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Sample records for myocardial metabolism imaging

  1. Characterization of Japanese standards for myocardial sympathetic and metabolic imaging in comparison with perfusion imaging

    Matsuo, Shinro; Nakajima, Kenichi; Okuda, Koichi; Yamashina, Shohei; Sakata, Kazuyuki; Momose, Mitsuru; Hashimoto, Jun; Kumita, Shinichiro; Kawano, Masaya

    2009-01-01

    The standard patterns of myocardial radiotracer distribution of 123 I-metaiodobenzylguanidine (MIBG) and 123 I-β-methyl-p-iodophenyl-pentadecanoic acid (BMIPP) should be defined in a Japanese population. The purpose of this study was to present and provide data on the characteristics of MIBG and BMIPP with respect to myocardial single photon emission computed tomography. The normal database included 123 I-MIBG and 123 I-BMIPP imaging and a 99 mTc-sestamibi/tetrofosmin myocardial perfusion study. The projection images were transferred by digital imaging and communications in medicine (DICOM) format and reconstructed and analyzed with polar maps. The projection data from multiple centers were successfully transferred to a common format for single photon emission computed tomography (SPECT) reconstruction. When the average values were analyzed using a 17-segment model, MIBG uptake in the inferior and apical wall appeared to be slightly lower than anterior uptake (P 99m Tc-tracer uptake (P<0.05). Myocardial sympathetic nerve and metabolic scintigraphy data that were specific for the Japanese population were generated and found to be different from that of perfusion tracers. The normal database can serve as a standard for nuclear cardiology work conducted in Japan. (author)

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

    Narita, Michihiro; Kurihara, Tadashi

    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 99m Tc-methoxy-isobutyl isonitrile (MIBI) imaging and rest 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 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 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 123 I-BMIPP). Eighteen normotensive patients with apical defect by 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 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 123 I-BMIPP showed 3 different types of perfusion. Many patients without hypertension show a pathologic process similar to hypertrophic cardiomyopathy. Perfusion and 123 I-BMIPP imaging are useful for the identification of these patients. (author)

  3. Myocardial viability assessment with dynamic low-dose iodine-123-iodophenylpentadecanoic acid metabolic imaging: comparison with myocardial biopsy and reinjection SPECT thallium after myocardial infarction.

    Murray, G L; Schad, N C; Magill, H L; Vander Zwaag, R

    1994-04-01

    Aggressive cardiac revascularization requires recognition of stunned and hibernating myocardium, and cost considerations may well govern the technique used. Dynamic low-dose (1 mCi) [123I]iodophenylpentadecanoic acid (IPPA) metabolic imaging is a potential alternative to PET using either 18FDG or 15O-water. Resting IPPA images were obtained from patients with severe ischemic cardiomyopathy, and transmural myocardial biopsies were obtained during coronary bypass surgery to confirm viability. Thirty-nine of 43 (91%) biopsies confirmed the results of the IPPA images with a sensitivity for viability of 33/36 (92%) and a specificity of 6/7 (86%). Postoperatively, wall motion improved in 80% of IPPA-viable, dysfunctional segments. Furthermore, when compared to reinjection thallium (SPECT-TI) scans after myocardial infarction, IPPA-SPECT-TI concordance occurred in 27/35 (77%) (K = 0.536, p = 0.0003). Similar to PET, IPPA demonstrated more viability than SPECT-TI, 26/35 (74%) versus 18/35 (51%) (p = 0.047). Metabolic IPPA cardiac viability imaging is a safe, inexpensive technique that may be a useful alternative to PET.

  4. Successive myocardial fatty acid metabolic imaging in patients with dilated cardiomyopathy. Usefulness as a prognostic indicator

    Narita, Michihiro; Kurihara, Tadashi; Sindoh, Takashi; Sawada, Yoshihiro; Honda, Minoru

    2000-01-01

    To evaluate the prognostic value of fatty acid metabolic imaging in patients with idiopathic dilated cardiomyopathy (DCM), we performed myocardial imaging with 123 I-BMIPP (BMIPP). We studied 23 patients with DCM who were admitted because of congestive heart failure (CHF) and after discharge the stable condition persisted for more than one year. BMIPP imaging was obtained when CHF recovered (first study) and the second study was performed one year after the first study. From BMIPP imaging we calculated % Uptake (percentage of cardiac uptake of isotope to total injected dose) and Defect Score (degree and extent of regional abnormality in BMIPP uptake, DS). In the first study, we performed myocardial imaging with 201 Tl to calculate Uptake Ratio of BMIPP (% Uptake of BMIPP divided by % Uptake of 201 Tl, UR). During the follow up period of 18.2±9.5 months (4.5-39.6 months) after the second study, cardiac event developed in 8 patients (cardiac death; 4, deterioration of CHF; 4). On univariate analysis, the following indices differed significantly between the event and event-free groups; left ventricular end-systolic dimension, graded DS, UR and % Uptake of 201 Tl at the first study, % Uptake of BMIPP and DS at the second study, difference of % Uptake of BMIPP and DS between the first and second study, and newly designed index from graded DS of the first study and its change in the second study (Defect Index, DI). Cox proportional hazard analysis showed that DI (p=0.0026) and age (p=0.0262) were independent predictors of cardiac event. In patients with DI≥3, the relative risk of cardiac event was 25.0 times greater than that in patients with DI≤2. These data suggested that the extent and degree of regional abnormality of BMIPP uptake (DS) and its changes with time were useful for evaluating the prognosis in patients with DCM even though a clinically stable condition is persisting. (author)

  5. Myocardial imaging. Coxsackie myocarditis

    Wells, R.G.; Ruskin, J.A.; Sty, J.R.

    1986-09-01

    A 3-week-old male neonate with heart failure associated with Coxsackie virus infection was imaged with Tc-99m PYP and TI-201. The abnormal imaging pattern suggested myocardial infarction. Autopsy findings indicated that the cause was myocardial necrosis secondary to an acute inflammatory process. Causes of abnormal myocardial uptake of Tc-99m PYP in pediatrics include infarction, myocarditis, cardiomyopathy, bacterial endocarditis, and trauma. Myocardial imaging cannot provide a specific cause diagnosis. Causes of myocardial infarction in pediatrics are listed in Table 1.

  6. Myocardial imaging. Coxsackie myocarditis

    Wells, R.G.; Ruskin, J.A.; Sty, J.R.

    1986-01-01

    A 3-week-old male neonate with heart failure associated with Coxsackie virus infection was imaged with Tc-99m PYP and TI-201. The abnormal imaging pattern suggested myocardial infarction. Autopsy findings indicated that the cause was myocardial necrosis secondary to an acute inflammatory process. Causes of abnormal myocardial uptake of Tc-99m PYP in pediatrics include infarction, myocarditis, cardiomyopathy, bacterial endocarditis, and trauma. Myocardial imaging cannot provide a specific cause diagnosis. Causes of myocardial infarction in pediatrics are listed in Table 1

  7. Clinical evaluation of 99Tcm-MIBI myocardial perfusion imaging for the detection of coronary artery disease in patients with metabolic syndrome

    Tian Yueqin; Wei Hongxing; Guo Xinhua; Guo Feng; He Zuoxiang

    2008-01-01

    Objective: Metabolic syndrome is a combination of medical disorders that consist of a collection of independent factors at risk of developing coronary artery disease. The purpose of this study was to evaluate the value of 99 Tc m -methoxyisobutylisonitrile (MIBI) myocardial perfusion imaging for the diagnosis of coronary artery disease in patients with metabolic syndrome. Methods: A total of 251 patients [mean age (59 ± 10) years, 179 men, 72 women] were included in this study. All patients underwent exercise and rest 99 Tc m -MIBI myocardial perfusion imaging and coronary angiography. Results: Of the 163 patients with significant coronary artery stenosis, 116 showed abnormal 99 Tc m -MIBI myocardial perfusion imaging; and among the 88 patients with normal coronary angiography, 82 showed normal myocardial perfusion imaging. The sensitivity, specificity and accuracy of 99 Tc m -MIBI myocardial perfusion imaging for coronary artery disease detection were 71% (116/163), 93% (82/88) and 79% (198/251), respectively. The positive and negative predictive values were 95% (116/122) and 64% (82/129), respectively. Conclusion: 99 Tc m -MIBI myocardial perfusion imaging has important clinical value for detecting coronary artery disease in patients with metabolic syndrome. (authors)

  8. Radioiodinated tracers for myocardial imaging

    Kulkarni, P.V.; Corbett, J.R.

    1990-01-01

    Recent advances in the efficient production of high purity radioiodine (123I) and new efficient radiolabeling techniques have allowed the development of new classes of cardiovascular radiopharmaceuticals. These include 123I-labeled fatty acids to assess myocardial metabolism, 123I-metaiodobenzylguanidine (MIBG) for myocardial neuronal activity, labeled monoclonal antibodies for myocardial necrosis, and labeled lipoproteins for receptor concentration. 123I-labeled fatty acids and MIBG are under clinical investigation with encouraging results. 123I- and 111In-labeled fragments of monoclonal antibodies to myosin have been used for imaging myocardial necrosis in humans. The development of radiotracers for imaging of cholinergic and adrenergic receptors is still in the experimental stage. Recent advances in imaging instrumentation and radiopharmaceuticals have resulted in cardiac imaging applications beyond blood pool ventriculography, perfusion, and infarct-avid imaging. Developments of radioiodine (123I)-labeled agents promise to play an important role in the assessment of myocardial metabolism, neuronal activity, and receptor concentration. The chemistry of iodine is well defined compared with that of 99mTc; therefore, iodine isotopes are well suited for labeling biologically important molecules. Among the iodine isotopes, 123I has nearly ideal nuclear properties for nuclear medical applications with a 13.3-hour half-life (T1/2) and 159 keV gamma emission (83%). Despite the nearly ideal chemical and nuclear properties of 123I, the widespread application of 123I-based radiopharmaceuticals in clinical practice has been limited by high production costs (123I is produced in a cyclotron), relatively limited availability, and the presence of undesirable radionuclidic impurities (124I, T1/2 = 4.2 days; 125I, T1/2 = 60 days; 126I, T1/2 = 13.1 days). 77 references

  9. Utility of adenosine PET (perfusion/metabolic) imaging in patients with acute myocardial infarction following thrombolytic therapy

    Gupta, N.C.; Esterbrooks, D.M.; Shiue, C.; Mohiuddin, S.; Hilleman, D.; Frick, M.P.

