological processes in children, including neonatal jaundice, gallbladder dysfunction, trauma, and liver transplantation. Phenobarbital premedication (5 mg/kg per day for a minimum of 5 days in divided doses) is used in infants who are being examined for neonatal jaundice to increase the accuracy of 99mTc-IDA scintigraphy in differentiating extrahepatic biliary atresia from neonatal hepatitis. Biliary atresia can be ruled out in an infant if a patent biliary tree is shown with passage of activity into the bowel. If no radiopharmaceutical is noted in the bowel on imaging up to 24 hours, distinction between severe hepatocellular disease and biliary atresia cannot be made. The literature reports 91% accuracy, 97% sensitivity, and 82% specificity for hepatobiliary imaging in the diagnosis of biliary atresia. The impairment of both intrahepatic and extrahepatic biliary drainage is an important cause of liver disease in cystic fibrosis. Hepatobiliary scintigraphy in cystic fibrosis has shown characteristic patterns of dilatation of mainly the left hepatic duct, narrowing of the distal common bile duct, gallbladder dysfunction, and delayed bowel transit. Cholecystitis in children may be acalculous. Sensitivity and specificity for the scintigraphic diagnosis of acute acalculous cholecystitis is reported to range from 68% to 93% and 38% to 93%, respectively. Cholescintigraphy in a suspected bile leak provides information generally not available with other techniques, except for direct cholangiography. If the amount of intraperitoneal accumulation of the tracer is greater than that entering the gastrointestinal tract, surgery is usually indicated. Hepatobiliary imaging in children who have undergone liver transplantation will assess graft vascularity, parenchymal function, biliary drainage, presence of a leak

  3. Role of scintigraphy in urinary tract infection

    There is controversy regarding the role of radiological imaging for urinary tract infection (UTI). The gold standard has been the intravenous pyelogram (IVP). Yet, the IVP has a very limited value with only about 25% of children with pyelonephritis demonstrating abnormalities. Ultrasound (US) has recently been advocated as a replacement for the poorly sensitive and poorly specific IVP. However, comparative studies between US and IVP indicate only an equivalent sensitivity and specificity. Cortical scintigraphy with Technetium-99m glucoheptonate (99mTc GH) or 99mTc dimercaptosuccinic acid (99mTc DMSA) has also been advocated as a means of differentiating parenchymal (pyelonephritis) from nonparenchymal (lower UTI) involvement in UTI. The clinical presentation may be misleading especially in the infant and child in whom an elevated temperature, flank pain, shaking chills, or an elevated sedimentation rate are often lacking. The clinician attempts to localize the site of infection for it has a direct bearing upon the therapy. A collecting system infection can often be eradicated with a single oral dose of an appropriate antibiotic, whereas renal parenchymal involvement requires IV therapy for an extended interval. Cortical scintigraphy can localize the site of infection with a high degree of accuracy. Recent studies report a sensitivity of 86% and specificity of 81% of pyelonephritis. This is in contrast to the IVP with a sensitivity of only 24% and US with a sensitivity of only 42%. The scintigraphic appearance of parenchymal infection of the kidney is a spectrum of minimal to gross defects reflecting the degree of histologic involvement that spans from a mild infection to frank abscess. Cortical scintigraphy can be used to monitor the evolution of scarring following infection. Cortical scintigraphy with 99mTc DMSA or 99mTc GH is the method of choice for the initial evaluation of UTI. 37 references

  4. Gamma-scintigraphy

    Gamma-scintigraphy is a medical technique making it possible to fix the image of certain organs after the concentration in these of emitting radioactive products. It is already widely used in the case of the thyroid gland with iodine-132 by applying the isotope iodine 131. The study of the liver and gall bladder is carried out using colloidal gold 198 and Bengal pink marked with iodine 131. Serum albumin marked with iodine 131 makes it possible to study rachidian blockages. Other applications can already be foreseen in this direction. (author)

  5. Cardioprotective effect of resveratrol analogue isorhapontigenin versus omega-3 fatty acids in isoproterenol-induced myocardial infarction in rats.

    Abbas, Amr M

    2016-09-01

    Myocardial infarction (MI) is a common cause of mortality worldwide. Isorhapontigenin is a derivative of stilbene with chemical structure similar to resveratrol. The omega-3 fatty acids (FA) have beneficial effects on neurodegenerative, inflammatory, and cardiovascular diseases. The aim of this study was to investigate the effects of pretreatment with isorhapontigenin and omega-3 FA on rat model of isoproterenol-induced MI. Fifty-six rats were divided into seven groups: normal, normal + isorhapontigenin, normal + omega-3 FA, MI, MI + isorhapontigenin, MI + omega-3 FA, and MI + isorhapontigenin + omega-3 FA. Serum levels of cardiac marker enzymes [lactate dehydrogenase (LDH) and creatine kinase-MB (CK-MB)], cardiac troponin I (cTnI), inflammatory markers [tumor necrosis factor-alpha (TNF-α) and interleukin-6], and lipid profile [triglycerides, total cholesterol (T.Ch), high and low density lipoproteins (HDL, LDL), and phospholipids] as well as cardiac levels of malondialdehyde and anti-oxidants [reduced glutathione (GSH), superoxide dismutase (SOD), and catalase)] were measured in all rats. ECG and histopathological examination were performed. Isoproterenol caused a significant elevation of ST segment, decreased R wave amplitude, HDL, and anti-oxidants, and increased LDH, CK-MB, cTnI, TNF-α, interleukin-6, malondialdehyde, triglycerides, T.Ch, LDL, and phospholipids. Omega-3 FA or isorhapontigenin significantly decreased the ST segment elevation, LDH, CK-MB, cTnI, TNF-α, interleukin-6, malondialdehyde, and phospholipids and increased R wave amplitude and anti-oxidants. The effects of combined omega-3 FA and isorhapontigenin were more significant than either of them alone. Therefore, we conclude that omega-3 FA and isorhapontigenin have a cardioprotective effect on rats with isoproterenol-induced MI through their anti-oxidant and anti-inflammatory actions. PMID:27193109

  6. Heart failure and 1231-M.I.B.G. scintigraphy: comeback; Scintigraphie cardiaque a la 1231-metaiodobenzylguanidine et cardiomyopathies: le retour

    Agostini, D.; Hugentobler, A.; Costo, S.; Bouvard, G. [Centre Hospitalier Universitaire Cote de Nacre, Service de Medecine Nucleaire, 14 - Caen (France); Manrique, A. [Centre de Lutte Contre le Cancer Henri-Becquerel, Service de Medecine Nucleaire, 76 - Rouen (France); Sabatier, R.; Grollier, G. [Centre Hospitalier Universitaire Cote de Nacre, Service de Cardiologie, 14 - Caen (France); Belin, A. [Hopital de Trouville, Service de Readaptation Cardiaque, 14 - Trouville (France)

    2007-09-15

    Congestive heart failure is a often associated with an impairment of sympathetic nervous system, i.e., global hyperactivity and regional impairment of adrenergic system. Cardiac {sup 123}I-meta-iodo-benzyl-guanidine (M.I.B.G.) scintigraphy is a radionuclide technique which can explore the presynaptic adrenergic function. Cardiac fixation of M.I.B.G. is decreased in congestive heart failure, reflecting a reduction of norepinephrine uptake by the myocardial presynaptic ending nerves. The impairment of presynaptic function is early and actually involved in the pathogenesis of cardiac failure. Cardiac M.I.B.G. scintigraphy is a useful tool to explore the myocardial adrenergic stores in patients with congestive heart failure. (authors)

  7. Evaluation of the impact of genetic polymorphisms in glutathione-related genes on the association between methylmercury or n-3 polyunsaturated long chain fatty acids and risk of myocardial infarction: a case-control study

    Norberg Margareta

    2011-04-01

    Full Text Available Abstract Background The n-3 polyunsaturated fatty acids eicosapentaenoic acid and docosahexaenoic acid, which are present in fish, are protective against myocardial infarction. However, fish also contains methylmercury, which influences the risk of myocardial infarction, possibly by generating oxidative stress. Methylmercury is metabolized by conjugation to glutathione, which facilitates elimination. Glutathione is also an antioxidant. Individuals with certain polymorphisms in glutathione-related genes may tolerate higher exposures to methylmercury, due to faster metabolism and elimination and/or better glutathione-associated antioxidative capacity. They would thus benefit more from the protective agents in fish, such as eicosapentaenoic+docosahexaenoic acid and selenium. The objective for this study was to elucidate whether genetic polymorphisms in glutathione-related genes modify the association between eicosapentaenoic+docosahexaenoic acid or methylmercury and risk of first ever myocardial infarction. Methods Polymorphisms in glutathione-synthesizing (glutamyl-cysteine ligase catalytic subunit, GCLC and glutamyl-cysteine ligase modifier subunit, GCLM or glutathione-conjugating (glutathione S-transferase P, GSTP1 genes were genotyped in 1027 individuals from northern Sweden (458 cases of first-ever myocardial infarction and 569 matched controls. The impact of these polymorphisms on the association between erythrocyte-mercury (proxy for methylmercury and risk of myocardial infarction, as well as between plasma eicosapentaenoic+docosahexaenoic acid and risk of myocardial infarction, was evaluated by conditional logistic regression. The effect of erythrocyte-selenium on risk of myocardial infarction was also taken into consideration. Results There were no strong genetic modifying effects on the association between plasma eicosapentaenoic+docosahexaenoic acid or erythrocyte-mercury and risk of myocardial infarction risk. When eicosapentaenoic

  8. Detection of coronary artery disease in asymptomatic aircrew members with thallium-201 scintigraphy

    Uhl, G.S.; Kay, T.N.; Hickman, J.R. Jr.; Montgomery, M.A.; McGranahan, G.M.

    1980-11-01

    Thallium-201 exercise myocardial perfusion scintigraphy was accomplished in 130 aircrew members prior to their undergoing coronary angiography. Most were undergoing cardiac catheterization for an abnormal exercise response to treadmill testing. Of these, 22 men had arteriographic evidence of obstructive coronary disease of at least 50% narrowing in a single vessel. All had abnormal myocardial scintigrams. There were 12 other aviators who had minimal degrees of coronary artery disease with lesions less than 50% as the maximum degree of obstruction. Of these, 8 had abnormal thallium scans showing a perfusion defect in the area of the myocardium, presumably supplied by the diseased coronary artery. Of the 96 men with normal angiograms, only 4 had abnormal myocardial scintigraphy. An abnormal myocardial scintigram was often associated with significant obstructive disease. A normal scan accurately ruled out the presence of high-grade obstructive lesions and missed only four cases of minimal coronary disease. The application of gated thallium myocardial perfusion scans in the practice of aerospace cardiology has important significant applications for followup of therapeutic modalities as well as screening for evidence of myocardial ischemia in apparently healthy aircrew members.

  9. Detection of coronary artery disease in asymptomatic aircrew members with thallium-201 scintigraphy

    Thallium-201 exercise myocardial perfusion scintigraphy was accomplished in 130 aircrew members prior to their undergoing coronary angiography. Most were undergoing cardiac catheterization for an abnormal exercise response to treadmill testing. Of these, 22 men had arteriographic evidence of obstructive coronary disease of at least 50% narrowing in a single vessel. All had abnormal myocardial scintigrams. There were 12 other aviators who had minimal degrees of coronary artery disease with lesions less than 50% as the maximum degree of obstruction. Of these, 8 had abnormal thallium scans showing a perfusion defect in the area of the myocardium, presumably supplied by the diseased coronary artery. Of the 96 men with normal angiograms, only 4 had abnormal myocardial scintigraphy. An abnormal myocardial scintigram was often associated with significant obstructive disease. A normal scan accurately ruled out the presence of high-grade obstructive lesions and missed only four cases of minimal coronary disease. The application of gated thallium myocardial perfusion scans in the practice of aerospace cardiology has important significant applications for followup of therapeutic modalities as well as screening for evidence of myocardial ischemia in apparently healthy aircrew members

  10. Effect of acute postinfusion lipemia and free fatty acids on myocardial contractility: Assessment with radionuclide ventriculography

    Ackerman, L.; Freeman, M.L.; Barnes, W.E.; Kaplan, E.; Pacold, I.; Loeb, H.S.; Johnson, B.; Reid, R.W.

    1986-08-01

    Equilibrium gated radionuclide ventriculography was used to valuate the effect of intravenous fat-emulsion overload and excess of free fatty acids (FFA) on left ventricular ejection fraction (LVEF) in 20 patients with and without coronary artery disease (CAD). Fifteen of these patients had normal (>50%) baseline LVEF and 5 had low (<50%) baseline LVEF. From 100 to 150 ml of 20% artificial fat emulsion (Liposyn) was infused over 20-25 min. At the end of the infusion, triglyceridemia reached 820 +- 220 mg% and left ventricular ejection fraction decreased from baseline 62 +- 19% (mean +-SD) to 58 +- 16% (P < 0.05, paired t-test). After completion of Liposyn infusion, 5,000 U of heparin was administered intravenously and monitoring of LVEF was continued. One and one-half hours following heparin administration, plasma FFA levels reached 3.7 + 2.0 mmol/l and LVEF rose to 69 +- 19% (P < 0.001, paired t-test). Our data indicate that acute intravenous fat overload can suppress and high pathophysiologic levels of FFA can increase LVEF. This effect is more uniform and statistically more reliable in patients with normal LVEF. The study failed to demonstrate any significant difference in the effect of this pharmacologic intervention between patients with and without CAD.

  11. Effect of acute postinfusion lipemia and free fatty acids on myocardial contractility: Assessment with radionuclide ventriculography

    Equilibrium gated radionuclide ventriculography was used to valuate the effect of intravenous fat-emulsion overload and excess of free fatty acids (FFA) on left ventricular ejection fraction (LVEF) in 20 patients with and without coronary artery disease (CAD). Fifteen of these patients had normal (>50%) baseline LVEF and 5 had low (<50%) baseline LVEF. From 100 to 150 ml of 20% artificial fat emulsion (Liposyn) was infused over 20-25 min. At the end of the infusion, triglyceridemia reached 820+-220 mg% and left ventricular ejection fraction decreased from baseline 62+-19% (mean +-SD) to 58+-16% (P<0.05, paired t-test). After completion of Liposyn infusion, 5,000 U of heparin was administered intravenously and monitoring of LVEF was continued. One and one-half hours following heparin administration, plasma FFA levels reached 3.7+2.0 mmol/l and LVEF rose to 69+-19% (P<0.001, paired t-test). Our data indicate that acute intravenous fat overload can suppress and high pathophysiologic levels of FFA can increase LVEF. This effect is more uniform and statistically more reliable in patients with normal LVEF. The study failed to demonstrate any significant difference in the effect of this pharmacologic intervention between patients with and without CAD. (orig.)

  12. Interest of the coronaries disease screening by myocardium scintigraphy of iterative perfusion for patients suffering of type 2 diabetes; Interet du depistage de la maladie coronaire par scintigraphie myocardique de perfusion iterative chez des patients diabetiques de type 2

    Eder, V. [hopital Trousseau, CHU de Tours, Service de medecine nucleaire, 37 (France)

    2010-07-01

    Achieving iterative myocardial scintigraphy in patients of type 2 diabetes at high asymptomatic cardiovascular risk with management of risk factors has ensured a predictive negative value (N.P.V.) of 100% and 15% for detecting coronary patients. (N.C.)

