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Sample records for exercise myocardial perfusion

  1. Increases in myeloperoxidase levels after exercise in myocardial perfusion scintigraphy are not induced by myocardial ischemia

    NARCIS (Netherlands)

    van der Zee, P. M.; Meuwese, M. C.; Verberne, H. J.; de Ruijter, M.; van Straalen, J. P.; Fischer, J. C.; Sturk, A.; van Eck-Smit, B. L. F.; Stroes, E. S. G.; de Winter, R. J.

    2008-01-01

    Background: Increased systemic levels of myeloperoxidase (MPO) have been reported in patients with acute myocardial ischemia. We studied the association between exercise-induced myocardial ischemia measured by myocardial perfusion scintigraphy (MPS) and the magnitude and time course of changes in

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

    DEFF Research Database (Denmark)

    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)....

  3. Exercise-induced thallium-201 myocardial perfusion defects in angina pectoris without significant coronary artery stenosis

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    Nakazato, Masayasu; Maruoka, Yuji; Sunagawa, Osahiko; Kinjo, Kunihiko; Tomori, Masayuki; Fukiyama, Koshiro (Ryukyu Univ., Nishihara, Okinawa (Japan). School of Medicine)

    1990-01-01

    We performed exercise thallium-201 myocardial scintigraphy in 32 patients with angina pectoris to study the incidence of perfusion defects, who had no significant organic stenosis on coronary angiography. None of them had myocardial infarction or cardiomyopathy. Thallium-201 myocardial scintigraphy and 12-lead ECG recording were performed during supine bicycle ergometer exercise. Perfusion defects in thallium-201 scintigrams in SPECT images were assessed during visual analysis by two observers. In the coronary angiograms obtained during intravenous infusion of nitroglycerin, the luminal diameter of 75% stenosis or less in the AHA classification was regarded as an insignificant organic stenosis. Myocardial perfusion defects in the thallium-201 scintigrams were detected in eight (25%) of the 32 patients. Six of these eight patients had variant angina documented during spontaneous attacks with ST elevations in standard 12-lead ECGs. Perfusion defects were demonstrated at the inferior or infero-posterior regions in six patients, one of whom had concomitant anteroseptal defect. The defects were not always accompanied by chest pain. All but one patient demonstrating inferior or inferoposterior defects showed ST depression in leads II, III and aV{sub F} on their ECGs, corresponding to inferior wall ischemia. The exception was a case with right bundle branch block. Thus, 25% of the patients with angina pectoris, who had no evidence of significant organic stenosis on their coronary angiograms, exhibited exercise-induced perfusion defects in their thallium-201 scintigrams. Coronary spasms might have caused myocardial ischemia in these patients. (author).

  4. Effects of diltiazem on myocardial perfusion abnormalities during exercise in patients with hypertrophic cardiomyopathy

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

    1998-12-01

    The effect of diltiazem on myocardial ischemia in patients with hypertrophic cardiomyopathy (HCM) was evaluated by exercise myocardial {sup 201}Tl single photon emission computed tomography (SPECT). Exercise myocardial SPECT was performed before and 8 weeks after oral administration of diltiazem (180 mg/day) in 20 patients with HCM who showed transient perfusion defects on exercise myocardial {sup 201}Tl SPECT under control conditions. SPECT images were divided into 17 segments. The {sup 201}Tl perfusion defects were visually scored and evaluated as the defect score. The transient dilation index was calculated as an index of subendocardial ischemia. Improvement of the defect score was demonstrated in 15 patients after the administration of diltiazem. The mean defect score decreased significantly from 9.90{+-}5.17 to 5.50{+-}4.89 (p<0.0001). Although 16 of 20 patients showed an abnormal transient dilation index before diltiazem treatment, 16 showed improvement and 13 of these normalized after diltiazem therapy. The mean transient dilation index decreased from 1.16{+-}0.10 to 1.02{+-}0.09 (p<0.0001). In conclusion, diltiazem prevents or diminishes myocardial ischemia in patients with HCM. (author)

  5. Characteristic findings of exercise ECG test, perfusion SPECT and coronary angiography in patients with exercise induced myocardial stunning

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    Ahn, Byeong Cheol; Seo, Ji Hyoung; Bae, Jin Ho; Jeong, Shin Young; Park, Hun Sik; Lee, Jae Tae; Chae, Shung Chull; Lee, Kyu Bo [School of Medicine, Kyungpook National Univ., Daegu (Korea, Republic of)

    2004-06-01

    Transient wall motion abnormality and contractile dysfunction of the left ventricle (LV) can be observed in patients with coronary artery disease due to post-stress myocardial stunning. To understand clinical characteristics of stress induced LV dysfunction, we have compared the findings of exercise stress test, myocardial perfusion SPECT and coronary angiography between subjects with and without post-stress LV dysfunction. Among subjects who underwent exercise stress test, myocardial perfusion SPECT and coronary angiography within a month of interval, we enrolled 36 patients with post-stress LV ejection fraction (LVEF) was {>=}5% lower than rest (stunning group) and 16 patients with difference of post-stress and rest LVEF was lesser than 1% (non-stunning group) for this study. Treadmill exercise stress gated myocardial perfusion SPECT was performed with dual head SPECT camera using 740 MBq Tc-99m MIBI and coronary angiography was also performed by conventional Judkins method. Stunning group had a significantly higher incidence of hypercholesterolemia than non-stunning group(45.5 vs 7.1%, p=0.01). Stunning group also had higher incidence of diabetes mellitus and lower incidence of hypertension, but these were not statistically significant. Stunning group had larger and more severe perfusion defect in stress perfusion myocardial SPECT than non-stunning group(extent 18.2 vs 9.2%, p=0.029; severity 13.5 vs 6.9, p=0.040). Stunning group also had higher degree of reversibility of perfusion defect, higher incidence of positive exercise stress test and higher incidence of having severe stenosis(80{approx}99%) in coronary angiography than non-stunning group, but these were not statistically significant. In stunning group, all of 4 patients without perfusion defect had significant coronary artery stenosis and had received revascularization treatment. Patients with post-stress LV dysfunction had larger and more severe perfusion defect and severe coronary artery stenosis than

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

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    Kurata, Chinori; Uehara, Akihiko; Sugi, Toshihiko; Yamazaki, Keisuke [Hamamatsu Univ. School of Medicine, Shizuoka (Japan); Tawarahara, Kei; Mikami, Tadashi; Matoh, Fumitaka; Odagiri, Keiichi

    2000-06-01

    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 {sup 201}Tl 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 {sup 201}Tl 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 {sup 201}Tl 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 {sup 201}Tl SPECT is useful for evaluating myocardial ischemia even in the elderly, but exercise electrocardiography has limitations such as lower specificity in the elderly than {sup 201}Tl SPECT. (author)

  7. Myocardial perfusion after marathon running.

    Science.gov (United States)

    Kalliokoski, Kari K; Laaksonen, Marko S; Luotolahti, Matti; Laine, Hanna; Takala, Teemu O; Nuutila, Pirjo; Knuuti, Juhani

    2004-08-01

    We investigated the effects of acute prolonged exercise (marathon running) on cardiac function and myocardial perfusion. Cardiac dimensions and function were measured in seven endurance-trained men using echocardiography before and repeatedly after marathon (42.2 km) running (at 10 min, 150 min, and 20 h). Myocardial perfusion and perfusion resistance were measured using positron emission tomography and 15O-H2O before and 85-115 min after running. Echocardiographic indices showed only mild and clinically non-significant changes in cardiac function after running. Rate-pressure-corrected basal myocardial perfusion (0.89+/-0.13 vs. 1.20+/-0.32 mL min(-1) g(-1), P=0.04) was increased after running. Also, adenosine-stimulated perfusion tended to be higher (3.67+/-0.81 vs. 4.47+/-0.52 mL min(-1) g(-1), P=0.12) and perfusion resistance during adenosine stimulation was significantly lower after running (26+/-6 vs. 18+/-3 mmHg min g mL(-1), P=0.03). Plasma free fatty acid (FFA) concentration was significantly increased after running. These results show that marathon running does not cause marked changes in cardiac function in healthy men. Basal perfusion was increased after exercise, probably reflecting changes in fuel preferences to increased use of FFAs. Strenuous exercise also seems to enhance coronary reactivity, which could thereby serve as a protective mechanism to vascular events after exercise.

  8. Clinical investigation of large perfusion defect cases with {sup 201}Tl exercise myocardial scintigraphy

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    Morota, Motoi; Kobayashi, Yasuhiko [Tokyo Medical Coll. (Japan)

    1999-02-01

    We investigated retrospectively the clinical significance of large perfusion defect on {sup 201}Thallium myocardial scintigraphy from the records of 833 patients during the past 3 years from 1991 to 1994. The patients were divided into 3 groups according to the extent of perfusion defect; cases with normal perfusion (n=561), with small perfusion defect (n=211) and with large perfusion defect (n=61). We found that the proportions of cases with large perfusion defect was significantly larger than that of cases with small perfusion defect in myocardial disease (MD; hypertrophic cardiomyopathy, dilated cardiomyopathy, and post myocarditis combined) (P<0.001). Analyzing patients with ischemic heart disease (IHD; angina pectoris and myocardial infarction) according to the severity of coronary artery lesion, the proportion of cases with large perfusion defect was significantly larger than that of cases with small perfusion defect in 3 vessel disease (P<0.001). Incidence of diabetes mellitus was significantly higher in patients with IHD than in those with MD in large perfusion defect group (P<0.01). As for symptoms in large perfusion defect group, the incidences of chest pain, chest oppression, and chest discomfort were significantly higher in patients with IHD than in those with MD (P<0.001), whereas the incidences of palpitation and shortness of breath were significantly higher in patients with MD (P<0.001). These results suggest that IHD with multiple artery lesions and MD underlie large perfusion defect on {sup 201}Thallium myocardial scintigraphy and that complication of diabetes mellitus and clinical symptoms may be useful in differentiating IHD from MD. (author)

  9. Prognostic value of normal exercise {sup 99m}Tc-MIBI myocardial perfusion SPECT: comparison with exercise electrocardiography and coronary angiography

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    Lee, Sang Woo; Lee, Jae Tae; Chun, Kyung Ah; Kang, Do Young; Kim, Dong Hwan; Cho, Yong Keun; Chae, Shung Chull; Lee, Kyu Bo [Kyungpook National Univ. College of Medicine, Taegu (Korea, Republic of)

    2000-06-01

    Myocardial perfusion scintigraphy is a useful technique to diagnose and to predict prognosis in patients with suspected or known coronary artery disease. The purpose of the present study is to evaluate the prognostic value of normal exercise {sup 99m}Tc-MIBI myocardial perfusion single photon emission computed tomography (SPECT) and to analyze results with regard to those of exercise electrocardiography or coronary angiography. We evaluated 301 patients (mean age 52{+-}10 years, 166 males and 135 females) with normal exercise {sup 99m}Tc-MIBI myocardial perfusion SPECT performed for suspected coronary artery disease. Subjects were evaluated for cardiac events and followed for 8-55 months (mean 19{+-}10 months) after imaging. During the follow-up period, there was no cardiac death but only one non-fatal myocardial infarction (event rate 0.21% per year). In addition, only one patient underwent coronary revascularization. There was no significant difference in cardiac event rate between patinets with positive (n=3D27) and negative (n=3D235) exercise electrocardiography (p:NS). There was no cardiac event in 17 patients who underwent coronary angiography (4 patients with >50% luminal narrowing, 2 patients with vasospasm and 11 patients with no significant lesion). Patients with normal exercise {sup 99m}Tc-MIBI myocardial perfusion SPECT has a very low risk for cardiac events regardless of exercise electrocardiographic and coronary angiographic findings.

  10. Prediction of 9-year cardiovascular outcomes by myocardial perfusion imaging in patients with normal exercise electrocardiographic testing.

    Science.gov (United States)

    Schinkel, Arend F L; Boiten, Henk J; van der Sijde, Jors N; Ruitinga, Pauline R; Sijbrands, Eric J G; Valkema, Roelf; van Domburg, Ron T

    2012-11-01

    Exercise myocardial perfusion imaging (MPI) is widely used, but the long-term prognostic value of this test in patients with normal exercise electrocardiographic testing is not defined. A consecutive group of 650 patients (428 men, mean age: 56 ± 11 years) with known or suspected coronary artery disease underwent exercise electrocardiographic testing and MPI. Follow-up endpoints were mortality and major adverse cardiac events (MACE). Predictors of outcome were identified by multivariate logistic regression analysis using clinical, exercise electrocardiographic testing and single-photon emission computed tomography (SPECT) variables. A total of 324 (50%) patients had an abnormal SPECT, and 131 (20%) had completely or partially reversible perfusion defects. During a mean follow-up of 9.2 ± 2.0 years, 107 (23%) patients died, 69 (11%) had a non-fatal myocardial infarction, 90 (14%) underwent coronary artery bypass surgery, and 142 (22%) percutaneous coronary intervention. Multivariate analysis demonstrated that the summed rest score was an independent predictor of mortality [hazard ratio (HR): 1.15, 95% confidence interval (CI): (1.08-1.22], P exercise electrocardiographic testing data provided incremental prognostic information for the prediction of mortality and MACE (both P exercise electrocardiographic testing have completely or partially reversible myocardial perfusion defects. MPI provides additional information for the prediction of 9-year cardiovascular outcomes in these patients.

  11. Measuring myocardial perfusion

    DEFF Research Database (Denmark)

    Qayyum, A A; Kastrup, J

    2015-01-01

    Recently, focus has changed from anatomical assessment of coronary arteries towards functional testing to evaluate the effect of stenosis on the myocardium before intervention. Besides positron-emission tomography (PET), cardiac MRI (CMR), and cardiac CT are able to measure myocardial perfusion......-known and is used in routine clinical practice. However, PET uses radioactive tracers and has a lower spatial resolution compared to CMR and CT. CMR and CT are emerging techniques in the field of myocardial perfusion imaging. CMR uses magnetic resonance to obtain images, whereas CT uses x-rays during first...

  12. Prognosis of patients with positive exercise test and normal myocardial perfusion SPECT

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    Seo, J. H.; Jeong, S. Y.; Bae, J. H.; Ahn, B. C.; Lee, J.; Lee, K. B [College of Medicine, Kyungpook National University, Daegu (Korea, Republic of)

    2004-07-01

    Exercise SPECT myocardial perfusion imaging(Ex-MPI) is regarded as a predictive technique particularly in patients with coronary artery disease(CAD) capable of performing exercise testing. In clinical practice, we encounter equivocal situations of discordant findings between exercise ECG and MPI. We evaluated the prognosis of subjects with positive ECG and normal MPI findings, and predictive factors for cardiac events. 2571 Ex-MPI studies were reviewed over a period of 3 years. Subjects were followed for more than 2 years(24-56 months, mean 35{+-}10months) for cardiac events after study. The cardiac events were defined as hard events(cardiac death and nonfatal myocardial infarction(MI)) and soft events(aggravation of CAD necessitating revascularization, congestive heart failure necessitating hospital admission). We evaluated age, sex, typical angina pain, rest ECG, hypertension, diabetes mellitus(DM), serum levels of cholesterol and LDL, smoking history, history of cerebrovascular disease(CVD) and peripheral artery disease(PAD), and rest left ventricular ejection fraction(LVEF) as clinical variables. Of 83 subjects with positive ECG and normal MPS findings, 6 were considered as false negative results confirmed with coronary angiography. There were 77 patients (mean age 52{+-}10 years, 39 males) with positive ECG and normal MPI results. During the follow-up period, of 77 there were 3 cardiac events (annual rate 1.9%), no cardiac death, 2 nonfatal MIs (annual rate 1.3%) and 1 soft event (annual rate 0.6%). 2/39 males(5.1%), and 1/38 females(2.6%) had cardiac events. All cardiac events were observed within 2 years. 1-year cardiac event rate was 0.6% and 2-year cardiac event rate was 1.9%. Among clinical factors, male sex, typical chest pain and smoking history at the time of MPI were predictive of cardiac events. Patients with positive ECG and negative EX-MPI results have low risk for cardiac events. Nevertheless, the cardiac events cannot be excluded totally in some

  13. Safety and feasibility of adjunctive regadenoson injection at peak exercise during exercise myocardial perfusion imaging: The Both Exercise and Regadenoson Stress Test (BERST) trial.

    Science.gov (United States)

    Ross, M I; Wu, E; Wilkins, J T; Gupta, D; Shen, S; Aulwes, D; Montero, K; Holly, T A

    2013-04-01

    The data existing in the literature regarding the safety of using regadenoson with symptom-limited exercise are limited, which motivated the authors to undertake this randomized study. We offered patients scheduled to undergo vasodilator stress nuclear myocardial perfusion imaging the opportunity to exercise instead. Patients who failed to reach target heart rate (THR) were randomized to (1) receive regadenoson at peak exercise or (2) stop exercise and receive regadenoson at rest. Patients who reached THR received a standard Tc-99m sestamibi injection with no regadenoson. 200 patients were included (66% male, mean age 52.5 ± 13.6). 125 patients (62%) reached THR with exercise alone. All stress protocols were well tolerated, and there were no significant adverse events. There were no statistically significant differences in the extent of perfusion abnormalities, image quality, or rate of referral to cardiac catheterization within 60 days between the groups. In fully adjusted logistic regression models, beta-blocker use and diabetes remained significant univariate predictors of failure to reach THR (OR 0.21, 95% CI 0.1-0.5, P regadenoson at peak exercise in patients unable to reach THR with exercise is feasible, well-tolerated, and yields comparable imaging results to a standard regadenoson injection at rest. In addition, pharmacologic stress testing may be over-ordered in current clinical practice, as patients referred for such testing were often able to exercise.

  14. Comparison of hemodynamic and stress testing variables in patients undergoing regadenoson stress myocardial perfusion imaging to regadenoson with adjunctive low-level exercise myocardial perfusion imaging.

    Science.gov (United States)

    Cabrera, Rafael; Husain, Zehra; Palani, Gurunanthan; Karthikeyan, Aarthee S; Choudhry, Zain; Dhanalakota, Sunita; Peterson, Ed; Ananthasubramaniam, Karthik

    2013-06-01

    Regadenoson (REG), a selective adenosine A2a receptor agonist, is becoming the preferred pharmacologic agent for stress myocardial perfusion imaging (MPI). Hemodynamic and stress variables, immediate safety and use of aminophylline when using REG combined with low-level exercise (REG WALK MPI) compared with REG MPI, have not been well studied and formed the basis of our study. Retrospective evaluation of patients who underwent REG MPI (n = 887) was compared to patients undergoing REG WALK MPI (n = 485) from January to November 2009. Patient demographics, hemodynamic parameters, REG MPI data, side effects, immediate major clinical events, and use of aminophylline were evaluated. Patients in REG WALK MPI group tended to be younger, male and obese compared to patients in REG MPI group. REG WALK MPI patients had higher stress heart rate (103 ± 20.5 vs 84 ± 19 bpm, P = .001), higher heart rate reserve (36.3 ± 19 vs 14.7 ± 15.5 bpm, P < .001), and greater systolic blood pressure rise (4.8 ± 21.3 vs -8.9 ± 19.8 mm Hg, P < .001), compared to REG MPI patients. No major adverse events were reported immediately after REG WALK MPI. There were no differences in drug-related side effects in between the two groups; however, the use of aminophylline was lower in REG WALK MPI Group (5.6% vs 11.4%, P = .001). REG WALK MPI gives more favorable hemodynamic response with lesser use of aminophylline and no increase in adverse events when compared with REG MPI.

  15. Myocardial perfusion modeling using MRI

    DEFF Research Database (Denmark)

    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...

  16. Regional myocardial perfusion defects during exercise, as assessed by three dimensional integration of morphology and function, in relation to abnormal endothelium dependent vasoreactivity of the coronary microcirculation

    Science.gov (United States)

    Schindler, T H; Nitzsche, E; Magosaki, N; Brink, I; Mix, M; Olschewski, M; Solzbach, U; Just, H

    2003-01-01

    Objective: To test the hypothesis that scintigraphic regional myocardial perfusion defects during exercise in patients with normal coronary angiography may be related to abnormal endothelium dependent vasoreactivity of the corresponding myocardial territory in response to cold pressor testing. Methods: 38 patients were classified into two groups according to the presence or absence of exercise induced scintigraphic myocardial perfusion defects. A cold pressor test was done in all patients during routine coronary angiography, followed by dynamic positron emission tomography to establish coronary blood flow mediated vasoreactivity of the epicardial coronary artery and the myocardial territories supplied by the left anterior descending, left circumflex, and right coronary arteries. Results: 28 patients had regional myocardial perfusion defects while 10 had normal scintigraphic imaging. The three dimensional scintigraphic fusion image revealed 49 regional myocardial perfusion defects with a mean (SD) reversibility of the original stress defect of 20 (3)%. In patients with exercise induced regional myocardial perfusion defects, the responses of epicardial luminal area and regional myocardial blood flow (RMBF) to cold pressor testing were reduced compared with patients with normal perfusion imaging (epicardial luminal area: 5.2 (1.2) to 4.2 (0.86) mm2 v 4.7 (0.5) to 5.8 (0.5) mm2; RMBF: 0.75 (0.16) to 0.78 (0.20) ml/g/min v 0.75 (0.15) to 1.38 (0.26) ml/g/min; p ≤ 0.03, respectively). In patients with regional abnormal scintigraphic perfusion, the corresponding RMBF response to cold pressor testing was more severely impaired than the mean myocardial blood flow in the remaining two vascular territories, but the difference was not significant (0.75 (0.16) to 0.78 (0.20) ml/g/min v 0.75 (0.10) to 0.87 (0.12) ml/g/min; NS). The endothelium independent increase in RMBF induced by glyceryl trinitrate did not differ between patients with exercise induced myocardial perfusion

  17. Regadenoson in Europe: first-year experience of regadenoson stress combined with submaximal exercise in patients undergoing myocardial perfusion scintigraphy.

    Science.gov (United States)

    Brinkert, M; Reyes, E; Walker, S; Latus, K; Maenhout, A; Mizumoto, R; Nkomo, C; Standbridge, K; Wechalekar, K; Underwood, S R

    2014-03-01

    Regadenoson was approved for clinical use in Europe in 2011. Since then, it has become the default form of stress at our institution. We have assessed the side-effect profile and tolerability of regadenoson in patients undergoing clinically indicated myocardial perfusion scintigraphy between July 2011 and July 2012. Clinical, stress and imaging data were recorded prospectively. Symptoms during stress were recorded and defined as mild, moderate or severe. An adverse event was defined as any symptom that persisted for more than 30 min or that required investigation or treatment. Of 1,764 consecutive patients, 1,581 (90%) received regadenoson combined with submaximal exercise unless contraindicated. Symptoms were common (63%) but transient and well-tolerated. The severity of symptoms was recorded in most patients as mild (84%). Dyspnoea (36%) and chest discomfort (12%) were the commonest side effects. Adverse events were reported in eight patients (0.5%), thought to be vasovagal in seven of these. All patients recovered fully without sequelae. There were no deaths, myocardial infarction or hospital admissions. Regadenoson stress was performed in 206 patients (12%) with asthma or chronic obstructive pulmonary disease (COPD) without bronchospasm or any other major side effect. We studied the symptom profile of regadenoson in the largest European cohort to date. Regadenoson combined with submaximal exercise was well tolerated, notably also in patients with asthma or COPD. The majority of regadenoson-related adverse events were vasovagal episodes without sequelae.

  18. Myocardial perfusion modeling using MRI

    DEFF Research Database (Denmark)

    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...... in the anterior myocardial wall were (mean +/- SD) Ki = 54 +/- 10 ml/100 g/min, lambda = 30 +/- 3 ml/100 g, Vb = 9 +/- 2 ml/100 g, delta T = 3.2 +/- 1.1 s. These results are in good agreement with similar results obtained by other methods....

  19. A useful and easy to develop combined stress test for myocardial perfusion imaging: Regadenoson and isometric exercise, preliminary results.

    Science.gov (United States)

    Janvier, Lucile; Pinaquy, J; Douard, H; Karcher, G; Bordenave, L

    2017-02-01

    Regadenoson, a selective A2a receptor agonist, is a vasodilator increasingly used in myocardial perfusion imaging. Adjunction of isometric exercise is a simple method that could improve side effect profile while providing better image quality. Patients undergoing SPECT MPI were prospectively enrolled in handgrip-Regadenoson (HG-Reg test, N = 20) and Regadenoson (Reg) stress test (N = 40). Investigator blinded to stress test analyzed clinical data and images. Heart rate (HR) increase was statistically higher in the HG-Reg group (27 vs 22 bpm, P = .019). Decrease in SBP was less frequent in the HG-Reg group than in the Reg group (55% vs 85.5%, P = .005), there were less drops >10 mmHg (45% vs 77.7%, P = .012). During stress testing, fewer subjects reported at least one side effect in the HG-Reg compared to Reg group (70% vs 92.5%, P = .021). Images were more often classified as good in the HG-Reg group (75% vs 52.5% in the Reg group, P = .25). Adjunction of handgrip exercise to Regadenoson administration is a well-tolerated and easy method, without loss of time. Furthermore, image quality seems to be better.

  20. Dynamic CT myocardial perfusion imaging

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    Caruso, Damiano [Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC (United States); Department of Radiological Sciences, Oncological and Pathological Sciences, University of Rome “Sapienza”, Latina (Italy); Eid, Marwen [Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC (United States); Schoepf, U. Joseph, E-mail: schoepf@musc.edu [Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC (United States); Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC (United States); Jin, Kwang Nam [Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC (United States); Department of Radiology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul (Korea, Republic of); Varga-Szemes, Akos [Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC (United States); Tesche, Christian [Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC (United States); Department of Cardiology and Intensive Care Medicine, Heart Center Munich-Bogenhausen, Munich (Germany); Mangold, Stefanie [Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC (United States); Department of Diagnostic and Interventional Radiology, University Hospital of Tuebingen, Tuebingen (Germany); and others

    2016-10-15

    Highlights: • CT myocardial perfusion provides functional assessment of the myocardium. • CCTA is limited in determining the hemodynamic significance of coronary stenosis. • CT-MPI can accurately detect hemodynamically significant coronary artery stenosis. - Abstract: Non-invasive cardiac imaging has rapidly evolved during the last decade due to advancements in CT based technologies. Coronary CT angiography has been shown to reliably assess coronary anatomy and detect high risk coronary artery disease. However, this technique is limited to anatomical assessment, thus non-invasive techniques for functional assessment of the heart are necessary. CT myocardial perfusion is a new CT based technique that provides functional assessment of the myocardium and allows for a comprehensive assessment of coronary artery disease with a single modality when combined with CTA. This review aims to discuss dynamic CT myocardial perfusion as a new technique in the assessment of CAD.

  1. Myocardial perfusion scintigraphy: the evidence.

    Science.gov (United States)

    Underwood, S R; Anagnostopoulos, C; Cerqueira, M; Ell, P J; Flint, E J; Harbinson, M; Kelion, A D; Al-Mohammad, A; Prvulovich, E M; Shaw, L J; Tweddel, A C

    2004-02-01

    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. Dosimetry in myocardial perfusion imaging

    Energy Technology Data Exchange (ETDEWEB)

    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)

  3. Percutaneous transluminal coronary angioplasty in patients with reduced left ventricular ejection fraction: effects on myocardial perfusion and left ventricular response to exercise.

    Science.gov (United States)

    Singh, A; Chandler, S; Pears, D; Perry, R; Murray, R G; Shiu, M F

    1989-05-01

    Many patients with coronary artery disease treated by percutaneous transluminal coronary angioplasty (PTCA) have a history of previous myocardial injury resulting in a reduced left ventricular ejection fraction (EF). The effects of successful PTCA on myocardial perfusion and left ventricular function in these patients were compared to treatment in patients with normal left ventricular EF. There were 21 patients with a normal EF (mean EF 59 +/- 2%) (Group I) and 15 patients with reduced EF (mean EF 43 +/- 1%) (Group II). Before PTCA a similar degree of reversible myocardial ischemia was present on thallium scintigraphy. At peak exercise left ventricular EF in the Group I patients decreased by 4 +/- 1% compared to 8 +/- 1% in Group II. At one month following successful PTCA there was resolution of reversible myocardial ischemia in both groups. No changes in EF at rest were observed. At the same level of exercise as before PTCA the mean EF was 5 +/- 1% higher than the pretreatment value in Group I and 10 +/- 1% higher in Group II. Thus in this study reversible myocardial ischemia was associated with severe compromise in the left ventricular response to exercise which was substantially improved by PTCA.

  4. Myocardial perfusion imaging in hyperthrophic cardiomyopathy

    Energy Technology Data Exchange (ETDEWEB)

    Moorin, B. [Southland Hospital, Invercargill, (New Zealand). Department of Nuclear Medicine

    1998-06-01

    Full text: Patients with Hyperthrophic Cardiomyopathy (HCM) frequently suffer from syncope and cardiac arrest which may lead to sudden death. This is most often caused by ventricular arrhythmia`s in adults, however in young patients the mechanisms are thought to be different. Ischaemia may play a significant role even in young asymptomatic HCM patients. The mechanisms of ischaemic development in HCM differ from those in the `normal` myocardium (Due to intramural small vessel abnormalities and abnormal myocellular architecture). In HCM the coronary microcirculation is most often affected and massive hypertrophy means more energy is required to promote contraction thus increasing oxygen demand and compounding the effects of any ischaemic changes. A case of a 12 year old HCM patient is presented who has symptoms of syncope associated with exercise whose mother died suddenly of cardiac arrest developed from HCM. A myocardial perfusion rest/stress study was undertaken to detect any underlying myocardial ischaemia. Myocardial perfusion scintigraphy demonstrates any reduction in the microcirculation in addition to that present in the macrocirculation, unlike angiography which will only detect the latter. In this case the scan clearly showed evidence of ischaemia in the lateral wall and this may be an explanation for her episodes of syncope. We suggest an algorithm or the routine work-up of young patients with HCM which makes aggressive use of myocardial perfusion imaging to detect ischaemic changes. This may identify patients who are at higher risk and will assist with treatment decisions. We feel myocardial perfusion scintigraphy is a sensitive non-invasive accurate method of detecting microcirculatory ischaemia and is thus invaluable in HCM patients

  5. Regadenoson in Europe: first-year experience of regadenoson stress combined with submaximal exercise in patients undergoing myocardial perfusion scintigraphy

    OpenAIRE

    Brinkert, M.; Reyes, E.; Walker, S.; Latus, K.; Maenhout, A.; Mizumoto, R.; Nkomo, C.; Standbridge, K.; Wechalekar, K.; Underwood, S. R.

    2013-01-01

    Purpose Regadenoson was approved for clinical use in Europe in 2011. Since then, it has become the default form of stress at our institution. We have assessed the side-effect profile and tolerability of regadenoson in patients undergoing clinically indicated myocardial perfusion scintigraphy between July 2011 and July 2012. Methods Clinical, stress and imaging data were recorded prospectively. Symptoms during stress were recorded and defined as mild, moderate or severe. An adverse event was d...

  6. Role of myocardial perfusion single photon emission computed tomography in pediatric cardiology practice

    Directory of Open Access Journals (Sweden)

    Sundaram P

    2009-01-01

    Full Text Available Diagnostic and prognostic power of myocardial perfusion imaging in patients with coronary artery disease has been demonstrated with planar imaging which was further improvised with addition of gated SPECT and newer Technetium labeled myocardial perfusion tracers like SestaMIBI, Tetrofosmin. Myocardial perfusion abnormalities at rest and after stress are considered to be the best predictors of cardiac event-free survival in adults with ischemic heart disease. This article highlights various myocardial perfusion imaging (MPIradiopharmaceuticals, exercise procedures, pharmacological stress protocols, indications for MPI and myocardial perfusion patterns in children with some of the common congenital and acquired heart diseases.

  7. Patient satisfaction with coronary CT angiography, myocardial CT perfusion, myocardial perfusion MRI, SPECT myocardial perfusion imaging and conventional coronary angiography

    Energy Technology Data Exchange (ETDEWEB)

    Feger, S.; Rief, M.; Zimmermann, E.; Richter, F.; Roehle, R. [Freie Universitaet Berlin, Department of Radiology, Charite - Universitaetsmedizin Berlin Campus Mitte, Humboldt-Universitaet zu Berlin, Berlin (Germany); Dewey, M. [Freie Universitaet Berlin, Department of Radiology, Charite - Universitaetsmedizin Berlin Campus Mitte, Humboldt-Universitaet zu Berlin, Berlin (Germany); Institut fuer Radiologie, Berlin (Germany); Schoenenberger, E. [Medizinische Hochschule Hannover, Department of Medicine, Hannover (Germany)

    2015-07-15

    To evaluate patient acceptance of noninvasive imaging tests for detection of coronary artery disease (CAD), including single-photon emission computed tomography myocardial perfusion imaging (SPECT-MPI), stress perfusion magnetic resonance imaging (MRI), coronary CT angiography (CTA) in combination with CT myocardial stress perfusion (CTP), and conventional coronary angiography (CCA). Intraindividual comparison of perception of 48 patients from the CORE320 multicentre multinational study who underwent rest and stress SPECT-MPI with a technetium-based tracer, combined CTA and CTP (both with contrast agent, CTP with adenosine), MRI, and CCA. The analysis was performed by using a validated questionnaire. Patients had significantly more concern prior to CCA than before CTA/CTP (p < 0.001). CTA/CTP was also rated as more comfortable than SPECT-MPI (p = 0.001). Overall satisfaction with CT was superior to that of MRI (p = 0.007). More patients preferred CT (46 %; p < 0.001) as a future diagnostic test. Regarding combined CTA/CTP, CTP was characterised by higher pain levels and an increased frequency of angina pectoris during the examination (p < 0.001). Subgroup analysis showed a higher degree of pain during SPECT-MPI with adenosine stress compared to physical exercise (p = 0.016). All noninvasive cardiac imaging tests are well accepted by patients, with CT being the preferred examination. (orig.)

  8. Protocols of myocardial perfusion SPECT

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Seong Min [College of Medicine, Chungnam National University, Daejeon (Korea, Republic of)

    2005-02-15

    In myocardial perfusion scintigraphy, the results of this evaluation now confront the practitioner of nuclear medicine with methodological options. Most nuclear cardiologic studies are performed using thallium-201, Tc-99m sestamibi and Tc-99m tertrofosmin. Some part of these studies use some form of pharmacologic stress test. While tailoring each test to the individual is ideal, this may be impractical for a busy department. Accordingly, established protocols to be used for patients with similar clinical presentations will be helpful. The following review presents methodology of various imaging protocols mainly according to the guidelines of nuclear cardiology procedures in American Society of Nuclear Cardiology.

  9. Influence of cardiac stress protocol on myocardial perfusion imaging accuracy: The role of exercise level on the evaluation of ischemic burden.

    Science.gov (United States)

    Gimelli, Alessia; Liga, Riccardo; Pasanisi, Emilio Maria; Casagranda, Mirta; Coceani, Michele; Marzullo, Paolo

    2016-10-01

    Some specifics of cardiac stress protocols, i.e., stressor used or exercise level achieved, may impact myocardial perfusion imaging (MPI) accuracy. Four-hundred and seventy-five patients were submitted to MPI and coronary angiography. MPI was performed after exercise (303 patients) or dipyridamole stress (172 patients). A coronary stenosis ≥70% was considered significant. In case of exercise test, a peak heart rate (HR) 75% and stress protocol adopted (AUC .76 for exercise vs .78 for vasodilator; P = NS). However, in case of an exercise stress test, a significant interaction between peak %HR and MPI diagnostic power was evident. While an elevated accuracy was still maintained in "Group 1" patients (AUC .79; P vs maximal exercise = NS), a significant drop was demonstrated in "Group 2" patients (AUC .66; P vs maximal exercise = .012, and P vs "Group 1" = .042). The accuracy of MPI is not influenced by the stress protocol adopted. Exercise MPI maintains an elevated accuracy as long as the %HR remains >75%.

  10. Identification of advanced coronary artery disease with exercise myocardial perfusion imaging: the clinical value of a novel approach for assessing lung thallium-201 uptake

    Energy Technology Data Exchange (ETDEWEB)

    Moralidis, Efstratios [Hippokration Hospital, Nuclear Medicine Department, Thessaloniki (Greece); Hippokration Medical Center, Larissa (Greece); Spyridonidis, Tryfon [Hippokration Medical Center, Larissa (Greece); Arsos, Georgios [Hippokration Hospital, Nuclear Medicine Department, Thessaloniki (Greece); Anagnostopoulos, Constantinos [Royal Brompton Hospital, Nuclear Medicine Department, London (United Kingdom)

    2007-04-15

    The precise clinical utility of lung{sup 201}Tl uptake in exercise SPECT myocardial perfusion imaging remains open to research. This study validates an optimal index for lung{sup 201}Tl uptake measurement and assesses its value in the prediction of higher-risk coronary artery disease (CAD). Three hundred and ninety-eight patients underwent exercise SPECT myocardial perfusion imaging. They were separated into derivation (n = 217) and validation (n = 186) groups, both including sub-populations of lower- and higher-risk CAD, according to coronary angiography. Another 56 individuals with a low probability of CAD comprised the control group. From a planar, anterior, post-exercise acquisition, the lung (L) to heart (H) maximal (L/H{sub max}), total (L/H{sub mean}) and background-subtracted total (L/H{sub net}) ratios were calculated. These were also adjusted for confounding variables, as assessed from the control group. ROC analysis was used to compare the L/H ratios and define thresholds of abnormality. The performance of the optimal index was assessed in the derivation group and was then tested in the validation population. Subsequently, it was compared with other scintigraphic, exercise electrocardiography and clinical variables. In the derivation group L/H{sub net} was a better discriminator for higher-risk CAD than both L/H{sub max} and L/H{sub mean}. Similarly, the adjusted L/H{sub net} was a better discriminator than both the adjusted L/H{sub max} and the adjusted L/H{sub mean}. No significant difference was attained between L/H{sub net} and the adjusted L/H{sub net}. At the upper defined threshold of abnormality, sensitivity and specificity of L/H{sub net} in the detection of higher-risk CAD in the derivation and the validation cohorts were 52% and 92% versus 47% and 94%, respectively (p = ns). The results were similar at other defined thresholds. Moreover, L/H{sub net} was found to be a significant predictor of higher-risk CAD, superior to myocardial perfusion

  11. Regadenoson for myocardial perfusion scintigraphy.

    Science.gov (United States)

    Reyes, Eliana; Pennell, Dudley J

    2010-09-01

    Stress myocardial perfusion scintigraphy (MPS) plays a major role in the detection of obstructive coronary artery disease and provides valuable diagnostic and prognostic information to guide clinical decision-making with regard to medical therapy and coronary revascularisation. Current stress techniques for MPS are effective but their use may be limited by reduced tolerability, contraindications and untoward side effects. The recently developed selective adenosine A2A receptor agonists have the potential for improving stress tolerability, hence expanding the indications for functional imaging in the assessment of coronary artery disease. This article reviews the basic principles underlying activation of coronary arteriolar adenosine A2A receptors. It describes the benefits and limitations of current vasodilator stress agents and highlights the effectiveness, side effect profile and tolerability of regadenoson, the only selective adenosine A2A receptor agonist available at present for clinical use. The reader will gain an understanding of the pharmacokinetics and mechanism of action of regadenoson for the assessment of coronary artery disease when combined with myocardial perfusion imaging. The reader will also become aware of the available evidence on the clinical usefulness of regadenoson MPS and its future applications. Selective activation of coronary arteriolar adenosine A2A receptors by regadenoson provides an effective modality of stress for the detection of inducible perfusion abnormality in patients with known or suspected coronary disease. The effectiveness of regadenoson is similar to that of adenosine, but test tolerability is improved with regadenoson. The use of this agent simplifies stress testing and has the potential for expanding the applications of functional imaging to patient populations unsuitable for conventional vasodilator stress with adenosine or dipyridamole.

  12. A strategy of symptom-limited exercise with regadenoson-as-needed for stress myocardial perfusion imaging: a randomized controlled trial.

    Science.gov (United States)

    Parker, Matthew W; Morales, Donna Chelle; Slim, Hanna B; Ahlberg, Alan W; Katten, Deborah M; Cyr, Giselle; Mathur, Shishir; Ardestani, Afrooz; Barmpouletos, Dimitrios; Iyah, Geeta Swamy; Borer, Steven M; Heller, Gary V

    2013-04-01

    Ambulatory patients with uncertain functional capacity may benefit from combined exercise and vasodilator stress protocols for myocardial perfusion imaging (MPI). The safety and MPI image quality with regadenoson administered during symptom-limited exercise have not been prospectively evaluated. A total of 140 patients (mean age 61 years, 48% female) referred for exercise with vasodilator stress MPI were randomized 2:1 to a strategy of exercise with regadenoson-as-necessary (Ex-Reg, n = 96) or dipyridamole with exercise (Dip-Ex, n = 44) after Duke Activity Status Index (DASI) scoring (median score 28 vs 24, P = .09). Ex-Reg subjects commenced treadmill exercise and regadenoson was administered only if the subject was unable to reach standard endpoints. Dip-Ex subjects received dipyridamole prior to symptom-limited exercise. Hemodynamics were recorded throughout. Subjects completed symptom questionnaires and MPI image quality was assessed by blinded read. Ex-Reg subjects were more likely to achieve ≥85% age-predicted maximum heart rate than Dip-Ex subjects (57% vs 32%, P regadenoson and none had symptomatic hemodynamic changes. Severe side effects or adverse events occurred in 16% of Ex-Reg and 24% of Dip-Ex subjects (P = .12). MPI image quality was "good" or "excellent" in 88% of Ex-Reg subjects and 86% of Dip-Ex subjects (P = .33). A strategy of exercise with regadenoson-as-needed for MPI offers similar safety and side effect profile with similar image quality compared to dipyridamole with exercise, with reduced pharmaceutical use.

  13. Added prognostic value of ischaemic threshold in radionuclide myocardial perfusion imaging: a common-sense integration of exercise tolerance and ischaemia severity

    Energy Technology Data Exchange (ETDEWEB)

    Marini, Cecilia [IRCCS AOU San Martino-National Institute for Cancer Research, CNR Institute of Bioimaging and Molecular Physiology, Section of Genoa c/o Nuclear Medicine, Pad. Sommariva, Genoa (Italy); Acampa, Wanda [National Council of Research, Naples (Italy); Bauckneht, Matteo; Capitanio, Selene; Fiz, Francesco; Dib, Bassam; Sambuceti, Gianmario [University of Genoa, IRCCS-AOU San Martino-National Institute for Cancer Research, Nuclear Medicine, Department of Health Science, Genoa (Italy); Daniele, Stefania; Cantoni, Valeria; Zampella, Emilia; Assante, Roberta; Cuocolo, Alberto [University Federico II, Nuclear Medicine, Naples (Italy); Bruzzi, Paolo [IRCCS AOU San Martino-National Institute for Cancer Research, Epidemiology Unit, Genoa (Italy)

    2015-04-01

    Reversible ischaemia at radionuclide myocardial perfusion imaging (MPI) accurately predicts risk of cardiac death and nonfatal myocardial infarction (major adverse cardiac events, MACE). This prognostic penetrance might be empowered by accounting for exercise tolerance as an indirect index of ischaemia severity. The present study aimed to verify this hypothesis integrating imaging assessment of ischaemia severity with exercise maximal rate pressure product (RPP) in a large cohort of patients with suspected or known coronary artery disease (CAD). We analysed 1,502 consecutive patients (1,014 men aged 59 ± 10 years) submitted to exercise stress/rest MPI. To account for exercise tolerance, the summed difference score (SDS) was divided by RPP at tracer injection providing a clinical prognostic index (CPI). Reversible ischaemia was documented in 357 patients (24 %) and was classified by SDS as mild (SDS 2-4) in 180, moderate (SDS 5-7) in 118 and severe (SDS >7) in 59. CPI values of ischaemic patients were clustered into tertiles with lowest and highest values indicating low and high risk, respectively. CPI modified SDS risk prediction in 119/357 (33 %) patients. During a 60-month follow-up, MACE occurred in 68 patients. Kaplan-Meier analysis revealed that CPI significantly improved predictive power for MACE incidence with respect to SDS alone. Multivariate Cox analysis confirmed the additive independent value of CPI-derived information. Integration of ischaemic threshold and ischaemia extension and severity can improve accuracy of exercise MPI in predicting long-term outcome in a large cohort of patients with suspected or known CAD. (orig.)

  14. Myocardial perfusion imaging with dual energy CT

    Energy Technology Data Exchange (ETDEWEB)

    Jin, Kwang Nam [Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC (United States); Department of Radiology, SMG-SNU Boramae Medical Center, Seoul (Korea, Republic of); De Cecco, Carlo N. [Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC (United States); Caruso, Damiano [Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC (United States); Department of Radiological Sciences, Oncology and Pathology, University of Rome “Sapienza”, Rome (Italy); Tesche, Christian [Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC (United States); Department of Cardiology and Intensive Care Medicine, Heart Center Munich-Bogenhausen, Munich (Germany); Spandorfer, Adam; Varga-Szemes, Akos [Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC (United States); Schoepf, U. Joseph, E-mail: schoepf@musc.edu [Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC (United States); Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC (United States)

    2016-10-15

    Highlights: • Stress dual-energy sCTMPI offers the possibility to directly detect the presence of myocardial perfusion defects. • Stress dual-energy sCTMPI allows differentiating between reversible and fixed myocardial perfusion defects. • The combination of coronary CT angiography and dual-energy sCTMPI can improve the ability of CT to detect hemodynamically relevant coronary artery disease. - Abstract: Dual-energy CT (DECT) enables simultaneous use of two different tube voltages, thus different x-ray absorption characteristics are acquired in the same anatomic location with two different X-ray spectra. The various DECT techniques allow material decomposition and mapping of the iodine distribution within the myocardium. Static dual-energy myocardial perfusion imaging (sCTMPI) using pharmacological stress agents demonstrate myocardial ischemia by single snapshot images of myocardial iodine distribution. sCTMPI gives incremental values to coronary artery stenosis detected on coronary CT angiography (CCTA) by showing consequent reversible or fixed myocardial perfusion defects. The comprehensive acquisition of CCTA and sCTMPI offers extensive morphological and functional evaluation of coronary artery disease. Recent studies have revealed that dual-energy sCTMPI shows promising diagnostic accuracy for the detection of hemodynamically significant coronary artery disease compared to single-photon emission computed tomography, invasive coronary angiography, and cardiac MRI. The aim of this review is to present currently available DECT techniques for static myocardial perfusion imaging and recent clinical applications and ongoing investigations.

  15. Myocardial perfusion abnormalities in asymptomatic type 2 diabetic patients

    Directory of Open Access Journals (Sweden)

    Ghada Al-Humaidi

    2018-01-01

    Conclusions: We found a high prevalence of myocardial perfusion abnormalities in asymptomatic type 2 diabetic patients. Perfusion abnormalities on myocardial perfusion SPECT images were associated with disease duration, insulin use, nephropathy, and neuropathy. Asymptomatic diabetic patients might be candidates with CAD abnormalities that can be studied using myocardial perfusion SPECT.

  16. Prognostic value of dobutamine-atropine stress myocardial perfusion imaging in patients with diabetes

    NARCIS (Netherlands)

    A.F.L. Schinkel (Arend); A. Elhendy (Abdou); J.J. Bax (Jeroen); E.C. Vourvouri (Eleni); F. Sozzi (Fabiola); R. Valkema (Roelf); D. Poldermans (Don); J.R.T.C. Roelandt (Jos); R.T. van Domburg (Ron)

    2002-01-01

    textabstractOBJECTIVE: Exercise tolerance in patients with diabetes is frequently impaired due to noncardiac disease such as claudication and polyneuropathy. This study assesses the prognostic value of dobutamine stress myocardial perfusion imaging in patients with diabetes.

  17. Positron emission tomography myocardial perfusion imaging in children with suspected coronary abnormalities.

    Science.gov (United States)

    Singh, T P; Muzik, O; Forbes, T F; Di Carli, M F

    2003-01-01

    Positron emission tomography (PET) myocardial perfusion imaging has higher spatial resolution than conventional single photon emission computed tomography (SPECT) imaging and allows accurate and reproducible quantification of myocardial blood flow (MBF). In this article, we describe the role of PET myocardial perfusion imaging in clinical decision making in children with suspected coronary abnormalities. We performed a PET myocardial perfusion study using N-13 ammonia in 10 children (median age, 14 years; range, 1-17 years). The indications included exercise-induced chest pain and ST segment changes during exercise testing, coronary artery ectasia, hypertrophic cardiomyopathy with myocardial bridging of the left anterior descending coronary artery, and suspected left coronary stenosis in an infant with William's syndrome. MBF was assessed at baseline and during adenosine hyperemia in all 10 patients and postexercise in 8 patients. Myocardial perfusion was homogeneous at baseline in all 10 patients, during adenosine perfusion in 9 of 10 patients, and postexercise in all 8 patients. Three patients with homogeneous rest and stress perfusion had impaired myocardial flow reserve. The infant with William's syndrome developed a large, reversible perfusion defect in the left coronary territory during adenosine stress and underwent surgical repair. Myocardial flow reserve findings were valuable for clinical decision making in individual patients. We conclude that MBF quantification with N-13 ammonia and PET provides supplemental perfusion information and is helpful in clinical decision making in children with suspected coronary abnormalities.

  18. Meta-Analysis of Stress Myocardial Perfusion Imaging

    Science.gov (United States)

    2017-06-06

    Coronary Disease; Echocardiography; Fractional Flow Reserve, Myocardial; Hemodynamics; Humans; Magnetic Resonance Imaging; Myocardial Perfusion Imaging; Perfusion; Predictive Value of Tests; Single Photon Emission Computed Tomography; Positron Emission Tomography; Multidetector Computed Tomography; Echocardiography, Stress; Coronary Angiography

  19. Update on myocardial perfusion imaging: role of regadenoson

    OpenAIRE

    Hendel, Robert

    2009-01-01

    Robert C HendelMidwest Heart Specialists, Central DuPage Hospital, Winfield, Illinois, USAAbstract: Pharmacologic stress myocardial perfusion imaging (MPI) is a noninvasive method for the evaluation of coronary artery disease in patients unable to exercise adequately. Commonly used pharmacologic stress agents (adenosine, dipyridamole, and dobutamine) have a high incidence of bothersome and potentially serious side-effects, several contraindications to testing, and require continuous infusion ...

  20. The efficacy of nisoldipine on myocardial perfusion in patients with silent myocardial ischemia

    Energy Technology Data Exchange (ETDEWEB)

    Yamazaki, Junichi; Muto, Hiroshi; Naitou, Katsutoshi [Toho University, Tokyo (Japan). Omori Hospital] [and others

    1997-06-01

    Patients who had old myocardial infarction associated with myocardial viability and ischemia were divided into a pain-free group and a pain-positive group of nine patients each. The improvement of myocardial perfusion with nisoldipine therapy was compared between the two groups using exercise-load Tl-201 myocardial SPECT (myocardial SPECT). The exercise time was significantly prolonged from 505 seconds to 607 seconds after administration of nisoldipine in the pain-positive group (p<0.05), but there was no change in the pain-free group. The extent score of the full circumference of the left ventricle, the severity score, and the %Tl uptake of the infarcted region were significantly improved in both groups by administration of nisoldipine. These findings suggested that nisoldipine caused a decrease in the myocardial oxygen requirements associated with reduction of the afterload and coronary artery dilatation in the pain-positive group, but mainly caused coronary dilatation in the pain-free group. Since myocardial perfusion also improved after nisoldipine administration in the pain-free group, the possibility that calcium antagonists can be used for prophylactic treatment of asymptomatic myocardial ischemia was suggested. (author)

  1. Nonrigid registration of myocardial perfusion MRI

    DEFF Research Database (Denmark)

    Ólafsdóttir, Hildur

    2005-01-01

    This paper describes a fully automatic registration of 10 multi-slice myocardial perfusion magnetic resonance image sequences. The registration of these sequences is crucial for the clinical interpretation, which currently is subjected to manual labour. The approach used in this study is a nonrig...

  2. Measurement of myocardial perfusion using magnetic resonance

    DEFF Research Database (Denmark)

    Fritz-Hansen, T.; Jensen, L.T.; Larsson, H.B.

    2008-01-01

    Cardiac magnetic resonance imaging (MRI) has evolved rapidly. Recent developments have made non-invasive quantitative myocardial perfusion measurements possible. MRI is particularly attractive due to its high spatial resolution and because it does not involve ionising radiation. This paper reviews...

  3. Myocardial perfusion abnormalities in asymptomatic patients with systemic lupus erythematosus

    Energy Technology Data Exchange (ETDEWEB)

    Hosenpud, J.D.; Montanaro, A.; Hart, M.V.; Haines, J.E.; Specht, H.D.; Bennett, R.M.; Kloster, F.E.

    1984-08-01

    Accelerated coronary artery disease and myocardial infarction in young patients with systemic lupus erythematosus is well documented; however, the prevalence of coronary involvement is unknown. Accordingly, 26 patients with systemic lupus were selected irrespective of previous cardiac history to undergo exercise thallium-201 cardiac scintigraphy. Segmental perfusion abnormalities were present in 10 of the 26 studies (38.5 percent). Five patients had reversible defects suggesting ischemia, four patients had persistent defects consistent with scar, and one patient had both reversible and persistent defects in two areas. There was no correlation between positive thallium results and duration of disease, amount of corticosteroid treatment, major organ system involvement or age. Only a history of pericarditis appeared to be associated with positive thallium-201 results (p less than 0.05). It is concluded that segmental myocardial perfusion abnormalities are common in patients with systemic lupus erythematosus. Whether this reflects large-vessel coronary disease or small-vessel abnormalities remains to be determined.

  4. Myocardial perfusion at fatal infarction

    DEFF Research Database (Denmark)

    Hvid-Jacobsen, K; Møller, J T; Kjøller, E

    1992-01-01

    In a consecutive study of myocardial scintigraphy in acute ischemic syndrome, four patients had 99mTc-hexamibi injected intravenously before they developed fatal cardiogenic shock. Planar scintigraphy was performed after death. Slices of the hearts after autopsy were analyzed for scintigraphic...

  5. Regional myocardial perfusion and performance

    NARCIS (Netherlands)

    H.C. Schamhardt (Henk)

    1980-01-01

    textabstractThe function of the heart is to pump blood from the veins into the arteries in response to the need of the tissues for oxygen and substrates. During its action the heart itself needs these nutrients. Factors that mainly determine the myocardial oxygen demand are (fig.0.1): heart rate,

  6. An alternative method for neonatal cerebro-myocardial perfusion

    Science.gov (United States)

    Luciani, Giovanni Battista; De Rita, Fabrizio; Faggian, Giuseppe; Mazzucco, Alessandro

    2012-01-01

    Several techniques have already been described for selective cerebral perfusion during repair of aortic arch pathology in children. One method combining cerebral with myocardial perfusion has also been proposed. A novel technique is reported here for selective and independent cerebro-myocardial perfusion for neonatal and infant arch surgery. Technical aspects and potential advantages are discussed. PMID:22307393

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

    Directory of Open Access Journals (Sweden)

    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.

  8. The influence of clopidogrel on ischemia diagnosed by myocardial perfusion stress testing.

    Science.gov (United States)

    Jovin, Ion S; Ebisu, Keita A; Oprea, Adriana D; Brandt, Cynthia A; Natale, Donna; Finta, Laurie A; Dziura, James; Wackers, Frans J

    2016-08-01

    Clopidogrel is a platelet adenosine receptor antagonist which can influence coronary vascular tone and thus can potentially interfere with myocardial perfusion imaging. We investigated whether clopidogrel can hamper the diagnosis of ischemia in patients undergoing myocardial perfusion testing. Data from a database of 6349 myocardial perfusion stress tests were analyzed. Using a propensity analysis, patients who were taking clopidogrel were compared with patients not taking clopidogrel for the presence of reversible perfusion defects on myocardial single-photon emission computed tomography scans. Of the 6349 tests, the stress technique was adenosine in 2713 patients and exercise in 3636. At the time of the stress test, 277 (4.3%) of the patients were taking clopidogrel. The odds ratio (OR) for patients taking clopidogrel to have a reversible perfusion defect was 2.75 (95% confidence interval [CI] 2.09-3.62; P clopidogrel, the OR was 1.06 (CI 0.76-1.49; P = .73) for patients undergoing adenosine stress tests and 1.60 (CI 0.85-3.00; P = .14) for patients undergoing exercise stress tests. We found no evidence that the use of clopidogrel decreases the likelihood of ischemia on adenosine or exercise stress myocardial perfusion scans.

  9. Feasibility and safety of exercise stress testing using an anti-gravity treadmill with Tc-99m tetrofosmin single-photon emission computed tomography (SPECT) myocardial perfusion imaging: A pilot non-randomized controlled study.

    Science.gov (United States)

    Daly, Patrick; Kayse, Regina; Rudick, Steven; Robbins, Nathan; Scheler, Jennifer; Harris, David; O'Donnell, Robert; Dwivedi, Alok K; Gerson, Myron C

    2017-08-31

    Exercise is the AHA/ACC guideline-recommended stress modality for myocardial perfusion imaging, but many patients are unable to exercise to target heart rate on a conventional treadmill. We examined the feasibility and safety of stress imaging using an anti-gravity treadmill in patients with perceived poor exercise capacity. 49 patients were recruited for stress testing by anti-gravity treadmill (n = 29) or to a regadenoson control group (n = 20). Seventeen anti-gravity test patients (59%) reached target heart rate obviating the need for a pharmacologic stress agent. Adverse effects of the anti-gravity treadmill were limited to minor muscle aches in 5 subjects. Stress myocardial perfusion image quality judged by 3 blinded readers on a 5-point scale was comparable for the anti-gravity treadmill (4.30 ± SD 0.87) vs pharmacologic stress (4.28 ± SD 0.66). Stress testing using an anti-gravity treadmill is feasible and may help some patients safely achieve target heart rate.

  10. Interarterial course of the right coronary artery: assessment with cardiac computed tomography and myocardial perfusion imaging.

    Science.gov (United States)

    Husmann, Lars; Valenta, Ines; Veit-Haibach, Patrick; Alkadhi, Hatem; Largiader, Thomas; Kaufmann, Philipp A

    2008-05-01

    A 50-year-old well-trained cyclist reported increasing brief episodes of chest pain over the last 8 years at maximum exercise during alpine bicycle training. Previous cardiac stress testing on a supine bicycle ergometer revealed nonspecific ST-T abnormalities. In June 2007, the patient was referred for computed tomography coronary angiography, which revealed a coronary anomaly, with the right coronary artery originating from the left coronary sinus and taking an interarterial course between the ascending aorta and the pulmonary trunk. There were no atherosclerotic alterations in the coronary arteries. Subsequent bicycle exercise stress and myocardial perfusion imaging revealed no myocardial perfusion defect.

  11. Update on myocardial perfusion imaging: role of regadenoson

    Directory of Open Access Journals (Sweden)

    Robert C Hendel

    2009-02-01

    Full Text Available Robert C HendelMidwest Heart Specialists, Central DuPage Hospital, Winfield, Illinois, USAAbstract: Pharmacologic stress myocardial perfusion imaging (MPI is a noninvasive method for the evaluation of coronary artery disease in patients unable to exercise adequately. Commonly used pharmacologic stress agents (adenosine, dipyridamole, and dobutamine have a high incidence of bothersome and potentially serious side-effects, several contraindications to testing, and require continuous infusion with weight-adjusted doses. Newer agents are, therefore, needed. Selective activation of A2A adenosine receptors on the coronary vasculature should provide coronary vasodilation for MPI with fewer or less severe side-effects associated with nonspecific agonists, such as adenosine and dipyridamole. Regadenoson is the first selective A2A receptor agonist to be approved as a pharmacologic stress agent for use with radionuclide MPI. Regadenoson is administered at a standard, fixed dose of 400 μg from a prefilled syringe or single-use vial by intravenous injection over 10 seconds. In clinical trials, regadenoson provided good quality images yielding accurate diagnostic information, and was safe and well tolerated. No infusion pump is required and the stress protocol is brief. Further studies are now required to evaluate regadenoson as a stress agent in combination with low-level exercise, with prior caffeine intake, and in patients with asthma or chronic obstructive pulmonary disease.Keywords: myocardial perfusion imaging, pharmacologic stress, A2A receptor agonist, regadenoson, ischemic heart disease, SPECT, diagnosis

  12. Regadenoson stress for myocardial perfusion imaging.

    Science.gov (United States)

    Reyes, Eliana

    2016-01-01

    Noninvasive functional imaging plays a major role in the diagnosis of hemodynamically significant coronary artery disease (CAD) by means of the detection of abnormal myocardial perfusion. For this, cardiac stressors are essential as they induce hypoperfusion in the presence of flow-limiting coronary stenosis. Several pharmacological stressors are currently available and it is important that clinicians who are involved in the care and management of patients with CAD become familiar with their indications, contraindications and protocols. Among the primary coronary vasodilator agents, regadenoson is increasingly used as the default stressor or as an alternative to other modalities of stress. This article provides an updated review of regadenoson stress for the assessment of patients with suspected or known CAD and describes its pharmacological properties, stress protocol, efficacy and safety profile.

  13. Influence of revascularization on myocardial perfusion, metabolism and function

    Energy Technology Data Exchange (ETDEWEB)

    Kropp, Joachim; Krois, Markus; Eichhorn, Bernd; Fehske, Wolfgang; Likungu, James; Kirchhoff, P.G.; Luederitz, Berndt; Biersack, Hans-Juergen [Bonn Univ. (Germany); Knapp, F.F. Jr.

    1993-12-01

    Thirty-nine patients with coronary artery disease (CAD) were investigated with sequential SPECT-scintigraphy after administration of 200 MBq of 15-(p-[I-123]iodophenyl)pentadecanoic acid (IPPA) at peak submaximal exercise. Twenty patients underwent coronary angioplasty (PTCA) from which 14 had control coronary arteriography (CA) and left ventricular cineventriculography (LVCV). Nineteen patients underwent bypass graft surgery (ACB) and stress sonography. Semi-quantification of uptake (Up, related to perfusion) and turnover (Tr, linked to metabolism) was obtained by segmental comparison of oblique slices. About 90% of the reperfused myocardial segments in the PTCA-group and 76% in the ACB-group showed an improvement of uptake after therapy (RUp). Out of these, 50% and 66% exhibited increased turnover (RTr) after PTCA or ACB, respectively. The remaining segments had persistingly pathologic RTr indicating a dissociation of improvement of perfusion and metabolism after therapy. Pathologic RTr was highly correlated with regional wall motion abnormalities (RWMA) after therapy in both groups. In the ACB-group improvement in RTr was correlated with improved RWM at rest and stress in 86% and 92%, respectively, whereas no improvement in RTr was correlated with impared function in 100% and 52%, respectively. IPPA-studies show potential to provide information about changes of perfusion and metabolism after reperfusion and IPPA-turnover is a good predictor of the pattern of contractile function. (author).

  14. The RegEx trial: a randomized, double-blind, placebo- and active-controlled pilot study combining regadenoson, a selective A(2A) adenosine agonist, with low-level exercise, in patients undergoing myocardial perfusion imaging.

    Science.gov (United States)

    Thomas, Gregory S; Thompson, Randall C; Miyamoto, Michael I; Ip, Tze K; Rice, Deborah L; Milikien, Douglas; Lieu, Hsiao D; Mathur, Vandana S

    2009-01-01

    Although vasodilator stress myocardial perfusion imaging (MPI) is increasingly performed with exercise, adenosine A(2A) receptor agonists have not been studied with exercise. To determine the safety of administering regadenoson during exercise and, secondarily, to evaluate image quality, patient acceptance, and detection of perfusion defects. Patients requiring pharmacologic MPI received a standard adenosine-supine protocol (AdenoSup, n = 60) and were then randomized (2:1) in a double-blind manner to low-level exercise with bolus intravenous injection of regadenoson (RegEx, n = 39) or placebo (PlcEx, n = 21). Adverse events occurred in 95%, 77%, and 33% of patients receiving AdenoSup, RegEx, and PlcEx, respectively. Peak heart rate was 13 beats per minute (bpm) and 21 bpm greater following RegEx compared to that following PlcEx and AdenoSup, respectively (P = .006 and or = 20 mm Hg showed no important differences between RegEx and PlcEx. No occurrences of 2nd degree or higher AV block were observed following RegEx or PlcEx; one patient developed 2nd degree AV block following AdenoSup. The mean heart-to-liver and heart-to-gut ratios were improved on RegEx vs AdenoSup: 0.85 (0.34) vs 0.65 (0.26), P regadenoson with low-level exercise is feasible, well tolerated, and associated with fewer side effects compared to AdenoSup.

  15. Regadenoson pharmacologic stress for myocardial perfusion imaging: a three-way comparison between regadenoson administered at peak exercise, during walk recovery, or no-exercise.

    Science.gov (United States)

    Thompson, Randall C; Patil, Harshal; Thompson, Elaine C; Thomas, Gregory S; Al-Amoodi, Mohammed; Kennedy, Kevin F; Bybee, Kevin A; Iain McGhie, A; O'Keefe, James H; Oakes, Lisa; Bateman, Timothy M

    2013-04-01

    Regadenoson (Reg) is being administered with increasing frequency either at peak exercise (ExPeak-Reg) or during a slow-down/walking recovery state (ExRec-Reg) rather than at rest (Rest-Reg). The aim of this study was to compare the clinical response of ExPeak-Reg, ExRec-Reg, and Rest-Reg. We compared 531 patients divided equally between Rest-Reg, ExPeak-Reg, and ExRec-Reg matched for age, sex, and BMI. The average systolic blood pressure (SBP) rise following Reg was modest, but there was considerable heterogeneity and the ExPeak-Reg group had a higher percentage of patients who had a SBP rise of 40 mm Hg or a fall of 20 mm Hg than either the ExRec-Reg or the Rest-Reg groups (≥40 mm Hg rise 6.8%, 1.7%, and 1.7%, respectively) (P Regadenoson injected at peak of symptom-limited exercise was generally well tolerated, but some patients had a significant rise or drop in SBP. There is no apparent advantage of administering regadenoson at peak exercise rather than during walk recovery, and the latter approach may have a greater safety margin.

  16. Electrocardiographic left ventricular hypertrophy without echocardiographic abnormalities evaluated by myocardial perfusion and fatty acid metabolic imaging

    Energy Technology Data Exchange (ETDEWEB)

    Narita, Michihiro; Kurihara, Tadashi [Sumitomo Hospital, Osaka (Japan)

    2000-01-01

    The pathophysiologic process in patients with electrocardiographic left ventricular hypertrophy with ST, T changes but without echocardiographic abnormalities was investigated by myocardial perfusion imaging and fatty acid metabolic imaging. Exercise stress {sup 99m}Tc-methoxy-isobutyl isonitrile (MIBI) imaging and rest {sup 123}I-beta-methyl-p-iodophenyl pentadecanoic acid (BMIPP) imaging were performed in 59 patients with electrocardiographic hypertrophy including 29 without apparent cause including hypertension and echocardiographic hypertrophy, and 30 with essential hypertension. Coronary angiography was performed in 6 patients without hypertension and 4 with hypertension and biopsy specimens were obtained from the left ventricular apex from 6 patients without hypertension. Myocardial perfusion and {sup 123}I-BMIPP images were classified into 3 types: normal, increased accumulation of the isotope at the left ventricular apex (high uptake) and defect. Transient perfusion abnormality and apical defect observed by {sup 123}I-BMIPP imaging were more frequent in patients without hypertension than in patients with hypertension (32% vs. 17%, p=0.04671 in perfusion; 62% vs. 30%, p=0.0236 in {sup 123}I-BMIPP). Eighteen normotensive patients with apical defect by {sup 123}I-BMIPP imaging included 3 of 10 patients with normal perfusion at exercise, 6 of 10 patients with high uptake and 9 of 9 patients with perfusion defect. The defect size revealed by {sup 123}I-BMIPP imaging was greater than that of the perfusion abnormality. Coronary stenoses were not observed and myocardial specimens showed myocardial disarray with hypertrophy. Moreover, 9 patients with hypertension and apical defects by {sup 123}I-BMIPP showed 3 different types of perfusion. Many patients without hypertension show a pathologic process similar to hypertrophic cardiomyopathy. Perfusion and {sup 123}I-BMIPP imaging are useful for the identification of these patients. (author)

  17. The EXERRT trial: "EXErcise to Regadenoson in Recovery Trial": A phase 3b, open-label, parallel group, randomized, multicenter study to assess regadenoson administration following an inadequate exercise stress test as compared to regadenoson without exercise for myocardial perfusion imaging using a SPECT protocol.

    Science.gov (United States)

    Thomas, Gregory S; Cullom, S James; Kitt, Therese M; Feaheny, Kathleen M; Ananthasubramaniam, Karthikeyan; Gropler, Robert J; Jain, Diwakar; Thompson, Randall C

    2017-06-01

    This study assessed the non-inferiority and safety of regadenoson administration during recovery from inadequate exercise compared with administration without exercise. Patients unable to achieve adequate exercise stress were randomized to regadenoson 0.4 mg either during recovery (Ex-Reg) or 1 hour after inadequate exercise (Regadenoson) (MPI1). All patients also underwent non-exercise regadenoson MPI 1-14 days later (MPI2). The number of segments with reversible perfusion defects (RPDs) detected using single photon emission computerized tomography imaging was categorized. The primary analysis evaluated the majority agreement rate between Ex-Reg and Regadenoson groups. 1,147 patients were randomized. The lower bound of the 95% confidence interval of the difference in agreement rates (-6%) was above the -7.5% non-inferiority margin, demonstrating non-inferiority of Ex-Reg to Regadenoson. Adverse events were numerically less with Ex-Reg (MPI1). In the Ex-Reg group, one patient developed an acute coronary syndrome and another had a myocardial infarction following regadenoson after exercise. Upon review, both had electrocardiographic changes consistent with ischemia prior to regadenoson. Administering regadenoson during recovery from inadequate exercise results in comparable categorization of segments with RPDs and with careful monitoring appears to be well tolerated in patients without signs/symptoms of ischemia during exercise and recovery.

  18. Quantification of myocardial perfusion by cardiovascular magnetic resonance.

    Science.gov (United States)

    Jerosch-Herold, Michael

    2010-10-08

    The potential of contrast-enhanced cardiovascular magnetic resonance (CMR) for a quantitative assessment of myocardial perfusion has been explored for more than a decade now, with encouraging results from comparisons with accepted "gold standards", such as microspheres used in the physiology laboratory. This has generated an increasing interest in the requirements and methodological approaches for the non-invasive quantification of myocardial blood flow by CMR. This review provides a synopsis of the current status of the field, and introduces the reader to the technical aspects of perfusion quantification by CMR. The field has reached a stage, where quantification of myocardial perfusion is no longer a claim exclusive to nuclear imaging techniques. CMR may in fact offer important advantages like the absence of ionizing radiation, high spatial resolution, and an unmatched versatility to combine the interrogation of the perfusion status with a comprehensive tissue characterization. Further progress will depend on successful dissemination of the techniques for perfusion quantification among the CMR community.

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

    Science.gov (United States)

    Özdemir, Semra; Gazi, Emine

    2013-01-01

    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. Conflict of interest:None declared. PMID:24003402

  20. Impairment of myocardial perfusion in children with sickle cell disease; Alteration de la perfusion myocardique chez l'enfant drepanocytaire

    Energy Technology Data Exchange (ETDEWEB)

    Maunoury, C. [Hopital Necker-Enfants-Malades, Service de Medecine Nucleaire, 75 - Paris (France); Acar, P. [Centre Hospitalier Universitaire, Hopital des Enfants, Service de Cardiologie Pediatrique, 31 - Toulouse (France); Montalembert, M. de [Hopital Necker-Enfants-Malades, Service de Pediatrie Generale, 75 - Paris (France)

    2003-10-01

    While brain, bone and spleen strokes are well documented in children with sickle cell disease (SCD), impairment of myocardial perfusion is an unknown complication. Non invasive techniques such as exercise testing and echocardiography have a low sensitivity to detect myocardial ischemia in patients with SCD. We have prospectively assessed myocardial perfusion with Tl-201 SPECT in 23 patients with SCD (10 female, 13 male, mean age 12 {+-} 5 years). Myocardial SPECT was performed after stress and 3 hours later after reinjection on a single head gamma camera equipped with a LEAP collimator (64 x 64 matrix size format, 30 projections over 180 deg C, 30 seconds per step). Left ventricular ejection fraction (LVEF) was assessed by equilibrium radionuclide angiography at rest on the same day. Myocardial perfusion was impaired in 14/23 patients: 9 reversible defects and 5 fixed defects. The left ventricular cavity was dilated in 14/23 patients. The mean LVEF was 63 {+-} 9%. There was no relationship between myocardial perfusion and left ventricular dilation or function. The frequent impairment of myocardial perfusion in children with SCD could lead to suggest a treatment with hydroxyurea, an improvement of perfusion can be noted with hydroxyurea. (author)

  1. Myocardial perfusion in type 2 diabetes with left ventricular hypertrophy

    DEFF Research Database (Denmark)

    Hesse, Birger; Meyer, Christian; Nielsen, Flemming S

    2004-01-01

    with PET using nitrogen-13 ammonia infused at rest and during dipyridamole hyperaemia. Twelve healthy control subjects were included in the study, five of whom were also studied with perindoprilat. Mean blood pressure in normo-albuminuric, asymptomatic patients was 123+/-7/65+/-9 mmHg. Compared......The purpose of this study was to assess whether acute angiotensin-converting enzyme (ACE) inhibition would improve myocardial perfusion and perfusion reserve in a subpopulation of normotensive patients with diabetes and left ventricular hypertrophy (LVH), both independent risk factors of coronary...... disease. Using positron emission tomography (PET), we investigated the response of regional myocardial perfusion to acute ACE inhibition with i.v. infusion of perindoprilat (vs saline infusion as control, minimum interval 3 days) in 12 diabetic patients with LVH. Myocardial perfusion was quantified...

  2. Role of CMR in assessment of myocardial perfusion

    Energy Technology Data Exchange (ETDEWEB)

    Prasad, S.K.; Lyne, J.; Chai Ping; Gatehouse, P. [Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, London (United Kingdom)

    2005-02-01

    Ischaemic heart disease is a major cause of morbidity and mortality. Assessment of myocardial perfusion is important in assessing the severity and extent of coronary artery lesions and in helping to guide revascularisation strategies where stenoses are documented. It provides information on the haemodynamic significance and a guide to prognosis. There has been much interest in the role of CMR assessment of perfusion and the opportunity for subendocardial resolution. We present an overview on its current status. (orig.)

  3. Direct myocardial perfusion imaging in valvular heart disease

    Energy Technology Data Exchange (ETDEWEB)

    Soto, R.C.; Durante, M.L.; Villacorta, E.V.; Torres, J.F.; Monzon, O.P.

    1981-02-01

    Twenty two patients with rheumatic valvular heart disease - 21 having a history of heart failure - were studied using direct coronary injection of /sup 99m/Tc labelled MAA particles during the course of hemodynamic and arteriographic studies. Myocardial perfusion deficit patterns have been shown to be consistent or indicative of either patchy, regional or gross ischemia. In patients with history of documented heart failure 90% (18 cases) had ischemic perfusion deficit in the involved ventricle. We conclude that diminished myocardial blood flow is an important mechanism contributing to the development of heart failure.

  4. Simvastatin may improve myocardial perfusion abnormality in slow coronary flow.

    Science.gov (United States)

    Cakmak, Mahmut; Tanriverdi, Halil; Cakmak, Nazmiye; Evrengul, Harun; Cetemen, Sebnem; Kuru, Omur

    2008-01-01

    The slow coronary flow (SCF) phenomenon is a coronary microvascular disorder characterized by the delayed passage of contrast in the absence of obstructive epicardial coronary disease. Recent studies showed the possible role of endothelial dysfunction, diffuse atherosclerosis and inflammation in the pathogenesis of this phenomenon. We aimed to investigate the effect of statin on myocardial perfusion in patients with SCF. The study population consisted of 97 patients with SCF. Coronary flow patterns of the cases are determined by thrombolysis in myocardial infarction (TIMI) frame count method. Single-photon emission computed tomographic myocardial perfusion imaging studies and lipid parameters of the patients were obtained before and after 6 months of simvastatin treatment period. During the study, daily single dose of 40 mg simvastatin has been given to each subject. We found a significant positive correlation between mean TIMI frame count and basal reversibility score (r = 0.84, p = 0.0001). In addition, analysis of the reversibility scores demonstrates that simvastatin treatment has significantly improved the myocardial perfusion abnormality at the end of the follow-up period. Present findings allow us to conclude that simvastatin improved myocardial perfusion in patients with SCF.

  5. Quantification of myocardial perfusion by cardiovascular magnetic resonance

    OpenAIRE

    Jerosch-Herold Michael

    2010-01-01

    Abstract The potential of contrast-enhanced cardiovascular magnetic resonance (CMR) for a quantitative assessment of myocardial perfusion has been explored for more than a decade now, with encouraging results from comparisons with accepted "gold standards", such as microspheres used in the physiology laboratory. This has generated an increasing interest in the requirements and methodological approaches for the non-invasive quantification of myocardial blood flow by CMR. This review provides a...