    1990-01-01

    This paper evaluates the diagnostic role of adenosine (AI) proton emission tomography (PET) in patients with acute myocardial infarction (AMI) and thrombolytic therapy using adenosine as a coronary vasodilator. The authors performed rest/stress myocardial perfusion and metabolic image studies (using N-13 NH 3 and F-18 FDG) in 14 patients within 1 week after thrombolytic therapy for an AMI. AI (140 μg/kg/min for 6 minutes) used a pharmacologic stressor resulted only in transient and well-tolerated side effects. Sensitivities and specificities of the rest/stress perfusion imaging and coronary angiographic results (performed within 1 week) are as follows: LAD, 87.5% and 83.3%; LCX, 100% and 100%; RCA, 100% and 83.3%; and overall, 94.4% and 91.3%. Resting NH 3 /FDG mismatch (hypoperfused viable myocardium) was seen in 2/14 patients in infarct-related (IR) and 3/14 patients in non-IR stenoses

  10. Diagnostic value of exercise induced 18F-FDG myocardial metabolism scintigraphy in myocardial ischemia

    Shen Rui; He Zuoxiang; Shi Rongfang; Liu Xiujie; Tian Yueqin; Guo Feng; Wei Hongxing; Wu Yongjian; Qin Xuewen; Gao Runlin

    2006-01-01

    Objective: To evaluate the feasibility and diagnostic accuracy of exercise induced myocardial imaging with 18 F-fluorodeoxyglucose (FDG) in myocardial ischemia. Methods: Twenty-six patients with known or suspected coronary artery, disease (CAD) and with no prior myocardial infarction underwent simultaneous myocardial perfusion and metabolism imaging following intravenous injection of 99 Tc m -methoxy-isobutylisonitrile ( 99 Tc m -sestamibi) and 18 F-FDG at peak exercise. Subsequently rest perfusion imaging and coronary angiography (CAG) were performed in all patients. Exercise 18 F-FDG myocardial imaging was compared with 99 Tc m -sestamibi imaging and CAG. Results: In 22 patients with ≥50% narrowing over l coronary artery, 18 had perfusion abnormalities (sensitivity 82%), whereas 20 had abnormal myocardial 18 F-FDG uptake (sensitivity 91%, P>0.05). Patients with reversible (12 cases) or partial reversible (3 cases) perfusion abnormalities had increased myocardial 18 F-FDG uptake in abnormal perfusion segments. Compared with CAG, perfusion defect was seen in myocardial segments corresponding to 25 vascular territories of 51 vessels with ≥50% narrowing in 22 patients in 99 Tc m -sestamibi imaging (sensitivity 49%), whereas increased 18 F-FDG uptake was seen in 34 vascular territories (sensitivity 67%, P=0.008). Conclusions: Exercise induced myocardial ischemia can be imaged directly with 18 F-FDG. Combined exercise 18 F-FDG and 99 Tc m -sestamibi imaging provides a better assessment of exercise-induced myocardial ischemia as compared with exercise-rest perfusion imaging. (authors)

  11. Thallium-201 myocardial imaging

    Wackers, F.J.Th.

    1980-01-01

    Three views are routinely obtained for 201 Tl scintigraphy: 0 0 anterior, 45 0 left-anterior-oblique, both views with the patient supine and a left-lateral view, with the patient lying on his right side. Following intravenous injection of 201 Tl, the scintiscans of a normal subject only demonstrate the left ventricle. In patients with normal myocardial perfusion, the left ventricle appears horseshoe or ovoid in shape. The central area of decreased activity represents the left ventricular cavity and is normal. The accumulation of 201 Tl in the normal left ventricle is usually homogeneous. However, some areas with apparent diminished uptake may occur in the normal subject. These variations of the normal image are discussed. The right ventricle, because of its smaller myocardial mass and relatively less 201 Tl accumulation per gram of tissue, is usually on a resting study not, or only faintly, visualized. However, following exercise, the right ventricle is clearly visualized. (Auth.)

  12. Nitrogen-13-labeled ammonia for myocardial imaging

    Walsh, W.F.; Fill, H.R.; Harper, P.V.

    1977-01-01

    Cyclotron-produced nitrogen-13 (half-life 10 min), as labeled ammonia (/sup 13/NH/sub 4//sup +/), has been evaluated as a myocardial perfusion imaging agent. The regional myocardial uptake of /sup 13/NH/sub 4//sup +/ has been shown to be proportional to regional tissue perfusion in animal studies. Intravenously administered /sup 13/NH/sub 4//sup +/ is rapidly cleared from the circulation, being extracted by the liver (15 percent), lungs, myocardium (2 percent--4 percent), brain, kidney, and bladder. Myocardial ammonia is metabolized mainly to glutamine via the glutamine synthetase pathway. Pulmonary uptake is substantial, but usually transient, except in smokers where clearance may be delayed. The positron annihilation irradiation (511 keV) of /sup 13/N may be imaged with a scintillation camera, using either a specially designed tungsten collimator or a pinhole collimator. After early technical problems with collimation and the production method of /sup 13/NH/sub 4//sup +/ were overcome, reproducible high quality myocardial images were consistently obtained. The normal myocardial image was established to be of a homogeneous ''doughnut'' configuration. Imaging studies performed in patients with varying manifestations of ischemic and valvular heart disease showed a high incidence of localized perfusion defects, especially in patients with acute myocardial infarction. Sequential studies at short intervals in patients with acute infarction showed correlation between alterations in regional perfusion and the clinical course of the patient. It is concluded that myocardial imaging with /sup 13/NH/sub 4//sup +/ and a scintillation camera provides a valid and noninvasive means of assessing regional myocardial perfusion. This method is especially suitable for sequential studies of acute cardiac patients at short intervals. Coincidence imaging of the 511 keV annihilation irradiation provides a tomographic and potentially quantitative assessment of the

  13. Synthesis and tissue distribution of fluorine-18 labeled trifluorohexadecanoic acids. Considerations in the development of metabolically blocked myocardial imaging agents

    Pochapsky, S.S.; Katzenellenbogen, J.A.; VanBrocklin, H.F.; Welch, M.J.

    1990-01-01

    A versatile method for the synthesis of trifluoro fatty acids, potential metabolically blocked myocardial imaging agents, has been developed. Two trifluorohexadecanoic (palmitic) acids have been prepared [6,6,16-trifluorohexadecanoic acid (I) and 7,7,16-trifluorohexadecanoic acid (II)], each of which bears two of the fluorine atoms as a gem-difluoromethylene unit on the fatty acid chain (at C-6 or C-7) and the third at the ω (C-16) position. The metabolic stability of carbon-fluorine bonds suggests the gem-difluoro group may block the β-oxidation pathway, while the terminal fluorine could be the site for labeling with fluorine-18. The convergent synthetic approach utilizes a 2-lithio-1,3-dithiane derived from 10-undecenal or 9-decenal, which is alkylated with the OBO (oxabicyclooctyl) ester of 5-bromopentanoic acid or 6-bromohexanoic acid, respectively. Hydroboration-oxidation and alcohol protection are followed by halofluorination to convert the 1,3-dithiane system to a gem-difluoro group. The third fluorine is introduced by fluoride ion displacement of a trifluoromethanesulfonate. This synthesis is adapted to the labeling of these trifluoro fatty acids with the short-lived radionuclide fluorine-18 (t 1/2 = 110 min), with the third fluorine introduced as fluoride ion in the penultimate step. The radiochemical syntheses proceed in 3-34% radiochemical yield (decay corrected), with an overall synthesis and purification time of 90 min. Tissue distribution studies in rats were performed with I and II, as well as with 16-[ 18 F]fluoropalmitic acid (III), [ 11 C]palmitic acid, and [ 11 C]octanoic acid. The heart uptake of the fluoropalmitic acids decreases with substitution, the 2-min activity level for 16-fluoropalmitic acid being 65% and that for both 6,6,16-and 7,7,17-trifluoropalmitic acids being 30% that of palmitic acid

  14. Metabolic imaging using PET

    Kudo, Takashi

    2007-01-01

    There is growing evidence that myocardial metabolism plays a key role not only in ischaemic heart disease but also in a variety of diseases which involve myocardium globally, such as heart failure and diabetes mellitus. Understanding myocardial metabolism in such diseases helps to elucidate the pathophysiology and assists in making therapeutic decisions. As well as providing information on regional changes, PET can deliver quantitative information about both regional and global changes in metabolism. This capability of quantitative measurement is one of the major advantages of PET along with physiological positron tracers, especially relevant in evaluating diseases which involve the whole myocardium. This review discusses major PET tracers for metabolic imaging and their clinical applications and contributions to research regarding ischaemic heart disease and other diseases such as heart failure and diabetic heart disease. Future applications of positron metabolic tracers for the detection of vulnerable plaque are also highlighted briefly. (orig.)

  15. A Score-Based Approach to 18F-FDG PET Images as a Tool to Describe Metabolic Predictors of Myocardial Doxorubicin Susceptibility

    Matteo Bauckneht

    2017-10-01

    Full Text Available Purpose: To verify the capability of 18F-fluorodeoxy-glucose positron emission tomography/computed tomography (FDG-PET/CT to identify patients at higher risk of developing doxorubicin (DXR-induced cardiotoxicity, using a score-based image approach. Methods: 36 patients underwent FDG-PET/CT. These patients had shown full remission after DXR-based chemotherapy for Hodgkin’s disease (DXR dose: 40–50 mg/m2 per cycle, and were retrospectively enrolled. Inclusion criteria implied the presence of both pre- and post-chemotherapy clinical evaluation encompassing electrocardiogram (ECG and echocardiography. Myocardial metabolism at pre-therapy PET was evaluated according to both standardized uptake value (SUV- and score-based approaches. The capability of the score-based image assessment to predict the occurrence of cardiac toxicity with respect to SUV measurement was then evaluated. Results: In contrast to the SUV-based approach, the five-point scale method does not linearly stratify the risk of the subsequent development of cardiotoxicity. However, converting the five-points scale to a dichotomic evaluation (low vs. high myocardial metabolism, FDG-PET/CT showed high diagnostic accuracy in the prediction of cardiac toxicity (specificity = 100% and sensitivity = 83.3%. In patients showing high myocardial uptake at baseline, in which the score-based method is not able to definitively exclude the occurrence of cardiac toxicity, myocardial SUV mean quantification is able to further stratify the risk between low and intermediate risk classes. Conclusions: the score-based approach to FDG-PET/CT images is a feasible method for predicting DXR-induced cardiotoxicity. This method might improve the inter-reader and inter-scanner variability, thus allowing the evaluation of FDG-PET/CT images in a multicentral setting.

  16. Validation of 99mTc-labeled '4+1' fatty acids for myocardial metabolism and flow imaging

    Mirtschink, Peter; Stehr, Sebastian N.; Walther, Martin; Pietzsch, Jens; Bergmann, Ralf; Pietzsch, Hans-Juergen; Weichsel, Johannes; Pexa, Annette; Dieterich, Peter; Wunderlich, Gerd; Binas, Bert; Kropp, Joachim; Deussen, Andreas

    2009-01-01

    Introduction: Our group has synthesized technetium-labeled fatty acids (FA) that are extracted into the myocardium and sequestered due to heart-type fatty acid binding protein (H-FABP) binding. In this article, we further address the detailed subcellular distribution and potential myocardial metabolism of [ 99m Tc]'4+1' FA. Methods: Experiments were conducted using isolated hearts of Wistar rats, as well as of wild-type and H-FABP -/- mice. Myocardium samples underwent subcellular fractionation [subsarcolemmal mitochondria (SM), intermyofibrillar mitochondria (IM), cytosol with microsomes, and nuclei and crude membranes] and analysis by thin-layer chromatography and high-performance liquid chromatography. Results: The largest fraction of tissue radioactivity was associated with cytosol [79.69±8.88% of infused dose]. About 9.07±0.95% and 3.43±1.38% of the infused dose were associated with SM and IM fractions, respectively. In the rat heart, etomoxir, an inhibitor of carnitin-palmitoyl transferase I, did not significantly decrease radioactivity associated with mitochondrial fractions, whereas myocardial extraction of [ 123 I]-labeled 15-(p-iodophenyl)-pentadecanoic acid (13.26% vs. 49.49% in controls) and the radioactivity associated with the SM and IM fractions were blunted. The percentage of the infused dose in the mitochondrial and crude fractions increased with the number of NH-amide groups of the FA derivative. Absence of H-FABP significantly decreased radioactivity count in the cytosolic fraction (P 99m Tc]'4+1' FA could be detected in any isolated heart. Conclusions: Myocardial [ 99m Tc]'4+1' FA extraction reflects binding to H-FABP and membrane structures (including the mitochondrial membrane). However, the compounds do not undergo mitochondrial metabolism because they do not reach the mitochondrial matrix.