  13. Arsenic-induced oxidative myocardial injury: protective role of arjunolic acid

    Manna, Prasenjit; Sinha, Mahua; Sil, Parames C. [Bose Institute, Department of Chemistry, Kolkata, West Bengal (India)

    2008-03-15

    Arsenic, one of the most harmful metalloids, is ubiquitous in the environment. The present study has been carried out to investigate the protective role of a triterpenoid saponin, arjunolic acid (AA) against arsenic-induced cardiac oxidative damage. In the study, NaAsO{sub 2} was chosen as the source of arsenic. The free radical scavenging activity and the effect of AA on the intracellular antioxidant power were determined from its 2,2-diphenyl-1-picryl hydrazyl radical scavenging ability and ferric reducing/antioxidant power assay, respectively. Oral administration of NaAsO{sub 2} at a dose of 10 mg/kg body weight for 2 days caused significant accumulation of arsenic in cardiac tissues of the experimental mice in association with the reduction in cardiac antioxidant enzymes activities, namely superoxide dismutase, catalase, glutathione-S-transferase, glutathione reductase and glutathione peroxidase. Arsenic intoxication also decreased the cardiac glutathione (GSH) and total thiol contents and increased the levels of oxidized glutathione (GSSG), lipid peroxidation end products and protein carbonyl content. Treatment with AA at a dose of 20 mg/kg body weight for 4 days prior to NaAsO{sub 2} intoxication protected the cardiac tissue from arsenic-induced oxidative impairment. In addition to oxidative stress, arsenic administration increased total cholesterol level as well as the reduced high-density lipoprotein cholesterol level in the sera of the experimental mice. AA pretreatment, however, could prevent this hyperlipidemia. Histological studies on the ultrastructural changes in cardiac tissue supported the protective activity of AA also. Combining all, results suggest that AA could protect cardiac tissues against arsenic-induced oxidative stress probably due to its antioxidant property. (orig.)

  14. Dosimetry in myocardial perfusion imaging

    Toledo, Janine M.; Trindade, Bruno; Ribeiro, Tarcisio P.C. [Universidade Federal de Minas Gerais (DEN/UFMG), Belo Horizonte (Brazil). Dept. de Engenharia Nuclear. Programa de Pos-Graduacao em Ciencias e Tecnicas Nucleares

    2011-07-01

    This paper conducts a dosimetric investigation on the myocardial perfusion image protocol, together with a literature reviewing, motivated by the significant statistic increasing on mortality, morbidity and disability associated with cardiovascular disease, surpassing infectious diseases. Nuclear Cardiology plays a role n the diagnostic functional evaluation of the heart and in the prognostic of patients with suspected or known cardiac ischemia. In the context of unstable myocardial ischemic syndrome, myocardial perfusion scintigraphy is a non-invasive procedure performed by administering a radiopharmaceutical targeted to the heart. As tool for this study are that the images obtained by thoracic angiotomography and abdominal aorta as a anatomic and functional information for model reproduction in SISCODES - System of Codes for Absorbed Dose Calculations based on Stochastic Methods. Data were manipulated in order to create a voxel computational model of the heart to be running in MCNP - Monte Carlo Neutron Particle Code. . It was assumed a homogeneous distribution of Tl-201 in cardiac muscle. Simulations of the transport of particles through the voxel and the interaction with the heart tissue were performed. As a result, the isodose curves in the heart model are displayed as well as the dose versus volume histogram of the heart muscle. We conclude that the present computational tools can generate doses distributed in myocardial perfusion. (author)

  15. Dosimetry in myocardial perfusion imaging

    This paper conducts a dosimetric investigation on the myocardial perfusion image protocol, together with a literature reviewing, motivated by the significant statistic increasing on mortality, morbidity and disability associated with cardiovascular disease, surpassing infectious diseases. Nuclear Cardiology plays a role n the diagnostic functional evaluation of the heart and in the prognostic of patients with suspected or known cardiac ischemia. In the context of unstable myocardial ischemic syndrome, myocardial perfusion scintigraphy is a non-invasive procedure performed by administering a radiopharmaceutical targeted to the heart. As tool for this study are that the images obtained by thoracic angiotomography and abdominal aorta as a anatomic and functional information for model reproduction in SISCODES - System of Codes for Absorbed Dose Calculations based on Stochastic Methods. Data were manipulated in order to create a voxel computational model of the heart to be running in MCNP - Monte Carlo Neutron Particle Code. . It was assumed a homogeneous distribution of Tl-201 in cardiac muscle. Simulations of the transport of particles through the voxel and the interaction with the heart tissue were performed. As a result, the isodose curves in the heart model are displayed as well as the dose versus volume histogram of the heart muscle. We conclude that the present computational tools can generate doses distributed in myocardial perfusion. (author)

  16. Myocardial Bridge

    ... Myocarditis Obstructive Sleep Apnea Pericarditis Peripheral Vascular Disease Rheumatic ... Related terms: myocardium, coronary arteries, myocardial ischemia Your heart is made of muscle, called the myocardium. The ...

  17. Myocardial Bridging.

    Yuan, Shi-Min

    2016-02-01

    Myocardial bridging is rare. Myocardial bridges are most commonly localized in the middle segment of the left anterior descending coronary artery. The anatomic features of the bridges vary significantly. Alterations of the endothelial morphology and the vasoactive agents impact on the progression of atherosclerosis of myocardial bridging. Patients may present with chest pain, myocardial infarction, arrhythmia and even sudden death. Patients who respond poorly to the medical treatment with β-blockers warrant a surgical intervention. Myotomy is a preferred surgical procedure for the symptomatic patients. Coronary stent deployment has been in limited use due to the unsatisfactory long-term results. PMID:27074276

  18. Myocardial Bridging

    Shi-Min Yuan

    2016-02-01

    Full Text Available Abstract Myocardial bridging is rare. Myocardial bridges are most commonly localized in the middle segment of the left anterior descending coronary artery. The anatomic features of the bridges vary significantly. Alterations of the endothelial morphology and the vasoactive agents impact on the progression of atherosclerosis of myocardial bridging. Patients may present with chest pain, myocardial infarction, arrhythmia and even sudden death. Patients who respond poorly to the medical treatment with β-blockers warrant a surgical intervention. Myotomy is a preferred surgical procedure for the symptomatic patients. Coronary stent deployment has been in limited use due to the unsatisfactory long-term results.

  19. Correlation between extent of metastatic lesions in whole body bone scintigraphy of patients with prostatic cancer and prostatic acid phosphatase (PAP) in blood by PAP RIA kit 'Eiken'

    Whole body bone scintigraphy of thirteen patients who were pathohistologically confirmed prostatic cancer was processed by four colors, and then the extent of bone metastases was estimated quantitatively. On the basis of this estimation, the grade of the expansion of bone metastases was classified into 4 grades (0, 1, 2, and 3 grades). And then, correlations of the expantion of bone metastases with PAP, AcP and AlP levels in blood were investigated. The results are as follows: 1) Correlation between the extent of bone metastases and PAP levels was relatively high (r = 0.81). 2) As for the relation between the expansion grade of bone metastases and PAP levels, the levels did not increase in 0 and 1 grades, but markedly increased in 2 and 3 grades. AcP also showed a little similar tendency. 3) In the correlation of PAP with AcP and with AlP, AcP (r = 0.78) was higher than AlP (r = 0.42). 4) Therefore, PAP levels seem to be a good index of the extent of bone metastases in prostatic cancer. (author)

  20. JNK/PI3K/Akt signaling pathway is involved in myocardial ischemia/reperfusion injury in diabetic rats: effects of salvianolic acid A intervention.

    Chen, Qiuping; Xu, Tongda; Li, Dongye; Pan, Defeng; Wu, Pei; Luo, Yuanyuan; Ma, Yanfeng; Liu, Yang

    2016-01-01

    Recent studies have demonstrated that diabetes impairs the phosphatidylinositol 3-kinase/Akt (PI3K/Akt) pathway, while insulin resistance syndrome has been associated with alterations of this pathway in diabetic rats after ischemia/reperfusion (I/R), and activation of C-jun N-terminal kinase (JNK) is involved. The present study was designed to investigate whether inhibiting JNK activity would partially restore the PI3K/Akt signaling pathway and protect against myocardial I/R injury in diabetic rats, and to explore the effect of intervention with salvianolic acid A (Sal A). The inhibitor of JNK (SP600125) and Sal A were used in type 2 diabetic (T2D) rats, outcome measures included heart hemodynamic data, myocardial infarct size, the release of lactate dehydrogenase (LDH), SERCA2a activity, cardiomyocyte apotosis, expression levels of Bcl-2, Bax and cleaved caspase-3, and the phosphorylation status of Akt and JNK. The p-Akt levels were increased after myocardial I/R in non-diabetic rats, while there was no change in diabetic rats. Pretreatment with the SP600125 and Sal A decreased the p-JNK levels and increased the p-Akt levels in diabetic rats with I/R, and heart hemodynamic data improved, infarct size and LDH release decreased, SERCA2a activity increased, Bax and cleaved caspase-3 expression levels decreased, and the expression of Bcl-2 and the Bcl-2/Bax ratio increased. Our results suggest that the JNK/PI3K/Akt signaling pathway is involved in myocardial I/R injury in diabetic rats and Sal A exerts an anti-apoptotic effect and improves cardiac function following I/R injury through the JNK/PI3K/Akt signaling pathway in this model. PMID:27398138

  1. Myocardial uptake ratio of iodine-123 labeled beta-methyl iodophenylpentadecanoic acid (123I-BMIPP) in relation to the concentration of the substrates of energy

    Iodine-123 beta-methyl iodophenylpentadecanoic acid (BMIPP) has been used for evaluating myocardial fatty acid metabolism in vivo. The whole body BMIPP imaging was acquired in 26 patients (11 with HCM, 11 with CAD and 4 with DCM) to calculate % uptake in the myocardium and to correlate its uptake with biochemical data, including blood sugar (BS), nonesterified fatty acid (NEFA) and insulin in the blood. BMIPP was administered at rest with overnight fasting state, and the anterior and posterior whole body imaging was performed one hour later. The background corrected whole myocardial counts were calculated to obtain %BMIPP uptake. In addition, the heart to mediastinum count ratio (H/M ratio) was calculated from the mean counts in the heart and the upper mediastinum in the anterior view. The %BMIPP uptake was 3.70±1.22% and H/M ratio was 2.30±0.23. The patients with DCM showed higher %BMIPP uptake value (DCM=5.58±0.67% vs. CAD=3.09±0.97% and HCM=3.63±0.86%, both p<0.01), but similar values of H/M ratio with other patients (DCM=2.43±0.20, CAD=2.22±0.25 and HCM=2.32±0.20). Although the biochemical data varied at the time of the tracer administration, they were not significantly correlated with the %BMIPP uptake or H/M ratio. However, there was a significant correlation between %BMIPP uptake and H/M ratio with the correlation coefficient of 0.80 (p<0.001). We conclude that the myocardial uptake of BMIPP is not influenced by the plasma substrate level under the fasting state. (author)

  2. Interest of the coronaries disease screening by myocardium scintigraphy of iterative perfusion for patients suffering of type 2 diabetes

    Achieving iterative myocardial scintigraphy in patients of type 2 diabetes at high asymptomatic cardiovascular risk with management of risk factors has ensured a predictive negative value (N.P.V.) of 100% and 15% for detecting coronary patients. (N.C.)

  3. Dietary omega-3 fatty acids attenuate myocardial arrhythmogenic factors and propensity of the heart to lethal arrhythmias in a rodent model of human essential hypertension

    Radošinská, J.; Bačová, B.; Knezl, V.; Beňová, T.; Žurmanová, J.; Soukup, Tomáš; Arnoštová, P.; Slezák, J.; Goncalvesová, E.; Tribulová, N.

    2013-01-01

    Roč. 31, č. 9 (2013), s. 1876-1885. ISSN 0263-6352 R&D Projects: GA ČR(CZ) GA304/08/0256; GA MŠk(CZ) 7AMB12SK158 Institutional research plan: CEZ:AV0Z50110509 Institutional support: RVO:67985823 Keywords : hypertension * omega-3 polyunsaturated fatty acids * ventricular fibrillation * sinus rhythm restoration * myocardial connexin-43 * protein kinase C * myosin heavy chain Subject RIV: EA - Cell Biology Impact factor: 4.222, year: 2013

  4. Aid in the detection of myocardial perfusion abnormality utilizing SPECT atlas and images registration: preliminary results

    Padua, Rodrigo Donizete Santana de [Universidade de Sao Paulo (USP), Ribeirao Preto, SP (Brazil). Faculdade de Medicina. Div. de Cardiologia]. E-mail: rodrigo_dsp@hcrp.fmrp.usp.br; Oliveira, Lucas Ferrari de [Universidade Federal de Pelotas (UFPel), RS (Brazil). Inst. de Fisica e Matematica. Dept. de Tecnologia da Informacao; Marques, Paulo Mazzoncini de Azevedo [Universidade de Sao Paulo (USP), Ribeirao Preto, SP (Brazil). Faculdade de Medicina. Centro de Ciencias das Imagens e Fisica Medica; Groote, Jean-Jacques Georges Soares de [Instituto de Ensino Superior COC, Ribeirao Preto, SP (Brazil). Lab. of Artifical Intelligence and Applications; Castro, Adelson Antonio de [Universidade de Sao Paulo (USP), Ribeirao Preto, SP, (Brazil). Faculdade de Medicina; Ana, Lauro Wichert [Universidade de Sao Paulo (USP), Ribeirao Preto, SP (Brazil). Faculdade de Medicina. Centro de Ciencias das Imagens e Fisica Medica; Simoes, Marcus Vinicius [Universidade de Sao Paulo (USP), Ribeirao Preto, SP, (Brazil). Faculdade de Medicina. Divisao de Cardiologia

    2008-11-15

    To develop an atlas of myocardial perfusion scintigraphy and evaluating its applicability in computer-aided detection of myocardial perfusion defects in patients with ischemic heart disease. The atlas was created with rest-stress myocardial perfusion scintigraphic images of 20 patients of both genders with low probability of coronary artery disease and considered as normal by two experienced observers. Techniques of image registration and mathematical operations on images were utilized for obtaining template images depicting mean myocardial uptake and standard deviation for each gender and physiological condition. Myocardial perfusion scintigraphy images of one male and one female patient were aligned with the corresponding atlas template image, and voxels with myocardial uptake rates two standard deviations below the mean voxel value of the respective region in the atlas template image were highlighted on the tomographic sections and confirmed as perfusion defects by both observe. The present study demonstrated the creation of an atlas of myocardial perfusion scintigraphy with promising results of this tool as an aid in the detection of myocardial perfusion defects. However, further prospective validation with a more representative sample is recommended. (author)

  5. Aid in the detection of myocardial perfusion abnormality utilizing SPECT atlas and images registration: preliminary results

    To develop an atlas of myocardial perfusion scintigraphy and evaluating its applicability in computer-aided detection of myocardial perfusion defects in patients with ischemic heart disease. The atlas was created with rest-stress myocardial perfusion scintigraphic images of 20 patients of both genders with low probability of coronary artery disease and considered as normal by two experienced observers. Techniques of image registration and mathematical operations on images were utilized for obtaining template images depicting mean myocardial uptake and standard deviation for each gender and physiological condition. Myocardial perfusion scintigraphy images of one male and one female patient were aligned with the corresponding atlas template image, and voxels with myocardial uptake rates two standard deviations below the mean voxel value of the respective region in the atlas template image were highlighted on the tomographic sections and confirmed as perfusion defects by both observe. The present study demonstrated the creation of an atlas of myocardial perfusion scintigraphy with promising results of this tool as an aid in the detection of myocardial perfusion defects. However, further prospective validation with a more representative sample is recommended. (author)

  6. RI scintigraphy in myasthenia gravis

    35 cases of myasthenia gravis were studied with RI scintigraphy. 67Ga-citrate was used in 34 patients and 76Se-selenomethionine in 5 patients for thymus scintigraphy. RI scintigram was negative in non-tumorous thymus, regardless of the severity of illness and it was positive in seven of nine patients with thymomas. RI accumulation in thymus was found both in benign and malignant thymomas. RI seems to accumulated in lymphocytic and mixed thymus more than epithelial type. (author)

  7. RI scintigraphy in myasthenia gravis

    Kuroda, Yoshikazu; Miyamoto, Mariko (Tokyo Metropolitan Fuchu Hospital (Japan)); Maki, Masako; Yamazaki, Toshiro

    1982-10-01

    35 cases of myasthenia gravis were studied with RI scintigraphy. /sup 67/Ga-citrate was used in 34 patients and /sup 76/Se-selenomethionine in 5 patients for thymus scintigraphy. RI scintigram was negative in non-tumorous thymus, regardless of the severity of illness and it was positive in seven of nine patients with thymomas. RI accumulation in thymus was found both in benign and malignant thymomas. RI seems to accumulated in lymphocytic and mixed thymus more than epithelial type.