  6. Arm exercise stress perfusion imaging predicts clinical outcome.

    Science.gov (United States)

    Chan, Albert K; Ilias-Khan, Nasreen A; Xian, Hong; Inman, Cindi; Martin, Wade H

    2011-12-01

    Treadmill exercise capacity in resting metabolic equivalents (METs) and stress hemodynamic, electrocardiographic (ECG), and myocardial perfusion imaging (MPI) responses are independently predictive of adverse clinical events. However, limited data exist for arm ergometer stress testing (AXT) in patients who cannot perform leg exercise because of lower extremity disabilities. We sought to determine the extent to which AXT METs, hemodynamic, ECG, and MPI responses to arm exercise add independent incremental value to demographic and clinical variables for prediction of all-cause mortality, myocardial infarction (MI), or late coronary revascularization, individually or as a composite. A prospective cohort of 186 patients aged 64 ± 10 (SD) yr, unable to perform lower extremity exercise, underwent AXT MPI for clinical reasons between 1997 and 2002, and were followed for 62 ± 23 mo, to an endpoint of death or 12/31/2006. Average annual rates were 5.4% for mortality, 2.2% for MI, 2.5% for late coronary revascularization, and 8.0% for combined events. After adjustment for age and clinical variables, AXT METs [P ECG (P ECG (P leg exercise because of lower extremity disabilities, AXT METs are as important as MPI for prediction of mortality alone and death and MI combined, and a positive AXT ECG prognosticates MI alone and death and MI combined.

  7. Factors affecting thrombolysis in myocardial infarction myocardial perfusion frame count: insights of myocardial tissue-level reperfusion from a novel index for assessing myocardial perfusion.

    Science.gov (United States)

    Pu, Jun; Shan, Pei-ren; Ding, Song; Qiao, Zhi-qin; Jiang, Li-sheng; Song, Wei; DU, Yong-ping; Shen, Jie-yan; Shen, Lin-hong; Jin, Shu-xuan; He, Ben

    2011-03-01

    Myocardial tissue-level perfusion failure is associated with adverse outcomes following ST-elevation myocardial infarction (STEMI) despite successful epicardial recanalization. We have developed a new quantitative index-thrombolysis in myocardial infarction (TIMI) myocardial perfusion frame count (TMPFC)--for assessing myocardial tissue level perfusion. However, factors affecting this novel index of myocardial perfusion are currently unknown. A total of 255 consecutive STEMI patients undergoing primary angioplasty were enrolled. Myocardial tissue level perfusion was assessed by TMPFC, which measures the filling and clearance of contrast in the myocardium using cine-angiographic frame counting. We differentiate three groups with two cut off values for TMPFC: a TMPFC of 90 frames was the upper boundary of the 95% confidence interval (CI) for the TMPFC observed in normal arteries, and a TMPFC of 130 was the 75th percentile of TMPFC. STEMI patients with TMPFC > 130 frames (68 patients, 26.7%) had higher clinical and angiographic risk factor profiles as well as a higher 30-day MACE rate compared with those with TMPFC ≤ 90 frames and those with TMPFC > 90 and ≤ 130 frames. Multivariable analysis identified that the independent predictors of TMPFC > 130 frames were age ≥ 75 years (OR 2.08, 95%CI 1.21 to 3.58, P = 0.007), diabetes (OR 1.37, 95%CI 1.01 to 1.86, P = 0.042), Killip class ≥ 2 (OR 1.52, 95%CI 1.05 to 2.21, P = 0.027), and prolonged pain-to-balloon time (OR 1.73, 95%CI 1.07 to 2.79, P = 0.013). TMPFC > 130 frames was identified as the strongest independent predictor of 30-day major adverse cardiac event (MACE) (OR 2.77, 95%CI 1.21 to 6.31, P = 0.008), along with age ≥ 75 years (OR 2.19, 95%CI 1.11 to 4.33, P = 0.016), female gender (OR 1.67, 95%CI 1.03 to 2.70, P = 0.038), and Killip class ≥ 2 (OR 1.83, 95%CI 1.07 to 3.14, P = 0.021). STEMI patients with poor myocardial perfusion assessed by TMPFC had higher risk factor profiles. Advanced age

  8. Quantification of myocardial perfusion by cardiovascular magnetic resonance

    Directory of Open Access Journals (Sweden)

    Jerosch-Herold Michael

    2010-10-01

    Full Text Available Abstract The potential of contrast-enhanced cardiovascular magnetic resonance (CMR for a quantitative assessment of myocardial perfusion has been explored for more than a decade now, with encouraging results from comparisons with accepted "gold standards", such as microspheres used in the physiology laboratory. This has generated an increasing interest in the requirements and methodological approaches for the non-invasive quantification of myocardial blood flow by CMR. This review provides a synopsis of the current status of the field, and introduces the reader to the technical aspects of perfusion quantification by CMR. The field has reached a stage, where quantification of myocardial perfusion is no longer a claim exclusive to nuclear imaging techniques. CMR may in fact offer important advantages like the absence of ionizing radiation, high spatial resolution, and an unmatched versatility to combine the interrogation of the perfusion status with a comprehensive tissue characterization. Further progress will depend on successful dissemination of the techniques for perfusion quantification among the CMR community.

  9. Detection of myocardial ischemia with myocardial perfusion SPECT in patients with diabetes mellitus

    Energy Technology Data Exchange (ETDEWEB)

    Seo, J. H.; Jeong, S. Y.; Bae, J. H.; Anh, B. C.; Lee, J.; Lee, K. B [Kyungpook National University Hospital, Daegu (Korea, Republic of)

    2004-07-01

    Diabetes mellitus(DM) is a critical disease associated with higher rates of cardiovascular morbidity and mortality. Atherosclerosis accounts for 65-80% of all deaths in diabetic patients and patients with DM are known to show high prevalence of coronary artery diseases(CAD). We evaluated the incidence of scintigraphic evidence of CAD in diabetic patients and results were compared with cardiovascular symptoms and clinical factors. 169 patients with DM(mean age 629years, 68 males) were referred for evaluation of CAD between Jan 2002 and Dec 2003. 101(60%) patients were with chest pain and 68(40%) were asymptomatic. Patients underwent exercise(n=6) or adenosine stress(n=163) SPECT myocardial perfusion imaging(MPI). Exclusion criteria included history of documented myocardial infarction, prior revascularization, clinically significant valvular heart disease, left-bundle branch block on rest ECG. We evaluated symptoms associated with cardiac problem and other clinical and laboratory data to reveal correlation with presence of CAD. MPI were assessed visually and semi-quantitatively with C-Equal program. Myocardial ischemia was detected in 52(31%) patients. Among them, 41 had 1-vessel and 9 had 2-vessel disease. In 52 patients with ischemia, 28(54%) were male and 24(46%) were female. 20/68(29%) asymptomatic and 32/101(32%) symptomatic patients had ischemia. Higher prevalence of neuropathy, hypertension, higher blood glucose level, HbA1c and CRP was noted in patients with myocardial ischemia. Serum levels of cholesterol and LDL was not significantly different between patients with ischemia and with normal MPI findings. Abnormal MPI findings were not related with gender and age. These results show a high prevalence of abnormal MPI results in diabetic patients regardless of symptoms. Screening stress MPI in diabetic patients should be indicated irrespective of symptoms, especially in patients with neuropathy, hypertension, higher level of blood glucose, or increased CRP.

  10. Non-invasive imaging in detecting myocardial viability: Myocardial function versus perfusion

    Directory of Open Access Journals (Sweden)

    Iqbal A. Elfigih

    2014-12-01

    Full Text Available Coronary artery disease (CAD is the most prevalent and single most common cause of morbidity and mortality [1] with the resulting left ventricular (LV dysfunction an important complication. The distinction between viable and non-viable myocardium in patients with LV dysfunction is a clinically important issue among possible candidates for myocardial revascularization. Several available non-invasive techniques are used to detect and assess ischemia and myocardial viability. These techniques include echocardiography, radionuclide images, cardiac magnetic resonance imaging and recently myocardial computed tomography perfusion imaging. This review aims to distinguish between the available non-invasive imaging techniques in detecting signs of functional and perfusion viability and identify those which have the most clinical relevance in detecting myocardial viability in patients with CAD and chronic ischemic LV dysfunction. The most current available studies showed that both myocardial perfusion and function based on non-invasive imaging have high sensitivity with however wide range of specificity for detecting myocardial viability. Both perfusion and function imaging modalities provide complementary information about myocardial viability and no optimum single imaging technique exists that can provide very accurate diagnostic and prognostic viability assessment. The weight of the body of evidence suggested that non-invasive imaging can help in guiding therapeutic decision making in patients with LV dysfunction.

  11. Quantitative myocardial perfusion measurement using CT perfusion: a validation study in a porcine model of reperfused acute myocardial infarction.

    Science.gov (United States)

    So, Aaron; Hsieh, Jiang; Li, Jian-Ying; Hadway, Jennifer; Kong, Hua-Fu; Lee, Ting-Yim

    2012-06-01

    We validated a CT perfusion technique with beam hardening (BH) correction for quantitative measurement of myocardial blood flow (MBF). Acute myocardial infarction (AMI) was created in four pigs by occluding the distal LAD for 1 h followed by reperfusion. MBF was measured from dynamic contrast enhanced CT (DCE-CT) scanning of the heart, with correction of cardiac motion and BH, before ischemic insult and on day 7, 10 and 14 post. On day 14 post, radiolabeled microspheres were injected to measure MBF and the results were compared with those measured by CT perfusion. Excised hearts were stained with 2,3,5-triphenyltetrazolium chloride (TTC) to determine the relationship between MBF measured by CT Perfusion and myocardial viability. MBF measured by CT perfusion was strongly correlated with that by microspheres over a wide range of MBF values (R = 0.81, from 25 to 225 ml min(-1) 100 g(-1)). While MBF in the LAD territory decreased significantly from 98.4 ± 2.5 ml min(-1) 100 g(-1) at baseline to 32.2 ± 9.1 ml min(-1) 100 g(-1), P 0.05). TTC staining confirmed incomplete infarction in the LAD territory and no infarction in the LCx territory. Microvascular obstruction in infarcted tissue resulted in no-reflow and hence persistently low MBF in the reperfused LAD territory which contained a mixture of viable and non-viable tissue. CT perfusion measurement of MBF was accurate and correlated well with histology and microspheres measurements.

  12. Stress-only myocardial perfusion scintigraphy

    DEFF Research Database (Denmark)

    Ejlersen, June A; May, Ole; Mortensen, Jesper

    2017-01-01

    OBJECTIVE: Patients with normal stress perfusion have an excellent prognosis. Prospective studies on the diagnostic accuracy of stress-only scans with contemporary, independent examinations as gold standards are lacking. PATIENTS AND METHODS: A total of 109 patients with typical angina and no pre...

  13. The EXERRT trial: ?EXErcise to Regadenoson in Recovery Trial?: A phase 3b, open-label, parallel group, randomized, multicenter study to assess regadenoson administration following an inadequate exercise stress test as compared to regadenoson without exercise for myocardial perfusion imaging using a SPECT protocol

    OpenAIRE

    Thomas, Gregory S.; Cullom, S. James; Kitt, Therese M.; Feaheny, Kathleen M.; Ananthasubramaniam, Karthikeyan; Gropler, Robert J.; Jain, Diwakar; Thompson, Randall C.

    2017-01-01

    Background This study assessed the non-inferiority and safety of regadenoson administration during recovery from inadequate exercise compared with administration without exercise. Methods Patients unable to achieve adequate exercise stress were randomized to regadenoson 0.4?mg either during recovery (Ex-Reg) or 1?hour after inadequate exercise (Regadenoson) (MPI1). All patients also underwent non-exercise regadenoson MPI 1-14?days later (MPI2). The number of segments with reversible perfusion...

  14. Tomographic myocardial perfusion scintigraphy in children with Kawasaki disease

    Energy Technology Data Exchange (ETDEWEB)

    Spielmann, R.P.; Nienaber, C.A.; Hausdorf, G.; Montz, R.

    1987-12-01

    Myocardial infarction and stenotic coronary lesions are serious late complications in children with Kawasaki disease. For the noninvasive assessment of myocardial perfusion, dipyridamole-redistribution /sup 201/Tl emission computed tomography (ECT) was performed in seven children (age 2 8/12-8 7/12 yr) 3-20 mo after the acute stage of the disease. In all patients, coronary aneurysms had been demonstrated by cross-sectional echocardiography. The scintigrams of six children showed no significant regional reduction of myocardial thallium uptake. These children had remained asymptomatic since the acute stage of Kawasaki disease. Persistent and transient thallium defects were present in one child with documented myocardial infarction. For this patient, obstruction of corresponding coronary vessels was confirmed by contrast angiography. It is suggested, that /sup 201/Tl ECT after dipyridamole-induced vasodilation may be used as a safe alternative to invasive coronary angiography for follow-up investigations in patients with Kawasaki disease.

  15. Decreased myocardial perfusion reserve in diabetic autonomic neuropathy

    DEFF Research Database (Denmark)

    Taskiran, Mustafa; Fritz-Hansen, Thomas; Rasmussen, Verner

    2002-01-01

    conditions and after Dipyridamole-induced vasodilatation in nine type 1 diabetic patients with autonomic neuropathy (AN+), defined by cardiovascular tests, as well as in 10 type 1 diabetic patients without autonomic neuropathy (AN-) and 10 healthy control subjects. Baseline myocardial perfusion index (K......The pathophysiological mechanisms responsible for increased cardiovascular mortality in diabetic autonomic neuropathy are unknown. To investigate the effect of autonomic neuropathy on myocardial function, we performed dynamic contrast-enhanced magnetic resonance perfusion imaging during baseline......(i)) was similar in the three groups (AN+ 88.6 +/- 8.7 ml. 100 g(-1). min(-1), AN- 82.6 +/- 7.2, control subjects 93.7 +/- 9.0) (means +/- SE). K(i) during Dipyridamole vasodilatation was significantly lower in the patients with autonomic neuropathy (P

  16. Acute myocardial infarction during regadenoson myocardial perfusion imaging.

    Science.gov (United States)

    Shah, Sachil; Parra, David; Rosenstein, Robert S

    2013-06-01

    Pharmacologic stress testing uses vasodilators to provide objective evidence of myocardial ischemia. Adenosine and dipyridamole are nonselective adenosine receptor agonists that have been associated with myocardial infarction (MI) during intravenous infusion. Mechanisms postulated for this effect include coronary steal, transmural steal, global hypotension, and direct vasoconstriction. Regadenoson, a direct A2A agonist, was approved for use in stress testing in 2008. We describe a 68-year-old man who presented to our institution with typical angina, relieved by nitroglycerin. He did not have electrocardiogram (ECG) changes suggestive of myocardial pathology, and laboratory testing did not reveal a significant rise in troponin-I levels. To further assess the etiology of his symptoms, he underwent a pharmacologic stress test with regadenoson followed by technetium 99 m sestamibi. Six minutes after regadenoson infusion, the patient developed severe retrosternal chest pain accompanied by ST elevations on ECG. Sublingual nitroglycerin was administered that resolved both the pain and ECG changes. The patient subsequently underwent urgent coronary angiography and was found to have a 95% critical stenosis involving the left anterior descending artery. We conclude this case represents a MI secondary to coronary steal phenomenon induced by regadenoson infusion. Clinicians should be aware this adverse effect can occur despite the improved side-effect profile of regadenoson. Continuous monitoring of vital signs and the ECG with regular assessment of symptoms is imperative to identify this rare but potentially devastating adverse event. © 2013 Pharmacotherapy Publications, Inc.

  17. Development of an Ex Vivo, Beating Heart Model for CT Myocardial Perfusion

    NARCIS (Netherlands)

    Pelgrim, Gert Jan; Das, Marco; Haberland, Ulrike; Slump, Cees; Handayani, Astri; van Tuijl, Sjoerd; Stijnen, Marco; Klotz, Ernst; Oudkerk, Matthijs; Wildberger, Joachim E.; Vliegenthart, Rozemarijn

    2015-01-01

    Objective. To test the feasibility of a CT-compatible, ex vivo, perfused porcine heart model for myocardial perfusion CT imaging. Methods. One porcine heart was perfused according to Langendorff. Dynamic perfusion scanning was performed with a second-generation dual source CT scanner. Circulatory

  18. Myocardial perfusion assessment with contrast echocardiography

    Science.gov (United States)

    Desco, Manuel; Ledesma-Carbayo, Maria J.; Santos, Andres; Garcia-Fernandez, Miguel A.; Marcos-Alberca, Pedro; Malpica, Norberto; Antoranz, Jose C.; Garcia-Barreno, Pedro

    2001-05-01

    Assessment of intramyocardial perfusion by contrast echocardiography is a promising new technique that allows to obtain quantitative parameters for the assessment of ischemic disease. In this work, a new methodology and a software prototype developed for this task are presented. It has been validated with Coherent Contrast Imaging (CCI) images acquired with an Acuson Sequoia scanner. Contrast (Optison microbubbles) is injected continuously during the scan. 150 images are acquired using low mechanical index U/S pulses. A burst of high mechanical index pulses is used to destroy bubbles, thus allowing to detect the contrast wash-in. The stud is performed in two conditions: rest and pharmacologically induced stress. The software developed allows to visualized the study (cine) and to select several ROIs within the heart wall. The position of these ROIs along the cardiac cycle is automatically corrected on the basis of the gradient field, and they can also be manually corrected in case the automatic procedure fails. Time curves are analyzed according to a parametric model that incorporates both contrast inflow rate and cyclic variations. Preliminary clinical results on 80 patients have allowed us to identify normal and pathological patterns and to establish the correlation of quantitative parameters with the real diagnosis.

  19. Assessment of myocardial viability by exercise stress-redistribution myocardial scintigraphy with thallium-201; The usefulness of C-map

    Energy Technology Data Exchange (ETDEWEB)

    Narita, Michihiro; Kurihara, Tadashi; Murano, Kenichi; Usami, Masahisa (Sumitomo Hospital, Osaka (Japan))

    1993-09-01

    This study was intended to clarify whether Tl-201 washout rate abnormality after exercise stress can detect myocardial viability in the myocardium with perfusion defect on redistribution (RD) images. The subjects were 29 patients with ischemic heart disease in whom perfusion defect was seen on delayed (3 hr) RD images and had percutaneous transluminal coronary angioplasty (PTCA). A combined map (C-map) was prepared by adding the location of washout rate abnormality ([<=]30%) to perfusion defect on RD images before PTCA. The C-map and myocardial images after PTCA (Post-map) were compared. The left ventriculogram was divided into 17 segments. C-map and Post-map were qualitatively concordant with each other in 27 of 29 patients (93%). In the other 2 patients, only one segment showed discordance of findings between the two maps. Out of 152 segments with perfusion defect on RD images, 75 segments (50%) showed normal perfusion in both the C-map and the Post-map. In segmental analysis, the C-map and the Post-map were found consistent in 80% of the cases. In 12 patients with fixed defect before PTCA, the agreement between the C-map and the Post-map was also excellent (86%). The present C-map was useful for not only qualitative but also quantitative analyses of myocardial viability in myocardial segments which show perfusion defect on standard RD images. (N.K.).

  20. Myocardial perfusion imaging in Denmark: activity from 1997 to 2001 and current practice

    DEFF Research Database (Denmark)

    Petersen, Claus Leth; Kjaer, Andreas

    2003-01-01

    A questionnaire was sent to all departments of nuclear medicine in Denmark (n=20) asking for details of myocardial perfusion imaging (MPI), including the number of patients examined each year from 1997 to 2001 and the current clinical and technical practice. All (100%) departments replied...... studies was dipyridamole/adenosine in 76%, exercise in 18% and dobutamine in 6%. Despite these encouraging figures, MPI activity for 2001 remained well below what is recommended by other national and international societies. The anticipated further increase in nuclear cardiology is encouraging...

  1. Comparison of Myocardial Perfusion Scintigraphy and Coronary Angiography Results

    Directory of Open Access Journals (Sweden)

    Umut Elboga

    2017-05-01

    Full Text Available Aim: Coronary artery disease (CAD is one of the most frequent causes of mortality and morbidity worldwide. Coronary angiography is the gold standard for the anatomical diagnosis of coronary artery stenosis. Myocardial Perfusion Scintigraphy (MPS is a non-invasive imaging modality used for the diagnosis of CAD. In this study, we aimed to compare the findings of MPS and coronary angiogram. Material and Method: Eighty-one patients (37 males, 44 females; mean age 55 ± 10.95 years with angina and detected perfusion defects on MPS were included in this study. All of the patients underwent coronary angiogram. A narrowing %u2265 50% was considered pathological on the coronary angiography. Results: Findings of the coronary angiogram and MPS were compared and found consistent in 51 (63% patients. A coronary narrowing < 50% was detected by coronary angiogram in 4 (5% of the remaining patients. Coronary angiogram was found to be normal in the remaining 26 patients (32% and these patients were evaluated as cardiac syndrome X (CSX known as microvascular angina (MA. Discussion: The findings showed that MPS is superior to coronary angiogram in the early diagnosis of myocardial perfusion disorders at the microvascular level. Therefore, we concluded that MPS should be the primary diagnostic tool to begin treatment before an anatomically large narrowing occurs in the coronaries.

  2. Myocardial perfusion imaging study of CO(2)-induced panic attack.

    Science.gov (United States)

    Soares-Filho, Gastão L F; Machado, Sergio; Arias-Carrión, Oscar; Santulli, Gaetano; Mesquita, Claudio T; Cosci, Fiammetta; Silva, Adriana C; Nardi, Antonio E

    2014-01-15

    Chest pain is often seen alongside with panic attacks. Moreover, panic disorder has been suggested as a risk factor for cardiovascular disease and even a trigger for acute coronary syndrome. Patients with coronary artery disease may have myocardial ischemia in response to mental stress, in which panic attack is a strong component, by an increase in coronary vasomotor tone or sympathetic hyperactivity setting off an increase in myocardial oxygen consumption. Indeed, coronary artery spasm was presumed to be present in cases of cardiac ischemia linked to panic disorder. These findings correlating panic disorder with coronary artery disease lead us to raise questions about the favorable prognosis of chest pain in panic attack. To investigate whether myocardial ischemia is the genesis of chest pain in panic attacks, we developed a myocardial perfusion study through research by myocardial scintigraphy in patients with panic attacks induced in the laboratory by inhalation of 35% carbon dioxide. In conclusion, from the data obtained, some hypotheses are discussed from the viewpoint of endothelial dysfunction and microvascular disease present in mental stress response. Copyright © 2014 Elsevier Inc. All rights reserved.

  3. Adenosine-stress dynamic myocardial perfusion imaging with second-generation dual-source CT: comparison with conventional catheter coronary angiography and SPECT nuclear myocardial perfusion imaging.

    Science.gov (United States)

    Wang, Yining; Qin, Ling; Shi, Ximin; Zeng, Yong; Jing, Hongli; Schoepf, U Joseph; Jin, Zhengyu

    2012-03-01

    The purpose of this article is to evaluate the feasibility of adenosine-stress dynamic myocardial perfusion imaging (MPI) with 128-MDCT dual-source CT for detecting myocardial ischemia in comparison with conventional catheter coronary angiography and nuclear MPI. Thirty patients (21 men and nine women; mean [± SD] age, 59.2 ± 7.6 years) prospectively underwent a combined stress CT perfusion and CT angiography (CTA) examination. Complete time-attenuation curves of the myocardium were acquired with prospectively ECG-triggered axial images at two alternating positions. Myocardial blood flow (MBF) was quantified according to dynamic CT perfusion, and MBF values of normal and abnormal segments were compared. Findings on CT perfusion were compared with those for stress and rest SPECT. Perfusion defects according to CT were correlated to flow-obstructing stenosis detected on CTA and catheter coronary angiography. On stress CT perfusion, 19 patients (63%) and 83 of 504 segments (16%) had perfusion abnormalities. There was a significant difference in MBF values between normal (142.9 ± 30.6 mL/100 mL/min) and hypoperfused (90.0 ± 22.8 mL/100 mL/min) segments (p stress CT perfusion detects myocardial perfusion defects in good correlation with nuclear MPI. CT perfusion combined with CTA improves the diagnostic accuracy for identifying flow-obstructing stenosis compared with CTA alone.

  4. Adenosine Stress Induced Left Bundle Branch Block During Technetium-99m Tetrofosmin Myocardial Perfusion Imaging.

    Science.gov (United States)

    Jayanthi, Mohan Roop; Sasikumar, Arun; Gorla, Arun Kumar Reddy; Sood, Ashwani; Bhattacharya, Anish; Mittal, Bhagwant Rai

    2017-01-01

    The occurrence of left bundle branch block (LBBB) in electrocardiogram during exercise testing is a relatively rare finding. The incidence of LBBB during exercise testing ranges from 0.5% to 1.1%. The mechanism of exercise-induced LBBB (EI-LBBB) is poorly understood, but ischemia is a proposed etiology. Stress myocardial perfusion imaging (MPI) can be useful in patients with EI-LBBB to rule out coronary artery disease. Adenosine vasodilator stress is the preferred mode of stress in patients with LBBB for performing stress-MPI. Here we present an interesting case of adenosine-induced LBBB during stress-MPI in a 67-year-old female patient with normal coronary angiography.

  5. Comparison of non-attenuation corrected and attenuation corrected myocardial perfusion SPE

    Directory of Open Access Journals (Sweden)

    Hasan Raza

    2016-09-01

    Conclusion: This study demonstrates that CT based attenuation corrected Tc-99mm sestamibi SPECT myocardial perfusion imaging significantly improved the specificity of the RCA territory compared with non-attenuation corrected Tc-99mm sestamibi SPECT myocardial perfusion imaging in both genders irrespective of BMI.

  6. Validation of myocardial perfusion quantification by dynamic CT in an ex-vivo porcine heart model

    NARCIS (Netherlands)

    Pelgrim, Gert Jan; Das, Marco; van Tuijl, Sjoerd; van Assen, Marly; Prinzen, Frits W; Stijnen, Marco; Oudkerk, Matthijs; Wildberger, Joachim E; Vliegenthart, Rozemarijn

    2017-01-01

    To test the accuracy of quantification of myocardial perfusion imaging (MPI) using computed tomography (CT) in ex-vivo porcine models. Five isolated porcine hearts were perfused according to Langendorff. Hearts were perfused using retrograde flow through the aorta and blood flow, blood pressure and

  7. Quantification of MRI measured myocardial perfusion reserve in healthy humans: a comparison with positron emission tomography

    DEFF Research Database (Denmark)

    Fritz-Hansen, Thomas; Hove, Jens D; Kofoed, Klaus F

    2008-01-01

    PURPOSE: To validate a noninvasive quantitative MRI technique, the K(i) perfusion method, for myocardial perfusion in humans using (13)N-ammonia PET as a reference method. MATERIALS AND METHODS: Ten healthy males (64 +/- 8 years) were examined with combined PET and MRI perfusion imaging at rest a...

  8. Myocardial perfusion single photon emission computed tomography in asymptomatic diabetics.

    Science.gov (United States)

    Harshad, K; Sathyamurthy, I; Ashish, G; Padma, D; Shelley, S; Indirani, M; Subramanian, K

    2010-01-01

    Coronary artery disease (CAD) is the most important cause of mortality in diabetic patients. Diabetes mellitus (DM) due to autonomic neuropathy leads to asymptomatic CAD. Hence, it is important to screen the patients with DM for CAD. To study the prevalence of asymptomatic CAD by Myocardial Perfuision SPECT (Single Photon Emission Computed Tomography) (MPS) in diabetics. This prospective study included 88 asymptomatic patients (58 males and 30 females) of Type 2 DM of more than 5 years duration in the age group of 40-65 years. Risk factors like hypertension, dyslipidemia, smoking, family history of CAD and Body Mass Index > or = 25 kg/sq.m were assessed. All these patients underwent MPS study as two day standard protocol. Thirty eight patients underwent invasive Coronary Angiography (CAG) and stenosis greater than 50% was considered significant. Abnormal perfusion was detected in 38 (43%) diabetics and 4 (11%) controls. A total of 81 perfusion defects were identified (19 fired and 62 reversible). CAG showed significant coronary stenosis in 26 (68.4%), insignificant in 8 (21%) and no stenosis in 4 (10.6%) patients. A total of 114 coronaries were analysed, significant stenosis in 67 (58.8%) coronaries, 21 (18.4%) had insignificant lesions and 26(22.8%) were normal. In comparison to CAG, MPS had sensitivity of 86.6% and specificity of 51%. The Myocardial Perfusion SPECT is a sensitive diagnostic tool to identify ischemia in asymptomatic diabetics. MPS can be used as screening test for risk stratification. It has a prognostic value in predicting the outcome of CAD and can be useful for long-term follow up too.

  9. The prognostic value of regadenoson myocardial perfusion imaging.

    Science.gov (United States)

    Hage, Fadi G; Ghimire, Gopal; Lester, Davis; Mckay, Joshua; Bleich, Steven; El-Hajj, Stephanie; Iskandrian, Ami E

    2015-12-01

    Regadenoson (REGA), a selective adenosine A2A receptor agonist, is the most widely used stress agent for SPECT myocardial perfusion imaging (MPI) in the United States. The diagnostic accuracy of REGA MPI is comparable to Adenosine MPI, but its prognostic value is not well defined. We categorized 1,400 patients (700 consecutive normal and 700 consecutive abnormal REGA-MPIs) into 4 groups based on the perfusion defect size using automated quantitative analysis: Group 1: normal perfusion; Group 2: 20%. The primary outcome was a composite of cardiac death, myocardial infarction (MI), and late coronary revascularization (CR >90 days after MPI). Of the 1,400 patients (42% male, 37% diabetes, 21% heart failure, 26% end-stage renal disease), the primary outcome occurred in 23% (17% cardiac death, 4% MI, 6% late CR) during 46 ± 18 months of follow-up and 8% had early CR (within 90 days of MPI). Early CR occurred in 0.4%, 9%, 17%, and 17% and the primary outcome in 10%, 27%, 31%, and 43% in Groups 1-4, respectively (P < .001 for both). In an adjusted Cox proportional model, the hazard ratio for the primary outcome was 2.68 (1.77-4.06), 3.32 (2.28-4.83), and 4.05 (2.78-5.91) for Groups 2-4 compared to Group 1. REGA MPI provides powerful prognostic information that has important implications in patient management and can guide clinical practice.

  10. Aid in the detection of myocardial perfusion abnormality utilizing SPECT atlas and images registration: preliminary results

    Energy Technology Data Exchange (ETDEWEB)

    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)

  11. Exercise may cause myocardial ischemia at the anaerobic threshold in cardiac rehabilitation programs.

    Science.gov (United States)

    Fuchs, A R C N; Meneghelo, R S; Stefanini, E; De Paola, A V; Smanio, P E P; Mastrocolla, L E; Ferraz, A S; Buglia, S; Piegas, L S; Carvalho, A A C

    2009-03-01

    Myocardial ischemia may occur during an exercise session in cardiac rehabilitation programs. However, it has not been established whether it is elicited when exercise prescription is based on heart rate corresponding to the anaerobic threshold as measured by cardiopulmonary exercise testing. Our objective was to determine the incidence of myocardial ischemia in cardiac rehabilitation programs according to myocardial perfusion SPECT in exercise programs based on the anaerobic threshold. Thirty-nine patients (35 men and 4 women) diagnosed with coronary artery disease by coronary angiography and stress technetium-99m-sestamibi gated SPECT associated with a baseline cardiopulmonary exercise test were assessed. Ages ranged from 45 to 75 years. A second cardiopulmonary exercise test determined training intensity at the anaerobic threshold. Repeat gated-SPECT was obtained after a third cardiopulmonary exercise test at the prescribed workload and heart rate. Myocardial perfusion images were analyzed using a score system of 6.4 at rest, 13.9 at peak stress, and 10.7 during the prescribed exercise (P exercise was defined as a difference > or = 2 between the summed stress score and summed rest score. Accordingly, 25 (64%) patients were classified as ischemic and 14 (36%) as nonischemic. MIBI-SPECT showed myocardial ischemia during exercise within the anaerobic threshold. The 64% prevalence of ischemia observed in the study should not be looked on as representative of the whole population of patients undergoing exercise programs. Changes in patient care and exercise programs were implemented as a result of our finding of ischemia during the prescribed exercise.

  12. Regadenoson in Myocardial Perfusion Study - First Institutional Experiences in Bosnia and Herzegovina.

    Science.gov (United States)

    Beslic, Nermina; Milardovic, Renata; Sadija, Amera; Ceric, Sejla; Raic, Zeljka

    2016-12-01

    Myocardial perfusion imaging (MPI) is widely used in the evaluation of known and suspected coronary artery disease (CAD). Imaging of heart in stress and rest enables the comparison of myocardial uptake of radiotracer in proportion to the needs and coronary flow, which is used for detection of perfusion defects. Exercise stress and pharmacologic agents are used for the stressing purpose. Novel pharmacologic stressor regadenoson is A2A selective adenosine agonist, which selectively binds to the adenosine receptors in coronary arteries causing coronary dilatation. We analyzed 50 myocardial perfusion studies performed with regadenoson as a pharmacologic agent that was injected before Tc99m-sestamibi in stress imaging. Stress and rest sets of images were evaluated for relative uptake of Tc99m-sestamibi in order to detect and characterize perfusion defects. After the injection of regadenoson, hemodynamic parameters and potential side-effects were closely monitored. Side-effects were stratified per severity as mild, moderate and severe. Studies were read by nuclear medicine physicians using quantitative perfusion SPECT software. Additional diagnostic information such as wall motion and wall thickening were provided by gating. Thirty-three patients (66%) experienced one or more side-effects upon the administration of regadenoson, most commonly warmth and chest discomfort. In all patients but one (98%), the symptoms were mild, of short duration and self-limiting. Out of all side-effects registered, 44 (96%) were mild, and 2 (4%) were moderate. Two moderate side-effects developed in one patient with a prior history of asthma, and included shortness of breath and cough. Heart rate changed by 16 +- 31 bpm. Highest increase in blood pressure was 30 mm Hg for systolic, and 10 mm Hg for diastolic. One case of significant decrease in blood pressure was noted from the hypertensive basal values, 50 mm for systolic, and 30 mm Hg for diastolic. ST segment depression of up to 1 mm

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

    Energy Technology Data Exchange (ETDEWEB)

    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.)

  14. Myocardial perfusion scintigraphy fi ndings in patients with mild coronary atherosclerotic lesions on coronary angiography

    Directory of Open Access Journals (Sweden)

    Zeki Dostbil

    2010-09-01

    Full Text Available Objectives: Myocardial perfusion scintigraphy (MPS iswidely used in functional assessment of myocardial per-fusion. But, some study results are in contradiction withseverity of coronary artery disease detected by coronaryangiography (CA. It is frequently encountered case thatCA is completely normal whereas MPS describes isch-emia. In this study, we aimed to investigate whether mildatherosclerotic lesions cause ischemia.Materials and methods: MPS with 99mTc-MIBI was per-formed in 52 patients who applied to cardiology clinics forhistory of chest pain and underwent diagnostic CA within3 months.Results: In 22 of 52 patients with mild atherosclerotic le-sions, ischemia in various degrees was detected on MPS.In statistical analysis, any signifi cant relationship was notfound between ischemia and gender, hypertension, DM,dyslipidemia, smoking, mitral valve insuffi ciency, left ven-tricular hypertrophy, exercise testing result and affectedcoronary artery.Conclusion: Our study fi ndings have shown that mild ath-erosclerotic lesions even at very early stage may causemyocardial ischemia

  15. Patterns of myocardial perfusion in humans evaluated with contrast-enhanced 320 multidetector computed tomography

    DEFF Research Database (Denmark)

    Kühl, J Tobias; Linde, Jesper J; Fuchs, Andreas

    2012-01-01

    of intravenous adenosine infusion on regional myocardial perfusion. To evaluate myocardial perfusion patterns at rest, we scanned 14 healthy subjects with PET and 14 age and gender matched subjects with 320 MDCT. To evaluate the effect of adenosine stress on relative perfusion patterns 14 subjects with near......-normal epicardial coronary arteries were studied at rest and during adenosine stress. Relative perfusion was assessed as attenuation density (AD) in 16 segments of the LV, and each segment was divided into 3 layers: endo-, mid- and epi-cardial. During rest the relative AD by MDCT was lower in the lateral wall...

  16. Diagnostic and prognostic role of myocardial perfusion scintigraphy in kidney transplant candidates: narrative review

    Directory of Open Access Journals (Sweden)

    Alberto Bestetti

    2016-10-01

    Full Text Available PurposeCardiac screening in adult kidney transplant candidates with myocardial perfusion scintigraphy (MPS can reveal findings associated with increased risk for coronary heart disease events, but the exact value of this screening test is still undetermined.MethodsNarrative review based on the available literature and guidelines on the yield, benefits, and harms of MPS screening in kidney transplant candidates.ResultsAlthough coronary angiography carries low risk in general population, it is not without risk particularly in patients with complex comorbid disease and the use of intravenous contrast media may precipitate a need for hospitalization and death. We could avoid invasive coronary angiography in patients with chronic kidney disease, although with high coronary calcium score, but good left ventricle function and normal perfusion, evaluated by Gated single-photon emission computed tomographic (SPECT MPS. In fact, although Gated SPECT MPS has not a high sensitivity, it provides some variables that are closely related to sudden death: post-stress and rest-ejection fraction and left ventricular volumes, left ventricle muscle mass, extent of ischemia and scar.ConclusionsGated SPECT MPS is a valid noninvasive cardiac screening test. It can be used as alternative to stress echocardiography in kidney transplant candidates with high cardiovascular risk and a positive or inconclusive exercise tolerance ECG test.Patients with abnormal perfusion and cardiac dysfunction should undergo invasive coronary artery imaging and endovascular treatment, while angiography could be avoided in patients with normal MPI, having good long-term prognosis.

  17. Septal myocardial perfusion imaging with thallium-201 in the diagnosis of proximal left anterior descending coronary artery disease

    Energy Technology Data Exchange (ETDEWEB)

    Pichard, A.D.; Wiener, I.; Martinez, E.; Horowitz, S.; Patterson, R.; Meller, J.; Goldsmith, S.J.; Gorlin, R.; Herman, M.V.

    1981-07-01

    The use of myocardial perfusion imaging (MPI) to identify obstructive coronary disease of the left anterior descending coronary artery proximal to the first septal perforator (prox LAD) was studied in 60 patients. Perfusion of the septum and anteroapical areas with thallium-201 injected during exercise was compared to results of coronary arteriography. Septal MPI defect was found in 92.3% of patients with obstruction of the proximal LAD, 27.7% of patients with obstruction of LAD distal to first septal perforator, 0% in patients with obstructions involving right or circumflex arteries, and in 10.5% of patients without coronary disease. Anteroapical MPI defects were found with similar frequency in the three groups with obstructive coronary disease. Septal MPI defect had a sensitivity of 92.3% and specificity of 85.4% in the diagnosis of proximal LAD disease. Normal septal perfusion with thallium-201 virtually excluded proximal LAD disease.

  18. [Acute stent thrombosis and reverse transient left ventricular dilatation after performing a single-photon emission computed tomography myocardial perfusion].

    Science.gov (United States)

    Miranda, B; Pizzi, M N; Aguadé-Bruix, S; Domingo, E; Candell-Riera, J

    2015-01-01

    A 63-year-old male patient with a history of stent implantation in the left anterior descending three months before. Due to the presentation of vegetative symptoms, he was referred for gated-SPECT myocardial perfusion. During acquisition of the resting images he presented chest pain and ST segment elevation, so that urgent cardiac catheterization was performed, showing stent thrombosis. Rest perfusion imaging showed a defect in anterior and apical perfusion, more severe and extensive than in the stress images, with striking left ventricular dilatation and a fall in the ejection fraction related to the acute ischemia phenomenon. Intense exercise is associated with a transient activation of the coagulation system and hemodynamic changes that might induce thrombosis, especially in recently implanted coronary stents that probably still have not become completely endothelialized. Copyright © 2014 Elsevier España, S.L.U. y SEMNIM. All rights reserved.

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

    DEFF Research Database (Denmark)

    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)....

  20. EANM/ESC procedural guidelines for myocardial perfusion imaging in nuclear cardiology

    NARCIS (Netherlands)

    Hesse, B.; Tägil, K.; Cuocolo, A.; Anagnostopoulos, C.; Bardiés, M.; Bax, J.; Bengel, F.; Busemann Sokole, E.; Davies, G.; Dondi, M.; Edenbrandt, L.; Franken, P.; Kjaer, A.; Knuuti, J.; Lassmann, M.; Ljungberg, M.; Marcassa, C.; Marie, P. Y.; McKiddie, F.; O'Connor, M.; Prvulovich, E.; Underwood, R.; van Eck-Smit, B.

    2005-01-01

    The European procedural guidelines for radionuclide imaging of myocardial perfusion and viability are presented in 13 sections covering patient information, radiopharmaceuticals, injected activities and dosimetry, stress tests, imaging protocols and acquisition, quality control and reconstruction

  1. A Unifying model of perfusion and motion applied to reconstruction of sparsely sampled free-breathing myocardial perfusion MRI

    DEFF Research Database (Denmark)

    Pedersen, Henrik; Ólafsdóttir, Hildur; Larsen, Rasmus

    2010-01-01

    The clinical potential of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) is currently limited by respiratory induced motion of the heart. This paper presents a unifying model of perfusion and motion in which respiratory motion becomes an integral part of myocardial perfusion...... quantification. Hence, the need for tedious manual motion correction prior to perfusion quantification is avoided. In addition, we demonstrate that the proposed framework facilitates the process of reconstructing DCEMRI from sparsely sampled data in the presence of respiratory motion. The paper focuses primarily...... on the underlying theory of the proposed framework, but shows in vivo results of respiratory motion correction and simulation results of reconstructing sparsely sampled data....

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

    DEFF Research Database (Denmark)

    Minarik, David; Senneby, Martin; Wollmer, Per

    2015-01-01

    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...... 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.......001) but not for patients with infarction. The correlation between the defect size and stress vector magnitude was also found to be significant (p assisting the visual interpretation in MPS studies. Further...

  3. Analysis of myocardial perfusion parameters in an ex-vivo porcine heart model using third generation dual-source CT

    NARCIS (Netherlands)

    Pelgrim, Gert Jan; Duguay, Taylor M; Stijnen, J Marco A; Varga-Szemes, Akos; Van Tuijl, Sjoerd; Schoepf, U Joseph; Oudkerk, Matthijs; Vliegenthart, Rozemarijn

    2017-01-01

    PURPOSE: To evaluate the relationship between fractional flow reserve (FFR)-determined coronary artery stenosis severity and myocardial perfusion parameters derived from dynamic myocardial CT perfusion imaging (CTP) in an ex-vivo porcine heart model. METHODS: Six porcine hearts were perfused

  4. The perfusion pattern in coronary artery occlusion: comparison of exercise and adenosine.p6.

    Science.gov (United States)

    Iskandrian, A S; Kegel, J; Heo, J; Ogilby, J D; Untereker, W J; Cave, V

    1992-12-01

    This study compared exercise to adenosine thallium-201 single photon emission computed tomography in detecting occlusion of left anterior descending or right coronary arteries in patients with no previous myocardial infarction. There were 41 patients who underwent adenosine thallium imaging (adenosine infusion at a rate of 140 micrograms/kg/min for 6 min), and 143 patients who underwent exercise thallium imaging. There were more patients with right coronary than left anterior descending coronary artery occlusion. Thus, in the adenosine group, there were 15 patients with left anterior descending artery occlusion, and 26 with right coronary artery occlusion, and in the exercise group, there were 46 patients with left anterior descending artery occlusion, and 97 patients with right coronary artery occlusion. In the adenosine group, the thallium images were abnormal in 41 patients (100%), while in the exercise group, the thallium images were abnormal in 125 patients (87%, P exercise group (P:NS). In patients with isolated single vessel occlusion, the size of the perfusion abnormality was 28 +/- 9% with adenosine, and 21 +/- 12% with exercise (P:NS). Thus, most patients with occlusion of the left anterior descending or right coronary artery have regional perfusion abnormality during stress; the different role of collaterals with each type of stress may explain the higher percentage of abnormal results with adenosine than exercise.

  5. Development of coronary vasospasm during adenosine-stress myocardial perfusion CT imaging

    Energy Technology Data Exchange (ETDEWEB)

    Nam, Jeong Gu; Choi, Seong Hoon; Kang, Byeong Seong; Bang, Min Aeo; Kwon, Woon Jeong [Dept. of Radiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan (Korea, Republic of)

    2015-06-15

    Adenosine is a short-acting coronary vasodilator, and it is widely used during pharmacological stress myocardial perfusion imaging. It has a well-established safety profile, and most of its side effects are known to be mild and transient. Until now, coronary vasospasm has been rarely reported as a side effect of adenosine during or after adenosine stress test. This study reports a case of coronary vasospasm which was documented on stress myocardial perfusion CT imaging during adenosine stress test.

  6. Specificity of the stress electrocardiogram during adenosine myocardial perfusion imaging in patients taking digoxin.

    Science.gov (United States)

    Hart, C Y; Miller, T D; Hodge, D O; Gibbons, R J

    2000-12-01

    In patients taking digoxin, the exercise electrocardiogram has a lower specificity for detecting coronary artery disease. However, the effect of digoxin on adenosine-induced ST-segment depression is unknown. The purpose of this study was to evaluate the specificity of the electrocardiogram during adenosine myocardial perfusion imaging in patients taking digoxin. Between May 1991 and September 1997, patients (n = 99) taking digoxin who underwent adenosine stress imaging with thallium-201 or technetium-99m sestamibi and coronary angiography within 3 months were retrospectively identified. Exclusion criteria included prior myocardial infarction, coronary artery angioplasty or bypass surgery, left bundle branch block, paced ventricular rhythm, or significant valvular disease. Twelve-lead electrocardiograms were visually interpreted at baseline, during adenosine infusion, and during the recovery period. The stress electrocardiogram was considered positive if there was > or =1 mm additional horizontal or downsloping ST-segment depression or elevation 0.08 seconds after the J-point compared with the baseline tracing. ST-segment depression and/or elevation occurred in 24 of 99 patients. There were only 2 false-positive stress electrocardiograms, yielding a specificity of 87% and positive predictive value of 92%. All 8 patients with > or =2 mm ST segment depression had multivessel disease by coronary angiography. ST-segment depression or elevation during adenosine myocardial perfusion imaging in patients taking digoxin is highly specific for coronary artery disease. Marked (> or =2 mm) ST-segment depression and/or ST-segment elevation is associated with a high likelihood of multivessel disease.

  7. Subendocardial versus transmural ischaemia in myocardial perfusion SPECT--a Monte Carlo study

    DEFF Research Database (Denmark)

    Bartosik, Jolanta; El-Ali, Henrik Hussein; Nilsson, Ulf

    2006-01-01

    Myocardial perfusion imaging with single-photon emission computed tomography (SPECT) is useful for the evaluation of patients with known or suspected coronary artery disease. Parameters of interest are the reduction in the blood perfusion (severity) and the lesion volume (extent). The aim of this...

  8. Effect of nicorandil on the myocardial tissue perfusion and myocardial cell injury in patients with diabetes after PCI

    Directory of Open Access Journals (Sweden)

    Xue-Li Ren1

    2017-04-01

    Full Text Available Objective: To study the effect of nicorandil on the myocardial tissue perfusion and myocardial cell damage in patients with diabetes after percutaneous coronary intervention (PCI. Methods: 68 patients with coronary heart disease and type 2 diabetes mellitus who received PCI in our hospital between May 2011 and September 2015 were collected and then divided into observation group and control group (n=34 according to the single-blind randomized control method. Control group of patients received PCI alone, and the observation group of patients received nicorandil therapy after PCI. After treatment, real-time myocardial ultrasound contrast was used to evaluate the myocardial perfusion of two groups of patients; blood biochemical analyzer was used to detect the contents of peripheral blood myocardial enzyme spectrum indexes; the ELISA method was used to detect the contents of serum oxidative stress indicators; RIA method was used to detect the contents of serum apoptosis molecules. Results: After treatment, the myocardial tissue perfusion parameters plateau peak intensity (A, slope rate of curve (β and myocardial blood flow (A×β levels of observation group were significantly higher than those of control group (P<0.05; peripheral blood myocardial enzyme spectrum indexes creatine kinase (CK, lactate dehydrogenase (LDH, troponin I (cTnI and glutamic oxalacetic transaminase (GOT contents of observation group were significantly lower than those of control group (P<0.05; serum vitamin E (VitE and vitamin C (VitC contents of observation group were significantly higher than those of control group while malondialdehyde (MDA, advanced oxidation protein products (AOPPs, soluble apoptosis-associated factor (sFas and soluble apoptosis-associated factor ligand (sFasL contents were lower than those of control group (P<0.05. Conclusion: Adjuvant nicorandil therapy can improve the myocardial perfusion and reduce the myocardial cell injury in patients with coronary

  9. Influence of the arm position in myocardial perfusion imaging acquisition

    Directory of Open Access Journals (Sweden)

    Marisa Izaki

    2014-07-01

    Full Text Available Objective: despite the technologic advances in myocardial perfusion imaging, we keep using an uncomfortable and sometimes impracticable patient position - supine with arms raised above the head (U. The purpose of this study was to investigate whether perfusion and functional cardiac gated SPECT scan results of acquisition U are equivalent to another position modality: supine with arms down at the sides of the trunk (D. Methods and Results: we performed U acquisition and in sequence D acquisition in 120 patients (pts using a one-day MPI (rest-gated/stress, with 99mTc-sestamibi (370 MBq and 1110 MBq. Images were processed by the iterative reconstruction method (OSEM. Rest (R and stress (S studies were scored using 17-segments model. Functional parameters (left ventricular ejection fraction, and volumes were automatically obtained by the quantitative gated SPECT (QGS program. According to the degree of stress defects observed in U study, the patients were categorized in two subgroups: normal (SSS ≤ 3 or 3 or ≥ 5%. Shoulder/back pain occurred in 23.3% of U patients and in 5% of D. No significant differences between U and D were found for SSS (p = 0.82 and SRS (p = 0.74 in normal group. In abnormal group, good correlation was found between U and D modes for SSS (Rho = 0.95, p = 0.0001 and SRS (Rho = 0.96 p = 0.0001, but the mean SSS (12.53 ± 7.54 and SRS (10.60 ± 7.08 values of D were significantly lower (p < 0.05 than SSS (13.43 ± 6.81 and SRS (11.33 ± 6.97 of U mode. Function measurements presented good correlations, except for end-diastolic volume (p = 0.0001. Conclusion: although D mode appears to be more comfortable and presented a good correlation with U values of SSS and SRS, in abnormal pts, the extent and severity of defects can be underestimated. Considering clinical implications of an accurate perfusion measurement, the acquisition with the arms down should be avoided.

  10. Adenosine-stress dynamic real-time myocardial perfusion CT and adenosine-stress first-pass dual-energy myocardial perfusion CT for the assessment of acute chest pain: Initial results

    Energy Technology Data Exchange (ETDEWEB)

    Weininger, Markus [Medical University of South Carolina, Department of Radiology and Radiological Science, Charleston, SC (United States); Schoepf, U. Joseph, E-mail: schoepf@musc.edu [Medical University of South Carolina, Department of Radiology and Radiological Science, Charleston, SC (United States); Department of Medicine, Division of Cardiology, Medical University of South Carolina, Charleston, SC (United States); Ramachandra, Ashok [Medical University of South Carolina, Department of Radiology and Radiological Science, Charleston, SC (United States); Fink, Christian [Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University (Germany); Rowe, Garrett W.; Costello, Philip [Medical University of South Carolina, Department of Radiology and Radiological Science, Charleston, SC (United States); Henzler, Thomas [Medical University of South Carolina, Department of Radiology and Radiological Science, Charleston, SC (United States); Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University (Germany)

    2012-12-15

    Purpose: Recent innovations in CT enable the evolution from mere morphologic imaging to dynamic and functional testing. We describe our initial experience performing myocardial stress perfusion CT in a clinical population with acute chest pain. Methods and materials: Myocardial stress perfusion CT was performed on twenty consecutive patients (15 men, 5 women; mean age 65 ± 8 years) who presented with acute chest pain and were clinically referred for stress/rest SPECT and cardiac MRI. Prior to CT each patient was randomly assigned either to Group A or to Group B in a consecutive order (10 patients per group). Group A underwent adenosine-stress dynamic real-time myocardial perfusion CT using a novel “shuttle” mode on a 2nd generation dual-source CT. Group B underwent adenosine-stress first-pass dual-energy myocardial perfusion CT using the same CT scanner in dual-energy mode. Two experienced observers visually analyzed all CT perfusion studies. CT findings were compared with MRI and SPECT. Results: In Group A 149/170 myocardial segments (88%) could be evaluated. Real-time perfusion CT (versus SPECT) had 86% (84%) sensitivity, 98% (92%) specificity, 94% (88%) positive predictive value, and 96% (92%) negative predictive value in comparison with perfusion MRI for the detection of myocardial perfusion defects. In Group B all myocardial segments were available for analysis. Compared with MRI, dual-energy myocardial perfusion CT (versus SPECT) had 93% (94%) sensitivity, 99% (98%) specificity, 92% (88%) positive predictive value, and 96% (94%) negative predictive value for detecting hypoperfused myocardial segments. Conclusion: Our results suggest the clinical feasibility of myocardial perfusion CT imaging in patients with acute chest pain. Compared to MRI and SPECT both, dynamic real-time perfusion CT and first-pass dual-energy perfusion CT showed good agreement for the detection of myocardial perfusion defects.

  11. Added value of attenuation-corrected myocardial perfusion scintigraphy in a patient with dextrocardia

    NARCIS (Netherlands)

    Slart, RHJA; De Boer, J; Jager, PL; Piers, DA

    2002-01-01

    A 52-year-old woman with dextrocardia was evaluated for chest pain. To exclude myocardial ischemia, she underwent a 2-day rest and bicycle stress myocardial perfusion study with 600 MBq (16 mCi) Tc-99m sestamibi. The rotational direction of the perpendicularly positioned camera heads was fixed and

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

    Energy Technology Data Exchange (ETDEWEB)

    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.

  13. Temporal Trends in the Prevalence, Severity, and Localization of Myocardial Ischemia and Necrosis at Myocardial Perfusion Imaging After Myocardial Infarction.

    Science.gov (United States)

    Nudi, Francesco; Schillaci, Orazio; Di Belardino, Natale; Versaci, Francesco; Tomai, Fabrizio; Pinto, Annamaria; Neri, Giandomenico; Procaccini, Enrica; Nudi, Alessandro; Frati, Giacomo; Biondi-Zoccai, Giuseppe

    2017-10-15

    The definition, presentation, and management of myocardial infarction (MI) have changed substantially in the last decade. Whether these changes have impacted on the presence, severity, and localization of necrosis at myocardial perfusion imaging (MPI) has not been appraised to date. Subjects undergoing MPI and reporting a history of clinical MI were shortlisted. We focused on the presence, severity, and localization of necrosis at MPI with a retrospective single-center analysis. A total of 10,476 patients were included, distinguishing 5 groups according to the period in which myocardial perfusion scintigraphy had been performed (2004 to 2005, 2006 to 2007, 2008 to 2009, 2010 to 2011, 2012 to 2013). Trend analysis showed over time a significant worsening in baseline features (e.g., age, diabetes mellitus, and Q waves at electrocardiogram), whereas medical therapy and revascularization were offered with increasing frequency. Over the years, there was also a lower prevalence of normal MPI (from 16.8% to 13.6%) and ischemic MPI (from 35.6% to 32.8%), and a higher prevalence of ischemic and necrotic MPI (from 12.0% to 12.7%) or solely necrotic MPI (from 35.7% to 40.9%, p necrosis (from 19.8% to 8.2%) and moderate necrosis (from 8.5% to 7.8%, p = 0.028). These trends were largely confirmed at regional level and after propensity score matching. In conclusion, the outlook of stable patients with previous MI has substantially improved in the last decade, with a decrease in the severity of residual myocardial ischemia and necrosis, despite an apparent worsening in baseline features. Copyright © 2017 Elsevier Inc. All rights reserved.

  14. Measurement of myocardial perfusion and infarction size using computer-aided diagnosis system for myocardial contrast echocardiography.

    Science.gov (United States)

    Du, Guo-Qing; Xue, Jing-Yi; Guo, Yanhui; Chen, Shuang; Du, Pei; Wu, Yan; Wang, Yu-Hang; Zong, Li-Qiu; Tian, Jia-Wei

    2015-09-01

    Proper evaluation of myocardial microvascular perfusion and assessment of infarct size is critical for clinicians. We have developed a novel computer-aided diagnosis (CAD) approach for myocardial contrast echocardiography (MCE) to measure myocardial perfusion and infarct size. Rabbits underwent 15 min of coronary occlusion followed by reperfusion (group I, n = 15) or 60 min of coronary occlusion followed by reperfusion (group II, n = 15). Myocardial contrast echocardiography was performed before and 7 d after ischemia/reperfusion, and images were analyzed with the CAD system on the basis of eliminating particle swarm optimization clustering analysis. The myocardium was quickly and accurately detected using contrast-enhanced images, myocardial perfusion was quantitatively calibrated and a color-coded map calibrated by contrast intensity and automatically produced by the CAD system was used to outline the infarction region. Calibrated contrast intensity was significantly lower in infarct regions than in non-infarct regions, allowing differentiation of abnormal and normal myocardial perfusion. Receiver operating characteristic curve analysis documented that -54-pixel contrast intensity was an optimal cutoff point for the identification of infarcted myocardium with a sensitivity of 95.45% and specificity of 87.50%. Infarct sizes obtained using myocardial perfusion defect analysis of original contrast images and the contrast intensity-based color-coded map in computerized images were compared with infarct sizes measured using triphenyltetrazolium chloride staining. Use of the proposed CAD approach provided observers with more information. The infarct sizes obtained with myocardial perfusion defect analysis, the contrast intensity-based color-coded map and triphenyltetrazolium chloride staining were 23.72 ± 8.41%, 21.77 ± 7.8% and 18.21 ± 4.40% (% left ventricle) respectively (p > 0.05), indicating that computerized myocardial contrast echocardiography can

  15. Myocardial metabolic abnormalities in hypertrophic cardiomyopathy assessed by iodine-123-labeled beta-methyl-branched fatty acid myocardial scintigraphy and its relation to exercise-induced ischemia

    Energy Technology Data Exchange (ETDEWEB)

    Matsuo, Shinro; Nakamura, Yasuyuki; Takahashi, Masayuki; Mitsunami, Kenichi; Kinoshita, Masahiko [Shiga Univ. of Medical Science, Otsu (Japan)

    1998-03-01

    Reversible thallium-201 ({sup 201}Tl) abnormalities during exercise stress have been used as markers of myocardial ischemia in hypertrophic cardiomyopathy (HCM) and are most likely to identify relatively underperfused myocardium. Although metabolic abnormalities in HCM were reported, the relationship between impaired energy metabolism and exercise-induced ischemia has not been fully elucidated as yet. To assess the relationship between myocardial perfusion abnormalities and fatty acid metabolic abnormalities, 28 patients with HCM underwent exercise {sup 201}Tl and rest {sup 123}I-15-(p-iodophenyl)-3-methyl pentadecanoic acid (BMIPP) scintigraphy. Perfusion abnormalities were observed by exercise {sup 201}Tl in 19/28 patients with HCM. {sup 123}I-BMIPP uptake was decreased compared with delayed {sup 201}Tl in 106/364 (29%) of the total myocardial segments (p<0.01, McNemar symmetry test). Such disparity between {sup 123}I-BMIPP and {sup 201}Tl was observed more often in the 49/75 (65%) segments with reversible exercise {sup 201}Tl defects (p<0.001). Our results indicate that exercise-induced myocardial ischemia exists in HCM, resulting in metabolic abnormalities. The combination of {sup 123}I-BMIPP and {sup 201}Tl suggests that myocardial ischemia may play an important role in metabolic abnormalities in HCM. (author)

  16. Blood temperature and perfusion to exercising and non-exercising human limbs

    DEFF Research Database (Denmark)

    González-Alonso, José; Calbet, José A. L.; Boushel, Robert

    2015-01-01

    - and metabolism-sensitive mechanisms are important for the control of human limb perfusion, possibly by activating ATP release from the erythrocytes.  Temperature-sensitive mechanisms may contribute to blood-flow regulation, but the influence of temperature on perfusion to exercising and non-exercising human...... limbs is not established. Blood temperature (TB), blood flow and oxygen uptake (V̇O2) in the legs and arms were measured in 16 healthy humans during 90 min of leg and arm exercise and during exhaustive incremental leg or arm exercise. During prolonged exercise, leg blood flow (LBF) was fourfold higher...

  17. Selective cerebro-myocardial perfusion in complex congenital aortic arch pathology: a novel technique.

    Science.gov (United States)

    De Rita, Fabrizio; Lucchese, Gianluca; Barozzi, Luca; Menon, Tiziano; Faggian, Giuseppe; Mazzucco, Alessandro; Luciani, Giovanni Battista

    2011-11-01

    Simultaneous cerebro-myocardial perfusion has been described in neonatal and infant arch surgery, suggesting a reduction in cardiac morbidity. Here reported is a novel technique for selective cerebral perfusion combined with controlled and independent myocardial perfusion during surgery for complex or recurrent aortic arch lesions. From April 2008 to April 2011, 10 patients with arch pathology underwent surgery (two hypoplastic left heart syndrome [HLHS], four recurrent arch obstruction, two aortic arch hypoplasia + ventricular septal defect [VSD], one single ventricle + transposition of the great arteries + arch hypoplasia, one interrupted aortic arch type B + VSD). Median age was 63 days (6 days-36 years) and median weight 4.0 kg (1.6-52). Via midline sternotomy, an arterial cannula (6 or 8 Fr for infants) was directly inserted into the innominate artery or through a polytetrafluoroethylene (PTFE) graft (for neonates cerebro-myocardial perfusion was 39 ± 18 min (17-69). Weaning from cardiopulmonary bypass was achieved without inotropic support in three and with low dose in seven patients. One patient required veno-arterial extracorporeal membrane oxygenation. Four patients, body weight cerebro-myocardial perfusion is feasible in patients with complex or recurrent aortic arch disease, starting from premature newborn less than 2.0 kg of body weight to adults. The technique is as safe as previously reported methods of cerebro-myocardial perfusion and possibly more versatile. © 2011, Copyright the Authors. Artificial Organs © 2011, International Center for Artificial Organs and Transplantation and Wiley Periodicals, Inc.

  18. Assessment of myocardial perfusion and function in victims of scorpion envenomation using gated-SPECT

    Energy Technology Data Exchange (ETDEWEB)

    Figueiredo, Alexandre Baldini de; Cupo, Palmira; Pintya, Antonio O.; Caligaris, Fabio; Marin-Neto, Jose A; Hering, Sylvia E.; Simoes, Marcus Vinicius, E-mail: simoesmv@yahoo.co [Universidade de Sao Paulo (USP), Ribeirao Preto, SP (Brazil). Faculdade de Medicina. Hospital das Clinicas

    2010-04-15

    Background: cardiogenic shock and acute pulmonary edema are the major causes of death of patients with scorpion envenomation, whose pathophysiological mechanism remains controversial. Objective: to investigate the correlation between myocardial perfusion abnormalities and left ventricular contractile function in victims of scorpion envenomation. Methods: fifteen patients underwent ECG-gated myocardial perfusion scintigraphy (gated SPECT) within 72 hours of, and 15 days after scorpion envenomation. Images were analyzed by means of a semi-quantitative visual perfusion score (0 = normal, 4 = absent) and motion score (0 = normal, 4 akinesia), using the 17-segment model. Summed perfusion (SPS) and summed motion (SMS) scores were calculated for each patient. Ejection fraction (LVEF) was calculated by a commercially available software. Results: at baseline, 12 out of the 15 patients presented abnormal myocardial perfusion and contractility. Mean values of SPS, SMS and LVEF were 12.5 +- 7.3, 17.0 +- 12.8, and 44.6 +- 16.0%, respectively. A positive correlation between SPS and SMS (r = 0.68; p = 0.005) and negative correlation between SPS and LVEF (r -0.75; p = 0.0021) were found. The follow-up studies showed recovery of global contractility (LVEF of 68.9 +- 9.5, p = 0.0002), segmental contractility (SMS of 2.6 +- 3.1, p = 0.0009) and perfusion (SPS of 3.7 +- 3.3, p = 0.0003). Improvement of LVEF correlated positively with improvement of SPS (r = 0.72; p = 0.0035). Conclusions: myocardial perfusion abnormalities are common in scorpion envenomation and correlate topographically with the contractile dysfunction. Recovery of contractility correlates with reversibility of perfusion defects. These findings suggest the participation of myocardial perfusion abnormalities in the pathophysiology of this form of acute ventricular failure. (author)

  19. Influence of revascularization on myocardial perfusion, metabolism and function evaluated with I-123-IPPA

    Energy Technology Data Exchange (ETDEWEB)

    Kropp, J.; Krois, M.; Eichhorn, B.; Feske, W.; Likungu, J.; Kirchhoff, P.J.; Luederitz, B.; Biersack, H.J. [Bonn Univ. (Germany); Knapp, F.F. Jr. [Oak Ridge National Lab., TN (United States)

    1993-10-01

    Patients with coronary artery disease (CAD) were investigated with sequential SPECT-scintigraphy after administration of 200 MBq of 15-(p-[I-123]iodophenyl)pentadecanoic acid (IPPA) at peak submaximal exercise. Twenty patients underwent coronary angioplasty (PTCA) from which 14 had control coronary arteriography (CA) and left ventricular cineventriculography (LVCV). Nineteen pts underwent bypass graft surgery (ACB) and stress sonagraphy. Semi-quantification of uptake (Up related to perfusion) and turnover (Tr) was obtained by segmental comparison of oblique slices. About 90% of the reperfused myocardial segments in the PTCA-group and 76% in the ACB-group showed an improvement of uptake after therapy (RUp). Of these, 50% and 66% exhibited increased turnover (RTr) after PTCA or ACB. Pathologic RTr was highly correlated with regional wall motion abnormalities after therapy in both groups. In the ACB-group presence of improvement of RTr was correlated with improved RWM at rest and stress. IPPA-studies show potential to provide information about changes of perfusion and metabolism after reperfusion and IPPA-turnover is a good predictor of the pattern of contractile function.

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

    Energy Technology Data Exchange (ETDEWEB)

    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.)

  1. Multidetector-row computed tomographic evaluation of myocardial perfusion in reperfused chronic myocardial infarction: value of color-coded perfusion map in a porcine model.

    Science.gov (United States)

    Yim, Nam Yeol; Kim, Yun-Hyeon; Choi, Song; Seon, Hyun Ju; Kim, Yeong Cheol; Jeong, Gwang Woo; Min, Byeong In; Lee, Sang Rok; Jeong, Myeong Ho; Kim, Jae Kyu; Park, Jin Gyoon; Kang, Heoung Keun

    2009-04-01

    We aimed to develop color-coded CT perfusion maps (CPM) of infarcted myocardium and assess the utility of CPM in evaluating ischemic heart disease on a cardiac multi-detector CT (MDCT) in a porcine reperfused-myocardial-infarction model. Myocardial infarctions were induced by 30 min occlusions of the proximal left anterior descending coronary artery (LAD) in 17 healthy adult female pigs. First-pass and 5 min-delayed cardiac MDCTs were performed after 4 weeks of LAD occlusion. Myocardial CPMs were obtained by using the CPM program. Triphenyltetrazolium chloride (TTC)-staining was performed on the cardiac specimens. We analyzed the intermodality agreement on the size and location of the myocardial infarctions. TTC staining revealed myocardial infarction in 16 of 17 pigs, and 15 of these (94%) showed matched infarcts on the CPM and first-pass images. The areas of perfusion deficit noted in early arterial phase images and CPM coincided exactly with the areas of poor TTC staining in 12 of 15 pigs (80%). In the three remaining pigs, the areas of poor TTC staining were larger than those of a perfusion deficit demonstrated by either early arterial phase images or CPM. The agreement between these tests is calculated to be moderate to good (k = 0.736, P infarction; CPM was helpful in visualizing the infarcted myocardium.

  2. Perfusion Computed Tomography for the Assessment of Myocardial Viability — a Case Series

    Directory of Open Access Journals (Sweden)

    Morariu Mirabela

    2016-06-01

    Full Text Available Myocardial viability plays an important role in preventing the development of left ventricular remodeling following an acute myocardial infarction. A preserved viability in the infarcted area has been demonstrated to be associated with a lower amplitude of the remodeling process, while the extent of the non-viable myocardium is directly correlated with the amplitude of the remodeling process. A number of methods are currently in use for the quantification of the viable myocardium, and some of them are based on the estimation of myocardial perfusion during pharmacologic stress. 64-slice Multi-detector Computed Tomography (MDCT during vasodilator stress test, associated with CT Coronary Angiography (CCTA has a high diagnostic accuracy in evaluating myocardial perfusion. In this article, we present a sequence of 3 clinical cases that presented with symptoms of myocardial ischemia, who underwent 64-slice MDCT imaging at rest and during adenosine stress test, in order to assess the extent of the hypoperfused myocardial areas. Coronary artery anatomy and the Coronary Calcium Score was assessed for all 3 patients by performing CT Coronary Angiography. The combination of CT Angiography and adenosine stress CT myocardial perfusion imaging can accurately detect atherosclerosic lesions that cause perfusion abnormalities, compared with the combination of invasive angiography and single-photon emission computed tomography (SPECT.

  3. Slaughterhouse blood as a perfusate for studying myocardial function under ischemic conditions

    Directory of Open Access Journals (Sweden)

    Bendjelid K.

    2003-01-01

    Full Text Available Metabolic studies using the in vitro non-recirculating blood-perfused isolated heart model require large volumes of blood. The present study was designed to determine whether heterologous pig blood collected from a slaughterhouse can be used as perfusate for isolated pig hearts perfused under aerobic and constant reduced flow conditions. Eight isolated working pig hearts perfused for 90 min at a constant flow of 1.5 ml g-1 min-1 with non-recirculated blood diluted with Krebs-Henseleit bicarbonate buffer at a hematocrit of 23% were compared to eight hearts subjected to the same protocol but perfused only with Krebs-Henseleit bicarbonate buffer solution. Hearts were paced at 100 bpm and subjected to aerobic perfusion at 38ºC. Hearts were weighed before perfusion and at the end of the experiment and the results are reported as percent weight gain (mean ± SD. Comparisons between groups were performed by the Student t-test (P<0.05. After 90 min of perfusion with modified Krebs-Henseleit, perfused hearts presented a larger weight gain than blood-perfused hearts (39.34 ± 9.27 vs 23.13 ± 5.42%, P = 0.003. Left ventricular end-diastolic pressure was higher in the modified Krebs-Henseleit-perfused group than in the blood group (2.8 ± 0.4 vs 2.3 ± 0.3 mmHg, respectively, P = 0.01. We conclude that heterologous blood perfusion, by preserving a more physiological myocardial water content, is a better perfusion fluid than modified Krebs-Henseleit solution for quantitative studies of myocardial metabolism and heart function under ischemic conditions.

  4. Myocardial perfusion imaging determination using an appropriate use smartphone application.

    Science.gov (United States)

    Mahajan, Ashish; Bal, Susan; Hahn, Harvey

    2015-02-01

    Inappropriate cardiac imaging has been a significant cost concern and cause of radiation burden to patients. To assess if a smartphone application (app) based on 2009 Appropriate Use Criteria (AUC) for Cardiac Radionuclide Imaging published by American College of Cardiology would be feasible at the point of order. We evaluated stress myocardial perfusion imaging (MPI) (N = 403) (mean age = 62.23 years; 47.89% males) over a 4 month period using a smartphone app to determine whether the study ordered was Appropriate, Inappropriate, or Uncertain per 2009 AUC. We also monitored the time needed to use the app to determine the level of appropriateness of each stress MPI. The results of the stress MPI were noted. Of the 403 stress MPIs evaluated, 267 (66.25%) were noted to be Appropriate, 118 (29.28%) were Inappropriate, and 13 (3.23%) were Uncertain, per AUC; 5 (1.25%) remained unclassified. Average time needed to use the app to assess each stress MPI for appropriateness was noted to be 44 (±9) seconds. Non-teaching physicians ordered 70 (38.89%) inappropriate stress MPIs as compared to 20 (23.53%) ordered by physicians on resident teaching service, and 28 (23.33%) by cardiologists (P = .0045). Among inappropriately ordered stress MPIs, 87 (42.65%) were ordered in females as compared to 31 (17.13%) in males (P smartphone app provides an easy-to-use tool to assist physicians in determining the level of appropriateness of stress MPI in a time- and cost-effective manner at the point of order. The smartphone app may have potential to promote the usage of the AUC and possibly aid reduction of healthcare cost and ionizing radiation burden.

  5. Prognostic Value of Combined Clinical and Myocardial Perfusion Imaging Data Using Machine Learning.

    Science.gov (United States)

    Betancur, Julian; Otaki, Yuka; Motwani, Manish; Fish, Mathews B; Lemley, Mark; Dey, Damini; Gransar, Heidi; Tamarappoo, Balaji; Germano, Guido; Sharir, Tali; Berman, Daniel S; Slomka, Piotr J

    2017-10-16

    This study evaluated the added predictive value of combining clinical information and myocardial perfusion single-photon emission computed tomography (SPECT) imaging (MPI) data using machine learning (ML) to predict major adverse cardiac events (MACE). Traditionally, prognostication by MPI has relied on visual or quantitative analysis of images without objective consideration of the clinical data. ML permits a large number of variables to be considered in combination and at a level of complexity beyond the human clinical reader. A total of 2,619 consecutive patients (48% men; 62 ± 13 years of age) who underwent exercise (38%) or pharmacological stress (62%) with high-speed SPECT MPI were monitored for MACE. Twenty-eight clinical variables, 17 stress test variables, and 25 imaging variables (including total perfusion deficit [TPD]) were recorded. Areas under the receiver-operating characteristic curve (AUC) for MACE prediction were compared among: 1) ML with all available data (ML-combined); 2) ML with only imaging data (ML-imaging); 3) 5-point scale visual diagnosis (physician [MD] diagnosis); and 4) automated quantitative imaging analysis (stress TPD and ischemic TPD). ML involved automated variable selection by information gain ranking, model building with a boosted ensemble algorithm, and 10-fold stratified cross validation. During follow-up (3.2 ± 0.6 years), 239 patients (9.1%) had MACE. MACE prediction was significantly higher for ML-combined than ML-imaging (AUC: 0.81 vs. 0.78; p clinical and imaging data variables was found to have high predictive accuracy for 3-year risk of MACE and was superior to existing visual or automated perfusion assessments. ML could allow integration of clinical and imaging data for personalized MACE risk computations in patients undergoing SPECT MPI. Copyright © 2017 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

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

    Energy Technology Data Exchange (ETDEWEB)

    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

  7. Acute myocardial infarction: estimation of at-risk and salvaged myocardium at myocardial perfusion SPECT 1 month after infarction.

    Science.gov (United States)

    Romero-Farina, Guillermo; Aguadé-Bruix, Santiago; Candell-Riera, Jaume; Pizzi, M Nazarena; Pineda, Victor; Figueras, Jaume; Cuberas, Gemma; de León, Gustavo; Castell-Conesa, Joan; García-Dorado, David

    2013-11-01

    To estimate at-risk and salvaged myocardium by using gated single photon emission computed tomography (SPECT) myocardial perfusion imaging after acute myocardial infarction (AMI). The study was approved by the hospital's Ethical Committee on Clinical Trials (trial register number, PR(HG)36/2000), and all patients gave informed consent. Forty patients (mean age, 61.78 years; eight women) with a first AMI underwent two gated SPECT examinations--one before percutaneous coronary intervention (PCI) and one 4-5 weeks after PCI. Myocardium at risk was estimated by assessing the perfusion defect at the first gated SPECT examination, and salvaged myocardium was estimated by assessing the risk area minus necrosis at the second examination. Myocardium at risk was estimated by determining the discordance between the areas of left ventricular (LV) wall motion and perfusion at the second examination. Concordance between tests was analyzed by means of linear regression analysis, the Pearson correlation, the intraclass correlation coefficient, and Bland-Altman analysis. An improvement in perfusion, wall motion, wall thickening, and LV ejection fraction (P Myocardial perfusion gated SPECT performed 1 month after early PCI in a first AMI provides potentially useful information on at-risk and salvaged myocardium. http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.13122324/-/DC1. RSNA, 2013

  8. Effect of beam hardening on transmural myocardial perfusion quantification in myocardial CT imaging

    Science.gov (United States)

    Fahmi, Rachid; Eck, Brendan L.; Levi, Jacob; Fares, Anas; Wu, Hao; Vembar, Mani; Dhanantwari, Amar; Bezerra, Hiram G.; Wilson, David L.