  17. Temporal Changes in Phosphatidylserine Expression and Glucose Metabolism after Myocardial Infarction: An in Vivo Imaging Study in Mice

    Sebastian Lehner

    2012-11-01

    Full Text Available Positron emission tomography (PET for in vivo monitoring of phosphatidylserine externalization and glucose metabolism can potentially provide early predictors of outcome of cardioprotective therapies after myocardial infarction. We performed serial [68Ga]annexin A5 PET (annexin-PET and [18F]fluorodeoxyglucose PET (FDG-PET after myocardial infarction to determine the time of peak phosphatidylserine externalization in relation to impaired glucose metabolism in infracted tissue. Annexin- and FDG-PET recordings were obtained in female (C57BL6/N mice on days 1 to 4 after ligation of the left anterior descending (LAD artery. [68Ga]annexin A5 uptake (%ID/g in the LAD artery territory increased from 1.7 ± 1.1 on day 1 to 5.0 ± 3.3 on day 2 and then declined to 2.0 ± 1.4 on day 3 (p = .047 vs day 2 and 1.6 ± 1.4 on day 4 (p = .014 vs day 2. These results matched apoptosis rates as estimated by autoradiography and fluorescein staining. FDG uptake (%ID/g declined from 28 ± 14 on day 1 to 14 ± 3.5 on day 4 (p < .0001 vs day 1. Whereas FDG-PET revealed continuous loss of cell viability after permanent LAD artery occlusion, annexin-PET indicated peak phosphatidylserine expression at day 2, which might be the optimal time point for therapy monitoring.

  18. Assessment of myocardial viability by MR imaging

    Sandstede, Joern J.W.

    2003-01-01

    Diagnosis of myocardial viability after infarction focuses on the prediction of functional improvement of dysfunctional myocardium after revascularization therapy. Magnetic resonance imaging provides different approaches for the detection of myocardial viability. Measurement of end-diastolic wall thickness is easy to perform and has a high sensitivity, but a low specificity, and can only be used 4 months after myocardial infarction due to infarct healing processes. Low-dose dobutamine stress has a good sensitivity with a high specificity for the prediction of wall motion improvement, but this is only true for patients with a singular dysfunctional area and only slightly depressed cardiac function. Late enhancement allows for direct visualization of necrotic or scarred tissue. By measuring the transmural extent of late enhancement, the probability of mechanical improvement can precisely be given. Imaging of microvascular obstruction by first-pass perfusion or late enhancement gives additional information on viability and patient prognosis. Metabolic imaging techniques, such as 31 P-MR spectroscopy and 23 Na-MR imaging, provide further insights into the mechanisms of myocardial infarction and viability. In conclusion, cardiac MRI offers several clinically usable approaches for the assessment of myocardial viability and will probably become the method of choice in the near future. (orig.)

  19. A preliminary feasibility study of simultaneous dual-isotope imaging with a solid-state dedicated cardiac camera for evaluating myocardial perfusion and fatty acid metabolism.

    Ko, Toshiyuki; Utanohara, Yuko; Suzuki, Yasuhiro; Kurihara, Makiko; Iguchi, Nobuo; Umemura, Jun; Sumiyoshi, Tetsuya; Tomoike, Hitonobu

    2016-01-01

    Simultaneous dual-isotope SPECT imaging with 201Tl and (123)I-β-methyl-p-iodophenylpentadecanoic acid (BMIPP) is used to study the perfusion-metabolism mismatch. It predicts post-ischemic functional recovery by detecting stunned myocardium. On the other hand, (99m)Tc-MIBI is another radioisotope widely used in myocardial perfusion imaging because of its better image quality and lower radiation exposure than 201Tl. However, since the photopeak energies of (99m)Tc and (123)I are very similar, crosstalk hampers the simultaneous use of these two radioisotopes. To overcome this problem, we conducted simultaneous dual-isotope imaging study using the D-SPECT scanner (Spectrum-Dynamics, Israel) which has a novel detector design and excellent energy resolution. We first conducted a basic experiment using cardiac phantom to simulate the condition of normal perfusion and impaired fatty acid metabolism. Subsequently, we prospectively recruited 30 consecutive patients who underwent successful percutaneous coronary intervention for acute myocardial infarction, and performed (99m)Tc-MIBI/(123)I-BMIPP dual-isotope imaging within 5 days after reperfusion. Images were interpreted by two experienced cardiovascular radiologists to identify the infarcted and stunned areas based on the coronary artery territories. As a result, cardiac phantom experiment revealed no significant crosstalk between (99m)Tc and (123)I. In the subsequent clinical study, (99m)Tc-MIBI/(123)I-BMIPP dual-isotope imaging in all participant yielded excellent image quality and detected infarcted and stunned areas correctly when compared with coronary angiographic findings. Furthermore, we were able to reduce radiation exposure to significantly approximately one-eighth. In conclusion, we successfully demonstrated the practical application of simultaneous assessment of myocardial perfusion and fatty acid metabolism by (99m)Tc-MIBI and (123)I-BMIPP using a D-SPECT cardiac scanner. Compared with conventional (201)Tl

  20. Validation of 99mTc-labeled '4+1' fatty acids for myocardial metabolism and flow imaging

    Mirtschink, Peter; Stehr, Sebastian N.; Walther, Martin; Pietzsch, Jens; Bergmann, Ralf; Pietzsch, Hans-Juergen; Weichsel, Johannes; Pexa, Annette; Dieterich, Peter; Wunderlich, Gerd; Binas, Bert; Kropp, Joachim; Deussen, Andreas

    2009-01-01

    Introduction: 13 C, 18 F and 123 I fatty acids (FA) are used for myocardial imaging. Recently, our group showed that [ 99m Tc]-labeled '4+1' FA are extracted into the rat and guinea pig myocardium. The present study evaluates determinants of myocardial uptake and whole body biodistribution of these FA derivatives. Methods: Studies were performed with isolated perfused hearts of Wistar-Kyoto (WKY) and spontaneously hypertensive rats (SHR) with a FAT/CD36 deficiency, as well as with heart type FA binding protein knockout mice (H-FABP) -/- and H-FABP +/+ . Eight 4+1- 99m Tc-FA were applied for 3 min followed by 1-min washout. A mathematical model was used to analyze FA dynamics and binding to proteins. Whole-body distribution was studied in rats with and without Tween 80. In vitro fractionation studies with [ 99m Tc]-FA assessed red blood cell uptake as well as association with plasma lipoproteins very low-density lipoprotein (VLDL), low-density lipoprotein (LDL) and high-density lipoprotein (HDL). Results: Myocardial extraction was 19.0-33.0% of the infused dose in isolated WKY and 15.2-26.4% in SHR hearts. However, H-FABP -/- showed a marked reduction of tracer extraction [2.8±0.6%ID (percent injected dose) vs. 17±2%ID P 99m Tc-FA with albumin reduced ventricular extraction (P 99m Tc]-FA 4+1 derivatives is dependent on H-FABP. These substances may therefore provide a new tool to specifically assess regional myocardial changes of H-FABP.

  1. Myocardial perfusion SPECT imaging in patients with myocardial bridging

    Fang Wei; Qiu Hong; Yang Weixian; Wang Feng; He Zuoxiang

    2008-01-01

    Objective: Stress myocardial perfusion SPECT imaging was used to assess myocardial ischemia in patients with myocardial bridging. Methods: Ninety-six patients with myocardial bridging of the left anterior descending artery documented by coronary angiography were included in this study. All under- went exercise or pharmacological stress myocardial perfusion SPECT assessing myocardial ischemia. None had prior myocardial infarction. One year follow-up by telephone interview was performed in all patients. Results The mean stenotic severity of systolic phase on angiography was (65 ± 19)%. In the SPECT study, 20 of 96 (20.8%) patients showed abnormal perfusion. This percentage was significantly higher than that of stress electrocardiogram (ECG). The higher positive rate of SPECT perfusion images was showed in the group of patients with severe systolic narrowing (≥75%) than that with mild-to-moderate systolic narrowing (50% vs 6.3%, P<0.001). The prevalence of abnormal image was significantly higher in ELDERLY PEOPLE; patients with STT change on rest ECG than in those with normal rest ECG (54.2% vs 9.7%, P<0.001). During follow-up, one patient with abnormal SPECT perfusion image sustained angina and accepted percutaneous coronary intervention, and no cardiac event occurred in patients with normal images. Conclusions: Stress myocardial perfusion SPECT imaging can be used effectively for assessing myocardial ischemia and has potential prognostic value for patients with myocardial bridging. (authors)

  2. Evaluation of the metabolism in rat hearts of two new radioiodinated 3-methyl-branched fatty acid myocardial imaging agents

    Ambrose, K R; Owen, B A; Goodman, M M; Knapp, Jr, F F

    1987-01-01

    The biological fate of two new radioiodinated 3-methyl-branched fatty acids has been evaluated in rat hearts following intravenous administration. Methyl-branching was introduced in (15-(p-iodophenyl)-3-R,S-methylpentadecanoic acid (BMIPP) and 15-(p-iodophenyl)-3,3-dimethylpentadecanoic acid (DMIPP) to inhibit ..beta..-oxidation. The goals of these studies were to correlate the effects of methyl-branching on the incorporation of these agents into the various fatty acid pools and subcellular distribution profiles, and to relate these data to the myocardial retention properties. The properties of BMIPP and DMIPP were compared with the 15-(p-iodophenyl)pentadecanoic acid straight-chain analogue (IPP). Differences in the heart retention of the analogues after intravenous administration in rats correlated with differences observed in subcellular distribution patterns. The dimethyl DMIPP analogue showed the longest retention and the highest association with the mitochondrial and microsomal fractions (34%, 38%) 30 min after injection. These data are in contrast to the rapid clearance of the straight-chain IPP analogue which showed much lower relative association with the mitochondria and microsomes (18%, 15%). The distribution patterns of each analogue in the various lipid pools appeared consistent with the expected capacity of the analogues to be metabolized by ..beta..-oxidation. In contrast to the rapid oxidation of the straight-chain IPP analogue, the 3-monomethyl BMIPP analogue appeared to undergo slower oxidation and clearance, whereas the dimethyl-branched DMIPP analogue was apparatently not catabolized by the myocardium. All three analogues showed some incorporation into triglycerides. The metabolism patterns of the branched analogues reported here may provide useful information in the description of the mechanisms by which BMIPP and DMIPP are retained in rat myocardium.

  3. Dynamic CT myocardial perfusion imaging

    Caruso, Damiano; Eid, Marwen; Schoepf, U. Joseph; Jin, Kwang Nam; Varga-Szemes, Akos; Tesche, Christian; Mangold, Stefanie

    2016-01-01

    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.