  8. Estrogen receptor scintigraphy.

    Scheidhauer, K; Scharl, A; Schicha, H

    1998-03-01

    Radio-labeled estrogen receptor ligands are tracers that can be used for functional receptor diagnosis. Their specificity towards receptors, together with the fact that only 50-70% of mammary carcinomas are receptor positive, renders them unsuitable for detection of primary tumors or metastases, and this means that estrogen receptor scintigraphy can be used neither for tumor screening nor for staging. However, both 18F-labeled and 123I-labeled estradiol derivatives are suitable for in vivo imaging of estrogen receptors. Their high specificity, established in animal experiments and in vitro studies has been reproduced in in vivo applications in humans. Tracers with positron radiation emitters are, however, hardly suitable for broad application owing to the short half-life of 18F, which would mean that users would need to be situated close to a cyclotron and a correspondingly equipped radiochemical laboratory. The number of available PET scanners, on the other hand, has increased over the last few years, especially in Germany, so that this, at least, does not present a limiting factor. All the same, 123I-labeled estradiol derivatives will find more widespread application, since the number of gamma-cameras incorporating modern multi-head systems is several times greater. The results of studies with 123I-E2-scintigraphy published to date are very promising, even given the initial technical problems mentioned above. As a method of examination, it could be optimised by using improved tracers with a higher tumor contrast and less disturbance from overlapping in diagnostically relevant locations, for instance, by selecting tracers with higher activities whose excretion is more renal than hepatobiliary. The use of modern multi-head camera systems can also be expected to improve the photon yield. PMID:9646642

  9. New trends in parathyroid scintigraphy

    Giordano, A. [Univ. Cattolica del Sacro Cuore, Ist. di Medicina Nucleare, Roma (Italy); Rubello, D.; Casara, D. [Azienda Ospedaliera di Padova, Servizio di Medicina Nucleare II, Padova (Italy)

    2001-09-01

    The paper focusses on the recent advances in parathyroid imaging in both diagnostic and surgical fields which justify the present favourable trend towards a considerable expansion of nuclear medicine applications in this area. The main methodological advances in parathyroid scintigraphy are the rebirth of the dual-tracer (subtraction) technique with technetium-99m sestamibi, the possibility of also using {sup 99m}Tc-tetrofosmin within a dual-tracer (subtraction) methodology and the more extensive use of single-photon emission tomography, which the authors believe will become the standard methodology. The indications for parathyroid scintigraphy have been affected by advances in hyperparathyroidism surgery, including wider use of unilateral neck exploration and of minimally invasive radioguided surgery. As these techniques can only be performed in hyperparathyroid patients with a single adenoma, careful pre-operative assessment is required, and parathyroid scintigraphy undoubtedly is the most accurate localisation method. To date, the majority of papers have also demonstrated the cost-effectiveness of scintigraphically guided limited neck surgery. The authors conclude that: (1) parathyroid scintigraphy can be recommended not only in persistent or recurrent hyperparathyroidism but also in hyperparathyroid patients prior to first surgery; (2) scintigraphy should always be performed by applying the most accurate technique available because reliable scintigraphy gains or reinforces the surgeon's trust, reliably guides cost-effective operative strategies and justifies the recognition of new potential diagnostic indications. (orig.)

  10. Exercise thallium scintigraphy in aortitis syndrome (Takayasu's arteritis)

    It is important for patient management to evaluate coronary arterial involvement in aortitis syndrome. Twenty one cases of aortitis syndrome who experienced chest pain were examined using exercise thallium scintigraphy. The patients were divided into four groups according to the angiographic findings. There were: Five patients with left main coronary arterial involvement (group A), four with left or right coronary arterial involvement (group B), nine with aortic regurgitation (group C), and three with pulmonary arterial involvement (group D). In group A and B, all patients had positive ECGs and thallium perfusion defects. Group A patients showed extensive anterolateral perfusion defects, which were compatible with left main coronary arterial involvement. Group C and D patients, who had normal coronary arteries, showed no remarkable perfusion defects although five had positive ECG findings. Thus, the sensitivity and specificity of exercise scintigraphy for detection of myocardial ischemia were 9/9 and 12/12, while those of stress ECG were 9/9 and 7/12 (58%), respectively. It is recommended that exercise thallium scintigraphy be used for detecting clinically occult but significant coronary arterial involvement in aortitis syndrome with chest pain. (orig.)

  11. Association of serum uric acid level with mortality and morbidity of patients with acute ST-elevation myocardial infarction

    Reza Hajizadeh

    2016-06-01

    Conclusion: In the current study, high serum UA level in patients with acute myocardial infarction (MI was not associated with higher in-hospital or midterm mortality, but it was associated with lower LVEF, higher Killip class, elevated cTnI, creatinine, triglyceride, and higher AF.

  12. Influence of stimulation by electroejaculation on myocardial function, acid-base and electrolyte status, and hematobiochemical profiles in male dromedary camels.

    Tharwat, M; Ali, A; Al-Sobayil, F; Derar, R; Al-Hawas, A

    2014-10-01

    This study was carried out to evaluate the effect of electroejaculation (EEJ) on myocardial function, acid-base balance, and hematobiochemical profiles in male dromedary camels. Twenty sexually mature, apparently healthy male camels were assigned to EEJ. Parallel, eight naturally mated male camels were enrolled as a control group. Three blood samples were collected from each camel: just before (T0), directly after (T1), and 24 hours after (T2) EEJ or natural mating. The serum concentrations of the cardiac biomarker troponin I (cTnI), blood gas parameters, and hematobiochemical profiles were determined. Nineteen camels were ejaculated by the end of the second circuit and one by the end of the first circuit. In both groups, the mean heart and respiratory rates had increased significantly immediately after the procedure, but returned to normal values 24 hours after the procedure. The mean serum concentration of cTnI had increased significantly in all camels after EEJ, but not in controls. However, at 24 hours post-EEJ, the serum concentration of cTnI did not differ significantly compared with baseline values. The blood pH and base excess had decreased, and the PCO2 and lactic acid had increased after EEJ. The EEJ provoked decreases in hematocrit and mean corpuscular volume. In the control group, the base excess, HCO3(-), TCO2, anion gap, and lactic acid increased slightly after mating but did not reach a significant level compared with premating values. It is concluded that EEJ in camels results in a reversible myocardial injury, changes in the acid-base status, and increase the lactic acid concentration. PMID:25139755

  13. Silent ischemia in patients after uncomplicated myocardial infarction

    The purpose of this study was to determine the frequency and importance of silent ischemia in patients (pts) after the acute myocardial infarction (A MI) as well as to establish diagnostic and prognostic value of exercise stress test (EST), Holter (H) monitoring and thallium-201 (Tl) scintigraphy. All the three tests were performed 2-4 months following the AMI. The criterion for diagnosing myocardial ischemia on EST and H is 1 mm or more of horizontal or down-sloping ST depression. Additional criteria for Holter imply the ischemic episode should last one minute and be separated from other episodes by at least one minute. Planar thallium images were performed 5-10 minute after the stress test; the delayed images were obtained after 3-6 hours. Visual and quantitative methods were employed in the analysis of TI-scintigraphy. Scintigraphy was considered positive if exercise- induced perfusion defects showed redistribution. The study included 74 asymptomatic patients after the AMI. The patients were divided into two groups by results of quantitative Tl-scintigraphy: Group I - 44 pts with silent ischemia, Group II - 30 pts without ischemia. In Group I, out of 44 pts, 9 had a positive exercise stress, 4 showed a painless ST depression on Holter and 7 had both tests positive, whereas 24 pts had only scintigraphy positive. In Group II one patient had positive EST and H. Sensitivity and specificity were determined by results of coronary arteriography performed on 33 pts: EST (Se=40%, Sp=80%), H (Se=219, Sp=100%) and scintigraphy (Se=93%, Sp =80%). During the follow-up period lasting at least 12 months, in Group I 3 pts died, 1 developed a new myocardial infarction and 15 pts had painful ischemic occurrences. In Group II only 3 pts developed symptoms of angina pectoris. Tl-scintigraphy was the only non-invasive test showing significant correlation with the follow-up outcomes. The diagnostic and prognostic superiority of Tl-scintigraphy justifies its value as the initial

  14. [Myocardial pyrophosphate uptake in cardiac amyloidosis: report of case].

    Redondo, Francisca; González, Patricio; Ramírez, Alfredo

    2002-03-01

    We report a previously healthy 73 years old woman, who was hospitalised with increasing dyspnea and signs of congestive heart failure. Echocardiography showed a normal left ventricular cavity with increased echogenicity of its walls and severe pulmonary hypertension. A lung ventilation/perfusion scintigraphy concluded that there was a low probability for pulmonary embolism. Coronary angiography was normal. A restrictive cardiomyopathy due to amyloid deposits was suspected. Myocardial pyrophosphate scintigraphy showed intense pyrophosphate uptake in the left ventricle wall. An abdominal fat tissue biopsy was positive for amyloid deposits. PMID:12043375

  15. Value of renal cortical scintigraphy in children with acute pyelonephritis

    Purpose: Acute pyelonephritis is a major cause of morbidity in children with urinary tract infection and can result in irreversible renal scarring leading to hypertension and end-stage renal disease. Tc-99m-dimercaptosuccinic acid (DMSA) scintigraphy is the imaging modality of choice for the detection of acute pyelonephhfis and renal scarfing. This study evaluated the importance of renal cortical scintigraphy to identify children at risk from renal damage due to acute pyelonephritis. Methods: Forty-nine children (ages 9 months to 11 years) with urinary tract infection having positive urine culture were studied. A DMSA scan was performed within 72 hours of receiving antibiotic during acute infection. Single or multiple areas of varying degrees of diminished cortical uptake or diffusely decreased uptake in an enlarged kidney was considered for the diagnosis of acute pyelonephrifis. Follow-up scintigraphy was done at 6 months of initial scan in children with acute pyelonephritis documented by DMSA scan. Renal scarring was considered if the affected kidney shows cortical thinning or focal cortical defect with loss of volume or become small kidney. Children with known renal tract abnormalities were excluded from the study. RESULTS: Twenty-seven children (55%) wine considered acute pyelonephritis by DMSA scintigraphy and the abnormality was bilateral in 17(63%) cases and unilateral in 10(37%) cases. Among these 44 abnormal kidneys, scintigraphy showed solitary defect in 29 kidneys, multiple defects in 6 kidneys and diffuse decreased uptake in 9 kidneys. Of them, twenty children were available for follow-up evaluation and scintigraphy demonstrated complete recovery in 21 of 34 (62%) kidneys and renal scarfing in 13 of 34 (38%) kidneys. Renal scarring was found in 5 of 7 kidneys (71%) with diffuse decreased uptake, 2 of 5 kidneys (40%) with multiple cortical defect and 6 of 22 (27%) with single focal detect. Conclusion: The scintigraphic pattern of acute pyelonephritis

  16. Myocardial ischemia in Kawasaki disease

    The detection of myocardial ischemia is essential for evaluation of patients with Kawasaki disease, especially who have had coronary artery lesions. To evaluate the clinical efficacy of Tl-201 single photon emission computed tomography (SPECT) after dipyridamole infusion (maximum dose 0.70 mg/kg) for detecting myocardial ischemia, 44 patients with Kawasaki disease aged 7.7±4.8 years at the study and 10 age matched controls were observed. In the Kawasaki disease group, significant coronary artery stenosis was observed in 14, coronary aneurysm without stenosis in 18, the regression of the coronary aneurysms in 2 and without coronary lesions in 10 patients. In 24 of 44 patients, treadmill exercise stress test was also performed at the same period. Myocardial ischemic changes were observed in 11 patients, all combined with significant coronary artery stenosis. The sensitivity of SPECT for detection of overall coronary stenosis was 79%, coronary that of treadmill exercise test was only 33% (p<0.001). Furthermore, among the patients having significant coronary stenosis, the severity score was significantly elevated in patients who had electrocardiographic abnormal Q wave compared to those without abnormal Q wave (51.0±38.8 versus 20.0±12.1, p<0.05). These data suggest that the pharmacological stress scintigraphy using dipyridamole injection provides not only the accurate detection but quantitative evaluation of myocardial ischemia in these patients. This noninvasive technique may become one of the most useful index for detection and follow-up of myocardial ischemia in Kawasaki disease. (author)

  17. Diagnostic value of a new myocardial perfusion agent, teboroxime (SO 30,217), utilizing a rapid planar imaging protocol: Preliminary results

    Technetium-99m-labeled agents have advantages over thallium-201 in terms of photon statistics, cost and clinical availability. They have been suggested as an alternative to thallium for myocardial perfusion imaging. Teboroxime is a new boronic acid adduct of technetium dioxime (BATO) compound that demonstrates favorable characteristics in preliminary studies. With use of a novel (seated) patient positioning technique and a rapid dynamic acquisition protocol, 30 patients underwent planar imaging with teboroxoime while at rest and after maximal treadmill exercise. Postexercise scans were completed in an average time (mean +/- SD) of 4.4 +/- 1.6 min, with 4.8 +/- 1.5 min for the views at rest. These results were compared with coronary arteriography or thallium scintigraphy after treadmill exercise, or both. Diagnostic agreement (abnormal versus normal) was present in 28 of the 30 patients (p less than 0.001). Regarding physiologic assessment as compared with thallium scintigraphy, the finding of infarction and ischemia was concordant in 89% and 86% of patients, respectively. This report describes the initial use of teboroxime with a rapid dynamic planar imaging technique, resulting in a high correlation with exercise thallium scintigraphy. Delayed postexercise images obtained 5 to 10 min after exercise demonstrated rapid disappearance of exercise-induced defects noted on the initial (0 to 5 min) postexercise views. The rapid differential washout with teboroxime has not been previously described and the possible clinical significance is discussed

  18. Diagnostic value of a new myocardial perfusion agent, teboroxime (SQ 30,217), utilizing a rapid planar imaging protocol: Preliminary results

    Hendel, R.C.; McSherry, B.; Karimeddini, M.; Leppo, J.A. (Univ. of Massachusetts Medical Center, Worcester (USA))

    1990-10-01

    Technetium-99m-labeled agents have advantages over thallium-201 in terms of photon statistics, cost and clinical availability. They have been suggested as an alternative to thallium for myocardial perfusion imaging. Teboroxime is a new boronic acid adduct of technetium dioxime (BATO) compound that demonstrates favorable characteristics in preliminary studies. With use of a novel (seated) patient positioning technique and a rapid dynamic acquisition protocol, 30 patients underwent planar imaging with teboroxime while at rest and after maximal treadmill exercise. Postexercise scans were completed in an average time (mean +/- SD) of 4.4 +/- 1.6 min, with 4.8 +/- 1.5 min for the views at rest. These results were compared with coronary arteriography or thallium scintigraphy after treadmill exercise, or both. Diagnostic agreement (abnormal versus normal) was present in 28 of the 30 patients (p less than 0.001). Regarding physiologic assessment as compared with thallium scintigraphy, the finding of infarction and ischemia was concordant in 89% and 86% of patients, respectively. This report describes the initial use of teboroxime with a rapid dynamic planar imaging technique, resulting in a high correlation with exercise thallium scintigraphy. Delayed postexercise images obtained 5 to 10 min after exercise demonstrated rapid disappearance of exercise-induced defects noted on the initial (0 to 5 min) postexercise views. The rapid differential washout with teboroxime has not been previously described and the possible clinical significance is discussed.