    2016-03-01

    The detection of subendocardial ischemia exhibiting an abnormal transmural perfusion gradient (TPG) may help identify ischemic conditions due to micro-vascular dysfunction. We evaluated the effect of beam hardening (BH) artifacts on TPG quantification using myocardial CT perfusion (CTP). We used a prototype spectral detector CT scanner (Philips Healthcare) to acquire dynamic myocardial CTP scans in a porcine ischemia model with partial occlusion of the left anterior descending (LAD) coronary artery guided by pressure wire-derived fractional flow reserve (FFR) measurements. Conventional 120 kVp and 70 keV projection-based mono-energetic images were reconstructed from the same projection data and used to compute myocardial blood flow (MBF) using the Johnson-Wilson model. Under moderate LAD occlusion (FFR~0.7), we used three 5 mm short axis slices and divided the myocardium into three LAD segments and three remote segments. For each slice and each segment, we characterized TPG as the mean "endo-to-epi" transmural flow ratio (TFR). BH-induced hypoenhancement on the ischemic anterior wall at 120 kVp resulted in significantly lower mean TFR value as compared to the 70 keV TFR value (0.29+/-0.01 vs. 0.55+/-0.01 p<1e-05). No significant difference was measured between 120 kVp and 70 keV mean TFR values on segments moderately affected or unaffected by BH. In the entire ischemic LAD territory, 120 kVp mean endocardial flow was significantly reduced as compared to mean epicardial flow (15.80+/-10.98 vs. 40.85+/-23.44 ml/min/100g; p<1e-04). At 70 keV, BH was effectively minimized resulting in mean endocardial MBF of 40.85+/-15.3407 ml/min/100g vs. 74.09+/-5.07 ml/min/100g (p=0.0054) in the epicardium. We also found that BH artifact in the conventional 120 kVp images resulted in falsely reduced MBF measurements even under non-ischemic conditions.

  9. Evaluation of myocardial CT perfusion in patients presenting with acute chest pain to the emergency department: comparison with SPECT-myocardial perfusion imaging.

    Science.gov (United States)

    Feuchtner, Gudrun Maria; Plank, Fabian; Pena, Constantino; Battle, Juan; Min, James; Leipsic, Jonathon; Labounty, Troy; Janowitz, Warren; Katzen, Barry; Ziffer, Jack; Cury, Ricardo C

    2012-10-01

    To determine whether evaluation of resting myocardial CT perfusion (CTP) from coronary CT angiography (CTA) datasets in patients presenting with chest pain (CP) to the emergency department (ED), might have added value to coronary CTA. 76 Patients (age 54.9 y±13; 32 (42%) women) presenting with CP to the ED underwent coronary 64-slice CTA. Myocardial perfusion defects were evaluated for CTP (American Heart Association 17-segment model) and compared with rest sestamibi single-photon emission CT myocardial perfusion imaging (SPECT-MPI). CTA was assessed for >50% stenosis per vessel. CTP demonstrated a sensitivity of 92% and 89%, specificity of 95% and 99%, positive predictive value (PPV) of 80% and 82% and negative predictive value (NPV) of 98% and 99% for each patient and for each segment, respectively. CTA showed an accuracy of 92%, sensitivity of 70.4%, specificity of 95.5%, PPV 67.8%, and NPV of 95% compared with SPECT-MPI. When CTP findings were added to CTA the PPV improved from 67% to 90.1%. In patients presenting to the ED with CP, the evaluation of rest myocardial CTP demonstrates high diagnostic performance as compared with SPECT-MPI. Addition of CTP to CTA improves the accuracy of CTA, primarily by reducing rates of false-positive CTA.

  10. Dobutamine stress myocardial perfusion imaging: 8-year outcomes in patients with diabetes mellitus.

    Science.gov (United States)

    Boiten, Hendrik J; van Domburg, Ron T; Valkema, Roelf; Zijlstra, Felix; Schinkel, Arend F L

    2016-08-01

    Many studies have examined the prognostic value of myocardial perfusion imaging (MPI) using single-photon emission computed tomography (SPECT) for the prediction of short- to medium-term outcomes. However, the long-term prognostic value of MPI in patients with diabetes mellitus remains unclear. Therefore, this study assessed the long-term prognostic value of MPI in a high-risk cohort of patients with diabetes mellitus. A high-risk cohort of 207 patients with diabetes mellitus who were unable to undergo exercise testing underwent dobutamine stress MPI. Follow-up was successful in 206 patients; 12 patients were excluded due to early revascularization. The current data are based on the remaining 194 patients. Follow-up end points were all-cause mortality, cardiac mortality, and nonfatal myocardial infarction. The Kaplan-Meier survival curves were constructed, and univariable and multivariable analyses were performed to identify predictors of long-term outcome. During a mean follow-up of 8.1 ± 5.9 years, 134 (69%) patients died of which 68 (35%) died due to cardiac causes. Nonfatal myocardial infarction occurred in 24 patients (12%), and late (>60 days) coronary revascularization was performed in 61 (13%) patients. Survival analysis showed that MPI provided optimal risk stratification up to 4 years after testing. After that period, the outcome was comparable in patients with normal and abnormal MPI. Multivariable analyses showed that MPI provided incremental prognostic value up to 4 years after testing. In high-risk patients with diabetes mellitus, dobutamine MPI provides incremental prognostic information in addition to clinical data for a 4-year period after testing. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2016. For permissions please email: journals.permissions@oup.com.

  11. The clinical role of stress myocardial perfusion imaging in women with suspected coronary artery disease.

    Science.gov (United States)

    Mieres, Jennifer H; Rosman, David R; Shaw, Leslee J

    2004-01-01

    Cardiovascular disease remains the number one cause of mortality for women in the United States, with coronary artery disease (CAD) accounting for 54% of all cardiovascular deaths. CAD claims the lives of more than 250,000 women each year and is therefore the single largest killer of American women. For several decades, the under-representation of women in clinical trials led to both a lack of available sex-specific evidence and a generalized misconception that CAD was a "man's disease." In actuality, not only are women vulnerable to CAD, they typically develop it 10 to 15 years later than men. Furthermore, sex differences exist in the mortality rates of women and men with CAD, such that once CAD is present in women, they have worse outcomes than their male counterparts. Consequently, early and accurate diagnosis of CAD is crucial for reducing mortality rates in women. Stress myocardial perfusion imaging (MPI) using contemporary techniques has been shown to have significant value in the diagnosis and prognosis of CAD in women. In the risk assessment of women with an intermediate clinical pretest likelihood of CAD, using MPI with exercise or pharmacologic stress has been shown to add incremental value to clinical variables or exercise electrocardiogram stress testing alone. This review discusses the clinical role of stress MPI in the management of women with suspected CAD.

  12. Nuclear myocardial perfusion imaging with a cadmium-telluride semiconductor detector gamma camera in patients with acute myocardial infarction.

    Science.gov (United States)

    Fukushima, Yoshimitsu; Kumita, Shin-ichiro; Kawaguchi, Tsuneaki; Maruyama, Takatoshi; Kawasaki, Yoshiyuki; Shinkai, Yasuhiro

    2014-08-01

    Since myocardial perfusion imaging (MPI) with conventional sodium iodine (NaI) device has low spatial resolution, there have been some cases in which small structures such as non-transmural myocardial infarction could not be properly detected. The purpose of this study was to evaluate potential usefulness of cadmium-telluride (CdTe) semiconductor detector-based high spatial resolution gamma cameras in detecting myocardial infarction sites, especially non-transmural infarction. A total of 38 patients (mean age ± SD: 64 ± 21 year) who were clinically diagnosed with acute myocardial infarction were included. Twenty-eight cases of them were with ST segment elevation myocardial infarction (STEMI) and 10 cases with non-ST segment elevation myocardial infarction (NSTEMI). In all patients, myocardial perfusion single photon emission computed tomography images were acquired with Infinia (NaI device) and R1-M (CdTe device), and the images were compared concerning the detectability of acute myocardial infarction sites. The detection rates of the myocardial infarction site in cases with STEMI were 100% both by NaI and CdTe images. In cases with NSTEMI, detection rate by NaI images was 50%, while that of CdTe images was 100% (p = 0.033). The summed rest score (SRS) value derived from CdTe images was significantly higher than that from NaI images in cases with STEMI [NaI images: 12 (7-18) versus CdTe images: 14 (9-20)] (p cases with NSTEMI [NaI images: 2 (0-5) versus CdTe images: 6 (6-8)] (p = 0.006). These results indicate that MPI using CdTe-semiconductor device will provide a much more accurate assessment of acute myocardial infarction in comparison to current methods.

  13. Low-dose dobutamine myocardial perfusion scintigraphy in the identification of viable myocardium

    Energy Technology Data Exchange (ETDEWEB)

    Moraes, Renata Freire de [Instituto Hermes Pardini, Belo Horizonte, MG (Brazil). Dept. of Molecular Imaging and Diagnosis. Div. of Nuclear Medicine; Meneghetti, Jose Claudio [Instituto do Coracao (InCor-HC/FM/USP), Sao Paulo, SP (Brazil). Unit of Nuclear Medicine and Molecular Imaging; Barroso, Adelanir Antonio, E-mail: renatafreire@yahoo.com.b [Nuclear Medcenter, Belo Horizonte, MG (Brazil)

    2010-09-15

    Objective: to evaluate the increase in specificity of dual isotope myocardial perfusion gated SPECT ({sup 99m}Tcsestamibi/thallium-201), a highly sensitive method to detect viable myocardium, with addition of data on contractile reserve simultaneously acquired by low-dose dobutamine gated SPECT, similarly to echocardiography. Materials and methods: a total of 260 myocardial segments were assessed in 13 patients with myocardial infarction referred for investigation of myocardial viability before undergoing revascularization. Cellular integrity and contractile reserve were evaluated by dual isotope perfusion myocardial gated SPECT with thallium rest and redistribution images and post-stress {sup 99m}Tc-sestamibi gated-SPECT images under basal conditions and with low-dose dobutamine. The improvement in the contractile performance detected by post-revascularization {sup 99m}Tc-sestamibi gated SPECT was the parameter considered for determining myocardial viability. For the purpose of results analysis, the functional parameters of the myocardial segments were quantified at the different phases of the study and stratified according to their viability for a later post-revascularization functional comparison. Results: in the statistical analysis, systolic wall thickening demonstrated to be a relevant parameter in the evaluation of myocardial contractile reserve by this method, with a tendency of improvement in the specificity (84%), demonstrating higher values than those observed in the literature. Conclusion: this method tends to present an effective contribution in the assessment of myocardial viability. (author)

  14. Discrepancy between myocardial perfusion and fatty acid metabolism following acute myocardial infarction for evaluating the dysfunctional viable myocardium.

    Science.gov (United States)

    Biswas, Shankar K; Sarai, Masayoshi; Toyama, Hiroshi; Hishida, Hitoshi; Ozaki, Yukio

    2012-01-01

    Following acute myocardial infarction (AMI) the area of myocardial perfusion and metabolism mismatch is designated as dysfunctional viable myocardium. (123)I-beta-methyl iodophenyl pentadecanoic acid (BMIPP) is clinically very useful for evaluating myocardial fatty acid metabolism, and (99)mTc-Tetrofosmin (TF) is a widely used tracer for myocardial perfusion. This study was designed to evaluate the degree of discrepancy between BMIPP and TF at the subacute state of AMI. Fifty-two patients (aged 59 ± 10 years; mean 46 years) with AMI were enrolled, and all of them underwent percutaneous coronary intervention (PCI). Patients were classified according to ST-T change and PCI timing. (123)I-beta-methyl iodophenyl pentadecanoic acid and TF cardiac scintigraphy were performed on 7 ± 3.5 days of admission using a dual headed gamma camera. Perfusion and fatty acid metabolism defect were scored on a 17 segments model. The mean BMIPP defect score on early and delayed images were 16.67 ± 10.19 and 16.25 ± 10.40, respectively. The mean TF defect score was 10 ± 7.69. Defect score of BMIPP was significantly higher than that of the TF (P TF), and 5 (10%) patients showed matched defect (BMIPP = TF). Mismatched defect score (MMDS) was significantly higher in patients with ST-segment elevation myocardial infarction (STEMI) than that of non-ST-segment elevation myocardial infarction (NSTEMI) (P < 0.041; 95% CI 0.11-5.19). At the subacute state of AMI, most of the patients showed perfusion-metabolism mismatch, which represents the dysfunctional viable myocardium, and patients with STEMI showed higher mismatch. Copyright © 2012 Cardiological Society of India. Published by Elsevier B.V. All rights reserved.

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

    Energy Technology Data Exchange (ETDEWEB)

    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

  16. Study of myocardial regional wall motion parameter's accuracy by software perfusion phantom.

    Science.gov (United States)

    Fidler, V; Fettich, J; Prepadnik, M

    1992-06-01

    Gated perfusion myocardial scintigraphy permits simultaneous evaluation of perfusion as well as regional contractile function of the left ventricle. Fourier analysis of regional myocardial spatial movement with respect to the myocardial geometric centre gives circular amplitude and phase profiles of ventricular contraction, in addition to regional maximum activity that represents an index of perfusion. To introduce such combined perfusion-contraction analysis the accuracy of the indices mentioned above should be evaluated for different doses of radioactivity typically administered to a patient. A mathematical software phantom, consisting of a half circularly profiled ring activity embedded in uniform background activity and noise generated by a Poisson-shaped random number generator, was constructed and used for this purpose. A 64 x 64 matrix and sequence of 16 frames per study was used. The maximum number of counts per pixel ranged from 10 to 100, simulating low count thallium and high count rate Tc-MIBI-gated studies. The relative standard error analysis (R.S.E.) with a 95.5% confidence level for a thallium type of 10 counts per pixel study exceeded 11%, while it reached acceptable values below 3% for studies with 60 and more counts per pixel. These results indicate that high count rate gated technetium-MIBI myocardial perfusion studies could also be used for reliable left ventricular regional wall motion evaluation.

  17. When is reacquisition necessary due to high extra-cardiac uptake in myocardial perfusion scintigraphy?

    DEFF Research Database (Denmark)

    Johansen, Allan; Lomsky, Milan; Gerke, Oke

    2013-01-01

    Technetium-labeled agents, which are most often used for assessing myocardial perfusion in myocardial perfusion scintigraphy (MPS), are cleared by the liver and excreted by the biliary system. Spillover from extra-cardiac activity into the myocardium, especially the inferior wall, might conceal d...... defects and lower the diagnostic accuracy of the study. The objective was to determine rules of thumb for when reacquisition is useful due to high extra-cardiac uptake, i.e., when interpretation of the studies was affected by poor image quality....

  18. The value of exercise tests after acute myocardial infarction

    DEFF Research Database (Denmark)

    Nielsen, F E; Nielsen, S L; Knudsen, F

    1992-01-01

    The aim of the present study was to relate the clinical course in patients after a first acute myocardial infarction with the response to exercise-tests performed one month after discharge. 90 consecutive patients who suffered an acute myocardial infarction for the first time were followed-up after...... (W) were predictive with respect to mortality, heart failure, and angina pectoris requiring drug treatment. Exercise tests following acute myocardial infarction could not predict the chances of returning to work....

  19. Myocardial perfusion alterations observed months after radiotherapy are related to the cellular damage

    Energy Technology Data Exchange (ETDEWEB)

    Dogan, I.; Sonmez, B. [Karadeniz Technical Univ., Trabzon (Turkey). Dept. of Nuclear Medicine; Sezen, O.; Zengin, A.Y.; Bahat, Z. [Karadeniz Technical Univ., Trabzon (Turkey). Dept. of Radiation Oncology; Yenilmez, E.; Yulug, E. [Karadeniz Technical Univ., Trabzon (Turkey). Dept. of Histology and Embryology; Abidin, I. [Karadeniz Technical Univ., Trabzon (Turkey). Dept. of Biophysics

    2010-07-01

    Myocardial perfusion scintigraphy (MPS) is one of the widely used tools to follow developing radiation-induced heart disease (RIHD). But the clinical significance of MPS defects has not been fully understood. We have investigated the biodistribution alterations related to perfusion defects following radiotherapy (RT) and showed coexisting morphological changes. Animals, methods: A total of 18 Wistar rats were divided into three groups (1 control and 2 irradiated groups). A single cardiac 20 Gy radiation dose was used to induce long term cardiac defects. Biodistribution studies with technetium ({sup 99m}Tc) sestamibi and histological evaluations were performed 4 and 6 months after irradiation. The percent radioactivity (%ID/g) was calculated for each heart. For determination of the myocardial damage, positive apoptotic cardiomyocytes, myocardial cell degeneration, myocardial fibrosis, vascular damage and ultrastructural structures were evaluated. Results: Six months after treatment, a significant drop of myocardial uptake was observed (p < 0.05). Irradiation-induced apoptosis rose within the first 4 months after radiation treatment and were stayed elevated until the end of the observation period (p < 0.05). Also, the irradiation has induced myocardial degeneration, perivascular and interstitial fibrosis in the heart at the end of six and four months (p < 0.01). The severity and extent of myocardial injury has became more evident at the end of six month (p < 0.05). At ultrastructural level, prominent changes have been observed in the capillary endothelial and myocardial cells. Conclusion: Our findings suggest that the reduced rest myocardial perfusion, occuring months after the radiation, indicates a serious myocard tissue damage which is characterized by myocardial degeneration and fibrosis. (orig.)

  20. GATED SPECT TO EVALUATE LEFT VENTRICULAR MYOCARDIAL PERFUSION, FUNCTION AND DYSSYNCHRONY FOR RESYNCHRONIZATION THERAPY

    Directory of Open Access Journals (Sweden)

    E.N. Ostroumov

    2009-01-01

    Full Text Available The study included 15 consecutive patients with heart failure and substantial LV dyssynchrony undergoing CRT. Clinical and phase analysis of gated myocardial perfusion SPECT assessed at baseline, after 2–3 days and after 3–4 months of CRT. The results demonstrated inversely relationship between the response to CRT and the nonviable myocardium. Evaluation of myocardial viability is necessary to considered in the selection process for CRT.

  1. Reverse Redistribution in Myocardial Perfusion Imaging: Revisited with 64-slice MDCT

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Min Kyung; Kim, Jeong Ho; Hwang, Kyung Hoon; Choi, In Suck; Choi, Soo Jin; Choe, Won Sick [Gachon University Gil Hospital, Incheon (Korea, Republic of); Yoon, Min Ki [Good Samaritan Hospital, Pohang (Korea, Republic of)

    2010-06-15

    The authors report myocardial perfusion imaging of a patient showing reverse redistribution (RR) and a 64-slice multidetector-row computed tomography (MDCT) with corresponding findings. The patient had subendocardial myocardial infarction (MI) with positive electrocardiogram (EMG) findings and elevated levels of cardiac isoenzymes. Experiencing this case emphasizes the importance of complementary correlation of a new diagnostic modality that helps us to understand the nature of RR.

  2. Perfusion imaging using rubidium-82 ((82)Rb) PET in rats with myocardial infarction

    DEFF Research Database (Denmark)

    Clemmensen, Andreas Ettrup; Ghotbi, Adam Ali; Bodholdt, Rasmus Poul

    2017-01-01

    of balanced coronary and small vessel disease is possible. For further evaluation of how 82Rb-PET can be used clinically, pre-clinical application of the method would be valuable. However, so far no data on the use of 82Rb-PET in small animals have been published nor has the use of 82Rb-PET, to the best......Assessing myocardial perfusion using 82Rb-PET is emerging as a valuable clinical tool.1,2 The rapid decay (T½ = 76 s) allows for absolute quantification of both rest and stress perfusion within 30 minutes. In addition to evaluation of epicardial disease with perfusion defects, also evaluation...

  3. Reversal of rest myocardial asynergy during exercise: a radionuclide scintigraphic study

    Energy Technology Data Exchange (ETDEWEB)

    Kimchi, A.; Rozanski, A.; Fletcher, C.; Maddahi, J.; Swan, H.J.; Berman, D.S.

    1985-11-01

    While exercise-induced segmental left ventricular wall motion abnormalities are well described, the phenomenon of improvement in certain asynergic segments during exercise in some patients remains a curiosity. To assess this unexpected finding, results were analyzed in 85 patients with wall motion abnormalities at rest who underwent two view exercise radionuclide ventriculography and exercise thallium-201 myocardial perfusion imaging. Wall motion was scored with a 5 point system; normalization or increase of 2 or more points with exercise signified improvement. Forty-eight patients (56%) had no change or further deterioration of wall motion at peak exercise, 15 (18%) showed both improvement of wall motion and deterioration and 22 (26%) showed only improvement of wall motion. Wall motion improvement during exercise was found in 57 (20%) of 279 segments with asynergy at rest. Of these 57 segments improving with exercise, 45 (79%) showed mild and 12 (21%) showed severe asynergy at rest. Only seven segments (12%) were associated with pathologic Q waves. Thallium-201 perfusion was normal in 44 segments (77%) while only 6 segments (11%) had reversible and only 7 (12%) had nonreversible thallium-201 defects. In conclusion segments with abnormal wall motion at rest that show improvement with exercise appear to represent viable nonischemic segments.

  4. Prognostic Value of Normal Perfusion but Impaired Left Ventricular Function in the Diabetic Heart on Quantitative Gated Myocardial Perfusion SPECT

    Energy Technology Data Exchange (ETDEWEB)

    Jeong, Hwanjeong; Choi, Sehun; Han, Yeonhee [Research Institute of Chonbuk National Univ. Medical School and Hospitial, Jeonju (Korea, Republic of); Lee, Dong Soo; Lee, Hoyoung; Chung, Junekey [Seoul National Univ., Seoul (Korea, Republic of)

    2013-09-15

    This study aimed at identifying the predictive parameters on quantitative gated myocardial perfusion single-photon emission computed tomography (QG-SPECT) in diabetic patients with normal perfusion but impaired function. Methods Among the 533 consecutive diabetic patients, 379 patients with normal perfusion on rest Tl-201/dipyridamole-stress Tc-{sup 99m} sestamibi Gated SPECT were enrolled. Patients were grouped into those with normal post-stress left ventricular function (Group I) and those with impaired function (EF <50 or impaired regional wall motion, Group II). We investigated cardiac events and cause of death by chart review and telephone interview. Survival analysis and Cox proportional hazard model analysis were performed. Between the Group I and II, cardiac events as well as chest pain symptoms, smoking, diabetic complications were significantly different (P<0.05). On survival analysis, event free survival rate in Group II was significantly lower than in Group I (P=0.016). In univariate Cox proportional hazard analysis on overall cardiac event, Group (II over I), diabetic nephropathy, summed motion score (SMS), summed systolic thickening score (STS), numbers of abnormal segmental wall motion and systolic thickening predicted more cardiac events (P<0.05). Multivariate analysis showed that STS was the only independent predictor cardiac event. The functional parameter, especially summed systolic thickening score on QG-SPECT had prognostic values, despite normal perfusion, in predicting cardiac events in diabetic patients, and QG-SPECT provides clinically useful risk stratification in diabetic patients with normal perfusion.

  5. Correlation of the myocardial perfusion corrected by attenuation with the coronariography. Preliminary results; Correlacion de la perfusion miocardica corregida por atenuacion con la coronariografia

    Energy Technology Data Exchange (ETDEWEB)

    Garcia C, S.E.; Garcia O, R. [Servicio de Medicina Nuclear, Centro Medico ABC, Campis Observatorio, IAP (Mexico)

    2005-07-01

    The attenuation that suffers the radiation in the soft tissues of the hinders the appropriate interpretation of the myocardial perfusion studies, for what have been implemented attenuation correction systems to reduce the attenuation for soft tissues and to provide myocardial perfusion images more accurate in the diagnosis of coronary illness. The objective was to evaluate the utility of an attenuation correction system (with source of Gadolinium 153) to minimize the devices that look like true defects of myocardial perfusion, caused by soft tissues (mammary tissue, thoracic wall, abdomen, left hemi diaphragm), and to compare those interpretations of the studies with the interpretations of the corresponding coronariographies. The method consists of 95 electronic files which were revised with the concept of heart catheterization, being identified 20 patients from the masculine sex to those that underwent coronariography among May 1999 and December 2002, and that they had study of myocardial perfusion in a maximum period of 3 months foresaw to the invasive procedure. (Author)

  6. MYOCARDIAL PERFUSION ASSESSMENT IN FORECASTING EFFECT OF CORONARY ANGIOPLASTY IN PATIENTS WITH ISCHEMIC CHRONIC HEART FAILURE

    Directory of Open Access Journals (Sweden)

    A. B. Mironkov

    2015-01-01

    Full Text Available Aim. To define influence of the left ventricle (LV perfusion defects on the clinical status dynamics after coronary angioplasty in patients with the expressed myocardium dysfunction of ischemic etiology. Materials and methods. Examined 86 patients (81 men and 5 women aged from 46 to 73 years before and in 2–3 days after percutaneous coronary intervention with diagnosis: CAD, CHF with NYHA class III–IV, echocardiography parameters of LV: ejection fraction less than 40%, end-diastolic volume is more than 200 ml. Perfusion defects of myocardium estimated with use of ECG-gated single photon emission computed tomography. Predictors were defined: perfusion defects on LV apex (in score, perfusion defects in the area of LAD, LCx and RCA (%, the LV global perfusion defects (in score and %. Results. In 42% of cases 6-minute walk test increased to 3 times; The NYHA class decreased by 2 classes (group 1. In 28 cases 6-minute walk test increased to 2 times and the NYHA class decreased on 1 class. In 22 patients 6-minute walk test increased less than 50% of reference values and there was no dynamics NYHA class (50 patients of the group 2. Initial extent of LV global perfusion defects in group 1 – 41,2 ± 4,0%, in group 2 – 58,3 ± 2,4% (р = 0,0004. Similar values are received for perfusion indicators in the area of LAD and the LV apex. Prevalence of myocardial perfusion defects at rest reflects prevalence of a cardiosclerosis in a cardiac muscle. Conclusion. Degree of LV myocardial perfusion defects in patients with the expressed heart failure of ischemic etiology is the key indicator influencing clinical efficiency of coronary angioplasty. Critical size for definition of the favorable forecast of revascularization are 60% and more perfusion defects testifying that in a cardiac muscle the focal cardiosclerosis prevails over the functioning myocardium. 

  7. Exercise Training Protects Against Acute Myocardial Infarction via Improving Myocardial Energy Metabolism and Mitochondrial Biogenesis

    OpenAIRE

    Lichan Tao; Yihua Bei; Shenghui Lin; Haifeng Zhang; Yanli Zhou; Jingfa Jiang; Ping Chen; Shutong Shen; Junjie Xiao; Xinli Li

    2015-01-01

    Background/Aims: Acute myocardial infarction (AMI) represents a major cause of morbidity and mortality worldwide. Exercise has been proved to reduce myocardial ischemia-reperfusion (I/R) injury However it remains unclear whether, and (if so) how, exercise could protect against AMI. Methods: Mice were trained using a 3-week swimming protocol, and then subjected to left coronary artery (LCA) ligation, and finally sacrificed 24 h after AMI. Myocardial infarct size was examined with triphenyltetr...

  8. Influence of chronic inflammation and autoimmunity on coronary calcifications and myocardial perfusion defects in systemic lupus erythematosus patients.

    Science.gov (United States)

    Plazak, Wojciech; Pasowicz, Mieczyslaw; Kostkiewicz, Magdalena; Podolec, Jakub; Tomkiewicz-Pajak, Lidia; Musial, Jacek; Podolec, Piotr

    2011-10-01

    Conventional risk factors for coronary artery disease fail to explain the increased frequency or cardiovascular morbidity in systemic lupus erythematosus (SLE) patients. This study was conducted to determine the possible influence of autoimmune and inflammatory phenomena markers on coronary artery calcifications and myocardial perfusion abnormalities in SLE patients. Multi-detector computed tomography (MDCT)-based coronary calcium scoring and single photon emission computerized tomography (SPECT) studies (Tc-99m sestamibi) were performed in 60 SLE patients in stable clinical condition, without a prior history of coronary artery disease. Laboratory evaluation included serum C-reactive protein (CRP), complement C3c and C4 components and antiphospholipid antibodies (aPL). The latter included anticardiolipin (aCL) and anti-β2-glycoprotein I (aβ2GPI) antibodies, of both IgG and IgM classes, and lupus anticoagulant (LA) in plasma. SPECT revealed persistent perfusion defects in 22 (36.7%) patients and exercise-induced defects in eight (13.3%), while MDCT revealed coronary calcifications in 15 (25%). Calcium scores ranged from 1 to 843.2 (mean 113.5 ± 259.7). No association was found between conventional coronary artery disease risk factors (obesity, hypertension, tobacco use, hyperlipidaemia, diabetes) nor CRP, C3c or C4 levels and coronary calcifications or myocardial perfusion defects. On the contrary, in patients with these pathologies, augmented autoimmunization was found, reflected by increased aCL IgG and antiβ2GPI IgG levels. In patients with aCL IgG >20 RU/ml or antiβ2GPI IgG >3 RU/ml, the relative risk of coronary calcification formation was 4.1 compared to patients with normal values. Accordingly, in LA-positive patients the relative risk of coronary calcification formation was 4.4 compared to LA-negative patients. Conventional risk factors for coronary artery disease as well as markers of an ongoing inflammation did not show any association with

  9. Early myocardial damage assessment in dystrophinopathies using 99Tcm-MIBI gated myocardial perfusion imaging

    Directory of Open Access Journals (Sweden)

    Zhang L

    2015-12-01

    Full Text Available Li Zhang,1,* Zhe Liu,2,* Ke-You Hu,3 Qing-Bao Tian,3 Ling-Ge Wei,4 Zhe Zhao,5 Hong-Rui Shen,5 Jing Hu5 1Department of Cardiovascular Disorders, 2Department of Geriatrics, The Third Hospital of Hebei Medical University, 3The Public Health Department, Hebei Medical University, 4Department of Nuclear Medicine, 5Department of Neuromuscular Disorders, The Third Hospital of Hebei Medical University, Shijiazhuang, People’s Republic of China *Li Zhang and Zhe Liu are first coauthors of this paper Background: Early detection of muscular dystrophy (MD-associated cardiomyopathy is important because early medical treatment may slow cardiac remodeling and attenuate symptoms of cardiac dysfunction; however, no sensitive and standard diagnostic method for MD at an earlier stage has been well-recognized. Thus, the aim of this study was to test the early diagnostic value of technetium 99m-methoxyisobutylisonitrile (99Tcm-MIBI gated myocardial perfusion imaging (G-MPI for MD.Methods and results: Ninety-one patients underwent 99Tcm-MIBI G-MPI examinations when they were diagnosed with Duchenne muscular dystrophy (DMD (n=77 or Becker muscular dystrophy (BMD; n=14. 99Tcm-MIBI G-MPI examinations were repeated in 43 DMD patients who received steroid treatments for 2 years as a follow-up examination. Myocardial defects were observed in nearly every segment of the left ventricular wall in both DMD and BMD patients compared with controls, especially in the inferior walls and the apices by using 99Tcm-MIBI G-MPI. Cardiac wall movement impairment significantly correlated with age in the DMD and BMD groups (rs=0.534 [P<0.05] and rs=0.784 [P<0.05], respectively. Intermittent intravenous doses of glucocorticoids and continuation with oral steroid treatments significantly improved myocardial function in DMD patients (P<0.05, but not in BMD patients.Conclusion: 99Tcm-MIBI G-MPI is a sensitive and safe approach for early evaluation of cardiomyopathy in patients with DMD or BMD

  10. Peak enhancement ratio of myocardium to aorta for identification of myocardial ischemia using dynamic myocardial computed tomography perfusion imaging.

    Science.gov (United States)

    Tanabe, Yuki; Kido, Teruhito; Kurata, Akira; Yokoi, Takahiro; Fukuyama, Naoki; Uetani, Teruyoshi; Nishiyama, Hikaru; Kawaguchi, Naoto; Tahir, Enver; Miyagawa, Masao; Mochizuki, Teruhito

    2017-12-01

    This study aimed to evaluate the feasibility of peak enhancement (PE) ratio of myocardium to aorta (PER) derived from stress dynamic computed tomography myocardial perfusion imaging (CTP) for the detection of myocardial ischemia assessed by magnetic resonance (MR) imaging. Forty-four patients who underwent stress dynamic CTP and MR imaging were retrospectively evaluated. From the time-attenuation curve, myocardial PE, PER, and myocardial blood flow (MBF) were calculated on a segment-based analysis. The correlation between myocardial and aortic PE was assessed by Spearman's correlation, and the differences in myocardial PE and PER between normal and ischemic myocardium were assessed by the Mann-Whitney U-test. The diagnostic accuracies of myocardial PE, PER, and MBF for detecting myocardial ischemia were compared by receiver operating characteristic analysis. Of 704 segments, 258 segments (37%) were diagnosed as myocardial ischemia with MR imaging. Myocardial and aortic PE were significantly correlated in both normal and ischemic segments (r=0.76 and 0.58; pmyocardial PE and PER of ischemic segments were significantly lower than those of normal segments (pmyocardial PE, 78% (67-88%) and 82% (95% CI, 70-91%) for PER, and 81% (95% CI, 73-87%) and 85% (95% CI, 79-92%) for MBF. There was a significantly larger area under the curve for PER (0.87; 95% CI, 0.84-0.90) and MBF (0.88; 95%CI, 0.85-0.91), compared to myocardial PE (0.75; 95% CI, 0.70-0.79) (pmyocardial ischemia, comparable to that of MBF. Copyright © 2017 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.

  11. Comparison of two- versus three-dimensional myocardial contrast echocardiography for assessing subendocardial perfusion abnormality after percutaneous coronary intervention in patients with acute myocardial infarction.

    Science.gov (United States)

    Iwakura, Katsuomi; Ito, Hiroshi; Okamura, Atsushi; Kurotobi, Toshiya; Koyama, Yasushi; Date, Motoo; Inoue, Koichi; Nagai, Hiroyuki; Imai, Michio; Arita, Yo; Toyoshima, Yuko; Ozawa, Makito; Fujii, Kenshi

    2007-11-15

    Myocardial contrast echocardiography (MCE) visualizes myocardial perfusion abnormalities after acute myocardial infarction. However, the limited view of 2-dimensional echocardiography reduces its ability to estimate perfusion abnormalities, especially in the subendocardial region. Three-dimensional echocardiography provides images of the left ventricular endocardium directly. This study was conducted to evaluate the ability of 3-dimensional MCE to assess abnormalities of subendocardial perfusion. Intracoronary 2- and 3-dimensional MCE was performed after primary percutaneous coronary intervention in 47 patients with acute myocardial infarction. Myocardial perfusion within the risk area was evaluated as good, poor, or no reflow on 2-dimensional MCE or as good, poor, or no myocardial opacification in endocardium on 3-dimensional MCE. The 2 methods showed different distributions of perfusion patterns: good, poor, and no reflow on 2-dimensional MCE in 31 (66%), 9 (19%), and 7 (15%) patients and good, poor, and no myocardial opacification in endocardium on 3-dimensional MCE in 17 (36%), 16 (34%), and 14 (20%) patients, respectively. Although only 19 patients (61%) with good reflow on 2-dimensional MCE showed myocardial perfusion grade 3 on angiography, 16 of 17 patients (94%) with good myocardial opacification in endocardium on 3-dimensional MCE showed myocardial perfusion grade 3. Although there were no significant differences in peak creatine kinase among the 3 subsets classified by 2-dimensional MCE, peak creatine kinase showed significant differences not only among the 3 groups but also among the subsets classified by 3-dimensional MCE. Classification by 3-dimensional MCE also predicted regional wall motion after 4.6 +/- 2.7 months, with significant differences between each pair of groups, whereas there was significant overlap of these values between the group with poor reflow and other 2 groups by 2-dimensional MCE. In conclusion, 3-dimensional MCE is a feasible

  12. Use of neural networks to improve quality control of interpretations in myocardial perfusion imaging

    DEFF Research Database (Denmark)

    Tagil, K.; Marving, J.; Lomsky, M.

    2008-01-01

    Tc-sestamibi myocardial perfusion scintigraphy. After a training process, the networks were used to select the 20 cases in each region that were more likely to have a false clinical interpretation. These cases, together with 20 control cases in which the networks detected no likelihood of false clinical interpretation...

  13. [Myocardial perfusion scintigraphy. Exact and cost-effective coronary disease imaging - secondary publication

    DEFF Research Database (Denmark)

    Hesse, B.; Petersen, C.L.; Marcassa, C.

    2008-01-01

    Mortality rates due to coronary arterial disease (CAD) have declined as result of improved prevention, diagnosis and management, but CAD remains the leading cause of death. Myocardial perfusion scintigraphy (MPS) provides a cost-effective tool for early detection of CAD in symptomatic individuals...

  14. Clinical value, cost-effectiveness, and safety of myocardial perfusion scintigraphy: a position statement

    DEFF Research Database (Denmark)

    Marcassa, C.; Bax, J.J.; Bengel, F.

    2008-01-01

    Mortality rates due to coronary artery disease (CAD) have declined in recent years as result of improved prevention, diagnosis, and management. Nonetheless, CAD remains the leading cause of death worldwide with most casualties expected to occur in developing nations. Myocardial perfusion scintigr...

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

    Energy Technology Data Exchange (ETDEWEB)

    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)

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

    DEFF Research Database (Denmark)

    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...

  17. Myocardial perfusion MRI with sliding-window conjugate-gradient HYPR.

    Science.gov (United States)

    Ge, Lan; Kino, Aya; Griswold, Mark; Mistretta, Charles; Carr, James C; Li, Debiao

    2009-10-01

    First-pass perfusion MRI is a promising technique for detecting ischemic heart disease. However, the diagnostic value of the method is limited by the low spatial coverage, resolution, signal-to-noise ratio (SNR), and cardiac motion-related image artifacts. In this study we investigated the feasibility of using a method that combines sliding window and CG-HYPR methods (SW-CG-HYPR) to reduce the acquisition window for each slice while maintaining the temporal resolution of one frame per heartbeat in myocardial perfusion MRI. This method allows an increased number of slices, reduced motion artifacts, and preserves the relatively high SNR and spatial resolution of the "composite images." Results from eight volunteers demonstrate the feasibility of SW-CG-HYPR for accelerated myocardial perfusion imaging with accurate signal intensity changes of left ventricle blood pool and myocardium. Using this method the acquisition time per cardiac cycle was reduced by a factor of 4 and the number of slices was increased from 3 to 8 as compared to the conventional technique. The SNR of the myocardium at peak enhancement with SW-CG-HYPR (13.83 +/- 2.60) was significantly higher (P < 0.05) than the conventional turbo-FLASH protocol (8.40 +/- 1.62). Also, the spatial resolution of the myocardial perfection images was significantly improved. SW-CG-HYPR is a promising technique for myocardial perfusion MRI. (c) 2009 Wiley-Liss, Inc.

  18. EANM procedural guidelines for radionuclide myocardial perfusion imaging with SPECT and SPECT/CT

    DEFF Research Database (Denmark)

    Verberne, Hein J; Acampa, Wanda; Anagnostopoulos, Constantinos

    2015-01-01

    Since the publication of the European Association of Nuclear Medicine (EANM) procedural guidelines for radionuclide myocardial perfusion imaging (MPI) in 2005, many small and some larger steps of progress have been made, improving MPI procedures. In this paper, the major changes from the updated ...

  19. Multi-scale parameterisation of a myocardial perfusion model using whole-organ arterial networks

    NARCIS (Netherlands)

    Hyde, Eoin R.; Cookson, Andrew N.; Lee, Jack; Michler, Christian; Goyal, Ayush; Sochi, Taha; Chabiniok, Radomir; Sinclair, Matthew; Nordsletten, David A.; Spaan, Jos; van den Wijngaard, Jeroen P. H. M.; Siebes, Maria; Smith, Nicolas P.

    2014-01-01

    A method to extract myocardial coronary permeabilities appropriate to parameterise a continuum porous perfusion model using the underlying anatomical vascular network is developed. Canine and porcine whole-heart discrete arterial models were extracted from high-resolution cryomicrotome vessel image

  20. EANM procedural guidelines for radionuclide myocardial perfusion imaging with SPECT and SPECT/CT: 2015 revision

    NARCIS (Netherlands)

    Verberne, Hein J.; Acampa, Wanda; Anagnostopoulos, Constantinos; Ballinger, Jim; Bengel, Frank; de Bondt, Pieter; Buechel, Ronny R.; Cuocolo, Alberto; van Eck-Smit, Berthe L. F.; Flotats, Albert; Hacker, Marcus; Hindorf, Cecilia; Kaufmann, Philip A.; Lindner, Oliver; Ljungberg, Michael; Lonsdale, Markus; Manrique, Alain; Minarik, David; Scholte, Arthur J. H. A.; Slart, Riemer H. J. A.; Trägårdh, Elin; de Wit, Tim C.; Hesse, Birger

    2015-01-01

    Since the publication of the European Association of Nuclear Medicine (EANM) procedural guidelines for radionuclide myocardial perfusion imaging (MPI) in 2005, many small and some larger steps of progress have been made, improving MPI procedures. In this paper, the major changes from the updated

  1. EANM procedural guidelines for radionuclide myocardial perfusion imaging with SPECT and SPECT/CT : 2015 revision

    NARCIS (Netherlands)

    Verberne, Hein J.; Acampa, Wanda; Anagnostopoulos, Constantinos; Ballinger, Jim; Bengel, Frank; De Bondt, Pieter; Buechel, Ronny R.; Cuocolo, Alberto; van Eck-Smit, Berthe L. F.; Flotats, Albert; Hacker, Marcus; Hindorf, Cecilia; Kaufmann, Philip A.; Lindner, Oliver; Ljungberg, Michael; Lonsdale, Markus; Manrique, Alain; Minarik, David; Scholte, Arthur J. H. A.; Slart, Riemer H. J. A.; Tragardh, Elin; de Wit, Tim C.; Hesse, Birger

    2015-01-01

    Since the publication of the European Association of Nuclear Medicine (EANM) procedural guidelines for radionuclide myocardial perfusion imaging (MPI) in 2005, many small and some larger steps of progress have been made, improving MPI procedures. In this paper, the major changes from the updated

  2. Myocardial perfusion scintigraphy in the UK: insights from the British Nuclear Cardiology Society Survey 2000

    OpenAIRE

    KELION, A; Anagnostopoulos, C.; Harbinson, M; Underwood, S; Metcalfe, M.; t for,

    2005-01-01

    Background: The National Institute for Health and Clinical Excellence (NICE) has recently published a very positive technology appraisal of myocardial perfusion scintigraphy (MPS). This has important implications for service provision within the National Health Service, and an accurate knowledge of the current level of MPS activity is necessary.

  3. A decision support system improves the interpretation of myocardial perfusion imaging

    DEFF Research Database (Denmark)

    Tagil, K.; Bondouy, M.; Chaborel, J.P.

    2008-01-01

    PURPOSE: 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). METHODS: Seven physicians independently...... physicians can improve their interpretation with the advice from such a system Udgivelsesdato: 2008/9...

  4. Systematic review of cost-effectiveness of myocardial perfusion scintigraphy in patients with ischaemic heart disease

    NARCIS (Netherlands)

    Tragardh, Elin; Tan, Siok Swan; Bucerius, Jan; Gimelli, Alessia; Gaemperli, Oliver; Lindner, Oliver; Agostini, Denis; Uebleis, Christopher; Sciagra, Roberto; Slart, Riemer H.; Underwood, S. Richard; Hyafil, Fabien; Hacker, Marcus; Verberne, Hein J.

    2017-01-01

    Coronary artery disease (CAD) is a major cause of death and disability. Several diagnostic tests, such as myocardial perfusion scintigraphy (MPS), are accurate for the detection of CAD, as well as having prognostic value for the prediction of cardiovascular events. Nevertheless, the diagnostic and

  5. Artifacts in Quantitative analysis of myocardial perfusion SPECT, using Cedars-Sinai QPS Software.

    Science.gov (United States)

    Malek, Hadi; Yaghoobi, Nahid; Hedayati, Raheleh

    2017-04-01

    Quantitative analysis of myocardial perfusion Single photon emission computerized tomography (SPECT) images is increasingly applied in modern nuclear cardiology practice, assisting in the interpretation of myocardial perfusion images (MPI). There are different extensively validated state-of-the-art software packages, including QPS (cedars-Sinai), Corridor 4DM (University of Michigan) and Emory cardiac toolbox (Emory university), providing highly accurate and reproducible data. However, these software packages may suffer from potential artifacts related to patient or technical factors. By recognizing the source of such artifacts, the interpreting physician can avoid misinterpretation of MPI study. In this review, we discuss some of technical pitfalls that may occur in Quantitative Perfusion SPECT software (QPS, cedars-Sinai Medical center).

  6. Doença arterial coronariana em diabéticas do tipo 2 assintomáticas: estudo comparativo entre o teste ergométrico, o teste cardiopulmonar e a cintilografia de perfusão miocárdica com dipiridamol na identificação de isquemia Coronary artery disease in asymptomatic type-2 diabetic women: a comparative study between exercise test, cardiopulmonary exercise test, and dipyridamole myocardial perfusion scintigraphy in the identification of ischemia

    Directory of Open Access Journals (Sweden)

    Paola Emanuela Poggio Smanio

    2007-11-01

    diagnosis and worse prognosis. Diabetic women are known to have a cardiovascular death risk higher than that in men. OBJECTIVE: To assess the prevalence of coronary artery disease (CAD in asymptomatic diabetic women. To compare the results of exercise test (ET, cardiopulmonary exercise test (CPET, and dipyridamole myocardial perfusion scintigraphy (MPS with the findings of coronary angiography, (ANGI in order of identify the most accurate method in the detection of significant CAD. METHODS: A total of 104 diabetic women were assessed with ET, CPET and MPS in the period within two months from the ANGI. MIBI-99mTc scintigraphy was performed using the gated-SPECT technique. Pearson's chi-square, Student's t tests were used for the statistical analysis and also the logistic regression analysis. RESULTS: The prevalence of CAD in the group studied was 32.7%. For the ET, an effective test (p=0.045, the chronotropic incompetence (p=0.031, and the exercise time performed (p=0.022 showed a significant association with DAC. For CPET, peak VO2 and HR achieved were associated with CAD (p=0.004 and p=0.025, respectively. Most of the MPS variables showed a significant association with CAD (p=0.001, for all. CONCLUSION: The results obtained may suggest a high prevalence of CAD in diabetic women. Thus, this population should be investigated from the cardiovascular point of view even without cardiac symptom. Of the noninvasive diagnostic methods used, dipyridamole MPS was the one that showed the highest discrimination power in relation to diabetic women with CAD.

  7. Adenosine-induced stress myocardial perfusion imaging using dual-source cardiac computed tomography.

    Science.gov (United States)

    Blankstein, Ron; Shturman, Leon D; Rogers, Ian S; Rocha-Filho, Jose A; Okada, David R; Sarwar, Ammar; Soni, Anand V; Bezerra, Hiram; Ghoshhajra, Brian B; Petranovic, Milena; Loureiro, Ricardo; Feuchtner, Gudrun; Gewirtz, Henry; Hoffmann, Udo; Mamuya, Wilfred S; Brady, Thomas J; Cury, Ricardo C

    2009-09-15

    This study sought to determine the feasibility of performing a comprehensive cardiac computed tomographic (CT) examination incorporating stress and rest myocardial perfusion imaging together with coronary computed tomography angiography (CTA). Although cardiac CT can identify coronary stenosis, very little data exist on the ability to detect stress-induced myocardial perfusion defects in humans. Thirty-four patients who had a nuclear stress test and invasive angiography were included in the study. Dual-source computed tomography (DSCT) was performed as follows: 1) stress CT: contrast-enhanced scan during adenosine infusion; 2) rest CT: contrast-enhanced scan using prospective triggering; and 3) delayed scan: acquired 7 min after rest CT. Images for CTA, computed tomography perfusion (CTP), and single-photon emission computed tomography (SPECT) were each read by 2 independent blinded readers. The DSCT protocol was successfully completed for 33 of 34 subjects (average age 61.4 +/- 10.7 years; 82% male; body mass index 30.4 +/- 5 kg/m(2)) with an average radiation dose of 12.7 mSv. On a per-vessel basis, CTP alone had a sensitivity of 79% and a specificity of 80% for the detection of stenosis > or =50%, whereas SPECT myocardial perfusion imaging had a sensitivity of 67% and a specificity of 83%. For the detection of vessels with > or =50% stenosis with a corresponding SPECT perfusion abnormality, CTP had a sensitivity of 93% and a specificity of 74%. The CTA during adenosine infusion had a per-vessel sensitivity of 96%, specificity of 73%, and negative predictive value of 98% for the detection of stenosis > or =70%. Adenosine stress CT can identify stress-induced myocardial perfusion defects with diagnostic accuracy comparable to SPECT, with similar radiation dose and with the advantage of providing information on coronary stenosis.

  8. Does Enhanced External Counterpulsation (EECP Significantly Affect Myocardial Perfusion?: A Systematic Review & Meta-Analysis.

    Directory of Open Access Journals (Sweden)

    Xiaoxia Qin

    Full Text Available Enhanced external counterpulsation (EECP is currently applied for treating coronary artery disease (CAD patients. However, the mechanism(s by which EECP ameliorates angina pectoris and long-term left ventricular function remain largely unknown. The aim of this study will be to assess whether EECP significantly affects myocardial perfusion in CAD patients through a systematic review and meta-analysis of the available literature.MEDLINE, EMBASE, and Cochrane CENTRAL databases were searched for prospective studies on CAD patients that underwent EECP and reported myocardial perfusion data pre- and post-EECP. The impact of EECP was assessed based on the weighted mean difference (WMD in myocardial perfusion from pre-EECP to post-EECP. Statistical heterogeneity was assessed by the I2 index. Publication bias was assessed through visual inspection of the funnel plot as well as Begg's and Egger's testing.Standard EECP therapy (i.e., 35-36 one-hour sessions within a seven-week period significantly increased myocardial perfusion in CAD patients (pooled WMD: -0.19, 95% CI: -0.38 to 0.00, p = 0.049. A random effects analysis was applied on account of significant heterogeneity (I2 = 89.1%, p = 0.000. There was no evidence of significant publication bias (Begg's p = 0.091; Egger's p = 0.282.Standard EECP therapy significantly increases myocardial perfusion in CAD patients. This study's findings support the continued use of standard EECP therapy in CAD patients and provides one putative physiological mechanism to help explain the improvements in angina pectoris and long-term left ventricular function observed in CAD patients after EECP therapy.

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

    Science.gov (United States)

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

    1986-01-01

    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 14C 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.

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

    Directory of Open Access Journals (Sweden)

    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. Dipyridamole-thallium-201 tomography documenting improved myocardial perfusion with therapy in Kawasaki disease

    Energy Technology Data Exchange (ETDEWEB)

    Nienaber, C.A.; Spielmann, R.P.; Hausdorf, G.

    1988-12-01

    Thallium-201 tomographic perfusion studies after pharmacologic vasodilation were performed in seven children (aged 2 years 8 months to 8 years 7 months), 3 to 20 months after the acute stage of the disease. In all patients coronary aneurysms were seen on cross-sectional echocardiograms. The scintigrams of six children showed no significant regional reduction of myocardial thallium-201 uptake. These children had remained asymptomatic in the follow-up period after the acute inflammatory stage of Kawasaki disease. Persistent and transient thallium defects were present in one child with acute posterolateral myocardial infarction; obstruction of two coronary vessels supplying the defect zones was confirmed by contrast angiography. After 8 months of treatment a follow-up nuclear scan showed marked reduction in the size of the defect and almost complete abolishment of the ischemic reaction. Thus tomographic thallium-201 perfusion scintigraphy in conjunction with vasodilation stress is useful to assess myocardial perfusion in children with Kawasaki disease and demonstrates marked improvement in regional perfusion after adequate medical therapy.

  12. Image registration and analysis for quantitative myocardial perfusion: application to dynamic circular cardiac CT

    Science.gov (United States)

    Isola, A. A.; Schmitt, H.; van Stevendaal, U.; Begemann, P. G.; Coulon, P.; Boussel, L.; Grass, M.

    2011-09-01

    Large area detector computed tomography systems with fast rotating gantries enable volumetric dynamic cardiac perfusion studies. Prospectively, ECG-triggered acquisitions limit the data acquisition to a predefined cardiac phase and thereby reduce x-ray dose and limit motion artefacts. Even in the case of highly accurate prospective triggering and stable heart rate, spatial misalignment of the cardiac volumes acquired and reconstructed per cardiac cycle may occur due to small motion pattern variations from cycle to cycle. These misalignments reduce the accuracy of the quantitative analysis of myocardial perfusion parameters on a per voxel basis. An image-based solution to this problem is elastic 3D image registration of dynamic volume sequences with variable contrast, as it is introduced in this contribution. After circular cone-beam CT reconstruction of cardiac volumes covering large areas of the myocardial tissue, the complete series is aligned with respect to a chosen reference volume. The results of the registration process and the perfusion analysis with and without registration are evaluated quantitatively in this paper. The spatial alignment leads to improved quantification of myocardial perfusion for three different pig data sets.

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

    Science.gov (United States)

    Goodman, S; Rubler, S; Bryk, H; Sklar, B; Glasser, L

    1989-04-01

    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.

  14. Quantitative three-dimensional evaluation of myocardial perfusion during regadenoson stress using multidetector computed tomography.

    Science.gov (United States)

    Mor-Avi, Victor; Lodato, Joseph A; Kachenoura, Nadjia; Chandra, Sonal; Freed, Benjamin H; Newby, Barbara; Lang, Roberto M; Patel, Amit R

    2012-01-01

    The ability of multidetector computed tomography (MDCT) to detect stress-induced myocardial perfusion abnormalities is of great clinical interest as a potential tool for the combined evaluation of coronary stenosis and its hemodynamic significance. We tested the hypothesis that quantitative 3-dimensional (3D) analysis of myocardial perfusion from MDCT images obtained during regadenoson stress would more accurately detect the presence of significant coronary artery disease (CAD) than identical analysis when performed on resting MDCT images. We prospectively studied 50 consecutive patients referred for CT coronary angiography (CTCA) who agreed to undergo additional imaging with regadenoson (0.4 mg; Astellas). Images were acquired using prospective gating (256-channel; Philips). Custom analysis software was used to define 3D myocardial segments, and calculate for each segment an index of severity and extent of perfusion abnormality, Qh, which was compared with perfusion defects predicted by the presence and severity of coronary stenosis on CTCA. Three patients were excluded because of image artifacts. In the remaining 47 patients, CTCA depicted stenosis more than 50% in 23 patients in 37 of 141 coronary arteries. In segments supplied by the obstructed arteries, myocardial attenuation was slightly reduced compared with normally perfused segments at rest (mean [SD], 91 [21] vs 93 [26] Hounsfield units, not significant) and, to a larger extent, at peak stress (102 [21] vs 112 [20] Hounsfield units, P regadenoson improved the diagnosis of CAD, as reflected by an increase in sensitivity (from 0.57 to 0.91) and improvement in accuracy (from 0.65 to 0.77). Quantitative 3D analysis of MDCT images allows objective detection of CAD, the accuracy of which is improved by regadenoson stress.

  15. Correlation of myocardial perfusion SPECT with invasive and computed tomography coronary angiogram.

    Science.gov (United States)

    Shelley, S; Indirani, M; Sathyamurthy, I; Subramanian, K; Priti, N; Harshad, K; Padma, D

    2012-01-01

    The consequences of atherosclerosis can be detected by multislice computed tomography (MSCT), invasive coronary angiogram (CAG) and the resultant myocardial ischaemia by myocardial perfusion single photon emission computed tomography (MPS). In this study an attempt is made to compare MSCT with MPS and also to compare the MSCT findings with that of invasive CAG in patients suspected to have coronary artery disease (CAD). A total of 99 patients suspected to have CAD underwent both MSCT and MPS with (99m)Tc sestamibi. The MSCT studies were classified as having no CAD, significant CAD (>50% diameter stenosis), and insignificant CAD (50% diameter stenosis). Multislice computed tomography correlated well in 46 (84%) with P value of 800). Myocardial perfusion single photon emission computed tomography was normal in 15 (27%) coronaries. Myocardial perfusion single photon emission computed tomography provides functional information of the anatomical lesions and MSCT provides anatomical information. Both are two different diagnostic modalities. The MSCT has high NPV in patients with less likelihood for CAD. When compared with CAG, the correlation with MSCT was good and is useful where the calcium score is low. Copyright © 2012 Cardiological Society of India. Published by Elsevier B.V. All rights reserved.

  16. Effects of aortic tortuosity on left ventricular diastolic parameters derived from gated myocardial perfusion single photon emission computed tomography in patients with normal myocardial perfusion.

    Science.gov (United States)

    Kurisu, Satoshi; Nitta, Kazuhiro; Sumimoto, Yoji; Ikenaga, Hiroki; Ishibashi, Ken; Fukuda, Yukihiro; Kihara, Yasuki

    2017-12-05

    Aortic tortuosity is often found on chest radiograph, especially in aged patients. We tested the hypothesis that aortic tortuosity was associated with LV diastolic parameters derived from gated SPECT in patients with normal myocardial perfusion. One-hundred and twenty-two patients with preserved LV ejection fraction and normal myocardial perfusion were enrolled. Descending aortic deviation was defined as the horizontal distance from the left line of the aortic knob to the most prominent left line of the descending aorta. This parameter was measured for the quantitative assessment of aortic tortuosity. Peak filling rate (PFR) and one-third mean filling rate (1/3 MFR) were obtained from redistribution images as LV diastolic parameters. Descending aortic deviation ranged from 0 to 22 mm with a mean distance of 4.5 ± 6.3 mm. Descending aortic deviation was significantly correlated with age (r = 0.38, p < 0.001) and estimated glomerular filtration rate (eGFR) (r = - 0.21, p = 0.02). Multivariate linear regression analysis revealed that eGFR (β = 0.23, p = 0.02) and descending aortic deviation (β = - 0.23, p = 0.01) were significantly associated with PFR, and that only descending aortic deviation (β = - 0.21, p = 0.03) was significantly associated with 1/3 MFR. Our data suggest that aortic tortuosity is associated with LV diastolic parameters derived from gated SPECT in patients with normal myocardial perfusion.

  17. A new clinical tool for the quantification of myocardial CT perfusion imaging in patients with suspected Ischemic Heart Disease

    Energy Technology Data Exchange (ETDEWEB)

    Ruiz Muñoz, A.; Dux-Santoy Hurtado, L.; Rodriguez Palomares, J.L.; Piella Fenoy, G.

    2016-07-01

    In the clinical practice, the evaluation of myocardial perfusion by using Computed Tomography (CT) Imaging is usually performed visually or semi-quantitatively. The scarcity of quantitative perfusion data not always allows a proper diagnose of patients which are suspected of suffering from some diseases, such as Ischemic Heart Disease (IHD). In this work, a clinical tool for the automatic quantification of myocardial perfusion in patients with suspected IHD is proposed. Myocardial perfusion is assessed based on a combined diagnosis protocol (CT/CTP protocol) which involves the acquisition of two contrastenhanced CT images, one obtained at rest and another acquired under pharmacological stress. The clinical tool allows the automatic quantification of perfusion in different myocardial segments defined according to the 16-AHA-segmentation model of the left ventricle, by providing the mean of Hounsfield Units in those regions. Based on this analysis, the clinicians can compare the values at baseline and at hyperemia, and they can better determine hypoperfusion defects in patients with IHD. The validation of the clinical tool was performed by comparing automatic and manual perfusion measurements of 10 patients with suspected IHD who were previously assessed with Single Photon Emission Computed Tomography (SPECT) for perfusion analysis. A strong linear correlation was found between the automatic and manual results. Afterwards, perfusion defects obtained from CT/CTP protocol were compared to perfusion defects from SPECT, to assess the applicability of this clinical tool for the diagnosis of IHD. (Author)

  18. Exercise Tl-201 myocardial scintigraphy and coronary blood flow velocity in patients with hypertrophic cardiomyopathy

    Energy Technology Data Exchange (ETDEWEB)

    Sugihara, Hiroki; Umamoto, Ikuo; Harada, Yoshiaki (Kyoto Prefectural Univ. of Medicine (Japan)) (and others)

    1992-03-01

    In 22 patients with hypertrophic cardiomyopathy not associated with coronary stenosis, findings of exercise Tl-201 myocardial scintigraphy were reviewed in relation to coronary blood flow velocity. Blood flow velocity of the left antero-inferior segment was recorded by using a Doppler catheter. From time velocity integration in systolic and diastolic phases, both % systolic fraction (%SF) and %diastolic 1st third fraction (%d1F) were obtained. A decreased perfusion was visually assessed on exercise Tl-201 myocardial images. In addition, transient dilation of the left ventricular cavity was quantitatively assessed by expressing it as a transient dilation index (TDI) for subendocardial ischemia. Coronary blood flow velocity was characterized by a decrease in both %SF and %d1F and negative systolic flow. Both %SF and %d1F were inversely correlated with TDI. Coronary negative systolic flow was frequently associated with a decreased perfusion. These results suggest factors such as left ventricular relaxation impairment, other than coronary small vessel lesions, may also be involved in the occurrence of myocardial ischemia in hypertrophic cardiomyopathy. (N.K.).

  19. Estimate of myocardial salvage in late presentation acute myocardial infarction by comparing functional and perfusion abnormalities in predischarge gated SPECT

    Energy Technology Data Exchange (ETDEWEB)

    Sotgia, Barbara; Sciagra, Roberto; Pupi, Alberto [University of Florence, Nuclear Medicine Unit, Department of Clinical Physiopathology, Florence (Italy); Parodi, Guido; Antoniucci, David [Careggi Hospital, Division of Cardiology, Florence (Italy); Kastrati, Adnan; Schoemig, Albert [Technische Universitaet, Deutsches Herzzentrum, Munich (Germany)

    2008-05-15

    We hypothesized that, because of persistent stunning, the extent of post-treatment functional abnormalities detected using gated single-photon emission computed tomography (SPECT) could be representative of the initial risk area in acute myocardial infarction (AMI) treated by reperfusion therapy. In 48 AMI patients, we acquired two {sup 99m}Tc-sestamibi gated SPECT studies (at admission with tracer injection before treatment and at discharge 5 to 10 days later). We assessed the myocardial salvage defined by the admission minus predischarge summed rest score, and we compared it with the value obtained by subtracting the extent of perfusion defect from the extent of wall motion or wall thickening abnormalities in predischarge gated SPECT. Myocardial salvage was expressed as salvage index (salvaged myocardium divided by initial risk area). There was a good correlation between summed rest score salvage index and wall motion (Spearman's {rho} = 0.754, p < 0.0001) or wall thickening salvage index (Spearman's {rho} = 0.798, p < 0.0001). The wall thickening salvage index was able to classify correctly the patients that had a summed rest score salvage index {>=} 0.10 with 73% sensitivity, 88% specificity, and 83% accuracy. The wall motion salvage index was highly sensitive (91%) but poorly specific (13%, p < 0.002 vs wall thickening salvage index) and less accurate (69%, p < 0.05 vs wall thickening salvage index). {sup 99m}Tc-sestamibi gated SPECT allows assessing myocardial salvage using only post-treatment data. The salvage index derived using wall thickening as surrogate of admission perfusion defect correlates well with the salvage index measured by comparing pre- and post-treatment perfusion defects. (orig.)

  20. Myocardial perfusion in patients with non-ischaemic systolic heart failure and type 2 diabetes

    DEFF Research Database (Denmark)

    Byrne, Christina; Hasbak, Philip; Kjaer, Andreas

    2017-01-01

    Both patients with non-ischaemic systolic heart failure and patients with type 2 diabetes (T2DM) often have reduced myocardial blood flow without significant coronary atherosclerosis. However, the mechanisms are not fully understood. The aim of this study was to investigate whether perfusion...... is reduced additionally when the 2 are combined. In a cross-sectional study, we scanned patients with non-ischaemic systolic heart failure with and without T2DM using Rubidium-82 positron emission tomography/computed tomography at rest and adenosine-induced stress, thereby obtaining the myocardial flow...... reserve (myocardial flow reserve (MFR) = stress flow/rest flow) as a measure of the myocardial vasomotor function; 28 patients with T2DM and 123 without T2DM were included. All patients received heart failure treatment according to guidelines. Multiple regression analysis was performed to assess...

  1. Myocardial perfusion analysis in cardiac computed tomography angiographic images at rest.

    Science.gov (United States)

    Xiong, Guanglei; Kola, Deeksha; Heo, Ran; Elmore, Kimberly; Cho, Iksung; Min, James K

    2015-08-01

    Cardiac computed tomography angiography (CTA) is a non-invasive method for anatomic evaluation of coronary artery stenoses. However, CTA is prone to artifacts that reduce the diagnostic accuracy to identify stenoses. Further, CTA does not allow for determination of the physiologic significance of the visualized stenoses. In this paper, we propose a new system to determine the physiologic manifestation of coronary stenoses by assessment of myocardial perfusion from typically acquired CTA images at rest. As a first step, we develop an automated segmentation method to delineate the left ventricle. Both endocardium and epicardium are compactly modeled with subdivision surfaces and coupled by explicit thickness representation. After initialization with five anatomical landmarks, the model is adapted to a target image by deformation increments including control vertex displacements and thickness variations guided by trained AdaBoost classifiers, and regularized by a prior of deformation increments from principal component analysis (PCA). The evaluation using a 5-fold cross-validation demonstrates the overall segmentation error to be 1.00 ± 0.39 mm for endocardium and 1.06 ± 0.43 mm for epicardium, with a boundary contour alignment error of 2.79 ± 0.52. Based on our LV model, two types of myocardial perfusion analyzes have been performed. One is a perfusion network analysis, which explores the correlation (as network edges) pattern of perfusion between all pairs of myocardial segments (as network nodes) defined in AHA 17-segment model. We find perfusion network display different patterns in the normal and disease groups, as divided by whether significant coronary stenosis is present in quantitative coronary angiography (QCA). The other analysis is a clinical validation assessment of the ability of the developed algorithm to predict whether a patient has significant coronary stenosis when referenced to an invasive QCA ground truth standard. By training three machine

  2. Quantitative Myocardial Perfusion with Dynamic Contrast-Enhanced Imaging in MRI and CT : Theoretical Models and Current Implementation

    NARCIS (Netherlands)

    Pelgrim, G J; Handayani, A; Dijkstra, H; Prakken, N H J; Slart, R H J A; Oudkerk, M; Van Ooijen, P M A; Vliegenthart, R; Sijens, P E

    2016-01-01

    Technological advances in magnetic resonance imaging (MRI) and computed tomography (CT), including higher spatial and temporal resolution, have made the prospect of performing absolute myocardial perfusion quantification possible, previously only achievable with positron emission tomography (PET).

  3. Exercise Training Protects Against Acute Myocardial Infarction via Improving Myocardial Energy Metabolism and Mitochondrial Biogenesis

    Directory of Open Access Journals (Sweden)

    Lichan Tao

    2015-08-01

    Full Text Available Background/Aims: Acute myocardial infarction (AMI represents a major cause of morbidity and mortality worldwide. Exercise has been proved to reduce myocardial ischemia-reperfusion (I/R injury However it remains unclear whether, and (if so how, exercise could protect against AMI. Methods: Mice were trained using a 3-week swimming protocol, and then subjected to left coronary artery (LCA ligation, and finally sacrificed 24 h after AMI. Myocardial infarct size was examined with triphenyltetrazolium chloride staining. Cardiac apoptosis was determined by TUNEL staining. Mitochondria density was checked by Mito-Tracker immunofluorescent staining. Quantitative reverse transcription polymerase chain reactions and Western blotting were used to determine genes related to apoptosis, autophagy and myocardial energy metabolism. Results: Exercise training reduces myocardial infarct size and abolishes AMI-induced autophagy and apoptosis. AMI leads to a shift from fatty acid to glucose metabolism in the myocardium with a downregulation of PPAR-α and PPAR-γ. Also, AMI induces an adaptive increase of mitochondrial DNA replication and transcription in the acute phase of MI, accompanied by an activation of PGC-1α signaling. Exercise abolishes the derangement of myocardial glucose and lipid metabolism and further enhances the adaptive increase of mitochondrial biogenesis. Conclusion: Exercise training protects against AMI-induced acute cardiac injury through improving myocardial energy metabolism and enhancing the early adaptive change of mitochondrial biogenesis.

  4. Exercise Training Protects Against Acute Myocardial Infarction via Improving Myocardial Energy Metabolism and Mitochondrial Biogenesis.

    Science.gov (United States)

    Tao, Lichan; Bei, Yihua; Lin, Shenghui; Zhang, Haifeng; Zhou, Yanli; Jiang, Jingfa; Chen, Ping; Shen, Shutong; Xiao, Junjie; Li, Xinli

    2015-01-01

    Acute myocardial infarction (AMI) represents a major cause of morbidity and mortality worldwide. Exercise has been proved to reduce myocardial ischemia-reperfusion (I/R) injury However it remains unclear whether, and (if so) how, exercise could protect against AMI. Mice were trained using a 3-week swimming protocol, and then subjected to left coronary artery (LCA) ligation, and finally sacrificed 24 h after AMI. Myocardial infarct size was examined with triphenyltetrazolium chloride staining. Cardiac apoptosis was determined by TUNEL staining. Mitochondria density was checked by Mito-Tracker immunofluorescent staining. Quantitative reverse transcription polymerase chain reactions and Western blotting were used to determine genes related to apoptosis, autophagy and myocardial energy metabolism. Exercise training reduces myocardial infarct size and abolishes AMI-induced autophagy and apoptosis. AMI leads to a shift from fatty acid to glucose metabolism in the myocardium with a downregulation of PPAR-α and PPAR-γ. Also, AMI induces an adaptive increase of mitochondrial DNA replication and transcription in the acute phase of MI, accompanied by an activation of PGC-1α signaling. Exercise abolishes the derangement of myocardial glucose and lipid metabolism and further enhances the adaptive increase of mitochondrial biogenesis. Exercise training protects against AMI-induced acute cardiac injury through improving myocardial energy metabolism and enhancing the early adaptive change of mitochondrial biogenesis. © 2015 S. Karger AG, Basel.

  5. A randomized, multicenter, multivendor study of myocardial perfusion imaging with regadenoson CT perfusion vs single photon emission CT.

    Science.gov (United States)

    Cury, Ricardo C; Kitt, Therese M; Feaheny, Kathleen; Blankstein, Ron; Ghoshhajra, Brian B; Budoff, Matthew J; Leipsic, Jonathon; Min, James K; Akin, Jamie; George, Richard T

    2015-01-01

    Myocardial CT perfusion (CTP) is a promising tool for the detection of myocardial ischemia. We hypothesize that regadenoson CTP is noninferior to regadenoson single photon emission CT (SPECT) for detecting or excluding myocardial ischemia. Patients (men ≥ 45 years; women ≥ 50 years) with known or suspected coronary artery disease (n = 124) were randomized to 1 of 2 diagnostic sequences: rest and regadenoson SPECT on day 1, then regadenoson CTP and rest CTP (and coronary CT angiography [CTA]) (CTA; same acquisition) on day 2 or regadenoson CTP and rest CTP (and CTA) on Day 1, then rest and regadenoson SPECT on day 2. Scanning platforms included 64-, 128-, 256-, and 320-slice systems. The primary analysis examined the agreement rate between CTP and SPECT for detecting or excluding reversible ischemia in ≥ 2 myocardial segments as assessed by independent, blinded readers. Complete and interpretable CTP and SPECT scans were obtained for 110 patients. Regadenoson CTP was noninferior to SPECT for detecting or excluding reversible ischemia with an agreement rate of 0.87 (95% confidence interval [CI], 0.77-0.97) and sensitivity and specificity of 0.90 (95% CI, 0.71-1.00) and 0.84 (95% CI, 0.77-0.91), respectively. The agreement rate for detecting or excluding ≥ 1 fixed defects by regadenoson CTP and SPECT was 0.86 (95% CI, 0.74-0.98). With SPECT as the reference standard, the diagnostic accuracies for detecting or excluding ischemia by regadenoson CTP and CTA alone were 0.85 (95% CI, 0.78-0.91) and 0.69 (95% CI, 0.60-0.77), respectively. This study establishes the noninferiority of regadenoson CTP to SPECT for detecting or excluding myocardial ischemia. Copyright © 2015 The Authors. Published by Elsevier Inc. All rights reserved.

  6. Caffeine intake inverts the effect of adenosine on myocardial perfusion during stress as measured by T1 mapping

    OpenAIRE

    Kuijpers, Dirkjan; Prakken, Niek H.; Vliegenthart, Rozemarijn; van Dijkman, Paul R. M.; Van der Harst, Pim; Oudkerk, Matthijs

    2016-01-01

    Caffeine intake before adenosine stress myocardial perfusion imaging may cause false negative findings. We hypothesized that the antagonistic effect of caffeine can be measured by T1 relaxation times in rest and adenosine stress cardiac magnetic resonance imaging (CMR), as T1 mapping techniques are sensitive to changes in myocardial blood volume. We prospectively analyzed 105 consecutive patients with adenosine stress perfusion CMR on a 1.5-T MRI system. Rest and stress T1 mapping was perform...

  7. Comparison of Myocardial Contrast Echocardiography Versus Rest Sestamibi Myocardial Perfusion Imaging in the Early Diagnosis of Acute Coronary Syndrome

    Science.gov (United States)

    Kang, Soo-Jin; Song, Jong-Min; Song, Jae-Kwan; Park, Seong-Wook; Park, Seung-Jung

    2010-01-01

    Background It remains unclear whether myocardial contrast echocardiography (MCE) is as accurate as myocardial perfusion imaging with technetium-99m sestamibi (MPI) for the diagnosis of acute coronary syndrome (ACS). We sought to directly compare the diagnostic accuracy of MCE with resting MPI in a head-to-head fashion. Methods We prospectively enrolled 98 consecutive patients (mean age; 59±9 years, 68 males) who presented to the emergency department with chest pain suggestive of acute myocardial ischemia. Early MCE was performed by using continuous infusion of perfluorocarbon-exposed sonicated dextrose albumin (PESDA) during intermittent power Doppler harmonic imaging. Myocardial perfusion defects observed in at least one coronary territory were considered positive. Sestamibi was injected immediately after MCE and MPI was obtained within 6 hours of tracer injection. Results ACS was confirmed in 67 patients. There were 32 patients with acute myocardial infarction (AMI) and 35 patients with unstable angina requiring urgent revascularization. The sensitivities of MCE and MPI for the diagnosis of ACS were 72% and 61%, respectively, which were significantly higher than those of ST segment change (24%, p<0.001 vs. MCE and vs. MPI) and troponin I (27%, p<0.001 vs. MCE and vs. MPI), with similar specificities of 90% to 100%. On a receiveroperating characteristics curve demonstrating diagnostic accuracy for ACS, the area under the curve of MCE was significantly larger than that of MPI (0.86 vs. 0.77, respectively; p=0.019). Conclusion MCE and MPI overcome the low sensitivity of routine triage tests for detecting ACS, and MCE is more accurate than MPI for the diagnosis of ACS in the emergency department. PMID:20706568

  8. Effect of long-term cholesterol-lowering treatment with HMG-CoA reductase inhibitor (Simvastatin) of myocardial perfusion evaluated by thallium-201 single photon emission computed tomography

    Energy Technology Data Exchange (ETDEWEB)

    Hosokawa, Ryohei; Nohara, Ryuji; Linxue, Li; Sasayama, Shigetake [Kyoto Univ. (Japan). Graduate School of Medicine; Tamaki, Shunichi; Hashimoto, Tetsuo; Tanaka, Masahiro; Miki, Shinji

    2000-03-01

    Fifteen patients with either angina pectoris or old myocardial infarction, who had positive {sup 201}Tl single photon emission computed tomography (SPECT) imaging and coronary sclerosis of more than 50%, were treated with an HMG-CoA reductase inhibitor (simvastatin) for more than 1 year. They were compared with an untreated control group (n=25). Total cholesterol decreased 22% and high-density lipoprotein (HDL) increased 9% with simvastatin; both changes were significantly different from those in controls. Long-term simvastatin induced improvement of myocardial perfusion on {sup 201}Tl SPECT images both during exercise and at rest, which was also significantly different from controls. In addition, the improvement of myocardial perfusion on {sup 201}Tl SPECT images was clearly related to the improvements in cholesterol values, especially nonHDL cholesterol. Thus, the greater the decrease in nonHDL cholesterol, the greater the improvement in myocardial perfusion at rest or during exercise with long-term treatment using an HMG-CoA reductase inhibitor. These findings indicate that the improvements in cholesterol values caused by HMG-CoA reductase inhibitor therapy are related to improvements of myocardial perfusion seen on {sup 201}Tl SPECT images. (author)

  9. Detection of serial changes in absolute myocardial perfusion with 82Rb PET.

    Science.gov (United States)

    deKemp, R A; Ruddy, T D; Hewitt, T; Dalipaj, M M; Beanlands, R S

    2000-08-01

    Serial changes in myocardial perfusion may represent an important marker of disease progression or regression or the effects of therapy for patients with coronary artery disease (CAD). Quantitative methods have not been developed for the assessment of serial changes in perfusion. The objective of this study was to use receiver operator characteristic (ROC) analysis to determine the sensitivity and specificity of direct paired comparisons (DPCs) to detect changes in absolute myocardial perfusion measured with 82Rb PET. Repeated dynamic 82Rb PET scans were obtained on 8 dogs at rest and during hyperemia induced with dobutamine (n = 4) or atrial pacing (n = 4). Radiolabeled microspheres were used to verify perfusion changes. Polar maps of absolute 82Rb retention and associated SD were estimated from the dynamic images. Paired comparisons were then performed using a t test on each of the 532 polar map sectors. Rest-rest and stress-stress differences were used to assess specificity and reproducibility, and stress-rest differences were used to assess sensitivity. 82Rb retention differences of 20% over baseline were detected with 85%-90% sensitivity and specificity, using the optimal DPC probability value and image smoothness. The average 82Rb retention differences correlated well with microspheres (r = 0.74; P = 0.001). Reproducibility of the mean retention values was 4.7% +/- 2.1%. As reproducibility varies, the DPC probability value can be adjusted to maintain specificity. These ROC results are directly applicable to other image modalities that produce measurements with similar SEs (3.7% +/- 0.9%). The developed method of DPCs is sensitive and specific for the detection of changes in absolute myocardial perfusion measured with 82Rb PET.