  4. Dynamic CT myocardial perfusion imaging

    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.

  5. Positron imaging in the evaluation of ischemia and myocardial infarction

    Goldstein, R.A.

    1985-01-01

    Positron emission tomography (PET) is a unique imaging approach since it allows quantification of regional myocardial radioactivity by virtue of its decay characteristics. Studies of regional myocardial metabolism are possible since there are positron emitting isotopes of carbon, oxygen and nitrogen that can be used to synthesize labeled fatty acids, amino acids or carbohydrate. Recent studies from the author's group have focused on Rb-82, a diffusible cation with a short half-life that is obtained from a generator and thus, has the potential for routine clinical use without a cyclotron. In this chapter, the basic principles of positron imaging and their application to imaging of acute myocardial infarction are discussed

  6. Dosimetry in myocardial perfusion imaging

    Toledo, Janine M.; Trindade, Bruno; Ribeiro, Tarcisio P.C. [Universidade Federal de Minas Gerais (DEN/UFMG), Belo Horizonte (Brazil). Dept. de Engenharia Nuclear. Programa de Pos-Graduacao em Ciencias e Tecnicas Nucleares

    2011-07-01

    This paper conducts a dosimetric investigation on the myocardial perfusion image protocol, together with a literature reviewing, motivated by the significant statistic increasing on mortality, morbidity and disability associated with cardiovascular disease, surpassing infectious diseases. Nuclear Cardiology plays a role n the diagnostic functional evaluation of the heart and in the prognostic of patients with suspected or known cardiac ischemia. In the context of unstable myocardial ischemic syndrome, myocardial perfusion scintigraphy is a non-invasive procedure performed by administering a radiopharmaceutical targeted to the heart. As tool for this study are that the images obtained by thoracic angiotomography and abdominal aorta as a anatomic and functional information for model reproduction in SISCODES - System of Codes for Absorbed Dose Calculations based on Stochastic Methods. Data were manipulated in order to create a voxel computational model of the heart to be running in MCNP - Monte Carlo Neutron Particle Code. . It was assumed a homogeneous distribution of Tl-201 in cardiac muscle. Simulations of the transport of particles through the voxel and the interaction with the heart tissue were performed. As a result, the isodose curves in the heart model are displayed as well as the dose versus volume histogram of the heart muscle. We conclude that the present computational tools can generate doses distributed in myocardial perfusion. (author)

  7. Dosimetry in myocardial perfusion imaging

    Toledo, Janine M.; Trindade, Bruno; Ribeiro, Tarcisio P.C.

    2011-01-01

    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)

  8. Imaging techniques for myocardial inflammation

    O'Connell, J.B.; Henkin, R.E.; Robinson, J.A.

    1986-01-01

    Dilated cardiomyopathy (DC) represents a heterogeneous group of disorders which results in morbidity and mortality in young individuals. Recent evidence suggests that a subset of these patients have histologic evidence of myocarditis which is potentially treatable with immunosuppression. The identification of myocardial inflammation may therefore lead to development of therapeutic regimens designed to treat the cause rather than the effect of the myocardial disease. Ultimately, this may result in improvement in the abysmal prognosis of DC. The currently accepted technique for identification of active myocardial inflammation is endomyocardial biopsy. This technique is not perfect, however, since pathologic standards for the diagnosis of myocarditis have not been established. Furthermore, focal inflammation may give rise to sampling error. The inflammation-avid radioisotope gallium-67 citrate has been used as an adjunct to biopsy improving the yield of myocarditis from 7 percent to 36 percent. Serial imaging correlates well to biopsy results. Future studies are designed to study the applicability of lymphocyte labelling techniques to myocardial inflammatory disease

  9. Assessment of myocardial metabolic rate of glucose by means of Bayesian ICA and Markov Chain Monte Carlo methods in small animal PET imaging

    Berradja, Khadidja; Boughanmi, Nabil

    2016-09-01

    In dynamic cardiac PET FDG studies the assessment of myocardial metabolic rate of glucose (MMRG) requires the knowledge of the blood input function (IF). IF can be obtained by manual or automatic blood sampling and cross calibrated with PET. These procedures are cumbersome, invasive and generate uncertainties. The IF is contaminated by spillover of radioactivity from the adjacent myocardium and this could cause important error in the estimated MMRG. In this study, we show that the IF can be extracted from the images in a rat heart study with 18F-fluorodeoxyglucose (18F-FDG) by means of Independent Component Analysis (ICA) based on Bayesian theory and Markov Chain Monte Carlo (MCMC) sampling method (BICA). Images of the heart from rats were acquired with the Sherbrooke small animal PET scanner. A region of interest (ROI) was drawn around the rat image and decomposed into blood and tissue using BICA. The Statistical study showed that there is a significant difference (p corrupted with spillover.

  10. Comparison of several potential myocardial imaging agents

    Watson, E.E.; Stabin, M.G.; Goodman, M.M.; Knapp, F.F. Jr.; Srivastava, P.C.

    1985-01-01

    Although myocardial imaging is currently dominated by Tl-201, several alternative agents with improved physiologic or radionuclidic properties have been proposed. Based on human and animal studies in the literature, the metabolism of several of these compounds was studied for the purpose of generating radiation dose estimates. Dose estimates are listed for several I-123 labeled free fatty acids, an I-123 labeled phosphonium compound, Rb-82, Cu-64, F-18 FDG (all compounds which are taken up by the normal myocardium), and for Tc-99m pyrophosphate (PYP) (which localizes in myocardial infarcts). Dose estimates could not be generated for C-11 palmitate, but this compound was included in a comparison of myocardial retention times. For the I-123 labeled compounds, I-124 was included as a contaminant in generating the dose estimates. Radiation doses were lowest for Rb-82 (gonads 0.3 to 0.5 μGy/MBq, heart wall 15 μGy/MBq). Doses for the I-123 labeled fatty acids were similar to one another, with IPPA being the lowest (gonads 20 μGy/MBq, heart wall 15 μGy/MBq). Doses for Tc-99m PYP were also low (gonads 4 to 7 μGy/MBq, heart wall 4 μGy/MBq, skeleton 15 μGy/MBq). The desirability of these compounds is discussed briefly, considering half life, imaging mode and energy, and dosimetry, including a comparison of the effective whole body dose equivalents. 34 refs., 11 tabs

  11. Tomoscintigraphic assessment of myocardial metabolic heterogenity

    Roesler, H.; Hess, T.; Weiss, M.; Noelpp, U.; Mueller, G.; Hoeflin, F.; Kinser, J.

    1983-01-01

    I-123-omega-heptadecanoic acid (HDA) was evaluated for myocardial scanning in 59 healthy volunteers and 133 patients, using a 7-pinhole collimator. Early (uptake) and late (retention) images were compared visually. Regional HDA elimination was also followed semiquantitatively based on the calculation of a retention-over-uptake ratio, R(phi), derived from the maximal counts/pixel in 60 midventricular slice sectors. The healthy heart concentrated HDA homogeneously in all segments with no difference between early and late images. The minimal R(phi), taken as representative of that myocardium with the best function, was unchanged after maximal ergometer stress and with dipyramidole-induced hyperperfusion. A circumscribed decreased HDA uptake is the clear-cut criterion for an abnormal finding. HDA tomography of the myocardium had an 86% sensitivity for myocardial infarcts (MIs) up to 4 wk old, and 83% for myocardial scars (MSs). Comparing early and late tomograms, we find a cool-warm sequence more often with acute and subacute MIs. A cool-cool or a cold-cold sequence dominated with MSs. HDA tomoscintigraphy cannot replace TI-201 for the evaluation of regional coronary reserve in coronary heart disease

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

    Ito, Kazuki; Tanabe, Takuji; Yuba, Tatsuya; Doue, Tomoki; Adachi, Yoshihiko; Katoh, Shuuji; Sugihara, Hiroki; Azuma, Akihiro; Nakagawa, Masao

    2001-01-01

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

  13. Thallium-201 myocardial imaging in acute-myocardial infarction

    Wackers, F.J.Th.; Lie, K.I.; Sokole, E.B.; Wellens, H.J.J.; Samson, G.; Schoot, J.B. van der

    1980-01-01

    Thallium-201 scintigraphy has proven to be an early and highly sensitive technique to detect myocardial perfusion abnormalities in patients with acute myocardial infarction. During the early phase of acute myocardial infarction, patients may be hemodynamically and electrically unstable. Therefore, scintigraphy is performed preferably at the bed side in the Coronary Care Unit using a mobile gamma camera. Additionally, in order to shorten imaging time in these often critically ill patients, the authors recommend injecting no less than 2 mCi of 201 Tl. Using this dosage, the imaging time per view will be approximately five minutes. Routinely, three views are taken: the first view is a supine 45 0 left-anterior-oblique view, followed by a supine anterior view and finally a left-lateral view, the latter with the patient turned on the right side. (Auth.)

  14. Myocardial perfusion imaging for detection of silent myocardial ischemia

    Beller, G.A.

    1988-01-01

    Despite the widespread use of the exercise stress test in diagnosing asymptomatic myocardial ischemia, exercise radionuclide imaging remains useful for detecting silent ischemia in numerous patient populations, including those who are totally asymptomatic, those who have chronic stable angina, those who have recovered from an episode of unstable angina or an uncomplicated myocardial infarction, and those who have undergone angioplasty or received thrombolytic therapy. Studies show that thallium scintigraphy is more sensitive than exercise electrocardiography in detecting ischemia, i.e., in part, because perfusion defects occur more frequently than ST depression and before angina in the ischemic cascade. Thallium-201 scintigraphy can be performed to differentiate a true- from a false-positive exercise electrocardiographic test in patients with exercise-induced ST depression and no angina. The development of technetium-labeled isonitriles may improve the accuracy of myocardial perfusion imaging. 11 references

  15. Myocardial viability assessment using nuclear imaging

    Matsunari, Ichiro; Hisada, Kinichi; Taki, Junichi; Nakajima, Kenichi; Tonami, Norihisa

    2003-01-01

    Myocardial assessment continues to be an issue in patients with coronary artery disease and left ventricular dysfunction. Nuclear imaging has long played an important role in this field. In particular, PET imaging using 18 F-fluorodeoxyglucose is regarded as the metabolic gold standard of tissue viability, which has been supported by a wide clinical experience. Viability assessment using SPECT techniques has gained more wide-spread clinical acceptance than PET, because it is more widely available at lower cost. Moreover, technical advances in SPECT technology such as gated-SPECT further improve the diagnostic accuracy of the test. However, other imaging techniques such as dobutamine echocardiography have recently emerged as competitors to nuclear imaging. It is also important to note that they sometimes may work in a complementary fashion to nuclear imaging, indicating that an appropriate use of these techniques may significantly improve their overall accuracy. In keeping these circumstances in mind, further efforts are necessary to further improve the diagnostic performance of nuclear imaging as a reliable viability test. (author) 107 refs

  16. Myocardial metabolism of 123I-BMIPP under low-dose dobutamine infusion: implications for clinical SPECT imaging of ischemic heart disease