  19. Diagnostic value of a new myocardial perfusion agent, teboroxime (SO 30,217), utilizing a rapid planar imaging protocol: Preliminary results

    Hendel, R.C.; McSherry, B.; Karimeddini, M.; Leppo, J.A. (Univ. of Massachusettes Medical Center, Worcester (USA))

    1990-11-01

    Technetium-99m-labeled agents have advantages over thallium-201 in terms of photon statistics, cost and clinical availability. They have been suggested as an alternative to thallium for myocardial perfusion imaging. Teboroxime is a new boronic acid adduct of technetium dioxime (BATO) compound that demonstrates favorable characteristics in preliminary studies. With use of a novel (seated) patient positioning technique and a rapid dynamic acquisition protocol, 30 patients underwent planar imaging with teboroxoime while at rest and after maximal treadmill exercise. Postexercise scans were completed in an average time (mean +/- SD) of 4.4 +/- 1.6 min, with 4.8 +/- 1.5 min for the views at rest. These results were compared with coronary arteriography or thallium scintigraphy after treadmill exercise, or both. Diagnostic agreement (abnormal versus normal) was present in 28 of the 30 patients (p less than 0.001). Regarding physiologic assessment as compared with thallium scintigraphy, the finding of infarction and ischemia was concordant in 89% and 86% of patients, respectively. This report describes the initial use of teboroxime with a rapid dynamic planar imaging technique, resulting in a high correlation with exercise thallium scintigraphy. Delayed postexercise images obtained 5 to 10 min after exercise demonstrated rapid disappearance of exercise-induced defects noted on the initial (0 to 5 min) postexercise views. The rapid differential washout with teboroxime has not been previously described and the possible clinical significance is discussed.

  20. Prognostic significance of normal quantitative planar thallium-201 stress scintigraphy in patients with chest pain

    The prognostic significance of normal quantitative planar thallium-201 stress scintigraphy was evaluated in patients with a chest pain syndrome. The prevalence of cardiac events during follow-up was related to the pretest (that is, before stress scintigraphy) likelihood of coronary artery disease determined on the basis of symptoms, age, sex and stress electrocardiography. In a consecutive series of 344 patients who had adequate thallium-201 stress scintigrams, 95 had unequivocally normal studies by quantitative analysis. The pretest likelihood of coronary artery disease in the 95 patients had a bimodal distribution. During a mean follow-up period of 22 +/- 3 months, no patient died. Three patients (3%) had a cardiac event: two of these patients (pretest likelihood of coronary artery disease 54 and 94%) had a nonfatal myocardial infarction 8 and 22 months, respectively, after stress scintigraphy, and one patient (pretest likelihood 98%) underwent percutaneous transluminal coronary angioplasty 16 months after stress scintigraphy for persisting anginal complaints. Three patients were lost to follow-up; all three had a low pretest likelihood of coronary artery disease. It is concluded that patients with chest pain and normal findings on quantitative thallium-201 scintigraphy have an excellent prognosis. Cardiac events are rare (infarction rate 1% per year) and occur in patients with a moderate to high pretest likelihood of coronary artery disease

  1. Scintigraphic evaluation of myocardial infarction and regional ventricular performance using technetium-99m hexakis (t-butylisonitrile) technetium (I) (TBI): A new myocardial imaging agent

    Campbell, S.; Kirshenbaum, J.M.; Antman, E.M.; Lister-James, J.; Davison, A.; Kozlowski, J.; English, R.J.; Jones, A.G.; Holman, B.L.

    1986-09-01

    Technetium-99m hexakis (t-butylisonitrile) technetium(I) (sup(99m)Tc-TBI) is a new myocardial perfusion imaging agent. To determine its potential in the evaluation of myocardial infarction, 15 patients with suspected or confirmed acute infarction were studied by beside imaging in the coronary care unit. Good-quality planar scintigrams in multiple projections were obtained in 13 patients. Gated perfusion studies were performed in 14 patients, and for comparison 13 of these were restudied 24-72 h later by standard gated equilibrium blood pool radionuclide ventriculography. Conventional and planar scintigraphic criteria for myocardial infarction (acute or old) agreed in 12 (92%) patients (k=0.81, p<0.05). All the infarcations detected by scintigraphy were associated with electrocardiographic Q-waves. Localization of infarction by the electrocardiogram and scintigraphy exhibited moderate agreement (k=0.49, p<0.1). Regional wall motion analysis by standard radio-nuclide ventriculography and gated sup(99m)Tc-TBI scintigraphy were in complete agreement for 25 (64%) of 39 left ventricular segments (k=0.35, p<0.05). However, in 7 other segments, associated with areas of infarction, regional wall motion abnormalities were noted only on gated sup(99m)Tc-TBI scintigraphy. Therefore, sup(99m)Tc-TBI scintigraphy can readily provide data on regional myocardial perfusion and wall motion, permitting detection and localization of areas of myocardial infarction. The superior imaging properties, ready availability and low cost of sup(99m)Tc point to the considerable potential value of sup(99m)Tc-TBI in assessing patients with suspected or confirmed myocardial infarction.

  2. The scintigraphic evaluation of myocardial infarction and regional ventricular performance using technetium-99m hexakis (t-butylisonitrile) technetium (I) (TBI): A new myocardial imaging agent

    Technetium-99m hexakis (t-butylisonitrile) technetium(I) (sup(99m)Tc-TBI) is a new myocardial perfusion imaging agent. To determine its potential in the evaluation of myocardial infarction, 15 patients with suspected or confirmed acute infarction were studied by beside imaging in the coronary care unit. Good-quality planar scintigrams in multiple projections were obtained in 13 patients. Gated perfusion studies were performed in 14 patients, and for comparison 13 of these were restudied 24-72 h later by standard gated equilibrium blood pool radionuclide ventriculography. Conventional and planar scintigraphic criteria for myocardial infarction (acute or old) agreed in 12 (92%) patients (k=0.81, p<0.05). All the infarcations detected by scintigraphy were associated with electrocardiographic Q-waves. Localization of infarction by the electrocardiogram and scintigraphy exhibited moderate agreement (k=0.49, p<0.1). Regional wall motion analysis by standard radio-nuclide ventriculography and gated sup(99m)Tc-TBI scintigraphy were in complete agreement for 25 (64%) of 39 left ventricular segments (k=0.35, p<0.05). However, in 7 other segments, associated with areas of infarction, regional wall motion abnormalities were noted only on gated sup(99m)Tc-TBI scintigraphy. Therefore, sup(99m)Tc-TBI scintigraphy can readily provide data on regional myocardial perfusion and wall motion, permitting detection and localization of areas of myocardial infarction. The superior imaging properties, ready availability and low cost of sup(99m)Tc point to the considerable potential value of sup(99m)Tc-TBI in assessing patients with suspected or confirmed myocardial infarction. (orig.)

  3. The role of DMSA renal scintigraphy in the first episode of urinary tract infection in childhood

    The role of dimercaptosuccinic acid (DMSA) renal scintigraphy in the first episode of urinary tract infection (UTI) has been the subject of debate for many years. The aim of this study was to evaluate the relationship of voiding cystourethrography (VCUG), renal ultrasonography and DMSA renal scintigraphy and to detect renal parenchymal changes by performing DMSA renal scintigraphy at 6 months after the first episode of UTI. A prospective study was conducted in 67 hospitalized children (46 boys, 21 girls). Mean age of the patients was 0.97±1.57 years (0.02-7.26 years). All children received VCUG, renal ultrasonography and DMSA renal scintigraphy. DMSA renal scintigraphy was performed at 1 and 6 months after UTI. Of 67 children, 17 (25.4%), 23 (34.3%) and 20 (29.9%) had vesicoureteral reflux (VUR), abnormal renal ultrasonography and abnormal DMSA renal scintigraphy, respectively. Unilateral hydronephrosis had a significant correlation with VUR at p value 0.024. In renal units, abnormal renal ultrasonography and hydronephrosis had significant correlations with VUR at p values 0.039 and 0.021, respectively. In patients and renal units, hydronephrosis had no significant correlation with abnormal DMSA renal scintigraphy at 1 month after UTI. However, abnormal renal ultrasonography and VUR had significant correlations with abnormal DMSA renal scintigraphy at p values 0.022 and <0.001 in patients and at p values 0.024 and <0.001 in renal units, respectively. Both in patients and renal units, VUR (Grade I-III) had no significant correlation with abnormal DMSA renal scintigraphy. However, severe VUR (Grade IV-V) had significant correlations with abnormal DMSA renal scintigraphy at p values <0.001 and <0.001, respectively. Seventeen patients underwent DMSA renal scintigraphy at 6 months after UTI. In addition, 15 (88.2%) developed persistent renal scarring. Abnormal renal ultrasonography and severe VUR identify renal parenchymal changes. DMSA renal scintigraphy in the first

  4. A preliminary feasibility study of simultaneous dual-isotope imaging with a solid-state dedicated cardiac camera for evaluating myocardial perfusion and fatty acid metabolism.

    Ko, Toshiyuki; Utanohara, Yuko; Suzuki, Yasuhiro; Kurihara, Makiko; Iguchi, Nobuo; Umemura, Jun; Sumiyoshi, Tetsuya; Tomoike, Hitonobu

    2016-01-01

    Simultaneous dual-isotope SPECT imaging with 201Tl and (123)I-β-methyl-p-iodophenylpentadecanoic acid (BMIPP) is used to study the perfusion-metabolism mismatch. It predicts post-ischemic functional recovery by detecting stunned myocardium. On the other hand, (99m)Tc-MIBI is another radioisotope widely used in myocardial perfusion imaging because of its better image quality and lower radiation exposure than 201Tl. However, since the photopeak energies of (99m)Tc and (123)I are very similar, crosstalk hampers the simultaneous use of these two radioisotopes. To overcome this problem, we conducted simultaneous dual-isotope imaging study using the D-SPECT scanner (Spectrum-Dynamics, Israel) which has a novel detector design and excellent energy resolution. We first conducted a basic experiment using cardiac phantom to simulate the condition of normal perfusion and impaired fatty acid metabolism. Subsequently, we prospectively recruited 30 consecutive patients who underwent successful percutaneous coronary intervention for acute myocardial infarction, and performed (99m)Tc-MIBI/(123)I-BMIPP dual-isotope imaging within 5 days after reperfusion. Images were interpreted by two experienced cardiovascular radiologists to identify the infarcted and stunned areas based on the coronary artery territories. As a result, cardiac phantom experiment revealed no significant crosstalk between (99m)Tc and (123)I. In the subsequent clinical study, (99m)Tc-MIBI/(123)I-BMIPP dual-isotope imaging in all participant yielded excellent image quality and detected infarcted and stunned areas correctly when compared with coronary angiographic findings. Furthermore, we were able to reduce radiation exposure to significantly approximately one-eighth. In conclusion, we successfully demonstrated the practical application of simultaneous assessment of myocardial perfusion and fatty acid metabolism by (99m)Tc-MIBI and (123)I-BMIPP using a D-SPECT cardiac scanner. Compared with conventional (201)Tl

  5. Thyroid scintigraphy in veterinary medicine.

    Daniel, Gregory B; Neelis, Dana A

    2014-01-01

    Thyroid scintigraphy is performed in cats and dogs and has been used to a limited degree in other species such as the horse. Thyroid scintigraphy is most commonly used to aid in the diagnosis and treatment management of feline hyperthyroidism but is also used in the evaluation of canine hypothyroidism and canine thyroid carcinoma. This article reviews the normal scintigraphic appearance of the thyroid in the cat, the dog, and the horse and the principles of interpretation of abnormal scan results in the cat and the dog. Radioiodine is the treatment of choice for feline hyperthyroidism, and the principles of its use in the cat are reviewed. PMID:24314043

  6. Myocardial performance and perfusion during exercise in patients with coronary artery disease caused by Kawasaki disease

    For a study of the natural history of coronary artery lesions after Kawasaki disease and their effect on myocardial blood flow reserve with exercise, five such patients underwent exercise testing on a bicycle. Oxygen consumption, carbon dioxide production, minute ventilation, and electrocardiograms were monitored continuously. Thallium-201 scintigraphy was performed for all patients. One patient stopped exercise before exhaustion of cardiovascular reserve but had no evidence of myocardial perfusion abnormalities. Four patients terminated exercise because of exhaustion of cardiovascular reserve; one had normal cardiovascular reserve and thallium scintiscans, but the remaining patients had diminished cardiovascular reserve. Thallium scintigrams showed myocardial ischemia in two and infarction in one. No patient had exercise-induced electrocardiographic changes. These results indicate that patients with residual coronary artery lesions after Kawasaki disease frequently have reduced cardiovascular reserve during exercise. The addition of thallium scintigraphy and metabolic measurements to exercise testing improved the detection of exercise-induced abnormalities of myocardial perfusion

  7. Relationship between branched-chain amino acid to tyrosine ratio (BTR) and porta-systemic shunt in the child-pugh grade a cirrhosis determined by per-rectal portal scintigraphy

    Purpose: It has been reported that the branched-chain amino acid (BCAA) to aromatic amino acid (AAA) ratio (Fisher $B!G (Bs ratio) is an important prognostic factor in cirrhosis. The clinical significance of the ratio of serum molar concentration of BCAA to that of tyrosine (BCAA to tyrosine ratio; BTR) resembles that of Fisher $B!G (Bs ratio, In Japan, because determination of BTR simpler and cheaper than that of Fisher $B!G (Bs ratio, BTR is now widely used for assessment of abnormality of amino acid metabolism in cirrhosis. In this study, we examined the difference between early cirrhotic patients with lower BTR and higher BTR in portal circulation using per-rectal portal scintigraphy with technetium-99m (99mTc) pertechnetate. Patients and Methods: Forty patients with Child-Pugh grade A cirrhosis and serum albumin level between 3.5 g/dl and 3.9 g/dl were enrolled in this study. Sixteen patients were infected with HBV and 24 with HCV. At entry, we measured the ratio of serum molar concentration of BCAA to that of tyrosine (BTR). BTR was measured by an enzymatic method (Ono Pharmaceutical Co., Ltd., Osaka, Japan). Thirteen patients had BTR 4.0. At the same time, we measured serum albumin, platelets, total bilirubin, prothrombin test, retention of indocyanine green in plasma after 15 minutes (ICGR-15) and NH3. To evaluate the portal circulation, all patients underwent per-rectal portal scintigraphy. A 370 MBq portion of 99mTc-pertechnetate (2 ml) was first given per rectum through a polyethylene tube, followed by 15 ml of air. Then time-activity curves for the heart and liver areas were obtained every 4 sec. At the enol of the 5 min-examinations, the 5-min summed image displayed in color was recorded. To evaluate the extent of porta-systemic shunt by shunt index (SI), we calculated the ratio of counts for the liver to counts for the heart integrated for 24 seconds immediately after the appearance of the liver time-activity curve. Results: Shunt index obtained

  8. Myocardial bridging: A ‘forgotten’ cause of acute coronary syndrome – a case report

    Ripa, Chiara; Melatini, Maria Cristina; Olivieri, Fabiola; Antonicelli, Roberto

    2007-01-01

    During a stress test, an asymptomatic 40-year-old man showed an ST depression above 4 mm and a horizontal ST depression above 2 mm in the V3 to V6 precordial leads during the recovery phase, without symptoms related to myocardial ischemia. After several days, he experienced recurrent episodes of oppressive retrosternal pain with radiation to the interscapular region, associated with stress dyspnea. Stress myocardial scintigraphy using technetium sestamibi was performed, which showed a modest ...