  10. Three dimensional first-pass myocardial perfusion imaging at 3T: feasibility study

    Directory of Open Access Journals (Sweden)

    Pohost Gerald M

    2008-12-01

    Full Text Available Abstract Background In patients with ischemic heart disease, accurate assessment of the extent of myocardial perfusion deficit may be important in predicting prognosis of clinical cardiac outcomes. The aim of this study was to compare the ability of three dimensional (3D and of two dimensional (2D multi-slice myocardial perfusion imaging (MPI using cardiovascular magnetic resonance (CMR in determining the size of defects, and to demonstrate the feasibility of 3D MPI in healthy volunteers at 3 Tesla. Methods A heart phantom was used to compare the accuracy of 3D and 2D multi-slice MPI in estimating the volume fraction of seven rubber insets which simulated transmural myocardial perfusion defects. Three sets of cross-sectional planes were acquired for 2D multi-slice imaging, where each set was shifted along the partition encoding direction by ± 10 mm. 3D first-pass contrast-enhanced (0.1 mmol/kg Gd-DTPA MPI was performed in three volunteers with sensitivity encoding for six-fold acceleration. The upslope of the myocardial time-intensity-curve and peak SNR/CNR values were calculated. Results Mean/standard deviation of errors in estimating the volume fraction across the seven defects were -0.44/1.49%, 2.23/2.97%, and 2.59/3.18% in 3D, 2D 4-slice, and 2D 3-slice imaging, respectively. 3D MPI performed in healthy volunteers produced excellent quality images with whole left ventricular (LV coverage. Peak SNR/CNR was 57.6 ± 22.0/37.5 ± 19.7 over all segments in the first eight slices. Conclusion 3D performed better than 2D multi-slice MPI in estimating the size of perfusion defects in phantoms. Highly accelerated 3D MPI at 3T was feasible in volunteers, allowing whole LV coverage with excellent image quality and high SNR/CNR.

  11. Optimization and comparison of simultaneous and separate acquisition protocols for dual isotope myocardial perfusion SPECT

    OpenAIRE

    Ghaly, Michael; Links, Jonathan M.; Frey, Eric C.

    2015-01-01

    Dual-isotope simultaneous-acquisition (DISA) rest-stress myocardial perfusion SPECT (MPS) protocols offer a number of advantages over separate acquisition. However, crosstalk contamination due to scatter in the patient and interactions in the collimator degrade image quality. Compensation can reduce the effects of crosstalk, but does not entirely eliminate image degradations. Optimizing acquisition parameters could further reduce the impact of crosstalk. In this paper we investigate the optim...

  12. Quantification of myocardial perfusion using free-breathing MRI and prospective slice tracking

    DEFF Research Database (Denmark)

    Pedersen, Henrik; Kelle, Sebastian; Ringgaard, Steffen

    2009-01-01

    Quantification of myocardial perfusion using first-pass magnetic resonance imaging (MRI) is hampered by respiratory motion of the heart. Prospective slice tracking (PST) potentially overcomes this problem, and may provide an attractive alternative or supplement to current breath-hold techniques. ...... on this field strength constituted a major source of error and needs further improvement to increase the accuracy and robustness of the method....

  13. Myocardial stress perfusion magnetic resonance: initial experience in a pediatric and young adult population using regadenoson.

    Science.gov (United States)

    Noel, Cory V; Krishnamurthy, Ramkumar; Moffett, Brady; Krishnamurthy, Rajesh

    2017-03-01

    Dipyridamole and adenosine are traditional pharmacological stressors for myocardial perfusion. Regadenoson, a selective adenosine A2A agonist, has a lower side effect profile with lower incidence of bronchospasm and bradycardia. There is a growing need for myocardial perfusion assessment within pediatrics. There is no report on the utility of regadenoson as a stress agent in children. To observe the safety and feasibility of regadenoson as a pharmacologic stressor for perfusion cardiac MR in a pilot cohort of pediatric patients weighing more than 40 kg who have congenital heart disease and pediatric acquired heart disease. We reviewed our initial experience with regadenoson stress cardiac MR in 31 pediatric patients 15.8 ± 1.7 years (range 12-22 years) with congenital heart disease and acquired heart disease. Mean patient weight was 60 ± 15 kg (range of 40-93 kg). All patients underwent cardiac MR because of concern for ischemia. The cohort included a heterogeneous group of patients at a pediatric institution with potential risk for ischemia. Subjects' heart rate and blood pressure were monitored and pharmacologic stress was induced by injection of 400 mcg of regadenoson. We evaluated their hemodynamic response and adverse effects using changes in vital signs and onset of symptoms. A pediatric cardiologist and radiologist qualitatively assessed myocardial perfusion and viability images. One child was unable to complete the stress perfusion portion of the examination, but did complete the remaining portion of the CMR. Resting heart rate was 72 ± 14 beats per minute (bpm) and rose to peak of 124 ± 17 bpm (95 ± 50% increase, P regadenoson. Image quality was considered good or diagnostic in all cases. Three patients had irreversible perfusion defects. Four patients had reversible perfusion defects. Nine of the patients underwent cardiac catheterization with angiography and the findings showed excellent agreement. Regadenoson might be a

  14. Myocardial stress perfusion magnetic resonance: initial experience in a pediatric and young adult population using regadenoson

    Energy Technology Data Exchange (ETDEWEB)

    Noel, Cory V. [Baylor College of Medicine, Department of Pediatric Cardiology, Houston, TX (United States); Texas Children' s Hospital, Department of Pediatric Cardiology, Houston, TX (United States); Krishnamurthy, Ramkumar; Krishnamurthy, Rajesh [Texas Children' s Hospital, Department of Radiology, Houston, TX (United States); Moffett, Brady [Texas Children' s Hospital, Department of Pharmacology, Houston, TX (United States)

    2017-03-15

    Dipyridamole and adenosine are traditional pharmacological stressors for myocardial perfusion. Regadenoson, a selective adenosine A2A agonist, has a lower side effect profile with lower incidence of bronchospasm and bradycardia. There is a growing need for myocardial perfusion assessment within pediatrics. There is no report on the utility of regadenoson as a stress agent in children. To observe the safety and feasibility of regadenoson as a pharmacologic stressor for perfusion cardiac MR in a pilot cohort of pediatric patients weighing more than 40 kg who have congenital heart disease and pediatric acquired heart disease. We reviewed our initial experience with regadenoson stress cardiac MR in 31 pediatric patients 15.8 ± 1.7 years (range 12-22 years) with congenital heart disease and acquired heart disease. Mean patient weight was 60 ± 15 kg (range of 40-93 kg). All patients underwent cardiac MR because of concern for ischemia. The cohort included a heterogeneous group of patients at a pediatric institution with potential risk for ischemia. Subjects' heart rate and blood pressure were monitored and pharmacologic stress was induced by injection of 400 mcg of regadenoson. We evaluated their hemodynamic response and adverse effects using changes in vital signs and onset of symptoms. A pediatric cardiologist and radiologist qualitatively assessed myocardial perfusion and viability images. One child was unable to complete the stress perfusion portion of the examination, but did complete the remaining portion of the CMR. Resting heart rate was 72 ± 14 beats per minute (bpm) and rose to peak of 124 ± 17 bpm (95 ± 50% increase, P < 0.005) with regadenoson. Image quality was considered good or diagnostic in all cases. Three patients had irreversible perfusion defects. Four patients had reversible perfusion defects. Nine of the patients underwent cardiac catheterization with angiography and the findings showed excellent agreement. Regadenoson might be a safe and

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

    Energy Technology Data Exchange (ETDEWEB)

    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.

  16. Myocardial perfusion in type 2 diabetes with left ventricular hypertrophy: normalisation by acute angiotensin-converting enzyme inhibition

    Energy Technology Data Exchange (ETDEWEB)

    Hesse, Birger; Meyer, Christian; Hove, Jens D.; Holm, Soeren; Kofoed, Klaus F. [Department of Clinical Physiology and Nuclear Medicine, KF 4011, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen (Denmark); Nielsen, Flemming S.; Sato, Asako; Parving, Hans-Henrik [Steno Diabetes Center, Gentofte (Denmark); Bang, Lia E.; Svendsen, Tage L. [Department of Internal Medicine, Naestved County Hospital (Denmark); Opie, Lionel H. [Department of Medicine, Cape Heart Center, University of Cape Town (South Africa)

    2004-03-01

    The purpose of this study was to assess whether acute angiotensin-converting enzyme (ACE) inhibition would improve myocardial perfusion and perfusion reserve in a subpopulation of normotensive patients with diabetes and left ventricular hypertrophy (LVH), both independent risk factors of coronary disease. Using positron emission tomography (PET), we investigated the response of regional myocardial perfusion to acute ACE inhibition with i.v. infusion of perindoprilat (vs saline infusion as control, minimum interval 3 days) in 12 diabetic patients with LVH. Myocardial perfusion was quantified with PET using nitrogen-13 ammonia infused at rest and during dipyridamole hyperaemia. Twelve healthy control subjects were included in the study, five of whom were also studied with perindoprilat. Mean blood pressure in normo-albuminuric, asymptomatic patients was 123{+-}7/65{+-}9 mmHg. Compared with controls, maximal perfusion was reduced in patients (1.8{+-}0.6 vs 2.5{+-}1.0 ml min{sup -1} g{sup -1}; P<0.05), and perfusion reserve was also lower, at borderline significance (2.7{+-}1.0 vs 3.6{+-}1.3; P=0.059). During perindoprilat infusion, myocardial perfusion reserve in patients increased to 3.9{+-}0.9 (P<0.001) due to normalisation of maximal perfusion (2.3{+-}0.5 ml min{sup -1} g{sup -1}, P<0.01). In the five control subjects both resting and hyperaemic perfusion remained unchanged during perindoprilat infusion. It is concluded that acute ACE inhibition with perindoprilat improves maximal achieved myocardial perfusion in non-hypertensive patients with diabetes and LVH. (orig.)

  17. The Effect of Milk, Water and Lemon Juice on Various Subdiaphragmatic Activity-Related Artifacts in Myocardial Perfusion Imaging

    OpenAIRE

    Malek; Hedayati; Yaghoobi; Bitarafan-Rajabi; Firoozabadi; Rastgou

    2015-01-01

    Background Subdiaphragmatic activity can produce subdiaphragmatic-related artifacts, which can degrade the quality of myocardial perfusion imaging (MPI). Objectives We examined the impact of drinking milk, water, and lemon juice on different subdiaphragmatic-related artifacts by using 99mTc-sestamibi myocardial single-photon emission computed tomography (SPECT) in order to determine a feasible method for improving the image qualit...

  18. Effect of improving spatial or temporal resolution on image quality and quantitative perfusion assessment with k-t SENSE acceleration in first-pass CMR myocardial perfusion imaging.

    Science.gov (United States)

    Maredia, Neil; Radjenovic, Aleksandra; Kozerke, Sebastian; Larghat, Abdulghani; Greenwood, John P; Plein, Sven

    2010-12-01

    k-t Sensitivity-encoded (k-t SENSE) acceleration has been used to improve spatial resolution, temporal resolution, and slice coverage in first-pass cardiac magnetic resonance myocardial perfusion imaging. This study compares the effect of investing the speed-up afforded by k-t SENSE acceleration in spatial or temporal resolution. Ten healthy volunteers underwent adenosine stress myocardial perfusion imaging using four saturation-recovery gradient echo perfusion sequences: a reference sequence accelerated by sensitivity encoding (SENSE), and three k-t SENSE-accelerated sequences with higher spatial resolution ("k-t High"), shorter acquisition window ("k-t Fast"), or a shared increase in both parameters ("k-t Hybrid") relative to the reference. Dark-rim artifacts and image quality were analyzed. Semiquantitative myocardial perfusion reserve index (MPRI) and Fermi-derived quantitative MPR were also calculated. The k-t Hybrid sequence produced highest image quality scores at rest (P = 0.015). Rim artifact thickness and extent were lowest using k-t High and k-t Hybrid sequences (P spatial resolution by k-t SENSE acceleration produces the greatest reduction in dark rim artifact. There is good agreement between k-t SENSE and standard acquisition methods for semiquantitative and fully quantitative myocardial perfusion analysis. Copyright © 2010 Wiley-Liss, Inc.

  19. Single photon emission computed tomography of technetium-99m tetrofosmin myocardial perfusion imaging in patients with systemic lupus erythematosus-A preliminary report

    Energy Technology Data Exchange (ETDEWEB)

    Lin, Jen-Jhy; Hsu, Hsiu-Bao; Sun, Shung-Shung; Kao, Chia-Hung [China Medical Coll., Taichung, Taiwan (China). Hospital; Wang, Jhi-Joung [Chi-Mei Medical Center, Tainan, Taiwan (China); Ho, Shung-Tai [National Defense Medical Center, Taipei, Taiwan (China). School of Medicine

    2003-01-01

    The purpose of this study was to evaluate the utility of single-photon emission computed tomography (SPECT) of technetium-99m tetrofosmin (Tc-99m TF) myocardial perfusion imaging to detect myocardial involvement in patients with systemic lupus erythematosus (SLE). Three groups of subjects-group 1: 25 SLE female patients with non-specific cardiac symptoms and signs, group 2: 25 female SLE patients without any cardiac symptoms and signs, and group 3: 25 female healthy controls-were evaluated by comparing rest and dipyridamole-stress Tc-99m TF myocardial perfusion SPECT. Tc-99m TF myocardial perfusion SPECT revealed perfusion defects in 88% and 40% of the cases in groups 1 and 2, respectively. However, no cases in group 3 demonstrated myocardial perfusion defects. Tc-99m TF myocardial perfusion SPECT is a useful noninvasive imaging modality to detect cardiac involvement in SLE patients with or without cardiac symptoms and signs. (author)

  20. Radiation-induced myocardial perfusion abnormalities in breast cancer patients following external beam radiation therapy

    Directory of Open Access Journals (Sweden)

    Mohammad Eftekhari

    2015-01-01

    Full Text Available Objective(s: Radiation therapy for breast cancer can induce myocardial capillary injury and increase cardiovascular morbidity and mortality. A prospective cohort was conducted to study the prevalence of myocardial perfusion abnormalities following radiation therapy of left-sided breast cancer patients as compared to those with right–sided cancer. Methods: To minimize potential confounding factors, only those patients with low 10-year risk of coronary artery disease (based on Framingham risk scoring were included. All patients were initially treated by modified radical mastectomy and then were managed by postoperative 3D Conformal Radiation Therapy (CRT to the surgical bed with an additional 1-cm margin, delivered by 46-50 Gy (in 2 Gy daily fractions over a 5-week course. The same dose-adjusted chemotherapy regimen (including anthracyclines, cyclophosphamide and taxol was given to all patients. Six months after radiation therapy, all patients underwent cardiac SPECT for the evaluation of myocardial perfusion. Results: A total of 71 patients with a mean age of 45.3±7.2 years [35 patients with leftsided breast cancer (exposed and 36 patients with right-sided cancer (controls] were enrolled. Dose-volume histogram (DVH [showing the percentage of the heart exposed to >50% of radiation] was significantly higher in patients with left-sided breast cancer. Visual interpretation detected perfusion abnormalities in 42.9% of cases and 16.7% of controls (P=0.02, Odds ratio=1.46. In semiquantitative segmental analysis, only apical (28.6% versus 8.3%, P=0.03 and anterolateral (17.1% versus 2.8%, P=0.049 walls showed significantly reduced myocardial perfusion in the exposed group. Summed Stress Score (SSS of>3 was observed in twelve cases (34.3%, while in five of the controls (13.9%,(Odds ratio=1.3. There was no significant difference between the groups regarding left ventricular ejection fraction. Conclusion: The risk of radiation induced myocardial

  1. [Comparison of low-dose dobutamine echocardiography and dual-isotope emission simultaneous myocardial perfusion acquisition for myocardial viability assessment].

    Science.gov (United States)

    Fang, Li-Gang; Chen, Li-Bo; Li, Fang; Zhu, Wen-Ling; Fang, Quan

    2007-04-01

    To compare the value of low-dose dobutamine echocardiography (LDDE) and dual-isotope emission simultaneous myocardial perfusion acquisition (technetium-99-m-tetrofosmin/fluorine 18-fluorodeoxy-glucose) single-photon emission computed tomography (DISA-SPECT) for myocardial viability assessment in patients with acute myocardial infarction (MI). LDDE and DISA-SPECT were performed in 44 patients within 5-10 days after onset of first acute MI and percutaneous coronary intervention was made thereafter. A 16-segment semi-quantitative scoring model was adopted for both techniques. Wall motion improvement at follow-up (3 months after acute MI) compared with baseline before dobutamine infusion derived from two dimensional images was used as golden criteria for myocardial viability. The sensitivity, specificity, diagnostic accuracy, positive and predictive values for identification of viable myocardium were 77%, 82%, 79%, 82% and 77%, respectively by LDDE and 85%, 62%, 74%, 71% and 79%, respectively by DISA. No difference was found between LDDE and DISA for identifying viable myocardium in hypokinetic segments (74.1% vs. 77.6%, P > 0.05) but less viable myocardium was detected by LDDE than DISA in akinetic segments (29% vs. 53%, P DISA compared to LDDE. Combined use of the two techniques could improve viable myocardium detection in patients with acute MI.

  2. Myocardial uptake of cocaine and effects of cocaine on myocardial substrate utilization and perfusion in hypertensive rats

    Energy Technology Data Exchange (ETDEWEB)

    Som, P.; Wang, G.J. (Brookhaven National Lab., Upton, NY (United States)); Oster, Z.H. (State Univ. of New York, Stony Brook, NY (United States)); Knapp, F.F. Jr. (Oak Ridge National Lab., TN (United States)); Yonekura, Y. (Kyoto Univ. (Japan). Faculty of Medicine); Fujibayashi, Y. (Kyoto Univ. (Japan). Hospital); Yamamoto, K. (Fukui Univ. (Japan). Medical School); Kubota, K. (Tohoku Univ., Sendai

    1992-01-01

    Cocaine abuse is a problem causing world-wide concern and the number of deaths following cocaine use is increasing. Cardiovascular complications following cocaine include severe tachyarrythmias, pulmonary edema, myocardial infarction, and acute renal failure, which are major problems confronting emergency facilities. While the studies of cocaine effects on the brain have been given the most attention, it is clear that the effects of cocaine on the cardiovascular system are of great importance, given the increasing number of reports on sudden death and myocardial infarctions in young adults related to cocaine use. The precise mechanisms of cardiotoxic actions of cocaine are unclear. We investigated the whole-body distribution of C-14-labeled cocaine to determine the cocaine-binding sites, including blocking experiments to determine the nature of regional binding sites, and differential response of the normal vs. diseased heart (hypertensive cardiomyopathy) in an animal model to mimic a potentially high risk population. We investigated the acute effects of cocaine on myocardial metabolism using two myocardial energy substrate analogs, fatty acid and glucose with comparison with regional perfusion.

  3. Myocardial uptake of cocaine and effects of cocaine on myocardial substrate utilization and perfusion in hypertensive rats

    Energy Technology Data Exchange (ETDEWEB)

    Som, P.; Wang, G.J. [Brookhaven National Lab., Upton, NY (United States); Oster, Z.H. [State Univ. of New York, Stony Brook, NY (United States); Knapp, F.F. Jr. [Oak Ridge National Lab., TN (United States); Yonekura, Y. [Kyoto Univ. (Japan). Faculty of Medicine; Fujibayashi, Y. [Kyoto Univ. (Japan). Hospital; Yamamoto, K. [Fukui Univ. (Japan). Medical School; Kubota, K. [Tohoku Univ., Sendai (Japan)

    1992-12-31

    Cocaine abuse is a problem causing world-wide concern and the number of deaths following cocaine use is increasing. Cardiovascular complications following cocaine include severe tachyarrythmias, pulmonary edema, myocardial infarction, and acute renal failure, which are major problems confronting emergency facilities. While the studies of cocaine effects on the brain have been given the most attention, it is clear that the effects of cocaine on the cardiovascular system are of great importance, given the increasing number of reports on sudden death and myocardial infarctions in young adults related to cocaine use. The precise mechanisms of cardiotoxic actions of cocaine are unclear. We investigated the whole-body distribution of C-14-labeled cocaine to determine the cocaine-binding sites, including blocking experiments to determine the nature of regional binding sites, and differential response of the normal vs. diseased heart (hypertensive cardiomyopathy) in an animal model to mimic a potentially high risk population. We investigated the acute effects of cocaine on myocardial metabolism using two myocardial energy substrate analogs, fatty acid and glucose with comparison with regional perfusion.

  4. Transmural myocardial perfusion gradients in relation to coronary artery stenoses severity assessed by cardiac multidetector computed tomography

    DEFF Research Database (Denmark)

    Linde, Jesper James; Kühl, Jørgen Tobias; Hove, Jens Dahlgaard

    2015-01-01

    = stress - PI/rest - PI), and the transmural perfusion ratio (TPR = subendocardium/subepicardium) were calculated. A coronary artery stenosis ≥50 % was present in 49 patients (25 %). Rest-PI and rest-TPR values were similar in patients with and without a coronary artery stenosis ≥50 %, whereas stress-PI...... stenosis assessed by MDCT angiography and semi-quantitative myocardial MDCT perfusion in 200 symptomatic patients. The perfusion index (PI = mean myocardial attenuation density/mean left ventricular lumen attenuation density) at rest and during adenosine stress, the myocardial perfusion reserve (MPR......, stress-TPR and MPR were significantly reduced in patients with a stenosis ≥50 % (p PI was significantly higher than subepicardial PI at rest and during stress for patients without a significant stenosis, whereas this difference was blurred...

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

    DEFF Research Database (Denmark)

    Ogard, Christina Gerlach; Søndergaard, Susanne Bonnichsen; Vestergaard, 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...

  6. Long-term prognostic implications of myocardial perfusion imaging in octogenarians: an all-comer, cohort study

    Energy Technology Data Exchange (ETDEWEB)

    Katsikis, Athanasios [Onassis Cardiac Surgery Center, Nuclear Medicine Department, Athens (Greece); 401 General Military Hospital of Athens, Cardiology Department, Athens (Greece); Theodorakos, Athanasios; Manira, Vassiliki; Koutelou, Maria [Onassis Cardiac Surgery Center, Nuclear Medicine Department, Athens (Greece); Papaioannou, Spyridon [Athens Naval Hospital, Cardiology Department, Athens (Greece); Kolovou, Genovefa; Voudris, Vassilios [Onassis Cardiac Surgery Center, Cardiology Department, Athens (Greece)

    2017-08-15

    Evaluation of the long-term prognostic value of myocardial perfusion imaging (MPI) in octogenarians. Six hundred and twenty-nine octogenarians [51% previous myocardial infarction (MI) or revascularization] who underwent single-isotope MPI (78% {sup 201}Tl, 22% {sup 99m}Tc-tetrofosmin) with exercise (38% Bruce, 2% leg ergometry) or pharmacologic (58% adenosine, 2% dobutamine) stress were studied. All patients had LVEF determined by echocardiography within 1 month from MPI. Myocardial perfusion scoring was performed on a 17-segment LV-model with a 5-point grading system and three summed stress score (SSS)-based risk categories were formed [high-(SSS > 12), low-(SSS < 4), medium]. Prospective follow-up was performed to document all-cause (ACD), cardiac death (CD), MI, and revascularization. Revascularization was used to censor follow-up in survival analysis regarding ACD, CD, and CD/MI. For analysis of the CD, MI, or late revascularization (LR) composite, only revascularizations within 3 months from MPI (early revascularizations) were used for censoring. After 9.3 years there were 187 ACDs, 86 CDs, 28 MIs, and 77 revascularizations, including 28 early revascularizations. Adjusting for LVEF and stress-modality type, SSS was identified as an independent predictor of ACD [HR 1.03 (1.01-1.05)], CD [HR 1.05 (1.03-1.08)], CD,MI [HR 1.05 (1.02-1.07)], and CD,MI or LR [HR 1.05 (1.03-1.07)] (p ≤ 0.001 in all cases). Increased lung uptake had independent prognostic value only for the CD, MI, or LR end-point [HR 3 (1.2-7.7), p = 0.02]. Survival modeling demonstrated that LVEF and SSS, but not non-perfusion scintigraphic data provided incremental prognostic value over pre-test available clinical and historical information for all end-points. Differences between Kaplan-Meier survival curves of SSS-based risk groups were significant for all end-points (p < 0.001 in all cases). In octogenarians, MPI provides effective long-term risk stratification, regardless of stress type used

  7. Myocardial CT perfusion imaging and SPECT for the diagnosis of coronary artery disease

    DEFF Research Database (Denmark)

    George, Richard T; Mehra, Vishal C; Chen, Marcus Y

    2014-01-01

    . MATERIALS AND METHODS: This study was approved by the institutional review board. Written informed consent was obtained from all patients. Sixteen centers enrolled 381 patients from November 2009 to July 2011. Patients underwent rest and adenosine stress CT perfusion imaging and rest and either exercise...... or pharmacologic stress SPECT before and within 60 days of coronary angiography. Images from CT perfusion imaging, SPECT, and coronary angiography were interpreted at blinded, independent core laboratories. The primary diagnostic parameter was the area under the receiver operating characteristic curve (Az...

  8. Considerations when measuring myocardial perfusion reserve by cardiovascular magnetic resonance using regadenoson.

    Science.gov (United States)

    Bhave, Nicole M; Freed, Benjamin H; Yodwut, Chattanong; Kolanczyk, Denise; Dill, Karin; Lang, Roberto M; Mor-Avi, Victor; Patel, Amit R

    2012-12-28

    Adenosine cardiovascular magnetic resonance (CMR) can accurately quantify myocardial perfusion reserve. While regadenoson is increasingly employed due to ease of use, imaging protocols have not been standardized. We sought to determine the optimal regadenoson CMR protocol for quantifying myocardial perfusion reserve index (MPRi) - more specifically, whether regadenoson stress imaging should be performed before or after rest imaging. Twenty healthy subjects underwent CMR perfusion imaging during resting conditions, during regadenoson-induced hyperemia (0.4 mg), and after 15 min of recovery. In 10/20 subjects, recovery was facilitated with aminophylline (125 mg). Myocardial time-intensity curves were used to obtain left ventricular cavity-normalized myocardial up-slopes. MPRi was calculated in two different ways: as the up-slope ratio of stress to rest (MPRi-rest), and the up-slope ratio of stress to recovery (MPRi-recov). In all 20 subjects, MPRi-rest was 1.78 ± 0.60. Recovery up-slope did not return to resting levels, regardless of aminophylline use. Among patients not receiving aminophylline, MPRi-recov was 36 ± 16% lower than MPRi-rest (1.13 ± 0.38 vs. 1.82 ± 0.73, P = 0.001). In the 10 patients whose recovery was facilitated with aminophylline, MPRi-recov was 20 ± 24% lower than MPRi-rest (1.40 ± 0.35 vs. 1.73 ± 0.43, P = 0.04), indicating incomplete reversal. In 3 subjects not receiving aminophylline and 4 subjects receiving aminophylline, up-slope at recovery was greater than at stress, suggesting delayed maximal hyperemia. MPRi measurements from regadenoson CMR are underestimated if recovery perfusion is used as a substitute for resting perfusion, even when recovery is facilitated with aminophylline. True resting images should be used to allow accurate MPRi quantification. The delayed maximal hyperemia observed in some subjects deserves further study. ClinicalTrials.gov NCT00871260.

  9. Considerations when measuring myocardial perfusion reserve by cardiovascular magnetic resonance using regadenoson

    Directory of Open Access Journals (Sweden)

    Bhave Nicole M

    2012-12-01

    Full Text Available Abstract Background Adenosine cardiovascular magnetic resonance (CMR can accurately quantify myocardial perfusion reserve. While regadenoson is increasingly employed due to ease of use, imaging protocols have not been standardized. We sought to determine the optimal regadenoson CMR protocol for quantifying myocardial perfusion reserve index (MPRi – more specifically, whether regadenoson stress imaging should be performed before or after rest imaging. Methods Twenty healthy subjects underwent CMR perfusion imaging during resting conditions, during regadenoson-induced hyperemia (0.4 mg, and after 15 min of recovery. In 10/20 subjects, recovery was facilitated with aminophylline (125 mg. Myocardial time-intensity curves were used to obtain left ventricular cavity-normalized myocardial up-slopes. MPRi was calculated in two different ways: as the up-slope ratio of stress to rest (MPRi-rest, and the up-slope ratio of stress to recovery (MPRi-recov. Results In all 20 subjects, MPRi-rest was 1.78 ± 0.60. Recovery up-slope did not return to resting levels, regardless of aminophylline use. Among patients not receiving aminophylline, MPRi-recov was 36 ± 16% lower than MPRi-rest (1.13 ± 0.38 vs. 1.82 ± 0.73, P = 0.001. In the 10 patients whose recovery was facilitated with aminophylline, MPRi-recov was 20 ± 24% lower than MPRi-rest (1.40 ± 0.35 vs. 1.73 ± 0.43, P = 0.04, indicating incomplete reversal. In 3 subjects not receiving aminophylline and 4 subjects receiving aminophylline, up-slope at recovery was greater than at stress, suggesting delayed maximal hyperemia. Conclusions MPRi measurements from regadenoson CMR are underestimated if recovery perfusion is used as a substitute for resting perfusion, even when recovery is facilitated with aminophylline. True resting images should be used to allow accurate MPRi quantification. The delayed maximal hyperemia observed in some subjects deserves further study. Trial

  10. The effect of beta blocker withdrawal on adenosine myocardial perfusion imaging.

    Science.gov (United States)

    Hoffmeister, C; Preuss, R; Weise, R; Burchert, W; Lindner, O

    2014-12-01

    The effect of beta blockers on myocardial blood flow (MBF) under vasodilators has been studied in several SPECT and PET myocardial perfusion imaging (MPI) studies with divergent results. The present study evaluated the effect of a beta blocker withdrawal on quantitative adenosine MBF and on MPI results. Twenty patients with beta blockers and CAD history were studied with quantitative adenosine N-13 ammonia PET. The first study was performed under complete medication and the second after beta blocker withdrawal. The PET studies were independently read with respect to MPI result and clinical decision making. Global MBF showed an increase from 180.2 ± 59.9 to 193.6 ± 60.8 mL·minute(-1)/100 g (P = .02) after beta blocker withdrawal. The segmental perfusion values were closely correlated (R(2) = 0.82) over the entire range of perfusion values. An essentially different interpretation after beta blocker discontinuation was found in two cases (10%). A beta blocker withdrawal induces an increase in adenosine MBF. In the majority of cases, MPI interpretation and decision making are independent of beta blocker intake. If a temporary beta blocker withdrawal before MPI is not possible or was not realized by the patient, it is appropriate to perform adenosine stress testing without loss of the essential MPI result.

  11. Reverse redistribution of Tc-99m-tetrofosmin in exercise myocardial SPECT in patients with hypertrophic cardiomyopathy

    Energy Technology Data Exchange (ETDEWEB)

    Sugihara, Hiroki; Taniguchi, Yoko; Kinoshita, Noriyuki [Kyoto Prefectural Univ. of Medicine (Japan)] [and others

    1998-10-01

    We examined the usefulness of Tc-99m-tetrofosmin in detecting exercise induced perfusion abnormalities in patients with hypertrophic cardiomyopathy (HCM) and to clarify time-related changes in myocardial distribution of Tc-99m-tetrofosmin after a single injection. We studied 44 consecutive patients with HCM by means of exercise/rest Tc-99m-tetrofosmin single photon emission computed tomography (SPECT). After injecting 370 MBq of Tc-99m-tetrofosmin at the peak exercise, the early SPECT imaging was performed at 30 min (EX-30) and the delayed imaging at 180 min (EX-180). Immediately after the delayed imaging, 740 MBq of Tc-99m-tetrofosmin was injected in the resting state, and the rest SPECT imaging was performed 30 min later. Exercise-induced regional perfusion defects and/or apparent reversible left ventricular cavity dilation were identified in 26 (68.2%) of the 44 patients. When EX-30 images and EX-180 images were compared, reverse redistribution was confirmed in 36 patients (81.8%). Reverse redistribution was detected most frequently in the septal portion of the anterior wall, followed by the septal portion of the posterior wall and the septum. Exercise/rest Tc-99m-tetrofosmin myocardial imaging was a useful method for assessing myocardial perfusion abnormalities in patients with HCM. Reverse redistribution was detected very frequently on early and delayed images of exercise. We assumed that reverse redistribution may reflect a retention disorder of Tc-99m-tetrofosmin caused by some metabolic dysfunction of myocytes. (author)

  12. Dipyridamole stress myocardial perfusion by computed tomography in patients with left bundle branch block

    Science.gov (United States)

    Cabeda, Estêvan Vieira; Falcão, Andréa Maria Gomes; Soares Jr., José; Rochitte, Carlos Eduardo; Nomura, César Higa; Ávila, Luiz Francisco Rodrigues; Parga, José Rodrigues

    2015-01-01

    Background Functional tests have limited accuracy for identifying myocardial ischemia in patients with left bundle branch block (LBBB). Objective To assess the diagnostic accuracy of dipyridamole-stress myocardial computed tomography perfusion (CTP) by 320-detector CT in patients with LBBB using invasive quantitative coronary angiography (QCA) (stenosis ≥ 70%) as reference; to investigate the advantage of adding CTP to coronary computed tomography angiography (CTA) and compare the results with those of single photon emission computed tomography (SPECT) myocardial perfusion scintigraphy. Methods Thirty patients with LBBB who had undergone SPECT for the investigation of coronary artery disease were referred for stress tomography. Independent examiners performed per-patient and per-coronary territory assessments. All patients gave written informed consent to participate in the study that was approved by the institution’s ethics committee. Results The patients’ mean age was 62 ± 10 years. The mean dose of radiation for the tomography protocol was 9.3 ± 4.6 mSv. With regard to CTP, the per-patient values for sensitivity, specificity, positive and negative predictive values, and accuracy were 86%, 81%, 80%, 87%, and 83%, respectively (p = 0.001). The per-territory values were 63%, 86%, 65%, 84%, and 79%, respectively (p < 0.001). In both analyses, the addition of CTP to CTA achieved higher diagnostic accuracy for detecting myocardial ischemia than SPECT (p < 0.001). Conclusion The use of the stress tomography protocol is feasible and has good diagnostic accuracy for assessing myocardial ischemia in patients with LBBB. PMID:26421532

  13. Dipyridamole stress myocardial perfusion by computed tomography in patients with left bundle branch block

    Directory of Open Access Journals (Sweden)

    Estêvan Vieira Cabeda

    2015-01-01

    Full Text Available AbstractBackground:Functional tests have limited accuracy for identifying myocardial ischemia in patients with left bundle branch block (LBBB.Objective:To assess the diagnostic accuracy of dipyridamole-stress myocardial computed tomography perfusion (CTP by 320-detector CT in patients with LBBB using invasive quantitative coronary angiography (QCA (stenosis ≥ 70% as reference; to investigate the advantage of adding CTP to coronary computed tomography angiography (CTA and compare the results with those of single photon emission computed tomography (SPECT myocardial perfusion scintigraphy.Methods:Thirty patients with LBBB who had undergone SPECT for the investigation of coronary artery disease were referred for stress tomography. Independent examiners performed per-patient and per-coronary territory assessments. All patients gave written informed consent to participate in the study that was approved by the institution’s ethics committee.Results:The patients’ mean age was 62 ± 10 years. The mean dose of radiation for the tomography protocol was 9.3 ± 4.6 mSv. With regard to CTP, the per-patient values for sensitivity, specificity, positive and negative predictive values, and accuracy were 86%, 81%, 80%, 87%, and 83%, respectively (p = 0.001. The per-territory values were 63%, 86%, 65%, 84%, and 79%, respectively (p < 0.001. In both analyses, the addition of CTP to CTA achieved higher diagnostic accuracy for detecting myocardial ischemia than SPECT (p < 0.001.Conclusion:The use of the stress tomography protocol is feasible and has good diagnostic accuracy for assessing myocardial ischemia in patients with LBBB.

  14. Quantitative perfusion parameters in a cohort of patients with no known ischemic heart disease and normal myocardial perfusion imaging studied by 82Rb-PET

    DEFF Research Database (Denmark)

    Hoff, Camilla; Balche, Abdallah; Majgaard, J

    commercially available software (QPET, Cedars Sinai). Parameters included were regional and global rest and stress myocardial blood flow (MBF) values, ejection fraction (EF) and total perfusion deficit (TPD). Results Mean global MBF at stress was 2.92 mL/g/min (±SD 0.49), lower limit (LL) 1.94 m...

  15. Tc{sup 99m}-sestamibi dosimetry in myocardial perfusion imaging

    Energy Technology Data Exchange (ETDEWEB)

    Toledo, Janine M.; Trindade, Bruno M.; Campos, Tarcisio P.R., E-mail: janine.toledo@gmail.com [Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG (Brazil). Departamento de Engenharia Nuclear. Programa de Pos-Graduaco em Ciencias e Tecnicas Nucleares

    2015-07-01

    This paper addressed myocardial perfusion imaging providing a spatial dosimetric investigation of the {sup 99m}Tc-radiopharmaceutical dose distribution at the myocardium. Radiological data manipulation was performed in order to create a computational voxel model of the heart. A set of images obtained by thoracic angiotomography and abdominal aorta was set up providing anatomic and functional information for heart modeling in SISCODES code. A homogeneous distribution of {sup 99m}Tc was assumed into the cardiac muscle. Simulations of the transport of particles through the voxel and the interaction with the heart tissues were performed on the MCNP - Monte Carlo Code. The spatial dose distribution in the heart model is displayed as well as the dose versus volume histogram of the heart muscle. The present computational tools can generate spatial doses distribution in myocardial perfusion imaging. Specially, the dosimetry performed elucidates imparted dose distribution in the myocardial muscle per unit of injected {sup 99m} Tc activity, which can contribute to future deterministic effect investigations. (author)

  16. Contrast-Enhanced Ultrasound Reveals Exercise-Induced Perfusion Deficits in Claudicants.

    Science.gov (United States)

    Kundi, Rishi; Prior, Steven J; Addison, Odessa; Lu, Michael; Ryan, Alice S; Lal, Brajesh K

    2017-01-01

    Contrast-Enhanced Ultrasonography (CEUS) is an imaging modality allowing perfusion quantification in targeted regions of interest of the lower extremity that has not been possible with color-flow imaging or with measurement of ankle brachial indices. We developed a protocol to quantify lower extremity muscle perfusion impairment in PAD patients in response to exercise. Thirteen patients with Rutherford Class I-III Peripheral Arterial Disease (PAD) and no prior revascularization procedures were recruited from the Baltimore Veterans Affairs Medical Center and compared with eight control patients without PAD. CEUS interrogation of the index limb gastrocnemius muscle was performed using an intravenous bolus of lipid-stabilized microsphere contrast before and after a standardized treadmill protocol. Peak perfusion (PEAK) and time to peak perfusion (TTP) were measured before and after exercise. Between and within group differences were assessed. Control subjects demonstrated a more rapid TTP (p<0.01) and an increase in peak perfusion (PEAK, p=0.02) after exercise, when compared to their baseline measures. Patients with PAD demonstrated TTP and PEAK measures equivalent to controls at baseline (p=0.39, p=0.71, respectively). However, they exhibited no significant exercise-induced changes in perfusion (TTP p=0.49 and PEAK 0.67, respectively compared to baseline). After exercise, normal subjects had significantly shorter TTP (p=0.04) and greater PEAK (p=0.02) than PAD patients. Consistent with their lack of ischemic symptoms at rest, class I to III claudicant PAD patients showed similar perfusion measures (TTP and PEAK) at rest. PAD patients, however, were unable to increase perfusion in response to exercise, whereas controls increased perfusion significantly. This corresponds with claudication and limited walking capacity observed in PAD. CEUS with bolus injection offers a convenient, objective, quantitative and visual physiologic assessment of perfusion limitation in

  17. Low dose dynamic CT myocardial perfusion imaging using a statistical iterative reconstruction method

    Energy Technology Data Exchange (ETDEWEB)

    Tao, Yinghua [Department of Medical Physics, University of Wisconsin-Madison, Madison, Wisconsin 53705 (United States); Chen, Guang-Hong [Department of Medical Physics and Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin 53705 (United States); Hacker, Timothy A.; Raval, Amish N. [Department of Medicine, University of Wisconsin-Madison, Madison, Wisconsin 53792 (United States); Van Lysel, Michael S.; Speidel, Michael A., E-mail: speidel@wisc.edu [Department of Medical Physics and Department of Medicine, University of Wisconsin-Madison, Madison, Wisconsin 53705 (United States)

    2014-07-15

    Purpose: Dynamic CT myocardial perfusion imaging has the potential to provide both functional and anatomical information regarding coronary artery stenosis. However, radiation dose can be potentially high due to repeated scanning of the same region. The purpose of this study is to investigate the use of statistical iterative reconstruction to improve parametric maps of myocardial perfusion derived from a low tube current dynamic CT acquisition. Methods: Four pigs underwent high (500 mA) and low (25 mA) dose dynamic CT myocardial perfusion scans with and without coronary occlusion. To delineate the affected myocardial territory, an N-13 ammonia PET perfusion scan was performed for each animal in each occlusion state. Filtered backprojection (FBP) reconstruction was first applied to all CT data sets. Then, a statistical iterative reconstruction (SIR) method was applied to data sets acquired at low dose. Image voxel noise was matched between the low dose SIR and high dose FBP reconstructions. CT perfusion maps were compared among the low dose FBP, low dose SIR and high dose FBP reconstructions. Numerical simulations of a dynamic CT scan at high and low dose (20:1 ratio) were performed to quantitatively evaluate SIR and FBP performance in terms of flow map accuracy, precision, dose efficiency, and spatial resolution. Results: Forin vivo studies, the 500 mA FBP maps gave −88.4%, −96.0%, −76.7%, and −65.8% flow change in the occluded anterior region compared to the open-coronary scans (four animals). The percent changes in the 25 mA SIR maps were in good agreement, measuring −94.7%, −81.6%, −84.0%, and −72.2%. The 25 mA FBP maps gave unreliable flow measurements due to streaks caused by photon starvation (percent changes of +137.4%, +71.0%, −11.8%, and −3.5%). Agreement between 25 mA SIR and 500 mA FBP global flow was −9.7%, 8.8%, −3.1%, and 26.4%. The average variability of flow measurements in a nonoccluded region was 16.3%, 24.1%, and 937

  18. Low-dose 4D myocardial perfusion with x-ray micro-CT

    Science.gov (United States)

    Clark, D. P.; Badea, C. T.

    2017-03-01

    X-ray CT is widely used, both clinically and pre-clinically, for fast, high-resolution, anatomic imaging; however, compelling opportunities exist to expand its use in functional imaging applications. For instance, temporally-resolved CT data can detail cardiac motion and blood flow dynamics for one-stop cardiovascular CT imaging procedures. In previous work, we demonstrated efficient, low-dose projection acquisition and reconstruction strategies for cardiac micro-CT imaging and for multiple-injection micro-CT perfusion imaging. Here, we extend this previous work with regularization based on rank-sparse kernel regression and on filtration with the Karhunen-Loeve transform. Using a dual source, prospectively gated sampling strategy which produces an approximately uniform distribution of projections, we apply this revised algorithm to the assessment of both myocardial perfusion and cardiac functional metrics from the same set of projection data. We test the algorithm in simulations using a modified version of the MOBY mouse phantom which contains realistic perfusion and cardiac dynamics. The proposed algorithm reduces the reconstruction error by 81% relative to unregularized, algebraic reconstruction. The results confirm our ability to simultaneously solve for cardiac temporal motion and perfusion dynamics. In future work, we will apply the algorithm and sampling protocol to small animal cardiac studies.

  19. Regadenoson: review of its established role in myocardial perfusion imaging and emerging applications.

    Science.gov (United States)

    Palani, Gurunanthan; Ananthasubramaniam, Karthikeyan

    2013-01-01

    Myocardial perfusion imaging is a well-established noninvasive modality for the diagnosis and prognosis of coronary artery disease. The pharmacologic stress agents adenosine and dipyridamole are widely used in imaging studies, but cause undesirable side effects, like atrioventricular block and bronchospasm, due to their nonselective adenosine receptor activation. Furthermore, the mode of administration of these agents as a bolus infusion is less preferred. Regadenoson, an A2A adenosine receptor selective pharmacologic stress agent was approved in 2008 and is widely used instead of adenosine and dipyridamole. This article reviews regadenosons structure, mechanism of action, advantages over adenosine and dipyridamole, and its role in various patient populations undergoing stress perfusion imaging. Emerging applications where regadenoson could be of potential use are also explored.

  20. Estimation of myocardial perfusion and viability using simultaneous 99mTc-tetrofosmin--FDG collimated SPECT.

    Science.gov (United States)

    Fukuchi, K; Katafuchi, T; Fukushima, K; Shimotsu, Y; Toba, M; Hayashida, K; Takamiya, M; Ishida, Y

    2000-08-01

    This study was designed to elucidate the usefulness of crosstalk correction for dual-isotope simultaneous acquisition (DISA) with 99mTc-tetrofosmin and FDG in estimating myocardial perfusion and viability. Eighteen patients with coronary artery disease were studied. First, SPECT was performed with a low-energy high-resolution collimator after a single injection of 99mTc-tetrofosmin (single 99mTc-tetrofosmin). Second, PET and DISA with an ultra-high-energy collimator were performed after glucose loading and an injection of FDG. DISA was designed to operate with simultaneous 3-channel acquisition, and weighted scatter correction of crosstalk from the 18F photopeak to the 99mTc photopeak was performed by modification of an existing dual-window technique. The FDG SPECT images were compared with the images obtained by PET. Both crosstalk-corrected and uncorrected 99mTc-tetrofosmin images were generated and compared with the single 99mTc-tetrofosmin images. Regional percentage uptake of FDG agreed well between DISA and PET. However, regional percentage uptake of 99mTc-tetrofosmin was generally higher on the uncorrected 99mTc-tetrofosmin images than on the single 99mTc-tetrofosmin images, especially in areas of low flow (percentage count of 99mTc-tetrofosmin > or = 50%). The crosstalk correction contributed to improving the agreement between regional percentage uptakes and significantly improved the detectability of myocardial perfusion-metabolism mismatching. With 3-channel acquisition and weighted-scatter correction of crosstalk from the 18F photopeak to the 99mTc photopeak, DISA with 99mTc-tetrofosmin and FDG is feasible for assessing regional myocardial perfusion and viability.

  1. Radiation dose to radiosensitive organs in PET/CT myocardial perfusion examination using versatile optical fibre

    Science.gov (United States)

    Salasiah, M.; Nordin, A. J.; Fathinul Fikri, A. S.; Hishar, H.; Tamchek, N.; Taiman, K.; Ahmad Bazli, A. K.; Abdul-Rashid, H. A.; Mahdiraji, G. A.; Mizanur, R.; Noor, Noramaliza M.

    2013-05-01

    Cardiac positron emission tomography (PET) provides a precise method in order to diagnose obstructive coronary artery disease (CAD), compared to single photon emission tomography (SPECT). PET is suitable for obese and patients who underwent pharmacologic stress procedures. It has the ability to evaluate multivessel coronary artery disease by recording changes in left ventricular function from rest to peak stress and quantifying myocardial perfusion (in mL/min/g of tissue). However, the radiation dose to the radiosensitive organs has become crucial issues in the Positron Emission Tomography/Computed Tomography(PET/CT) scanning procedure. The objective of this study was to estimate radiation dose to radiosensitive organs of patients who underwent PET/CT myocardial perfusion examination at Centre for Diagnostic Nuclear Imaging, Universiti Putra Malaysia in one month period using versatile optical fibres (Ge-B-doped Flat Fibre) and LiF (TLD-100 chips). All stress and rest paired myocardial perfusion PET/CT scans will be performed with the use of Rubidium-82 (82Rb). The optic fibres were loaded into plastic capsules and attached to patient's eyes, thyroid and breasts prior to the infusion of 82Rb, to accommodate the ten cases for the rest and stress PET scans. The results were compared with established thermoluminescence material, TLD-100 chips. The result shows that radiation dose given by TLD-100 and Germanium-Boron-doped Flat Fiber (Ge-B-doped Flat Fiber) for these five organs were comparable to each other where the p>0.05. For CT scans,thyroid received the highest dose compared to other organs. Meanwhile, for PET scans, breasts received the highest dose.

  2. Variability of myocardial perfusion dark rim Gibbs artifacts due to sub-pixel shifts

    Directory of Open Access Journals (Sweden)

    Kellman Peter

    2009-05-01

    Full Text Available Abstract Background Gibbs ringing has been shown as a possible source of dark rim artifacts in myocardial perfusion studies. This type of artifact is usually described as transient, lasting a few heart beats, and localised in random segments of the myocardial wall. Dark rim artifacts are known to be unpredictably variable. This article aims to illustrate that a sub-pixel shift, i.e. a small displacement of the pixels with respect to the endocardial border, can result in different Gibbs ringing and hence different artifacts. Therefore a hypothesis for one cause of dark rim artifact variability is given based on the sub-pixel position of the endocardial border. This article also demonstrates the consequences for Gibbs artifacts when two different methods of image interpolation are applied (post-FFT interpolation, and pre-FFT zero-filling. Results Sub-pixel shifting of in vivo perfusion studies was shown to change the appearance of Gibbs artifacts. This effect was visible in the original uninterpolated images, and in the post-FFT interpolated images. The same shifted data interpolated by pre-FFT zero-filling exhibited much less variability in the Gibbs artifact. The in vivo findings were confirmed by phantom imaging and numerical simulations. Conclusion Unless pre-FFT zero-filling interpolation is performed, Gibbs artifacts are very dependent on the position of the subendocardial wall within the pixel. By introducing sub-pixel shifts relative to the endocardial border, some of the variability of the dark rim artifacts in different myocardial segments, in different patients and from frame to frame during first-pass perfusion due to cardiac and respiratory motion can be explained. Image interpolation by zero-filling can be used to minimize this dependency.

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

    Energy Technology Data Exchange (ETDEWEB)

    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. The effects of preceding exercise on myocardial damage in rats

    OpenAIRE

    Hyun, Seung Hee; Kim, Young Mi; Park, Su Jin

    2017-01-01

    [Purpose] The purpose of this study was to investigate the effects of exercise on myocardial injury in male Sprague-Dawley rats. Two groups of rats were trained with either moderate- or high-intensity treadmill running for four weeks. Subsequently, the concentrations of cardiac troponin and the N-terminal of prohormone brain natriuretic peptide (NT-proBNP) were examined following a single bout of prolonged intensive exercise (lasting 3 h). [Subjects and Methods] The study included 40 six-week...

  5. A generator-produced gallium-68 radiopharmaceutical for PET imaging of myocardial perfusion.

    Directory of Open Access Journals (Sweden)

    Vijay Sharma

    Full Text Available Lipophilic cationic technetium-99m-complexes are widely used for myocardial perfusion imaging (MPI. However, inherent uncertainties in the supply chain of molybdenum-99, the parent isotope required for manufacturing 99Mo/99mTc generators, intensifies the need for discovery of novel MPI agents incorporating alternative radionuclides. Recently, germanium/gallium (Ge/Ga generators capable of producing high quality 68Ga, an isotope with excellent emission characteristics for clinical PET imaging, have emerged. Herein, we report a novel 68Ga-complex identified through mechanism-based cell screening that holds promise as a generator-produced radiopharmaceutical for PET MPI.

  6. Prevalence and predictors of an abnormal stress myocardial perfusion study in asymptomatic patients with type 2 diabetes mellitus

    Energy Technology Data Exchange (ETDEWEB)

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

    2009-04-15

    The purpose of this study was to evaluate the prevalence of an abnormal stress myocardial perfusion study in a cohort of truly asymptomatic patients with type 2 diabetes mellitus using myocardial perfusion imaging by means of single photon emission computed tomography (SPECT). Secondly, we determined which clinical characteristics may predict an abnormal stress myocardial perfusion study in this population. A total of 120 asymptomatic patients (mean age 53{+-}10 years) with type 2 diabetes mellitus and one or more risk factors for coronary artery disease were prospectively recruited from an outpatient diabetes clinic. All patients underwent myocardial perfusion imaging by means of adenosine {sup 99m}Tc sestamibi SPECT. Images were evaluated for the presence of perfusion abnormalities as well as other nonperfusion abnormalities that may indicate extensive ischaemia, including left ventricular dysfunction (defined as a left ventricular ejection fraction <45%), transient ischaemic dilatation and adenosine-induced ST segment depression. Multivariable analysis was performed using a backward selection strategy to identify potential predictors for an abnormal stress myocardial perfusion study. Finally, all patients were followed up for 12 months to determine the occurrence of cardiovascular events: (1) cardiac death, (2) nonfatal myocardial infarction, (3) unstable angina requiring hospitalization, (4) revascularization, or (5) stroke. Of the 120 patients, 40 (33%) had an abnormal stress study, including myocardial perfusion abnormalities in 30 patients (25%). In 10 patients (8%), indicators of extensive (possibly balanced ischaemia) were observed in the absence of abnormal perfusion. The multivariable analysis identified current smoking, duration of diabetes and the cholesterol/high-density lipoprotein (HDL) ratio as independent predictors of an abnormal stress study. During a follow-up period of 12 months six patients (5%) had a cardiovascular event. The current study

  7. Technetium-99m tetrofosmin: Use for myocardial perfusion imaging in the detection of coronary artery disease

    Directory of Open Access Journals (Sweden)

    Helen Erica D’Arceuil

    2010-08-01

    Full Text Available Helen Erica D’ArceuilDepartment of Radiology, Stanford University School of Medicine, California, USAAbstract: Technetium-99m tetrofosmin is a radioactive tracer which is designed for ­myocardial perfusion imaging. Differential tracer uptake allows discrimination between normal and ischemic myocardium. Technetium-99m tetrofosmin has shown excellent utility as a safe, cost-effective, and technically sound agent for use in the diagnosis of coronary artery disease. This paper provides an overview of the available literature on clinical applications of technetium-99m tetrofosmin, and shows how this tracer has gained widespread acceptance as a diagnostic aid since its inception approximately 17 years ago. The various cardiac imaging modalities and imaging protocols which have employed this agent are also briefly reviewed.Keywords: technetium-99m tetrofosmin, myocardial, viability, imaging

  8. Diagnostic and prognostic significance of ischemic electrocardiographic changes with regadenoson-stress myocardial perfusion imaging.

    Science.gov (United States)

    Doukky, Rami; Olusanya, Adebayo; Vashistha, Raj; Saini, Abhimanyu; Fughhi, Ibtihaj; Mansour, Khaled; Nigatu, Abiy; Confer, Kara; Sims, Shannon A

    2015-08-01

    The diagnostic and prognostic value of regadenoson-induced ST-segment depression (ST↓) is not defined. Due to the low incidence of ST↓ ≥1.0 mm with vasodilator stress, a lower threshold to define ischemic ECG response may provide improved clinical utility. We conducted a retrospective cohort study of patients who underwent regadenoson-stress SPECT myocardial perfusion imaging (MPI) followed by coronary angiography within 6 months. Ischemic ST↓ was defined as ≥0.5 mm. The prevalence of angiographically severe coronary artery disease (CAD) and the rates of major adverse cardiac events (MACE) including cardiac death, myocardial infarction, and coronary revascularization were determined. In a diagnostic cohort of 629 subjects, 117 (18.6%) had ST↓ ≥0.5 mm. Severe CAD was more prevalent in the ST↓ ≥0.5 vs ST regadenoson-induced ST↓ ≥0.5 mm was associated with higher rates of severe CAD and MACE, irrespective of MPI finding.

  9. SPECT myocardial perfusion imaging. Long-term prognostic value in diabetic patients with and without coronary artery disease

    Energy Technology Data Exchange (ETDEWEB)

    Koehli, M. [Dept. of Endocrinology, Diabetology and Metabolism, Univ. Hospital Lausanne (Switzerland); Dept. of Nuclear Medicine, Univ. Hospital Lausanne (Switzerland); Monbaron, D.; Gaillard, R.C.; Ruiz, J. [Dept. of Endocrinology, Diabetology and Metabolism, Univ. Hospital Lausanne (Switzerland); Prior, J.O.; Bischof Delaloye, A. [Dept. of Nuclear Medicine, Univ. Hospital Lausanne (Switzerland); Calcagni, M.L. [Dept. of Nuclear Medicine, Univ. Hospital Lausanne (Switzerland); Dept. of Cardiology, Univ. Hospital Lausanne (Switzerland); Fivaz-Arbane, M.; Stauffer, J.C. [Inst. of Nuclear Medicine, Univ. Cattolica del Sacro Cuore, Roma (Italy)

    2006-07-01

    Aim: To determine the long-term prognostic value of SPECT myocardial perfusion imaging (MPI) for the occurrence of cardiovascular events in diabetic patients. Patients, methods: SPECT MPI of 210 consecutive Caucasian diabetic patients were analysed using Kaplan-Meier event-free survival curve and independent predictors were determined by Cox multivariate analyses. Results: Follow-up was complete in 200 (95%) patients with a median period of 3.0 years (0.8-5.0). The population was composed of 114 (57%) men, age 65 {+-} 10 years, 181 (90.5%) type 2 diabetes mellitus, 50 (25%) with a history of coronary artery disease (CAD) and 98 (49%) presenting chest pain prior to MPI. The prevalence of abnormal MPI was 58%. Patients with a normal MPI had neither cardiac death, nor myocardial infarction, independently of a history of coronary artery disease or chest pain. Among the independent predictors of cardiac death and myocardial infarction, the strongest was abnormal MPI (p < 0.0001), followed by history of CAD (Hazard Ratio (HR) = 15.9; p = 0.0001), diabetic retinopathy (HR = 10.0; p = 0.001) and inability to exercise (HR = 7.7; p = 0.02). Patients with normal MPI had a low revascularisation rate of 2.4% during the follow-up period. Compared to normal MPI, cardiovascular events increased 5.2 fold for reversible defects, 8.5 fold for fixed defects and 20.1 fold for the association of both defects. Conclusion: Diabetic patients with normal MPI had on excellent prognosis independently of history of CAD. On the opposite, an abnormal MPI led to a > 5-fold increase in cardiovascular events. This emphasizes the value of SPECT MPI in predicting and risk-stratifying cardiovascular events in diabetic patients. (orig.)

  10. Lessons from regadenoson and low-level treadmill/regadenoson myocardial perfusion imaging: initial clinical experience in 1263 patients.

    Science.gov (United States)

    Kwon, Deborah H; Cerqueira, Manuel D; Young, Ron; Houghtaling, Penny; Lieber, Elizabeth; Menon, Venu; Brunken, Richard C; Jaber, Wael A

    2010-10-01

    Regadenoson is a pharmacologic stress agent, which was recently approved for stress myocardial perfusion imaging (MPI). Aside from the initial protocol-driven studies, clinical experience with this stress agent is limited. Furthermore, low-level treadmill testing in a large population with regadenoson has not previously been evaluated. We describe our experience in the first 6 months of routine inpatient and outpatient clinical use. Between 7/1/08 and 12/04/08, 1263 patients underwent regadenoson stress testing (596 with low-level treadmill, 667 supine). Past medical history, clinical symptoms during stress, and changes in systolic blood pressure were prospectively recorded. Low-level treadmill testing was well tolerated in our patient population. Shortness of breath, dizziness, palpitations, transient heart block, and nausea were less frequent when patients were able to exercise. In our population, 51% experienced a drop in systolic blood pressure greater than 10 mmHg, with 9% experiencing a decrease in more than 30 mmHg. This decrease in blood pressure was more common in patients who underwent low-level treadmill testing vs those that were supine (56% vs 47%, P-value Regadenoson MPI was well tolerated. There were no procedural deaths. Regadenoson and Regadenoson combined with low level exercise MPI appear to be safe and well tolerated. An asymptomatic fall in systolic blood pressure seems to be more common in patients who undergo low-level treadmill testing.

  11. Prognostic value of transient ischemic dilation with regadenoson myocardial perfusion imaging.

    Science.gov (United States)

    Lester, Davis; El-Hajj, Stephanie; Farag, Ayman A; Bhambhvani, Pradeep; Tauxe, Lindsey; Heo, Jaekyeong; Iskandrian, Ami E; Hage, Fadi G

    2016-10-01

    Transient ischemic dilation (TID) of the left ventricle seen on myocardial perfusion imaging (MPI) is sometimes used as a marker of severe coronary artery disease. The prognostic value of TID obtained using regadenoson, a selective adenosine A2A receptor agonist, as a stress agent for MPI has not been studied. TID ratio was measured using an automated software program on consecutive patients with normal and abnormal perfusion pattern on regadenoson MPI at a single institution. An abnormal TID was defined as greater than 1.33. The primary outcome was a composite of cardiac death, non-fatal myocardial infarction (MI), and late coronary revascularization (CR, >90 days after MPI). The study population consisted of 887 patients (62 ± 12 years, 66% male, 48% diabetes, 46% prior CR, 75% with abnormal perfusion pattern, left ventricular ejection fraction-LVEF 55 ± 6%). An abnormal TID was present in 51 (6%) patients. Baseline characteristics were not different based on the presence or absence of TID. Early CR (≤90 days) was performed in 11 (22%) patients with vs 92 (11%) patients without TID (P = .04). During a mean follow-up of 29 ± 19 months, the primary outcome occurred in 271 (31%) patients (22% cardiac death, 6% MI, 9% late CR). TID was associated with increased risk of the primary outcome (log-rank P = .017), an association largely driven by late CR. In a Cox proportional model adjusted for multiple variables including perfusion defect size (PDS) and LVEF, the hazard ratio for TID was 1.92 (95% CI 1.20-3.08, P = .007). In the subset of patients with normal perfusion pattern, there was no association between TID and outcomes. TID on regadenoson MPI carries important prognostic information that is independent from PDS and LVEF, but this association is restricted to patients with abnormal perfusion on imaging.

  12. Myocardial perfusion abnormality and effects of Ca channel blockers on myocardial ischemia in patients with hypertrophic cardiomyopathy

    Energy Technology Data Exchange (ETDEWEB)

    Taniguchi, Yoko [Kyoto Prefectural Univ. of Medicine (Japan)

    1997-03-01

    The purpose of this study was to investigate the frequency of myocardial ischemia and characteristic regions of myocardial hypoperfusion during stress in patients with hypertrophic cardiomyopathy. Furthermore, the effects of Ca channel blocker (verapamil, diltiazem) on myocardial ischemia were studied. One hundred patients with hypertrophic cardiomyopathy underwent exercise {sup 201}Tl SPECT. Sixty-eight patients had one or more {sup 201}Tl abnormalities. Of the 68 patients with {sup 201}Tl abnormalities, 56 had reversible {sup 201}Tl abnormalities and 12 had fixed defect. {sup 201}Tl abnormalities were frequently distributed in the anterior and posterior areas of junction between the ventricular septum and the free wall and the apex. Of the 56 patients with reversible {sup 201}Tl abnormalities, 40 patients underwent one more exercise {sup 201}Tl SPECT after 8 weeks of oral administration of verapamil or diltiazem. The {sup 201}Tl defect was visually scored as the defect score. Transient dilation index was calculated as an index of subendocardial ischemia. The mean defect score decreased significantly from 9.80{+-}4.35 to 5.50{+-}4.63 after verapamil and from 9.90{+-}5.17 to 5.50{+-}4.89 after diltiazem. Mean transient dilation index decreased from 1.20{+-}0.12 to 1.08{+-}0.09 after treatment with verapamil and from 1.16{+-}0.10 to 1.02{+-}0.09 after treatment with diltiazem. (K.H.)

  13. Fully automated framework for the analysis of myocardial first-pass perfusion MR images.

    Science.gov (United States)

    Beache, Garth M; Khalifa, Fahmi; El-Baz, Ayman; Gimel'farb, Georgy

    2014-10-01

    To develop an automated framework for accurate analysis of myocardial perfusion using first-pass magnetic resonance imaging. The proposed framework consists of four processing stages. First, in order to account for heart deformations due to respiratory motion and heart contraction, a two-step registration methodology is proposed, which has the ability to account for the global and local motions of the heart. The methodology involves an affine-based registration followed by a local B-splines alignment to maximize a new similarity function based on the first- and second-order normalized mutual information. Then the myocardium is segmented using a level-set function, its evolution being constrained by three features, namely, a weighted shape prior, a pixelwise mixed object/background image intensity distribution, and an energy of a second-order binary Markov-Gibbs random field spatial model. At the third stage, residual segmentation errors and imperfection of image alignment are reduced by employing a Laplace-based registration refinement step that provides accurate pixel-on-pixel matches on all segmented frames to generate accurate parametric perfusion maps. Finally, physiology is characterized by pixel-by-pixel mapping of empirical indexes (peak signal intensity, time-to-peak, initial upslope, and the average signal change of the slowly varying agent delivery phase), based on contrast agent dynamics. The authors tested our framework on 24 perfusion data sets from 8 patients with ischemic damage who are undergoing a novel myoregeneration therapy. The performance of the processing steps of our framework is evaluated using both synthetic and in-vivo data. First, our registration methodology is evaluated using realistic synthetic phantoms and a distance-based error metric, and an improvement of registration is documented using the proposed similarity measure (P-value ≤10(-4)). Second, evaluation of our segmentation using the Dice similarity coefficient, documented an

  14. Efficacy of milk versus water to reduce interfering infra-cardiac activity in 99mTc-sestamibi myocardial perfusion scintigraphy.

    Science.gov (United States)

    Hofman, Michael; McKay, John; Nandurkar, Dee

    2006-11-01

    Interference from infra-cardiac radionuclide activity prevents accurate interpretation of true myocardial perfusion. The study aim was to compare the efficacy of milk versus water in reducing infra-cardiac activity in myocardial perfusion scintigraphy. We prospectively randomized 198 patients undergoing stress-rest (99m)Tc-sestamibi SPECT with exercise or pharmacological stress to drink 300 ml of water or milk prior to imaging. A semi-quantitative grading of the relative intensity of infra-cardiac activity compared to the myocardial activity and a qualitative assessment of the effect on the overall interpretation was performed. For stress images, there was no infra-cardiac activity in 37.9%, less intense infra-cardiac activity in 40.8%, equal in 11.7% and greater than infra-cardiac activity in 9.7% with milk, compared with 20.0%, 49.5%, 20.0% and 10.5%, respectively, with water (P=0.038). For rest images, there was also less intense infra-cardiac activity with milk compared to water (P=0.014). However, no change in subsequent image interpretation was seen. Administration of milk resulted in a significant decrease in the intensity of infra-cardiac activity compared to water. However, this did not translate into an improvement in image interpretation.

  15. Current concepts relating coronary flow, myocardial perfusion and metabolism in left bundle branch block and cardiac resynchronisation therapy.

    Science.gov (United States)

    Claridge, Simon; Chen, Zhong; Jackson, Tom; Sammut, Eva; Sohal, Manav; Behar, Jonathan; Razavi, Reza; Niederer, Steven; Rinaldi, Christopher Aldo

    2015-02-15

    Cardiac resynchronisation therapy (CRT) improves mortality and symptoms in heart failure patients with electromechanically dyssynchronous ventricles. There is a 50% non-response rate and reproducible biomarkers to predict non-response have not been forthcoming. Therefore, there has been increasing interest in the pathophysiological effects of dyssynchrony particularly focusing on coronary flow, myocardial perfusion and metabolism. Studies suggest that dyssynchronous electrical activation effects coronary flow throughout the coronary vasculature from the epicardial arteries to the microvascular bed and that these changes can be corrected by CRT. The effect of both electrical and mechanical dyssynchrony on myocardial perfusion is unclear with some studies suggesting there is a reduction in septal perfusion whilst others propose that there is an increase in lateral perfusion. Better understanding of these effects offers the possibility for better prediction of non-response. CRT appears to improve homogeneity in myocardial perfusion where heterogeneity is described in the initial substrate. Novel approaches to the identification of non-responders via metabolic phenotyping both invasively and non-invasively have been encouraging. There remains a need for further research to clarify the interaction of coronary flow with perfusion and metabolism in patients who undergo CRT. Crown Copyright © 2014. Published by Elsevier Ireland Ltd. All rights reserved.

  16. Semi-quantitative myocardial perfusion measured by computed tomography in patients with refractory angina

    DEFF Research Database (Denmark)

    Qayyum, Abbas Ali; Kühl, Jørgen Tobias; Kjaer, Andreas

    2017-01-01

    scanner and CT/PET 64-slice scanner. CT measured myocardial attenuation density (AD) and perfusion index (PI) were correlated to absolute PET myocardial perfusion values. RESULTS: Rest AD, rest and stress PI did not correlate to PET findings (r = 0·412, P = 0·113; r = 0·300, P = 0·259; and r = 0·508, P...... = 0·064, respectively). However, there was a significant correlation between stress AD and stress PET values (r = 0·670, P = 0·009) and between stress and rest differences for AD and PI with PET differences (r = 0·620, P = 0·006; and r = 0·639, P = 0·004, respectively). Furthermore, significant...... differences were observed between remote and stenotic territories for rest and stress AD (48 ± 14HU and 37 ± 16HU, P = 0·002; 76 ± 19HU and 58 ± 13HU, PPI (9·6 ± 2·9 and 7·5 ± 3·1, P = 0·002; 21·6 ± 4·1 and 16·9 ± 3·9, P

  17. Comparison of the prognostic value of regadenoson and adenosine myocardial perfusion imaging.

    Science.gov (United States)

    Farzaneh-Far, Afshin; Shaw, Linda K; Dunning, Allison; Oldan, Jorge D; O'Connor, Christopher M; Borges-Neto, Salvador

    2015-08-01

    Regadenoson is now widely used in single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI). However, the prognostic value of abnormal stress perfusion findings with regadenoson vs adenosine are unclear. The aim of this study was to evaluate the prognostic value of regadenoson SPECT and to compare it to that of adenosine SPECT. 3698 consecutive patients undergoing either adenosine or regadenoson SPECT were assessed at 1 year for the endpoints of cardiovascular death and a composite endpoint of cardiovascular death or MI. Weighted Cox proportional hazards regression modeling with the inverse probability weighted (IPW) estimators method adjusting to propensity for agent was used to account for differences in baseline characteristics. Patients undergoing adenosine SPECT MPI had a significantly higher prevalence of smoking history, diabetes, hypertension, and prior myocardial infarction (P regadenoson SPECT MPI is a significant predictor of events and provides incremental prognostic information beyond basic clinical variables. We have shown for the first time that use of regadenoson vs adenosine as stress agent does not modify the prognostic significance of SSS. Similar findings were seen with SDS.

  18. Myocardial Perfusion SPECT Imaging in Dextrocardia with Situs Inversus: A Case Report.

    Science.gov (United States)

    Ayeni, Olusegun Akinwale; Malan, Nico; Hammond, Emmanuel Niiboye; Vangu, Mboyo-Di-Tamba Heben

    2016-01-01

    Dextrocardia is a cardiac positional anomaly in which the heart is located in the right hemithorax with its base-to-apex axis directed to the right and caudad. Situs inversus is an autosomal recessive disorder that causes organs in the chest and abdomen to be positioned in a mirror image from their normal position. Dextrocardia may occur in isolation or as part of situs inversus. Similarly, situs inversus may occur with or without dextrocardia. Situs inversus accompanied with dextrocardia (situs inversus totalis) is a rare congenital abnormality occurring in 0.01% of live births. Herein, we present the case of a 35-year-old man with previously diagnosed situs inversus totalis with mirror-image dextrocardia, referred to our facility for diagnosis of coronary artery disease (CAD). The incidence and presentation of CAD in patients with dextrocardia are similar to the normal population. However, considerable attention should be paid to the acquisition of myocardial perfusion scintigraphy and data processing/analysis in this group of patients. The present case highlights the distinctive applications and potential pitfalls of myocardial perfusion single-photon emission computed tomography (SPECT) imaging in patients with dextrocardia.

  19. Myocardial Perfusion SPECT Imaging in Dextrocardia with Situs Inversus: A Case Report

    Directory of Open Access Journals (Sweden)

    Olusegun Akinwale Ayeni

    2016-07-01

    Full Text Available Dextrocardia is a cardiac positional anomaly in which the heart is located in the right hemithorax with its base-to-apex axis directed to the right and caudad. Situs inversus is an autosomal recessive disorder that causes organs in the chest and abdomen to be positioned in a mirror image from their normal position. Dextrocardia may occur in isolation or as part of situs inversus. Similarly, situs inversus may occur with or without dextrocardia. Situs inversus accompanied with dextrocardia (situs inversus totalis is a rare congenital abnormality occurring in 0.01% of live births. Herein, we present the case of a 35-yearold man with previously diagnosed situs inversus totalis with mirror-image dextrocardia, referred to our facility for diagnosis of coronary artery disease (CAD. The incidence and presentation of CAD in patients with dextrocardiaare similar to the normal population. However, considerable attention should be paid to the acquisition of myocardial perfusion scintigraphy and data processing/analysis in this group of patients. The present case highlights thedistinctive applications and potential pitfalls of myocardial perfusion single photon emission computed tomography (SPECT imaging in patients with dextrocardia.

  20. An unsupervised approach for measuring myocardial perfusion in MR image sequences

    Science.gov (United States)

    Discher, Antoine; Rougon, Nicolas; Preteux, Francoise

    2005-08-01

    Quantitatively assessing myocardial perfusion is a key issue for the diagnosis, therapeutic planning and patient follow-up of cardio-vascular diseases. To this end, perfusion MRI (p-MRI) has emerged as a valuable clinical investigation tool thanks to its ability of dynamically imaging the first pass of a contrast bolus in the framework of stress/rest exams. However, reliable techniques for automatically computing regional first pass curves from 2D short-axis cardiac p-MRI sequences remain to be elaborated. We address this problem and develop an unsupervised four-step approach comprising: (i) a coarse spatio-temporal segmentation step, allowing to automatically detect a region of interest for the heart over the whole sequence, and to select a reference frame with maximal myocardium contrast; (ii) a model-based variational segmentation step of the reference frame, yielding a bi-ventricular partition of the heart into left ventricle, right ventricle and myocardium components; (iii) a respiratory/cardiac motion artifacts compensation step using a novel region-driven intensity-based non rigid registration technique, allowing to elastically propagate the reference bi-ventricular segmentation over the whole sequence; (iv) a measurement step, delivering first-pass curves over each region of a segmental model of the myocardium. The performance of this approach is assessed over a database of 15 normal and pathological subjects, and compared with perfusion measurements delivered by a MRI manufacturer software package based on manual delineations by a medical expert.

  1. Effect of Chinese drugs for supplementing Qi, nourishing Yin and activating blood circulation on myocardial perfusion in patients with acute myocardial infarction after revascularization.

    Science.gov (United States)

    Li, Yong-Qiang; Jin, Mei; Qiu, Sheng-Lei; Wang, Pei-Li; Zhu, Tian-Gang; Wang, Cheng-Long; Li, Tian-Chang; Liu, Hong-Xu; Bian, Hong; Yao, Li-Fang; Shi, Da-Zhuo

    2009-02-01

    To observe the effects of Chinese drugs for supplementing qi, nourishing yin and activating blood circulation on the myocardial perfusion in acute myocardial infarction (AMI) patients after revascularization. Eighty patients with anterior or inferior ventricular wall AMI, who had received revascularization by intravenous thrombolysis or coronary bypass, were randomized into the treated group and the control group equally, both treated with conventional Western medical treatment, but combined, respectively, with Xinyue Capsule (, XYC) plus Composite Salvia Tablet (CST) and placebo for 3 months. Dobutamine stress echocardiography (DSE) was performed 14 days and 3 months after revascularization, respectively on every patient to observe blood perfusion extent (b value), myocardial perfusion velocity (k value) and local blood fl ow volume (k x b) in left ventricular infarction-related vascular segments under stressed state. With 5 cases dropping out in the observation period (3 in the treated group and 2 in the control group), the trial was completed in 75 patients in total. The 14-day DSE shows that the b value and k x b value of left anterior ventricular wall mid segment and apex segment, and the k value of apex segment in patients with anterior wall AMI, as well as the b value and k x b of basal segment in patients with inferior wall AMI in the treated group were significantly higher than those in the control group (Pcirculation in combination with conventional Western medical treatment could obviously improve the blood perfusion at the myocardial tissue level in infarction-related vascular segments.