    Hosokawa, Ryohei; Fujita, Masatoshi; Kambara, Naoshige; Ohba, Muneo; Tadamura, Eiji; Kimura, Takeshi; Kita, Toru; Nohara, Ryuji; Hirai, Taku; Fujibayashi, Yasuhisa

    2005-01-01

    123 I-(p-iodophenyl)-3-(R,S)-methylpentadecanoic acid ( 123 I-BMIPP) is a fatty acid analog for single-photon emission computed tomography (SPECT) imaging that is mainly stored in the triglyceride pool. Low-dose dobutamine infusion has been reported to improve BMIPP uptake in the stunned myocardium, but the mechanism underlying this effect remains unclear. The purpose of this study was therefore to investigate the myocardial metabolism of 123 I-BMIPP in the stunned myocardium under low-dose dobutamine infusion, and to elucidate the mechanism by which dobutamine improves BMIPP uptake. Using open-chest dogs, stunned myocardium was induced by occlusion of the left anterior descending artery (LAD) for 30 min, with subsequent reperfusion (ischemia group, n=6). After direct injection of BMIPP into the LAD, myocardial extraction and retention were examined and metabolites evaluated (using high-performance liquid chromatography) during dobutamine infusion. The results in the ischemia group were compared with findings obtained in a control group under dobutamine infusion (n=6). Dobutamine infusion significantly increased both the rapid extraction (within 30 s) of BMIPP into the myocardium (control vs ischemia group: 48±19% vs 66±14%, p<0.05) and its subsequent retention (73±13% vs 85±8%, p<0.05). The metabolites from the myocardium consisted of back diffusion of nonmetabolized BMIPP, the alpha-oxidation metabolite, intermediate metabolites, and the full-oxidation metabolite. Among these metabolites, the full-oxidation metabolite decreased significantly (from 34.0±20.0% to 15.8±9.3%, p<0.05) in the stunned regions, though back diffusion of nonmetabolized BMIPP increased (from 51.3±21.9% to 71.3±10.1%, p<0.05). These results indicate that increased uptake of BMIPP in stunned myocardium is mainly due to decreased beta-oxidation in tissue and increased shunt retention of BMIPP in the triglyceride pool, and thereby provide further insight into the pathophysiology of

  17. Myocardial metabolism of {sup 123}I-BMIPP under low-dose dobutamine infusion: implications for clinical SPECT imaging of ischemic heart disease

    Hosokawa, Ryohei; Fujita, Masatoshi; Kambara, Naoshige; Ohba, Muneo; Tadamura, Eiji; Kimura, Takeshi; Kita, Toru [Kyoto University Graduate School of Medicine, Department of Cardiovascular Medicine, and Nuclear Medicine, Kyoto (Japan); Nohara, Ryuji [The Tazuke Kofukai Medical Research Institute, Department of Cardiology, Kitano Hospital, Osaka (Japan); Hirai, Taku [Kinki University School of Medicine, Department of Cardiology, Nara Hospital, Nara (Japan); Fujibayashi, Yasuhisa [Fukui Medical University, Molecular Imaging, Biomedical Imaging Research Center, Fukui (Japan)

    2005-01-01

    {sup 123}I-(p-iodophenyl)-3-(R,S)-methylpentadecanoic acid ({sup 123}I-BMIPP) is a fatty acid analog for single-photon emission computed tomography (SPECT) imaging that is mainly stored in the triglyceride pool. Low-dose dobutamine infusion has been reported to improve BMIPP uptake in the stunned myocardium, but the mechanism underlying this effect remains unclear. The purpose of this study was therefore to investigate the myocardial metabolism of {sup 123}I-BMIPP in the stunned myocardium under low-dose dobutamine infusion, and to elucidate the mechanism by which dobutamine improves BMIPP uptake. Using open-chest dogs, stunned myocardium was induced by occlusion of the left anterior descending artery (LAD) for 30 min, with subsequent reperfusion (ischemia group, n=6). After direct injection of BMIPP into the LAD, myocardial extraction and retention were examined and metabolites evaluated (using high-performance liquid chromatography) during dobutamine infusion. The results in the ischemia group were compared with findings obtained in a control group under dobutamine infusion (n=6). Dobutamine infusion significantly increased both the rapid extraction (within 30 s) of BMIPP into the myocardium (control vs ischemia group: 48{+-}19% vs 66{+-}14%, p<0.05) and its subsequent retention (73{+-}13% vs 85{+-}8%, p<0.05). The metabolites from the myocardium consisted of back diffusion of nonmetabolized BMIPP, the alpha-oxidation metabolite, intermediate metabolites, and the full-oxidation metabolite. Among these metabolites, the full-oxidation metabolite decreased significantly (from 34.0{+-}20.0% to 15.8{+-}9.3%, p<0.05) in the stunned regions, though back diffusion of nonmetabolized BMIPP increased (from 51.3{+-}21.9% to 71.3{+-}10.1%, p<0.05). These results indicate that increased uptake of BMIPP in stunned myocardium is mainly due to decreased beta-oxidation in tissue and increased shunt retention of BMIPP in the triglyceride pool, and thereby provide further insight

  18. Effect of eating on thallium myocardial imaging

    Wilson, R.A.; Sullivan, P.J.; Okada, R.D.; Boucher, C.A.; Morris, C.; Pohost, G.M.; Strauss, H.W.

    1986-01-01

    To determine if eating between initial and delayed thallium images alters the appearance of the delayed thallium scan, a prospective study was performed; 184 subjects sent for routine thallium imaging were randomized into two groups, those who ate a meal high in carbohydrates between initial and delayed thallium myocardial images (n = 106), and those who fasted (n = 78). The 201 Tl images were interpreted in blinded fashion for global myocardial and pulmonary clearance of 201 Tl myocardial defects. The eating group had a significantly lower incidence of transient myocardial defects compared to the noneating group (7 percent vs 18 percent, respectively; p less than 0.05). The time between initial and delayed images and the incidence of exercise-induced ischemic ST-segment depression or pathologic Q waves on the electrocardiogram were not significantly different between the two groups. These data suggest that eating a high-carbohydrate meal between initial and delayed 201 Tl images causes increased 201 Tl myocardial clearance rates and may alter 201 Tl myocardial redistribution over time

  19. Thrombolytic therapy of acute myocardial infarction alters collagen metabolism

    Høst, N B; Hansen, S S; Jensen, L T

    1994-01-01

    The objective of the study was to monitor collagen metabolism after thrombolytic therapy. Sequential measurements of serum aminoterminal type-III procollagen propeptide (S-PIIINP) and carboxyterminal type-I procollagen propeptide (S-PICP) were made in 62 patients suspected of acute myocardial.......05). A less pronounced S-PIIINP increase was noted with tissue-plasminogen activator than with streptokinase. Thrombolytic therapy induces collagen breakdown regardless of whether acute myocardial infarction is confirmed or not. With confirmed acute myocardial infarction collagen metabolism is altered...... for at least 6 months. Furthermore, fibrin-specific and nonspecific thrombolytic agents appear to affect collagen metabolism differently....

  20. Myocardial perfusion imaging with dual energy CT

    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.

  1. Non-Q-wave myocardial infarction: impaired myocardial energy metabolism in regions with reduced 99mTc-MIBI accumulation.

    Moka, D; Baer, F M; Theissen, P; Schneider, C A; Dietlein, M; Erdmann, E; Schicha, H

    2001-05-01

    Reduced regional technetium-99m methoxyisobutylisonitrile (99mTc-MIBI) accumulation in patients with chronic non-Q-wave infarction (NQWI) but without significant coronary artery stenosis indicates non-transmural damage of the myocardial wall. The aim of this study was to characterise cardiac energy metabolism after NQWI using phosphorus-31 magnetic resonance spectroscopy (31P-MRS) and to compare the biochemical remodelling with changes in regional 99mTc-MIBI uptake and with morphological and functional parameters assessed by magnetic resonance imaging (MRI). Fifteen patients with a history of NQWI, exclusion of significant coronary artery stenosis (energy metabolism. Spectroscopic measurements were performed in the infarct-related myocardial region. Corresponding gradient-echo MR images and myocardial 99mTc-MIBI single-photon emission tomography images were acquired for exact localisation of the infarct region. All examinations were performed at rest under anti-ischaemic medication. Data were compared with those of patients in whom coronary artery disease had been excluded by angiography (group B, n=10). All patients of group A displayed anterior wall hypokinesia in the infarcted area on both ventriculography and MRI, with a reduced myocardial accumulation of 99mTc-MIBI (66.3%+/-11.8% vs 95.6%+/-2.2% in group B). The mean wall thickness during the complete cardiac cycle (9.5+/-1.8 mm vs 13.1+/-1.1 mm in group B, Penergy metabolism.

  2. Rationale and radiopharmaceuticals for myocardial imaging

    Poe, N.D.

    1976-01-01

    Static radionuclide imaging procedures are now available for evaluating regional myocardial perfusion and for detecting acute myocardial infarction. Thallium-201, a radiopharmaceutical which possesses many of the characteristics of potassium analogs, at present is receiving the greatest attention as a regional blood flow indicator. Ischemic lesions appear as areas of decreased tracer uptake. Unfortunately, this agent is expensive, is in limited supply and has a photopeak which is low for optimum imaging. Positive infarct images can be obtained with various technetium-99m chelates. Pyrophosphate appears to be the best of the technetium compounds studied to date although the mechanism of uptake of the chelates has not yet been fully elucidated. Therefore, quantitative measurements of infarct size are not justified. As perfusion imaging and infarct imaging provide useful, complementary data, a dual tracer approach to evaluating patients with suspected coronary artery disease and/or myocardial infarction is probably justifiable

  3. [Clinical significance of myocardial 123I-BMIPP imaging in patients with myocardial infarction].

    Narita, M; Kurihara, T; Shindoh, T; Honda, M

    1997-03-01

    In order to clarify the characteristics of fatty acid metabolism in patients with myocardial infarction (MI), we performed myocardial imaging with 123I-beta-methyl-p-iodophenylpentadecanoic acid (BMIPP) and we compared these findings with exercise stress (Ex) and resting myocardial perfusion imaging with 99mTc-methoxyisobutylisonitrile (MIBI) and left ventricular wall motion index (WMI) which were obtained by left ventriculography. We studied 55 patients with MI, 14 patients with recent MI (RMI) and 41 patients with old MI (OMI), and myocardial images were divided into 17 segments and myocardial uptake of the radionuclide was graded from 0 (normal) to 3 (maximal abnormality). In 28 patients we compared segmental defect score (SDS) with WMI which were obtained by centerline method at the corresponded segments. As a whole, the mean total defect scores (TDSs) of BMIPP and Ex were similar and they were greater than the mean TDS of resting perfusion. In 30 patient (55%) TDS of BMIPP was greater than that of TDS of resting perfusion. In 24 patients perfusion abnormality developed by Ex and the location of BMIPP abnormality coincided with the abnormality of Ex. But in the other 6 patients Ex did not induce any abnormality and they were all RMI and infarcted coronary artery was patent. However in the group with TDS of BMIPP identical to TDS of resting perfusion (25 patients), 92% did not show myocardial perfusion abnormality after Ex. In the comparison of SDS and WMI, myocardial segments were divided into 3 groups; both SDSs of BMIPP and resting perfusion were normal or borderline abnormality (Group 1, 82 segments), SDS of resting perfusion was normal or borderline and SDS of BMIPP was definitely abnormal (Group 2, 10 segments) and both SDSs of BMIPP and resting perfusion were definitely abnormal (Group 3, 48 segments). In Group 1, WMS (-0.41 +/- 0.77) was significantly (p acid metabolism may appear in viable myocardium such as jeopardized myocardium and myocardium which

  4. Proton chemical shift imaging after myocardial infarction

    Bouchard, A.; Doyle, M.; Pohost, G.M.