  9. Effect of stenosed and occluded coronary arteries on immediate and late myocardial uptake of thallium-201.

    Clitsakis, D; Layton, C A; Battersby, W; Johns, M; Stockley, A V

    1981-01-01

    Exercise and redistribution myocardial scintigraphy using thallium-201 was compared with the left ventricular angiogram and with the presence of stenosis or occlusion of coronary arteries on angiography. Irreversible scintigraphic defects representing areas of myocardial infarction were found in all patients with occlusion of the left anterior descending artery but nearly one-third of patients with stenosis of that artery also showed evidence of infarction. For the right coronary or circumfle...

  10. Preparation of carbon-11 labelled acetate and palmitic acid for the study of myocardial metabolism by emission-computerised axial tomography

    Methods have been developed for the labelling of acetate and palmitic acid with the positron-emitting radionuclide, 11C(T=20.4 min). Labelling was achieved via carbonation of the appropriate alkyl magnesium bromide (methyl magnesium bromide or n-pentadecyl magnesium bromide) with 11C-labelled carbon dioxide produced by the 14Np(p,α)11C nuclear reaction. The radiochemical yield and speed of each method of labelling are such that a radiochemically pure product is obtained in injectable form and in activity (>10 mCi) suitable for the study of myocardial metabolism by emission-computerised axial tomography. High pressure liquid chromatography and thin layer chromatography were used to assess the radiochemical purity of each radiopharmaceutical. The specific activity of 11C-labelled acetate was estimated by an enzymic procedure to be greater than 0.5 Ci/μmole. (author)

  11. Serial change of 123I-BMIPP SPECT imaging during recovery from stunned myocardium after acute myocardial infarction. Correlation with 201Tl and two-dimensional echocardiography

    Using 123I-β-methyl iodophenyl pentadecanoic acid (123I-BMIPP), we investigated changes in myocardial fatty acid metabolism at recovery from stunned myocardium after acute myocardial infarction (AMI), correlation with recovery of regional wall motion and thallium-201 (201Tl) distribution in particular. The subjects were 15 patients who underwent successful reperfusion therapy after the first onset of AMI. None of the patients had multi-vessel disease or ischemic episode during their clinical course. Patients underwent 123I-BMIPP scintigraphy, 201Tl scintigraphy and two-dimensional echocardiography during the acute and chronic phases. Then, we compared regional wall motion with distribution of 123I-BMIPP and 201Tl. Regional wall motion and SPECT were evaluated by the established 16 segment model. In patients, showing serial improvement in regional wall motion, there was 80.0% (8/10) showed normal 201Tl distribution during the acute phase or normalized during the chronic phase. However, distribution of 123I-BMIPP normalized only in 10.0% (1/10) of this group. In examination of each segment that showed serial improvement in regional wall motion, 92.3% (24/26) of these segments showed normal distribution of 201Tl during the acute phase or normalized distribution during chronic phase, despite distribution of 123I-BMIPP improved in only 3.8% (1/26) of these segments. These indicate that, in the process of recovery from myocardial stunning after AMI, abnormal distribution of 123I-BMIPP continued longer than abnormal distribution of 201Tl. (author)

  12. Gallium scintigraphy in acute panniculitis

    Gallium scintigraphy was performed in a 27-yr-old female in search of a possible occult focus of infection; it showed an unusual diffuse superficial accumulation in the thighs and buttocks. Biopsy of an area of abnormal uptake showed lobular panniculitis which, in the clinical context, led to the diagnosis of Weber-Christian syndrome

  13. A parathyroid scintigraphy case study

    O' Leary, Desiree [UCD School of Diagnostic Imaging, St Anthony' s Campus, Herbert Avenue, Dublin 4 (Ireland)]. E-mail: desiree.oleary@ucd.ie

    2005-05-01

    Background: There has been much debate concerning the most suitable protocol for parathyroid scintigraphy; the merits of various radiopharmaceuticals versus the correct imaging protocol to visualise both ectopic and anatomically placed adenomas against the various equipment choices have been debated. Aim: To demonstrate, through the use of a case study, the necessity of changing imaging protocols for parathyroid scintigraphy where a definitive imaging diagnosis is absent in the face of strong clinical suspicion. Method: Use is made of Tc99mMIBI, full field chest scintigraphy, a clearly defined imaging protocol and SPECT imaging to locate ectopic parathyroid tissue in a female patient with significant symptoms of parathyroid hyperfunction. Results: A single hyperfunctioning adenoma is located in the pre-carinal area of the mediastinum. Using a radioguided surgical technique the hyperfunctioning tissue is excised and confirmed by histopathology. Conclusion: Whilst a dramatic reduction in patient symptoms was not seen immediately in this patient, the symptoms of the illness have been subsiding since January 2003. This case study demonstrates the necessity of changing imaging protocols for parathyroid scintigraphy where a definitive imaging diagnosis is absent in the face of strong clinical suspicion.

  14. Dynamic oesophageal scintigraphy in achalasia

    The dynamic oesophageal scintigraphy and the 'condensed image' of the dynamic study was performed in 15 patients (5 women and 10 men) with mean age 53 ± 6 years. In all patients it was found a retention of the radioactive water bolus in the proximal and middle third of the oesophagus. The radionuclide oesophageal transit was impaired in achalasia. (author)

  15. Bone scintigraphy in children: trauma

    The sensitivity of radionuclide imaging in identifying skeletal trauma in children has been established. Growth plates present a set of problems unique to pediatric studies and diagnotic accuracy is very technique dependent. Imaging for sports injuries and suspected child abuse has been productive. An expanding role for bone scintigraphy in the management of orthopedic problems post-trauma is developing

  16. Scintigraphic evaluation of experimental myocardial ischemia evidenced by morphologic examination

    Due to the fact that there were difficulties in interpreting the cardiac scintigrams after 99mTc pyrophosphate had been given to patients with coronary heart disease without acute myocardial infarction, an experimental study was undertaken. The scintigraphic characteristics were examined in 10 cats following ligation of the interventricular artery for more than 20 min. The histochemical and electron microscopic studies indicated that there were both reversible and irreversible cardiomyocyte lesions. Reversible myocardial changes were detected not only in the ischemic area, but in the other myocardial regions away from the basin of the ligated artery. There is experimental evidence for applying 99mTc-pyrophosphate scintigraphy in the clinical setting to reveal reversible myocardial changes that are most common in chronic coronary heart disease

  17. Scintigraphy, pH measurement and radiography in the evaluation of gastroesophageal reflux

    Scintigraphy as a diagnostic tool has been explored in 69 patients with gastroesophageal reflux (GER) symptoms and endoscopic esophagitis. In all subjects the presence of reflux was also evaluated by radiography and intraesophageal pH measurements (standard acid reflux test). The overall sensitivity of scintigraphy (85.5%) was significantly higher than those of radiography (27.5%) and pH measurements (69.5%). Scintigraphy was performed with normal saline and with acidified orange juice as the transport medium for the isotope 99mTc. The yield of positive scintigrams was higher (22.3 to 61.1%, depending on the grade of endoscopic esophagitis) with the latter variant. Moreover, demonstration of spontaneous reflux was greatly facilitated by the acid scintigraphy. This was particularly obvious in the grade I esophagitis, in which the freqency of spontaneous reflux with saline method was 3.4% and with acid medium 34/3%. Reflux (induced or spontaneous) was seen in 22 normal control subjects with the saline method, and in 1 subject only with the acid method. On the basis of these findings it is concluded that scintigraphy, especially the acid variant of the technique, is a valuable diagnostic procedure in GER disease

  18. Serial Myocardial Imaging after a Single Dose of Thallium-201

    Takahiko Kamata

    2014-10-01

    Full Text Available Although thallium-201 exercise scintigraphy has been established for the detection of myocardial ischemia and viability, little is known regarding the myocardial thallium-201 kinetics during angioplasty. Herein, we report a 77-year old man with angina pectoris, in whom serial myocardial imaging after a single dose of thallium-201 was helpful in identifying not only the culprit lesion and myocardial viability, but also the dynamic changes in myocardial perfusion during angioplasty. Thallium-201 images after exercise showed a perfusion defect in the inferior wall, with a trivial redistribution 3 hours after the exercise and a marked improvement 24 hours later. Coronary angiography, performed 27 hours after exercise scintigraphy, showed severe stenosis in the right coronary artery. Guidewire crossing of the lesion interrupted the antegrade flow, which was restored after balloon dilation and stent implantation. Thallium-201 images, 2 hours after angioplasty (i.e., 30 hours after exercise, showed a decreased tracer uptake in the inferior wall, which improved the next day (i.e., 48 hours after exercise. Cardiac biomarkers were negative in the clinical course.

  19. Amnestic mild cognitive impairment with low myocardial metaiodobenzylguanidine uptake

    Sakakibara, Ryuji; Ogata, Takeshi; Haruta, Masayuki; Kishi, Masahiko; Tsuyusaki, Yohei; Tateno, Akihiko; Tateno, Fuyuki; Mouri, Takayuki

    2012-01-01

    Objectives: We reported cases of amnestic mild cognitive impairment (MCI) without the core clinical features of dementia with Lewy bodies (DLB) (dementia and spontaneous parkinsonism) with low uptake in 123I-metaiodobenzylguanidine (MIBG) myocardial scintigraphy. Methods: During a 3-year period at a university clinic, we had 254 patients with memory complaints; 106 men, 148 women; mean age 72.5 years (48-95 years). In all patients we performed neurologic examination; memory tests including th...

  20. Prevalence of asymptomatic myocardial ischaemia in diabetic subjects.

    Koistinen, M J

    1990-01-01

    OBJECTIVE--To compare the prevalence of silent myocardial ischaemia associated with coronary artery disease in diabetic subjects with that in controls of similar age and sex. DESIGN--A controlled study in which subjects with positive findings on exercise electrocardiography, 24 hour electrocardiographic recording, or dynamic thallium scintigraphy (diabetics only) underwent coronary angiography. SETTING--Academic medical centre; referral based cardiology clinic. SUBJECTS--136 Diabetic subjects...

  1. Characterization of 99mTc(CO)3-iminodiacetic acid (IDA) and its comparison with 99mTc-(IDA)2 using compounds for hepatobiliary scintigraphy

    The organometallic precursor of fac-[99mTc(CO)3(H2O)3]+ has attracted much attention because of the robustness and small size of Tc(I)-tricarbonyl complexes compared to Tc(V) complexes and the good labeling affinity with a variety of donor atoms. Among various ligand systems, an iminodiacetic acid (IDA) was proven as a good chelating group to form a Tc(III)-complex as well as has been shown its potential as a chelating system for fac-[99mTc(CO)3] precursor. In an attempt to confirm the similarity and the difference between 99mTc(CO)3-IDA and 99mTc-(IDA)2-complex, M(CO)3-IDA (M = 99mTc, Re) complexes of disofenin, mebrofenin and N-(3-iodo-2,4,6-trimethyl phenylcarbamoylmethyl) iminodiacetic acid were prepared, and the biological evaluation of 99mTc(CO)3-disofenin was performed. The 99mTc(CO)3-IDA complexes were prepared with a high radiolabeling yield (>98%) in a quantitative manner and showed a negative charge. The in vivo pharmacokinetic behavior of 99mTc(CO)3-disofenin showed a similar biological activity to 99mTc-(disofenin)2 in that those complexes were quickly cleared from the blood by the hepatocytes and excreted into the gallbladder and intestine. Accordingly, the 99mTc(CO)3-IDA derivatives of disofenin and mebrofenin might be used as hepatobiliary imaging agents. Since an IDA is a promising chelator for 99mTc-based radiopharmaceutical and the biological properties of 99mTc(CO)3-IDA derivative shows similar to that of 99mTc-complex, a biomolecule containing IDA can be freely radiolabeled with fac-[99mTc(CO)3]-precursor or 99mTc. However, the radiolabeling efficiency and the biological behavior demonstrates the favorable properties of 99mTc(CO)3-IDA compound for the development of a new imaging agent. (author)

  2. Study of pathophysiology of pulmonary circulation in polycythemia using scintigraphy

    Fujii, Tadashige; Tanaka, Masao; Takeda, Tadashi; Kawashima, Akira; Kubo, Keiji; Kobayashi, Toshio; Handa, Kenjiro; Yoshimura, Kazuhiko (Shinshu Univ., Matsumoto, Nagano (Japan). Faculty of Medicine)

    1993-09-01

    In order to evaluate the pathophysiology of pulmonary circulation in polycythemia, Tl-201 myocardial scintigraphy and perfusion lung scintigraphy with 99m-Tc-MAA were performed in 19 cases of polycythemia including polycythemia rubra vera and in 11 cases of secondary polycythemia due to pulmonary diseases. Tl-201 lung uptake, right ventricular visualization and pulmonary perfusion impairment were studied. In the 19 cases, Tl-201 lung uptake was observed in all cases and 54.5% of them showed moderate lung uptake. The grade of right ventricular visualization was moderate in one case and slight in 16 cases; right ventricular hypertrophy was shown in 89.5% of all cases by Tl-201 scintigraphy, only one of which showed right ventricular hypertrophy on electrocardiography. Abnormalities of lung perfusion consisted of scattered small areas of hypoperfusion in 36.8%, peripheral hypoperfusion in 78.9% and uneven distribution of pulmonary perfusion in 94.7%. The degree of hypoperfusion was slightly related to decrease in FEV 1.0%, V25 and PaO[sub 2] and increase in circulating blood volume and peripheral red blood cell counts. Abnormalities of pulmonary function consisted of increased RV/TLC in 50.0%, increased CV/VC in 35.7% and decreased V25 in 36.8%. Arterial blood gases showed hypoxemia in 57.1%, the degree of which was slightly related to increase in RV/TLC and CV/VC and decrease in V25. Cases of secondary polycythemia due to pulmonary diseases showed more marked right ventricular visualization, pulmonary perfusion impairment and abnormalities of various kinds of pulmonary function than polycythemia rubra vera cases. It seems to be important to evaluate the pathophysiology of pulmonary circulation in polycythemia rubra vera as well as secondary polycythemia due to cardio-pulmonary diseases, because pulmonary perfusion impairment and moderate right ventricular visualization are observed frequently in polycythemia rubra vera. (author).