  2. Endotoxaemic myocardial dysfunction: the role of coronary driving pressure in subendocardial perfusion.

    Science.gov (United States)

    Lorigados, Clara B; Ariga, Suely K; Batista, Tiago R; Velasco, Irineu T; Soriano, Francisco G

    2015-03-01

    To investigate the role of coronary driving pressure (CDP) in myocardial microcirculatory blood flow during sepsis. We hypothesised that in septic shock there is an impaired autoregulation of microcirculation, and blood flow is totally dependent on CDP. We analysed the effect of lipopolysaccharide (LPS)-induced shock on myocardial microcirculation, separating subendocardial and epicardial areas. We then studied the effect of CDP increases using noradrenaline (NOR) or metaraminol (Aramine [ARA]) on myocardial microcirculation and function, and we analysed the effect of volume infusion on CDP and myocardial function. Endotoxaemia was induced in male Wistar rats by an intraperitoneal injection of LPS 10 mg/kg. Animals were divided into a control (CT) group, an LPS-injected group, and an LPS-injected group treated with saline fluid, NOR or ARA. Ninety minutes later, a haemodynamic evaluation was performed. NOR or ARA were used to manage the mean arterial pressure (MAP) and CDP, and we inserted a catheter into the left ventricle to measure cardiac parameters. To measure blood flow in the myocardium and other organs, microspheres were introduced into the left ventricle using an infusion pump. After LPS treatment, left ventricular (LV) systolic function (dP/dt max) and diastolic function (dP/dt min) decreased by 34% and 15%, respectively, and load-independent indices (LV contractility in ejection phase and dP/dt max÷end-diastolic volume) were reduced. The CDP was also reduced (by 58%) in the endotoxaemic rats. Myocardial blood flow was reduced (by 80%) in animals with an MAP≤65 mmHg. NOR increased the CDP (LPS, 38 mmHg [SEM, 2 mmHg]; LPS+NOR, 59 mmHg [SEM, 3 mmHg]) and microcirculatory perfusion (LPS, 2 mL/min/g tissue [SEM, 0.6 mL/min/g]; LPS+NOR, 6.2 mL/min/g [SEM, 0.8 mL/min/g]). ARA was also effective in improve microcirculation but saline volume infusion was ineffective in improving CDP or myocardial function. CDP showed a significant correlation with

  3. Quantitative myocardial perfusion PET parametric imaging at the voxel-level

    Science.gov (United States)

    Mohy-ud-Din, Hassan; Lodge, Martin A.; Rahmim, Arman

    2015-08-01

    Quantitative myocardial perfusion (MP) PET has the potential to enhance detection of early stages of atherosclerosis or microvascular dysfunction, characterization of flow-limiting effects of coronary artery disease (CAD), and identification of balanced reduction of flow due to multivessel stenosis. We aim to enable quantitative MP-PET at the individual voxel level, which has the potential to allow enhanced visualization and quantification of myocardial blood flow (MBF) and flow reserve (MFR) as computed from uptake parametric images. This framework is especially challenging for the 82Rb radiotracer. The short half-life enables fast serial imaging and high patient throughput; yet, the acquired dynamic PET images suffer from high noise-levels introducing large variability in uptake parametric images and, therefore, in the estimates of MBF and MFR. Robust estimation requires substantial post-smoothing of noisy data, degrading valuable functional information of physiological and pathological importance. We present a feasible and robust approach to generate parametric images at the voxel-level that substantially reduces noise without significant loss of spatial resolution. The proposed methodology, denoted physiological clustering, makes use of the functional similarity of voxels to penalize deviation of voxel kinetics from physiological partners. The results were validated using extensive simulations (with transmural and non-transmural perfusion defects) and clinical studies. Compared to post-smoothing, physiological clustering depicted enhanced quantitative noise versus bias performance as well as superior recovery of perfusion defects (as quantified by CNR) with minimal increase in bias. Overall, parametric images obtained from the proposed methodology were robust in the presence of high-noise levels as manifested in the voxel time-activity-curves.

  4. Double-gated myocardial ASL perfusion imaging is robust to heart rate variation.

    Science.gov (United States)

    Do, Hung Phi; Yoon, Andrew J; Fong, Michael W; Saremi, Farhood; Barr, Mark L; Nayak, Krishna S

    2017-05-01

    Cardiac motion is a dominant source of physiological noise (PN) in myocardial arterial spin labeled (ASL) perfusion imaging. This study investigates the sensitivity to heart rate variation (HRV) of double-gated myocardial ASL compared with the more widely used single-gated method. Double-gating and single-gating were performed on 10 healthy volunteers (n = 10, 3F/7M; age, 23-34 years) and eight heart transplant recipients (n = 8, 1F/7M; age, 26-76 years) at rest in the randomized order. Myocardial blood flow (MBF), PN, temporal signal-to-noise ratio (SNR), and HRV were measured. HRV ranged from 0.2 to 7.8 bpm. Double-gating PN did not depend on HRV, while single-gating PN increased with HRV. Over all subjects, double-gating provided a significant reduction in global PN (from 0.20 ± 0.15 to 0.11 ± 0.03 mL/g/min; P = 0.01) and per-segment PN (from 0.33 ± 0.23 to 0.21 ± 0.12 mL/g/min; P < 0.001), with significant increases in global temporal SNR (from 11 ± 8 to 18 ± 8; P = 0.02) and per-segment temporal SNR (from 7 ± 4 to 11 ± 12; P < 0.001) without significant difference in measured MBF. Single-gated myocardial ASL suffers from reduced temporal SNR, while double-gated myocardial ASL provides consistent temporal SNR independent of HRV. Magn Reson Med 77:1975-1980, 2017. © 2016 International Society for Magnetic Resonance in Medicine. © 2016 International Society for Magnetic Resonance in Medicine.

  5. Microheterogeneity of regional myocardial blood flows in low-perfused rat hearts evaluated by double-tracer digital radiography

    Energy Technology Data Exchange (ETDEWEB)

    Matsumoto, Takeshi [Bioengineering Division, Osaka University Graduate School of Engineering Science, Machikaneyamacho 13, Toyonaka 5608531 (Japan)]. E-mail: matsu@me.es.osaka-u.ac.jp; Asano, Takahisa [Department of Medical Engineering and Systems Cardiology, Kawasaki Medical School Matsushima 577, Kurashiki 7010192 (Japan); Takemoto, Mami [Department of Medical Engineering and Systems Cardiology, Kawasaki Medical School Matsushima 577, Kurashiki 7010192 (Japan); Tachibana, Hiroyuki [Department of Medical Engineering and Systems Cardiology, Kawasaki Medical School Matsushima 577, Kurashiki 7010192 (Japan); Ogasawara, Yasuo [Department of Medical Engineering and Systems Cardiology, Kawasaki Medical School Matsushima 577, Kurashiki 7010192 (Japan); Kajiya, Fumihiko [Department of Medical Engineering and Systems Cardiology, Kawasaki Medical School Matsushima 577, Kurashiki 7010192 (Japan)

    2007-08-15

    Using {sup 3}H- and {sup 125}I-labeled desmethylimipramine (DMI) for regional flow tracers, we established a two-time measurement method for the spatial pattern of myocardial perfusion in cross-circulated rat hearts. Myocardial extractions and retentions of these tracers were confirmed to be satisfactory; however, the latter were less than 90% after 3 min at a perfusion rate of 2.9 ml/min/g, limiting the present application to a short-time perfusion measurement. Distributions of myocardial depositions were separated by subtraction digital radiography with 400-{mu}m pixel resolution. Its feasibility was examined by regression analysis between local deposition densities of {sup 3}H- and {sup 125}I-DMI injected simultaneously. The slope, y-intercept, and correlation coefficient (r) of the regression line were 0.98{+-}0.04, 0.02{+-}0.04, and 0.95{+-}0.03, respectively, indicating the validity of the present image subtraction technique. The spatial pattern of myocardial perfusion in response to flow reduction was evaluated by the injections of {sup 3}H- and {sup 125}I-DMI, respectively, before and after a nearly 70% flow reduction. A significant correlation between normalized density distributions of these tracers was found in both subepicardium (r=0.77{+-}0.12) and subendocardium (r=0.73{+-}0.20), indicating the stable pattern of myocardial perfusion. However, the coefficient of variation of tracer densities showed a decrease of subendocardial flow heterogeneity from 35{+-}15% to 31{+-}16%. Thus, flow differences between originally high- and low-flow regions in subendocardium were reduced on a relative basis during low perfusion.

  6. The Myocardial Perfusion Scintigraphy in Predicting Risk for Coronary Artery Disease in Patients with Anxiety and Depression Symptoms

    Directory of Open Access Journals (Sweden)

    Billur Çalışkan

    2016-06-01

    Full Text Available INTRODUCTION: An association between psychological factors and cardiovascular disease, has long been suspected. However it is not clear whether chest pain is caused by emotional distress or whether coronary spasms are caused by the onset of coronary artery disease (CAD. We aimed to predict the risk for CAD in patients referred to myocardial perfusion imaging (MPI with chest pain using depression, stress, and anxiety symptoms. METHODS: The emotional status of all patients was evaluated using the Hospital Anxiety and Depression Scale (HADS-A and HADS-D, the State and Trait Anxiety Inventory (STAI-1 and STAI-2, the Perceived Stress Scale (PSS, and the Anxiety Sensitivity Index-3 (ASI. Myocardial perfusion was measured using a 17-segment model and 5-point scoring system (0: normal perfusion; 4: no perfusion. RESULTS: MPI revealed reversible perfusion defects in 24 of 141 patients and no perfusion defects in 117 patients. The STAI-2 and HADS-A and HADS-D scores were significantly higher in patients with myocardial ischemia than in those without (STAI-2: 50.8 ± 7.5 vs. 46.3 ± 7.1, respectively; p = 0.008; HADS-A: 9.5 ± 3.9 vs. 7.8 ± 3.4, respectively; p = 0.033; HADS-D: 8.7 ± 3.0 vs. 7.3 ± 3.0, respectively; p = 0.05. Unadjusted correlation analysis showed that there was statistically significant correlation between reversible perfusion defects and anxiety scores (r=0.186, p= 0.029. DISCUSSION AND CONCLUSION: The patients with symptoms of depression and high-trait anxiety may be at higher risk of myocardial ischemia than patients without such symptoms. Thus, the emotional status of patients should be taken into consideration during clinical evaluation for CAD.

  7. Determinants of coronary flow reserve in non-diabetic patients with chest pain without myocardial perfusion defects.

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    Helena U Westergren

    Full Text Available Microvascular dysfunction could be responsible for chest pain in patients without myocardial perfusion defects. We evaluated microvascular function using ultrasound-assessed coronary flow reserve (CFR in patients with chest pain and normal myocardial perfusion scintigram. Secondly, we investigated association between cardiovascular parameters and decreased CFR in a sex specific manner.A total of 202 (128 women non-diabetic patients with chest pain and suspected myocardial ischemia, but without myocardial perfusion defects on myocardial perfusion scintigram, were enrolled and underwent CFR examination and blood sampling. All patients were followed-up for cardiovascular events. We used a supervised principal component analysis including 66 variables such as clinical parameters, ongoing medication, coronary artery disease history, lipids, metabolic parameters, inflammatory and other cardiovascular parameters.During a median follow-up time of 5.4 years, 25 cardiovascular events occurred; (men;18, women;7. Average CFR of the study cohort was 2.7±1.2 and 14% showed impaired CFR<2.0. In an adjusted Cox regression analysis, CFR<2.0 independently predicted event-free survival (HR:2.5, p = 0.033. In the supervised principal component analysis high insulin resistance assessed by Homeostatic model assessment for insulin resistance was the strongest biochemical marker associated with decreased CFR. Interestingly, upon sex specific multivariable linear regression analysis, the association was only significant in men (β = -0.132, p = 0.041 while systolic blood pressure remained an independent predictor in women (β = -0.009, p = 0.011.In non-diabetic patients with chest pain without myocardial perfusion defects, low CFR has prognostic value for future cardiovascular events. Insulin resistance appears to be a marker for decreased CFR in men. Indeed, in the context of contribution of traditional risk factors in this patient population, the value of systolic

  8. Measurement of extracellular volume and transit time heterogeneity using contrast-enhanced myocardial perfusion MRI in patients after acute myocardial infarction.

    Science.gov (United States)

    Kunze, Karl P; Rischpler, Christoph; Hayes, Carmel; Ibrahim, Tareq; Laugwitz, Karl-Ludwig; Haase, Axel; Schwaiger, Markus; Nekolla, Stephan G

    2017-06-01

    To assess the ability of dynamic contrast-enhanced myocardial perfusion MRI to measure extracellular volume (ECV) and to investigate the possibility of estimating capillary transit time heterogeneity (CTH) in patients after myocardial infarction and successful revascularization. Twenty-four perfusion data sets were acquired on a 3 Tesla positron emission tomography (PET)/MRI scanner. Three perfusion models of different complexity were implemented in a hierarchical fashion with an Akaike information criterion being used to determine the number of fit parameters supported by the data. Results were compared sector-wise to ECV from an equilibrium T1 mapping method (modified look-locker inversion recovery (MOLLI)). ECV derived from the perfusion analysis correlated well with equilibrium measurements (R² = 0.76). Estimation of CTH was supported in 16% of sectors (mostly remote). Inclusion of a nonzero CTH parameter usually led to lower estimates of first-pass extraction and slightly higher estimates of blood volume and flow. Estimation of the capillary permeability-surface area product was feasible in 81% of sectors. Transit time heterogeneity has a measurable effect on the kinetic analysis of myocardial perfusion MRI data, and Gd-DTPA extravasation in the myocardium is usually not flow-limited in infarct-related pathology. Measurement of myocardial ECV using perfusion imaging could provide a scan-time efficient alternative to methods based on T1 mapping. Magn Reson Med 77:2320-2330, 2017. © 2016 International Society for Magnetic Resonance in Medicine. © 2016 International Society for Magnetic Resonance in Medicine.

  9. Exercise increases human skeletal muscle insulin sensitivity via coordinated increases in microvascular perfusion and molecular signaling

    DEFF Research Database (Denmark)

    Sjøberg, Kim Anker; Frøsig, Christian; Kjøbsted, Rasmus

    2017-01-01

    Insulin resistance is a major health risk and although exercise clearly improves skeletal muscle insulin sensitivity, the mechanisms are unclear. Here we show that initiation of a euglycemic hyperinsulinemic clamp four hours after single-legged exercise in humans increased microvascular perfusion...

  10. A tourniquet assisted cardiopulmonary resuscitation augments myocardial perfusion in a porcine model of cardiac arrest.

    Science.gov (United States)

    Yang, Zhengfei; Tang, David; Wu, Xiaobo; Hu, Xianwen; Xu, Jiefeng; Qian, Jie; Yang, Min; Tang, Wanchun

    2015-01-01

    During cardiopulmonary resuscitation (CPR), myocardial blood flow generated by chest compression rarely exceeds 35% of its normal level. Cardiac output generated by chest compression decreases gradually with the prolongation of cardiac arrest and resuscitation. Early studies have demonstrated that myocardial blood flow during CPR is largely dependent on peripheral vascular resistance. In this study, we investigated the effects of chest compression in combination with physical control of peripheral vascular resistance assisted by tourniquets on myocardial blood flow during CPR. Ventricular fibrillation was induced and untreated for 7 min in ten male domestic pigs weighing between 33 and 37 kg. The animals were then randomized to receive CPR alone or a tourniquet assisted CPR (T-CPR). In the CPR alone group, chest compression was performed by a miniaturized mechanical chest compressor. In the T-CPR group, coincident with the start of resuscitation, the thin elastic tourniquets were wrapped around the four limbs from the distal end to the proximal part. After 2 min of CPR, epinephrine (20 μg/kg) was administered via the femoral vein. After 5 min of CPR, defibrillation was attempted by a single 150 J shock. If resuscitation was not successful, CPR was resumed for 2 min before the next defibrillation. The protocol was continued until successful resuscitation or for a total of 15 min. Five minutes after resuscitation, the elastic tourniquets were removed. The resuscitated animals were observed for 2h. T-CPR generated significantly greater coronary perfusion pressure, end-tidal carbon dioxide and carotid blood flow. There was no difference in both intrathoracic positive and negative pressures between the two groups. All animals were successfully resuscitated with a single shock in both groups. There were no significant changes in hemodynamics observed in the animals treated in the T-CPR group before-and-after the release of tourniquets at post-resuscitation 5 min. T

  11. Evaluation of heart perfusion in patients with acute myocardial infarction using dynamic contrast-enhanced magnetic resonance imaging

    DEFF Research Database (Denmark)

    Nielsen, Gitte; Hansen, Thomas Fritz; Dirks, Christina G

    2004-01-01

    with acute transmural myocardial infarction were studied using a Turbo-fast low angle shot (FLASH) MRI sequence to monitor the first pass of an extravascular contrast agent (CA), gadolinium diethylene triamine pentaacetic acid (Gd-DTPA). Quantitation of perfusion, expressed as Ki (mL/100 g/minute), in five...... acutely ill patients following acute myocardial infarction. The technique provides information on both the volume and severity of affected myocardial tissue, enabling the power of treatment regimes to be assessed objectively, and this approach should aid individual patient stratification and prognosis...

  12. Evaluation of heart perfusion in patients with acute myocardial infarction using dynamic contrast-enhanced magnetic resonance imaging

    DEFF Research Database (Denmark)

    Nielsen, Gitte; Fritz-Hansen, Thomas; Dirks, Christina G

    2004-01-01

    acutely ill patients following acute myocardial infarction. The technique provides information on both the volume and severity of affected myocardial tissue, enabling the power of treatment regimes to be assessed objectively, and this approach should aid individual patient stratification and prognosis...... with acute transmural myocardial infarction were studied using a Turbo-fast low angle shot (FLASH) MRI sequence to monitor the first pass of an extravascular contrast agent (CA), gadolinium diethylene triamine pentaacetic acid (Gd-DTPA). Quantitation of perfusion, expressed as Ki (mL/100 g/minute), in five...

  13. Prediction of revascularization after myocardial perfusion SPECT by machine learning in a large population.

    Science.gov (United States)

    Arsanjani, Reza; Dey, Damini; Khachatryan, Tigran; Shalev, Aryeh; Hayes, Sean W; Fish, Mathews; Nakanishi, Rine; Germano, Guido; Berman, Daniel S; Slomka, Piotr

    2015-10-01

    We aimed to investigate if early revascularization in patients with suspected coronary artery disease can be effectively predicted by integrating clinical data and quantitative image features derived from perfusion SPECT (MPS) by machine learning (ML) approach. 713 rest (201)Thallium/stress (99m)Technetium MPS studies with correlating invasive angiography with 372 revascularization events (275 PCI/97 CABG) within 90 days after MPS (91% within 30 days) were considered. Transient ischemic dilation, stress combined supine/prone total perfusion deficit (TPD), supine rest and stress TPD, exercise ejection fraction, and end-systolic volume, along with clinical parameters including patient gender, history of hypertension and diabetes mellitus, ST-depression on baseline ECG, ECG and clinical response during stress, and post-ECG probability by boosted ensemble ML algorithm (LogitBoost) to predict revascularization events. These features were selected using an automated feature selection algorithm from all available clinical and quantitative data (33 parameters). Tenfold cross-validation was utilized to train and test the prediction model. The prediction of revascularization by ML algorithm was compared to standalone measures of perfusion and visual analysis by two experienced readers utilizing all imaging, quantitative, and clinical data. The sensitivity of machine learning (ML) (73.6% ± 4.3%) for prediction of revascularization was similar to one reader (73.9% ± 4.6%) and standalone measures of perfusion (75.5% ± 4.5%). The specificity of ML (74.7% ± 4.2%) was also better than both expert readers (67.2% ± 4.9% and 66.0% ± 5.0%, P revascularization after MPS, and is significantly better than standalone measures of perfusion derived from MPS.

  14. Diagnostic performance of stress myocardial perfusion imaging for coronary artery disease: A systematic review and meta-analysis

    NARCIS (Netherlands)

    M.C. de Jong (Marcus); T.S.S. Genders (Tessa); R.J.M. van Geuns (Robert Jan); A. Moelker (Adriaan); M.G.M. Hunink (Myriam)

    2012-01-01

    textabstractObjectives To determine and compare the diagnostic performance of stress myocardial perfusion imaging (MPI) for the diagnosis of obstructive coronary artery disease (CAD), using conventional coronary angiography (CCA) as the reference standard. Methods We searched Medline and Embase for

  15. Caffeine intake inverts the effect of adenosine on myocardial perfusion during stress as measured by T1 mapping

    NARCIS (Netherlands)

    Kuijpers, Dirkjan; Prakken, Niek H.; Vliegenthart, Rozemarijn; van Dijkman, Paul R. M.; van der Harst, Pim; Oudkerk, Matthijs

    2016-01-01

    Caffeine intake before adenosine stress myocardial perfusion imaging may cause false negative findings. We hypothesized that the antagonistic effect of caffeine can be measured by T1 relaxation times in rest and adenosine stress cardiac magnetic resonance imaging (CMR), as T1 mapping techniques are

  16. Quantitative Myocardial Perfusion with Dynamic Contrast-Enhanced Imaging in MRI and CT: Theoretical Models and Current Implementation

    Directory of Open Access Journals (Sweden)

    G. J. Pelgrim

    2016-01-01

    Full Text Available Technological advances in magnetic resonance imaging (MRI and computed tomography (CT, including higher spatial and temporal resolution, have made the prospect of performing absolute myocardial perfusion quantification possible, previously only achievable with positron emission tomography (PET. This could facilitate integration of myocardial perfusion biomarkers into the current workup for coronary artery disease (CAD, as MRI and CT systems are more widely available than PET scanners. Cardiac PET scanning remains expensive and is restricted by the requirement of a nearby cyclotron. Clinical evidence is needed to demonstrate that MRI and CT have similar accuracy for myocardial perfusion quantification as PET. However, lack of standardization of acquisition protocols and tracer kinetic model selection complicates comparison between different studies and modalities. The aim of this overview is to provide insight into the different tracer kinetic models for quantitative myocardial perfusion analysis and to address typical implementation issues in MRI and CT. We compare different models based on their theoretical derivations and present the respective consequences for MRI and CT acquisition parameters, highlighting the interplay between tracer kinetic modeling and acquisition settings.

  17. Positron emission tomographic evaluation of regulation of myocardial perfusion in physiological (elite athletes) and pathological (systemic hypertension) left ventricular hypertrophy

    DEFF Research Database (Denmark)

    Kjaer, Andreas; Meyer, Christian; Wachtell, Kristian

    2005-01-01

    Myocardial perfusion (MP) may differ in physiologic and pathologic left ventricular hypertrophy (LVH). We compared MP in LVH in elite athletes and patients with hypertension with healthy, age-matched subjects. We included 12 rowers with LVH, 19 patients with hypertension with LVH, and 2 age...

  18. Development and validation of a patient-tailored dose regime in myocardial perfusion imaging using czt-spect

    NARCIS (Netherlands)

    van Dijk, Joris David; van Dijk, J.D.; Iskandrian, A.; de Jager, P.L.; Mouden, M.; Slump, Cornelis H.; Ottervanger, J.P.; Boer, J.; Oostdijk, A.H.J.; van Dalen, J.A.

    2014-01-01

    Background: Guidelines for SPECT myocardial perfusion imaging (MPI) traditionally recommend a fixed tracer dose. Yet, clinical practice shows degraded image quality in heavier patients. The aim was to optimize and validate the tracer dose and scan time to obtain a constant image quality less

  19. Quantitation in Dextrocardia on myocardial perfusion imaging: how to perform quantitative analysis using Cedars-Sinai software.

    Science.gov (United States)

    Qutbi, Mohsen; Soltanshahi, Mehdi; Ansari, Mojtaba; Hashemi, Hoda; Neshandar Asli, Isa; Shafiei, Babak

    2018-01-01

    Dextrocardia, although a rare cardiac abnormality, carries the same risk for cardiac events as other people. SPECT Myocardial perfusion imaging is a potentially helpful diagnostic tool in patients with dextrocardia. Because of swapping of lateral and septal walls on SPECT slices, although visual analysis is possible, quantitation is substantially limited. Here, we introduce a simple practical method to make quantitative analysis feasible and accurate.

  20. Diagnostic value of transmural perfusion ratio derived from dynamic CT-based myocardial perfusion imaging for the detection of haemodynamically relevant coronary artery stenosis

    Energy Technology Data Exchange (ETDEWEB)

    Coenen, Adriaan; Lubbers, Marisa M.; Dedic, Admir; Chelu, Raluca G.; Geuns, Robert-Jan M. van; Nieman, Koen [Erasmus University Medical Center, Department of Radiology, Rotterdam (Netherlands); Erasmus University Medical Center, Department of Cardiology, Rotterdam (Netherlands); Kurata, Akira; Kono, Atsushi; Dijkshoorn, Marcel L. [Erasmus University Medical Center, Department of Radiology, Rotterdam (Netherlands); Rossi, Alexia [Erasmus University Medical Center, Department of Radiology, Rotterdam (Netherlands); Barts Health NHS Trust, NIHR Cardiovascular Biomedical Research Unit at Barts, William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London and Department of Cardiology, London (United Kingdom)

    2017-06-15

    To investigate the additional value of transmural perfusion ratio (TPR) in dynamic CT myocardial perfusion imaging for detection of haemodynamically significant coronary artery disease compared with fractional flow reserve (FFR). Subjects with suspected or known coronary artery disease were prospectively included and underwent a CT-MPI examination. From the CT-MPI time-point data absolute myocardial blood flow (MBF) values were temporally resolved using a hybrid deconvolution model. An absolute MBF value was measured in the suspected perfusion defect. TPR was defined as the ratio between the subendocardial and subepicardial MBF. TPR and MBF results were compared with invasive FFR using a threshold of 0.80. Forty-three patients and 94 territories were analysed. The area under the receiver operator curve was larger for MBF (0.78) compared with TPR (0.65, P = 0.026). No significant differences were found in diagnostic classification between MBF and TPR with a territory-based accuracy of 77 % (67-86 %) for MBF compared with 70 % (60-81 %) for TPR. Combined MBF and TPR classification did not improve the diagnostic classification. Dynamic CT-MPI-based transmural perfusion ratio predicts haemodynamically significant coronary artery disease. However, diagnostic performance of dynamic CT-MPI-derived TPR is inferior to quantified MBF and has limited incremental value. (orig.)

  1. Transient Receptor Potential Vanilloid 2 Regulates Myocardial Response to Exercise.

    Directory of Open Access Journals (Sweden)

    Mindi Naticchioni

    Full Text Available The myocardial response to exercise is an adaptive mechanism that permits the heart to maintain cardiac output via improved cardiac function and development of hypertrophy. There are many overlapping mechanisms via which this occurs with calcium handling being a crucial component of this process. Our laboratory has previously found that the stretch sensitive TRPV2 channels are active regulators of calcium handling and cardiac function under baseline conditions based on our observations that TRPV2-KO mice have impaired cardiac function at baseline. The focus of this study was to determine the cardiac function of TRPV2-KO mice under exercise conditions. We measured skeletal muscle at baseline in WT and TRPV2-KO mice and subjected them to various exercise protocols and measured the cardiac response using echocardiography and molecular markers. Our results demonstrate that the TRPV2-KO mouse did not tolerate forced exercise although they became increasingly exercise tolerant with voluntary exercise. This occurs as the cardiac function deteriorates further with exercise. Thus, our conclusion is that TRPV2-KO mice have impaired cardiac functional response to exercise.

  2. Prospective evaluation of a new protocol for the provisional use of perfusion imaging with exercise stress testing

    Energy Technology Data Exchange (ETDEWEB)

    Duvall, W.L. [Hartford Hospital, Division of Cardiology (Henry Low Heart Center), Hartford, CT (United States); Mount Sinai Medical Center, Division of Cardiology (Mount Sinai Heart), New York, NY (United States); Savino, John A.; Levine, Elliot J.; Croft, Lori B.; Henzlova, Milena J. [Mount Sinai Medical Center, Division of Cardiology (Mount Sinai Heart), New York, NY (United States); Hermann, Luke K. [Mount Sinai Medical Center, Department of Emergency Medicine, New York, NY (United States)

    2014-11-04

    Previous literature suggests that myocardial perfusion imaging (MPI) adds little to the prognosis of patients who exercise >10 metabolic equivalents (METs) during stress testing. With this in mind, we prospectively tested a provisional injection protocol in emergency department (ED) patients presenting for the evaluation of chest pain in which a patient would not receive an injection of radioisotope if adequate exercise was achieved without symptoms and a negative ECG response. All patients who presented to the ED over a 5-year period who were referred for stress testing as part of their ED evaluation were included. Patients considered for a provisional protocol were: exercise stress, age <65 years, no known coronary artery disease, and an interpretable rest ECG. Criteria for not injecting included a maximal predicted heart rate ≥85 %, ≥10 METs of exercise, no anginal symptoms during stress, and no ECG changes. Groups were compared based on stress test results, all-cause and cardiac mortality, follow-up cardiac testing, subsequent revascularization, and cost. A total of 965 patients were eligible with 192 undergoing exercise-only and 773 having perfusion imaging. After 41.6 ± 19.6 months of follow-up, all-cause mortality was similar in the exercise-only versus the exercise plus imaging group (2.6 % vs. 2.1 %, p = 0.59). There were no cardiac deaths in the exercise-only group. At 1 year there was no difference in the number of repeat functional stress tests (1.6 % vs. 2.1 %, p = 0.43), fewer angiograms (0 % vs. 4.0 %, p = 0.002), and a significantly lower cost (65 ± 332 vs 506 ± 1,991, p = 0.002; values are in US dollars) in the exercise-only group. The radiation exposure in the exercise plus imaging group was 8.4 ± 2.1 mSv. A provisional injection protocol has a very low mortality, few follow-up diagnostic tests, and lower cost compared to standard imaging protocols. If adopted it would decrease radiation exposure, save time and decrease health-care costs

  3. Pericardial fat and myocardial perfusion in asymptomatic adults from the Multi-Ethnic Study of Atherosclerosis.

    Directory of Open Access Journals (Sweden)

    Tina E Brinkley

    Full Text Available Pericardial fat has adverse effects on the surrounding vasculature. Previous studies suggest that pericardial fat may contribute to myocardial ischemia in symptomatic individuals. However, it is unknown if pericardial fat has similar effects in asymptomatic individuals.We determined the association between pericardial fat and myocardial blood flow (MBF in 214 adults with no prior history of cardiovascular disease from the Minnesota field center of the Multi-Ethnic Study of Atherosclerosis (43% female, 56% Caucasian, 44% Hispanic. Pericardial fat volume was measured by computed tomography. MBF was measured by MRI at rest and during adenosine-induced hyperemia. Myocardial perfusion reserve (PR was calculated as the ratio of hyperemic to resting MBF.Gender-stratified analyses revealed significant differences between men and women including less pericardial fat (71.9±31.3 vs. 105.2±57.5 cm(3, p<0.0001 and higher resting MBF (1.12±0.23 vs. 0.93±0.19 ml/min/g, p<0.0001, hyperemic MBF (3.49±0.76 vs. 2.65±0.72 ml/min/g, p<0.0001, and PR (3.19±0.78 vs. 2.93±0.89, p = 0.03 in women. Correlations between pericardial fat and clinical and hemodynamic variables were stronger in women. In women only (p = 0.01 for gender interaction higher pericardial fat was associated with higher resting MBF (p = 0.008. However, this association was attenuated after accounting for body mass index or rate-pressure product. There were no significant associations between pericardial fat and hyperemic MBF or PR after multivariate adjustment in either gender. In logistic regression analyses there was also no association between impaired coronary vasoreactivity, defined as having a PR <2.5, and pericardial fat in men (OR, 1.18; 95% CI, 0.82-1.70 or women (OR, 1.11; 95% CI, 0.68-1.82.Our data fail to support an independent association between pericardial fat and myocardial perfusion in adults without symptomatic cardiovascular disease. Nevertheless, these

  4. High-resolution myocardial perfusion imaging at 3 T: comparison to 1.5 T in healthy volunteers

    Energy Technology Data Exchange (ETDEWEB)

    Strach, K.; Meyer, C.; Thomas, D.; Naehle, C.P.; Cheng, B.; Schild, H.; Sommer, T. [University of Bonn, Department of Radiology, Bonn (Germany); Schmitz, C. [University of Bonn, Department of Cardiac Surgery, Bonn (Germany); Litt, H. [University of Pennsylvania Medical Center, Department of Radiology, Philadelphia, PA (United States); Bernstein, A. [Harvard School of Public Health, Department of Nutrition, Boston, MA (United States)

    2007-07-15

    The purpose of this study was to evaluate high-resolution (HR) myocardial first-pass perfusion in healthy volunteers at 3 T compared to a typical clinical imaging protocol at 1.5 T, with respect to overall image quality and the presence of subendocardial dark rim artifacts. Myocardial first-pass rest perfusion studies were performed at both field strengths using a T1-weighted saturation-recovery segmented k-space gradient-echo sequence combined with parallel imaging (Gd-DTPA 0.05 mmol/kg). Twenty-six healthy volunteers underwent (1) a HR perfusion scan at 3 T(pixel size 3.78 mm{sup 2}) and (2) a standard perfusion approach at 1.5 T(pixel size 9.86 mm{sup 2}). The contrast enhancement ratio (CER) and overall image quality (4-point grading scale: 4: excellent; 1: non-diagnostic) were assessed, and a semiquantitative analysis of dark rim artifacts was performed for all studies. CER was slightly higher (1.31 {+-} 0.32 vs. 1.14 {+-} 0.34; p<0.01), overall image quality was significantly improved (3.03 {+-} 0.43 vs. 2.37 {+-} 0.39; p<0.01), and the number of dark rim artifacts (139 {+-} 2.09 vs. 243 {+-} 2.33; p<0.01) was significantly reduced for HR perfusion imaging at 3 T compared to the standard approach at 1.5 T. HR myocardial rest perfusion at 3 T is superior to the typical clinical perfusion protocol performed at 1.5 T with respect to the overall image quality and presence of subendocardial dark rim artifacts. (orig.)

  5. Spatial heterogeneity of myocardial perfusion predicts local potassium channel expression and action potential duration.

    Science.gov (United States)

    Stoll, Marion; Quentin, Michael; Molojavyi, Andrej; Thämer, Volker; Decking, Ulrich K M

    2008-02-01

    In the heart, there is not only a transmural gradient of left ventricular perfusion and action potential duration (APD), but also spatial heterogeneity within each myocardial layer, where local blood flow and energy turnover vary more than three-fold between individual regions. We analysed at high spatial resolution whether a corresponding heterogeneity also extends to ion channel gene expression and APD. In the open-chest beagle dog, left ventricular 300 microL samples of very low or high flow were identified by radioactive microspheres and expression levels determined by quantitative PCR. The distribution of epicardial APD was assessed by mapping local activation repolarization intervals (ARIs) and QT interval (QT). ERG, the potassium channel mediating IKr, and KChIP2, the interacting protein modulating Ito, were increased in Low flow (3.3- and 2.5-fold, P channel expression and APD. Whenever this newly recognized intramural dispersion of APD increases, it may contribute to arrhythmogenesis.

  6. The elusive role of myocardial perfusion imaging in stable ischemic heart disease: Is ISCHEMIA the answer?

    Science.gov (United States)

    Xie, Joe X; Winchester, David E; Phillips, Lawrence M; Hachamovitch, Rory; Berman, Daniel S; Blankstein, Ron; Di Carli, Marcelo F; Miller, Todd D; Al-Mallah, Mouaz H; Shaw, Leslee J

    2017-10-01

    The assessment of ischemia through myocardial perfusion imaging (MPI) is widely accepted as an index step in the diagnostic evaluation of stable ischemic heart disease (SIHD). Numerous observational studies have characterized the prognostic significance of ischemia extent and severity. However, the role of ischemia in directing downstream SIHD care including coronary revascularization has remained elusive as reductions in ischemic burden have not translated to improved clinical outcomes in randomized trials. Importantly, selection bias leading to the inclusion of many low risk patients with minimal ischemia have narrowed the generalizability of prior studies along with other limitations. Accordingly, an ongoing randomized controlled trial entitled ISCHEMIA (International Study of Comparative Health Effectiveness with Medical and Invasive Approaches) will compare an invasive coronary revascularization strategy vs a conservative medical therapy approach among stable patients with moderate to severe ischemia. The results of ISCHEMIA may have a substantial impact on the management of SIHD and better define the role of MPI in current SIHD pathways of care.

  7. Technetium myocardial perfusion scanning in prerenal transplant evaluation in the United kingdom.

    LENUS (Irish Health Repository)

    Wong, C F

    2008-06-01

    Because death with a functioning graft remains one of the most important causes of long-term renal transplant failure, cardiac risk stratification and screening for coronary artery disease are essential components of pretransplant assessment. Pretransplant screening for occult coronary artery disease in a subset of these patients may improve outcome. The UK follows the European Best practice guideline 1.5.5 E. Although echocardiography, thallium myocardial perfusion scanning (MPS), dobutamine stress echocardiography, and coronary angiography have been suggested as means of cardiovascular assessment, the best means of assessment remains undetermined. Therefore, we investigated the role of 99m technetium sestamibi myocardial perfusion scanning as an assessment tool for identifying those patients with end-stage renal failure at high risk of cardiovascular death after renal transplantation. Retrospectively, we studied 126 patients that had a MPS as part of their pretransplant assessment. Overall unadjusted survival was 65% at 3 years. Twelve deaths resulted from cardiovascular causes. A reversible defect on MPS was associated with a fatal cardiac event and all-cause mortality. The unadjusted hazard ratio of cardiac event with reversible defect on MPS was 3.1 (95% confidence interval, 1.1 to 18.2) and hazard ratio of death with reversible defect on MPS was 1.92 (95% confidence interval, 1.1 to 4.4). Thus, MPS may be a useful tool in cardiac risk stratification and in selecting patients with a favorable outcome after renal transplantation. Our patients with a reversible defect in particular have increased cardiac mortality. This group may benefit from coronary angiography.

  8. Myocardial Perfusion in Rheumatoid Arthritis Patients: Associations with Traditional Risk Factors and Novel Biomarkers

    Directory of Open Access Journals (Sweden)

    Miguel Bernardes

    2017-01-01

    Full Text Available Introduction. Cardiovascular (CV diseases are a major cause of death in rheumatoid arthritis (RA patients. Novel biomarkers [B-type natriuretic peptide (BNP; osteoprotegerin (OPG/receptor activator of nuclear factor-kappa B ligand (RANKL ratio; and dickkopf-1 (DKK-1] have been used in CV risk assessment. We analysed, in established RA patients, the presence of silent myocardial ischemia and its association with clinical variables, BNP, and bone and atheroma biomarkers. Methods. From a single-center tertiary referral hospital, RA patients asymptomatic for CV disease were submitted to myocardial perfusion scintigraphy (MPS under adenosine stress and biomarkers measurements. Logistic regression was used to estimate crude odds ratios (OR and 95% confidence intervals (CI. Results. In 189 patients, perfusion defects were frequent (25% and associated with BNP ≥ 100 pg/mL (OR = 5.68; 95% CI: 2.038–15.830, fourth log OPG/RANKL ratio quartile (OR = 2.88; 95% CI: 1.091–7.622, and DKK-1 ≥ 133 pmol/L (OR = 2.69; 95% CI: 1.058–6.840. Similar associations were confirmed in those with C-reactive protein > or ≤ 3 mg/L. No relationship was found with the majority of traditional CV factors nor with disease variables. Conclusions. Our results corroborated the hypothesis that MPS could reveal subclinical CV dysfunction, supported the utility of BNP measurements as a screening tool, and put in perspective the potential usefulness of complementary approaches in CV risk assessment in RA patients.

  9. Subendocardial versus transmural ischaemia in myocardial perfusion SPECT--a Monte Carlo study.

    Science.gov (United States)

    Bartosik, Jolanta; El-Ali, Henrik Hussein; Nilsson, Ulf; Dahlström, Jan; Edenbrandt, Lars; Ljungberg, Michael

    2006-11-01

    Myocardial perfusion imaging with single-photon emission computed tomography (SPECT) is useful for the evaluation of patients with known or suspected coronary artery disease. Parameters of interest are the reduction in the blood perfusion (severity) and the lesion volume (extent). The aim of this study was to evaluate these parameters, as calculated by automatic quantification software, for different cases of subendocardial and transmural myocardial lesions. A computer phantom was used to simulate 32 male patients with different defect locations and activity uptakes, which were based on clinical patient studies. The Monte Carlo program SIMIND was used to simulate realistic SPECT projections which were reconstructed to give short-axis images, analysed by the AutoQUANT program using the same procedure as for a real patient. The results showed a disparity between the quantification of transmural and subendocardial lesions with the same lesion activity uptake reduction and this could be confirmed by visual interpretation. Neither the parameters given by the quantification program nor visual interpretation could distinguish between the transmural lesions and the subendocardial lesions with activity uptake reduction twice as high as in the corresponding transmural lesions. Transmural lesions and the corresponding subendocardial lesions with the same activity uptake reduction could be separated by the quantification software for SPECT imaging and visual analysis. The subendocardial lesions with activity uptake reduction twice as high as in the corresponding transmural lesions could not be differentiated neither by the quantification software nor by visual interpretation. Thus these lesions will get the same scoring when analysed by the AutoQUANT program.

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

    Science.gov (United States)

    Ramos, Susie Medeiros Oliveira; Glavam, Adriana Pereira; Kubo, Tadeu Takao Almodovar; de Sá, Lidia Vasconcellos

    2014-01-01

    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 99mTc-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. PMID:25741088

  11. Static Myocardial Perfusion Imaging using denoised dynamic Rb-82 PET/CT scans

    DEFF Research Database (Denmark)

    Petersen, Maiken N.M.; Hoff, Camilla; Harms, Hans

    . Administered 82Rb dose was 1110 MBq. Denoising using HYPR-LR or Hotelling 3D algorithms was performed as post-processing on the dynamic images series. Static series were created by summing frames from 2.5-5 min. The image data was analysed in QPET (Cedars-Sinai). Relative segmental perfusion (normalized......Introduction: Relative and absolute measures of myocardial perfusion are derived from a single 82Rb PET/CT scan. However, images are inherently noising due to the short half-life of 82Rb. We have previously shown that denoising techniques can be applied to dynamic 82Rb series with excellent...... quantitative accuracy. In this study, we examine static images created by summing late frames of denoised dynamic series. Method: 47 random clinical 82Rb stress and rest scans (27 male, age 68+/- 12 y., BMI 27.9 +/- 5.5 kg/m2) performed on a GE Discovery 690 PET/CT scanner were included in the study...

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

    Energy Technology Data Exchange (ETDEWEB)

    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)

  13. Effect of exhaustive exercise on myocardial performance.

    Science.gov (United States)

    Grimditch, G K; Barnard, R J; Duncan, H W

    1981-11-01

    Several investigators have reported ultrastructural changes in hearts of animals exercised to exhaustion. The present study was designed to determine whether functional changes occur in the intact heart at exhaustion. Adult mongrel dogs (n = 8) were chronically instrumented to measure cardiac output, coronary blood flow, aortic blood pressure, left ventricular pressure, +dP/dtmax, and -dP/dtmax. After recovery, the dogs were run to exhaustion at a constant work load, eliciting approximately 70% of maximum heart rate. The exhaustive bouts were terminated when the animals either refused or were unable to continue running, at which time their rectal temperatures approaches 42.2 degree C. The mean exhaustion time was 76.7 +/- 11.8 min. All parameters increased from rest to steady state with the exception of stroke volume (23.2 +/- 4.9 vs. 20.5 +/- 1.6 ml), which remained constant. In the transition from steady state to exhaustion, only +dP/dtmax (6,652 +/- 291 vs. 7,689 +/- 479 Torr/s) and -dP/dtmax (4,110 +/- 227 vs. 4,890 +/- 215 Torr/s) increased significantly; all other values exhibited no significant change. Similarly, when maximum cardiovascular parameters were measured before and after exhaustion, no significant changes were found. These data show that cardiac contractile function is not depressed in dogs as a result of exhaustive exercise.

  14. Cardiac screening with electrocardiography, stress echocardiography, or myocardial perfusion imaging: advice for high-value care from the American College of Physicians.

    Science.gov (United States)

    Chou, Roger

    2015-03-17

    Cardiac screening in adults with resting or stress electrocardiography, stress echocardiography, or myocardial perfusion imaging can reveal findings associated with increased risk for coronary heart disease events, but inappropriate cardiac testing of low-risk adults has been identified as an important area of overuse by several professional societies. Narrative review based on published systematic reviews; guidelines; and articles on the yield, benefits, and harms of cardiac screening in low-risk adults. Cardiac screening has not been shown to improve patient outcomes. It is also associated with potential harms due to false-positive results because they can lead to subsequent, potentially unnecessary tests and procedures. Cardiac screening is likely to be particularly inefficient in adults at low risk for coronary heart disease given the low prevalence and predictive values of testing in this population and the low likelihood that positive findings will affect treatment decisions. In this patient population, clinicians should focus on strategies for mitigating cardiovascular risk by treating modifiable risk factors (such as smoking, diabetes, hypertension, hyperlipidemia, and overweight) and encouraging healthy levels of exercise. Clinicians should not screen for cardiac disease in asymptomatic, low-risk adults with resting or stress electrocardiography, stress echocardiography, or stress myocardial perfusion imaging.

  15. Ventricular dyssynchrony assessed by gated myocardial perfusion SPECT using a geometrical approach: a feasibility study

    Energy Technology Data Exchange (ETDEWEB)

    Veen, Berlinda J. van der; Younis, Imad Al [Leiden University Medical Centre, Department of Nuclear Medicine, Leiden (Netherlands); Ajmone-Marsan, Nina; Bax, Jeroen J. [Leiden University Medical Centre, Department of Cardiology, Leiden (Netherlands); Westenberg, Jos J.M.; Roos, Albert de [Leiden University Medical Centre, Department of Radiology, Leiden (Netherlands); Stokkel, Marcel P.M. [Antoni van Leeuwenhoek Hospital, Department of Nuclear Medicine, Netherlands Cancer Institute, Amsterdam (Netherlands)

    2012-03-15

    Left ventricular dyssynchrony may predict response to cardiac resynchronization therapy and may well predict adverse cardiac events. Recently, a geometrical approach for dyssynchrony analysis of myocardial perfusion scintigraphy (MPS) was introduced. In this study the feasibility of this geometrical method to detect dyssynchrony was assessed in a population with a normal MPS and in patients with documented ventricular dyssynchrony. For the normal population 80 patients (40 men and 40 women) with normal perfusion (summed stress score {<=}2 and summed rest score {<=}2) and function (left ventricular ejection fraction 55-80%) on MPS were selected; 24 heart failure patients with proven dyssynchrony on MRI were selected for comparison. All patients underwent a 2-day stress/rest MPS protocol. Perfusion, function and dyssynchrony parameters were obtained by the Corridor4DM software package (Version 6.1). For the normal population time to peak motion was 42.8 {+-} 5.1% RR cycle, SD of time to peak motion was 3.5 {+-} 1.4% RR cycle and bandwidth was 18.2 {+-} 6.0% RR cycle. No significant gender-related differences or differences between rest and post-stress acquisition were found for the dyssynchrony parameters. Discrepancies between the normal and abnormal populations were most profound for the mean wall motion (p value <0.001), SD of time to peak motion (p value <0.001) and bandwidth (p value <0.001). It is feasible to quantify ventricular dyssynchrony in MPS using the geometrical approach as implemented by Corridor4DM. (orig.)

  16. The effects of preceding exercise on myocardial damage in rats.

    Science.gov (United States)

    Hyun, Seung Hee; Kim, Young Mi; Park, Su Jin

    2017-03-01

    [Purpose] The purpose of this study was to investigate the effects of exercise on myocardial injury in male Sprague-Dawley rats. Two groups of rats were trained with either moderate- or high-intensity treadmill running for four weeks. Subsequently, the concentrations of cardiac troponin and the N-terminal of prohormone brain natriuretic peptide (NT-proBNP) were examined following a single bout of prolonged intensive exercise (lasting 3 h). [Subjects and Methods] The study included 40 six-week-old male Sprague-Dawley rats weighing 150-180 g each. The aerobic exercise group was divided into high-intensity (28 m/min) and moderate-intensity (15 m/min) subgroups. Both subgroups were trained for 35 min daily for six days per week (excluding Sunday) over a four-week period. Following training, the high- and moderate-intensity exercise groups and a nonexercise group performed one bout of prolonged treadmill exercise for 3 h at a speed of 15 m/min. [Results] The cardiac troponin and NT-proBNP levels differed significantly between the groups. [Conclusion] The exercise groups showed lower levels of cardiac troponin and NT-proBNP than the nonexercise group after the bout of prolonged intensive exercise.

  17. Quantitative assessment of magnetic resonance derived myocardial perfusion measurements using advanced techniques: microsphere validation in an explanted pig heart system.

    Science.gov (United States)

    Schuster, Andreas; Zarinabad, Niloufar; Ishida, Masaki; Sinclair, Matthew; van den Wijngaard, Jeroen Phm; Morton, Geraint; Hautvast, Gilion Ltf; Bigalke, Boris; van Horssen, Pepijn; Smith, Nicolas; Spaan, Jos Ae; Siebes, Maria; Chiribiri, Amedeo; Nagel, Eike

    2014-10-14

    Cardiovascular Magnetic Resonance (CMR) myocardial perfusion imaging has the potential to evolve into a method allowing full quantification of myocardial blood flow (MBF) in clinical routine. Multiple quantification pathways have been proposed. However at present it remains unclear which algorithm is the most accurate. An isolated perfused, magnetic resonance (MR) compatible pig heart model allows very accurate titration of MBF and in combination with high-resolution assessment of fluorescently-labeled microspheres represents a near optimal platform for validation. We sought to investigate which algorithm is most suited to quantify myocardial perfusion by CMR at 1.5 and 3 Tesla using state of the art CMR perfusion techniques and quantification algorithms. First-pass perfusion CMR was performed in an MR compatible blood perfused pig heart model. We acquired perfusion images at physiological flow ("rest"), reduced flow ("ischaemia") and during adenosine-induced hyperaemia ("hyperaemia") as well as during coronary occlusion. Perfusion CMR was performed at 1.5 Tesla (n = 4 animals) and at 3 Tesla (n = 4 animals). Fluorescently-labeled microspheres and externally controlled coronary blood flow served as reference standards for comparison of different quantification strategies, namely Fermi function deconvolution (Fermi), autoregressive moving average modelling (ARMA), exponential basis deconvolution (Exponential) and B-spline basis deconvolution (B-spline). All CMR derived MBF estimates significantly correlated with microsphere results. The best correlation was achieved with Fermi function deconvolution both at 1.5 Tesla (r = 0.93, p < 0.001) and at 3 Tesla (r = 0.9, p < 0.001). Fermi correlated significantly better with the microspheres than all other methods at 3 Tesla (p < 0.002). B-spline performed worse than Fermi and Exponential at 1.5 Tesla and showed the weakest correlation to microspheres (r = 0.74, p < 0.001). All other comparisons

  18. {sup 99m}Tc sestamibi myocardial perfusion scintigraphy with the novel use of metamizol for the detection of perfusion reversibility

    Energy Technology Data Exchange (ETDEWEB)

    Erguen, Eser Lay; Caglar, Meltem; Bozkurt, Murat Fani [Hacettepe University, Department of Nuclear Medicine, School of Medicine, Ankara (Turkey); Erguen, Hakan [Ankara University, Department of Pharmacology and Clinical Pharmacology, Faculty of Medicine, Ankara (Turkey)

    2008-08-15

    This study aims to investigate whether induction with metamizol, an analgesic-antipyretic drug having spasmolitic activity, could be used to increase the detectability of ischemic/jeopardized myocardium during MPS (myocardial perfusion scintigraphy). Metamizol-enhanced rest MPS (45 min after administration of 1 g metamizol orally, 740 MBq {sup 99m}Tc sestamibi was injected, MPS was acquired 45 min later) was performed in 21 patients who had perfusion defects on their previous stress-rest {sup 99m}Tc sestamibi MPS. Blood pressure was monitored at 15-min intervals. Stress, rest, metamizol-rest MPS images were interpreted on the model of 20 segments using a visual uptake score (VUS; 0 = normal, 1 = mild, 2 = moderate, 3 = significant decreases, 4 = no uptake). {sup 99m}Tc sestamibi uptake ratios (MIBI-UR; mean counts in the region of the perfusion defect/mean counts in the region of the normal-perfused wall) were obtained on each MPS and compared with each other. Average MIBI-UR in each scintigraphic examination was calculated. MPS were compared with coronary angiography results. VUS and MIBI-UR results showed that metamizol-rest MPS displayed the defect reversibility better than rest MPS. Of the 14 segments with fixed perfusion defects on stress-rest MPS, 8 showed improvement of perfusion after metamizol induction. In 33 segments, lesion reversibility was better delineated on metamizol-rest MPS. Metamizol-induced sestamibi uptake was significantly higher (p < 0.001) than stress/baseline rest examinations as calculated by the MIBI-UR. Blood pressure remained unaltered. Coronary angiography results were in concordance with metamizol induced MPS. Metamizol-enhanced rest MPS increases detectability of ischemic/viable myocardium during MPS. Metamizol should be discontinued like nitrates before stress MPS since it may mask the visualization of ischemic perfusion defects. (orig.)

  19. Is myocardial stress perfusion MR-imaging suitable to predict the long term clinical outcome after revascularization?

    Energy Technology Data Exchange (ETDEWEB)

    Klumpp, B., E-mail: bernhard.klumpp@med.uni-tuebingen.de [Eberhard Karls University Tuebingen, Department for Diagnostic and Interventional Radiology, Hoppe-Seyler-Str. 3, 72076 Tuebingen (Germany); Seeger, A., E-mail: achim.seeger@med.uni-tuebingen.de [Eberhard Karls University Tuebingen, Department for Diagnostic and Interventional Radiology, Hoppe-Seyler-Str. 3, 72076 Tuebingen (Germany); Bretschneider, C., E-mail: christiane.bretschneider@med.uni-tuebingen.de [Eberhard Karls University Tuebingen, Department for Diagnostic and Interventional Radiology, Hoppe-Seyler-Str. 3, 72076 Tuebingen (Germany); Mangold, S., E-mail: stephanie.mangold@med.uni-tuebingen.de [Eberhard Karls University Tuebingen, Department for Diagnostic and Interventional Radiology, Hoppe-Seyler-Str. 3, 72076 Tuebingen (Germany); Krumm, P., E-mail: patrick.krumm@med.uni-tuebingen.de [Eberhard Karls University Tuebingen, Department for Diagnostic and Interventional Radiology, Hoppe-Seyler-Str. 3, 72076 Tuebingen (Germany); Miller, S., E-mail: Miller@radiologie-tue.de [Eberhard Karls University Tuebingen, Department for Diagnostic and Interventional Radiology, Hoppe-Seyler-Str. 3, 72076 Tuebingen (Germany); Claussen, C.D., E-mail: claus.claussen@med.uni-tuebingen.de [Eberhard Karls University Tuebingen, Department for Diagnostic and Interventional Radiology, Hoppe-Seyler-Str. 3, 72076 Tuebingen (Germany); Gawaz, M.P., E-mail: meinrad.gawaz@med.uni-tuebingen.de [Eberhard Karls University Tuebingen, Department for Cardiology, Ottfried-Mueller-Str. 10, 72076 Tuebingen (Germany); May, A.E., E-mail: andreas.may@med.uni-tuebingen.de [Eberhard Karls University Tuebingen, Department for Cardiology, Ottfried-Mueller-Str. 10, 72076 Tuebingen (Germany); Kramer, U., E-mail: ulrich.kramer@med.uni-tuebingen.de [Eberhard Karls University Tuebingen, Department for Diagnostic and Interventional Radiology, Hoppe-Seyler-Str. 3, 72076 Tuebingen (Germany)

    2013-10-01

    Introduction: Aim of our study was to evaluate, whether myocardial ischemia or myocardial infarction (MI) depicted by myocardial stress perfusion MR imaging (SP CMR) can predict the clinical outcome in patients with coronary artery disease (CAD). Materials and method: 220 patients were included. Myocardial perfusion was assessed at stress and at rest, using a 2D saturation recovery gradient echo sequence (SR GRE) and myocardial viability by late gadolinium enhancement magnetic resonance images (LGE CMR). MR-images were assessed in regard of presence and extent of MI and ischemia. Patients were monitored for major adverse cardiac events (MACE) (monitoring period: 5–7 years). MACE were correlated with the initial results of SP CMR. Results: Ischemia was found in 143 patients, MI in 107 patients. Number of MACE was in patients with normal SP CMR 0 (51 patients), with ischemia 21 (62 patients), with MI 14 (26 patients), with ischemia and MI 52 (81 patients). In all patients with severe MACE (MI, death) and in 63 of those with recurring symptoms LGE CMR revealed MI at baseline. Conclusion: Negative SP CMR indicates low risk for MACE. In patients with stress induced ischemia, MACE might occur even after myocardial revascularization. The presence of MI proved by LGE CMR is associated with a significantly increased risk for MACE.

  20. Noninvasive quantification of myocardial perfusion heterogeneity by Markovian analysis in SPECT nuclear imaging; Quantification non invasive de l'heterogeneite de la perfusion du myocarde par analyse markovienne en imageries nucleaire SPECT

    Energy Technology Data Exchange (ETDEWEB)

    Pons, G.

    2011-04-28

    Cardiovascular diseases are the leading cause of mortality worldwide, and third of these deaths are caused by coronary artery disease and rupture of vulnerable atherosclerotic plaques. The heterogeneous alteration of the coronary microcirculation is an early phenomenon associated with many cardiovascular risk factors that can strongly predict the subsequent development of coronary artery disease, and lead to the appearance of myocardial perfusion heterogeneity. Nuclear medicine allows the study of myocardial perfusion in clinical routine through scintigraphic scans performed after injection of a radioactive tracer of coronary blood flow. Analysis of scintigraphic perfusion images currently allows the detection of myocardial ischemia, but the ability of the technique to measure the perfusion heterogeneity in apparently normally perfused areas is unknown. The first part of this thesis focuses on a retrospective clinical study to determine the feasibility of myocardial perfusion heterogeneity quantification measured by Thallium-201 single photon emission computed tomography (SPECT) in diabetic patients compared with healthy subjects. The clinical study has demonstrated the ability of routine thallium-201 SPECT imaging to quantify greater myocardial perfusion heterogeneity in diabetic patients compared with normal subjects. The second part of this thesis tests the hypothesis that the myocardial perfusion heterogeneity could be quantified in small animal SPECT imaging by Thallium-201 and/or Technetium-99m-MIBI in an experimental study using two animal models of diabetes, and is correlated with histological changes. The lack of difference in myocardial perfusion heterogeneity between control and diabetic animals suggests that animal models are poorly suited, or that the technology currently available does not seem satisfactory to obtain similar results as the clinical study. (author)

  1. [Regadenoson as a new stress agent in myocardial perfusion imaging. Initial experience in The Netherlands].

    Science.gov (United States)

    Jager, P L; Buiting, M; Mouden, M; Oostdijk, A H J; Timmer, J; Knollema, S

    2014-01-01

    Regadenoson is a recently approved selective adenosine-2A receptor agonist to induce pharmacological stress in myocardial perfusion imaging (MPI) procedures using a single bolus injection. We included 123 patients referred for MPI because of suspected coronary arterial disease (CAD). Of these, 66 patients underwent a regadenoson stress test and 57 patients underwent an adenosine stress test preceding standard myocardial SPECT imaging. Technicians, physicians and patients were asked to report their experience using questionnaires. As compared to adenosine, regadenoson did not produce any atrio-ventricular block (0 vs. 10% with adenosine), but did produce minor tachycardia and minimal blood pressure changes while all other side effects were milder and shorter. There were fewer patients with severe complaints after taking regadenoson than adenosine (17% vs. 32%, respectively, p<0.01). The most frequent complaint reported was dyspnea, followed by flushing and chest pain. However, when they did occur, they usually disappeared rapidly. The overall symptom score, including severity and duration of side effects, was significantly lower after regadenoson than after adenosine (6.7±6.3 vs. 10.0±7.9, respectively; p<0.01.) SPECT imaging results were similar. The regadenoson procedure was faster and more practical. Regadenoson, the new selective adenosine-2A receptor agonist, is a stress agent for MPI with a patient- and department friendly profile. Copyright © 2014 Elsevier España, S.L.U. and SEMNIM. All rights reserved.

  2. EANM procedural guidelines for radionuclide myocardial perfusion imaging with SPECT and SPECT/CT: 2015 revision

    Energy Technology Data Exchange (ETDEWEB)

    Verberne, Hein J.; Eck-Smit, Berthe L.F. van; Wit, Tim C. de [University of Amsterdam, Department of Nuclear Medicine, F2-238, Academic Medical Center, Amsterdam (Netherlands); Acampa, Wanda [National Council of Research, Institute of Biostructures and Bioimaging, Naples (Italy); Anagnostopoulos, Constantinos [Academy of Athens, Center for Experimental Surgery, Clinical and Translational Research, Biomedical Research Foundation, Athens (Greece); Ballinger, Jim [Guy' s Hospital - Guy' s and St Thomas' Trust Foundation, Department of Nuclear Medicine, London (United Kingdom); Bengel, Frank [Hannover Medical School, Department of Nuclear Medicine, Hannover (Germany); Bondt, Pieter De [OLV Hospital, Department of Nuclear Medicine, Aalst (Belgium); Buechel, Ronny R.; Kaufmann, Philip A. [University Hospital Zurich, Cardiac Imaging, Zurich (Switzerland); Cuocolo, Alberto [University Federico II, Department of Advanced Biomedical Sciences, Naples (Italy); Flotats, Albert [Universitat Autonoma de Barcelona, Nuclear Medicine Department, Hospital de la Santa Creu i Sant Pau, Barcelona (Spain); Hacker, Marcus [Medical University of Vienna, Division of Nuclear Medicine, Department of Biomedical Imaging and Image-Guided Therapy, Vienna (Austria); Hindorf, Cecilia [Skaane University Hospital, Department of Radiation Physics, Lund (Sweden); Lindner, Oliver [University Hospital of the Ruhr-University Bochum, Heart and Diabetes Center North Rhine-Westphalia, Institute for Radiology, Nuclear Medicine and Molecular Imaging, Bad Oeynhausen (Germany); Ljungberg, Michael [Lund University, Department of Medical Radiation Physics, Lund (Sweden); Lonsdale, Markus [Bispebjerg Hospital, Department of Clinical Physiology and Nuclear Medicine, Copenhagen (Denmark); Manrique, Alain [Caen University Hospital, Department of Nuclear Medicine, Service Commun Investigations chez l' Homme, GIP Cyceron, Caen (France); Minarik, David [Skaane University Hospital, Radiation Physics, Malmoe (Sweden); Scholte, Arthur J.H.A. [Leiden University Medical Center, Department of Cardiology, Leiden (Netherlands); Slart, Riemer H.J.A. [University of Groningen, University Medical Center Groningen, Department of Nuclear Medicine and Molecular Imaging, Groningen (Netherlands); Traegaardh, Elin [Skaane University Hospital and Lund University, Clinical Physiology and Nuclear Medicine, Malmoe (Sweden); Hesse, Birger [University Hospital of Copenhagen, Department of Clinical Physiology and Nuclear Medicine and PET, Rigshospitalet, Copenhagen (Denmark)

    2015-11-15

    Since the publication of the European Association of Nuclear Medicine (EANM) procedural guidelines for radionuclide myocardial perfusion imaging (MPI) in 2005, many small and some larger steps of progress have been made, improving MPI procedures. In this paper, the major changes from the updated 2015 procedural guidelines are highlighted, focusing on the important changes related to new instrumentation with improved image information and the possibility to reduce radiation exposure, which is further discussed in relation to the recent developments of new International Commission on Radiological Protection (ICRP) models. Introduction of the selective coronary vasodilator regadenoson and the use of coronary CT-contrast agents for hybrid imaging with SPECT/CT angiography are other important areas for nuclear cardiology that were not included in the previous guidelines. A large number of minor changes have been described in more detail in the fully revised version available at the EANM home page: http://eanm.org/ publications/guidelines/2015{sub 0}7{sub E}ANM{sub F}INAL myocardial{sub p}erfusion{sub g}uideline.pdf. (orig.)

  3. High-resolution myocardial stress perfusion at 3 T in patients with suspected coronary artery disease

    Energy Technology Data Exchange (ETDEWEB)

    Meyer, Carsten; Strach, Katharina; Thomas, Daniel; Naehle, Claas P.; Schwenger, Ulrich; Schild, Hans H.; Sommer, Torsten [University of Bonn, Department of Radiology, Bonn (Germany); Litt, Harold [University of Pennsylvania Medical Center, Department of Radiology, Philadelphia (United States); Tiemann, Klaus [University of Bonn, Department of Cardiology, Bonn (United States)

    2008-02-15

    To implement a high-resolution first-pass myocardial perfusion imaging protocol (HRPI) at 3 T, and to evaluate the feasibility, image quality and accuracy of this approach prospectively in patients with suspected CAD. We hypothesized that utilizing the gain in SNR at 3 T to increase spatial resolution would reduce partial volume effects and subendocardial dark rim artifacts in comparison to 1.5 T. HRPI studies were performed on 60 patients using a segmented k-space gradient echo sequence (in plane resolution 1.97 x 1.94 mm{sup 2}). Semiquantitative assessment of dark rim artifacts was performed for the stress studies on a slice-by-slice basis. Qualitative visual analysis was compared to quantitative coronary angiography (QCA) results; hemodynamically significant CAD was defined as stenosis {>=}70% at QCA. Dark rim artifacts appeared in 108 of 180 slices (average extent 1.3 {+-} 1.2 mm representing 11.8 {+-} 10.8% of the transmural myocardial thickness). Sensitivity, specifity, and test accuracy for the detection of significant CAD were 89%,79%, and 85%. HRPI studies at 3 T are feasible in a clinical setting, providing good image quality and high accuracy for detection of significant CAD. The presence of dark rim artifacts does not appear to represent a diagnostic problem when using a HRPI approach. (orig.)

  4. Correlation of angina pectoris and perfusion decrease by collateral circulation in single-vessel coronary chronic total occlusion using myocardial perfusion single-photon emssion computed tomography

    Energy Technology Data Exchange (ETDEWEB)

    Cho, Sang Geon; Park, Ki Seong; Kang, Sae Ryung [Chonnam National University Hospital, Gwangju (Korea, Republic of); and others

    2016-03-15

    To evaluate the perfusion decrease in donor myocardium by collateral circulation and its correlation with angina pectoris in patients with chronic total occlusion (CTO) using myocardial perfusion single-photon emission computed tomography (MPS). Thirty-six patients with single-vessel CTO without any other stenosis were included. All patients underwent MPS and coronary angiography (CAG) within 2 months. Total 72 donor arteries were evaluated for the grades of collaterals to the CTO artery using the Rentrop grading system on CAG. Perfusion defects and perfusion scores in donor and CTO territories were analyzed on MPS. Myocardial perfusion of donor and CTO territories were evaluated according to the presence of angina pectoris and the grades of collateral circulation. When the CTO territory was ischemic, symptomatic patients showed higher summed difference scores in the CTO territory compared to asymptomatic patients (3.5 ± 2.4 vs. 1.5 ± 0.8 for symptomatic and asymptomatic groups respectively; p = 0.034). However, when the CTO territory was nonischemic, symptomatic patients showed higher summed stress scores (SSS, 4.3 ± 2.9 vs. 1.6 ± 1.2; p = 0.032) and summed rest scores (SRS, 4.2 ± 2.5 vs. 1.5 ± 1.1; p = 0.003) in the donor territories. On the per-vessel analysis, perfusion defects in donor territories were more frequent (0 % vs. 53 % vs. 86 % for Rentrop 0, Rentrop 1–2 and Rentrop 3, respectively; p < 0.001) and showed higher SSS (0.0 ± 0.0, 1.3 ± 1.6 and 2.1 ± 1.1 for Rentrop 0, Rentrop 1–2 and Rentrop 3, respectively; p = 0.001) and SRS (0.0 ± 0.0, 1.0 ± 1.4 and 1.7 ± 1.2; p = 0.003) at higher Rentrop grades, but their patterns were variable. Angina pectoris was related to either ischemia of the myocardium beyond CTO or a perfusion decrease in the donor myocardium. The perfusion decrease in donor myocardium positively correlated with the collateral grades.

  5. Attenuation correction in myocardial perfusion SPECT/CT: effects of misregistration and value of reregistration.

    Science.gov (United States)

    Goetze, Sibyll; Brown, Tracy L; Lavely, William C; Zhang, Zhe; Bengel, Frank M

    2007-07-01

    The accuracy of myocardial perfusion SPECT improves with attenuation correction. Algorithms for attenuation correction in hybrid SPECT/CT systems have the potential for misregistration of emission and transmission scans because CT and SPECT are obtained sequentially. Misregistration will influence regional tracer distribution and may reduce diagnostic accuracy. This study focused on the role of misregistration in cardiac SPECT/CT and the performance of a software-based approach for reregistration. We included 105 consecutive patients who underwent clinical myocardial perfusion imaging on a SPECT/CT system. Images were quantitatively assessed for misregistration using fusion software. Results were recorded in millimeters in the x-, y-, and z-axes. Regional tracer uptake in 6 segments (anterior, septal, inferior, lateral, anteroapical, and inferoapical) for noncorrected and attenuation-corrected images before and after reregistration was obtained from polar maps. To determine the relative influence of misregistration, we correlated individual differences between noncorrected and attenuation-corrected images, as well as between attenuation-corrected images before and after reregistration, with the degree of misregistration in a multivariate analysis including additional clinical variables such as sex and body weight. The difference in regional radiotracer uptake was significant between noncorrected and attenuation-corrected images in all 6 segments and was most pronounced in the inferior wall. On multivariate analysis, misregistration contributed significantly to changes in radiotracer distribution in the anterior (P = 0.038), septal (P = 0.011), and inferior (P = 0.006) segments. The mean misregistration was 8.6 +/- 3.8 mm (1.25 +/- 0.55 pixel). Misregistration of one or more pixels was observed in 64% of studies. Reregistration of misalignment significantly affected regional radiotracer distribution in the segments shown to be influenced by misregistration

  6. Dietary red palm oil supplementation reduces myocardial infarct size in an isolated perfused rat heart model

    Directory of Open Access Journals (Sweden)

    Esterhuyse Adriaan J

    2010-06-01

    Full Text Available Abstract Background and Aims Recent studies have shown that dietary red palm oil (RPO supplementation improves functional recovery following ischaemia/reperfusion in isolated hearts. The main aim of this study was to investigate the effects of dietary RPO supplementation on myocardial infarct size after ischaemia/reperfusion injury. The effects of dietary RPO supplementation on matrix metalloproteinase-2 (MMP2 activation and PKB/Akt phosphorylation were also investigated. Materials and methods Male Wistar rats were divided into three groups and fed a standard rat chow diet (SRC, a SRC supplemented with RPO, or a SRC supplemented with sunflower oil (SFO, for a five week period, respectively. After the feeding period, hearts were excised and perfused on a Langendorff perfusion apparatus. Hearts were subjected to thirty minutes of normothermic global ischaemia and two hours of reperfusion. Infarct size was determined by triphenyltetrazolium chloride staining. Coronary effluent was collected for the first ten minutes of reperfusion in order to measure MMP2 activity by gelatin zymography. Results Dietary RPO-supplementation decreased myocardial infarct size significantly when compared to the SRC-group and the SFO-supplemented group (9.1 ± 1.0% versus 30.2 ± 3.9% and 27.1 ± 2.4% respectively. Both dietary RPO- and SFO-supplementation were able to decrease MMP2 activity when compared to the SRC fed group. PKB/Akt phosphorylation (Thr 308 was found to be significantly higher in the dietary RPO supplemented group when compared to the SFO supplemented group at 10 minutes into reperfusion. There was, however, no significant changes observed in ERK phosphorylation. Conclusions Dietary RPO-supplementation was found to be more effective than SFO-supplementation in reducing myocardial infarct size after ischaemia/reperfusion injury. Both dietary RPO and SFO were able to reduce MMP2 activity, which suggests that MMP2 activity does not play a major role in

  7. Effect of intracoronary injection of tirofiban combined with anisodamine on myocardial perfusion in patients with STEMI after PCI

    Directory of Open Access Journals (Sweden)

    Xiao-Gang Zhu

    2016-10-01

    Full Text Available Objective: To analyze the effect of intracoronary injection of tirofiban combined with anisodamine on myocardial perfusion in patients with STEMI after PCI. Methods: A total of 78 patients with acute ST segment elevation myocardial infarction (STEMI who received PCI therapy in our hospital were randomly divided into control group and observation group, control group accepted routine PCI treatment, observation group received intracoronary injection of tirofiban and anisodamine in PCI, and myocardial perfusion of two groups was compared. Results: QRS duration values of observation group the instant after PCI and 4h after PCI were less than those of control group (P<0.05; 99mTc-MIBI and 18F-FDG intake of observation group after PCI were more than those of control group (P<0.05; serum MCP-1, sFas, Copeptin, OPN and vWF levels of observation group 4 h after PCI were lower than those of control group (P<0.05. Conclusions: Intracoronary injection of tirofiban combined with anisodamine can optimize myocardial perfusion in patients with STEMI after PCI, and has positive clinical significance.

  8. An empirical method for reducing variability and complexity of myocardial perfusion quantification by dual bolus cardiac MRI.

    Science.gov (United States)

    Chatterjee, Neil; Benefield, Brandon C; Harris, Kathleen R; Fluckiger, Jacob U; Carroll, Timothy; Lee, Daniel C

    2017-06-01

    Myocardial perfusion can be quantified using the "dual bolus" technique, which uses two separate contrast boluses to avoid signal nonlinearity in the blood pool. This technique relies on knowing the precise ratio of contrast concentrations between the two boluses. In this study, we investigated the variability found in these ratios, as well as the error it introduces, and developed a method for correction. Five dogs received dual bolus myocardial perfusion MRI scans. Perfusion was calculated separately using assumed contrast dilution ratios and empirically determined contrast ratios. Perfusion was compared with reference standard fluorescent microspheres. The same technique was then applied to a cohort of six patients with no significant coronary artery stenosis by cardiac catheterization. Assumed contrast dilution ratios were 10:1 for all animal and patient scans. Empirically derived contrast ratios were significantly different for animal (8.51:1 ± 1.53:1, P empirically derived ratios for animal scans improved correlation with microspheres from 0.84 to 0.90 (P Empirically deriving the correct ratio is feasible and improves the accuracy of quantitative perfusion measurements. Magn Reson Med 77:2347-2355, 2017. © 2016 International Society for Magnetic Resonance in Medicine. © 2016 International Society for Magnetic Resonance in Medicine.

  9. MRI-assisted dual motion correction for myocardial perfusion defect detection in PET imaging.

    Science.gov (United States)

    Wang, Xinhui; Rahmim, Arman; Tang, Jing

    2017-09-01

    Myocardial perfusion (MP) PET imaging is a powerful tool in risk assessment and stratification of patients with coronary artery disease. Involuntary organ motion degrades cardiac PET image resolution, while respiratory and/or cardiac gating to freeze the motion leads to noisier reconstructed images due to reduced counts in the gated frames. In this work, we propose an MRI-assisted dual motion correction method to compensate for respiratory and cardiac motion in MP PET data and study the impact of dual motion correction on MP defect detection using systematically designed experiments. The proposed dual motion correction method addresses the respiratory motion before correcting the cardiac motion among the respiratory motion corrected cardiac gates. The respiratory motion is estimated from the respiratory-gated only PET images and compensated within a 4D motion-incorporated image reconstruction algorithm. The cardiac motion is then corrected using the motion vector fields estimated from the corresponding cardiac-gated MR images. To evaluate the proposed method, we performed experiments using the standard XCAT phantom and two individual-specific volunteer XCAT phantoms. For each of the three phantoms, we simulated four dual-gated Rb-82 MP PET imaging datasets, one with normal perfusion and the other three with 50% nontransmural, 75% nontransmural, and transmural regionally reduced perfusion. The corresponding cardiac-gated MR images were simulated by the SIMRI simulator, with the sequence specified to be 3D T1-weighted as used in a protocol of a clinical PET/MRI scanner. We quantitatively evaluated the reconstructed images with no motion correction, only respiratory motion correction and dual motion correction, in terms of the myocardium to blood pool contrast and the trade-off between the noise and the normal to defect contrast. Using the channelized Hotelling observer, we performed receiver operating characteristic analysis for the task of detecting perfusion

  10. Myocardial perfusion magnetic resonance imaging using sliding-window conjugate-gradient HYPR methods in canine with stenotic coronary arteries.