    1989-01-01

    The present study was undertaken to test whether chemical shift imaging could detect spatially the lipids known to accumulate in myocardium after an ischemic insult. Seven dogs underwent a 24-hour coronary artery occlusion. Hearts were removed and imaged ex vivo by the Dixon method (1.5 T), and myocardial samples were obtained for high-resolution H-1 spectroscopy. Lipid images revealed regions of increased signal intensity in the periphery f the myocardial infarction. The zones of high lipid signal corresponded to zones with elevated mobile lipids as detected by H-1 spectroscopy

  5. Quantitative aspects of myocardial perfusion imaging

    Vogel, R.A.

    1980-01-01

    Myocardial perfusion measurements have traditionally been performed in a quantitative fashion using application of the Sapirstein, Fick, Kety-Schmidt, or compartmental analysis principles. Although global myocardial blood flow measurements have not proven clinically useful, regional determinations have substantially advanced our understanding of and ability to detect myocardial ischemia. With the introduction of thallium-201, such studies have become widely available, although these have generally undergone qualitative evaluation. Using computer-digitized data, several methods for the quantification of myocardial perfusion images have been introduced. These include orthogonal and polar coordinate systems and anatomically oriented region of interest segmentation. Statistical ranges of normal and time-activity analyses have been applied to these data, resulting in objective and reproducible means of data evaluation

  6. Validation of {sup 99m}Tc-labeled '4+1' fatty acids for myocardial metabolism and flow imaging

    Mirtschink, Peter [Institute of Physiology, Technical University Dresden, 01307 Dresden (Germany)], E-mail: peter_mirtschink@web.de; Stehr, Sebastian N. [Department of Anesthesiology, Technical University Dresden, 01307 Dresden (Germany); Walther, Martin; Pietzsch, Jens; Bergmann, Ralf; Pietzsch, Hans-Juergen [Institute of Radiopharmacy, Forschungszentrum Dresden-Rossendorf, 01314 Dresden (Germany); Weichsel, Johannes; Pexa, Annette; Dieterich, Peter [Institute of Physiology, Technical University Dresden, 01307 Dresden (Germany); Wunderlich, Gerd [Department of Nuclear Medicine, Technical University Dresden, 01307 Dresden (Germany); Binas, Bert [Department of Veterinary Pathobiology, Texas A and M University, College Station, TX 77843 (United States); Kropp, Joachim [Department of Nuclear Medicine Carl-Thiem Hospital Cottbus, 03048 Cottbus (Germany); Deussen, Andreas [Institute of Physiology, Technical University Dresden, 01307 Dresden (Germany)

    2009-10-15

    Introduction: {sup 13}C, {sup 18}F and {sup 123}I fatty acids (FA) are used for myocardial imaging. Recently, our group showed that [{sup 99m}Tc]-labeled '4+1' FA are extracted into the rat and guinea pig myocardium. The present study evaluates determinants of myocardial uptake and whole body biodistribution of these FA derivatives. Methods: Studies were performed with isolated perfused hearts of Wistar-Kyoto (WKY) and spontaneously hypertensive rats (SHR) with a FAT/CD36 deficiency, as well as with heart type FA binding protein knockout mice (H-FABP){sup -/-} and H-FABP{sup +/+}. Eight 4+1-{sup 99m}Tc-FA were applied for 3 min followed by 1-min washout. A mathematical model was used to analyze FA dynamics and binding to proteins. Whole-body distribution was studied in rats with and without Tween 80. In vitro fractionation studies with [{sup 99m}Tc]-FA assessed red blood cell uptake as well as association with plasma lipoproteins very low-density lipoprotein (VLDL), low-density lipoprotein (LDL) and high-density lipoprotein (HDL). Results: Myocardial extraction was 19.0-33.0% of the infused dose in isolated WKY and 15.2-26.4% in SHR hearts. However, H-FABP{sup -/-} showed a marked reduction of tracer extraction [2.8{+-}0.6%ID (percent injected dose) vs. 17{+-}2%ID P<.001]. Uptake in red blood cells (<1.2%ID) and incorporation into lipoproteins were negligible. Incubation of {sup 99m}Tc-FA with albumin reduced ventricular extraction (P<.001) into the range of established iodinated FA tracers. polyoxyethylene(20) sorbitan monooleate improved the heart-to-liver ratio in the biodistribution studies. Conclusions: Myocardial uptake of [{sup 99m}Tc]-FA 4+1 derivatives is dependent on H-FABP. These substances may therefore provide a new tool to specifically assess regional myocardial changes of H-FABP.

  7. Myocardial imaging with cesium-130

    Harper, P.V.; Resnekov, L.; Stark, V.; Odeh, N.

    1984-01-01

    Recently comparative studies using nitrogen-13 ammonia and cesium-130 have shown strikingly different myocardial localization patterns in the same subjects with ischemic heart disease. Initial localization of ammonia, an avidly extracted agent, reflects the perfusion pattern in viable myocardial tissue. The myocardial localization of cesium ion, taking place more slowly over 15 to 20 minutes, is apparently much less flow dependent, causing uptake defects shown with ammonia to be largely filled in. Cesium thus appears to provide information on the extent of the viable myocardial mass, apart from perfusion. Cesium-130 (t1/2 30 m) decays by positron emission and electron capture. The whole body radiation absorbed dose, assuming uniform distribution, is 24 mrad/mCi. While abundant production of Cs-130 results from proton bombardment of natural xenon [Xe-130(rho,n)Cs-130] at 15 MeV, small amounts of Cs-129, -131, and -132 are also produced, and enriched Xe-130 is not available. Alternatively almost completely uncontaminated Cs-130 is available by alpha bombardment of natural I-127. Anhydrous sodium iodide is dissolved in acetone and a thin layer (≅20 mg per centimeter squared) is evaporated onto the gold plated tip of the internal target backing which is oscillated vertically to spread out the area upon which the beam is incident. The target surface is inclined 2.5 degrees to the beam giving a power density of about 400 watts per centimeter squared at 100μA which is adequately handled by water cooling. A 30-minute bombardment yields 4 to 5 mCi of Cs-130 which is dissolved directly from the target. This approach appears to offer a new and helpful method for evaluating ischemic heart disease by permitting evaluation of viable myocardial mass

  8. Noninvasive assessment of canine myocardial oxidative metabolism with carbon-11 acetate and positron emission tomography

    Brown, M.A.; Myears, D.W.; Bergmann, S.R.

    1988-01-01

    Noninvasive quantification of regional myocardial metabolism would be highly desirable to evaluate pathogenetic mechanisms of heart disease and their response to therapy. It was previously demonstrated that the metabolism of radiolabeled acetate, a readily utilized myocardial substrate predominantly metabolized to carbon dioxide (CO2) by way of the tricarboxylic acid cycle, provides a good index of oxidative metabolism in isolated perfused rabbit hearts because of tight coupling between the tricarboxylic acid cycle and oxidative phosphorylation. In the present study, in a prelude to human studies, the relation between myocardial clearance of carbon-11 (11C)-labeled acetate and myocardial oxygen consumption was characterized in eight intact dogs using positron emission tomography. Anesthetized dogs were studied during baseline conditions and again during either high or low work states induced pharmacologically. High myocardial extraction and rapid blood clearance of tracer yielded myocardial images of excellent quality. The turnover (clearance) of 11C radioactivity from the myocardium was biexponential with the mean half-time of the dominant rapid phase averaging 5.4 +/- 2.2, 2.8 +/- 1.3 and 11.1 +/- 1.3 min in control, high and low work load studies, respectively. No significant difference was found between the rate of clearance of 11C radioactivity from the myocardium measured noninvasively with positron emission tomography and the myocardial efflux of 11CO2 measured directly from the coronary sinus. The rate of clearance of the 11C radioactivity from the heart correlated closely with myocardial oxygen consumption (r = 0.90, p less than 0.001) as well as with the rate-pressure product (r = 0.95, p less than 0.001). Hence, the rate of oxidation of 11C-acetate can be determined noninvasively with positron emission tomography, providing a quantitative index of oxidative metabolism under diverse conditions

  9. Meta-Analysis of Stress Myocardial Perfusion Imaging

    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

  10. Genomic and metabolic disposition of non-obese type 2 diabetic rats to increased myocardial fatty acid metabolism.

    Sriram Devanathan

    Full Text Available Lipotoxicity of the heart has been implicated as a leading cause of morbidity in Type 2 Diabetes Mellitus (T2DM. While numerous reports have demonstrated increased myocardial fatty acid (FA utilization in obese T2DM animal models, this diabetic phenotype has yet to be demonstrated in non-obese animal models of T2DM. Therefore, the present study investigates functional, metabolic, and genomic differences in myocardial FA metabolism in non-obese type 2 diabetic rats. The study utilized Goto-Kakizaki (GK rats at the age of 24 weeks. Each rat was imaged with small animal positron emission tomography (PET to estimate myocardial blood flow (MBF and myocardial FA metabolism. Echocardiograms (ECHOs were performed to assess cardiac function. Levels of triglycerides (TG and non-esterified fatty acids (NEFA were measured in both plasma and cardiac tissues. Finally, expression profiles for 168 genes that have been implicated in diabetes and FA metabolism were measured using quantitative PCR (qPCR arrays. GK rats exhibited increased NEFA and TG in both plasma and cardiac tissue. Quantitative PET imaging suggests that GK rats have increased FA metabolism. ECHO data indicates that GK rats have a significant increase in left ventricle mass index (LVMI and decrease in peak early diastolic mitral annular velocity (E' compared to Wistar rats, suggesting structural remodeling and impaired diastolic function. Of the 84 genes in each the diabetes and FA metabolism arrays, 17 genes in the diabetes array and 41 genes in the FA metabolism array were significantly up-regulated in GK rats. Our data suggest that GK rats' exhibit increased genomic disposition to FA and TG metabolism independent of obesity.

  11. Effects of activation of endocannabinoid system on myocardial metabolism

    Agnieszka Polak

    2016-05-01

    Full Text Available Endocannabinoids exert their effect on the regulation of energy homeostasis via activation of specific receptors. They control food intake, secretion of insulin, lipids and glucose metabolism, lipid storage. Long chain fatty acids are the main myocardial energy substrate. However, the heart exerts enormous metabolic flexibility emphasized by its ability to utilzation not only fatty acids, but also glucose, lactate and ketone bodies. Endocannabinoids can directly act on the cardiomyocytes through the CB1 and CB2 receptors present in cardiomyocytes. It appears that direct activation of CB1 receptors promotes increased lipogenesis, pericardial steatosis and bioelectrical dysfunction of the heart. In contrast, stimulation of CB2 receptors exhibits cardioprotective properties, helping to maintain appropriate amount of ATP in cardiomyocytes. Furthermore, the effects of endocannabinoids at both the central nervous system and peripheral tissues, such as liver, pancreas, or adipose tissue, resulting indirectly in plasma availability of energy substrates and affects myocardial metabolism. To date, there is little evidence that describes effects of activation of the endocannabinoid system in the cardiovascular system under physiological conditions. In the present paper the impact of metabolic diseases, i. e. obesity and diabetes, as well as the cardiovascular diseases - hypertension, myocardial ischemia and myocardial infarction on the deregulation of the endocannabinoid system and its effect on the metabolism are described.