  3. Study of pathophysiology of pulmonary circulation in polycythemia using scintigraphy

    In order to evaluate the pathophysiology of pulmonary circulation in polycythemia, Tl-201 myocardial scintigraphy and perfusion lung scintigraphy with 99m-Tc-MAA were performed in 19 cases of polycythemia including polycythemia rubra vera and in 11 cases of secondary polycythemia due to pulmonary diseases. Tl-201 lung uptake, right ventricular visualization and pulmonary perfusion impairment were studied. In the 19 cases, Tl-201 lung uptake was observed in all cases and 54.5% of them showed moderate lung uptake. The grade of right ventricular visualization was moderate in one case and slight in 16 cases; right ventricular hypertrophy was shown in 89.5% of all cases by Tl-201 scintigraphy, only one of which showed right ventricular hypertrophy on electrocardiography. Abnormalities of lung perfusion consisted of scattered small areas of hypoperfusion in 36.8%, peripheral hypoperfusion in 78.9% and uneven distribution of pulmonary perfusion in 94.7%. The degree of hypoperfusion was slightly related to decrease in FEV 1.0%, V25 and PaO2 and increase in circulating blood volume and peripheral red blood cell counts. Abnormalities of pulmonary function consisted of increased RV/TLC in 50.0%, increased CV/VC in 35.7% and decreased V25 in 36.8%. Arterial blood gases showed hypoxemia in 57.1%, the degree of which was slightly related to increase in RV/TLC and CV/VC and decrease in V25. Cases of secondary polycythemia due to pulmonary diseases showed more marked right ventricular visualization, pulmonary perfusion impairment and abnormalities of various kinds of pulmonary function than polycythemia rubra vera cases. It seems to be important to evaluate the pathophysiology of pulmonary circulation in polycythemia rubra vera as well as secondary polycythemia due to cardio-pulmonary diseases, because pulmonary perfusion impairment and moderate right ventricular visualization are observed frequently in polycythemia rubra vera. (author)

  4. Scintigraphy of spinal disorders in adolescents

    Bone scintigraphy in adolescents is useful in helping to differentiate between developmental (atypical lumbar Scheuermann disease), infectious (discitis, osteomyelitis), neoplastic (osteoid osteoma, osteoblastoma), and traumatic (occult fractures, spondylolysis, pseudoarthrosis) disease of the spine. Double-phase (blood pool, delayed images) scintigraphy can characterize the pattern (i.e., linear in fracture, ovoid in nidus of osteoid osteoma). Single-photon emission computed tomography (SPECT) can be helpful in detecting the subtle presence of stress reaction (spondylolyses) not noted on routine planar scintigraphy and radiography. Bone scintigraphy is most beneficial when correlated with other imaging modalities in refining the diagnosis of spinal diseases. (orig.)

  5. Scintigraphy with Tc99m-MIBI to annual prediction the evolution of women referred for evaluation of precordial pain

    In order to evaluate the capacity of myocardial perfusion scintigraphy with Tc99m-MIBI to predict the evolution of women referred for evaluation of precordial pain, the rates of cardiovascular events at one year were studied in a group of patients with normal scintigraphy (group 1: 17 patients) and in another with reversible perfusion defects (group 2: 17 patients). The one-day protocol was applied for scintigraphy with Tc99m-MIBI (rest/stress) with combined stress (ergometrin bicycle plus 0.28 mg/Ig of dipyridamole) in those cases where it was necessary. A quantitative and qualitative analysis of the regional uptake was made. Patients from group 1 were younger than those from group 2 (average age: 49 vs 55, respectively, p = 0.04) and they had less hypercholesterolemia (112 % vs 59 %, respectively, p = 0.01). The rates of appearance of cardiovascular events at one year were calculated for patients from group 2 by using the Kaplan-Meier's method. The rates of appearance of clinical events (myocardial infarction and unstable angina) and of revascularization procedures (percutaneous transluminal coronary angioplasty and aortocoronary bypass surgery) were 0.24 in both cases. Only a patient from group 1 presented varying angina at 5 months. No deaths were reported in any of the groups. 94 % of the patients with normal perfusion scintigraphy were free of events after a one-year follow-up, whereas only 53 % of those with reversible perfusion defects showed a similar behavior. It was concluded that myocardial perfusion scintigraphy with Tc99m-MIBI is a useful tool to predict the evolution of women referred for evaluation of precordial pain at one year

  6. Bone scintigraphy in drug addiction

    Lopez-Majano, V.; Miskew, D.; Sansi, P.

    1981-01-01

    In 22 drug addicts, the clinical diagnosis of osteomyelitis and/or septic arthritis was suspected because of symptoms of sepsis and pain in various locations. All patients underwent bone scintigraphy with 17-20 mCi of /sup 99/sup(m)Tc labeling either pyrophosphate or methylene diphosphonate. Whole body and spot scans located the area of disease in most patients. This permitted biopsy of the affected area when the pathogen recurs. One of the two patients whose scintigrams were normal was on adequate treatment before the bone scintigram and the other was on oxacillin. Radiographs of the affected areas were normal, which indicates bone scintigraphy should be preferred to radiography in the early diagnosis of osseous infections.

  7. Bone scintigraphy in drug addiction

    In 22 drug addicts, the clinical diagnosis of osteomyelitis and/or septic arthritis was suspected because of symptoms of sepsis and pain in various locations. All patients underwent bone scintigraphy with 17-20 mCi of 99sup(m)Tc labeling either pyrophosphate or methylene diphosphonate. Whole body and spot scans located the area of disease in most patients. This permitted biopsy of the affected area when the pathogen recurs. One of the two patients whose scintigrams were normal was on adequate treatment before the bone scintigram and the other was on oxacillin. Radiographs of the affected areas were normal, which indicates bone scintigraphy should be preferred to radiography in the early diagnosis of osseous infections. (orig.)

  8. Liver scintigraphy of fulminant hepatitis

    The liver scintigraphies of five patients with fulminant hepatitis were examined. Scintiphotos using sup(99m)Tc-phytate were taken within two weeks after the onset. Scintiphotos of 12 normal subjects, 11 cases with acute hepatitis, 17 cases with liver cirrhosis were served as control. Their scintiphotos showed reduction of the size, well-maintained uptake, mostly homogenous RI distribution, and no left lobe enlargement, which could differentiate them from the chronic liver dysfunction. In one of the cases chronological changes in liver scintigraphy were observed. The size of the liver was reduced progressively until the 16th day and re-enlarged at the 30th day and thereafter. Three indices [S/W, (R + L)/W, and L/R] were calculated. S: area of liver, R or L: longitudinal length of the right or left lobe, W: body width. Relative size of the liver expressed by S/W or (R + L)/W showed significant reduction in fulminant hepatitis compared with acute hepatitis. However, they were not different significantly from those of normal subjects. Except for liver cirrhosis, L/R (left lobe swelling index) did not show significant differences among fulminant hepatitis, normal subjects, and acute hepatitis. These indices were also useful in follow-up study of the liver scintigraphy. The liver scintigraphy in the early phase of fulminant hepatitis seems to reflect the degree of massive hepatic necrosis. It is also useful to differentiate chronic hepatic failure. Apparant reduction in scintigraphical liver size seems to suggest poor prognosis, however, it should also kept in mind that the size of the liver in this condition might change quite rapidly and greatly. (author)

  9. Changes in endothelium-derived vascular regulatory factors during dobutamine-stress-induced silent myocardial ischemia in patients with Kawasaki disease.

    Hino, Y; Ohkubo, T; Katsube, Y; Ogawa, S

    1999-07-01

    The changes in endothelium-derived vascular regulatory factors during dobutamine (DOB)-induced myocardial ischemia (MI) were investigated in 21 patients with Kawasaki disease aged from 11 months to 18 years. They were classified into an ischemia group (8 patients) and a non-ischemia group (13 patients) based on the results of 99mTc myocardial scintigraphy and DOB stress 99mTc myocardial scintigraphy. In the ischemia group, MI was relatively mild, because there were ischemic changes on the electrocardiogram and no significant symptoms during DOB stress. Catheters were positioned near the orifice of the coronary artery (Ao) and at the coronary sinus (CS). Hemodynamics and the blood concentrations of lactic acid and endothelin-1, as well as NO3-, 6-keto-prostaglandin F1alpha, and thromboxane B2, (which are inactive metabolites of nitric oxide, prostaglandin I2 and thromboxane A2, respectively), were measured at rest and after DOB stress (maximum dose: 30 microg x kg(-1) x min(-1)). The CS/Ao ratio was determined for all parameters. The rate-pressure product, an index of work load, and the cardiac index were significantly increased by DOB stress in both groups. Coronary angiography showed no vasospasm of the epicardial coronary arteries before or after DOB stress in either group. The plasma concentrations of endothelin-1 and 6-keto-prostaglandin F1alpha were significantly increased after DOB stress in the ischemia group, but the serum concentration of NO did not increase. The lack of an increase in NO production during DOB stress may have contributed to the worsening of MI in patients with Kawasaki disease. PMID:10462014

  10. Isotopic scintigraphy in kidney grafting

    Isotopic explorations of kidney transplants were performed on sixty-six patients. Three scintigraphic techniques were used: labelled ferrous ascorbate scintigraphy, sequential 99m technetium DTPA scintigraphy and the 131I hippuran nephrogram. The aim of this study is to analyse the results obtained under different pathological circumstances affecting the transplant, to discuss the advantages of the techniques and to propose a working procedure. The most reliable and accurate technique is the 131I hippuran nephrogram combined with sequential 99mTc DTPA, by which renal vascularisation may be judged labelled ferrous ascorbate on the other hand is too insensitive. Although the information supplied is mostly contained in the scintigraphic images, the nephrographic curves and the blood radioactivity decay time and rad V/rad R ratio measurements are very helpful in the early diagnosis and differential diagnosis of complications affecting the transplant. The proper use of isotopic scintigraphy in kidney grafting should provide optimum conditions for better survival of the transplant at minimum risk to the patient

  11. Reorganization of microcirculation in the lungs during rehabilitation of patients after myocardial infarction

    A study was made of the regional distribution of the pulmonary blood flow by means of perfusion scintigraphy of the lungs with 99mTc-albumin macroaggregates with relation to a clinical course of IHD, the state of intracardiac and pulmonary hemodynamics. The time course of microcirculation in the lesser blood flow during rehabilitation of patents after myocardial infarction was assessed. Redistribution of the pulmonary blood flow was shown to be connected with the clinical features of a course of IHD, severity of myocardial lesion, and a degree of disorder of intracardiac and pulmonary hemodynamics. Therefore these changes can be of important prognostic value in patients after myocardial infarction

  12. Role of hepatobiliary scintigraphy in biliary ascariasis

    Following the introduction of immunodiacetic acid (IDA) compounds labelled with 99Tcm, hepatobiliary scintigraphy has successfully been used to identify a variety of hepatobiliary pathologies. This study deals with the scintigraphic findings in patients having involvement of the hepatobiliary system with ascariasis. Patients clinically suspected of having hepatobiliary pathology were routinely sent for radionuclide evaluation of the hepatobiliary system. 99Tcm HIDA, EHIDA or BULLIDA was injected under the gamma camera and one min frames were collected for 40 min over the abdominal region using an on-line computer. After the sequential study was over, if the gallbladder was not visualized, late pictures were taken until the gallbladder was seen or for 4 hours, whichever was earlier. When the gallbladder was visualized, post-fatty-meal images were made for visual analysis and time/activity curves were generated over regions of interest for further evaluation. Patients having total or partial subhepatic biliary channel obstruction with or without dilatation of intrahepatic ducts were subjected to endoscopic retrograde cholangio-pancreatography (ERCP) within the next two to three days. Out of 360 patients thus evaluated, 84 (23%) showed partial, total or near total subhepatic obstruction. In 55 cases the whole biliary tree was dilated; in 17 cases the left hepatic duct and the common bile duct (CBD); in seven cases the left hepatic duct alone, and in five cases the CBD alone. ERCP findings were concurrent in most cases. However, in 13 cases no abnormality of the biliary tree could be detected by ERCP, although worms were found in the duodenum. In 28 cases single or multiple worms were found inside the hepatobiliary channel. Video recordings of the ERCP revealed in some cases that the worms were moving in and out of the biliary channel. In 41 cases of proven biliary ascariasis, scintigraphic finding was indicative in all cases. Hepatobiliary scintigraphy appears to be a

  13. Regional heterogeneity in cardiac sympathetic innervation in acute myocardial infarction: relationship with myocardial oedema on magnetic resonance

    Gimelli, Alessia; Masci, Pier Giorgio; Pasanisi, Emilio Maria; Lombardi, Massimo [Fondazione CNR/Regione Toscana, Pisa (Italy); Liga, Riccardo; Grigoratos, Chrysanthos [University Hospital of Pisa, Pisa (Italy); Marzullo, Paolo [Fondazione CNR/Regione Toscana, Pisa (Italy); Institute of Clinical Physiology, CNR, Pisa (Italy)

    2014-09-15

    To assess the relationships between myocardial structure and function on cardiac magnetic resonance (CMR) imaging and sympathetic tone on {sup 123}I-metaiodobenzylguanidine ({sup 123}I-MIBG) scintigraphy early after myocardial infarction (MI). Ten patients underwent {sup 123}I-MIBG and {sup 99m}Tc-tetrofosmin rest cadmium zinc telluride scintigraphy 4 ± 1 days after MI. The segmental left ventricular (LV) relative radiotracer uptake of both {sup 99m}Tc-tetrofosmin and early {sup 123}I-MIBG was calculated. The day after scintigraphy, on CMR imaging, the extent of ischaemia-related oedema and of myocardial fibrosis (late gadolinium enhancement, LGE) was assessed. Accordingly, the extent of oedema and LGE was evaluated for each segment and segmental wall thickening determined. Based on LGE distribution, LV segments were categorized as ''infarcted'' (56 segments), ''adjacent'' (66 segments) or ''remote'' (48 segments). Infarcted segments showed a more depressed systolic wall thickening and greater extent of oedema than adjacent segments (p < 0.001) and remote segments (p < 0.001). Interestingly, while uptake of {sup 99m}Tc-tetrofosmin was significantly depressed only in infarcted segments (p < 0.001 vs. both adjacent and remote segments), uptake of {sup 123}I-MIBG was impaired not only in infarcted segments (p < 0.001 vs. remote) but also in adjacent segments (p = 0.024 vs. remote segments). At the regional level, after correction for {sup 99m}Tc-tetrofosmin and LGE distribution, segmental {sup 123}I-MIBG uptake (p < 0.001) remained an independent predictor of ischaemia-related oedema. After acute MI the regional impairment of sympathetic tone extends beyond the area of altered myocardial perfusion and is associated with myocardial oedema. (orig.)