    Science.gov (United States)

    Ge, Lan; Kino, Aya; Lee, Daniel; Dharmakumar, Rohan; Carr, James C; Li, Debiao

    2010-01-01

    First-pass perfusion magnetic resonance imaging (MRI) is a promising technique for detecting ischemic heart disease. However, the diagnostic value of the method is limited by the low spatial coverage, resolution, signal-to-noise ratio (SNR), and cardiac motion-related image artifacts. A combination of sliding window and conjugate-gradient HighlY constrained back-PRojection reconstruction (SW-CG-HYPR) method has been proposed in healthy volunteer studies to reduce the acquisition window for each slice while maintaining the temporal resolution of 1 frame per heartbeat in myocardial perfusion MRI. This method allows for improved spatial coverage, resolution, and SNR. In this study, we use a controlled animal model to test whether the myocardial territory supplied by a stenotic coronary artery can be detected accurately by SW-CG-HYPR perfusion method under pharmacological stress. Results from 6 mongrel dogs (15-25 kg) studies demonstrate the feasibility of SW-CG-HYPR to detect regional perfusion defects. Using this method, the acquisition time per cardiac cycle was reduced by a factor of 4, and the spatial coverage was increased from 2 to 3 slices to 6 slices as compared with the conventional techniques including both turbo-Fast Low Angle Short (FLASH) and echoplanar imaging (EPI). The SNR of the healthy myocardium at peak enhancement with SW-CG-HYPR (12.68 ± 2.46) is significantly higher (P < 0.01) than the turbo-FLASH (8.65 ± 1.93) and EPI (5.48 ± 1.24). The spatial resolution of SW-CG-HYPR images is 1.2 × 1.2 × 8.0 mm, which is better than the turbo-FLASH (1.8 × 1.8 × 8.0 mm) and EPI (2.0 × 1.8 × 8.0 mm). Sliding-window CG-HYPR is a promising technique for myocardial perfusion MRI. This technique provides higher image quality with respect to significantly improved SNR and spatial resolution of the myocardial perfusion images, which might improve myocardial perfusion imaging in a clinical setting.

  11. Quantification of myocardial perfusion using cardiac magnetic resonance imaging correlates significantly to rubidium-82 positron emission tomography in patients with severe coronary artery disease

    DEFF Research Database (Denmark)

    Qayyum, Abbas A; Hasbak, Philip; Larsson, Henrik B W

    2014-01-01

    INTRODUCTION: Aim was to compare absolute myocardial perfusion using cardiac magnetic resonance imaging (CMRI) based on Tikhonov's procedure of deconvolution and rubidium-82 positron emission tomography (Rb-82 PET). MATERIALS AND METHODS: Fourteen patients with coronary artery stenosis underwent ...

  12. High spatial resolution myocardial perfusion imaging during high dose dobutamine/atropine stress magnetic resonance using k-t SENSE.

    Science.gov (United States)

    Gebker, R; Jahnke, C; Manka, R; Frick, M; Hucko, T; Kozerke, S; Schnackenburg, B; Fleck, E; Paetsch, I

    2012-07-26

    To prospectively evaluate the feasibility and diagnostic accuracy of high spatial resolution myocardial perfusion imaging during high dose dobutamine/atropine stress magnetic resonance (DSMR) for the detection of coronary artery disease (CAD). DSMR-wall motion was combined with perfusion imaging (DSMR-perfusion) in 78 patients prior to clinically indicated invasive coronary angiography. For DSMR-perfusion an in-plane spatial resolution of 1.5 × 1.5mm(2) was attained by using 8 × k-space and time sensitivity encoding (k-t SENSE). Image quality and extent of artifacts during perfusion imaging were evaluated. Wall motion and perfusion data were interpreted sequentially. Significant CAD (stenosis ≥ 70%) was present in 52 patients and involved 86 coronary territories. One patient did not reach target heart rate despite maximum infusion of dobutamine/atropine. Two studies (3%) were non-diagnostic due k-t SENSE related artifacts resulting from insufficient breathhold capability. Overall image quality was good. Dark-rim artifacts were limited to the endocardial border at a mean width of 1.8mm. The addition of DSMR-perfusion to DSMR-wall motion data improved sensitivity for the detection of CAD (92% vs. 81%, P=0.03) and accurate determination of disease extent (85% vs. 66% of territories, Pspatial resolution DSMR-perfusion imaging at maximum stress level was feasible, improved sensitivity over DSMR-wall motion for the detection of CAD and allowed an accurate determination of disease extent. Specificity of DSMR-perfusion with k-t SENSE improved compared to prior studies using lower spatial resolution. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

  13. Prediction of long-term (> 10 year) cardiovascular outcomes in heart transplant recipients: Value of stress technetium-99m tetrofosmin myocardial perfusion imaging.

    Science.gov (United States)

    Veenis, Jesse F; Boiten, Hendrik J; van den Berge, Jan C; Caliskan, Kadir; Maat, Alex P W M; Valkema, Roelf; Constantinescu, Alina A; Manintveld, Olivier C; Zijlstra, Felix; van Domburg, Ron T; Schinkel, Arend F L

    2017-11-07

    Myocardial perfusion imaging (MPI) using single-photon emission computed tomography (SPECT) is useful in the evaluation of cardiac allograft vasculopathy (CAV) in heart transplant (HTx) recipients. The current study evaluated the long-term prognostic value of stress SPECT MPI for predicting all-cause mortality and cardiac events in HTx recipients. The study population consisted of 166 HTx recipients (mean age 54 ± 10 years, 84% male) who underwent exercise or dobutamine stress (99m)Tc-tetrofosmin SPECT MPI for the assessment of CAV. An abnormal SPECT MPI was defined as the presence of a fixed or a reversible perfusion defect. Endpoints were all-cause mortality, cardiac mortality, and non-fatal myocardial infarction (MI). MPI abnormalities were detected in 55 patients (33%), including fixed defects in 28 patients (17%), partially reversible in 17 patients (10%), and completely reversible defects in 10 patients (6%). During a median follow-up of 12.8 years (range 0-15, mean follow-up 9.5 years), 109 (66%) patients died (all-cause mortality), of which 67 (40%) were due to cardiac causes. A total of 5 (3%) patients experienced a non-fatal MI. HTx recipients with a normal stress (99m)Tc-tetrofosmin SPECT MPI had a significantly better prognosis as compared with those with an abnormal study, up to 5 years after the initial test. The presence of a reversible perfusion defect was a significant predictor of all-cause mortality, cardiac mortality, and major cardiac events, during the entire follow-up period. Stress (99m)Tc-tetrofosmin SPECT MPI provides valuable prognostic information for the prediction of long-term outcome in HTx recipients. Patients with a normal stress (99m)Tc-tetrofosmin SPECT MPI have a significantly better prognosis as compared with those with an abnormal study, up to 5 years after initial testing.

  14. Effect of verapamil on myocardial ischemia in patients with hypertrophic cardiomyopathy; Evaluation by exercise [sup 201]Tl SPECT

    Energy Technology Data Exchange (ETDEWEB)

    Taniguchi, Yoko; Sugihara, Hiroki; Ootsuki, Katsuichi (Kyoto Prefectural Univ. of Medicine (Japan)) (and others)

    1993-01-01

    Effect of verapamil on myocardial ischemia in patients with hypertrophic cardiomyopathy (HCM) was evaluated by exercise stress myocardial [sup 201]Tl SPECT (EX-Tl). EX-Tl was performed before and after 8.8 weeks of oral verapamil (240 mg/day) in 12 patients with HCM who showed transient [sup 201]Tl perfusion defects under control conditions. [sup 201]Tl perfusion defect was visually scored and judged for 4 grades as normal (0), mild defect (1), moderate defect (2), and severe defect (3). Transient dilation index (TDI) was calculated as an index of subendocardial ischemia. Improvements of defect score were demonstrated in 10 patients after administration of verapamil. Two patients showed no change of defect score. Mean defect score decreased significantly from 5.50 to 3.03 (p<0.001). Although 11 of 12 patients showed abnormal TDI under control conditions, 10 of these revealed improvements of TDI and 7 of the 10 disclosed normal TDI after verapamil. Mean TDI decreased from 1.263 to 1.090 significantly (p<0.01). In conclusion, verapamil may improve myocardial ischemia in patients with HCM. (author).

  15. Incremental value of myocardial perfusion over coronary angiography by spectral computed tomography in patients with intermediate to high likelihood of coronary artery disease

    Energy Technology Data Exchange (ETDEWEB)

    Carrascosa, Patricia M., E-mail: investigacion@diagnosticomaipu.com.ar; Deviggiano, Alejandro; Capunay, Carlos; Campisi, Roxana; López Munain, Marina de; Vallejos, Javier; Tajer, Carlos; Rodriguez-Granillo, Gaston A.

    2015-04-15

    Highlights: •We evaluated myocardial perfusion by dual energy computed tomography (DECT). •We included patients with intermediate to high likelihood of coronary artery disease. •Stress myocardial perfusion by DECT had a reliable accuracy for the detection of ischemia. •Stress myocardial perfusion with DECT showed an incremental value over anatomical evaluation. •DECT imaging was associated to a significant reduction in radiation dose compared to SPECT. -- Abstract: Purpose: We sought to explore the diagnostic performance of dual energy computed tomography (DECT) for the evaluation of myocardial perfusion in patients with intermediate to high likelihood of coronary artery disease (CAD). Materials and methods: Consecutive patients with known or suspected CAD referred for myocardial perfusion imaging by single-photon emission computed tomography (SPECT) constituted the study population and were scanned using a DECT scanner equipped with gemstone detectors for spectral imaging, and a SPECT. The same pharmacological stress was used for both scans. Results: Twenty-five patients were prospectively included in the study protocol. The mean age was 63.4 ± 10.6 years. The total mean effective radiation dose was 7.5 ± 1.2 mSv with DECT and 8.2 ± 1.7 mSv with SPECT (p = 0.007). A total of 425 left ventricular segments were evaluated by DECT, showing a reliable accuracy for the detection of reversible perfusion defects [area under ROC curve (AUC) 0.84 (0.80–0.87)]. Furthermore, adding stress myocardial perfusion provided a significant incremental value over anatomical evaluation alone by computed tomography coronary angiography [AUC 0.70 (0.65–0.74), p = 0.003]. Conclusions: In this pilot investigation, stress myocardial perfusion by DECT demonstrated a significant incremental value over anatomical evaluation alone by CTCA for the detection of reversible perfusion defects.

  16. Endocardial-epicardial distribution of myocardial perfusion reserve assessed by multidetector computed tomography in symptomatic patients without significant coronary artery disease

    DEFF Research Database (Denmark)

    Kühl, Jørgen Tobias; George, Richard T; Mehra, Vishal C

    2016-01-01

    (MPR) in humans. We aimed to test the hypothesis that MPR in all myocardial layers is determined by age, gender, and cardiovascular risk profile in patients with ischaemic symptoms or equivalent but without obstructive coronary artery disease (CAD). METHODS AND RESULTS: A total of 149 patients enrolled...... in endocardial-epicardial distribution of perfusion reserve may be demonstrated with static CT perfusion. Low MPR in all myocardial layers was observed specifically in obese patients....

  17. An investigation of skin perfusion in venous leg ulcer after exercise.

    Science.gov (United States)

    Mutlak, Omar; Aslam, Mohammed; Standfield, Nigel J

    2018-01-01

    A venous leg ulcer (VLU) has a major impact on the quality of life and functional ability of individuals, but no single treatment is yet effective. This study investigates the changes induced by dorsiflexion exercise on skin perfusion in VLU patients to achieve a better understanding of venous ulcer pathophysiology. Seventy-eight venous leg ulcer patients were randomised into four groups. The non-exercise groups included a control group (n = 18) and a compression therapy group (n = 20) and the exercise groups included an exercise-only group (n = 20) and a compression and exercise group (n = 20). The exercise groups were expected to perform exercise for three months. Measurements included transcutaneous oximetry (tcPO 2 ) and laser Doppler flowmetry (LDF). Skin perfusion measurements for all groups were taken twice: at the beginning and end of the three-month period. Initially, all participants showed a low level of tcPO 2 . The exercise groups showed a significant increase after three months of exercise (pvenous leg ulcer and this effect may play a role in understanding the pathophysiology of VLU.

  18. Glycopyrrolate abolishes the exercise-induced increase in cerebral perfusion in humans

    DEFF Research Database (Denmark)

    Seifert, Thomas; Fisher, James P; Young, Colin N

    2010-01-01

    Brain blood vessels contain muscarinic receptors that are important for cerebral blood flow (CBF) regulation, but whether a cholinergic receptor mechanism is involved in the exercise-induced increase in cerebral perfusion or affects cerebral metabolism remains unknown. We evaluated CBF and cerebral...

  19. Cerebral perfusion, oxygenation and metabolism during exercise in young and elderly individuals

    NARCIS (Netherlands)

    Fisher, James P.; Hartwich, Doreen; Seifert, Thomas; Olesen, Niels D.; McNulty, Clare L.; Nielsen, Henning B.; van Lieshout, Johannes J.; Secher, Niels H.

    2013-01-01

    We evaluated cerebral perfusion, oxygenation and metabolism in 11 young (22 ± 1 years) and nine older (66 ± 2 years) individuals at rest and during cycling exercise at low (25% W(max)), moderate (50% Wmax), high (75% W(max)) and exhaustive (100% W(max)) workloads. Mean middle cerebral artery blood

  20. Glycopyrrolate abolishes the exercise-induced increase in cerebral perfusion in humans

    DEFF Research Database (Denmark)

    Seifert, Thomas; Fisher, James P; Young, Colin N

    2010-01-01

    Brain blood vessels contain muscarinic receptors that are important for cerebral blood flow (CBF) regulation, but whether a cholinergic receptor mechanism is involved in the exercise-induced increase in cerebral perfusion or affects cerebral metabolism remains unknown. We evaluated CBF and cerebr...

  1. Detection of perfusion abnormalities in patients with permanent pacemakers on stress-rest 99mTc-tetrofosmin myocardial perfusion single-photon emission computed tomography: comparison between right ventricular apex and right ventricular outflow tract pacing.

    Science.gov (United States)

    Das, Kalpa J; Patel, Chetan D; Sharma, Gautam; Naik, Nitish; Singh, Harmandeep

    2016-04-01

    The aim of the study was to compare the myocardial perfusion defects in patients with right ventricular outflow tract (RVOT) and right ventricular apex (RVA) pacing on stress-rest Tc-tetrofosmin myocardial perfusion single-photon emission computed tomography. A total of 31 patients with permanent pacemakers (RVOT: 16 and RVA: 15) underwent stress-rest Tc-tetrofosmin involving a 1-day protocol. All patients underwent 1-day low-dose stress-gated and high-dose rest-gated Tc-tetrofosmin myocardial perfusion single-photon emission computed tomography imaging. Fixed perfusion defects were noted in 13 (42%) of 31 patients. Two (13%) patients of the RVOT group and 11 (69%) patients of the RVA group showed fixed perfusion defects (P=0.003). The fixed perfusion defects were located in the anteroapical, anteroseptal, and apical in the RVOT pacing group and in the apical, distal anteroseptal, inferoapical, distal anterior, and distal inferoseptal in the RVA pacing group. On univariate analysis, the incidence of perfusion defects was significantly associated with apical pacing, longer pQRS duration, and higher percentage of ventricular pacing. On multivariate analysis, the site of pacemaker insertion was found to be the most important pacemaker parameter determining the incidence of perfusion defects. Importantly, the duration of postpacemaker implantation did not show any significant relation to the incidence of perfusion defects. Fixed perfusion abnormalities are observed in patients with pacemakers and are independent of duration of time since implantation. RVOT pacing is associated with fewer incidences of myocardial perfusion abnormalities compared with RVA pacing.

  2. SU-C-201-04: Quantification of Perfusion Heterogeneity Based On Texture Analysis for Fully Automatic Detection of Ischemic Deficits From Myocardial Perfusion Imaging

    Energy Technology Data Exchange (ETDEWEB)

    Fang, Y [National Cheng Kung University, Tainan, Taiwan (China); Huang, H [Chang Gung University, Taoyuan, Taiwan (China); Su, T [Chang Gung Memorial Hospital, Taoyuan, Taiwan (China)

    2015-06-15

    Purpose: Texture-based quantification of image heterogeneity has been a popular topic for imaging studies in recent years. As previous studies mainly focus on oncological applications, we report our recent efforts of applying such techniques on cardiac perfusion imaging. A fully automated procedure has been developed to perform texture analysis for measuring the image heterogeneity. Clinical data were used to evaluate the preliminary performance of such methods. Methods: Myocardial perfusion images of Thallium-201 scans were collected from 293 patients with suspected coronary artery disease. Each subject underwent a Tl-201 scan and a percutaneous coronary intervention (PCI) within three months. The PCI Result was used as the gold standard of coronary ischemia of more than 70% stenosis. Each Tl-201 scan was spatially normalized to an image template for fully automatic segmentation of the LV. The segmented voxel intensities were then carried into the texture analysis with our open-source software Chang Gung Image Texture Analysis toolbox (CGITA). To evaluate the clinical performance of the image heterogeneity for detecting the coronary stenosis, receiver operating characteristic (ROC) analysis was used to compute the overall accuracy, sensitivity and specificity as well as the area under curve (AUC). Those indices were compared to those obtained from the commercially available semi-automatic software QPS. Results: With the fully automatic procedure to quantify heterogeneity from Tl-201 scans, we were able to achieve a good discrimination with good accuracy (74%), sensitivity (73%), specificity (77%) and AUC of 0.82. Such performance is similar to those obtained from the semi-automatic QPS software that gives a sensitivity of 71% and specificity of 77%. Conclusion: Based on fully automatic procedures of data processing, our preliminary data indicate that the image heterogeneity of myocardial perfusion imaging can provide useful information for automatic determination

  3. Myocardial perfusion defect on thallium-201 imaging in patients with chronic obstructive pulmonary disease

    Energy Technology Data Exchange (ETDEWEB)

    Mehrotra, P.P.; Weaver, Y.J.; Higginbotham, E.A.

    1983-08-01

    Six patients with angina pectoris had reversible perfusion defects on stress and redistribution thallium imaging. Three patients had a positive electrocardiographic response to exercise. No significant coronary artery lesions were seen on coronary arteriography in any of the six patients. All had mild to moderate hypoxemia at rest and physiologic evidence of chronic obstructive pulmonary disease as defined by the decrease in the ratio of forced expiratory volume at 1 second to forced vital capacity (FEV1/FVC X 100) or decrease in the forced midexpiratory flow rate (FEF25-75), or both. None had clinical findings suggestive of any of the reported causes of positive thallium scans in patients with normal coronary arteriograms. Cellular dysfunction produced by hypoxemia affecting the uptake of thallium seems to be the most likely mechanism of this abnormality.

  4. Caffeine intake inverts the effect of adenosine on myocardial perfusion during stress as measured by T1 mapping.

    Science.gov (United States)

    Kuijpers, Dirkjan; Prakken, Niek H; Vliegenthart, Rozemarijn; van Dijkman, Paul R M; van der Harst, Pim; Oudkerk, Matthijs

    2016-10-01

    Caffeine intake before adenosine stress myocardial perfusion imaging may cause false negative findings. We hypothesized that the antagonistic effect of caffeine can be measured by T1 relaxation times in rest and adenosine stress cardiac magnetic resonance imaging (CMR), as T1 mapping techniques are sensitive to changes in myocardial blood volume. We prospectively analyzed 105 consecutive patients with adenosine stress perfusion CMR on a 1.5-T MRI system. Rest and stress T1 mapping was performed using Modified Look-Locker Inversion recovery. T1 reactivity was defined as difference in T1rest and T1stress (∆T1). Fifteen patients drank coffee within 4 h of CMR (8H caffeine group). Comparison was made to patients without self-reported coffee intake: 50 with normal CMR (control group), 18 with myocardial ischemia, and 12 with myocardial infarction. The national review board approved the study; all patients gave written informed consent. The T1 of -7.8 % (T1rest 975 ± 42 ms, T1stress 898 ± 51 ms, p 8H caffeine group showed reduced T1 reactivity (1.8 %; T1rest 979 ms, T1stress 997 ms) compared to the controls (4.3 %; T1rest 977 ± 40 ms, T1stress 1018 ± 40 ms), p infarcted myocardium showed minimal T1 reactivity (0.2 and 0.3 %, respectively). Caffeine intake inverts the adenosine effect during stress perfusion CMR as measured by T1 mapping. T1 reactivity can assess the adequacy of adenosine-induced stress in perfusion CMR.

  5. MIBI Uptake in a Huge Breast Mass Obscuring the Anterior and Lateral Myocardial Walls in Perfusion Imaging

    OpenAIRE

    Forough Kalantari; Mehrshad Abbasi; Saeed Farzanefar

    2015-01-01

    Background: Cardiac risk assessment with myocardial perfusion imaging (MPI) is a common practice for some elderly breast cancer patients who are candidates for operation. In rare cases the tumor may become visible in the images.Case presentation: This is the report of a case with a huge slow-growing breast tumor suspicious for malignancy and presenting with methoxy-isobutyl-isonitrile (MIBI) uptake in the tumor. The patient was referred to the nuclear medicine department for preoperative card...

  6. Influence of chronic inflammation and autoimmunity on coronary calcifications and myocardial perfusion defects in systemic lupus erythematosus patients

    OpenAIRE

    Plazak, Wojciech; Pasowicz, Mieczyslaw; Kostkiewicz, Magdalena; Podolec, Jakub; Tomkiewicz-Pajak, Lidia; Musial,Jacek; Podolec, Piotr

    2011-01-01

    Objective Conventional risk factors for coronary artery disease fail to explain the increased frequency or cardiovascular morbidity in systemic lupus erythematosus (SLE) patients. This study was conducted to determine the possible influence of autoimmune and inflammatory phenomena markers on coronary artery calcifications and myocardial perfusion abnormalities in SLE patients. Materials and methods Multi-detector computed tomography (MDCT)-based coronary calcium scoring and single photon emis...

  7. Direct parametric reconstruction in dynamic PET myocardial perfusion imaging: in vivo studies

    Science.gov (United States)

    Petibon, Yoann; Rakvongthai, Yothin; El Fakhri, Georges; Ouyang, Jinsong

    2017-05-01

    Dynamic PET myocardial perfusion imaging (MPI) used in conjunction with tracer kinetic modeling enables the quantification of absolute myocardial blood flow (MBF). However, MBF maps computed using the traditional indirect method (i.e. post-reconstruction voxel-wise fitting of kinetic model to PET time-activity-curves-TACs) suffer from poor signal-to-noise ratio (SNR). Direct reconstruction of kinetic parameters from raw PET projection data has been shown to offer parametric images with higher SNR compared to the indirect method. The aim of this study was to extend and evaluate the performance of a direct parametric reconstruction method using in vivo dynamic PET MPI data for the purpose of quantifying MBF. Dynamic PET MPI studies were performed on two healthy pigs using a Siemens Biograph mMR scanner. List-mode PET data for each animal were acquired following a bolus injection of ~7-8 mCi of 18F-flurpiridaz, a myocardial perfusion agent. Fully-3D dynamic PET sinograms were obtained by sorting the coincidence events into 16 temporal frames covering ~5 min after radiotracer administration. Additionally, eight independent noise realizations of both scans—each containing 1/8th of the total number of events—were generated from the original list-mode data. Dynamic sinograms were then used to compute parametric maps using the conventional indirect method and the proposed direct method. For both methods, a one-tissue compartment model accounting for spillover from the left and right ventricle blood-pools was used to describe the kinetics of 18F-flurpiridaz. An image-derived arterial input function obtained from a TAC taken in the left ventricle cavity was used for tracer kinetic analysis. For the indirect method, frame-by-frame images were estimated using two fully-3D reconstruction techniques: the standard ordered subset expectation maximization (OSEM) reconstruction algorithm on one side, and the one-step late maximum a posteriori (OSL-MAP) algorithm on the other

  8. Direct parametric reconstruction in dynamic PET myocardial perfusion imaging: in vivo studies.

    Science.gov (United States)

    Petibon, Yoann; Rakvongthai, Yothin; El Fakhri, Georges; Ouyang, Jinsong

    2017-05-07

    Dynamic PET myocardial perfusion imaging (MPI) used in conjunction with tracer kinetic modeling enables the quantification of absolute myocardial blood flow (MBF). However, MBF maps computed using the traditional indirect method (i.e. post-reconstruction voxel-wise fitting of kinetic model to PET time-activity-curves-TACs) suffer from poor signal-to-noise ratio (SNR). Direct reconstruction of kinetic parameters from raw PET projection data has been shown to offer parametric images with higher SNR compared to the indirect method. The aim of this study was to extend and evaluate the performance of a direct parametric reconstruction method using in vivo dynamic PET MPI data for the purpose of quantifying MBF. Dynamic PET MPI studies were performed on two healthy pigs using a Siemens Biograph mMR scanner. List-mode PET data for each animal were acquired following a bolus injection of ~7-8 mCi of 18 F-flurpiridaz, a myocardial perfusion agent. Fully-3D dynamic PET sinograms were obtained by sorting the coincidence events into 16 temporal frames covering ~5 min after radiotracer administration. Additionally, eight independent noise realizations of both scans-each containing 1/8th of the total number of events-were generated from the original list-mode data. Dynamic sinograms were then used to compute parametric maps using the conventional indirect method and the proposed direct method. For both methods, a one-tissue compartment model accounting for spillover from the left and right ventricle blood-pools was used to describe the kinetics of 18 F-flurpiridaz. An image-derived arterial input function obtained from a TAC taken in the left ventricle cavity was used for tracer kinetic analysis. For the indirect method, frame-by-frame images were estimated using two fully-3D reconstruction techniques: the standard ordered subset expectation maximization (OSEM) reconstruction algorithm on one side, and the one-step late maximum a posteriori (OSL-MAP) algorithm on the other

  9. Mild troponin I elevation does not predict ischemia on myocardial perfusion imaging

    Directory of Open Access Journals (Sweden)

    Le Dung Ha

    2017-08-01

    Full Text Available IntroductionData are limited on the degree of mild troponin I elevation and clinical risk factors in predicting myocardial ischemia.MethodsHospitalized adult patients who underwent myocardial perfusion imaging (MPI from 2015 to 2016 at Rochester General Hospital and had mild troponin I elevation (>0.1 and <1.5 ng/mL were included. Predictors of outcomes were determined using logistic regression model.ResultsOne hundred and sixty-six patients with mild troponin I elevation who underwent MPI were followed. Mean age was 69.6 ± 12.5 years and 53.0% of the patients were female. Fourteen patients (8.4% presented with typical chest pain (CP, 60 patients (36.1% had atypical CP and 92 patients (55.4% had no CP on presentation. MPI was positive for ischemia in 45 patients (27.1%. There was no difference in peak troponin I level with ischemia versus no ischemia on MPI (0.34 ng/dL [0.13-0.69] vs. 0.23 ng/dL [0.14-0.50], p value 0.254. Atypical CP did not predict the presence of ischemia on MPI (odds ratio [OR] 1.97, 95% confidence interval [CI] 0.91-4.26. Coronary artery disease (CAD history (age and sex adjusted p value 0.013, diabetes (adjusted p value 0.036, creatinine ≥2 mg/dL (adjusted p value 0.019 and dialysis (adjusted p value 0.006 were statistically significant predictors of ischemia on MPI.ConclusionsIn patients presenting with mild troponin I elevation, peak troponin I level did not predict ischemia on MPI. The presence of CAD history, diabetes, elevated creatinine and dialysis were predictors of ischemia on MPI.

  10. Coronary risk factors and myocardial perfusion in asymptomatic adults: the Multi-Ethnic Study of Atherosclerosis (MESA).

    Science.gov (United States)

    Wang, Lu; Jerosch-Herold, Michael; Jacobs, David R; Shahar, Eyal; Folsom, Aaron R

    2006-02-07

    The purpose of this study was to determine the cross-sectional relation between myocardial perfusion and coronary heart disease (CHD) risk factors among adults with no clinical CHD. Clinical studies suggest that myocardial perfusion is often abnormal in individuals without CHD but with risk factors. Epidemiologic study in asymptomatic populations is lacking. Two hundred twenty-two men and women, ages 45 to 84 years and free of a CHD diagnosis, in the University of Minnesota field center of the Multi-Ethnic Study of Atherosclerosis (MESA) had myocardial blood flow (MBF) determined using cardiac magnetic resonance imaging at rest and during adenosine-induced hyperemia. Perfusion reserve (PR) was calculated as the ratio of hyperemic to rest MBF. Both resting and hyperemic MBF were lower in men than in women, even after considering age and menopause. Hyperemic MBF was also significantly lower in subjects who were older, and in those with higher blood pressure, higher fasting glucose, and lower low-density lipoprotein cholesterol. After adjusting for age, gender, and race, reduced PR was independently associated with hypertension, higher diastolic blood pressure, and higher total and low-density lipoprotein cholesterol, but was not associated with cigarette smoking, obesity, physical activity, or diabetes. Moreover, hyperemic MBF and PR were correlated strongly and inversely with estimated 10-year CHD risk based on Framingham equations (p for trends: adults without symptomatic CHD.

  11. Technetium-99m sestamibi single-photon emission tomography detects subclinical myocardial perfusion abnormalities in patients with systemic lupus erythematosus

    Energy Technology Data Exchange (ETDEWEB)

    Schillaci, O. [Nuclear Medicine, University of l`Aquila (Italy); Lagana, B.; Gentile, R.; Tubani, L.; Baratta, L. [Department of Clinical Medicine, University ``La Sapienza``, Rome (Italy); Danieli, R.; Scopinaro, F. [Section of Nuclear Medicine, Department of Experimental Medicine and Pathology, University ``La Sapienza``, Rome (Italy)

    1999-07-01

    In patients with systemic lupus erythematosus, involvement of the cardiovascular system is the third leading cause of death. However, although autopsy studies have demonstrated a high incidence of abnormalities in both the myocardium and coronary vessels, clinical manifestations have been reported in only a small percentage of cases. The aim of this study was to evaluate myocardial perfusion in asymptomatic lupus patients using technetium-99m sestamibi single-photon emission tomography (SPET). Twenty-eight patients without overt cardiac involvement and risk factors were studied with {sup 99m}Tc-sestamibi SPET at rest and after dipyridamole infusion. Perfusion abnormalities were detected in 18 cases: six had persistent defects, three had reversible defects, seven had both persistent and reversible defects, and two showed rest defects which normalized on dipyridamole images (``reverse redistribution pattern``). Coronary angiography was performed in eight patients with positive {sup 99m}Tc-sestamibi SPET, and showed normal epicardial vessels in all the cases. These results indicate that {sup 99m}Tc-sestamibi SPET reveals a high prevalence (18 out of 28 patients in this study, i.e. 64%) of myocardial perfusion abnormalities in asymptomatic lupus patients, probably due to the primary immunological damage of this autoimmune disease. In conclusion, rest/dipyridamole {sup 99m}Tc-sestamibi SPET can be a useful non-invasive method to identify subclinical myocardial involvement in systemic lupus erythematosus, and patients potentially at risk of later cardiac events. (orig.) With 2 figs., 2 tabs., 21 refs.

  12. Use of myocardial perfusion imaging and estimation of associated radiation doses in Germany from 2005 to 2012

    Energy Technology Data Exchange (ETDEWEB)

    Lindner, O.; Burchert, W. [University Hospital of the Ruhr University Bochum, Institute of Radiology, Nuclear Medicine and Molecular Imaging, Heart and Diabetes Center North Rhine-Westphalia, Bad Oeynhausen (Germany); Bengel, F.M. [Hanover Medical School, Department of Nuclear Medicine, Hanover (Germany); Hacker, M. [Medical University of Vienna, Department of Biomedical Imaging and Image-guided Therapy, Division of Nuclear Medicine, Vienna (Austria); Schaefer, W. [Kliniken Maria Hilf GmbH, Clinic of Nuclear Medicine, Moenchengladbach (Germany); Collaboration: Working Group Cardiovascular Nuclear Medicine of the German Society of Nuclear Medicine

    2014-05-15

    For several years the Working Group Cardiovascular Nuclear Medicine of the German Society of Nuclear Medicine has been performing a regular survey to obtain information on technique, utilization and development of myocardial perfusion scintigraphy (MPS). Currently, data of six surveys from 2005 to 2012 are available. The aim of this paper is to deliver a general and comprehensive overview of all surveys documenting the course of patient doses over time and the development of the method. A one-page questionnaire with number of MPS patients, number of stress and rest MPS, referral structure and several technical issues was sent to all centres performing MPS in Germany and evaluated. With the data on protocol utilization, effective MPS patient doses were estimated. MPS per million population (pmp) varied between 2,380 and 2,770. In 2012, MPS pmp showed a slight increase for the first time. From 2005 to 2009 the angiography to MPS ratio increased from 3.4 to 4.4, and the revascularization to MPS ratio decreased from 0.66 to 0.53. In 2012, both indices demonstrated an opposite trend for the first time (4.1 and 0.55). A total of 108 centres participated in all surveys. They showed an increase in MPS patients of 4.0 % over the reporting period. In 2012, more than 50 % of the centres experienced no change or an increase in MPS numbers. The leading single competitor was MRI, followed by angiography and stress echocardiography. {sup 201}Tl studies have decreased since 2005 from 20 to 5 %. {sup 99m}Tc MPS studies showed a mild increase in 2-day protocols. In 2012, the average effective dose per patient was estimated at 7.4 mSv. Due to the decreasing use of {sup 201}Tl, a mild decline over the observation period can be documented. Dynamic exercise stress was the most common stress test and adenosine the leading pharmacological stress agent, with a growing percentage. In 2012, the regadenoson percentage was 9 %. Gated single photon emission computed tomography (SPECT) noted an

  13. Detection of significant stenosis in the left anterior descending artery by 'virtual myocardial perfusion' bolus tracking, 320 slice computed tomography.

    Science.gov (United States)

    Takaoka, Hiroyuki; Funabashi, Nobusada; Fujimoto, Yoshihide; Kobayashi, Yoshio

    2014-12-20

    We used bolus-tracking CT-images, which are usually used only to detect contrast-material in target organs for optimal-starting of acquisition, as virtual first pass myocardial perfusion images. Retrospective-analysis of 14 patients (10 male, 63 ± 10 years) diagnosed with ≥ 75% stenosis confined to left-anterior-descending-artery (LAD) (7 patients, Group-1) or insignificant stenosis of any coronary artery (7 patients Group-2) diagnosed using invasive-coronary-angiograms (ICA) and enhanced 320-slice-CT within 3-months and without incident between examinations. Bolus-tracking CT-images were acquired at mid-level left-ventricle (LV) until CT-attenuation of descending-aorta increased to 200 HU. We measured CT-attenuation (HU) in the LV anterior-wall (AW), the basal inter-ventricular-septum (BIVS), and LV basal lateral-wall (BLW) in end-systole using both bolus-tracking images and routine, enhanced, early-phase CT-images. In the bolus-tracking images, the Group-1 LV AW, BIVS, BLW CT-attenuation and ratio of LV AW CT attenuation to the average of BIVS and BLW were 36 ± 7HU, 62 ± 11HU, 58 ± 25HU, and 0.6 ± 0.1 respectively. In Group-2, they were 53 ± 14HU, 56 ± 9HU, 54 ± 15HU, and 1.0 ± 0.3 respectively. LV AW CT attenuation and the ratio of LV AW CT values to the average of BIVS and BLW, were significantly lower in Group-1 (both P BLW and without the need for drugs, exercise or additional radiation-exposure. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  14. Diagnostic accuracy of combined coronary angiography and adenosine stress myocardial perfusion imaging using 320-detector computed tomography: pilot study

    Energy Technology Data Exchange (ETDEWEB)

    Nasis, Arthur; Ko, Brian S.; Leung, Michael C.; Antonis, Paul R.; Wong, Dennis T.; Kyi, Leo; Cameron, James D.; Meredith, Ian T.; Seneviratne, Sujith K. [Southern Health and Monash University, Monash Cardiovascular Research Centre, Monash Heart, Department of Medicine Monash Medical Centre (MMC), Melbourne (Australia); Nandurkar, Dee; Troupis, John M. [MMC, Southern Health, Department of Diagnostic Imaging, Melbourne (Australia)

    2013-07-15

    To determine the diagnostic accuracy of combined 320-detector row computed tomography coronary angiography (CTA) and adenosine stress CT myocardial perfusion imaging (CTP) in detecting perfusion abnormalities caused by obstructive coronary artery disease (CAD). Twenty patients with suspected CAD who underwent initial investigation with single-photon-emission computed tomography myocardial perfusion imaging (SPECT-MPI) were recruited and underwent prospectively-gated 320-detector CTA/CTP and invasive angiography. Two blinded cardiologists evaluated invasive angiography images quantitatively (QCA). A blinded nuclear physician analysed SPECT-MPI images for fixed and reversible perfusion defects. Two blinded cardiologists assessed CTA/CTP studies qualitatively. Vessels/territories with both >50 % stenosis on QCA and corresponding perfusion defect on SPECT-MPI were defined as ischaemic and formed the reference standard. All patients completed the CTA/CTP protocol with diagnostic image quality. Of 60 vessels/territories, 17 (28 %) were ischaemic according to QCA/SPECT-MPI criteria. Sensitivity, specificity, PPV, NPV and area under the ROC curve for CTA/CTP was 94 %, 98 %, 94 %, 98 % and 0.96 (P < 0.001) on a per-vessel/territory basis. Mean CTA/CTP radiation dose was 9.2 {+-} 7.4 mSv compared with 13.2 {+-} 2.2 mSv for SPECT-MPI (P < 0.001). Combined 320-detector CTA/CTP is accurate in identifying obstructive CAD causing perfusion abnormalities compared with combined QCA/SPECT-MPI, achieved with lower radiation dose than SPECT-MPI. (orig.)

  15. Radio-adaptive Response in Myocardial Perfusion Imaging Induced by Technetium-99m.

    Science.gov (United States)

    Shirazi, Mohammad Mehdi; Shabestani-Monfared, Ali; Shahidi, Maryam; Amiri, Mehrangiz; Abedi, Seyed Mohammad; Borzoueisileh, Sajad; Gorji, Kourosh Ebrahim Nejad

    2017-01-01

    Low dose radiation will induce adaptation and following exposure to an adaptive dose, the cells are more resistance to following challenging doses. This phenomenon is known as radio-adaptive response. The aim of this study was to investigate the percentage of apoptotic cells in the peripheral blood samples of the patients which undergo myocardial perfusion imaging (MPI) with technetium-99m (Tc-99m) before thallium scan to assess the induction of radio-adaptive response. In this study, 97 samples from 74 patients, referred to nuclear medicine center of Mazandaran Heart Hospital for MPI, which had no history of diagnostic, therapeutic, occupational, and radioactive exposures during past 2 years, were provided. The participants were classified into four groups including control, patients which were scanned solely with technetium, the patients which examined by thallium and the last group were the patients that examined by technetium followed by thallium. Then 2 ml Peripheral blood samples were obtained, and after 24 h incubating, the samples were studied by neutral comet assay. Statistical analysis was carried out using Student's t-test along with one-way analysis of variance. The mean percentage of apoptotic cells in the exposed groups were higher than the control. Furthermore, among exposed groups, the apoptotic cells in thallium group were more than others and this index was significantly lower in the group which was undergone technetium administration before thallium scan. These findings suggest that exposure to Tc-99m could induce a radio-adaptive response against the exposure of thallium-201.

  16. Safety and tolerability of regadenoson for myocardial perfusion imaging - first Danish experience.

    Science.gov (United States)

    Pape, Marianne; Zacho, Helle D; Aarøe, Jens; Eggert Jensen, Svend; Petersen, Lars J

    2016-06-01

    Evaluating safety and tolerability of the selective A2A receptor agonist, regadenoson, in patients referred for single photon emission computed tomography myocardial perfusion imaging (MPI). Observational study of patients referred for MPI stress testing using a 400 μg regadenoson (Rapiscan(®)) bolus. Hemodynamic variables and severity of adverse events (AE) were recorded before, during, and after administration. A total of 232 patients were included. One or more AE were reported in 90% of patients; the AEs were graded mostly mild to moderate in severity, resolved spontaneously, and were mainly dyspnea, headache, and chest pain. No advanced heart block or bronchospasm were seen. Transient ST-segment changes developed in 10 patients. The maximum increase in heart rate was 19 ± 11 beats/minute. The mean systolic blood pressure decreased from 144 to 139 mmHg (p regadenoson. Regadenoson for MPI is easy to use with a high frequency of AEs, which are generally mild in severity, transient, and resolve spontaneously.

  17. Value of attenuation correction in stress-only myocardial perfusion imaging using CZT-SPECT.

    Science.gov (United States)

    van Dijk, J D; Mouden, M; Ottervanger, J P; van Dalen, J A; Knollema, S; Slump, C H; Jager, P L

    2017-04-01

    Attenuation correction (AC) improves the diagnostic outcome of stress-only myocardial perfusion imaging (MPI) using conventional SPECT. Our aim was to determine the value of AC using a cadmium zinc telluride-based (CZT)-SPECT camera. We retrospectively included 107 consecutive patients who underwent stress-optional rest MPI CZT-SPECT/CT. Next, we created three types of images for each patient; (1) only displaying reconstructed data without the CT-based AC (NC), (2) only displaying AC, and (3) with both NC and AC (NC + AC). Next, two experienced physicians visually interpreted these 321 randomized images as normal, equivocal, or abnormal. Image outcome was compared with all hard events over a mean follow-up time of 47.7 ± 9.8 months. The percentage of images interpreted as normal increased from 45% using the NC images to 72% using AC and to 67% using NC + AC images (P < .001). Hard event hazard ratios for images interpreted as normal were not different between using NC and AC (1.01, P = .99), or NC and NC + AC images (0.97, P = .97). AC lowers the need for additional rest imaging in stress-first MPI using CZT-SPECT, while long-term patient outcome remained identical. Use of AC reduces the need for additional rest imaging, decreasing the mean effective dose by up to 1.2 mSv.

  18. Diagnostic performance of fusion of myocardial perfusion imaging (MPI) and computed tomography coronary angiography

    Science.gov (United States)

    Santana, Cesar A.; Garcia, Ernest V.; Faber, Tracy L.; Sirineni, Gopi K. R.; Esteves, Fabio P.; Sanyal, Rupan; Halkar, Raghuveer; Ornelas, Mario; Verdes, Liudmila; Lerakis, Stamatios; Ramos, Julie J.; Aguadé-Bruix, Santiago; Cuéllar, Hugo; Candell-Riera, Jaume; Raggi, Paolo

    2011-01-01

    Background We evaluated the incremental diagnostic value of fusion images of coronary computed tomography angiography (CTA) and myocardial perfusion imaging (MPI) over MPI alone or MPI and CTA side-by-side to identify obstructive coronary artery disease (CAD > 50% stenosis) using invasive coronary angiography (ICA) as the gold standard. Methods 50 subjects (36 men; 56 ± 11 years old) underwent rest-stress MPI and CTA within 12-26 days of each other. CTAs were performed with multi-detector CT-scanners (31 on 64-slice; and 19 on 16-slice). 37 patients underwent ICA while 13 subjects did not because of low (area under the curve (AUC) for fused images: 0.89; P = .005 vs MPI, P = .04 vs side-by-side MPI-CTA) and for localization of CAD to the left anterior descending coronary artery (AUC: 0.82, P < .001 vs MPI; P = .007 vs side-by-side MPI-CTA). There was a non-significant trend for better detection of multi-vessel disease with fusion. Conclusions Using ICA as the gold standard, fusion imaging provided incremental diagnostic information compared to MPI alone or side-by-side MPI-CTA for the diagnosis of obstructive CAD and for localization of CAD to the left anterior descending coronary artery. PMID:19156478

  19. (13)N-Ammonia PET/CT Detection of Myocardial Perfusion Abnormalities in Beagle Dogs After Local Heart Irradiation.

    Science.gov (United States)

    Song, Jianbo; Yan, Rui; Wu, Zhifang; Li, Jianguo; Yan, Min; Hao, Xinzhong; Liu, Jianzhong; Li, Sijin

    2017-04-01

    Our objective was to determine the potential value of (13)N-ammonia PET/CT myocardial perfusion imaging (MPI) for early detection of myocardial perfusion changes induced by radiation damage. Methods: Thirty-six Beagle dogs were randomly divided into a control group (n = 18) or an irradiation group (n = 18). The latter underwent local irradiation to the left ventricular anterior cardiac wall with a single dose of 20 Gy, whereas the former received sham irradiation. All dogs underwent (13)N-ammonia PET/CT MPI 1 wk before irradiation and at 3, 6, and 12 mo after sham or local irradiation. One week after undergoing (13)N-ammonia PET/CT MPI, the irradiation group underwent coronary angiography. Six randomly selected dogs from each group were sacrificed and used to detect pathologic cardiac injury at 3, 6, and 12 mo after irradiation. Results: Compared with the control group and baseline, the irradiation group showed significantly increased perfusion in the irradiated area of the heart at 3 mo after irradiation, perfusion reduction at 6 mo after irradiation, and a perfusion defect at 12 mo after irradiation. There was no significant difference in the left ventricular ejection fraction between the control and irradiation groups at baseline or at 3 mo after irradiation. The irradiation group showed a reduction of left ventricular ejection fraction compared with the control group at 6 mo (50.0% ± 8.1% vs. 59.3% ± 4.1%, P = 0.016) and 12 mo (47.2% ± 6.7% vs. 57.4% ± 3.3%, P = 0.002) after irradiation. No coronary stenosis was observed in the irradiation group. Regional wall motion abnormalities appeared in the irradiated area at 6 mo after irradiation, and its extent was enlarged at 12 mo after irradiation. Pathologic changes were observed; radiation-induced myocardial tissue damage and microvascular fibrosis in the irradiated area progressively increased over time. Conclusion:(13)N-ammonia PET/CT MPI can dynamically detect myocardial perfusion changes together with

  20. Comparison of exogenous adenosine and voluntary exercise on human skeletal muscle perfusion and perfusion heterogeneity

    DEFF Research Database (Denmark)

    Heinonen, Ilkka H.A.; Kemppainen, Jukka; Kaskinoro, Kimmo

    2010-01-01

    Adenosine is a widely used pharmacological agent to induce a 'high flow' control condition to study the mechanisms of exercise hyperemia, but it is not known how well adenosine infusion depicts exercise-induced hyperemia especially in terms of blood flow distribution at the capillary level in human...... muscle. Additionally, it remains to be determined what proportion of adenosine-induced flow elevation is specifically directed to muscle only. In the present study we measured thigh muscle capillary nutritive blood flow in nine healthy young men using positron emission tomography at rest and during...... femoral artery infusion of adenosine (1 mg * min(-1) * litre thigh volume(-1)), which has previously been shown to induce maximal whole thigh blood flow of ~8 L/min. This response was compared to the blood flow induced by moderate-high intensity one-leg dynamic knee extension exercise. Adenosine increased...

  1. Myocardial perfusion SPECT in stable angina;Place de la scintigraphie myocardique dans l'angor stable

    Energy Technology Data Exchange (ETDEWEB)

    Jau, P.; Jacob, T. [HP Clairval, Service de medecine nucleaire, 13 - Marseille (France); Lecorff, G.; Bouvier, J.L.; Novella, P.; Bechet, V.; Pelet, V. [HP Clairval, Service de cardiologie, 13 - Marseille (France)

    2010-03-15

    We study the precise contribution of myocardial scintigraphy in the therapeutic management of stable coronary artery disease. Until recently, treatment was focused on revascularization, often by coronary angioplasty.Recent studies have challenged this practice by showing the absence of superiority of angioplasty compared to optimal medical therapy.The problem now is to define for each stable coronary artery disease, and individually, the best of both treatment options. In this spirit, the functional approach to coronary artery disease by myocardial perfusion scintigraphy is most interesting.The diagnostic performance, including sensitivity and negative predictive value, and the prognostic value of the technique are clearly established. Recent studies show that a therapeutic decision based on a functional approach to the patient is valid.We need to know this development in cardiology for best position in the multidisciplinary discussions, myocardial scintigraphy as a functional approach to stable coronary artery disease. (N.C.)

  2. Dual-energy CT perfusion during pharmacologic stress for the assessment of myocardial perfusion defects using a second-generation dual-source CT: a comparison with cardiac magnetic resonance imaging.

    Science.gov (United States)

    Kim, Sung Mok; Chang, Sung-A; Shin, Wonseon; Choe, Yeon Hyeon

    2014-01-01

    This study aimed to assess the diagnostic performance of adenosine-stress dual-energy myocardial computed tomography perfusion (DECTP) imaging using 128-slice dual-source computed tomography (CT) for the detection of myocardial perfusion defects in comparison with stress-perfusion magnetic resonance imaging (MRI). This prospective study included 50 patients (mean age, 66 [9] years; 64% men) with suspected coronary artery disease who underwent adenosine-stress DECTP using 128-slice dual-source CT as well as adenosine-stress cardiac MRI using a 1.5-T scanner. Estimates of diagnostic accuracy in detecting myocardial perfusion defects were calculatedand compared with those of cardiac MRI. The estimates of diagnostic accuracy in detecting myocardial perfusion defects using DECTP were as follows: sensitivity, 77% (95% confidence interval [CI], 67%-87%); specificity, 94% (95% CI, 92%-95%); positive predictive value, 53% (95% CI, 44%-63%); and negative predictive value, 98% (95% CI, 97%-99%). The results of DECTP imaging were positively correlated with those of cardiac MRI (r = 0.602, P stress DECTP imaging and rest coronary CTA were 6.5 (2.2) and 4.9 (1.7) mSv, respectively. Adenosine-stress DECTP imaging enables detection of myocardial ischemia. However, further technical developments are necessary to reduce artifacts and improve the sensitivity of DECTP.

  3. High resolution myocardial magnetic resonance stress perfusion imaging at 3 T using a 1 M contrast agent

    Energy Technology Data Exchange (ETDEWEB)

    Klumpp, Bernhard D.; Seeger, Achim; Doering, Joerg; Kramer, Ulrich; Fenchel, Michael; Claussen, Claus D.; Miller, Stephan [Eberhard Karls University Tuebingen, Department for Diagnostic Radiology, Tuebingen (Germany); Doesch, Christina; Hoevelborn, Tobias; Gawaz, Meinrad P. [Eberhard Karls University Tuebingen, Department for Cardiology, Tuebingen (Germany)

    2010-03-15

    Stress perfusion magnetic resonance imaging (MSPMRI) is an established technique for the assessment of myocardial perfusion. Shortcomings at 1.5 T are low signal to noise ratio (SNR) and contrast to noise ratio (CNR). One approach to overcome these shortcomings is to increase field strength and contrast concentration. The aim of our study was to investigate the diagnostic capability of high resolution MSPMRI at 3-T field strength using a 1 M contrast agent. Fifty-seven patients (62.3{+-} 11.0 years) with symptoms of coronary artery disease (CAD) were examined at 3 T. MMRSPI was assessed using a 2D saturation recovery gradient echo (SR GRE) sequence in short axis orientation (TR 1.9 ms, TE 1.0 ms, flip 12 , 0.1 mmol gadobutrol/kg body weight (bw), 140{mu}g adenosine/kg bw/min). Perfusion images were assessed visually and semiquantitatively (upslope, peak signal intensity (SI), and myocardial perfusion reserve index (MPRI)). Standard of reference was invasive coronary angiography. Stress-induced hypoperfusion was found in 43 patients. Sensitivity for hemodynamically relevant CAD (stenoses greater than 70%) was 95%/98%, specificity 80%/87%, diagnostic accuracy 91%/95% (reader 1/reader 2). The MPRI was significantly lower in hypoperfused myocardium (1.3 {+-} 0.2) compared with normal myocardium (2.6 {+-} 0.7). High resolution MMRSPI at 3 T using 1 M contrast agent under daily routine conditions provides reliable detection of stress-induced myocardial hypoperfusion with higher diagnostic accuracy than 1.5-T conditions. (orig.)

  4. MYOCARDIAL PROTECTION DURING CORONARY ANGIOPLASTY WITH AUTOPERFUSION AND FORCED PERFUSION - AN IN-VITRO COMPARISON

    NARCIS (Netherlands)

    DEMUINCK, ED; VERKERKE, BJ; RAKHORST, G; LIE, KI

    During coronary angioplasty, perfusion distal to the inflated angioplasty balloon can be maintained with autoperfusion balloon catheters and coronary perfusion pumps. The blood flow rates through the autoperfusion balloon catheters and the flow rates achieved with a perfusion pump were compared in

  5. Optimization and comparison of simultaneous and separate acquisition protocols for dual isotope myocardial perfusion SPECT

    Science.gov (United States)

    Ghaly, Michael; Links, Jonathan M.; Frey, Eric C.

    2015-07-01

    Dual-isotope simultaneous-acquisition (DISA) rest-stress myocardial perfusion SPECT (MPS) protocols offer a number of advantages over separate acquisition. However, crosstalk contamination due to scatter in the patient and interactions in the collimator degrade image quality. Compensation can reduce the effects of crosstalk, but does not entirely eliminate image degradations. Optimizing acquisition parameters could further reduce the impact of crosstalk. In this paper we investigate the optimization of the rest Tl-201 energy window width and relative injected activities using the ideal observer (IO), a realistic digital phantom population and Monte Carlo (MC) simulated Tc-99m and Tl-201 projections as a means to improve image quality. We compared performance on a perfusion defect detection task for Tl-201 acquisition energy window widths varying from 4 to 40 keV centered at 72 keV for a camera with a 9% energy resolution. We also investigated 7 different relative injected activities, defined as the ratio of Tc-99m and Tl-201 activities, while keeping the total effective dose constant at 13.5 mSv. For each energy window and relative injected activity, we computed the IO test statistics using a Markov chain Monte Carlo (MCMC) method for an ensemble of 1,620 triplets of fixed and reversible defect-present, and defect-absent noisy images modeling realistic background variations. The volume under the 3-class receiver operating characteristic (ROC) surface (VUS) was estimated and served as the figure of merit. For simultaneous acquisition, the IO suggested that relative Tc-to-Tl injected activity ratios of 2.6-5 and acquisition energy window widths of 16-22% were optimal. For separate acquisition, we observed a broad range of optimal relative injected activities from 2.6 to 12.1 and acquisition energy window of widths 16-22%. A negative correlation between Tl-201 injected activity and the width of the Tl-201 energy window was observed in these ranges. The results

  6. Feasibility of one-eighth time gated myocardial perfusion SPECT functional imaging using IQ-SPECT

    Energy Technology Data Exchange (ETDEWEB)

    Caobelli, Federico; Thackeray, James T.; Bengel, Frank M. [Medizinische Hochschule Hannover, Klinik fuer Nuklearmedizin, Hannover (Germany); Soffientini, Alberto; Pizzocaro, Claudio; Guerra, Ugo Paolo [Fondazione Poliambulanza, Department of Nuclear Medicine, Brescia (Italy)

    2015-11-15

    IQ-SPECT, an add-on to general purpose cameras based on multifocal collimation, can reduce myocardial perfusion imaging (MPI) acquisition times to one-fourth that of standard procedures (to 12 s/view). In a phantom study, a reduction of the acquisition time to one-eighth of the standard time (to 6 s/view) was demonstrated as feasible. It remains unclear whether such a reduction could be extended to clinical practice. Fifty patients with suspected or diagnosed CAD underwent a 2-day stress-rest {sup 99m}Tc-sestamibi MPI protocol. Two consecutive SPECT acquisitions (6 and 12 s/view) were performed. Electrocardiogram-gated images were reconstructed with and without attenuation correction (AC). Polar maps were generated and visually scored by two blinded observers for image quality and perfusion in 17 segments. Global and regional summed stress score (SSS), summed rest score (SRS) and summed difference score (SDS) were determined. Left ventricular volumes and ejection fraction were calculated based on automated contour detection. Image quality was scored higher with the 12 s/view acquisition, both with and without AC. Summed scores were statistically comparable between the 6 s/view and the 12 s/view acquisition, both globally and in individual coronary territories (e.g. in images with AC, SSS were 6.6 ± 8.3 and 6.2 ± 8.2 with 6 s and 12 s/view, respectively, p = 0.10; SRS were 3.9 ± 5.6 and 3.5 ± 5.3, respectively, p = 0.19; and SDS were 2.8 ± 5.7 and 2.6 ± 5.7, respectively, p = 0.59). Both acquisitions allowed MPI-based diagnosis of CAD in 25 of the 50 patients (with AC). Calculated end-diastolic volume (EDV) and end-systolic volume (ESV) were modestly higher with the 6 s/view acquisition than with the 12 s/view acquisition (EDV +4.8 ml at rest and +3.7 ml after stress, p = 0.003; ESV +4.1 ml at rest and +2.6 ml after stress, p = 0.01), whereas the ejection fraction did not differ (-1.2 % at rest, p = 0.20, and -0.9 % after stress, p = 0.27). Image quality and

  7. Feasibility study of myocardial perfusion and oxygenation by noncontrast MRI: comparison with PET study in a canine model.

    Science.gov (United States)

    McCommis, Kyle S; Zhang, Haosen; Herrero, Pilar; Gropler, Robert J; Zheng, Jie

    2008-01-01

    The purpose of this study was to examine the feasibility of quantifying myocardial blood flow (MBF) and rate of myocardial oxygen consumption (MVO(2)) during pharmacologically induced stress without using a contrast agent. The former was measured by the arterial spin labeling (ASL) method and the latter was obtained by measuring the oxygen extraction fraction (OEF) with the magnetic resonance imaging (MRI) blood oxygenation level-dependent effect and Fick's law. The MRI results were compared with the established positron emission tomography (PET) methods. Six mongrel dogs with induced acute moderate left coronary artery stenosis were scanned using a clinical PET and a 1.5-T MRI system, in the same day. Regional MBF, myocardial OEF and MVO(2) were measured with both imaging modalities. Correlation coefficients (R(2)) of the three myocardial indexes (MBF, OEF and MVO(2)) between MRI and PET methods ranged from 0.70 to 0.93. Bland-Altman statistics demonstrated that the estimated precision of the limits of agreement between MRI and PET measurements varied from 18% (OEF) to 37% (MBF) and 45% (MVO(2)). The detected changes in these indexes, at rest and during dobutamine stress, were similar between two image modalities. The proposed noncontrast MRI technique is a promising method to quantitatively assess myocardial perfusion and oxygenation.

  8. Resveratrol preserves myocardial function and perfusion in remote nonischemic myocardium in a swine model of metabolic syndrome.

    Science.gov (United States)

    Robich, Michael P; Chu, Louis M; Burgess, Thomas A; Feng, Jun; Han, Yuchi; Nezafat, Reza; Leber, Michael P; Laham, Roger J; Manning, Warren J; Sellke, Frank W

    2012-11-01

    Resveratrol has been shown to reverse some of the detrimental effects of metabolic syndrome (MetS). We sought to define the impact of supplemental resveratrol on normal myocardium remote from an ischemic territory in a swine model of MetS and chronic myocardial ischemia. Yorkshire swine were fed a normal diet (control), a high cholesterol diet (HCD), or a high cholesterol diet with orally supplemented resveratrol (HCD-R; 100 mg/kg/day). Four weeks after diet modification, myocardial ischemia was induced by ameroid constrictor placement. Seven weeks later, myocardial tissue from a territory remote from the ischemia was harvested. Animals in the HCD and HCD-R groups underwent functional cardiac MRI before ischemia and before sacrifice. Tissue was harvested for protein expression analysis. After 7 weeks of ischemia, regional left ventricular systolic function was significantly increased in HCD-R as compared with HCD animals. During ventricular pacing the HCD group had significantly decreased flow (p = 0.03); perfusion in the HCD-R was preserved as compared with the control. There was no difference in microvascular relaxation. Expression of metabolic proteins Sirt-1 (p = 0.002), AMPkinase (p = 0.02), and carnitine palmitoyltransferase-I (p = 0.002) were upregulated in the HCD-R group. Levels of protein oxidative stress were significantly increased in the HCD and HCD-R groups, as compared with the controls (p = 0.003). Activated endothelial nitric oxide synthase (eNOS) was increased in the HCD-R group (p = 0.01). There was no difference in myocardial endothelial cell density between the groups; however, dividing endothelial cells were decreased in the HCD and HCD-R groups (p = 0.006). Resveratrol supplementation improves regional left ventricular function and preserves perfusion to myocardium remote from an area of ischemia in an animal model of metabolic syndrome and chronic myocardial ischemia. Copyright © 2012 American College of Surgeons. Published by Elsevier Inc

  9. Platelet counts on admission affect coronary flow, myocardial perfusion and left ventricular systolic function after primary percutaneous coronary intervention.

    Science.gov (United States)

    Sharif, Dawod; Abu-Salem, Mira; Sharif-Rasslan, Amal; Rosenschein, Uri

    2017-10-01

    Patients with acute ST-elevation myocardial infarction (STEMI) and increased platelet count treated by fibrinolysis have worse outcomes. The aim of this study was to test the hypothesis that platelet blood count at admission in patients with acute STEMI treated by primary percutaneous coronary intervention affects coronary flow, myocardial perfusion and recovery of left ventricular systolic function. A total of 174 patients presenting with acute anterior STEMI and treated with primary percutaneous coronary intervention were included and divided into subgroups of admission platelet blood count of 400 K. Evaluation of coronary artery flow and myocardial blush grade was performed according to the TIMI criteria. Electrocardiographic ST elevation resolution post-primary percutaneous coronary intervention was evaluated. Doppler echocardiographic evaluation of left anterior descending coronary artery velocities early and late after primary percutaneous coronary intervention and assessment of left ventricular ejection fraction and wall motion score index (WMSI) of left ventricular and left anterior descending coronary artery territory were performed. Post-primary percutaneous coronary intervention TIMI, myocardial blush grade and ST elevation resolution were similar in all groups. Patients with platelet counts primary percutaneous coronary intervention, and higher prevalence of left anterior descending coronary artery velocity deceleration time exceeding 600 ms, (45.5% vs. 40%, P400 K presented with worse left ventricular ejection fraction, left ventricular WMSI and left anterior descending coronary artery WMSI, and before discharge this subgroup had worse left ventricular WMSI and left anterior descending coronary artery WMSI, Pprimary percutaneous coronary intervention with lower admission platelet count had higher left anterior descending coronary artery diastolic velocities, better myocardial perfusion with more patients having left anterior descending coronary artery

  10. Intracoronary Administration of Allogeneic Adipose Tissue-Derived Mesenchymal Stem Cells Improves Myocardial Perfusion But Not Left Ventricle Function, in a Translational Model of Acute Myocardial Infarction.

    Science.gov (United States)

    Bobi, Joaquim; Solanes, Núria; Fernández-Jiménez, Rodrigo; Galán-Arriola, Carlos; Dantas, Ana Paula; Fernández-Friera, Leticia; Gálvez-Montón, Carolina; Rigol-Monzó, Elisabet; Agüero, Jaume; Ramírez, José; Roqué, Mercè; Bayés-Genís, Antoni; Sánchez-González, Javier; García-Álvarez, Ana; Sabaté, Manel; Roura, Santiago; Ibáñez, Borja; Rigol, Montserrat

    2017-05-03

    Autologous adipose tissue-derived mesenchymal stem cells (ATMSCs) therapy is a promising strategy to improve post-myocardial infarction outcomes. In a porcine model of acute myocardial infarction, we studied the long-term effects and the mechanisms involved in allogeneic ATMSCs administration on myocardial performance. Thirty-eight pigs underwent 50 minutes of coronary occlusion; the study was completed in 33 pigs. After reperfusion, allogeneic ATMSCs or culture medium (vehicle) were intracoronarily administered. Follow-ups were performed at short (2 days after acute myocardial infarction vehicle-treated, n=10; ATMSCs-treated, n=9) or long term (60 days after acute myocardial infarction vehicle-treated, n=7; ATMSCs-treated, n=7). At short term, infarcted myocardium analysis showed reduced apoptosis in the ATMSCs-treated animals (48.6±6% versus 55.9±5.7% in vehicle; P =0.017); enhancement of the reparative process with up-regulated vascular endothelial growth factor, granulocyte macrophage colony-stimulating factor, and stromal-derived factor-1α gene expression; and increased M2 macrophages (67.2±10% versus 54.7±10.2% in vehicle; P =0.016). In long-term groups, increase in myocardial perfusion at the anterior infarct border was observed both on day-7 and day-60 cardiac magnetic resonance studies in ATMSCs-treated animals, compared to vehicle (87.9±28.7 versus 57.4±17.7 mL/min per gram at 7 days; P =0.034 and 99±22.6 versus 43.3±14.7 22.6 mL/min per gram at 60 days; P =0.0001, respectively). At day 60, higher vascular density was detected at the border zone in the ATMSCs-treated animals (118±18 versus 92.4±24.3 vessels/mm 2 in vehicle; P =0.045). Cardiac magnetic resonance-measured left ventricular ejection fraction of left ventricular volumes was not different between groups at any time point. In this porcine acute myocardial infarction model, allogeneic ATMSCs-based therapy was associated with increased cardioprotective and reparative

  11. Enhancement of dynamic myocardial perfusion PET images based on low-rank plus sparse decomposition.

    Science.gov (United States)

    Lu, Lijun; Ma, Xiaomian; Mohy-Ud-Din, Hassan; Ma, Jianhua; Feng, Qianjin; Rahmim, Arman; Chen, Wufan

    2018-02-01

    The absolute quantification of dynamic myocardial perfusion (MP) PET imaging is challenged by the limited spatial resolution of individual frame images due to division of the data into shorter frames. This study aims to develop a method for restoration and enhancement of dynamic PET images. We propose that the image restoration model should be based on multiple constraints rather than a single constraint, given the fact that the image characteristic is hardly described by a single constraint alone. At the same time, it may be possible, but not optimal, to regularize the image with multiple constraints simultaneously. Fortunately, MP PET images can be decomposed into a superposition of background vs. dynamic components via low-rank plus sparse (L + S) decomposition. Thus, we propose an L + S decomposition based MP PET image restoration model and express it as a convex optimization problem. An iterative soft thresholding algorithm was developed to solve the problem. Using realistic dynamic 82Rb MP PET scan data, we optimized and compared its performance with other restoration methods. The proposed method resulted in substantial visual as well as quantitative accuracy improvements in terms of noise versus bias performance, as demonstrated in extensive 82Rb MP PET simulations. In particular, the myocardium defect in the MP PET images had improved visual as well as contrast versus noise tradeoff. The proposed algorithm was also applied on an 8-min clinical cardiac 82Rb MP PET study performed on the GE Discovery PET/CT, and demonstrated improved quantitative accuracy (CNR and SNR) compared to other algorithms. The proposed method is effective for restoration and enhancement of dynamic PET images. Copyright © 2017 Elsevier B.V. All rights reserved.

  12. Coronary grafts flow and cardiac pacing modalities: how to improve perioperative myocardial perfusion.

    LENUS (Irish Health Repository)

    D'Ancona, Giuseppe

    2012-02-03

    OBJECTIVE: Aim of this study was to investigate modifications of coronary grafts flow during different pacing modalities after CABG. MATERIALS AND METHODS: Two separate prospective studies were conducted in patients undergoing CABG and requiring intraoperative epicardial pacing. In a first study (22 patients) coronary grafts flows were measured during dual chamber pacing (DDD) and during ventricular pacing (VVI). In a second study (10 patients) flows were measured during DDD pacing at different atrio-ventricular (A-V) delay periods. A-V delay was adjusted in 25 ms increments from 25 to 250 ms and flow measurements were performed for each A-V delay increment. A transit time flowmeter was used for the measurements. RESULTS: An average of 3.4 grafts\\/patient were performed. In the first study, average coronary graft flow was 47.4+\\/-20.8 ml\\/min during DDD pacing and 41.8+\\/-18.2 ml\\/min during VVI pacing (P = 0.0004). Furthermore average systolic pressure was 94.3+\\/-10.1 mmHg during DDD pacing and 89.6+\\/-12.2 mmHg during VVV pacing (P = 0.0007). No significant differences in diastolic pressure were recorded during the two different pacing modalities. In the second study, maximal flows were achieved during DDD pacing with an A-V delay of 175 ms (54+\\/-9.6 ml\\/min) and minimal flows were detected at 25 ms A-V delay (38.1+\\/-4.7 ml\\/min) (P=ns). No significant differences in systolic or diastolic blood pressure were noticed during the different A-V delays. CONCLUSION: Grafts flowmetry provides an extra tool to direct supportive measures such as cardiac pacing after CABG. DDD mode with A-V delay around 175 ms. should be preferred to allow for maximal myocardial perfusion via the grafts.

  13. Myocardial perfusion imaging laboratory efficiency with the use of regadenoson compared to adenosine and dipyridamole.

    Science.gov (United States)

    Friedman, Michelle; Spalding, James; Kothari, Smita; Wu, You; Gatt, Elyse; Boulanger, Luke

    2013-01-01

    Adenosine, dipyridamole, and regadenoson are pharmacologic stress agents used in myocardial perfusion imaging (MPI), to diagnose and monitor coronary artery disease. Clinical studies suggest that regadenoson has pharmacologic properties that simplify the MPI procedure through availability to a wider range of patients and easier administrative requirements. This study assesses the operational advantages and laboratory efficiency associated with the use of regadenoson compared to adenosine and dipyridamole. A web-based survey of 141 nuclear medicine technologists working in US-based cardiovascular imaging laboratories from June-July 2009. Descriptive statistics measured the adenosine, dipyridamole, and regadenoson cohorts. Bivariate analyses compared the overall and staff-specific time to conduct an MPI test. The site-specific sub-groups were defined by hospital vs non-hospital setting, hours of operation, number of SPECT cameras, and number of full-time equivalent staff, including nurses, nuclear technologists, physicians, and nurse practitioners/physician assistants. The total time to conduct an MPI test was shortest with regadenoson 156 (46) min compared to adenosine and dipyridamole 182 (63) and 191 (61) min, respectively. Time from regadenoson administration to the start of the imaging session, including dose calculation and infusion time, was 14.2 min less than adenosine, and 12.0 min less than dipyridamole. The time to manage adverse events was shortest if it occurred with regadenoson compared to adenosine and dipyridamole, with minor exceptions. Due to the nature of survey implementation, possible recall bias may limit the results. Some differences in procedures times may be attributable to differences in laboratories' protocols. Overall time savings and time savings stratified by operational ability (number of staff, number of SPECT cameras, hours of operation) translate to a more efficient utilization of laboratory resources when using regadenoson

  14. Myocardial perfusion scintigraphy in the UK: insights from the British Nuclear Cardiology Society Survey 2000.

    Science.gov (United States)

    Kelion, A D; Anagnostopoulos, C; Harbinson, M; Underwood, S R; Metcalfe, M

    2005-09-01

    The National Institute for Health and Clinical Excellence (NICE) has recently published a very positive technology appraisal of myocardial perfusion scintigraphy (MPS). This has important implications for service provision within the National Health Service, and an accurate knowledge of the current level of MPS activity is necessary. A postal questionnaire was sent to 207 nuclear medicine departments in the UK, requesting information about nuclear cardiology facilities, activity, and practice. Non-responding departments were sent a second questionnaire, followed where necessary by a telephone call. A response rate of 61% was achieved; 52% of departments performed MPS, and these tended to have more gamma cameras than those which did not (median (25th-75th centile) 2.0, 1.5-2.5 v 1.0, 0.5-1.5; p = 0.02). The median number of studies performed was 256 (144-460). The estimated rate of MPS in the UK for the year 2000 was 1200 per million population. The median (25th-75th centile) waiting time for MPS was 16 (9-24) weeks. Pharmacological stress was used in 77% of studies, and a technetium-99m based radiopharmaceutical in 60% (two day protocol in 75%). Tomographic rather than planar imaging was performed in 88% of studies, of which 22% were ECG gated. A cardiologist was involved in reporting in 35% of studies. MPS activity in the UK remains low, and it tends to be provided as a low volume service with unacceptably long waiting times and a lack of involvement by cardiologists. The recent NICE appraisal may provide an impetus for further resourcing and development.

  15. Adenosine stress high-pitch 128-slice dual-source myocardial computed tomography perfusion for imaging of reversible myocardial ischemia: comparison with magnetic resonance imaging.

    Science.gov (United States)

    Feuchtner, Gudrun; Goetti, Robert; Plass, André; Wieser, Monika; Scheffel, Hans; Wyss, Christophe; Stolzmann, Paul; Donati, Olivio; Schnabl, Johannes; Falk, Volkmar; Alkadhi, Hatem; Leschka, Sebastian; Cury, Ricardo C

    2011-09-01

    Coronary computed tomography angiography (CTA) enables accurate anatomic evaluation of coronary artery stenosis but lacks information about hemodynamic significance. The aim of this study was to evaluate 128-slice myocardial CT perfusion (CTP) imaging with adenosine stress using a high-pitch mode, in comparison with cardiac MRI (CMR). Thirty-nine patients with intermediate to high coronary risk profile underwent adenosine stress 128-slice dual source CTP (128×0.6 mm, 0.28 seconds). Among those, 30 patients (64 ± 10 years, 6% women) also underwent adenosine stress CMR (1.5T). The 2-step CTP protocol consisted of (1) adenosine stress-CTP using a high-pitch factor (3.4) ECG-synchronized spiral mode and (2) rest-CTP/coronary-CTA using either high-pitch (heart rate 63 bpm). Results were compared with CMR and with invasive angiography in 25 patients. The performance of stress-CTP for detection of myocardial perfusion defects compared with CMR was sensitivity, 96%; specificity, 88%; positive predictive value (PPV), 93%; negative predictive value (NPV), 94% (per vessel); and sensitivity, 78%; specificity, 87%; PPV, 83%; NPV, 84% (per segment). The accuracy of stress-CTP for imaging of reversible ischemia compared with CMR was sensitivity, 95%; specificity, 96%; PPV, 95%; and NPV, 96% (per vessel). In 25 patients who underwent invasive angiography, the accuracy of CTA for detection of stenosis >70% was (per segment): sensitivity, 96%; specificity, 88%; PPV, 67%; and NPV, 98.9%. The accuracy improved from 84% to 95% after adding stress CTP to CTA. Radiation exposure of the entire stress/rest CT protocol was only 2.5 mSv. Adenosine-induced stress 128-slice dual-source high-pitch myocardial CTP allows for simultaneously assessment of reversible myocardial ischemia and coronary stenosis, with good diagnostic accuracy as compared with CMR and invasive angiography, at a very low radiation exposure.

  16. Type 2 diabetes mellitus correlates with systolic function during myocardial stress perfusion scanning with Nitrogen-13 ammonia PET.

    Science.gov (United States)

    Juárez-Orozco, Luis Eduardo; van der Zant, Friso M; Slart, Riemer H J A; Lazarenko, Sergiy V; Alexanderson, Erick; Tio, Rene A; Knol, Remco J J

    2017-08-01

    The influence of type 2 diabetes mellitus (DM2) on systolic function is partially determined by the coronary vasodilator function, nevertheless, an independent effect is suspected. We evaluated the relationship between DM2 and systolic function considering PET quantitative myocardial perfusion. We analyzed 585 patients without a previous myocardial infarction referred to a rest and adenosine stress Nitrogen-13 ammonia PET. A bootstrapped multiple linear regression analysis was performed using DM2, stress myocardial blood flow (sMBF), myocardial perfusion reserve (MPR), and clinical risk factors as predictors and LVEF as the outcome variable; an interaction term was additionally investigated. Two hundred and ninety male and 295 female patients (mean age 65.3 ± 9.9 and 67.4 ± 10 years, respectively) were included. 57.1% presented hypertension, 16% smoking, 37.6% hypercholesterolemia, 33.8% family history for CAD, and 15.2% DM2. The mean MPR was 2.13 ± 0.48 and 2.21 ± 0.60, mean sMBF was 2.01 ± 0.51 and 2.15 ± 0.54, and mean LVEF was 63% ± 10.4 and 67% ± 10.1 for diabetics and non-diabetics, respectively. A significant relation was detected for sMBF (B = 5.830 95% CI [3.505, 9.549], P = .001) and DM2 (B = -2.599 95% CI [-5.125, -0.119], P = .03) with LVEF. The interaction (DM2 × sMBF) yielded no significance (P = .512). DM2 influences PET-measured systolic function in patients without previous myocardial infarction independently from myocardial perfusion parameters. Our study supports the importance of DM2 as an independent risk factor for deteriorating systolic function.

  17. Detection of obstructive coronary artery disease using regadenoson stress and 82Rb PET/CT myocardial perfusion imaging.