  12. Fatty acid myocardial imaging using 123I-β-methyl-iophenyl pentadecanoic acid (BMIPP): Comparison of myocardial perfusion and fatty acid utilization in canine myocardial infarction

    Nishimura, Tsunehiko; Sago, Masayoshi; Kihara, Koichi; Oka, Hisashi; Shimonagata, Tsuyoshi; Katabuchi, Tetsuro; Hayashi, Makoto; Uehara, Toshiisa; Hayashida, Kohei; Noda, Hiroyuki; Takano, Hisateru

    1989-01-01

    To evaluate the relationship between myocardial perfusion and fatty acid metabolism in canine myocardial infarction, 16 dogs were studied using thallium and 123 I-β-methyl-iodophenyl pentadecanoic acid (BMIPP). Eight dogs (group A) had left anterior coronary arterial occlusion (6 h ligation), 6 dogs (group B) had reperfusion (3 h ligation and 1 h reperfusion) and 2 dogs served as the normal control. Myocardial imaging with BMIPP was excellent, owing to its higher uptake and longer retention in myocardium and rapid blood disappearance in addition to diminished liver and lung uptake. The mean half time value which was generated from the BMIPP myocardial washout curve, was significantly larger in the reperfused myocardium. The gamma camera imaging showed uncoupling of BMIPP and thallium (BMIPP uptake greater than thallium uptake) in five dogs in group B. On the other hand, all dogs in group A had a persistent defect in BMIPP and thallium uptake. Our findings indicate that the combination of BMIPP and thallium for myocardial imaging supply different information about the zone of infarction and ischemia, which may be useful for the assessment of myocardial viability. (orig.)

  13. The development of radioiodinated fatty acids for myocardial imaging

    Knapp, F.F. Jr.

    1993-01-01

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

  14. Detection of regional derangements in myocardial metabolism by positron computed tomography in Duchenne's muscular dystrophy

    Henze, E.; Schelbert, H.R.; Perloff, J.K.; Schwaiger, M.; Phelps, M.E.

    1982-01-01

    Duchenne's Muscular Dystrophy is unique in genetically targeting for disease a specific region of myocardium: the postero-basal left ventricular wall. Postmortem examinations revealed focal fibrous degenerations in the postero-basal segment, while the coronary arteries were usually not affected. A predystrophic metabolic fault has been postulated for this region. This hypothesis was tested with positron computed tomography as a new means for the noninvasive study of regional myocadial perfusion and metabolism and to determine the incidence of regional and global left ventricular dysfunction and perfusion abnormalities using Thallium-201 and gated blood pool imaging. Myocardial perfusion was evaluated with N-13 ammonia while regional myocardial glucose uptake was studied with the glucose analog F-18 DG. The sensitivity of each diagnostic test for detecting cardiac involvement in Duchenne's Muscular Dystrophy was evaluated. It was highest for ammonia and glucose imaging and it was low for Thallium and radionuclide blood pool imaging

  15. Is myocardial fatty acid metabolism different between hypertrophic cardiomyopathy and hypertensive hypertrophy?

    Narita, Michihiro; Kurihara, Tadashi; Usami, Masahisa; Honda, Minoru

    1994-01-01

    To investigate characteristics of fatty acid metabolism in hypertrophic cardiomyopathy (HCM), we performed myocardial imaging with 123 I-iodophenyl-3-methylpentadecanoic acid (BMIPP) in 24 HCM patients, 13 patients with hypertensive hypertrophy (HT) and 10 normal subjects. Rest myocardial imaging with 123 I-BMIPP was obtained at 20 minutes and 3 hours after 123 I-BMIPP injection. Rest 201 Tl imaging was also performed. In addition to ordinary tomography, whole body imaging was performed to calculate %Uptake (percentage of cardiac uptake of the isotope to total injected dose). As global indexes of fatty acid metabolism, we calculated two parameters; Uptake Ratio (%Uptake of 123 I-BMIPP normalized by myocardial perfusion) and WOR (percent reduction of myocardial 123 I-BMIPP within 3 hours). Regional abnormality was evaluated by visual assessment of ordinary tomograms and by BMIPP/Tl map. BMIPP/Tl map was made from Bull's-eye maps of 123 I-BMIPP and 201 Tl, and it represented 123 I-BMIPP uptake normalized by myocardial perfusion of each pixel which constructed the image. %Uptake of 123 I-BMIPP was not different among three groups. Uptake Ratio was significantly (p HT (1.03±0.08)>HCM (0.87±0.09). WOR of 123 I-BMIPP was accerelated in HCM (12.7±4.7%) and HT (10.2±2.9%) compared with normal (5.1±3.1%) (p 123 I-BMIPP distribution was found in 17 of 24 patients (71%) including 3 patients with equivocal abnormality. In HT patients, only equivocal abnormality was observed in 23%. In BMIPP/Tl map, abnormality was observed in 92% of HCM and 8% of HT. Although global myocardial fatty acid metabolism was equally disturbed both in HCM and HT, regional abnormality of fatty acid metabolism was observed preferetially in HCM. This indicated myocardial fatty acid metabolism was not identical between HCM and HT. (author)

  16. ECG-gated myocardial imaging with 201Tl

    Baehre, M.

    1980-01-01

    ECG-gated myocardial scintigraphy by means of 201 TI was performed in 11 patients. Good scintigrams could be gained by using long imaging times, but there was no additional information when compared with static images. Disadvantages were long imaging time, higher technical expenditure, and the smaller number of projections. Furthermore, there is no possibility of performing myocardial imaging under stress. (orig.) [de

  17. Myocardial perfusion imaging in hyperthrophic cardiomyopathy

    Moorin, B.

    1998-01-01

    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

  18. Comparison of radiation dosimetry for several potential myocardial imaging agents

    Watson, E.E.; Stabin, M.G; Goodman, M.M.; Knapp, F.F. Jr.; Srivastava, P.C.

    1986-01-01

    Although myocardial imaging is currently dominated by Tl-201, several alternative agents with improved physiologic or radionuclidic properties have been proposed. Based on human and animal studies in the literature, the metabolism of several of these compounds was studied for the purpose of generating radiation dose estimates. Dose estimates are listed for several I-123-labeled free fatty acids, an I-123-labeled phosphonium compound, Rb-82, Cu-64, F-18 FDG (all compounds which are taken up by the normal myocardium), and for Tc-99m pyrophosphate (PYP) (which localizes in myocardial infarcts). Dose estimates could not be generated for C-11 palmitate, but his compound was included in a comparison of myocardial retention times. For the I-123-labeled compounds, I-124 was included as a contaminant in generating the dose estimates. Radiation doses were lowest for Rb-82 (gonads 0.3-0.4 Gy/MBq, kidneys 8.6 Gy/MBq). Doses for the I-123-labeled fatty acids were similar to one another, with IPPA being the lowest (gonads 15 Gy/MBq, heart wall 18 Gy/MBq). Doses for Tc-99m PYP were also low (gonads 4-7 Gy/MBq, heart wall 4 Gy/MBq, skeleton 15 Gy/MBq). The desirability of these compounds is discussed briefly, considering half-life, imaging mode and energy, and dosimetry, including a comparison of the effective whole body dose equivalents. 37 references, 11 tables

  19. Myocardial perfusion imaging by digital subtraction angiography

    Kadowaki, Hiroyuki; Ishikawa, Kinji; Ogai, Toshihiro; Katori, Ryo

    1986-01-01

    Several methods of digital subtraction angiography (DSA) were compared to determine which could better visualize regional myocardial perfusion using coronary angiography in seven patients with myocardial infarction, two with angina pectoris and five with normal coronary arteries. Satisfactory DSA was judged to be achieved if the shape of the heart on the mask film was identical to that on the live film and if both films were exactly superimposed. To obtain an identical mask film in the shape of each live film, both films were selected from the following three phases of the cardiac cycle; 1) at the R wave of the electrocardiogram, 2) 100 msec before the R wave, and 3) 200 msec before the R wave. The last two were superior for obtaining mask and live films which were similar in shape, because the cardiac motion in these phases was relatively small. Using these mask and live films, DSA was performed either with the continuous image mode (CI mode) or the time interval difference mode (TID mode). The overall perfusion of contrast medium through the artery to the vein was adequately visualized using the CI mode. Passage of contrast medium through the artery, capillary and vein was visualized at each phase using TID mode. Subtracted images were displayed and photographed, and the density of the contrast medium was adequate to display contour lines as in a relief map. Using this DSA, it was found that regional perfusion of the contrast medium was not always uniform in normal subjects, depending on the typography of the coronary artery. In all patients with anterior myocardial infarction, low perfusion was observed at the infarcted portion compared to the non-infarcted myocardium. In patients with inferior myocardial infarction, this low perfusion area was not observed because right coronary angiography was not subjected to DSA in this study. (J.P.N.)

  20. Present assessment of myocardial viability by nuclear imaging.

    Saha, G B; MacIntyre, W J; Brunken, R C; Go, R T; Raja, S; Wong, C O; Chen, E Q

    1996-10-01

    Prospective delineation of viable from nonviable myocardium in patients with coronary artery disease in an important factor in deciding whether a patient should be revascularized or treated medically. Two common techniques--single-photon emission computed tomography (SPECT) and positron-emission computed tomography (PET)--are used in nuclear medicine using various radiopharmaceuticals for the detection of myocardial viability in patients. Thallium-201 (201Tl) and technetium-99m (99mTc)-sestamibi are the common radiopharmaceuticals used in different protocols using SPECT, whereas fluoride-18 (18F)-fluorodeoxyglucose (FDG) and rubidium-82 (82Rb) are most widely used in PET. The SPECT protocols involve stress/redistribution, stress/redistribution/reinjection, and rest/redistribution imaging techniques. Many studies have compared the results of 201Tl and (99mTc)-sestamibi SPECT with those of FDG PET; in some studies, concordant results have been found between delayed thallium and FDG results, indicating that 201Tl, although considered a perfusion agent, shows myocardial viability. Discordant results in a number of studies have been found between sestamibi and FDG, suggesting that the efficacy of sestamibi as a viability marker has yet to be established. Radiolabeled fatty acids such as iodine-123 (123I)-para-iodophenylpentadecanoic acid and carbon-11 (11C)-palmitic acid have been used for the assessment of myocardial viability with limited success. 11C-labeled acetate is a good marker of oxidative metabolism in the heart and has been used to predict the reversibility of wall motion abnormalities. (18F)-FDG is considered the marker of choice for myocardial viability, although variable results are obtained under different physiological conditions. Detection of myocardial viability can be greatly improved by developing new equipment and radiopharmaceuticals of better quality.