  14. O teste ergométrico é factível, eficaz e custo-efetivo na predição de eventos cardiovasculares no paciente muito idoso, quando comparado à cintilografia de perfusão miocárdica In comparison to the myocardial perfusion scintigraphy, a treadmill stress test is a viable, efficient and cost effective option to predict cardiovascular events in elderly patients

    Luciano Janussi Vacanti

    2007-05-01

    Full Text Available OBJETIVO: Definir o valor prognóstico e a custo-efetividade do teste ergométrico (TE em comparação à cintilografia de perfusão miocárdica com dipiridamol (DIP em indivíduos com > 75 anos de idade. MÉTODOS: Foram avaliados, consecutiva e prospectivamente, 66 pacientes (40% homens, com média de idade de 81 ± 5 anos. Desses pacientes, 57% eram hipertensos, 38% eram dislipidêmicos e 28%, diabéticos. O protocolo de Bruce para rampa foi adaptado, obtendo-se o valor prognóstico do TE pelo escore de Duke. RESULTADOS: A duração do TE, o porcentual da freqüência cardíaca máxima preconizada e o duplo produto no pico do exercício foram, respectivamente, de 7 ± 3 minutos, 95 ± 9% e 24.946 ± 4.576 (bpm x mmHg. O TE e a DIP apresentaram resultados positivos para isquemia miocárdica similares (21% vs 15%, respectivamente. A concordância entre os testes foi de 88% (Kappa 0,63, p OBJECTIVE: To define the prognostic value and cost-effectiveness of the treadmill stress test (TST in comparison to the dipyridamole myocardial perfusion scintigraphy (DIP, in individuals >75 years of age. METHODS: Consecutive and prospective assessment of 66 patients (40% male aged 81 ± 5 years of which 57% were hypertensive, 38% had dyslipidemia and 28% were diabetics. The Bruce protocol was adapted for a tilt treadmill and the TST prognostic value was obtained using the Duke treadmill score. RESULTS: The TST duration, recommended maximum heart rate percentage and double product at peak exercise were respectively: 7 ± 3 minutes, 95 ± 9% and 24,946 ± 4,576 (bpm x mmHg. The TST and DIP presented similar positive results for myocardial ischemia (21% vs 15%, respectively. The correlation between the tests was 88% (Kappa 0.63, p<0.01. During 685 ± 120 days of follow-up, nine major events occurred: 6 deaths, 2 acute coronary syndromes and 1 myocardial revascularization. The variables associated with the major events were: age (83 ± 6 vs 80 ± 4 years; p=0

  15. Diffuse Myocardial Uptake of 99mTc-HDP in Multiple Myeloma

    Soft tissue uptake is a rare finding in bone scintigraphy, with an incidence of 2%. Although the mechanism has not yet been fully clarified, several causes have been reported for this unusual uptake pattern. This paper presents a case of diffuse myocardial accumulation of technetium-99m hydroxymethylene diphosphonate (99mTc-HDP) without either solid/visceral organ or soft tissue with multiple myeloma (MM) in skeletal scintigraphy. A 93-year-old man with hypertension and chronic heart failure for 14 years underwent bone scanning due to a 2-month history of back pain within a 1-year period of MM. Three hours later, 99mTc-HDP late static images showed diffuse myocardial radiotracer accumulation and there were no other sites of abnormal soft tissue or visceral uptake. Myocardial accumulation had disappeared on 24-h delayed static images. This accumulation was thought to be related with AL-type amyloidosis associated with MM

  16. Assessment of coronary atherosclerosis by cardiac image: complementary amount of the calcium score to myocardial perfusion

    Vitola, Joao Vicente; Cerci, Rodrigo J.; Zapparoli, Marcello, E-mail: joaovitola@quantamn.com.br [Quanta Diagnostico Nuclear, Curitiba, PR (Brazil)

    2011-04-15

    Over the last decades we have witnessed significant advances on diagnostic tools and management of patients with or suspected cardiovascular disease, and consequently a significant reduction in mortality. Nevertheless, cardiovascular disease remains the leader cause of death in many countries, including Brazil. Identifying the high risk patient is important, so we can intensify prevention strategies. Non invasive diagnostic tools have been developed to identify the high risk patient in need of a myocardial revascularization, notably using myocardial scintigraphy. However, many clinicians still question, what is the best management for a patient with traditional risk factors, who has a positive treadmill test result and a completely normal myocardial scintigraphy? What is the literature showing in relation to the role of coronary calcium score for these patients? In this article we will reflect over these issues which are so frequently encountered in daily cardiology practice. (author)

  17. Assessment of coronary atherosclerosis by cardiac image: complementary amount of the calcium score to myocardial perfusion

    Over the last decades we have witnessed significant advances on diagnostic tools and management of patients with or suspected cardiovascular disease, and consequently a significant reduction in mortality. Nevertheless, cardiovascular disease remains the leader cause of death in many countries, including Brazil. Identifying the high risk patient is important, so we can intensify prevention strategies. Non invasive diagnostic tools have been developed to identify the high risk patient in need of a myocardial revascularization, notably using myocardial scintigraphy. However, many clinicians still question, what is the best management for a patient with traditional risk factors, who has a positive treadmill test result and a completely normal myocardial scintigraphy? What is the literature showing in relation to the role of coronary calcium score for these patients? In this article we will reflect over these issues which are so frequently encountered in daily cardiology practice. (author)

  18. Diffuse Myocardial Uptake of {sup 99m}Tc-HDP in Multiple Myeloma

    Demirel, Koray; Sadic, Murat; Korkmaz, Meliha; Comak, Aylin; Atilgan, Hasan Ikbal; Koca, Goekhan [Ministry of Health Ankara Training and Research Hospital, Ankara (Turkmenistan)

    2013-09-15

    Soft tissue uptake is a rare finding in bone scintigraphy, with an incidence of 2%. Although the mechanism has not yet been fully clarified, several causes have been reported for this unusual uptake pattern. This paper presents a case of diffuse myocardial accumulation of technetium-99m hydroxymethylene diphosphonate ({sup 99m}Tc-HDP) without either solid/visceral organ or soft tissue with multiple myeloma (MM) in skeletal scintigraphy. A 93-year-old man with hypertension and chronic heart failure for 14 years underwent bone scanning due to a 2-month history of back pain within a 1-year period of MM. Three hours later, {sup 99m}Tc-HDP late static images showed diffuse myocardial radiotracer accumulation and there were no other sites of abnormal soft tissue or visceral uptake. Myocardial accumulation had disappeared on 24-h delayed static images. This accumulation was thought to be related with AL-type amyloidosis associated with MM.

  19. Parathyroid scintigraphy during hypocalcaemia in primary hyperparathyroidism

    Øgard, Christina G; Thomsen, Jørn Bo; Jakobsen, Henrik;

    2005-01-01

    Minimally invasive parathyroid surgery in patients with primary hyperparathyroidism (PHPT) demands high imaging accuracy. By increasing blood flow to the parathyroid adenoma before injection of a perfusion marker, we intended to improve the parathyroid scintigraphy. We have named the technique...... stimulated parathyroid scintigraphy (SPS)....

  20. Bone scintigraphy, plasma ALP, TAP and PAP in patients with prostatic cancer

    This study assessed the ability of bone scintigraphy, alkaline phosphatase (ALP), total acid phosphatase (TAP), and prostatic acid phosphatase (PAP) to diagnose bone metastasis in a series of 62 patients with histologically proven prostatic cancer. Abnormal uptake was seen on the bone scan in 49 patients (79 %). A final diagnosis of bone metastasis was made in 40 patients (65 %). The sensitivity and specificity were 100 % and 59 %, respectively, for bone scintigraphy; 50 % and 96 % for ALP; 65 % and 82 % for TAP; and 73 % and 77 % for PAP. For 40 patients with bone metastasis, all of the ALP, TAP, and PAP were positive in 17 patients (43 %) and negative in 8 patients (20 %). Higher levels of ALP, TAP, and PAP tended to be associated with more extensive bone metastasis. Although serological examination showed lower sensitivity than bone scintigraphy in the diagnosis of bone metastasis, PAP may be most frequently used as a screening procedure of bone metastasis. (Namekawa, K.)

  1. Exercise-induced ST-segment depression and myocardial ischemia in patients with hypertrophic cardiomyopathy. Myocardial scintigraphic study

    Patients with hypertrophic cardiomyopathy (HCM) sometimes develop myocardial ischemia during exercise in the absence of coronary lesions. The relationship between myocardial ischemia and ST-segment depression was investigated during exercise testing in patients with HCM. Regional hypoperfusion and/or transient left ventricular cavity dilation, a parameter of subendocardial hypoperfusion, were assessed on exercise 99mTc-tetrofosmin myocardial scintigraphy in 42 patients with non-obstructive HCM. The scintigraphic results were further correlated with the ST-segment responses to exercise. Regional hypoperfusion or transient left ventricular cavity dilation were observed in 19 (45%) or 16 (38%) patients with HCM, respectively. The incidence of ST-segment depression ≥0.1 mV during exercise testing was similar in HCM patients with regional hypoperfusion, with transient left ventricular cavity dilation, and without hypoperfusion (42%, 38%, 38%, p=0.95). Furthermore, exercise-induced ST-segment depression ≥0.1 mV occurred similarly irrespective of symptoms, exercise tolerance, the degree or the site of hypertrophy, or the presence or absence of resting ST-segment depression. ST-segment depression during exercise testing was common in patients with HCM, but seems to be an unreliable marker of myocardial ischemia as assessed by exercise scintigraphy. (author)

  2. Cardiomyocyte-Restricted Deletion of PPARβ/δ in PPARα-Null Mice Causes Impaired Mitochondrial Biogenesis and Defense, but No Further Depression of Myocardial Fatty Acid Oxidation

    Jian Liu

    2011-01-01

    Full Text Available It is well documented that PPARα and PPARβ/δ share overlapping functions in regulating myocardial lipid metabolism. However, previous studies demonstrated that cardiomyocyte-restricted PPARβ/δ deficiency in mice leads to severe cardiac pathological development, whereas global PPARα knockout shows a benign cardiac phenotype. It is unknown whether a PPARα-null background would alter the pathological development in mice with cardiomyocyte-restricted PPARβ/δ deficiency. In the present study, a mouse model with long-term PPARβ/δ deficiency in PPARα-null background showed a comparably reduced cardiac expression of lipid metabolism to those of single PPAR-deficient mouse models. The PPARα-null background did not rescue or aggravate the cardiac pathological development linked to cardiomyocyte-restricted PPARβ/δ deficiency. Moreover, PPARα-null did not alter the phenotypic development in adult mice with the short-term deletion of PPARβ/δ in their hearts, which showed mitochondrial abnormalities, depressed cardiac performance, and cardiac hypertrophy with attenuated expression of key factors in mitochondrial biogenesis and defense. The present study demonstrates that cardiomyocyte-restricted deletion of PPARβ/δ in PPARα-null mice causes impaired mitochondrial biogenesis and defense, but no further depression of fatty acid oxidation. Therefore, PPARβ/δ is essential for maintaining mitochondrial biogenesis and defense in cardiomyocytes independent of PPARα.

  3. Global analysis of myocardial peptides containing cysteines with irreversible sulfinic and sulfonic Acid post-translational modifications

    Paulech, Jana; Liddy, Kiersten A; Engholm-Keller, Kasper;

    2015-01-01

    Cysteine (Cys) oxidation is a crucial post-translational modification (PTM) associated with redox signaling and oxidative stress. As Cys is highly reactive to oxidants it forms a range of post-translational modifications, some that are biologically reversible (e.g. disulfides, Cys sulfenic acid...

  4. Evaluation of infantile ventricular tachycardia by 201Tl myocardial SPECT

    201Tl myocardial SPECT findings in infantile ventricular tachycardia (VT) were examined. The subjects were 4 cases of infantile VT subjected exercise-loading 201Tl scintigraphy in 1990. These cases (3 males and 1 female) were aged 11-14 years, being persistent and non-persistent type VT (2 cases each). Echocardiography revealed no abnormal findings in these 4 cases. Exercise-loading was performed by means of sitting ergometer. ECG revealed sinus arrhythmia except for one case which throughout its course of treatment, had already been presenting ventricular extrasystole from before the excercise-loading. Myocardial SPECT revealed persistent defects (antero-septal wall defects in three cases). The above suggests that 201Tl myocardial SPECT enables us to search for etiology of VT, prognosis and the like. (author)

  5. CMR of microvascular obstruction and hemorrhage in myocardial infarction

    Wu Katherine C

    2012-09-01

    Full Text Available Abstract Microvascular obstruction (MO or no-reflow phenomenon is an established complication of coronary reperfusion therapy for acute myocardial infarction. It is increasingly recognized as a poor prognostic indicator and marker of subsequent adverse LV remodeling. Although MO can be assessed using various imaging modalities including electrocardiography, myocardial contrast echocardiography, nuclear scintigraphy, and coronary angiography, evaluation by cardiovascular magnetic resonance (CMR is particularly useful in enhancing its detection, diagnosis, and quantification, as well as following its subsequent effects on infarct evolution and healing. MO assessment has become a routine component of the CMR evaluation of acute myocardial infarction and will increasingly play a role in clinical trials of adjunctive reperfusion agents and strategies. This review will summarize the pathophysiology of MO, current CMR approaches to diagnosis, clinical implications, and future directions needed for improving our understanding of this common clinical problem.

  6. Skeletal scintigraphy following incidental trauma

    The significance of antecedent trauma in skeletal scintigraphy was assessed in 503 patients, of whom 241 (46%) had prior fracture or tooth extraction. In patients with sufficiently accurate histories for site-by-site analysis, 33 of 131 fracture sites and 16 of 83 dental-procedure sites were positive scintigraphically. In general, the frequency of scan positivity diminished as the interval between trauma and scanning increased, but a significant number of patients showed prolonged uptake at fracture sites. Several patterns of uptake suggested trauma rather than metastatic disease. Knowledge of a history of trauma is often critical in bone scan interpretation

  7. Scintigraphy of the pancreas head

    Emphasis is placed on the considerable improvement due to the computer in pancreatic scintigraphy, which has become more exact as a result. A liver subtraction technique is used. From the data acquired in this method two matrices are established, one for selenomethionine 75 and the other for gold 198. For processing the data are integrated in two broad hepatic areas, of coordinates identical in the two scintigrams, and their ratio is found; the computer multiplies the specifically hepatic matrix by this ratio then subtracts one from the two scintigrams thus normalized. The background can be subtracted from the resulting image

  8. Myocardial ischemia, carotid, and peripheral arterial disease and their interrelationship in type 2 diabetes patients

    Poulsen, Mikael K; Henriksen, Jan Erik; Dahl, Jordi; Johansen, Allan; Møller, Jacob E; Gerke, Oke; Vach, Werner; Haghfelt, Torben; Beck-Nielsen, Henning; Høilund-Carlsen, Poul Flemming

    2009-01-01

    for the first time and age-matched nondiabetic reference subjects (n = 40) were screened for myocardial ischemia, carotid, and peripheral arterial disease by means of myocardial perfusion scintigraphy, carotid artery ultrasonography, and peripheral ankle and toe systolic blood pressure measurements....... RESULTS: In the T2DM patients, the prevalence of myocardial ischemia, carotid, and peripheral arterial disease was 30%, 42%, and 15%, respectively, almost three times higher than in the reference subjects (P = 0.007, P = 0.001, and P = 0.09, respectively). T2DM patients with myocardial ischemia, carotid......, or peripheral arterial disease had a significantly increased risk of CVD in other vascular territories as well (OR: 1.99, 2.09, and 3.09, respectively). However, 40%, 52%, and 22% of the T2DM patients with myocardial ischemia, carotid, or peripheral arterial disease demonstrated exclusively this...