    Science.gov (United States)

    Hsiao, Edward; Ali, Bilal; Blankstein, Ron; Skali, Hicham; Ali, Towhid; Bruyere, John; Kwong, Raymond Y; Di Carli, Marcelo F; Dorbala, Sharmila

    2013-10-01

    Our objective was to study the diagnostic performance of regadenoson (82)Rb myocardial perfusion PET imaging to detect obstructive coronary artery disease (CAD). We studied 134 patients (mean age, 63 ± 12 y; mean body mass index, 31 ± 9 kg/m(2)) without known CAD (96 with coronary angiography and 38 with low pretest likelihood of CAD). Stress left ventricular ejection fraction (LVEF) minus rest LVEF defined LVEF reserve. The Duke score was used to estimate the anatomic extent of jeopardized myocardium. Regadenoson PET had a high sensitivity, 92% (95% confidence interval [CI], 83%-97%), in detecting obstructive CAD, with a normalcy rate of 97% (95% CI, 86%-99%), specificity of 77% (54/70 patients; 95% CI, 66%-86%), and area under the receiver-operator-characteristic curve of 0.847 (95% CI, 0.774-0.903; P Regadenoson PET demonstrated high sensitivity to detect CAD in patients with single-vessel CAD (89%; 95% CI, 70%-98%). The mean LVEF reserve was significantly higher in patients with normal myocardial perfusion imaging results (6.5% ± 5.4%) than in those with mild (4.3 ± 5.1, P = 0.03) and moderate to severe reversible defects (-0.2% ± 8.4%, P = 0.001). Also, mean LVEF reserve was significantly higher in patients with a low likelihood of CAD (7.2% ± 4.5%, P Regadenoson (82)Rb myocardial perfusion imaging is accurate for the detection of obstructive CAD. LVEF reserve is high in patients without significant ischemia or significant angiographic jeopardized myocardium.

  18. Usefulness of combination post-stress dysfunction and perfusion imaging in technetium-99m-tetrofosmin myocardial scintigraphy

    Energy Technology Data Exchange (ETDEWEB)

    Yamazaki, Yoko; Imai, Kamon; Konaka, Ryohei; Nakajima, Takatomo; Goto, Sayaka; Horie, Toshinobu [Saitama Cardiovascular and Respiratory Center, Konan (Japan); Saito, Satoshi; Ozawa, Yukio; Kanmatsuse, Katsuo

    2001-09-01

    Myocardial perfusion imaging has lower sensitivity for the diagnosis of coronary artery disease in patients with three-vessel disease. The presence of post-stress dysfunction of the left ventricle, evaluated by electrocardiography (ECG) gated single photon emission computed tomography (SPECT) with a quantitative gated SPECT program, was investigated in patients with coronary artery disease, and also whether combining post-stress dysfunction and myocardial perfusion imaging improved the diagnosis of coronary artery disease. ECG gated technetium-99m-tetrofosmin SPECT was performed using a one day, stress and rest, protocol in 139 patients. SPECT and coronary angiography were performed within 1 month. The coronary artery disease group consisted of 89 patients: 43 with one-vessel disease (1VD), 28 with two-vessel disease (2VD), and 18 with three-vessel disease (3VD). The group with zero-vessel disease (0VD) consisted of 50 patients. According to post-stress and rest ejection fraction (EF) and end-systolic volume (ESV), post-stress dysfunction is defined as follows: rest EF - post-stress EF{>=}5% and post-stress ESV - rest ESV{>=}5ml. In the coronary artery disease group, post-stress ESV was larger than rest ESV (37.8{+-}26.4, 34.0{+-}24.2 ml, p<0.001), and post-stress EF was lower than rest EF (61.5{+-}11.1%, 64.2{+-}10.8%, p<0.001). In the 0VD group, ESV and EF were the same for post-stress and rest (25.7{+-}20.8, 26.2{+-}21.6 ml, NS; 70.4{+-}9.5%, 70.0{+-}9.6%, NS). Post-stress dysfunction was 6.0% in the 0VD group and 30.3% in the coronary artery disease group (p<0.001). Furthermore, post-stress dysfunction in the 2VD (35.7%) and 3VD (38.9%) groups was higher than that in the 0VD group (p<0.01, p<0.01). Sensitivity of coronary artery disease diagnosis by myocardial perfusion imaging was 75%. The combination of post-stress dysfunction and myocardial perfusion imaging improved sensitivity from 75% to 82% (p<0.05), but reduced the specificity from 92% to 86% (p=0

  19. The reproducibility and prognostic value of serial measurements of heart rate response to regadenoson during myocardial perfusion imaging.

    Science.gov (United States)

    Andrikopoulou, Efstathia; AlJaroudi, Wael A; Farag, Ayman; Lester, Davis; Patel, Hiren; Iskandrian, Ami E; Hage, Fadi G

    2016-07-01

    The heart rate response (HRR, percentage change from baseline) to regadenoson during myocardial perfusion imaging (MPI) can provide incremental prognostic value in patients with known or suspected coronary artery disease. Our purpose was to evaluate the variability and prognostic value of HRR on serial measurements. We studied 648 consecutive patients (61 ± 11 years, 48 % with diabetes) who underwent two regadenoson MPI studies (16 ± 9 months between studies). HRR regadenoson on serial measurements without systematic or proportional biases. Patients with consistently normal HRR had the best prognosis.

  20. Exercise training prior to myocardial infarction attenuates cardiac deterioration and cardiomyocyte dysfunction in rats.

    Science.gov (United States)

    Bozi, Luiz Henrique Marchesi; Maldonado, Izabel Regina dos Santos Costa; Baldo, Marcelo Perim; Silva, Márcia Ferreira da; Moreira, José Bianco Nascimento; Novaes, Rômulo Dias; Ramos, Regiane Maria Soares; Mill, José Geraldo; Brum, Patricia Chakur; Felix, Leonardo Bonato; Gomes, Thales Nicolau Prímola; Natali, Antônio José

    2013-04-01

    The present study was performed to investigate 1) whether aerobic exercise training prior to myocardial infarction would prevent cardiac dysfunction and structural deterioration and 2) whether the potential cardiac benefits of aerobic exercise training would be associated with preserved morphological and contractile properties of cardiomyocytes in post-infarct remodeled myocardium. Male Wistar rats underwent an aerobic exercise training protocol for eight weeks. The rats were then assigned to sham surgery (SHAM), sedentary lifestyle and myocardial infarction or exercise training and myocardial infarction groups and were evaluated 15 days after the surgery. Left ventricular tissue was analyzed histologically, and the contractile function of isolated myocytes was measured. Student's t-test was used to analyze infarct size and ventricular wall thickness, and the other parameters were analyzed by the Kruskal-Wallis test followed by Dunn's test or a one-way analysis of variance followed by Tukey's test (pmyocardial infarction extension, a thicker infarcted wall and less collagen accumulation as compared to myocardial infarctions in sedentary animals. Myocardial infarction-induced left ventricular dilation and cardiac dysfunction, as evaluated by +dP/dt and -dP/dt, were both prevented by previous aerobic exercise training. Moreover, aerobic exercise training preserved cardiac myocyte shortening, improved the maximum shortening and relengthening velocities in infarcted hearts and enhanced responsiveness to calcium. Previous aerobic exercise training attenuated the cardiac dysfunction and structural deterioration promoted by myocardial infarction, and such benefits were associated with preserved cardiomyocyte morphological and contractile properties.

  1. Prediction of clinical outcome by myocardial CT perfusion in patients with low-risk unstable angina pectoris

    DEFF Research Database (Denmark)

    Linde, Jesper J; Sørgaard, Mathias; Kühl, Jørgen T

    2017-01-01

    The prognostic implications of myocardial computed tomography perfusion (CTP) analyses are unknown. In this sub-study to the CATCH-trial we evaluate the ability of adenosine stress CTP findings to predict mid-term major adverse cardiac events (MACE). In 240 patients with acute-onset chest pain, yet...... %) suffered a MACE (cardiac death, non-fatal myocardial infarction and revascularizations). Accuracy for the prediction of MACE expressed as the area under curve (AUC) on receiver-operating characteristic curves was 0.88 (0.83-0.92) for visual assessment of a PD and 0.80 (0.73-0.85) for stress TPR (transmural.......98-0.99) for stress TPR, p 10 % of the LV myocardium had a worse prognosis compared to patients with a PD covering sensitivity 84...

  2. Added value of hybrid myocardial perfusion SPECT and CT coronary angiography in the diagnosis of coronary artery disease.

    Science.gov (United States)

    Schaap, Jeroen; de Groot, Joris A H; Nieman, Koen; Meijboom, W Bob; Boekholdt, S Matthijs; Kauling, Robert M; Post, Martijn C; Van der Heyden, Jan A; de Kroon, Thom L; Rensing, Benno J W M; Moons, Karel G M; Verzijlbergen, J Fred

    2014-11-01

    Hybrid single photon emission computed tomography (SPECT)/coronary computed tomography angiography (CCTA) has only been evaluated for its diagnostic accuracy as a single test in patients suspected of significant coronary artery disease (CAD). Added value of hybrid SPECT/CCTA beyond usual clinical work-up, or use of each of these tests separately, remains unclear. We evaluated the added value of hybrid myocardial perfusion SPECT (SPECT) and CCTA, beyond pre-test likelihood and exercise stress ECG (X-ECG), in the diagnosis of CAD. Two hundred and five patients with stable angina pectoris and intermediate-to-high pre-test likelihood were prospectively included. All patients underwent clinical history and examination, X-ECG, stress and rest SPECT, coronary calcium scoring (CCS) and CCTA. Fractional flow reserve measurement 50% on coronary angiography (CA) served as reference standard for significant CAD. Multiple imputation was used to correct for missing test results (17-20%). Added value of hybrid SPECT/CCTA to the basic model of pre-test likelihood plus X-ECG was quantified using logistic regression analysis. Model differences were then assessed using differences in C-index and in net reclassification improvement (NRI). The basic model had a C-index of 0.73 (95%CI 0.66-0.80). This significantly increased to 0.85 (95%CI 0.80-0.91) by addition of only SPECT, to 0.90 (95%CI 0.85-0.94) when adding only CCTA, and to 0.96 (95%CI 0.92-0.99) when adding hybrid SPECT/CCTA. The accompanying NRIs were 0.82 (95%CI 0.62-1.02), 0.86 (95%CI 0.66-1.06) and 1.57 (95%CI 1.11-1.59) respectively. Current analysis resembles clinical routine of layered testing and shows that hybrid SPECT/CCTA imaging has a substantially higher yield than standalone SPECT or CCTA in the diagnostic workup of patients suspected of significant CAD. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2014. For permissions please email: journals.permissions@oup.com.

  3. Stress myocardial perfusion imaging by CMR provides strong prognostic value to cardiac events regardless of patient's sex.

    Science.gov (United States)

    Coelho-Filho, Otavio R; Seabra, Luciana F; Mongeon, François-Pierre; Abdullah, Shuaib M; Francis, Sanjeev A; Blankstein, Ron; Di Carli, Marcelo F; Jerosch-Herold, Michael; Kwong, Raymond Y

    2011-08-01

    The major aim of this study is to test the hypothesis that stress cardiac magnetic resonance (CMR) imaging can provide robust prognostic value in women presenting with suspected ischemia, to the same extent as in men. Compelling evidence indicates that women with coronary artery disease (CAD) experience worse outcomes than men owing to a lack of early diagnosis and management. Numerous clinical studies have shown that stress CMR detects evidence of myocardial ischemia and infarction at high accuracy. Compared to nuclear scintigraphy, CMR is free of ionizing radiation, has high spatial resolution for imaging small hearts, and overcomes breast attenuation artifacts, which are substantial advantages when imaging women for CAD. We performed stress CMR in 405 patients (168 women, mean age 58 ± 14 years) referred for ischemia assessment. CMR techniques included cine cardiac function, perfusion imaging during vasodilating stress, and late gadolinium enhancement imaging. All patients were followed for major adverse cardiac events (MACE). At a median follow-up of 30 months, MACE occurred in 36 patients (9%) including 21 cardiac deaths and 15 acute myocardial infarctions. In women, CMR evidence of ischemia (ISCHEMIA) demonstrated strong association with MACE (unadjusted hazard ratio: 49.9, p women with ISCHEMIA(+) had an annual MACE rate of 15%, women with ISCHEMIA(-) had very low annual MACE rate (0.3%), which was not statistically different from the low annual MACE rate in men with ISCHEMIA(-) (1.1%). CMR myocardial ischemia score was the strongest multivariable predictor of MACE in this cohort, for both women and men, indicating robust cardiac prognostication regardless of sex. In addition to avoiding exposure to ionizing radiation, stress CMR myocardial perfusion imaging is an effective and robust risk-stratifying tool for patients of either sex presenting with possible ischemia. Copyright © 2011 American College of Cardiology Foundation. Published by Elsevier Inc. All

  4. The effect of CT-based attenuation correction on the automatic perfusion score of myocardial perfusion imaging using a dedicated cardiac solid-state CZT SPECT/CT.

    Science.gov (United States)

    Kennedy, John A; Brodov, Yafim; Weinstein, Adam L; Israel, Ora; Frenkel, Alex

    2017-05-01

    Data regarding cardiac cadmium-zinc-telluride (CZT)-specific augmented databases and their impact on CT-based attenuation correction (AC) perfusion scores in myocardial perfusion imaging (MPI) were obtained on a multiple-pinhole CZT SPECT/CT. Summed stress (SSS) and rest scores (SRS) were measured using automated software in three independent patient groups: group 1 (n = 80) underwent MPI on both CZT and conventional sodium iodide (NaI) devices, group 2 (n = 80) with low coronary artery disease likelihood and normal MPI provided reference CZT databases; and group 3 (n = 152) served to compare AC and non-AC (NAC) scores on CZT. Group 1 CZT and NaI scores gave a significant 1:1 linear correlation for CZT scores referenced to the custom database vs NaI scores referenced to the default database, but these were not concordant when CZT scores were referenced to the default database. AC significantly decreased average SSS and SRS in men vs NAC, 4.29 ± 6.30 vs 5.37 ± 7.26 (P < 0.001) and 2.37 ± 4.72 vs 3.13 ± 5.85 (P < 0.001), but not in women, 2.28 ± 3.42 vs 2.28 ± 3.08 (p NS) and 0.46 ± 1.51 vs 0.61 ± 1.86, (p NS), respectively. Specifically designed databases for solid-state CZT cardiac SPECT provide accurate quantitation of perfusion scores concordant with those previously validated for conventional SPECT. AC and NAC CZT scores differed significantly, especially in men.

  5. Comparison of 18F-Labeled Fluoroalkylphosphonium Cations with 13N-NH3 for PET Myocardial Perfusion Imaging.

    Science.gov (United States)

    Kim, Dong-Yeon; Kim, Hyeon Sik; Reder, Sybille; Zheng, Jin Hai; Herz, Michael; Higuchi, Takahiro; Pyo, A Young; Bom, Hee-Seung; Schwaiger, Markus; Min, Jung-Joon

    2015-10-01

    Despite substantial advances in the diagnosis of cardiovascular disease, there is a need for 18F-labeled myocardial perfusion agents for the diagnosis of ischemic heart disease because current PET tracers for myocardial perfusion imaging have a short half-life that limits their widespread clinical use in PET. Thus, 18F-labeled fluoroalkylphosphonium derivatives (18F-FATPs), including (5-18F-fluoropentyl)triphenylphosphonium cation (18F-FPTP), (6-18F-fluorohexyl)triphenylphosphonium cation (18F-FHTP), and (2-(2-18F-fluoroethoxy)ethyl)triphenylphosphonium cation (18F-FETP), were synthesized. The myocardial extraction and image quality of the 18F-FATPs were compared with those of 13N-NH3 in rat models. The first-pass extraction fraction (EF) values of the 18F-FATPs (18F-FPTP, 18F-FHTP, 18F-FETP) and 13N-NH3 were measured in isolated rat hearts perfused with the Langendorff method (flow velocities, 0.5, 4.0, 8.0, and 16.0 mL/min). Normal and myocardial infarction rats were imaged with small-animal PET after intravenous injection of 37 MBq of 18F-FATPs and 13N-NH3. To determine pharmacokinetics, a region of interest was drawn around the heart, and time-activity curves of the 18F-FATPs and 13N-NH3 were generated to obtain the counts per pixel per second. Defect size was analyzed on the basis of polar map images of 18F-FATPs and 13N-NH3. The EF values of 18F-FATPs and 13N-NH3 were comparable at low flow velocity (0.5 mL/min), whereas at higher flows EF values of 18F-FATPs were significantly higher than those of 13N-NH3 (4.0, 8.0, and 16.0 mL/min, PNH3 were 2.10±0.30, 4.36±0.20, 3.88±1.03, and 0.70±0.09, respectively, 10 min after injection, whereas myocardium-to-lung ratios were 5.00±0.25, 4.33±0.20, 7.98±1.23, and 2.26±0.14, respectively. Although 18F-FATPs and 13N-NH3 sharply delineated myocardial perfusion defects, defect size on the 13N-NH3 images was significantly smaller than on the 18F-FATP images soon after tracer injection (0-10 min, P=0.027). 18F

  6. Exercise training prior to myocardial infarction attenuates cardiac deterioration and cardiomyocyte dysfunction in rats

    Directory of Open Access Journals (Sweden)

    Luiz Henrique Marchesi Bozi

    2013-04-01

    Full Text Available OBJECTIVES: The present study was performed to investigate 1 whether aerobic exercise training prior to myocardial infarction would prevent cardiac dysfunction and structural deterioration and 2 whether the potential cardiac benefits of aerobic exercise training would be associated with preserved morphological and contractile properties of cardiomyocytes in post-infarct remodeled myocardium. METHODS: Male Wistar rats underwent an aerobic exercise training protocol for eight weeks. The rats were then assigned to sham surgery (SHAM, sedentary lifestyle and myocardial infarction or exercise training and myocardial infarction groups and were evaluated 15 days after the surgery. Left ventricular tissue was analyzed histologically, and the contractile function of isolated myocytes was measured. Student's t-test was used to analyze infarct size and ventricular wall thickness, and the other parameters were analyzed by the Kruskal-Wallis test followed by Dunn's test or a one-way analysis of variance followed by Tukey's test (p<0.05. RESULTS: Myocardial infarctions in exercise-trained animals resulted in a smaller myocardial infarction extension, a thicker infarcted wall and less collagen accumulation as compared to myocardial infarctions in sedentary animals. Myocardial infarction-induced left ventricular dilation and cardiac dysfunction, as evaluated by +dP/dt and -dP/dt, were both prevented by previous aerobic exercise training. Moreover, aerobic exercise training preserved cardiac myocyte shortening, improved the maximum shortening and relengthening velocities in infarcted hearts and enhanced responsiveness to calcium. CONCLUSION: Previous aerobic exercise training attenuated the cardiac dysfunction and structural deterioration promoted by myocardial infarction, and such benefits were associated with preserved cardiomyocyte morphological and contractile properties.

  7. Feasibility of one-eighth time gated myocardial perfusion SPECT functional imaging using IQ-SPECT.

    Science.gov (United States)

    Caobelli, Federico; Thackeray, James T; Soffientini, Alberto; Bengel, Frank M; Pizzocaro, Claudio; Guerra, Ugo Paolo

    2015-11-01

    IQ-SPECT, an add-on to general purpose cameras based on multifocal collimation, can reduce myocardial perfusion imaging (MPI) acquisition times to one-fourth that of standard procedures (to 12 s/view). In a phantom study, a reduction of the acquisition time to one-eighth of the standard time (to 6 s/view) was demonstrated as feasible. It remains unclear whether such a reduction could be extended to clinical practice. Fifty patients with suspected or diagnosed CAD underwent a 2-day stress-rest (99m)Tc-sestamibi MPI protocol. Two consecutive SPECT acquisitions (6 and 12 s/view) were performed. Electrocardiogram-gated images were reconstructed with and without attenuation correction (AC). Polar maps were generated and visually scored by two blinded observers for image quality and perfusion in 17 segments. Global and regional summed stress score (SSS), summed rest score (SRS) and summed difference score (SDS) were determined. Left ventricular volumes and ejection fraction were calculated based on automated contour detection. Image quality was scored higher with the 12 s/view acquisition, both with and without AC. Summed scores were statistically comparable between the 6 s/view and the 12 s/view acquisition, both globally and in individual coronary territories (e.g. in images with AC, SSS were 6.6 ± 8.3 and 6.2 ± 8.2 with 6 s and 12 s/view, respectively, p = 0.10; SRS were 3.9 ± 5.6 and 3.5 ± 5.3, respectively, p = 0.19; and SDS were 2.8 ± 5.7 and 2.6 ± 5.7, respectively, p = 0.59). Both acquisitions allowed MPI-based diagnosis of CAD in 25 of the 50 patients (with AC). Calculated end-diastolic volume (EDV) and end-systolic volume (ESV) were modestly higher with the 6 s/view acquisition than with the 12 s/view acquisition (EDV +4.8 ml at rest and +3.7 ml after stress, p = 0.003; ESV +4.1 ml at rest and +2.6 ml after stress, p = 0.01), whereas the ejection fraction did not differ (-1.2 % at rest, p = 0.20, and -0

  8. Quantification of myocardial perfusion using cardiac magnetic resonance imaging correlates significantly to rubidium-82 positron emission tomography in patients with severe coronary artery disease: A preliminary study

    Energy Technology Data Exchange (ETDEWEB)

    Qayyum, Abbas A., E-mail: abbas.ali.qayyum@regionh.dk [Department of Cardiology and Cardiac Catheterization Laboratory 2014, The Heart Centre, Rigshospitalet, University Hospital of Copenhagen and Faculty of Health Sciences, Copenhagen University, Blegdamsvej 9, 2100 Copenhagen (Denmark); Hasbak, Philip, E-mail: philip.hasbak@regionh.dk [Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, University Hospital of Copenhagen and Faculty of Health Sciences, Copenhagen University, Blegdamsvej 9, 2100 Copenhagen (Denmark); Larsson, Henrik B.W., E-mail: henrik.larsson@regionh.dk [Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, University Hospital of Copenhagen and Faculty of Health Sciences, Copenhagen University, Blegdamsvej 9, 2100 Copenhagen (Denmark); Functional Imaging Unit, Diagnostic Department, Glostrup Hospital, University Hospital of Copenhagen and Faculty of Health Sciences, Copenhagen University, Ndr. Ringvej 57, 2600 Copenhagen (Denmark); Christensen, Thomas E., E-mail: thomas.emil.christensen@regionh.dk [Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, University Hospital of Copenhagen and Faculty of Health Sciences, Copenhagen University, Blegdamsvej 9, 2100 Copenhagen (Denmark); Ghotbi, Adam A., E-mail: adam.ali.ghotbi@regionh.dk [Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, University Hospital of Copenhagen and Faculty of Health Sciences, Copenhagen University, Blegdamsvej 9, 2100 Copenhagen (Denmark); Mathiasen, Anders B., E-mail: anders.b.mathiasen@gmail.com [Department of Cardiology and Cardiac Catheterization Laboratory 2014, The Heart Centre, Rigshospitalet, University Hospital of Copenhagen and Faculty of Health Sciences, Copenhagen University, Blegdamsvej 9, 2100 Copenhagen (Denmark); and others

    2014-07-15

    Introduction: Aim was to compare absolute myocardial perfusion using cardiac magnetic resonance imaging (CMRI) based on Tikhonov's procedure of deconvolution and rubidium-82 positron emission tomography (Rb-82 PET). Materials and methods: Fourteen patients with coronary artery stenosis underwent rest and adenosine stress imaging by 1.5-Tesla MR Scanner and a mCT/PET 64-slice Scanner. CMRI were analyzed based on Tikhonov's procedure of deconvolution without specifying an explicit compartment model using our own software. PET images were analyzed using standard clinical software. CMRI and PET data was compared with Spearman's rho and Bland–Altman analysis. Results: CMRI results were strongly and significantly correlated with PET results for the absolute global myocardial perfusion differences (r = 0.805, p = 0.001) and for global myocardial perfusion reserve (MPR) (r = 0.886, p < 0.001). At vessel territorial level, CMRI results were also significantly correlated with absolute PET myocardial perfusion differences (r = 0.737, p < 0.001) and MPR (r = 0.818, p < 0.001). Each vessel territory had similar strong correlation for absolute myocardial perfusion differences (right coronary artery (RCA): r = 0.787, p = 0.001; left anterior descending artery (LAD): r = 0.796, p = 0.001; left circumflex artery (LCX): r = 0.880, p < 0.001) and for MPR (RCA: r = 0.895, p < 0.001; LAD: r = 0.886, p < 0.001; LCX: r = 0.886, p < 0.001). Conclusion: On a global and vessel territorial basis, CMRI-measured absolute myocardial perfusion differences and MPR were strongly and significantly correlated with the Rb-82 PET findings.

  9. Impact of integrating heart rate response with perfusion imaging on the prognostic value of regadenoson SPECT myocardial perfusion imaging in patients with end-stage renal disease.

    Science.gov (United States)

    Gomez, Javier; Fughhi, Ibtihaj; Campagnoli, Tania; Ali, Amjad; Doukky, Rami

    2017-10-01

    We investigated whether integrating heart rate response (HRR) to regadenoson with myocardial perfusion imaging (MPI) analysis can enhance risk prediction in end-stage renal disease (ESRD) patients. We prospectively followed 303 ESRD patients after regadenoson stress MPI for a mean of 35 months. Normal HRR to regadenoson was defined as ≥28% increase from baseline. Normal MPI was defined as a summed stress score ≤3 and left ventricular ejection fraction ≥50%. The study cohort was divided in four groups based on various combinations of normal/abnormal HRR and MPI. There was a step-wise increase in the risk of primary endpoint of all-cause death and the composite secondary endpoint of cardiac death or myocardial infarction; patients with Normal MPI/Normal HRR had the lowest event rates and those with Abnormal MPI/Abnormal HRR had the highest, whereas subjects with Abnormal MPI/Normal HRR and Normal MPI/Abnormal HRR had intermediate event rates. This pattern was maintained after adjusting for important clinical covariates. In ESRD patients, integrating HRR to vasodilator stress with MPI interpretation improves risk stratification. Normal HRR/Normal MPI identify truly low-risk group, whereas abnormal MPI or abnormal HRR portrays elevated risk.

  10. Accuracy of technetium-99m tetrofosmin myocardial perfusion imaging in the detection of spontaneous recanalization in patients with acute anterior myocardial infarction

    Energy Technology Data Exchange (ETDEWEB)

    Hamada, Shinichi; Nakamura, Seishi; Nishiue, Takashi; Watanabe, Junko; Hatada, Kengo; Miyoshi, Hironori; Iwasaka, Toshiji [Cardiovascular Center, Kansai Medical University, Osaka (Japan); Sugiura, Tetsuro [Dept. of Clinical Laboratory Medicine, Kochi Medical School, Kochi (Japan); Baden, Masato [Division of Cardiology, Takarazuka Hospital, Hyogo (Japan)

    2001-03-01

    To avoid the haemorrhagic risk of unnecessary thrombolysis in acute myocardial infarction (MI), early and precise diagnosis of spontaneous recanalization (SR) of the infarct-related artery is required. To clarify the accuracy of technetium-99m tetrofosmin myocardial single-photon emission tomography (SPET) in the detection of SR in patients with acute anterior MI, electrocardiography (ECG), echocardiography and {sup 99m}Tc-tetrofosmin SPET imaging were performed in 49 patients with acute anterior MI before emergency coronary angiography. Defect score was calculated as the sum of the perfusion defects of each segment: from 3 (complete defect) to 0 (normal perfusion). Echocardiographic asynergic score (the sum of asynergic grades) and the greatest ST elevation of the 12-lead ECG on admission were also measured. SR was defined as Thrombolysis in Myocardial Infarction (TIMI) grade 3 flow on emergency coronary angiography. Defect score in 11 patients with SR (9.2{+-}3.7) was significantly lower than that in 38 patients without SR (18.5{+-}5.0) (P<0.001), whereas there were no significant differences in asynergic score and ST elevation between the two groups. From the receiver operating characteristic curves, the optimal cut-off points of defect score, asynergic score and ST elevation for the detection of SR were calculated to be 12, 13 and 3.5, respectively. The sensitivity and specificity of the scintigraphic defect score (91% and 89%) were significantly higher than those of the asynergic score (64% and 68%) and ST elevation (73% and 71%). Thus, {sup 99m}Tc-tetrofosmin SPET imaging on admission is a very accurate method for the detection of SR in patients with acute anterior MI. (orig.)

  11. Inter-observer agreement and diagnostic accuracy of myocardial perfusion reserve quantification by cardiovascular magnetic resonance at 3 Tesla in comparison to quantitative coronary angiography.

    Science.gov (United States)

    Ikuye, Katharina; Buckert, Dominik; Schaaf, Lisa; Walcher, Thomas; Rottbauer, Wolfgang; Bernhardt, Peter

    2013-03-27

    Quantification of cardiovascular magnetic resonance (CMR) myocardial perfusion reserve (MPR) at 1.5 Tesla has been shown to correlate to invasive evaluation of coronary artery disease (CAD) and to yield good inter-observer agreement. However, little is known about quantitative adenosine-perfusion CMR at 3 Tesla and no data about inter-observer agreement is available. Aim of our study was to evaluate inter-observer agreement and to assess the diagnostic accuracy in comparison to quantitative coronary angiography (QCA). Fifty-three patients referred for coronary x-ray angiography were previously examined in a 3 Tesla whole-body scanner. Adenosine and rest perfusion CMR were acquired for the quantification of MPR in all segments. Two blinded and independent readers analyzed all images. QCA was performed in case of coronary stenosis. QCA data was used to assess diagnostic accuracy of the MPR measurements. Inter-observer agreement was high for all myocardial perfusion territories (ρ = 0.92 for LAD, ρ = 0.93 for CX and RCA perfused segments). Compared to QCA receiver-operating characteristics yielded an area under the curve of 0.78 and 0.73 for RCA, 0.66 and 0.69 for LAD, and 0.52 and 0.53 for LCX perfused territories. Inter-observer agreement of MPR quantification at 3 Tesla CMR is very high for all myocardial segments. Diagnostic accuracy in comparison to QCA yields good values for the RCA and LAD perfused territories, but moderate values for the posterior LCX perfused myocardial segments.

  12. Cell therapy in reperfused acute myocardial infarction does not improve the recovery of perfusion in the infarcted myocardium: a cardiac MR imaging study.

    Science.gov (United States)

    Robbers, Lourens F H J; Nijveldt, Robin; Beek, Aernout M; Hirsch, Alexander; van der Laan, Anja M; Delewi, Ronak; van der Vleuten, Pieter A; Tio, René A; Tijssen, Jan G P; Hofman, Mark B M; Piek, Jan J; Zijlstra, Felix; van Rossum, Albert C

    2014-07-01

    To investigate the effects of cell therapy on myocardial perfusion recovery after treatment of acute myocardial infarction (MI) with primary percutaneous coronary intervention (PCI). In this HEBE trial substudy, which was approved by the institutional review board (trial registry number ISRCTN95796863), the authors assessed the effects of intracoronary infusion with bone marrow-derived mononuclear cells (BMMCs) or peripheral blood-derived mononuclear cells (PBMCs) on myocardial perfusion recovery by using cardiac magnetic resonance (MR) imaging after revascularization. In 152 patients with acute MI treated with PCI, cardiac MR imaging was performed after obtaining informed consent-before randomization to BMMC, PBMC, or standard therapy (control group)-and repeated at 4-month follow-up. Cardiac MR imaging consisted of cine, rest first-pass perfusion, and late gadolinium enhancement imaging. Perfusion was evaluated semiquantitatively with signal intensity-time curves by calculating the relative upslope (percentage signal intensity change). The relative upslope was calculated for the MI core, adjacent border zone, and remote myocardium. Perfusion differences among treatment groups or between baseline and follow-up were assessed with the Wilcoxon signed rank or Mann-Whitney U test. At baseline, myocardial perfusion differed between the MI core (median, 6.0%; interquartile range [IQR], 4.1%-8.0%), border zone (median, 8.4%; IQR, 6.4%-10.2%), and remote myocardium (median, 12.2%; IQR, 10.5%-15.9%) (P < .001 for all), with equal distribution among treatment groups. These interregional differences persisted at follow-up (P < .001 for all). No difference in perfusion recovery was found between the three treatment groups for any region. After revascularization of ST-elevation MI, cell therapy does not augment the recovery of resting perfusion in either the MI core or border zone. © RSNA, 2014.

  13. A Simulation Study of the Effect of Phase-Shift on Dual Gated Myocardial Perfusion ECT.

    Science.gov (United States)

    Lee, Taek-Soo; Park, Min Jae; Tsui, Benjamin M W

    2011-10-01

    We evaluated the effect of relative phase-shift of cardiac and respiratory (C&R) motions in myocardial perfusion (MP) ECT. Previously, we generated a set of realistic 3D XCAT (eXtended CArdiac Torso) phantoms that model simultaneous C&R motions for use in the study of new data acquisition methods and corrective image reconstruction techniques for improved gated MP ECT, including PET and SPECT. The respiratory motion (RM) over a respiration cycle was modeled using 24 equally-spaced time frames while the cardiac beating motion (CBM) over a cardiac cycle was divided into 48 equally-spaced time frames for each of the 24 RM phases. Almost noise-free projection datasets were generated separately from the heart, blood pool, lungs, liver, kidneys, stomach, gall bladder and remaining body at each of the 24 × 48 time points using Monte Carlo simulation techniques that include the effect of collimator detector response, photon attenuation and scatter. To demonstrate the effect of relative phase-shift, a typical (99m)Tc Sestamibi MP SPECT projection dataset were generated. They were then scaled and combined to model different degrees of relative C&R phase shifting and grouped into 6 respiratory-gates with 8 cardiac-gates. Each projection was reconstructed using a 3D OS-EM without and with attenuation correction using an averaged and phase-mismatched gated attenuation maps. The image artifacts of the reconstructed images were compared by visual inspection of the MP polar maps. The results showed significant changes of artifactual non-uniformity in the polar maps for off-phase of RM compared to those of CBM. The changes in the polar maps also demonstrated the effect of phase shifting accordingly. We conclude that the 4D XCAT phantom dataset with simultaneous C&R motions provides a powerful tool in the study of the effects of C&R motions with relative phase shifts, and development of C&R gating schemes and motion correction methods for improved ECT/CT imaging.

  14. Minimizing patient-specific tracer dose in myocardial perfusion imaging using CZT SPECT.

    Science.gov (United States)

    van Dijk, Joris D; Jager, Pieter L; Ottervanger, Jan Paul; Slump, Cornelis H; de Boer, Jaep; Oostdijk, Adrianus H J; van Dalen, Jorn A

    2015-03-01

    Myocardial perfusion imaging (MPI) with SPECT is widely adopted in clinical practice but is associated with a relatively high radiation dose. The aim of this study was to determine the minimum product of tracer dose and scan time that will maintain diagnostic value for cadmium zinc telluride (CZT) SPECT MPI. Twenty-four patients underwent clinically indicated stress MPI using CZT SPECT and a body weight-dependent (3 MBq/kg) (99m)Tc-tetrofosmin tracer dose. Data were acquired for 8 min in list mode. Next, images were reconstructed using 2-, 4-, 6-, and 8-min time frames. Differences between the 8-min reference scan and the shorter scans were determined in segmental uptake values (using the 17-segment cardiac model), ejection fraction, and end-diastolic volume. A 5% difference in segmental uptake was considered to significantly influence the diagnostic value. Next, the quality of the 4-, 6-, and 8-min scans was scored on a 4-point scale by consensus by 3 experienced nuclear medicine physicians. The physicians did not know the scan time or patient information. Differences in segmental uptake values, ejection fraction, and end-diastolic volume were greater for shorter scans than for the 8-min reference scan. On average, the diagnostic value was influenced in 7.7 segments per patient using the 2-min scans, in comparison to 2.0 and 0.8 segments per patient using the 4- and 6-min scans, respectively. In addition, the 4-min scans led to a significantly reduced image quality compared with the 8-min scans (P < 0.05). This was not the case for the 6-min scan. Six minutes was the shortest acquisition time in stress MPI using CZT SPECT that did not affect the diagnostic value for a tracer dose of 3 MBq/kg. Hence, the patient-specific product of tracer dose and scan time can be reduced to a minimum of 18 MBq·min/kg, which may lower the effective radiation dose for patients to values below 1 mSv. © 2015 by the Society of Nuclear Medicine and Molecular Imaging, Inc.

  15. Comparison of the Peripheral Reactive Hyperemia Index with Myocardial Perfusion Reserve by (82)Rb PET/CT in HIV-Infected Patients

    DEFF Research Database (Denmark)

    Ørbæk, Mathilde; Hasbak, Philip; Sejersten Ripa, Rasmus

    2017-01-01

    After the introduction of antiretroviral therapy (ART) the life expectancy of patients infected with human immunodeficiency virus (HIV) is now approaching that of the general population and the importance of non-AIDS co-morbidities is increasing. Specifically, the risk of coronary artery disease...... previously undergone measurement of the myocardial perfusion reserve by (82)-rubidium PET/CT for study purposes. We found an inverse correlation between the reactive hyperemia index and the myocardial perfusion reserve which most likely indicates different vascular physiology. This study did not find...

  16. Adenosine versus regadenoson comparative evaluation in myocardial perfusion imaging: results of the ADVANCE phase 3 multicenter international trial.

    Science.gov (United States)

    Iskandrian, Ami E; Bateman, Timothy M; Belardinelli, Luiz; Blackburn, Brent; Cerqueira, Manuel D; Hendel, Robert C; Lieu, Hsiao; Mahmarian, John J; Olmsted, Ann; Underwood, S Richard; Vitola, João; Wang, Whedy

    2007-01-01

    Earlier phase 1 and 2 studies have shown that regadenoson has desirable features as a stress agent for myocardial perfusion imaging. This multicenter, double-blinded phase 3 trial involved 784 patients at 54 sites. Each patient underwent 2 sets of gated single photon emission computed tomography myocardial perfusion imaging studies: an initial qualifying study with adenosine and a subsequent randomized study with either regadenoson (2/3 of patients) or adenosine. Regadenoson was administered as a rapid bolus (adenosine-regadenoson images and adenosine-adenosine images, lay above a prespecified noninferiority margin. Other prospectively defined safety and tolerability comparisons and supporting analyses were also performed. The average agreement rate based on the median of 3 independent blinded readers was 0.63 +/- 0.03 for regadenoson-adenosine and 0.64 +/- 0.04 for adenosine-adenosine-a 1% absolute difference with the lower limit of the 95% confidence interval lying above the prespecified noninferiority margin. Side-by-side interpretation of regadenoson and adenosine images provided comparable results for detecting reversible defects. The peak increase in heart rate was greater with regadenoson than adenosine, but the blood pressure nadir was similar. A summed symptom score of flushing, chest pain, and dyspnea was less with regadenoson than adenosine (P = .013). This phase 3 trial shows that regadenoson provides diagnostic information comparable to a standard adenosine infusion. There were no serious drug-related side effects, and regadenoson was better tolerated than adenosine.

  17. Using a registration-based motion correction algorithm to correct for respiratory motion during myocardial perfusion imaging.

    Science.gov (United States)

    Redgate, Shelley; Barber, David C; Al-Mohammad, Abdallah; Tindale, Wendy B

    2013-08-01

    The aim of the study was to develop and evaluate a registration-based motion correction algorithm as a method of reducing respiratory motion artefacts in myocardial perfusion imaging. The NCAT software was used to build nine male and nine female computer simulations of myocardial perfusion imaging data, with different respiratory motions and left ventricular ejection fractions. Imaging data were generated at various time points throughout each cardiac cycle. The data were summed over each cardiac cycle, forward projected, normalized, noise added and reconstructed with and without motion correction. Motion correction was performed using an algorithm that aligns images within a projection using nonlinear registrations. A standard simulation with no respiratory motion was also generated for comparison. The algorithm was applied to the standard to determine its effect on images with no respiratory motion. The median difference in mean segmental counts compared with the standard was calculated for each simulation. The mean (range) of these values was 3% (1-6%), 14% (12-16%) and 28% (28-29%) for displacements of 1, 2 and 3 cm, respectively. The largest changes occurred inferiorly and anteriorly. Motion correction reduced these differences to 2% (0-4%), 5% (2-7%) and 7% (7-7%), respectively. The process of correcting for motion reduced the mean counts in all segments by 3% (1-5%). Artefacts resulting from respiratory motion are improved using our algorithm when motion is 2 cm or greater.

  18. Evaluation of Patients with Acute Chest Pain Using SPECT Myocardial Perfusion Imaging: Prognostic Implications of Mildly Abnormal Scans.

    Science.gov (United States)

    Goldkorn, Ronen; Naimushin, Alexey; Beigel, Roy; Naimushin, Ekaterina; Narodetski, Michael; Matetzky, Shlomi

    2017-06-01

    While patients presenting to emergency departments (ER) with chest pain are increasingly managed in chest pain units (CPU) that utilize accelerated diagnostic protocols for risk stratification, such as single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI), data are lacking regarding the prognostic implications of mildly abnormal scans in this population. To evaluate the prognostic implications of mildly abnormal SPECT MPI results in patients with acute chest pain. Of the 3753 chest pain patients admitted to the CPU at the Leviev Heart Center, Sheba Medical Center 1593 were further evaluated by SPECT MPI. Scans were scored by extent and severity of stress-induced perfusion defects, with 1221 patients classified as normal, 82 with myocardial infarction without ischemia, 236 with mild ischemia, and 54 with more than mild ischemia. Mild ischemia patients were further classified to those who did and did not undergo coronary angiography within 7 days. Mild ischemia patients who underwent coronary angiography were more likely to be male (92% vs. 81%, P = 0.01) and to have left anterior descending ischemia (67% vs. 42%, P = 0.004). After 50 months, these patients returned less often to the ER with chest pain (53% vs. 87%, P acute coronary syndrome and death (8% vs. 16%, P patients with chronic stable angina, patients presenting with acute chest pain exhibiting mildly abnormal SPECT MPI findings should perhaps undergo a more aggressive diagnostic and therapeutic approach.

  19. Optimization of OSEM parameters in myocardial perfusion imaging reconstruction as a function of body mass index: a clinical approach*

    Science.gov (United States)

    de Barros, Pietro Paolo; Metello, Luis F.; Camozzato, Tatiane Sabriela Cagol; Vieira, Domingos Manuel da Silva

    2015-01-01

    Objective The present study is aimed at contributing to identify the most appropriate OSEM parameters to generate myocardial perfusion imaging reconstructions with the best diagnostic quality, correlating them with patients’ body mass index. Materials and Methods The present study included 28 adult patients submitted to myocardial perfusion imaging in a public hospital. The OSEM method was utilized in the images reconstruction with six different combinations of iterations and subsets numbers. The images were analyzed by nuclear cardiology specialists taking their diagnostic value into consideration and indicating the most appropriate images in terms of diagnostic quality. Results An overall scoring analysis demonstrated that the combination of four iterations and four subsets has generated the most appropriate images in terms of diagnostic quality for all the classes of body mass index; however, the role played by the combination of six iterations and four subsets is highlighted in relation to the higher body mass index classes. Conclusion The use of optimized parameters seems to play a relevant role in the generation of images with better diagnostic quality, ensuring the diagnosis and consequential appropriate and effective treatment for the patient. PMID:26543282

  20. Stress and rest dynamic myocardial perfusion imaging by evaluation of complete time-attenuation curves with dual-source CT.

    Science.gov (United States)

    Ho, Kheng-Thye; Chua, Kia-Chong; Klotz, Ernst; Panknin, Christoph

    2010-08-01

    This study sought to describe a protocol for myocardial perfusion imaging using dipyridamole stress, with 128-slice dual-source computed tomography (CT), and to assess the ability of CT myocardial perfusion imaging (MPI) to detect abnormal flow reserve and infarction in comparison with nuclear MPI (NMPI). CT MPI has not been previously described with the 128-slice dual-source CT scanner, or with the complete evaluation of dynamic time-attenuation curves of the myocardium. Thirty-five patients underwent a stress CT MPI protocol. Complete time-attenuation curves of the myocardium were acquired using a novel scan mode, which acquires prospectively electrocardiogram (ECG)-triggered axial images at 2 rapidly alternating positions. Myocardial blood flow (MBF) values of fixed and reversible defects obtained were compared between rest and stress. Findings on CT MPI were correlated to NMPI. Perfusion defects detected on CT were correlated to coronary stenoses detected on CT angiography (CTA) and invasive coronary angiography (ICA). There was a 1.5-fold difference between stress (1.21 +/- 0.31 cc/cc/min) and rest (0.82 +/- 0.22 cc/cc/min) MBF in normal tissue. In reversible defects, MBF was 0.65 +/- 0.21 cc/cc/min and 0.63 +/- 0.18 cc/cc/min at stress and rest, respectively. In fixed defects, the MBF was 0.57 +/- 0.22 cc/cc/min at stress and 0.54 +/- 0.23 cc/cc/min at rest. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of CT MPI for identifying segments with perfusion defects was 0.83, 0.78, 0.79, and 0.82, respectively. ICA results were available for 30 patients. Sensitivity, specificity, PPV, and NPV of CT MPI compared with ICA were 0.95, 0.65, 0.78, and 0.79, respectively. The radiation dose for CT MPI was 9.15 +/- 1.32 mSv for the stress scan and 9.09 +/- 1.40 mSv for the rest scan. Vasodilator-stress CT MPI may be feasible in human subjects at a radiation dose similar to NMPI. It identifies areas of abnormal flow reserve

  1. Reduced left ventricular cavitary activity ("black hole sign") in thallium-201 SPECT perfusion images of anteroapical transmural myocardial infarction.

    Science.gov (United States)

    Civelek, A C; Shafique, I; Brinker, J A; Durski, K; Weiss, J L; Links, J M; Natarajan, T K; Ozguven, M A; Wagner, H N

    1991-11-01

    Apparently reduced left ventricular (LV) cavitary thallium activity in both planar and tomographic perfusion images has been previously observed by these and other investigators. With single-photon emission computerized tomography, we have clinically noted that this "black hole sign" was associated with an aneurysm in the setting of a transmural anterior or anteroapical perfusion defect. We have now prospectively studied the etiology and predictive value of this sign in 84 consecutive patients with an anterior, anteroapical transmural perfusion defect. Of the 84 patients, 49 had both LV aneurysm (confirmed by contrast ventriculography, echocardiography or gated blood pool studies) and a black hole sign. Only 1 patient with an aneurysm did not have the black hole sign, and 2 without aneurysm did. Thus, it is concluded that this sign is highly accurate in diagnosing LV aneurysm. Because thallium-201 single-photon emission computerized tomography imaging is often performed as one of the first diagnostic tests soon after myocardial infarction, this has important clinical management implications.

  2. Assessment of global myocardial perfusion reserve using cardiovascular magnetic resonance of coronary sinus flow at 3 Tesla

    Science.gov (United States)

    2014-01-01

    Background Despite increasing clinical use, there is limited data regarding regadenoson in stress perfusion cardiovascular magnetic resonance (CMR). In particular, given its long half-life the optimal stress protocol remains unclear. Although Myocardial Perfusion Reserve (MPR) may provide additive prognostic information, current techniques for its measurement are cumbersome and challenging for routine clinical practice. The aims of this study were: 1) To determine the feasibility of MPR quantification during regadenoson stress CMR by measurement of Coronary Sinus (CS) flow; and 2) to investigate the role of aminophylline reversal during regadenoson stress-CMR. Methods 117 consecutive patients with possible myocardial ischemia were prospectively enrolled. Perfusion imaging was performed at 1 minute and 15 minutes after administration of 0.4 mg regadenoson. A subgroup of 41 patients was given aminophylline (100 mg) after stress images were acquired. CS flow was measured using phase-contrast imaging at baseline (pre CS flow), and immediately after the stress (peak CS flow) and rest (post CS flow) perfusion images. Results CS flow measurements were obtained in 92% of patients with no adverse events. MPR was significantly underestimated when calculated as peak CS flow/post CS flow as compared to peak CS flow/pre CS flow (2.43 ± 0.20 vs. 3.28 ± 0.32, p = 0.03). This difference was abolished when aminophylline was administered (3.35 ± 0.44 vs. 3.30 ± 0.52, p = 0.95). Impaired MPR (peak CS flow/pre CS flow Regadenoson stress CMR with MPR measurement from CS flow can be successfully performed in most patients. This measurement of MPR appears practical to perform in the clinical setting. Residual hyperemia is still present even 15 minutes after regadenoson administration, at the time of resting-perfusion acquisition, and is completely reversed by aminophylline. Our findings suggest routine aminophylline administration may be required when

  3. Non invasive evaluation of the coronary atherosclerosis illness in patients with silent ischemia: utility of the SPECT of myocardial perfusion. Electric, angiographic and image correlation; Valoracion no invasiva de la enfermedad ateroesclerosa coronaria en pacientes con isquemia silente: utilidad del SPECT de perfusion miocardica. Correlacion electrica, angiografica y de imagen

    Energy Technology Data Exchange (ETDEWEB)

    Puente B, A.; Roffe G, F.; Aceves C, J.; Gomez A, E. [Hospital Centro Medico Nacional 20 de Noviembre, ISSSTE, Mexico D.F. (Mexico)

    2005-07-01

    The objective of the work was to determine the utility of the SPECT (Single Photon Emission Computerized Tomography) of myocardial perfusion for the ischemia detection in asymptomatic patients with Coronary Atherosclerosis Illness. It was concluded that the SPECT of myocardial perfusion has a high sensitivity (97%) for the silent ischemia diagnosis.

  4. Normal value of functional parameters in gated myocardial perfusion SPECT in patients with low risk of coronary artery disease: emory cardiac tool box program

    Energy Technology Data Exchange (ETDEWEB)

    Kang, D. Y.; Kim, M. H.; Kim, Y. D.; Kim, D. K. [Donga University College of Medicine, Busan (Korea, Republic of)

    2002-07-01

    Absolute value of the functional data of gated myocardial perfusion SPECT is necessary to determine that individual patient is normal or not. Tc-99m MIBI gated myocardial perfusion SPECT was performed using emory cardiac tool box program. All patients (M:F=15:36, age 64{+-}10 yrs) showed normal myocardial perfusion. The patients with following characteristics were excluded; previous angina or MI, ECG change with Q wave or ST-T change, diabetes mellitus, hypercholesterolemia, typical chest pain and hypertension. In all patients, myocardial mass is 117{+-}23 g in stress gated SPECT, 106{+-}22 g in stress ungated SPECT and 102{+-}21 g in rest ungated SPECT. EDV is 90{+-}28 ml, ESV 26{+-}20 ml, SV 66{+-}21 ml, EF 73{+-}10 % and TID 1.06{+-}0.14. Myocardial mass in rest ungated SPECT is significantly different between men and women (p=0.025). Myocardial mass is significantly different between stress gated SPECT and stress ungated SPECT (p=0.000), and between stress ungated SPECT and rest ungated SPECT (p=0.003). We provide normal value of functional parameters to determine the abnormality of individual patients in patients with low risk of coronary artery disease.

  5. Prognostic value of normal stress-only myocardial perfusion imaging: a comparison between conventional and CZT-based SPECT

    Energy Technology Data Exchange (ETDEWEB)

    Yokota, Shu; Ottervanger, Jan Paul; Timmer, Jorik R. [Isala Hospital, Department of Cardiology, Zwolle (Netherlands); Mouden, Mohamed; Engbers, Elsemiek [Isala Hospital, Department of Cardiology, Zwolle (Netherlands); Isala Hospital, Department of Nuclear Medicine, Zwolle (Netherlands); Knollema, Siert; Jager, Pieter L. [Isala Hospital, Department of Nuclear Medicine, Zwolle (Netherlands)

    2016-02-15

    Single photon emission computed tomography (SPECT) myocardial perfusion imaging has proven to have prognostic importance in patients with suspected stable coronary artery disease (CAD). The recently introduced ultrafast cadmium zinc telluride (CZT)-based gamma cameras have been associated with less equivocal findings and more normal interpretations, allowing stress-only imaging to be performed more often. However, it is yet unclear whether normal stress-only CZT SPECT has comparable prognostic value as normally interpreted stress-only conventional SPECT. The study population consisted of 1,650 consecutive patients without known CAD with normal stress-only myocardial perfusion results with either conventional (n = 362) or CZT SPECT (n = 1,288). The incidence of major adverse cardiac events (MACE, all-cause death, non-fatal myocardial infarction and/or coronary revascularization) was compared between the conventional SPECT and CZT SPECT groups. Multivariable analyses using the Cox model were used to adjust for differences in baseline variables. Patients scanned with CZT were less often male (33 vs 39 %), had less often hypercholesterolaemia (41 vs 50 %) and had more often a family history of CAD (57 vs 49 %). At a median follow-up time of 37 months (interquartile range 28-45 months) MACE occurred in 68 patients. The incidence of MACE was 1.5 %/year in the CZT group, compared to 2.0 %/year in the conventional group (p = 0.08). After multivariate analyses, there was a trend to a lower incidence of MACE in the CZT SPECT group (hazard ratio 0.61, 95 % confidence interval 0.35-1.04, p = 0.07). The prognostic value of normal stress-only CZT SPECT is at least comparable and may be even better than that of normal conventional stress SPECT. (orig.)

  6. Detection of myocardial perfusion abnormalities: standard dual-source coronary computed tomography angiography versus rest/stress technetium-99m single-photo emission CT.

    Science.gov (United States)

    Cheng, W; Zeng, M; Arellano, C; Mafori, W; Goldin, J; Krishnam, M; Ruehm, S G

    2010-08-01

    We compared coronary dual-source computed tomography angiography (corDSCTA) with technetium-99m single-photon emission computed tomography (SPECT) for the detection of myocardial perfusion abnormalities. Fifty-five consecutive patients underwent both gated myocardial perfusion SPECT and corDSCTA, the latter during a single arterial-phase injection of contrast agent. The perfusion defects visualised by corDSCTA correlated with the findings of rest/stress SPECT. Abnormal findings on stress SPECT, which were due to either ischaemia or infarct, were found in 24 patients. In comparison to SPECT at rest, corDSCTA detected perfusion defects with a sensitivity and specificity of 100% and 78%, respectively. Compared to SPECT at stress, the sensitivity and specificity values of corDSCTA were 83.3% and 90.3%, respectively. On corDSCTA , the average attenuation values of perfusion defects that corresponded to chronic infarcts (-8.5+/-22.2 HU) were significantly lower (p = 0.002) than those of non-infarct-related perfusion defects (43.1+/-17.5 HU). Using rest/stress SPECT is the gold standard for the diagnosis of myocardial ischaemia, corDSCTA was able to diagnose ischaemic disease (defined as the presence of high-grade stenotic CAD (>or=50% luminal narrowing)) with a sensitivity and specificity of 59% and 89%, respectively, in patients with no known history of myocardial infarction (n = 4). Thus, corDSCTA may serve as a diagnostic tool for the detection of perfusion abnormalities (first) visualised by SPECT. There appears to be a limited correlation between coronary stenotic disease and SPECT findings.

  7. The dream of a one-stop-shop : Meta-analysis on myocardial perfusion CT

    NARCIS (Netherlands)

    Pelgrim, Gert Jan; Dorrius, Monique; Xie, Xueqian; den Dekker, Martijn A. M.; Schoepf, U. Joseph; Henzler, Thomas; Oudkerk, Matthijs; Vliegenthart, Rozemarijn

    2015-01-01

    Purpose: To determine the diagnostic performance of computed tomography (CT) perfusion techniques for the detection of functionally relevant coronary artery disease (CAD) in comparison to reference standards, including invasive coronary angiography (ICA), single photon emission computed tomography

  8. Mapping contrast agent uptake and retention in MRI studies of myocardial perfusion: case control study of dogs with Duchenne muscular dystrophy.

    Science.gov (United States)

    Kerwin, William S; Naumova, Anna; Storb, Rainer; Tapscott, Stephen J; Wang, Zejing

    2013-04-01

    Myocardial perfusion studies using dynamic contrast-enhanced cardiac magnetic resonance imaging (CMRI) could provide valuable, quantitative information regarding heart physiology in diseases such as Duchenne muscular dystrophy (DMD), that lead to diffuse myocardial damage. The goal of this effort was to develop an intuitive but physiologically meaningful method for quantifying myocardial perfusion by CMRI and to test its ability to detect global myocardial differences in a dog model of DMD. A discrete-time model was developed that parameterizes contrast agent kinetics in terms of an uptake coefficient that describes the forward flux of contrast agent into the tissue, and a retention coefficient that describes the rate of decay in tissue concentration due to contrast agent efflux. This model was tested in 5 dogs with DMD and 6 healthy controls which were imaged using a perfusion sequence on a 3T clinical scanner. CINE and delayed-enhancement CMRI acquisitions were also used to assess cardiac function and the presence of myocardial scar. Among functional parameters measured by CMRI, no significant differences were observed. No myocardial scar was observed. Increased perfusion in DMD was observed with an uptake coefficient of 6.76 ± 2.41 % compared to 2.98 ± 1.46 % in controls (p = 0.03). Additionally, the retention coefficient appeared lower at 82.2 ± 5.8 % in dogs with DMD compared to 90.5 ± 6.6 % in controls (p = 0.12). A discrete-time kinetic model of uptake and retention of contrast agent in perfusion CMRI shows potential for the study of DMD.

  9. Effects of prasugrel pretreatment on angiographic myocardial perfusion parameters in patients with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention.

    Science.gov (United States)

    Perl, Leor; Sasson, Liat; Weissler-Snir, Adaya; Greenberg, Gabriel; Vaknin-Assa, Hana; Kornowski, Ran; Assali, Abid; Lev, Eli I

    2015-12-01

    Prasugrel is a third-generation thienopyridine, with significant pharmacodynamic and clinical advantages over clopidogrel. There are few data on the effects of prasugrel therapy, as compared with clopidogrel, in terms of perfusion during percutaneous coronary intervention (PCI), in patients with ST-elevation myocardial infarction (STEMI). A total of 128 patients with STEMI, pretreated with prasugrel 60 mg loading dose (mean age=55.9±9.1; 10.9% were women and 18.0% had diabetes), were compared with 128 propensity-matched patients pretreated with clopidogrel 600 mg (mean age=58.7±10.7; 10.2% were women and 19.5% had diabetes) for the primary endpoint of thrombolysis in myocardial infarction (TIMI) flow and myocardial blush grade at completion of the PCI. Secondary endpoints included the combined sum of major adverse events: death, reinfarction or target vessel revascularization at 1 year. Mean TIMI flow grade pre-PCI was similar between the two groups (1.31±1.3 in the prasugrel group and 1.30±1.2 in the clopidogrel group, P=0.96). However, after intervention, it was higher in the prasugrel group (2.94±0.24 vs. 2.84±0.37, respectively, P=0.016), as was myocardial blush (2.70±0.76 vs. 2.31±0.52, respectively, P<0.001). The percentage of TIMI 3 after intervention was also higher in the prasugrel group (97.70 vs. 90.60%, P=0.02). The combined rate of major adverse events at 1 year (8.7 vs. 11.6%, P=0.11), as well as total mortality (3.1±5.6 vs. 4.7±9.1%, P=0.52), did not differ between the two groups. In patients with STEMI undergoing primary PCI, pretreatment with prasugrel resulted in better angiographic perfusion results, as compared with pretreatment with clopidogrel.

  10. Effect of thrombolytic therapy on exercise response during early recovery from acute myocardial infarction

    DEFF Research Database (Denmark)

    Svendsen, J H; Madsen, J K; Saunamäki, K I

    1992-01-01

    Several studies have shown that infarct size is reduced following thrombolytic treatment in patients with acute myocardial infarction. Exercise test variables, such as an impaired heart rate response during exercise, are known to be related to left ventricular function and patient prognosis follo...

  11. The Benefits of Prone SPECT Myocardial Perfusion Imaging in Reducing Both Artifact Defects and Patient Radiation Exposure

    Directory of Open Access Journals (Sweden)

    Maria Stathaki

    2015-10-01

    Full Text Available AbstractBackground:Prone imaging has been demonstrated to minimize diaphragmatic and breast tissue attenuation.Objectives:To determine the role of prone imaging on the reduction of unnecessary rest perfusion studies and coronary angiographies performed, thus decreasing investigation time and radiation exposure.Methods:We examined 139 patients, 120 with an inferior wall and 19 with an anterior wall perfusion defect that might represented attenuation artifact. Post-stress images were acquired in both the supine and prone position. Coronary angiography was used as the “gold standard” for evaluating coronary artery patency. The study was terminated and rest imaging was obviated in the presence of complete improvement of the defect in the prone position. Quantitative interpretation was performed. Results were compared with clinical data and coronary angiographic findings.Results:Prone acquisition correctly revealed defect improvement in 89 patients (89/120 with inferior wall and 12 patients (12/19 with anterior wall attenuation artifact. Quantitative analysis demonstrated statistically significant difference in the mean summed stress scores (SSS of supine and mean SSS of prone studies in patients with disappearing inferior wall defect in the prone position and patent right coronary artery (true negative results. The mean difference between SSS in supine and in prone position was higher with disappearing than with remaining defects.Conclusion:Technetium-99m (Tc-99m tetrofosmin myocardial perfusion imaging with the patient in the prone position overcomes soft tissue attenuation; moreover it provides an inexpensive, accurate approach to limit the number of unnecessary rest perfusion studies and coronary angiographies performed.

  12. A micro-SPECT imaging pilot study of myocardial perfusion in mice; Etude pilote de la perfusion myocardique chez la souris par micro-imagerie TEMP

    Energy Technology Data Exchange (ETDEWEB)

    Constantinesco, A.; Choquet, P.; Israel-Jost, V. [Hopital de Hautepierre, Service de Biophysique et Medecine Nucleaire, 67 - Strasbourg (France); Israel-Jost, V.; Sonnendrucker, E. [Institut de Recherche Mathematique Avancee de Strasbourg, 67 (France); Monassier, L. [Institut National de la Sante et de la Recherche Medicale (INSERM U333), 67 - Strasbourg (France); Elfertak, L. [Institut Clinique de la Souris (ICS), 67 - Illkirch (France)

    2004-04-01

    Objective: demonstrate the feasibility of micro-SPECT for myocardial perfusion imaging in mice. Methods: a micro-SPECT dedicated camera with a field of view of 17 cm x 17 cm, a 1,5 mm pinhole with a focal distance of 12 cm was used. An infra millimetric linear phantom permitted to measure the planar and tomographic FWHM. Two normal adult mice were studied under gaseous anaesthesia (isoflurane 1,5%) and after IV administration of 0,1 mL of {sup 99m}Tc-Sestamibi (350 MBq) in one case and {sup 201}Tl (64 MBq) in the other case. In the two cases, 48 projections of 1 mn over 180 deg C in a 64 x 64 image format with a radius of rotation of 2,5 cm were used with a 20% window centered on the photoelectric peak of 99mTc or the 71 KeV of {sup 201}Tl. Tomographic reconstruction was done with a specific ART cone beam algorithm. Results: phantoms FWHM were respectively 1.6 mm and 1.5 mm in planar and tomographic modes with a reconstructed field of view of 26 mm and 1 mm when the reconstructed field of view was 10 mm. Micro-SPECT perfusion images using a reconstructed voxel volume of 0.064 mm{sup 3} of the mice myocardium were obtained with a better anatomical resolution with Sestamibi than thallium. Conclusion: this pilot study demonstrate the potential of micro-SPECT imaging for mice nuclear cardiology. (author)

  13. Biphasic thallium 201 SPECT-imaging for the noninvasive diagnosis of myocardial perfusion abnormalities in a child with Kawasaki disease--a case report

    Energy Technology Data Exchange (ETDEWEB)

    Hausdorf, G.; Nienaber, C.A.; Spielman, R.P.

    1988-02-01

    The mucocutaneous lymph node syndrome (Kawasaki disease) is of increasing importance for the pediatric cardiologist, for coronary aneurysms with the potential of thrombosis and subsequent stenosis can develop in the course of the disease. The authors report a 2 1/2-year-old female child in whom, fourteen months after the acute phase of Kawasaki disease, myocardial infarction occurred. Biphasic thallium 201 SPECT-imaging using dipyridamole depicted anterior wall ischemia and inferolateral infarction. This case demonstrates that noninvasive vasodilation-redistribution thallium 201 SPECT-imaging has the potential to predict reversible myocardial perfusion defects and myocardial necrosis, even in small infants with Kawasaki disease.

  14. Effect of changes in perfusion defect size during serial regadenoson myocardial perfusion imaging on cardiovascular outcomes in high-risk patients.

    Science.gov (United States)

    El-Hajj, Stephanie; AlJaroudi, Wael A; Farag, Ayman; Bleich, Steven; Manaoragada, Padma; Iskandrian, Ami E; Hage, Fadi G

    2016-02-01

    The prognostic value of single-photon emission computed tomography myocardial perfusion imaging (MPI) is well established. There is a paucity of data on the prognostic value of changes in perfusion defect size (PDS) on serial MPIs. From the MPI database at the University of Alabama at Birmingham, consecutive patients who underwent two regadenoson stress MPIs between July 2008 and March 2013 were identified. The MPIs were analyzed side-by-side using an automated software program for presence and change in PDS. Improvement in PDS was defined as a reduction ≥5% of left ventricle. A drop in left ventricular ejection fraction (LVEF) was defined as a decrease ≥5%. The primary outcome was a composite of death, myocardial infarction (MI), and coronary revascularization (CR). There were 698 patients (61 ± 11 years, 53% male, 48% diabetes, 25% prior MI, 49% prior CR) who underwent two regadenoson MPIs within 16 ± 9 months for clinical indications. The primary outcome occurred in 167 (24%) patients (8% death, 9% MI, 15% CR) during 24 ± 16 months of follow-up after the second MPI. The MPIs were normal in both studies in 399 (57%, Group 1), showed improvement in 94 (14%, Group 2, PDS 15% ± 16% vs 28% ± 18%, P < .001) and no change or worsening in 205 patients (29%, Group 3, 28% ± 17% vs 20% ± 17%, P < .001). The best outcomes were seen in Group 1 and the worst in Group 3 (log-rank P < .001). Similar trends were seen for the components of the primary outcome (P = .04 for death, P < .001 for MI, P < .001 for CR). In a Cox-regression model that adjusted for baseline factors including PDS and LVEF on initial MPI, the hazard ratios for primary outcome were 2.0 (P = .02) and 3.9 (P < .001) for Groups 2 and 3 compared to Group 1, respectively. In addition, an LVEF drop ≥5% was independently associated with the primary outcome (HR 1.5, P = .01). Changes in PDS and LVEF on serial MPIs provide incremental prognostic information to initial and follow-up MPI findings. Lack of

  15. Detection and severity classification of extracardiac interference in {sup 82}Rb PET myocardial perfusion imaging

    Energy Technology Data Exchange (ETDEWEB)

    Orton, Elizabeth J., E-mail: eorton@physics.carleton.ca; Kemp, Robert A. de; Glenn Wells, R. [Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, Ontario K1Y 4W7 (Canada); Department of Physics, Carleton University, 1125 Colonel By Drive, Ottawa, Ontario K1S 5B6 (Canada); Al Harbi, Ibraheem [Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, Ontario K1Y 4W7 (Canada); Department of Medicine (Cardiology), King Fahad Hospital, Medina 42351 (Saudi Arabia); Klein, Ran [Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, Ontario K1Y 4W7 (Canada); Department of Biomedical Engineering, Carleton University, 1125 Colonel By Drive, Ottawa, Ontario K1S 5B6 (Canada); Beanlands, Rob S. B. [Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, Ontario K1Y 4W7 (Canada)

    2014-10-15

    Purpose: Myocardial perfusion imaging (MPI) is used for diagnosis and prognosis of coronary artery disease. When MPI studies are performed with positron emission tomography (PET) and the radioactive tracer rubidium-82 chloride ({sup 82}Rb), a small but non-negligible fraction of studies (∼10%) suffer from extracardiac interference: high levels of tracer uptake in structures adjacent to the heart which mask the true cardiac tracer uptake. At present, there are no clinically available options for automated detection or correction of this problem. This work presents an algorithm that detects and classifies the severity of extracardiac interference in {sup 82}Rb PET MPI images and reports the accuracy and failure rate of the method. Methods: A set of 200 {sup 82}Rb PET MPI images were reviewed by a trained nuclear cardiologist and interference severity reported on a four-class scale, from absent to severe. An automated algorithm was developed that compares uptake at the external border of the myocardium to three thresholds, separating the four interference severity classes. A minimum area of interference was required, and the search region was limited to that facing the stomach wall and spleen. Maximizing concordance (Cohen’s Kappa) and minimizing failure rate for the set of 200 clinician-read images were used to find the optimal population-based constants defining search limit and minimum area parameters and the thresholds for the algorithm. Tenfold stratified cross-validation was used to find optimal thresholds and report accuracy measures (sensitivity, specificity, and Kappa). Results: The algorithm was capable of detecting interference with a mean [95% confidence interval] sensitivity/specificity/Kappa of 0.97 [0.94, 1.00]/0.82 [0.66, 0.98]/0.79 [0.65, 0.92], and a failure rate of 1.0% ± 0.2%. The four-class overall Kappa was 0.72 [0.64, 0.81]. Separation of mild versus moderate-or-greater interference was performed with good accuracy (sensitivity

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

    Energy Technology Data Exchange (ETDEWEB)

    Hanyu, Haruo; Shimizu, Soichiro; Hirao, Kentaro; Kanetaka, Hidekazu; Iwamoto, Toshihiko [Tokyo Medical University, Department of Geriatric Medicine, Tokyo (Japan); Chikamori, Taishiro; Usui, Yasuhiro; Yamashina, Akira [Tokyo Medical University, 2. Department of Internal Medicine, Tokyo (Japan); Koizumi, Kiyoshi; Abe, Kimihiko [Tokyo Medical University, Department of Radiology, Tokyo (Japan)

    2006-03-15

    Both decreased occipital perfusion on brain single-photon emission computed tomography (SPECT) and reduction in cardiac {sup 123}I-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-[{sup 123}I]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.)

  17. 3.0 T magnetic resonance myocardial perfusion imaging for semi-quantitative evaluation of coronary microvascular dysfunction in hypertrophic cardiomyopathy.

    Science.gov (United States)

    Yin, Liang; Xu, Hai-Yan; Zheng, Sui-Sheng; Zhu, Ying; Xiao, Jiang-Xi; Zhou, Wei; Yu, Si-Si; Gong, Liang-Geng

    2017-12-01

    This study aimed to assess coronary microvascular dysfunction (CMD) differences in hypertrophic cardiomyopathy (HCM) patients using cardiac magnetic resonance (CMR) first-pass perfusion and late gadolinium enhancement imaging. Forty-seven patients with HCM and twenty-one healthy volunteers underwent CMR at rest. Imaging protocols included short axis cine, first-pass myocardial perfusion, and late gadolinium enhancement (LGE). Left ventricular end-diastolic wall thickness (EDTH), LGE, time to peak (T peak ), maximal up-slope (Slope max ), and peak signal intensity (SI peak ) were assessed for each myocardial segment. The HCM myocardial segments were grouped by the degree of LGE and hypertrophy. T peak , SI peak , Slope max and EDTH in multiple groups were assessed and compared by ANOVA test/Kruskal-Wallis test. The Spearman correlation test was used to determine the relationships between EDTH, LGE and perfusion parameters (T peak , Slope max and SI peak ). Compared to control group segments, T peak increased while Slope max and SI peak decreased in non-LGE/non-hypertrophic segments and LGE/hypertrophic segments in the HCM group, while T peak increased more significantly in LGE/hypertrophic segments (all p hypertrophic segments of HCM patients, and it may be helpful in the early diagnosis of coronary microvascular dysfunction in HCM. This abnormal perfusion is associated with the severity of myocardial fibrosis and the degree of hypertrophy.

  18. Myocardial perfusion at rest in patients with Diabetes Mellitus Type 1 compared with healthy controls assessed with Multi Detector Computed Tomography

    DEFF Research Database (Denmark)

    Byrne, Christina; Jensen, Tonny; Hjortkjær, Henrik Øder

    2015-01-01

    years (p5,p95: 17,49). Median coronary calcium score was higher in T1DM patients (51 vs. 2, p=0.037) compared with controls. However, a similar frequency of >50% stenosis in one or more coronary arteries was found in T1DM patients and controls (18% vs. 14%, p=0.49). LV myocardial perfusion at rest (Myo...

  19. Preservation of Myocardial Perfusion and Function by Keeping Hypertrophied Heart Empty and Beating for Valve Surgery: An In Vivo MR Study of Pig Hearts.

    Science.gov (United States)

    Wang, Jian; Xiang, Bo; Deng, Jixian; Lin, Hung-Yu; Freed, Darren H; Arora, Rakesh C; Tian, Ganghong

    2017-01-01

    Objectives . Normothermic hyperkalemic cardioplegia arrest (NHCA) may not effectively preserve hypertrophied myocardium during open-heart surgery. Normothermic normokalemic beating perfusion (NNBP), keeping hearts empty-beating, was utilized as an alternative to evaluate its cardioprotective role. Materials and Methods . Twelve hypertrophied pig hearts at 58.6 ± 7.2 days after ascending aorta banding underwent NNBP and NHCA, respectively. Near infrared myocardial perfusion imaging with indocyanine green (ICG) was conducted to assess myocardial perfusion. Left ventricular (LV) contractile function was assessed by cine MRI. TUNEL staining and western blotting for caspase-3 cleavage and cardiac troponin I (cTnI) degradation were conducted in LV tissue samples. Results . Ascending aortic diameter was reduced by 52.7% ± 0.4% at approximately fifty-eight days after banding. LV wall thickness was significantly higher in aorta banding than in sham operation. Myocardial blood flow reflected by maximum ICG absorbance value was markedly higher in NNBP than in NHCA. The amount of apoptotic cardiomyocyte was significantly lower in NNBP than in NHCA. NNBP alleviated caspase-3 cleavage and cTnI degradation associated with NHCA. NNBP displayed a substantially increased postoperative ejection fraction relative to NHCA. Conclusions . NNBP was better than NHCA in enhancing myocardial perfusion, inhibiting cardiomyocyte apoptosis, and preserving LV contractile function for hypertrophied hearts.

  20. High doses of vascular endothelial growth factor 165 safely, but transiently, improve myocardial perfusion in no-option ischemic disease.

    Science.gov (United States)

    Giusti, Imarilde I; Rodrigues, Clarissa G; Salles, Felipe B; Sant'Anna, Roberto T; Eibel, Bruna; Han, Sang W; Ludwig, Eduardo; Grossman, Gabriel; Prates, Paulo Roberto L; Sant'Anna, João Ricardo M; Filho, Guaracy F Teixeira; Markoski, Melissa M; Nesralla, Ivo A; Nardi, Nance B; Kalil, Renato A K

    2013-10-01

    Gene therapy can induce angiogenesis in ischemic tissues. The aim of this study was to assess safety, feasibility, and results, both clinical and on myocardial perfusion, of gene therapy in refractory angina. This was a phase I/II, prospective, temporal-controlled series, clinical trial. Thirteen patients were maintained for minimum 6 months under optimized clinical management, and then received intramyocardial injections of 2000 μg plasmid vascular endothelial growth factor 165 and were followed by single-photon emission computed tomography (SPECT), treadmill tests, Minnesota quality of life questionnaire (QOL), and New York Heart Association (NYHA) functional plus Canadian Cardiovascular Society (CCS) angina classifications. There were no deaths, early or late. During the optimized clinical treatment, we observed worsening of rest ischemia scores on SPECT (p<0.05). After treatment, there was a transitory increase in myocardial perfusion at the third-month SPECT under stress (pre-operative [pre-op] 18.38 ± 7.51 vs. 3 months 15.31 ± 7.30; p<0.01) and at the sixth month under rest (pre-op 13.23 ± 7.98 vs. 6 months: 16.92 ± 7.27; p<0.01). One year after, there were improvements in treadmill test steps (pre-op 2.46 ± 2.07 vs.12 months 4.15 ± 2.23; p<0.01) and oxygen consumption (pre-op 7.66 ± 4.47 vs.12 months 10.89 ± 4.65; p<0.05), QOL (pre-op 48.23 ± 18.35 vs.12 months 28.31 ± 18.14; p<0.01) scores, and CCS (pre-op 3 [3-3.5] vs.12 months 2 [1-2.5]; p<0.01) and NYHA (pre-op 3 [3-3] vs. 2 [2-2] vs. 12 months 2 [1-2]; p<0.01) classes. Gene therapy demonstrated to be feasible and safe in this advanced ischemic cardiomyopathy patient sample. There were improvements in clinical evaluation parameters, and a transitory increase in myocardial perfusion detectable by SPECT scintigraphy. NCT00744315 http://clinicaltrials.gov/

  1. Two-dimensional strain echocardiography technology for evaluation of myocardial strain in swimming athletes after high-intensity exercise.

    Science.gov (United States)

    Liang, Chen; Ma, Yun; Gao, Can; Zhang, Jianhong; Yang, Min; Chen, Gen; Fu, Shan; Zhu, Tiangang

    2017-02-01

    The aim of this study was to investigate the change in myocardial strain in swimming athletes before and after high-intensity exercise using two-dimensional strain echocardiography (2DSE) technology. To assess whether the local and overall myocardial function and myocardial injury are accurately measured using 2DSE technology, 15 swimming athletes were selected as research objects. We applied 2DSE technology to track the 2D ultrasound images of the apical four chambers, the apical two chambers, and the apical long axis before and after high-intensity, increasing-load exercise. We recorded indices such as the left ventricular global strain (GS) and the left ventricular segmental wall longitudinal peak systolic strain (PS) in 18 systoles and analyzed the myocardial strain change before and after exercise. After high-intensity exercise, the overall myocardial strain decreased, especially the strain of the posterior wall, posterior divider, lateral wall, lower wall, and the basal and middle segments of the anterior wall. The influence of exercise on myocardial strain was greater on the basal and middle segments than on the apical segment. One-time intensive exercise negatively affected the myocardial muscle. Myocardial muscles in the apical segment and the myocardial wall were more sensitive to intensive exercise. The 2DSE technology can precisely position the motion-sensitive areas and help locate myocardial injury. © 2017, Wiley Periodicals, Inc.

  2. Comparison between stress myocardial perfusion SPECT recorded with cadmium-zinc-telluride and Anger cameras in various study protocols

    Energy Technology Data Exchange (ETDEWEB)

    Verger, Antoine; Karcher, Gilles [CHU-Nancy, Department of Nuclear Medicine, Nancy (France); INSERM U947, Nancy (France); Nancyclotep Experimental Imaging Platform, Nancy (France); Djaballah, Wassila [CHU-Nancy, Department of Nuclear Medicine, Nancy (France); INSERM U947, Nancy (France); Fourquet, Nicolas [Clinique Pasteur, Toulouse (France); Rouzet, Francois; Le Guludec, Dominique [AP-HP, Hopital Bichat, Department of Nuclear Medicine, Paris (France); INSERM U 773 Inserm and Denis Diderot University, Paris (France); Koehl, Gregoire; Roch, Veronique [CHU-Nancy, Department of Nuclear Medicine, Nancy (France); Nancyclotep Experimental Imaging Platform, Nancy (France); Imbert, Laetitia [CHU-Nancy, Department of Nuclear Medicine, Nancy (France); Nancyclotep Experimental Imaging Platform, Nancy (France); Centre Alexis Vautrin, Department of Radiotherapy, Vandoeuvre (France); Poussier, Sylvain [INSERM U947, Nancy (France); Nancyclotep Experimental Imaging Platform, Nancy (France); Fay, Renaud [INSERM, Centre d' Investigation Clinique CIC-P 9501, Nancy (France); Marie, Pierre-Yves [CHU-Nancy, Department of Nuclear Medicine, Nancy (France); Nancyclotep Experimental Imaging Platform, Nancy (France); INSERM U961, Nancy (France); Hopital de Brabois, CHU-Nancy, Medecine Nucleaire, Vandoeuvre-les-Nancy (France)

    2013-03-15

    The results of stress myocardial perfusion SPECT could be enhanced by new cadmium-zinc-telluride (CZT) cameras, although differences compared to the results with conventional Anger cameras remain poorly known for most study protocols. This study was aimed at comparing the results of CZT and Anger SPECT according to various study protocols while taking into account the influence of obesity. The study population, which was from three different institutions equipped with identical CZT cameras, comprised 276 patients referred for study using protocols involving {sup 201}Tl (n = 120) or {sup 99m}Tc-sestamibi injected at low dose at stress ({sup 99m}Tc-Low; stress/rest 1-day protocol; n = 110) or at high dose at stress ({sup 99m}Tc-High; rest/stress 1-day or 2-day protocol; n = 46). Each Anger SPECT scan was followed by a high-speed CZT SPECT scan (2 to 4 min). Agreement rates between CZT and Anger SPECT were good irrespective of the study protocol (for abnormal SPECT, {sup 201}Tl 92 %, {sup 99m}Tc-Low 86 %, {sup 99m}Tc-High 98 %), although quality scores were much higher for CZT SPECT with all study protocols. Overall correlations were high for the extent of myocardial infarction (r = 0.80) and a little lower for ischaemic areas (r = 0.72), the latter being larger on Anger SPECT (p < 0.001). This larger extent was mainly observed in 50 obese patients who were in the {sup 201}Tl or {sup 99m}Tc-Low group and in whom stress myocardial counts were particularly low with Anger SPECT (228 {+-} 101 kcounts) and dramatically enhanced with CZT SPECT (+279 {+-} 251 %). Concordance between the results of CZT and Anger SPECT is good regardless of study protocol and especially when excluding obese patients who have low-count Anger SPECT and for whom myocardial counts are dramatically enhanced on CZT SPECT. (orig.)

  3. Septal and Anterior Reverse Mismatch of Myocardial Perfusion and Metabolism in Patients With Coronary Artery Disease and Left Bundle Branch Block

    Science.gov (United States)

    Wang, Jian-Guang; Fang, Wei; Yang, Min-Fu; Tian, Yue-Qin; Zhang, Xiao-Li; Shen, Rui; Sun, Xiao-Xin; Guo, Feng; Wang, Dao-Yu; He, Zuo-Xiang

    2015-01-01

    Abstract The effects of left bundle branch block (LBBB) on left ventricular myocardial metabolism have not been well investigated. This study evaluated these effects in patients with coronary artery disease (CAD). Sixty-five CAD patients with complete LBBB (mean age, 61.8 ± 9.7 years) and 65 without LBBB (mean age, 59.9 ± 8.4 years) underwent single photon emission computed tomography, positron emission tomography, and contrast coronary angiography. The relationship between myocardial perfusion and metabolism and reverse mismatch score, and that between QRS length and reverse mismatch score and wall motion score were evaluated. The incidence of left ventricular septum and anterior wall reverse mismatching between the two groups was significantly different (P < 0.001 and P = 0.002, respectively). The incidences of normal myocardial perfusion and metabolism in the left ventricular lateral and inferior walls were also significantly different between the two groups (P < 0.001 and P < 0.001, respectively). The incidence of septal reverse mismatching in patients with mild to moderate perfusion was significantly higher among those with LBBB than among those without LBBB (P < 0.001). In CAD patients with LBBB, septal reverse mismatching was significantly more common among those with mild to moderate perfusion than among those with severe perfusion defects (P = 0.002). The correlation between the septal reverse mismatch score and QRS length was significant (P = 0.026). In patients with CAD and LBBB, septal and anterior reverse mismatching of myocardial perfusion and metabolism was frequently present; the septal reverse mismatch score negatively correlated with the QRS interval. PMID:25997045

  4. Myocardial imaging artifacts caused by mitral valve annulus calcification

    Energy Technology Data Exchange (ETDEWEB)

    Wagoner, L.E.; Movahed, A.; Reeves, W.C. (East Carolina Univ. School of Medicine, Greenville, NC (USA))

    1991-02-01

    Knowledge of imaging artifact of myocardial perfusion studies with thallium-201 is critical for improving the diagnostic accuracy of coronary artery disease. Three patients are described who underwent exercise or pharmacologic stress thallium-201 imaging studies and had a moderate, fixed myocardial perfusion defect (scar) involving the posterolateral and inferoposterior walls of the left ventricle. This was an imaging artifact caused by a heavily calcified mitral valve annulus.

  5. NOGA-guided analysis of regional myocardial perfusion abnormalities treated with intramyocardial injections of plasmid encoding vascular endothelial growth factor A-165 in patients with chronic myocardial ischemia: subanalysis of the EUROINJECT-ONE multicenter double-blind randomized study

    DEFF Research Database (Denmark)

    Gyongyosi, Mariann; Khorsand, Aliasghar; Zamini, Sholeh

    2005-01-01

    BACKGROUND: The aim of this substudy of the EUROINJECT-ONE double-blind randomized trial was to analyze changes in myocardial perfusion in NOGA-defined regions with intramyocardial injections of plasmid encoding plasmid human (ph)VEGF-A(165) using an elaborated transformation algorithm. METHODS A...

  6. Assessment of functional effects using gated myocardial perfusion SPECT after mesenchymal stem cells transplantation in a porcine model of myocardial infarction

    Energy Technology Data Exchange (ETDEWEB)

    Heo, Young Jun; Ahn, Young Eun; Lim, Sang Yup; Song, Ho Chun; Bom, Hee Seung; Min, Joeng Jun; Jeong, Myung Ho; Cho, Jeong Gwan; Park, Jong Chun; K, Jung Chaee [School of Medicine, Chonnam National University, Gwangju (Korea, Republic of)

    2004-07-01

    Bone-marrow-derived Mesenchymal stem cells(MSCs) have shown therapeutic potential of successfully delivered to the intended site of myocardial infarction. The purpose of study is to test the feasibility and usefulness of gated myocardial perfusion SPECT(GSPECT) in the evaluation of the function and perfusion of the left ventricle(LV) after transplantation of MSCs transduced with Akt in a porcine model of myocardial infarction(MI). MSCs were separated from hematopoietic cells based on their preferential attachment to polystyrene surfaces and genetically engineered using ex-vivo myr-Akt-adenoviral gene transfer. MSCs were delivered by intracoronary injection to adult farm pigs (n=15) after MI [group I(control:n=5), media only:group II(n=5), MSCs only:group III(n=5), MSCs modified with Akt]. GSPECT with Tc-99m tetrofosmin was done before and 4 weeks after MSC transplantation. LV volume, left ventricular ejection fraction(LVEF) and area of MI were calculated from the GSPECT data by QGS. Pigs were sacrificed for immunocytochemical characterization. Mean LVEF was 44.8{+-}16.6%, 29.8{+-}7.6%, and 41.2{+-}8.3% at first (each n=5) and changed to 29.8{+-}8.5%, 39.0{+-}9.5%, and 60.1{+-}17.4% at 4 weeks after the MSC implantation in group I, II, and III, respectively. Mean MI area was 17.6{+-}9.2%, 35.0{+-}11.8%, and 24.3{+-}11.2% at first, and changed to 19.6{+-}10.1%, 27.2{+-}13.9%, and 7.4{+-}5.3% in group I, II, and III, respectively. Transplantation of {approx}107cells into the ischemic porcine myocardium in group II increased the LVEF (-14.9{+-}15.3% versus 9.0{+-}8.6%, n=5 in each, p=0.016) and decreased the area of MI (2.1{+-}1.3% versus -7.9{+-}9.0%, n=5 in each, p=0.04) compared with control group and much more different in group III in LVEF (19.2{+-}16.4%, p=0.006) and in area of MI (-16.3{+-}6.4%, p=0.037). GSPECT is useful to estimate the functional effects on repair of the injured area, remodeling, and systolic performance in infarcted hearts after the

  7. Myocardial perfusion of infarcted and normal myocardium in propofol-anesthetized minipigs using 82Rubidium PET

    DEFF Research Database (Denmark)

    Rasmussen, Thomas; Larsen, Bjarke Follin; Kastrup, Jens

    2016-01-01

    challenges. Animals, which have been anesthetized during PET acquisition, might react differently to used stress medications, and therefore difficulties might exist while evaluating the resulting PET images using standard software packages from commercial vendors optimized for human hearts. Furthermore...... propofol, used for anesthesia, can influence myocardial perfusion and coronary flow reserve due to its vasorelaxant effect, and interactions might exist between propofol and used stress agents, potentially affecting the result of the examination. We present cardiac 82Rb-PET studies performed in propofol......-anesthetized minipigs with normal and infarcted myocardium stressed with both adenosine and dipyridamole. Despite the mentioned challenges, we were able to trace the small minipig heart with software designed for human cardiac PET and to achieve blood flow measurements comparable with results in humans with both...

  8. MIBI Uptake in a Huge Breast Mass Obscuring the Anterior and Lateral Myocardial Walls in Perfusion Imaging

    Directory of Open Access Journals (Sweden)

    Forough Kalantari

    2015-02-01

    Full Text Available Background: Cardiac risk assessment with myocardial perfusion imaging (MPI is a common practice for some elderly breast cancer patients who are candidates for operation. In rare cases the tumor may become visible in the images.Case presentation: This is the report of a case with a huge slow-growing breast tumor suspicious for malignancy and presenting with methoxy-isobutyl-isonitrile (MIBI uptake in the tumor. The patient was referred to the nuclear medicine department for preoperative cardiac risk assessment with MPI.Conclusion: There was high uptake in the tumor was note worthy in two different aspects: 1high MIBI uptake in the tumor is more suggestive of malignant rather than benign tumors and thus, underscores the importance of extra-cardiac uptake sites in pre-operation MPI; and 2high uptake in the left breast tumor may obscure the MPI image and hinder proper interpretation.

  9. Prognostic value of heart rate response during regadenoson stress myocardial perfusion imaging in patients with end stage renal disease.

    Science.gov (United States)

    AlJaroudi, Wael; Campagnoli, Tania; Fughhi, Ibtihaj; Wassouf, Marwan; Ali, Amjad; Doukky, Rami

    2016-06-01

    Blunted heart rate response (HRR) to vasodilator stress agents is associated with worse outcomes. There are limited data assessing the effect of impaired HRR to regadenoson among patients with end-stage renal disease (ESRD) undergoing stress myocardial perfusion imaging (MPI). We prospectively followed patients with ESRD enrolled in the ASSUAGE and ASSUAGE-CKD trials. HRR was defined as 100*(peak stress heart rate-resting heart rate)/resting heart rate. Study cohort was dichotomized to blunted and normal HRR groups according to an established median HRR value 90 days) coronary revascularization. There were 303 patients followed for 35 ± 10 months. In the entire cohort, there was a stepwise increase in the rates of death and all secondary endpoints with worsening HRR (P values ≤.001). Blunted HRR (regadenoson is a strong and independent predictor of death and cardiovascular events in patients with ESRD and adds incremental prognostic value.

  10. Transient ischemic dilation for coronary artery disease in quantitative analysis of same-day sestamibi myocardial perfusion SPECT.

    Science.gov (United States)

    Xu, Yuan; Arsanjani, Reza; Clond, Morgan; Hyun, Mark; Lemley, Mark; Fish, Mathews; Germano, Guido; Berman, Daniel S; Slomka, Piotr J

    2012-06-01

    Transient ischemic dilation (TID) of the left ventricle in myocardial perfusion SPECT (MPS) has been shown to be a clinically useful marker of severe coronary artery disease (CAD). However, TID has not been evaluated for 99mTc-sestamibi rest/stress protocols (Mibi-Mibi). We aimed to develop normal limits and evaluate diagnostic power of TID ratio for Mibi-Mibi scans. TID ratios were automatically derived from static rest/stress MPS (TID) and gated rest/stress MPS from the end-diastolic phase (TID(ed)) in 547 patients who underwent Mibi-Mibi scans [215 patients with correlating coronary angiography and 332 patients with low likelihood (LLk) of CAD]. Scans were classified as severe (≥ 70% stenosis in proximal left anterior descending (pLAD) artery or left main (LM), or ≥ 90% in ≥ 2 vessels), mild to moderate (≥ 90% stenosis in 1 vessel or ≥ 70%-90% in ≥ 1 vessel except pLAD or LM), and normal (TID and 1.23 for TID(ed) as established in 259 LLk patients. Both ratios increased with disease severity (P TID increased from 2% in normal patients to >36% in patients with severe CAD. Similarly, when DI was used to classify disease severity, the average ratios showed significant increasing trend with DI increase (P TID also increased with increasing DI. The incidence of abnormal TID in the group with high perfusion scores significantly increased compared to the group with low perfusion scores (stress total perfusion deficit, TPD TID when added to mild to moderate perfusion abnormality (3% ≤ TPD TID(ed)/TID(es): 69% vs 64%, P = .08, while the accuracy remained consistent if abnormal TID was considered as a marker in addition to stress TPD. Similar results were obtained when DI was used for the definition of severe CAD (sensitivity: 76% vs 66%, P TID was combined with stress TPD). TID ratios obtained from gated or ungated Mibi-Mibi MPS and are useful markers of severe CAD.

  11. Metrics of quality care in veterans: correlation between primary-care performance measures and inappropriate myocardial perfusion imaging.

    Science.gov (United States)

    Winchester, David E; Kitchen, Andrew; Brandt, John C; Dusaj, Raman S; Virani, Salim S; Bradley, Steven M; Shaw, Leslee J; Beyth, Rebecca J

    2015-04-01

    Approximately 10% to 20% of myocardial perfusion imaging (MPI) tests are inappropriate based on professional-society recommendations. The correlation between inappropriate MPI and quality care metrics is not known. Inappropriate MPI will be associated with low achievement of quality care metrics. We conducted a retrospective cross-sectional investigation at a single Veterans Affairs medical center. Myocardial perfusion imaging tests ordered by primary-care clinicians between December 2010 and July 2011 were assessed for appropriateness (by 2009 criteria). Using documentation of the clinical encounter where MPI was ordered, we determined how often quality care metrics were achieved. Among 516 MPI patients, 52 (10.1%) were inappropriate and 464 (89.9%) were not inappropriate (either appropriate or uncertain). Hypertension (82.2%), diabetes mellitus (41.3%), and coronary artery disease (41.1%) were common. Glycated hemoglobin levels were lower in the inappropriate MPI cohort (6.6% vs 7.5%; P = 0.04). No difference was observed in the proportion with goal hemoglobin (62.5% vs 46.3% for appropriate/uncertain; P = 0.258). Systolic blood pressure was not different (132 mm Hg vs 135 mm Hg; P = 0.34). Achievement of several other categorical quality metrics was low in both cohorts and no differences were observed. More than 90% of clinicians documented a plan to achieve most metrics. Inappropriate MPI is not associated with performance on metrics of quality care. If an association exists, it may be between inappropriate MPI and overly aggressive care. Most clinicians document a plan of care to address failure of quality metrics, suggesting awareness of the problem. © 2015 Wiley Periodicals, Inc.

  12. Effects of pimobendan on myocardial perfusion and pulmonary transit time in dogs with myxomatous mitral valve disease: a pilot study.

    Science.gov (United States)

    Apple, S M; Menciotti, G; Braz-Ruivo, L; Crosara, S; Häggström, J; Borgarelli, M

    2016-09-01

    To describe pulmonary transit time (nPTT) and myocardial perfusion (nMP) normalised to heart rate in dogs with stable ACVIM stage C myxomatous mitral valve disease (MMVD) and to assess short-term effects of pimobendan on these variables. We hypothesised that nPTT and nMP would increase in dogs with MMVD compared with normal dogs. Additionally, we hypothesised that treatment with pimobendan would decrease nMP and nPTT in dogs with MMVD. Prospective, single-blind study involving 6 normal dogs and 12 dogs with MMVD. Dogs with MMVD were treated with enalapril and furosemide for at least 1 month prior to examination. All dogs underwent standard and contrast echocardiographic examinations at the beginning of the study (T0). At this time, MMVD dogs were randomly assigned to receive either pimobendan (0.4-0.6 mg/kg) or not. All dogs with MMVD were re-evaluated by standard and contrast echocardiography after 1 week (T1) and nPTT and nMP were measured. nPTT was significantly increased in dogs with MMVD (P = 0.0063), compared with normal dogs. It was significantly decreased at T1 in dogs receiving pimobendan (P = 0.0250). The nMP was not significantly different in dogs with MMVD, compared with healthy dogs (P = 0.2552), and it was not significantly different at T1 in the treatment group (P = 0.8798). Contrast echocardiography was a valid, complementary tool for echocardiographic analysis of dogs with MMVD. Pimobendan decreased nPTT in dogs affected by MMVD. Myocardial perfusion was not different in dogs with severe MMVD. © 2016 Australian Veterinary Association.

  13. First-pass myocardial perfusion MRI with reduced subendocardial dark-rim artifact using optimized Cartesian sampling.

    Science.gov (United States)

    Zhou, Zhengwei; Bi, Xiaoming; Wei, Janet; Yang, Hsin-Jung; Dharmakumar, Rohan; Arsanjani, Reza; Bairey Merz, C Noel; Li, Debiao; Sharif, Behzad

    2017-02-01

    The presence of subendocardial dark-rim artifact (DRA) remains an ongoing challenge in first-pass perfusion (FPP) cardiac magnetic resonance imaging (MRI). We propose a free-breathing FPP imaging scheme with Cartesian sampling that is optimized to minimize the DRA and readily enables near-instantaneous image reconstruction. The proposed FPP method suppresses Gibbs ringing effects-a major underlying factor for the DRA-by "shaping" the underlying point spread function through a two-step process: 1) an undersampled Cartesian sampling scheme that widens the k-space coverage compared to the conventional scheme; and 2) a modified parallel-imaging scheme that incorporates optimized apodization (k-space data filtering) to suppress Gibbs-ringing effects. Healthy volunteer studies (n = 10) were performed to compare the proposed method against the conventional Cartesian technique-both using a saturation-recovery gradient-echo sequence at 3T. Furthermore, FPP imaging studies using the proposed method were performed in infarcted canines (n = 3), and in two symptomatic patients with suspected coronary microvascular dysfunction for assessment of myocardial hypoperfusion. Width of the DRA and the number of DRA-affected myocardial segments were significantly reduced in the proposed method compared to the conventional approach (width: 1.3 vs. 2.9 mm, P subendocardial perfusion defects and patient results were consistent with the gold-standard invasive test. The proposed free-breathing Cartesian FPP imaging method significantly reduces the prevalence of severe DRAs compared to the conventional approach while maintaining similar resolution and image quality. 2 J. Magn. Reson. Imaging 2017;45:542-555. © 2016 International Society for Magnetic Resonance in Medicine.

  14. Effect of physical exercise on pain thresholds and plasma beta-endorphins in patients with silent and symptomatic myocardial ischaemia

    OpenAIRE

    Droste, C.; Meyer-Blankenburg, H.; Greenlee, Mark W.; Roskamm, H.

    1988-01-01

    In a double-blind study, eight patients with symptomatic myocardial ischaemia and nine with asymptomatic myocardial ischaemia were compared during physical exercise under naloxone (6 mg i.v.) or placebo. Plasma beta-endorphin, cortisol and catecholamines were measured before exercise, during maximal exercise, and 10, 20 and 60 min after exercise. A tourniquet pain test (on the forearm, under control of transcutaneous PO2), and an electrical pain test (intracutaneous electrode placed in the fi...

  15. Influence of attenuation correction on transient left ventricular dilation in dual isotope myocardial perfusion imaging in patients with known or suspected coronary artery disease.

    Science.gov (United States)

    Brodov, Yafim; Frenkel, Alex; Chouraqui, Pierre; Przewloka, Kinga; Rispler, Shmuel; Abadi, Sobhi; Keidar, Zohar

    2012-07-01

    The aim of this study was to assess the effect of attenuation correction (AC) on left ventricular (LV) volumes and LV transient ischemic dilatation (TID) during dual-isotope single-photon emission computer tomographic (SPECT) myocardial perfusion imaging (MPI). Ninety-six patients (mean age 58 ± 11 years, 15% women, 38 patients completed exercise and 58 dipyridamole pharmacologic stress tests) assessed for known or suspected coronary artery disease underwent dual-isotope thallium-201 rest and technetium-99m sestamibi stress SPECT MPI with computed tomography-based AC. The TID ratio was calculated separately for non-AC and AC SPECT MPI studies as the ratio of the LV endocardial volume at stress divided by LV endocardial volume at rest. The mean and range of the gated LV ejection fraction during exercise and pharmacologic stress was 54 ± 12% (29% to 80%) and 58 ± 12% (27% to 80%), respectively. In the exercise stress group, the same mean LV endocardial volumes in non-AC and AC stress (76.4 ± 30 and 76.5 ± 28) and rest (66.3 ± 26 and 66.4 ± 24) studies were found (p = 0.90). There was no statistical difference between the mean exercise TID ratio in non-AC and AC studies (1.27 vs 1.31, respectively, p = 0.10). The same mean LV endocardial volumes in non-AC and AC in pharmacologic stress (79.9 ± 42 and 80 ± 41) and rest (71.4 ± 41 and 72.3 ± 37), respectively, were found (p = 0.50). There was no statistical difference between the mean dipyridamole TID ratio in non-AC and AC studies (1.20 vs 1.17, respectively, p = 0.10). In conclusion, LV volumes and TID indexes obtained on SPECT MPI with exercise or pharmacologic stress using dipyridamole are not affected by AC. Copyright © 2012 Elsevier Inc. All rights reserved.

  16. Image Registration and Analysis for Quantitative Myocardial Perfusion: Application to Dynamic Circular Cardiac CT

    NARCIS (Netherlands)

    Isola, A.; Schmitt, H.; Van Stevendaal, U.; Begemann, P.G.C.; Coulon, P.; Boussel, L.; Grass, M.

    2012-01-01

    Large area detector computed tomography systems with fastrotating gantries enable volumetric dynamic cardiac perfusion studies. Prospectively ECG-triggered acquisitions limit the data acquisition to a predefined cardiac phase and thereby reduce X-ray dose andlimit motion artifacts. Even in the case

  17. Comparative analysis of iterative reconstruction algorithms with resolution recovery and new solid state cameras dedicated to myocardial perfusion imaging.

    Science.gov (United States)

    Brambilla, Marco; Lecchi, Michela; Matheoud, Roberta; Leva, Lucia; Lucignani, Giovanni; Marcassa, Claudio; Zoccarato, Orazio

    2017-09-01

    New technologies are available in myocardial perfusion imaging. They include new software that recovers image resolution and limits image noise, multifocal collimators and dedicated cardiac cameras in which solid-state detectors are used and all available detectors are constrained to imaging just the cardiac field of view. These innovations resulted in shortened study times or reduced administered activity to patients, while preserving image quality. Many single center and some multicenter studies have been published during the introduction of these innovations in the clinical practice. Most of these studies were lead in the framework of "agreement studies" between different methods of clinical measurement. They aimed to demonstrate that these new software/hardware solutions allow the acquisition of images with reduced acquisition time or administered activity with comparable results (as for image quality, image interpretation, perfusion defect quantification, left ventricular volumes and ejection fraction) to the standard-time or standard-dose SPECT acquired with a conventional gamma camera and reconstructed with the traditional FBP method, considered as the gold standard. The purpose of this review is to provide the reader with a comprehensive understanding of the pro and cons of the different approaches summarizing the achievements reached so far and the issues that need further investigations. Copyright © 2017 Associazione Italiana di Fisica Medica. Published by Elsevier Ltd. All rights reserved.

  18. Two-position supine/prone myocardial perfusion SPECT (MPS) imaging improves visual inter-observer correlation and agreement.

    Science.gov (United States)

    Arsanjani, Reza; Hayes, Sean W; Fish, Mathews; Shalev, Aryeh; Nakanishi, Rine; Thomson, Louise E J; Friedman, John D; Germano, Guido; Berman, Daniel S; Slomka, Piotr

    2014-08-01

    We aimed to compare the inter-observer agreement between two experienced readers using supine vs combined supine/prone myocardial perfusion SPECT (MPS) in a large population. 1,181 consecutive patients without known coronary artery disease (CAD) undergoing rest (201)Tl/stress (99m)Tc-sestamibi MPS studies were evaluated. Visual reads were performed in two consecutive steps, with readers scoring the stress supine perfusion images during step 1 and rescoring the images using both supine/prone data during step 2. Visual summed stress scores (SSS) of two readers including regional scores in different vascular territories were compared. The specificity for both readers improved using combined supine/prone imaging (reader 1: 92% vs 86% [P = .0002], reader 2: 88% vs 72% [P only reading. The overall correlation between SSS scores for two readers improved with supine/prone imaging for both genders, as well as in the left anterior descending and right coronary territories. The inter-observer correlation and agreement significantly improve using two-position supine/prone vs supine-only imaging.

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

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    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.

  20. Assessment of ischaemic burden in angiographic three-vessel coronary artery disease with high-resolution myocardial perfusion cardiovascular magnetic resonance imaging

    Science.gov (United States)

    Motwani, Manish; Maredia, Neil; Fairbairn, Timothy A.; Kozerke, Sebastian; Greenwood, John P.; Plein, Sven

    2014-01-01

    Aims This study compared the myocardial ischaemic burden (MIB) in patients with angiographic three-vessel coronary artery disease (3VD) using high-resolution and standard-resolution myocardial perfusion cardiovascular magnetic resonance (perfusion CMR) imaging. Methods and results One hundred and five patients undergoing coronary angiography had two separate stress/rest perfusion CMR studies, one with standard-resolution (2.5 mm in-plane) and another with high-resolution (1.6 mm in-plane). Quantitative coronary angiography was used to define patients with angiographic 3VD. Perfusion CMR images were anonymized, randomly ordered and visually reported by two observers acting in consensus and blinded to all clinical and angiographic data. Perfusion was graded in each segment on a four-point scale and summed to produce a perfusion score and estimate of MIB for each patient. In patients with angiographic 3VD (n = 35), high-resolution acquisition identified more abnormal segments (7.2 ± 3.8 vs. 5.3 ± 4.0; P = 0.004) and territories (2.4 ± 0.9 vs. 1.6 ± 1.1; P = 0.002) and a higher overall perfusion score (20.1 ± 7.7 vs. 11.9 ± 9.4; P subendocardial ischaemia was greater with high-resolution acquisition (195 vs. 101; P subendocardial ischaemia. High-resolution perfusion CMR may therefore be preferred for risk stratification and management of this high-risk patient group. PMID:24493156

  1. Prognostic impact of myocardial perfusion single photon emission computed tomography in patients with major extracardiac findings by computed tomography for attenuation correction.

    Science.gov (United States)

    Zadro, Charline; Roussel, Noé; Cassol, Emmanuelle; Pascal, Pierre; Petermann, Antoine; Meyrignac, Olivier; Jaffro, Marion; Fournier, Pauline; Cournot, Maxime; Galinier, Michel; Carrié, Didier; Rousseau, Hervé; Berry, Isabelle; Lairez, Olivier

    2017-03-09

    Attenuation correction computed tomography (CT) contributes to an improvement in the diagnostic accuracy of myocardial perfusion imaging (MPI) by single photon emission tomography (SPECT). The aim of this study was to explore the prognosis of patients with major findings by CT according to the results of MPI. 1506 patients who underwent MPI by SPECT were retrospectively included. Attenuation correction CT images were systematically analyzed for major and minor abnormalities. 830 (55.1%) and 212 (14.1%) patients had minor and major extracardiac findings, respectively. Among patients with major extracardiac findings, the abnormality was previously unknown in 113 (53.3%) patients. 90 (41.9%) had abnormal MPI, 73 (34.4%) had a myocardial infarction scar, 55 (25.9%) had myocardial ischemia, and 38 (17.7%) patients had both myocardial infarction scar and myocardial ischemia. Among the 201 patients available for survival analysis, there were 67 (31.2%) deaths over a follow-up period of 3.2±1.3 years. There was no significant impact on survival arising from MPI, whatever the result. The results were the same among the 103 patients with previously unknown major extracardiac findings. Extracardiac findings by CT during MPI are frequent. Patients with major extracardiac findings have a poor mid-term outcome, whatever the results of the myocardial perfusion imaging. Extracardiac findings should be systematically checked when attenuation correction CT is performed.

  2. Protective effect of trimetazidine for the rat myocardial tissue after exhaustion exercise

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    Xiao-yan LI

    2016-12-01

    Full Text Available Objective  To explore the protective effect of trimetazidine on the myocardial tissue of rats by observing the oxidative stress, apoptosis and energy metabolism in myocardial tissue of rats after exhausted exercise. Methods  Thirty healthy adult male Wistar rats were randomly assigned to three groups (10 each: quiet control group (C, exhausted exercise group (E and exhausted exercise plus trimetazidine group (TE. Exhausted exercise model was established by forcing the rats swim ceaselessly, rats in group TE received hydrochloric acid trimetazidine (10mg/kg for intervention. The myocardial tissue of rats was collected after the last exhausted exercise. The myocardial tissue of rats was evaluated by HE staining. The concentrations of superoxide dismutase (SOD, glutathione peroxidase 1 (GSH-Px and malondialdehyde (MDA in rats' myocardial cell mitochondria were detected by spectrophotometry. RT-PCR and immunohistochemistry were performed to quantify the mRNA and protein levels of Bax, Bcl-2 and uncoupling protein 2 (UCP2 in myocardial tissue of rats. Terminal-deoxynucleoitidyl Transferase Mediated Nick End Labeling (TUNEL assay was employed to detect the apoptotic rate of myocardial tissue. Results  Compared with group C, the SOD and GSH-Px activities in groups E and TE were reduced (P<0.01, while the MDA activity was increased (P<0.01, and more obvious changes were in group E. The SOD and GSH-Px activities decreased, while the MDA activity increased in group E than in group TE (P<0.01. Compared with group C, the apoptotic rate of myocardial tissue increased in groups E and TE (P<0.01, and the highest apoptotic rate was in group E (P<0.01. Furthermore, the mRNA and protein levels of Bax were significantly elevated in groups E and TE (P<0.01, and the highest expression was in group E (P<0.01. The mRNA and protein levels of BCL-2 were significantly reduced in groups E and TE (P<0.01, and the lowest expression was in group E (P<0.01. Meanwhile

  3. Assessment of coronary atherosclerosis by cardiac image: complementary amount of the calcium score to myocardial perfusion

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    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)

  4. Qualitative and quantitative assessment of adenosine triphosphate stress whole-heart dynamic myocardial perfusion imaging using 256-slice computed tomography.

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    Akira Kurata

    Full Text Available BACKGROUND: The aim of this study was to investigate the correlation of the qualitative transmural extent of hypoperfusion areas (HPA using stress dynamic whole-heart computed tomography perfusion (CTP imaging by 256-slice CT with CTP-derived myocardial blood flow (MBF for the estimation of the severity of coronary artery stenosis. METHODS AND RESULTS: Eleven patients underwent adenosine triphosphate (0.16 mg/kg/min, 5 min stress dynamic CTP by 256-slice CT (coverage: 8 cm, 0.27 s/rotation, and 9 of the 11 patients underwent coronary angiography (CAG. Stress dynamic CTP (whole-heart datasets over 30 consecutive heart beats in systole without spatial and temporal gaps was acquired with prospective ECG gating (effective radiation dose: 10.4 mSv. The extent of HPAs was visually graded using a 3-point score (normal, subendocardial, transmural. MBF (ml/100g/min was measured by deconvolution. Differences in MBF (mean ± standard error according to HPA and CAG results were evaluated. In 27 regions (3 major coronary territories in 9 patients, 11 coronary stenoses (> 50% reduction in diameter were observed. In 353 myocardial segments, HPA was significantly related to MBF (P 70%], 119 ± 69. CONCLUSION: The qualitative transmural extent of HPA using stress whole-heart dynamic CTP imaging by 256-slice CT exhibits a good correlation with quantitative CTP-derived MBF and may aid in assessing the hemodynamic significance of coronary artery disease.

  5. Effect of intramyocardial delivery of autologous bone marrow mononuclear stem cells on the regional myocardial perfusion. NOGA-guided subanalysis of the MYSTAR prospective randomised study.

    Science.gov (United States)

    Charwat, Silvia; Lang, Irene; Dettke, Markus; Graf, Senta; Nyolczas, Noemi; Hemetsberger, Rayyan; Zamini, Sholeh; Khorsand, Aliasghar; Sochor, Heinz; Maurer, Gerald; Glogar, Dietmar; Gyöngyösi, Mariann

    2010-03-01

    The aim of the sub-study of the MYSTAR randomised trial was to analyse the changes in myocardial perfusion in NOGA-defined regions of interest (ROI) with intramyocardial injections of autologous bone marrow mononuclear cells (BM-MNC) using an elaborated transformation algorithm. Patients with recent first acute myocardial infarction (AMI) and left ventricular (LV) ejection fraction (EF) between 30-45% received BM-MNC by intramyocardial followed by intracoronary injection 68 +/- 34 days post-AMI (pooled data of MYSTAR). NOGA-guided endocardial mapping and 99m-Sestamibi-SPECT (single photon emission computer tomography) were performed at baseline and at three months follow-up (FUP). ROI was delineated as a best polygon by connecting of injection points of NOGA polar maps. ROIs were projected onto baseline and FUP polar maps of SPECT calculating the perfusion severity of ROI. Infarct size was decreased (from 27.2 +/- 10.7% to 24.1 +/- 11.5%, por=5% improvement in perfusion defect severity received a significantly higher number of intramyocardial BM-MNC. In conclusion, combined cardiac BM-MNC delivery induces significant improvement in myocardial viability and perfusion in the intramyocardially injected area.

  6. Appearance of microvascular obstruction on high resolution first-pass perfusion, early and late gadolinium enhancement CMR in patients with acute myocardial infarction

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    Redwood Simon

    2009-08-01

    Full Text Available Abstract Background The presence and extent of microvascular obstruction (MO after acute myocardial infarction can be measured by first-pass gadolinium-enhanced perfusion cardiovascular magnetic resonance (CMR or after gadolinium injection with early or late enhancement (EGE/LGE imaging. The volume of MO measured by these three methods may differ because contrast agent diffusion into the MO reduces its apparent extent over time. Theoretically, first-pass perfusion CMR should be the most accurate method to measure MO, but this technique has been limited by lower spatial resolution than EGE and LGE as well as incomplete cardiac coverage. These limitations of perfusion CMR can be overcome using spatio-temporal undersampling methods. The purpose of this study was to compare the extent of MO by high resolution first-pass k-t SENSE accelerated perfusion, EGE and LGE. Methods 34 patients with acute ST elevation myocardial infarction, treated successfully with primary percutaneous coronary intervention (PPCI, underwent CMR within 72 hours of admission. k-t SENSE accelerated first-pass perfusion MR (7 fold acceleration, spatial resolution 1.5 mm × 1.5 mm × 10 mm, 8 slices acquired over 2 RR intervals, 0.1 mmol/kg Gd-DTPA, EGE (1–4 minutes after injection with a fixed TI of 440 ms and LGE images (10–12 minutes after injection, TI determined by a Look-Locker scout were acquired. MO volume was determined for each technique by manual planimetry and summation of discs methodology. Results k-t SENSE first-pass perfusion detected more cases of MO than EGE and LGE (22 vs. 20 vs. 14, respectively. The extent of MO imaged by first-pass perfusion (median mass 4.7 g, IQR 6.7 was greater than by EGE (median mass 2.3 g, IQR 7.1, p = 0.002 and LGE (median mass 0.2 g, IQR 2.4, p = 0.0003. The correlation coefficient between MO mass measured by first-pass perfusion and EGE was 0.91 (p Conclusion The extent of MO following acute myocardial infarction appears larger on

  7. Appearance of microvascular obstruction on high resolution first-pass perfusion, early and late gadolinium enhancement CMR in patients with acute myocardial infarction.

    Science.gov (United States)

    Mather, Adam N; Lockie, Timothy; Nagel, Eike; Marber, Michael; Perera, Divaka; Redwood, Simon; Radjenovic, Aleksandra; Saha, Ansuman; Greenwood, John P; Plein, Sven

    2009-08-21

    The presence and extent of microvascular obstruction (MO) after acute myocardial infarction can be measured by first-pass gadolinium-enhanced perfusion cardiovascular magnetic resonance (CMR) or after gadolinium injection with early or late enhancement (EGE/LGE) imaging. The volume of MO measured by these three methods may differ because contrast agent diffusion into the MO reduces its apparent extent over time. Theoretically, first-pass perfusion CMR should be the most accurate method to measure MO, but this technique has been limited by lower spatial resolution than EGE and LGE as well as incomplete cardiac coverage. These limitations of perfusion CMR can be overcome using spatio-temporal undersampling methods. The purpose of this study was to compare the extent of MO by high resolution first-pass k-t SENSE accelerated perfusion, EGE and LGE. 34 patients with acute ST elevation myocardial infarction, treated successfully with primary percutaneous coronary intervention (PPCI), underwent CMR within 72 hours of admission. k-t SENSE accelerated first-pass perfusion MR (7 fold acceleration, spatial resolution 1.5 mm x 1.5 mm x 10 mm, 8 slices acquired over 2 RR intervals, 0.1 mmol/kg Gd-DTPA), EGE (14 minutes after injection with a fixed TI of 440 ms) and LGE images (1012 minutes after injection, TI determined by a Look-Locker scout) were acquired. MO volume was determined for each technique by manual planimetry and summation of discs methodology. k-t SENSE first-pass perfusion detected more cases of MO than EGE and LGE (22 vs. 20 vs. 14, respectively). The extent of MO imaged by first-pass perfusion (median mass 4.7 g, IQR 6.7) was greater than by EGE (median mass 2.3 g, IQR 7.1, p = 0.002) and LGE (median mass 0.2 g, IQR 2.4, p = 0.0003). The correlation coefficient between MO mass measured by first-pass perfusion and EGE was 0.91 (p < 0.001). The extent of MO following acute myocardial infarction appears larger on high-resolution first-pass perfusion CMR than on

  8. Effect of Ischemia Duration and Door-to-Balloon Time on Myocardial Perfusion in ST-Segment Elevation Myocardial Infarction: An Analysis From HORIZONS-AMI Trial (Harmonizing Outcomes with Revascularization and Stents in Acute Myocardial Infarction).

    Science.gov (United States)

    Prasad, Abhiram; Gersh, Bernard J; Mehran, Roxana; Brodie, Bruce R; Brener, Sorin J; Dizon, José M; Lansky, Alexandra J; Witzenbichler, Bernhard; Kornowski, Ran; Guagliumi, Giulio; Dudek, Dariusz; Stone, Gregg W

    2015-12-28

    This study sought to investigate the effect of treatment delay on microvascular reperfusion in ST-segment elevation myocardial infarction (STEMI) patients from the large, multicenter, prospective HORIZONS-AMI (Harmonizing Outcomes with Revascularization and Stents in Acute Myocardial Infarction) trial. Despite restoration of epicardial blood flow during primary percutaneous coronary intervention (PCI), one-third of patients do not obtain myocardial perfusion due to impairment in the microvascular circulation. We examined the effect of symptom onset-to-balloon time (SBT) and door-to-balloon time (DBT) on myocardial reperfusion during primary PCI in STEMI, utilizing resolution of ST-segment elevation (STR) and the myocardial blush grade (MBG). The primary analysis was the relationships between SBT ≤2, >2 to 4, and >4 h and DBT ≤1, >1 to 1.5, >1.5 to 2, and >2 h with MBG and STR. Clinical risk was assessed using a modified version of the Thrombolysis In Myocardial Infarction risk score for STEMI. In 2,056 patients, absent microvascular perfusion (MBG 0/1) and STR (STR <30%) after primary PCI was significantly more common in patients with longer SBT, in patients with both low and high clinical risk profiles. By multivariable analysis, SBT (p < 0.0001), anterior infarction (p < 0.0001), reference vessel diameter (p = 0.005), lesion minimum lumen diameter (p < 0.0001), hyperlipidemia (p = 0.03), and current smoking (p = 0.001) were independent predictors of MBG 0/1, whereas SBT (p = 0.007), anterior infarction (p < 0.0001), and history of renal insufficiency (p = 0.0002) were independent predictors of absent STR. DBT (p < 0.0001) was an independent predictor of MBG 0/1. MBG 0/1 and STR<30% identified patients with increased 3-year mortality. The present study suggests that delay in mechanical reperfusion therapy during STEMI is associated with greater injury to the microcirculation. Copyright © 2015 American College of Cardiology Foundation. Published by Elsevier

  9. Reproducibility of rest and exercise stress contrast-enhanced calf perfusion magnetic resonance imaging in peripheral arterial disease

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    Jiji Ronny S

    2013-01-01

    Full Text Available Abstract Background The purpose was to determine the reproducibility and utility of rest, exercise, and perfusion reserve (PR measures by contrast-enhanced (CE calf perfusion magnetic resonance imaging (MRI of the calf in normal subjects (NL and patients with peripheral arterial disease (PAD. Methods Eleven PAD patients with claudication (ankle-brachial index 0.67 ±0.14 and 16 age-matched NL underwent symptom-limited CE-MRI using a pedal ergometer. Tissue perfusion and arterial input were measured at rest and peak exercise after injection of 0.1 mM/kg of gadolinium-diethylnetriamine pentaacetic acid (Gd-DTPA. Tissue function (TF and arterial input function (AIF measurements were made from the slope of time-intensity curves in muscle and artery, respectively, and normalized to proton density signal to correct for coil inhomogeneity. Perfusion index (PI = TF/AIF. Perfusion reserve (PR = exercise TF/ rest TF. Intraclass correlation coefficient (ICC was calculated from 11 NL and 10 PAD with repeated MRI on a different day. Results Resting TF was low in NL and PAD (mean ± SD 0.25 ± 0.18 vs 0.35 ± 0.71, p = 0.59 but reproducible (ICC 0.76. Exercise TF was higher in NL than PAD (5.5 ± 3.2 vs. 3.4 ± 1.6, p = 0.04. Perfusion reserve was similar between groups and highly variable (28.6 ± 19.8 vs. 42.6 ± 41.0, p = 0.26. Exercise TF and PI were reproducible measures (ICC 0.63 and 0.60, respectively. Conclusion Although rest measures are reproducible, they are quite low, do not distinguish NL from PAD, and lead to variability in perfusion reserve measures. Exercise TF and PI are the most reproducible MRI perfusion measures in PAD for use in clinical trials.

  10. Shexiang Tongxin Dropping Pill combined with thrombus aspiration improves myocardial perfusion after PCI in patients with STEMI: the clinical research

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    Shan-Shan Xiao

    2017-04-01

    Full Text Available Objective: To study the effect of Shexiang Tongxin Dropping Pill combined with thrombus aspiration on improving myocardial perfusion after PCI in patients with STEMI. Methods: A total of 104 patients with STEMI who received emergency PCI combined with thrombus aspiration in our hospital between May 2013 and October 2015 were selected as the research subjects and randomly divided into two groups: observation group received perioperative antiplatelet combined with Shexiang Tongxin Dropping Pill therapy, and the control group received perioperative antiplatelet therapy alone. Before treatment and 3 days after treatment, serum myocardial injury indexes, endothelial injury indexes and RAS system indexes were determined; 4 weeks after treatment, serum ventricular remodeling indexes were determined. Results: 3 d after treatment, serum CK, CK-MB, cTnI, cTnT, ET-1, vWF, PRA, AngII and ALD levels of both groups were significantly lower than those before treatment while NO level was significantly higher than that before treatment; serum CK, CK-MB, cTnI, cTnT, ET-1, vWF, PRA, AngII and ALD levels of observation group 3 d after treatment were significantly lower than those of control group while NO level was significantly higher than that of control group; 4 weeks after treatment, serum PICP, ICTP, PIIINP, HSP47 and GDF-15 levels of observation group were significantly lower than those of control group. Conclusion: Shexiang Tongxin Dropping Pill application during perioperative period of PCI combined with thrombus aspiration can reduce myocardial cell damage and endothelial function injury as well as inhibit RAS system activation and ventricular remodeling.

  11. The prognostic value of regadenoson SPECT myocardial perfusion imaging in patients with end-stage renal disease.

    Science.gov (United States)

    Doukky, Rami; Fughhi, Ibtihaj; Campagnoli, Tania; Wassouf, Marwan; Ali, Amjad

    2017-02-01

    The prognostic value of regadenoson SPECT myocardial perfusion imaging (MPI) has not been specifically studied in patients with end-stage renal disease (ESRD). We prospectively followed ESRD patients enrolled in the ASSUAGE and ASSUAGE-CKD trials in which they received regadenoson-stress 99m Tc-tetrofosmin SPECT-MPI. Images were semiquantitatively analyzed by an investigator blinded to clinical and outcome data. Patients were followed for cardiac death, myocardial infarction (MI), and coronary revascularization (CR). Revascularizations occurring >90 days post-MPI were considered "late" events. Survival analysis was performed using Cox regression models, adjusting for age, gender, diabetes, dyslipidemia, smoking, and known coronary artery disease. We analyzed 303 patients (mean age 54 years; 64% men), who were followed for 35 ± 10 months. Adjusting for clinical covariates, abnormal regadenoson-stress MPI (SSS ≥ 4) was associated with increased risk of the composite of cardiac death or MI (23.9% vs 14.4%; HR 1.88; CI 1.04-3.41; P = .037) and the composite of cardiac death, MI, or late CR (27.3% vs 16.7%; HR 1.80; CI 1.03-3.14; P = .039). Adjusting for clinical covariates, regadenoson-induced myocardial ischemia (SDS ≥ 2) was associated with increased rate of the composite endpoint of cardiac death, MI, or CR (33.3% vs 16.9%; HR 1.97; CI 1.19-3.27; P = .008). Regadenoson-stress SPECT-MPI provides a significant prognostic value in patients with ESRD. ESRD patients with normal SPECT-MPI have relatively high adverse event rates.

  12. Dose reduction assessment in dynamic CT myocardial perfusion imaging in a porcine balloon-induced-ischemia model

    Science.gov (United States)

    Fahmi, Rachid; Eck, Brendan L.; Vembar, Mani; Bezerra, Hiram G.; Wilson, David L.

    2014-03-01

    We investigated the use of an advanced hybrid iterative reconstruction (IR) technique (iDose4, Philips Health- care) for low dose dynamic myocardial CT perfusion (CTP) imaging. A porcine model was created to mimic coronary stenosis through partial occlusion of the left anterior descending (LAD) artery with a balloon catheter. The severity of LAD occlusion was adjusted with FFR measurements. Dynamic CT images were acquired at end-systole (45% R-R) using a multi-detector CT (MDCT) scanner. Various corrections were applied to the acquired scans to reduce motion and imaging artifacts. Absolute myocardial blood flow (MBF) was computed with a deconvolution-based approach using singular value decomposition (SVD). We compared a high and a low dose radiation protocol corresponding to two different tube-voltage/tube-current combinations (80kV p/100mAs and 120kV p/150mAs). The corresponding radiation doses for these protocols are 7.8mSv and 34.3mSV , respectively. The images were reconstructed using conventional FBP and three noise-reduction strengths of the IR method, iDose. Flow contrast-to-noise ratio, CNRf, as obtained from MBF maps, was used to quantitatively evaluate the effect of reconstruction on contrast between normal and ischemic myocardial tissue. Preliminary results showed that the use of iDose to reconstruct low dose images provide better or comparable CNRf to that of high dose images reconstructed with FBP, suggesting significant dose savings. CNRf was improved with the three used levels of iDose compared to FBP for both protocols. When using the entire 4D dynamic sequence for MBF computation, a 77% dose reduction was achieved, while considering only half the scans (i.e., every other heart cycle) allowed even further dose reduction while maintaining relatively higher CNRf.

  13. Computed tomography myocardial perfusion vs {sup 15}O-water positron emission tomography and fractional flow reserve

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    Williams, Michelle C.; Dweck, Marc R.; Golay, Saroj K. [University of Edinburgh/British Heart Foundation Centre for Cardiovascular Science, Edinburgh (United Kingdom); Mirsadraee, Saeed; Weir, Nicholas W.; Fletcher, Alison; Lucatelli, Christophe; Reid, John H. [University of Edinburgh, Clinical Research Imaging Centre, Edinburgh (United Kingdom); MacGillivray, Tom; Van Beek, Edwin J.R.; Newby, David E. [University of Edinburgh/British Heart Foundation Centre for Cardiovascular Science, Edinburgh (United Kingdom); University of Edinburgh, Clinical Research Imaging Centre, Edinburgh (United Kingdom); Cruden, Nicholas L.; Henriksen, Peter A.; Uren, Neal [Edinburgh Heart Centre, Royal Infirmary of Edinburgh, Edinburgh (United Kingdom); McKillop, Graham; Patel, Dilip [Department of Radiology, Royal Infirmary of Edinburgh, Edinburgh (United Kingdom); Lima, Joao A.C. [Johns Hopkins Hospital, Departments of Medicine and Radiology, Baltimore, MD (United States)

    2017-03-15

    Computed tomography (CT) can perform comprehensive cardiac imaging. We compared CT coronary angiography (CTCA) and CT myocardial perfusion (CTP) with {sup 15}O-water positron emission tomography (PET) and invasive coronary angiography (ICA) with fractional flow reserve (FFR). 51 patients (63 (61-65) years, 80 % male) with known/suspected coronary artery disease (CAD) underwent 320-multidetector CTCA followed by ''snapshot'' adenosine stress CTP. Of these 22 underwent PET and 47 ICA/FFR. Obstructive CAD was defined as CTCA stenosis >50 % and CTP hypoperfusion, ICA stenosis >70 % or FFR <0.80. PET hyperaemic myocardial blood flow (MBF) was lower in obstructive than non-obstructive territories defined by ICA/FFR (1.76 (1.32-2.20) vs 3.11 (2.44-3.79) mL/(g/min), P < 0.001) and CTCA/CTP (1.76 (1.32-2.20) vs 3.12 (2.44-3.79) mL/(g/min), P < 0.001). Baseline and hyperaemic CT attenuation density was lower in obstructive than non-obstructive territories (73 (71-76) vs 86 (84-88) HU, P < 0.001 and 101 (96-106) vs 111 (107-114) HU, P 0.001). PET hyperaemic MBF corrected for rate pressure product correlated with CT attenuation density (r = 0.579, P < 0.001). There was excellent per-patient sensitivity (96 %), specificity (85 %), negative predictive value (90 %) and positive predictive value (94 %) for CTCA/CTP vs ICA/FFR. CT myocardial attenuation density correlates with {sup 15}O-water PET MBF. CTCA and CTP can accurately identify obstructive CAD. (orig.)

  14. Comparison of the prognostic value of normal regadenoson with normal adenosine myocardial perfusion imaging with propensity score matching.

    Science.gov (United States)

    Iqbal, Fahad M; Hage, Fadi G; Ahmed, Ali; Dean, Phillip J; Raslan, Saleem; Heo, Jaekyeong; Iskandrian, Ami E

    2012-10-01

    The aim of this study was to test the hypothesis that patients with normal regadenoson myocardial perfusion imaging (MPI) have a low rate of cardiac events, similar to patients with normal adenosine MPI. Regadenoson, a new selective adenosine A(2A) receptor agonist, is now a widely used stress agent for MPI. The low rate of cardiac events in patients with normal adenosine MPI is well-documented, but the prognostic implications of a normal regadenoson MPI have not been examined and compared with those with adenosine. Data on primary composite endpoint (cardiac death, myocardial infarction, and coronary revascularization) were collected for 2,000 patients (1,000 regadenoson, and 1,000 adenosine stress) with normal myocardial perfusion and left ventricular ejection fraction referred for vasodilator MPI. In addition, propensity scores were used to assemble a balanced cohort of 505 pairs of patients who were balanced on 36 baseline characteristics. The primary endpoint occurred in 21 (2.1%; 1.1%/year) patients in the regadenoson group and 33 (3.3%; 1.7%/year) patients in the adenosine group (hazard ratio [HR] for regadenoson vs. adenosine: 0.62; 95% confidence interval [CI]: 0.36 to 1.08; p = 0.090). In the propensity-matched pairs, the primary endpoint occurred in 7 (1.4%; 0.7%/year) patients in the regadenoson group and 13 (2.6%; 1.3%/year) patients in the adenosine group (matched HR: 0.58; 95% CI: 0.23 to 1.48; p = 0.257). Cardiac deaths were infrequent in the entire sample and in the propensity-matched groups; the cardiac death rate was 0.9%/year and 1.15%/year in the regadenoson and adenosine groups (HR: 0.77; 95% CI: 0.42 to 1.43; p = 0.404) in the pre-match sample and 0.5%/year and 0.7%/year in the matched groups, respectively (HR: 0.83; 95% CI: 0.25 to 2.73; p = 0.763). Major cardiac events are infrequent in patients with normal regadenoson MPI. These findings provide assurance that normal MPI using a simpler stress protocol with regadenoson provides prognostic

  15. Myocardial perfusion magnetic resonance imaging using sliding-window conjugate-gradient highly constrained back-projection reconstruction for detection of coronary artery disease.

    Science.gov (United States)

    Ma, Heng; Yang, Jun; Liu, Jing; Ge, Lan; An, Jing; Tang, Qing; Li, Han; Zhang, Yu; Chen, David; Wang, Yong; Liu, Jiabin; Liang, Zhigang; Lin, Kai; Jin, Lixin; Bi, Xiaoming; Li, Kuncheng; Li, Debiao

    2012-04-15

    Myocardial perfusion magnetic resonance imaging (MRI) with sliding-window conjugate-gradient highly constrained back-projection reconstruction (SW-CG-HYPR) allows whole left ventricular coverage, improved temporal and spatial resolution and signal/noise ratio, and reduced cardiac motion-related image artifacts. The accuracy of this technique for detecting coronary artery disease (CAD) has not been determined in a large number of patients. We prospectively evaluated the diagnostic performance of myocardial perfusion MRI with SW-CG-HYPR in patients with suspected CAD. A total of 50 consecutive patients who were scheduled for coronary angiography with suspected CAD underwent myocardial perfusion MRI with SW-CG-HYPR at 3.0 T. The perfusion defects were interpreted qualitatively by 2 blinded observers and were correlated with x-ray angiographic stenoses ≥50%. The prevalence of CAD was 56%. In the per-patient analysis, the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of SW-CG-HYPR was 96% (95% confidence interval 82% to 100%), 82% (95% confidence interval 60% to 95%), 87% (95% confidence interval 70% to 96%), 95% (95% confidence interval 74% to100%), and 90% (95% confidence interval 82% to 98%), respectively. In the per-vessel analysis, the corresponding values were 98% (95% confidence interval 91% to 100%), 89% (95% confidence interval 80% to 94%), 86% (95% confidence interval 76% to 93%), 99% (95% confidence interval 93% to 100%), and 93% (95% confidence interval 89% to 97%), respectively. In conclusion, myocardial perfusion MRI using SW-CG-HYPR allows whole left ventricular coverage and high resolution and has high diagnostic accuracy in patients with suspected CAD. Copyright © 2012 Elsevier Inc. All rights reserved.

  16. Motion correction for improving the accuracy of dual-energy myocardial perfusion CT imaging

    Science.gov (United States)

    Pack, Jed D.; Yin, Zhye; Xiong, Guanglei; Mittal, Priya; Dunham, Simon; Elmore, Kimberly; Edic, Peter M.; Min, James K.

    2016-03-01

    Coronary Artery Disease (CAD) is the leading cause of death globally [1]. Modern cardiac computed tomography angiography (CCTA) is highly effective at identifying and assessing coronary blockages associated with CAD. The diagnostic value of this anatomical information can be substantially increased in combination with a non-invasive, low-dose, correlative, quantitative measure of blood supply to the myocardium. While CT perfusion has shown promise of providing such indications of ischemia, artifacts due to motion, beam hardening, and other factors confound clinical findings and can limit quantitative accuracy. In this paper, we investigate the impact of applying a novel motion correction algorithm to correct for motion in the myocardium. This motion compensation algorithm (originally designed to correct for the motion of the coronary arteries in order to improve CCTA images) has been shown to provide substantial improvements in both overall image quality and diagnostic accuracy of CCTA. We have adapted this technique for application beyond the coronary arteries and present an assessment of its impact on image quality and quantitative accuracy within the context of dual-energy CT perfusion imaging. We conclude that motion correction is a promising technique that can help foster the routine clinical use of dual-energy CT perfusion. When combined, the anatomical information of CCTA and the hemodynamic information from dual-energy CT perfusion should facilitate better clinical decisions about which patients would benefit from treatments such as stent placement, drug therapy, or surgery and help other patients avoid the risks and costs associated with unnecessary, invasive, diagnostic coronary angiography procedures.

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

    Science.gov (United States)

    Kashyap, Raghava; Abrar, Mohd Labeeb; Bhattacharya, Ansih; Rohit, Manoj Kumar; Mittal, Bhagwant Rai

    2012-01-01

    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. PMID:24019657

  18. Development of a universal dual-bolus injection scheme for the quantitative assessment of myocardial perfusion cardiovascular magnetic resonance

    Directory of Open Access Journals (Sweden)

    Alfakih Khaled

    2011-05-01

    Full Text Available Abstract Background The dual-bolus protocol enables accurate quantification of myocardial blood flow (MBF by first-pass perfusion cardiovascular magnetic resonance (CMR. However, despite the advantages and increasing demand for the dual-bolus method for accurate quantification of MBF, thus far, it has not been widely used in the field of quantitative perfusion CMR. The main reasons for this are that the setup for the dual-bolus method is complex and requires a state-of-the-art injector and there is also a lack of post processing software. As a solution to one of these problems, we have devised a universal dual-bolus injection scheme for use in a clinical setting. The purpose of this study is to show the setup and feasibility of the universal dual-bolus injection scheme. Methods The universal dual-bolus injection scheme was tested using multiple combinations of different contrast agents, contrast agent dose, power injectors, perfusion sequences, and CMR scanners. This included 3 different contrast agents (Gd-DO3A-butrol, Gd-DTPA and Gd-DOTA, 4 different doses (0.025 mmol/kg, 0.05 mmol/kg, 0.075 mmol/kg and 0.1 mmol/kg, 2 different types of injectors (with and without "pause" function, 5 different sequences (turbo field echo (TFE, balanced TFE, k-space and time (k-t accelerated TFE, k-t accelerated balanced TFE, turbo fast low-angle shot and 3 different CMR scanners from 2 different manufacturers. The relation between the time width of dilute contrast agent bolus curve and cardiac output was obtained to determine the optimal predefined pause duration between dilute and neat contrast agent injection. Results 161 dual-bolus perfusion scans were performed. Three non-injector-related technical errors were observed (1.9%. No injector-related errors were observed. The dual-bolus scheme worked well in all the combinations of parameters if the optimal predefined pause was used. Linear regression analysis showed that the optimal duration for the predefined

  19. Improved accuracy of myocardial perfusion SPECT for detection of coronary artery disease by machine learning in a large population.

    Science.gov (United States)

    Arsanjani, Reza; Xu, Yuan; Dey, Damini; Vahistha, Vishal; Shalev, Aryeh; Nakanishi, Rine; Hayes, Sean; Fish, Mathews; Berman, Daniel; Germano, Guido; Slomka, Piotr J

    2013-08-01

    We aimed to improve the diagnostic accuracy of myocardial perfusion SPECT (MPS) by integrating clinical data and quantitative image features with machine learning (ML) algorithms. 1,181 rest (201)Tl/stress (99m)Tc-sestamibi dual-isotope MPS studies [713 consecutive cases with correlating invasive coronary angiography (ICA) and suspected coronary artery disease (CAD) and 468 with low likelihood (LLk) of CAD rest perfusion change, and transient ischemic dilatation were derived by automated perfusion quantification software and were combined with age, sex, and post-electrocardiogram CAD probability by a boosted ensemble ML algorithm (LogitBoost). The diagnostic accuracy of the model for prediction of obstructive CAD ≥70% was compared to standard prone/supine quantification and to visual analysis by two experienced readers utilizing all imaging, quantitative, and clinical data. Tenfold stratified cross-validation was performed. The diagnostic accuracy of ML (87.3% ± 2.1%) was similar to Expert 1 (86.0% ± 2.1%), but superior to combined supine/prone TPD (82.8% ± 2.2%) and Expert 2 (82.1% ± 2.2%) (P < .01). The receiver operator characteristic areas under curve for ML algorithm (0.94 ± 0.01) were higher than those for TPD and both visual readers (P < .001). The sensitivity of ML algorithm (78.9% ± 4.2%) was similar to TPD (75.6% ± 4.4%) and Expert 1 (76.3% ± 4.3%), but higher than that of Expert 2 (71.1% ± 4.6%), (P < .01). The specificity of ML algorithm (92.1% ± 2.2%) was similar to Expert 1 (91.4% ± 2.2%) and Expert 2 (88.3% ± 2.5%), but higher than TPD (86.8% ± 2.6%), (P < .01). ML significantly improves diagnostic performance of MPS by computational integration of quantitative perfusion and clinical data to the level rivaling expert analysis.

  20. Automatic Valve Plane Localization in Myocardial Perfusion SPECT/CT by Machine Learning: Anatomic and Clinical Validation.

    Science.gov (United States)

    Betancur, Julian; Rubeaux, Mathieu; Fuchs, Tobias A; Otaki, Yuka; Arnson, Yoav; Slipczuk, Leandro; Benz, Dominik C; Germano, Guido; Dey, Damini; Lin, Chih-Jen; Berman, Daniel S; Kaufmann, Philipp A; Slomka, Piotr J

    2017-06-01

    Precise definition of the mitral valve plane (VP) during segmentation of the left ventricle for SPECT myocardial perfusion imaging (MPI) quantification often requires manual adjustment, which affects the quantification of perfusion. We developed a machine learning approach using support vector machines (SVM) for automatic VP placement. Methods: A total of 392 consecutive patients undergoing 99mTc-tetrofosmin stress (5 min; mean ± SD, 350 ± 54 MBq) and rest (5 min; 1,024 ± 153 MBq) fast SPECT MPI attenuation corrected (AC) by CT and same-day coronary CT angiography were studied; included in the 392 patients were 48 patients who underwent invasive coronary angiography and had no known coronary artery disease. The left ventricle was segmented with standard clinical software (quantitative perfusion SPECT) by 2 experts, adjusting the VP if needed. Two-class SVM models were computed from the expert placements with 10-fold cross validation to separate the patients used for training and those used for validation. SVM probability estimates were used to compute the best VP position. Automatic VP localizations on AC and non-AC images were compared with expert placement on coronary CT angiography. Stress and rest total perfusion deficits and detection of per-vessel obstructive stenosis by invasive coronary angiography were also compared. Results: Bland-Altman 95% confidence intervals (CIs) for VP localization by SVM and experts for AC stress images (bias, 1; 95% CI, -5 to 7 mm) and AC rest images (bias, 1; 95% CI, -7 to 10 mm) were narrower than interexpert 95% CIs for AC stress images (bias, 0; 95% CI, -8 to 8 mm) and AC rest images (bias, 0; 95% CI, -10 to 10 mm) (P characteristic curve for the 2 experts (AUC, 0.79 [95% CI, 0.7-0.87]; AUC, 0.81 [95% CI, 0.73-0.89]) and the SVM (0.82 [0.74-0.9]) for AC data were the same (P = NS) and were higher than those for the unadjusted VP (0.63 [0.53-0.73]) (P characteristic curve for the experts (AUC, 0.77 [95% CI, 0.69-0.89]; AUC

  1. Cerebral perfusion, oxygenation and metabolism during exercise in young and elderly individuals

    DEFF Research Database (Denmark)

    Fisher, James P; Hartwich, Doreen; Seifert, Thomas

    2013-01-01

    We evaluated cerebral perfusion, oxygenation, and metabolism in eleven young (age 22 ± 1 years) and nine older (age 66 ± 2 years) individuals at rest and during cycling exercise at low (25% W(max)), moderate (50% W(max)), high (75% W(ma)) and exhaustive (100% W(max)) workloads. Mean middle cerebral...... artery blood velocity (MCA V(mean)), mean arterial pressure (MAP), cardiac output (CO) and the partial pressure of arterial carbon dioxide (PaCO(2)) were measured. Blood samples were obtained from the right internal jugular vein and brachial artery to determine concentration differences for oxygen (O(2......)), glucose and lactate across the brain. The molar ratio between the cerebral uptake of O(2) versus carbohydrate (O(2)-carbohydrate index; O(2) / [glucose + 0.5 lactate]; OCI), the cerebral metabolic rate of O(2) (CMRO(2)) and changes in mitochondrial O(2) tension (P(mito)O(2)) were calculated. W...

  2. Exercise training with ageing protects against ethanol induced myocardial glutathione homeostasis.

    Science.gov (United States)

    Kakarla, Pushpalatha; Kesireddy, Sathyavelureddy; Christiaan, Leeuwenburgh

    2008-05-01

    Glutathione plays a central role in the maintenance of cellular antioxidant defense. The alterations in the glutathione and associated recyclic enzymes caused by both exercise training and ethanol are well documented; however, their interactive effects with age are not well understood. Therefore, the influence of ageing and the interactive effects of exercise training and ethanol on the myocardial glutathione system in 3 months and 18 months old rats were examined. The results showed a significant (pEthanol consumption significantly (pethanol consumption significantly (pethanol significantly (pethanol treated rats in both age groups, indicating the suppression of ethanol-induced oxidative stress by exercise training. In conclusion, there was a compensatory myocardial response lessening ethanol-induced oxidative stress by exercise training, which seemed to result from the higher activity of glutathione recycling and utilizing enzymes, which may be critical for preventing chronic oxidative damage to the myocardium during ageing and even due to ethanol consumption.

  3. Prognostic risk stratification of myocardial ischaemia evaluated by gated myocardial perfusion SPECT in patients with chronic kidney disease

    Energy Technology Data Exchange (ETDEWEB)

    Hatta, Tsuguru [Ohmihachiman Community Medical Center, Division of Nephrology, Department of Medicine, Shiga (Japan); Nishimura, Shigeyuki [Saitama Medical School Hospital, Division of Cardiology, Saitama (Japan); Nishimura, Tsunehiko [Kyoto Prefectural University of Medicine, Department of Radiology, Graduate School of Medical Science, Kyoto (Japan)

    2009-11-15

    The aim of this study was to identify useful predictors of cardiac events in patients with chronic kidney disease (CKD). Among 4,031 patients identified from the Japanese Assessment of Cardiac Events and Survival Study (J-ACCESS) database with suspected or known ischaemic heart disease, we selected 820 with an estimated glomerular filtration rate (eGFR) of < 60 ml/min per 1.73 m{sup 2}. A total of 75 cardiac events developed among these 820 patients. The incidence of cardiac events was higher in the group with a lower eGFR. Multivariate Cox analysis indicated that age, diabetes mellitus, end-systolic volume, summed stress score (SSS) and eGFR were predictors of cardiac events. Event rates of patients with SSS {>=} 9 were significantly higher in groups with lower eGFR values (< 40 and 40-49 ml/min). The SSS value ({>=} 9) is a reliable predictor of cardiac events and myocardial single photon emission computed tomography has incremental value for predicting cardiac events and survival in CKD. (orig.)

  4. Nuclear medicine and coronary artery disease: evaluation of tracers of myocardial perfusion and vulnerable atherosclerotic plaque; Medecine nucleaire et maladie coronarienne: evaluation de traceurs de la perfusion myocardique et de la plaque d'atherome vulnerable

    Energy Technology Data Exchange (ETDEWEB)

    Broisat, A

    2005-04-15

    Coronary artery disease is one of the primary cause of mortality worldwide. Nuclear medicine is the major imaging technique for diagnosis and following of this disease. perfusion: nowadays, major radioactive agents used in clinical practice are myocardial perfusion tracers. The reference tracer is thallium-201. However, {sup 201}Tl presents some drawbacks. {sup 99m}Tcn-noet has been proposed for its replacement. This study shows that in contrast with previous studies realized in vitro on cardio myocytes, verapamil, an l-type calcium channel inhibitor, does not inhibit myocardial fixation of {sup 99m}Tcn-noet in vivo in dog. This data is in agreement with the hypothesis of a non specific endothelial fixation of this tracer. Moreover, this study shows that as a pure tracer of myocardial perfusion, {sup 99m}Tcn-noet can also be used to assess myocardial viability on a model of myocardial chronic infarction in rat. atherosclerosis: disruption of vulnerable atherosclerotic plaques is the main event leading to coronary accidents. The second part of this study concerns the evaluation of new potential tracers of the vulnerable atherosclerotic plaque in an experimental model of rabbit with an inheritable hypercholesterolemia. The four tracers evaluated (b2702(r), b2702-I, b2702-Tc and Tc-raft-b2702) are synthetic peptides comprising the residues 75-84 of hla-b2702, a molecule known to link vcam-1, an adhesion molecule expressed in vulnerable atherosclerotic plaque. The autoradiography studies show that all tracers accumulate within atherosclerotic plaque expressing vcam- and that. i-b2702 shows the best plaque/control fixation ratio. (author)

  5. Disappearance of myocardial perfusion defects on prone SPECT imaging: Comparison with cardiac magnetic resonance imaging in patients without established coronary artery disease

    Directory of Open Access Journals (Sweden)

    Hedén Bo

    2009-08-01

    Full Text Available Abstract Background It is of great clinical importance to exclude myocardial infarction in patients with suspected coronary artery disease who do not have stress-induced ischemia. The diagnostic use of myocardial perfusion single-photon emission computed tomography (SPECT in this situation is sometimes complicated by attenuation artifacts that mimic myocardial infarction. Imaging in the prone position has been suggested as a method to overcome this problem. Methods In this study, 52 patients without known prior infarction and no stress-induced ischemia on SPECT imaging were examined in both supine and prone position. The results were compared with cardiac magnetic resonance imaging (CMR with delayed-enhancement technique to confirm or exclude myocardial infarction. Results There were 63 defects in supine-position images, 37 of which disappeared in the prone position. None of the 37 defects were associated with myocardial infarction by CMR, indicating that all of them represented attenuation artifacts. Of the remaining 26 defects that did not disappear on prone imaging, myocardial infarction was confirmed by CMR in 2; the remaining 24 had no sign of ischemic infarction but 2 had other kinds of myocardial injuries. In 3 patients, SPECT failed to detect small scars identified by CMR. Conclusion Perfusion defects in the supine position that disappeared in the prone position were caused by attenuation, not myocardial infarction. Hence, imaging in the prone position can help to rule out ischemic heart disease for some patients admitted for SPECT with suspected but not documented ischemic heart disease. This would indicate a better prognosis and prevent unnecessary further investigations and treatment.

  6. [Diagnostic value of echocardiography with dipyridamole in coronary disease and evaluation of its prognostic potentiality face to ergometry, plane dipyridamole Tc99m-MIBI myocardial perfusion scintigraphy and coronary cineangiography].

    Science.gov (United States)

    Kaiser, S E; Bueno, M S; Pedras, I V; de Freitas, E V; de la Nuez, S B; Luna, R L

    1995-08-01

    To assess in a consecutive series of patients, the diagnostic accuracy of dipyridamole echocardiography and to compare its prognostic power with that from other tests. Seventy eight patients prospectively were underwent to dipyridamole echocardiography (DET) and coronary arteriography for diagnostic and post-infarction investigation. The majority was underwent to treadmill stress test and Tc99MIBI-dipyridamole planar myocardial scintigraphy. Eleven variables with possible prognostic importance were analyzed in a stepwise model to identify independent predictors of events. Sensitivity and specificity for the presence of coronary artery disease (in non-M patients) and multivessel disease (in post-MI patients) were, respectively, 44%, 91%, 53% and 88%. Mean follow-up was 21 +/- 9 months, during which there were four deaths, four unstable angina episodes, four nonfatal myocardial infarctions and eight revascularization procedures. By multivariate analysis, the only independent predictor of events was the change in wall motion score index from rest to peak stress. DET is a valuable alternative to exercise stress test and myocardial perfusion scintigraphy. Semiquantitative estimation of ischemic area during pharmacological stress is an important prognostic marker.

  7. Comparison between stress myocardial perfusion SPECT recorded with cadmium-zinc-telluride and Anger cameras in various study protocols.

    Science.gov (United States)

    Verger, Antoine; Djaballah, Wassila; Fourquet, Nicolas; Rouzet, François; Koehl, Grégoire; Imbert, Laetitia; Poussier, Sylvain; Fay, Renaud; Roch, Véronique; Le Guludec, Dominique; Karcher, Gilles; Marie, Pierre-Yves

    2013-02-01

    The results of stress myocardial perfusion SPECT could be enhanced by new cadmium-zinc-telluride (CZT) cameras, although differences compared to the results with conventional Anger cameras remain poorly known for most study protocols. This study was aimed at comparing the results of CZT and Anger SPECT according to various study protocols while taking into account the influence of obesity. The study population, which was from three different institutions equipped with identical CZT cameras, comprised 276 patients referred for study using protocols involving (201)Tl (n = 120) or (99m)Tc-sestamibi injected at low dose at stress ((99m)Tc-Low; stress/rest 1-day protocol; n = 110) or at high dose at stress ((99m)Tc-High; rest/stress 1-day or 2-day protocol; n = 46). Each Anger SPECT scan was followed by a high-speed CZT SPECT scan (2 to 4 min). Agreement rates between CZT and Anger SPECT were good irrespective of the study protocol (for abnormal SPECT, (201)Tl 92 %, (99m)Tc-Low 86 %, (99m)Tc-High 98 %), although quality scores were much higher for CZT SPECT with all study protocols. Overall correlations were high for the extent of myocardial infarction (r = 0.80) and a little lower for ischaemic areas (r = 0.72), the latter being larger on Anger SPECT (p < 0.001). This larger extent was mainly observed in 50 obese patients who were in the (201)Tl or (99m)Tc-Low group and in whom stress myocardial counts were particularly low with Anger SPECT (228 ± 101 kcounts) and dramatically enhanced with CZT SPECT (+279 ± 251 %). Concordance between the results of CZT and Anger SPECT is good regardless of study protocol and especially when excluding obese patients who have low-count Anger SPECT and for whom myocardial counts are dramatically enhanced on CZT SPECT.

  8. Improved myocardial perfusion after transmyocardial laser revascularization in a patient with microvascular coronary artery disease

    Directory of Open Access Journals (Sweden)

    Peyman Mesbah Oskui

    2014-03-01

    Full Text Available We report the case of a 59-year-old woman who presented with symptoms of angina that was refractory to medical management. Although her cardiac catheterization revealed microvascular coronary artery disease, her symptoms were refractory to optimal medical management that included ranolazine. After undergoing transmyocardial revascularization, her myocardial ischemia completely resolved and her symptoms dramatically improved. This case suggests that combination of ranolazine and transmyocardial revascularization can be applied to patients with microvascular coronary artery disease.

  9. Story of rubidium-82 and advantages for myocardial perfusion PET imaging

    Directory of Open Access Journals (Sweden)

    Jean-Francois eChatal

    2015-09-01

    Full Text Available Rubidium-82 has a long story, starting in 1954. After preclinical studies in dogs showing that myocardial uptake of this radionuclide wa