  9. Diagnosis of acute myocardial infarction by indium-111 antimyosin antibodies and correlation with the traditional techniques for the evaluation of extent and localization

    This clinical study evaluated the accuracy of planar myocardial scintigraphy with antimyosin monoclonal antibodies radiolabeled with indium-111 (AMA-Fab) in the detection and localization of acute myocardial infarction (AMI). Fifty-seven patients admitted for suspected AMI were studied; 17 patients underwent thrombolytic therapy with intravenous streptokinase and 11 had clinical signs of reperfusion; 9 had had a previous myocardial infarction. Fifty of 57 patients were discharged from the coronary care unit with a confirmed diagnosis of AMI. The AMA-Fab study results were positive for AMI in 49 patients (98%) and negative in 1 (2%). Among the 7 patients without AMI, 5 had unstable angina, 1 had Prinzmetal's variant angina and 1 had acute pancreatitis. AMA-Fab results were negative in 6 of 7 patients (85%) and positive in 1 (15%). Therefore, the sensitivity and specificity of AMA-Fab scintigraphy were 0.98 and 0.85, respectively. To assess accuracy in defining the extent and location of AMI, AMA-Fab results were compared with those of the electrocardiogram, echocardiogram, technetium-99m pyrophosphate myocardial scintigraphy and coronary angiography and left ventriculography. AMA-Fab scintigraphy showed a good concordance with the traditional techniques in the topographic definition of the infarcted regions. No uptake of AMA-Fab was seen in the regions of previous old infarcts. Ten healthy volunteers also underwent AMA-Fab scintigraphy. No evidence of myocardial tracer uptake was noted in them. No adverse reactions or side effects were noted after injection of AMA-Fab in any patient. It is concluded that planar myocardial scintigraphy with AMA-Fab is a reliable method for AMI detection and location

  10. Usefulness of gastroesophageal reflux scintigraphy using the knee-chest position for the diagnosis of gastroesophageal reflux disease

    The aim of this study is to evaluate the usefulness of gastroesophageal reflux (GER) scintigraphy using the knee-chest (KC) position for the diagnosis of gastroesophageal reflux disease (GERD). The study subjects were 37 patients with GERD and 8 healthy volunteers (control group). Endoscopically observed esophageal mucosal breaks were evaluated with the Los Angeles classification. For GER scintigraphy, the subjects ingested liquid yogurt labeled with 99mTc-diethylene triamine pentaacetic acid (99mTc-DTPA) and water. Imaging was performed in the supine and KC position, and GER was graded as 1-4 according to the extent of GER assessed by scintigraphy. GER scintigraphy revealed no reflux in the control group (specificity: 100%). In the supine position, gastroesophageal reflux was observed in 49% of the patients with GERD, compared to 76% in the KC position. 21 of 23 (91%) patients with erosive esophagitis were shown to have GER with scintigraphy. GER scintigraphy revealed severe reflux (grade 3 or 4) (83%, 10/12) in the patients who had severe mucosal breaks (the Los Angels classification grade C or D). GER scintigraphy detected grade 1 or 2 reflux in 7 of the 14 patients who were endoscopically negative. There was a correlation between the endoscopically determined severity of mucosa and the reflux grade which was determined with GER scintigraphy. GER scintigraphy can detect gastroesophageal reflux with a high sensitivity in the KC position and might be a useful method in the screening and assessment of the severity of this disease. This method would be useful for the diagnosis of GERD in endoscopically negative patients. (author)

  11. Radionuclide scintigraphy of bacterial nephritis

    Pyelonephritis is a leading cause of renal failure and is expected to cost as much as three billion dollars in 1984. The diagnosis of urinary tract infection is usually not difficult. However, localization of the infection within the renal parenchyma as opposed to the collecting system is much more difficult. Flank pain, fever, bacteiuria and evidence of parenchymal involvement by intravenous urography may be absent or unrecognized particularly in the infant. Ultrasound and Nuclear Medicine are advocated as better methods to define parenchymal involvement. Such definition is important in the consideration of treatment since parenchymal involvement of the kidney carries a much more ominous potential outcome than infection restricted to within the collecting system. 38 children with a clinical diagnosis of urinary tract infection were studied. 26 of the patients demonstrated abnormal renal parenchymal findings with Gallium-67 Citrate or Tc-99m Glucoheptonate scintigraphy. Intravenous urography was notably ineffective with only 5 of the 20 interpreted as abnormal due to parenchymal disease or decreased function. 11 were entirely normal while only 5 demonstrated scars or hydronephrosis. Only 10 of 17 patients demonstrated intranvesicoureteral reflux on x-ray or nuclear cystography. Ultrasound depicted 6 of 20 patients as having parenchymal abnormalities. Seven were normal. Nonspecific findings such as dilitation of the renal pelvis or renal enlargement was noted in 11 of the 20 patients. Radionuclide Scintigraphy is the most efficacious modality to detect since acute bacterial nephritis

  12. Platelet scintigraphy in atherothrombotic disease

    Isaka, Yoshinari (Osaka National Hospital (Japan))

    1993-01-01

    Indium-111 platelet scintigraphy for the measurement of in vivo thrombogenicity is a useful noninvasive technique with a number of applications. From 1982 to 1989, we explored clinical relevance of this method for 576 consecutive patients with atherothrombotic disease. There was a disease-related difference in the percentage of positive platelet accumulation; 85% in patients with Dacron bifurcation graft, 75% in abdominal or thoracic aneurysm, 40% in intra-cardiac thrombi, 33% in arteriosclerosis obliterans and 25% in ischemic cerebrovascular disease. Labelled platelets accumulated frequently in the lesion with severe arteriographic abnormality. Aspirin clearly inhibited platelet accumulation on carotid atheroma but the effect of ticlopidine has been less conclusive. Short-term orally active PGI[sub 2] analogue had inhibitory effects on platelet accumulation in carotid atheroma and platelet aggregability, but did not cause significant reduction in plaque size. The results suggest the usefulness of platelet scintigraphy for monitoring the thrombogenicity in various atherothrombotic diseases. It will be necessary, however, to simplify the labelling procedures and to develop a new [sup 99m]Tc-labelled thrombus imaging agent, if thrombus imaging is to be considered for more generall use for patients with atherosclerosis. (author).

  13. Platelet scintigraphy in atherothrombotic disease

    Indium-111 platelet scintigraphy for the measurement of in vivo thrombogenicity is a useful noninvasive technique with a number of applications. From 1982 to 1989, we explored clinical relevance of this method for 576 consecutive patients with atherothrombotic disease. There was a disease-related difference in the percentage of positive platelet accumulation; 85% in patients with Dacron bifurcation graft, 75% in abdominal or thoracic aneurysm, 40% in intra-cardiac thrombi, 33% in arteriosclerosis obliterans and 25% in ischemic cerebrovascular disease. Labelled platelets accumulated frequently in the lesion with severe arteriographic abnormality. Aspirin clearly inhibited platelet accumulation on carotid atheroma but the effect of ticlopidine has been less conclusive. Short-term orally active PGI2 analogue had inhibitory effects on platelet accumulation in carotid atheroma and platelet aggregability, but did not cause significant reduction in plaque size. The results suggest the usefulness of platelet scintigraphy for monitoring the thrombogenicity in various atherothrombotic diseases. It will be necessary, however, to simplify the labelling procedures and to develop a new 99mTc-labelled thrombus imaging agent, if thrombus imaging is to be considered for more generall use for patients with atherosclerosis. (author)

  14. Adrenal scintigraphy using 131I-Adosterol

    131I-Adosterol (6β-iodomethyl-19-norcholest-5(10)-3β-ol) was administered to evaluate adrenal grand in 20 patients including 9 patients with primary aldosteronism, 5 with Cushing's syndrome, one with pheochromocytoma, one with retroperitoneal tumor, 3 with essential hypertension and one with obesity. Standard scintigraphies were performed at 3rd day and again 6th day after administration of 131I-adosterol (1-1.5 mCi). Suppression scintigraphies were obtained while the patients were taking dexamethasone 2 to 3 mg daily from 3 days prior to injection of the tracer until adrenal imaging. In the cases with essential hypertension and obesity, both adrenal glands were delineated equally by standard scintigraphy, and in one patient, undergone suppression scintigraphy, the uptake of 131I-adosterol by both glands were completely inhibited by dexamethasone administration. In primary aldosteronism, six of the 9 patients demonstrated the increased radioactivity in one side, and were diagnosed as aldosteronoma. In 3 cases, failed to show the lesions on standard scintigraphy, the lesions could be detected by suppression scintigraphy, and aldosteronomas measuring 1 x 1 x 0.7, 2 x 2 x 1 and 1.7 x 1.5 x 0.8 cm were confirmed by operation. In Cushing's syndrome, standard scintigraphy could easily distinguish between adenoma (one case) and bilateral hyperplasia (4 cases). Adrenal scintigraphy was also a useful method in order to assess the effect of pituitary irradiation therapy in the case of hyperplasia. In pheochromocytoma and retroperitoneal tumor, the side of the lesion was identified by the absence of a functioning gland. Suppression scintigraphy was particularly useful in detecting the localization of the small tumor in primary aldosteronism. (auth.)

  15. Engineering of scintigraphy equipment - the basic design

    Basic design of scintigraphy equipment for imaging small organs has been made. The equipment is a mini gamma camera. The function of the equipment is provide images of metabolism process in a body organ. The result of the equipment can be used to diagnose an illness. Radiation detection from a body organ is designed using single scintillation crystal detector which is coupled to a position sensitive photomultiplier tube (PSPMT). With this basic design of scintigraphy equipment is expected that scintigraphy equipment engineering activity can be carried out. (author)

  16. Scintigraphy of ORL tumours with cobalt bleomycin

    Our experiences with cobalt bleomycin scintigraphy in the treatment planning of ORL tumors are described. 142 scintigrams taken from 127 patients have been examined. As is shown by our investigation, cobalt bleomycin scintigraphy is a good examination method, however, too much expenditure is needed to have the necessary data for therapy planning. To our opinion, the information obtained in oto-rhino-laryngology by an exact clinical examination is as good as that of cobalt bleomycin scintigraphy. Our treatment schemes had only to be revised in some exceptional cases. (orig.)

  17. Relationship Between Adenosine - Induced ST Segment Depression During 99mTc-MIBI Scintigraphy and The Severity of Coronary Artery Disease

    Pharmacologic coronary vasodilation in conjunction with myocardial perfusion scintigraphy has become an alternative to dynamic exercise test for the diagnosis and risk stratification of coronary artery disease, especially in patients who are unable to perform adequate exercise. Dipyridamole and adenosine have been used for pharmacologic stress testing with myocardial perfusion imaging. Adenosine is a potent, coronary vasodilator with rapid onset of action, short half life, near maximal coronary vasodilation and less serious side effects. ST segment depression has been reported in about 7-15% of patients with coronary artery disease receiving dipyridamole in conjunction with myocardial perfusion imaging. The exact cause and clinical significance are not known. In order to evaluate the relationship between adenosine-induced ST segment depression during 99mTc-MIBI myocardial perfusion scintigraphy and the severity of coronary artery disease, we performed 99m-MIBI imaging after intravenous infusion of adenosine in 120 patients with suspected coronary artery disease. Of the 120 patients, 28 also performed coronary angiography. There were 24 patients with ST segment depression during 99mTc-MIIBI scintigraphy and 96 patients without ST segment depression. Adenosine was infused intravenously at a dose of 0.14 mg/kg per minute for 6 minutes and 99MmTc-MIB1 was injected at 3 minute. We then compared the hemodynamic changes, side effects, scintigraphic and angiographic findings. Heart rate increased 90 ± 19 beats/minute in the group with ST depression compared with 80 ±16 beats/minute in the group without ST depression(p9mTc-MIBI images were abnormal in 23(96%) patients with ST segment depression and 66(69%) patients without ST segment depression(p99mTc-MIBI myocardial perfusion scintigraphy with intravenous adenosine is related to the severity of coronary artery disease.

  18. Myocardial contractility

    Comet, M.; Machecourt, J.

    1988-01-01

    The myocardial contractility characterizes the intensity of the activation representing the globality of the processes which lead to the formation of the sites where the strength is generated. Some parameters allowing a quantification of the contractility are measured during the isovolumic phase of the ventricular contraction: they are essentially dP/dt/sub max/, and eventually V/sub max/. For the measurement of these parameters, a pressure detector needs to be introduced into the left ventricle. Other parameters are measured during the systolic ejection phase: they are the ejection fraction, which is easy to measure and is very load dependant, and the maximal elastance. This last parameter is not easy to measure, but seems load independant. With the radioisotopes, it is possible to measure the ejection fraction and the maximal elastance. Contractility measurements are of interest in the study of ischemic cardiopathies and of valvular desease.

  19. Rapid washout of Tc-99m tetrofosmin between immediate and two-hour myocardial images in the injured but viable myocardium with impaired of fatty acid uptake

    The purpose of this study was to assess Tc-99m tetrofosmin (TF) kinetics in viable but injured myocardium in patients with acute myocardial infarction (AMI). Fourteen patients (11 males, 72±10 years) with AMI were studied. Ten patients undergoing successful reperfusion therapy and 4 treated medically. All patients showed viable but injured myocardium revealed as Tc-99m pyrophosphate (PYP) and thallium-201 (Tl) overlap lesions. PYP and Tl SPECT was performed 90 mins after injection of PYP 740 MBq and Tl 111 MBq by dual SPECT aquisition within 8 days from onset of AMI. Rest TF SPECT was performed 15 mins and 120 mins after injection of TF 740 MBq at one month after the onset of AMI. Rest I-123 betamethyl branched fatty acid (BMIPP) SPECT was performed 15 mins after injection of BMIPP 111 MBq at one month after the onset of AMI. All tracers activities were visually scored using a four-point grading system: 0=normal to 3=severe defect and a 17 segmental model. The lower cutoff level of PYP and Tl were 40% and 25%. Overlap lesions were defined as PYP positive and defect score of Tl was 0 to 2 in at least 2 segments. For quantitative analysis, the decay-corrected washout rate (WO) was calculated in each segment. The number of score deteriorated (tracer washout) segments and WO values were larger in overlap segments than PYP negative segments (34/69 vs 25/115, p<0.01, 18.6±11.6 vs 10.6±13.2, p<0.01). Ninety percents of the segments with high washout of TF showed decreased BMIPP uptake. One patient showed residual myocardium with endocardial fibrosis by the results of autopsy. Those patients with AMI after one month from the onset showed high washout, of TF and TF kinetics was modulated by intracellular calcium concentration as shown by PYP accumulation. (author)

  20. Bone scintigraphy in traumas and stress injuries

    Bone scintigraphy is an easy and cheap diagnostic method for examination of stress injuries of lower extremities. A more specific diagnosis often has to be supplemented by MR scanning or X-radiography. (EG)