  1. Magnetic Resonance Imaging in Myocardial Fibrosis Related to Ischemic Events

    Himcinschi Elisabeta

    2017-09-01

    Full Text Available Given the higher amount of detail it offers, the use of magnetic resonance (MR in the field of cardiology has increased, thus leading to a decrease in the use of invasive and irradiating methods for diagnosing various cardiovascular disorders. The only precautions for MR imaging are metallic implants and advanced-stage chronic kidney disease. For the acquisition of clear and dynamic myocardial images, methods such as spin echo imaging for anatomical description, steady-state free precession imaging for the assessment of ventricular cavity size and function, flow velocity encoding for blood flow measurements, radiofrequency tagging for dynamics, and even spectroscopy for metabolism evaluation are used. Cardiac magnetic resonance (CMR is considered the gold standard imaging method for the anatomical characterization of the heart and obtaining information related to myocardial dynamics. In case of ischemic events, CMR is used for a detailed description of the necrotic area and the complications, and for tracking the ventricular remodeling. By administrating a contrast agent (gadolinium, the difference between sub-endothelial and transmural infarctions can be distinguished, highlighting even microvascular lesions responsible for the extension of the necrosis. The assessment of the dynamics of ventricular remodeling and viability through late gadolinium enhancement (LGE technology highlights the area of fibrosis and the occurrence of late complications.

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

    Hashizume, Toshikazu; Sakai, Yasuhito; Hayashi, Yasushi

    2000-01-01

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

  3. Metabolic imaging using SPECT

    Taki, Junichi; Matsunari, Ichiro

    2007-01-01

    In normal condition, the heart obtains more than two-thirds of its energy from the oxidative metabolism of long chain fatty acids, although a wide variety of substrates such as glucose, lactate, ketone bodies and amino acids are also utilised. In ischaemic myocardium, on the other hand, oxidative metabolism of free fatty acid is suppressed and anaerobic glucose metabolism plays a major role in residual oxidative metabolism. Therefore, metabolic imaging can be an important technique for the assessment of various cardiac diseases and conditions. In SPECT, several iodinated fatty acid traces have been introduced and studied. Of these, 123 I-labelled 15-(p-iodophenyl)3-R, S-methylpentadecanoic acid (BMIPP) has been the most commonly used tracer in clinical studies, especially in some of the European countries and Japan. In this review article, several fatty acid tracers for SPECT are characterised, and the mechanism of uptake and clinical utility of BMIPP are discussed in detail. (orig.)

  4. The review of myocardial positron emission computed tomography and positron imaging by gamma camera

    Ohtake, Tohru [Tokyo Univ. (Japan). Faculty of Medicine

    1998-04-01

    To measure myocardial blood flow, Nitrogen-13 ammonia, Oxygen-15 water, Rubidium-82 and et al. are used. Each has merit and demerit. By measuring myocardial coronary flow reserve, the decrease of flow reserve during dipyridamole in patients with hypercholesterolemia or diabetes mellitus without significant coronary stenosis was observed. The possibility of early detection of atherosclerosis was showed. As to myocardial metabolism, glucose metabolism is measured by Fluorine-18 fluorodeoxyglucose (FDG), and it is considered as useful for the evaluation of myocardial viability. We are using FDG to evaluate insulin resistance during insulin clamp in patients with diabetes mellitus by measuring glucose utilization rate of myocardium and skeletal muscle. FFA metabolism has been measured by {sup 11}C-palmitate, but absolute quantification has not been performed. Recently the method for absolute quantification was reported, and new radiopharmaceutical {sup 18}F-FTHA was reported. Oxygen metabolism has been estimated by {sup 11}C-acetate. Myocardial viability, cardiac efficiency was evaluated by oxygen metabolism. As to receptor or sympathetic nerve end, cardiac insufficiency or cardiac transplantation was evaluated. Imaging of positron emitting radiopharmaceutical by gamma camera has been performed. Collimator method is clinically useful for cardiac imaging of viability study. (author). 54 refs.

  5. Reproducibility of 201Tl myocardial imaging

    McLaughlin, P.R.; Martin, R.P.; Doherty, P.; Daspit, S.; Goris, M.; Haskell, W.; Lewis, S.; Kriss, J.P.; Harrison, D.C.

    1977-01-01

    Seventy-six thallium-201 myocardial perfusion studies were performed on twenty-five patients to assess their reproducibility and the effect of varying the level of exercise on the results of imaging. Each patient had a thallium-201 study at rest. Fourteen patients had studies on two occasions at maximum exercise, and twelve patients had studies both at light and at maximum exercise. Of 70 segments in the 14 patients assessed on each of two maximum exercise tests, 64 (91 percent) were reproducible. Only 53 percent (16/30) of the ischemic defects present at maximum exercise were seen in the light exercise study in the 12 patients assessed at two levels of exercise. Correlation of perfusion defects with arteriographically proven significant coronary stenosis was good for the left anterior descending and right coronary arteries, but not as good for circumflex artery disease. Thallium-201 myocardial imaging at maximum exercise is reproducible within acceptable limits, but careful attention to exercise technique is essential for valid comparative studies

  6. Investigation of (/sup 18/F)2-fluoro-2-deoxyglucose for the measure of myocardial glucose metabolism

    Phelps, M.E.; Hoffman, E.J.; Selin, C.; Huang, S.C.; Robinson, G.; MacDonald, N.; Schelbert, H.; Kuhl, D.E.

    1978-12-01

    Fluorine-18-labeled 2-deoxyglucose (FDG) was studied as a glucose analog for the measure of myocardial glucose metabolism. Myocardial uptake and retention, blood clearance, species dependence (dog, monkey, man), and effect of diet on uptake were investigated. Normal myocardial uptake of FDG was 3 to 4% of injected dose in dog and monkey, and 1 to 4% in man, compared with brain uptakes of 1.5 to 3% in dog, 5 to 6% in monkey, and 4 to 8% in man. The myocardial metabolic rate (MR) for glucose in the nonfasting (glycolytic) state was 2.8 times that in the fasting (ketogenic) state. Human subjects showed higher myocardial uptake after a normal meal than after a meal containing mostly free fatty acids (FFA). Blood clearance was rapid with initial clearance t/sub 1/2/ of 0.2 to 0.3 min, followed by a t/sub 1/2/ of 8.4 +- 1.2 min in dog and 11.6 +- 1.1 min in man. A small third component had half-times of 59 +- 10 min and 88 +- 4 min in dog and man, respectively. With the ECAT positron tomograph, high image-contrast ratios were found between heart and blood (dog 3.5/1, man 14/1), heart and lung (dog 9/1, man 20/1), and heart and liver (dog 15/1, man 10/1). The FDG was taken up rapidly by the myocardium without any significant tissue clearance over a 4-hr period. The FDG exhibited excellent imaging properties. Average counting rates of 12K, 20K, and 40K c/min-mCi injected are obtained in human subjects with high, medium, and low resolutions of the ECAT tomograph. Determination of glucose and FFA MR in vivo with EACT provides a method for investigation and assessment of changing aerobic and anaerobic metabolic rates in ischemic heart disease in man.

  7. Investigation of [18F]2-fluoro-2-deoxyglucose for the measure of myocardial glucose metabolism

    Phelps, M.E.; Hoffman, E.J.; Selin, C.; Huang, S.C.; Robinson, G.; MacDonald, N.; Schelbert, H.; Kuhl, D.E.

    1978-01-01

    Fluorine-18-labeled 2-deoxyglucose (FDG) was studied as a glucose analog for the measure of myocardial glucose metabolism. Myocardial uptake and retention, blood clearance, species dependence (dog, monkey, man), and effect of diet on uptake were investigated. Normal myocardial uptake of FDG was 3 to 4% of injected dose in dog and monkey, and 1 to 4% in man, compared with brain uptakes of 1.5 to 3% in dog, 5 to 6% in monkey, and 4 to 8% in man. The myocardial metabolic rate (MR) for glucose in the nonfasting (glycolytic) state was 2.8 times that in the fasting (ketogenic) state. Human subjects showed higher myocardial uptake after a normal meal than after a meal containing mostly free fatty acids (FFA). Blood clearance was rapid with initial clearance t/sub 1/2/ of 0.2 to 0.3 min, followed by a t/sub 1/2/ of 8.4 +- 1.2 min in dog and 11.6 +- 1.1 min in man. A small third component had half-times of 59 +- 10 min and 88 +- 4 min in dog and man, respectively. With the ECAT positron tomograph, high image-contrast ratios were found between heart and blood (dog 3.5/1, man 14/1), heart and lung (dog 9/1, man 20/1), and heart and liver (dog 15/1, man 10/1). The FDG was taken up rapidly by the myocardium without any significant tissue clearance over a 4-hr period. The FDG exhibited excellent imaging properties. Average counting rates of 12K, 20K, and 40K c/min-mCi injected are obtained in human subjects with high, medium, and low resolutions of the ECAT tomograph. Determination of glucose and FFA MR in vivo with EACT provides a method for investigation and assessment of changing aerobic and anaerobic metabolic rates in ischemic heart disease in man

  8. Evaluation of myocardial involvement in Duchenne's progressive muscular dystrophy with thallium-201 myocardial perfusion imaging

    Kawai, Naoki; Sotobata, Iwao; Okada, Mitsuhiro

    1985-01-01

    Myocardial involvement in progressive muscular dystrophy of the Duchenne type was evaluated in 19 patients using thallium-201 myocardial perfusion imaging. A qualitative analysis was performed from five projection images by three experienced physicians. Distinct perfusion defects were shown in 13 patients, especially in the LV posterolateral or posterior wall (11 patients). There was no significant relationship between the presence of perfusion defects and the skeletal muscle involvements or thoracic deformities assessed by transmission computed tomography. Extensive perfusion defects were shown in 2 patients who died of congestive heart failure 1 to 2 years after the scintigraphic study. Progression of the myocardial scintigraphic abnormalities were considered to be minimal in 7 of 9 patients who underwent two serial scintigraphic studies over 2 to 3 years. It was concluded that thallium myocardial perfusion imaging is a useful clinical technique to assess myocardial involvement in Duchenne's progressive muscular dystrophy. (author)

  9. MR imaging of acute myocardial infarction

    Revel, D.; Dandis, G.; Pichard, J.B.; Ovize, M.; DeLorgeril, M.; Amiel, M.

    1990-01-01

    This paper reports on superparamagnetic iron oxide particles (AMI-25) evaluated in comparison with paramagnetic Gd-DOTA for the MR evaluation of acute myocardial infarct size. Twelve openchest dogs underwent 2 hours of LAD occlusion followed by 6 hours of reperfusion. AMI-25 and Gd-DOTA were intravenously injected 1 hour and 10 minutes before euthanasia, respectively, in two groups of six dogs. Gradient-echo and T1- and T2-weighted spin-echo images were obtained in six AMI-25-injected excised hearts, and T1- and T2-weighted images in six Gd-DOTA injected excised hearts. Infarct size was evaluated by planimetry of each 8-mm-thick transverse slice after ex vivo double staining and correlated with the planimetry of each 8-mm-thick transverse MR section

  10. Application of 123I-labelled long-chained fatty acids for the study of myocardial metabolism

    Freundlieb, C.; Hoeck, A.; Vyska, F.; Feinendegen, L.E.; Machulla, H.J.; Stoecklin, G.

    1978-01-01

    Radioiodine-labelled fatty acids are useful tracers for myocardial imaging. The present study extends myocardial scintigraphy with ω-123-I-heptadecanoic acid to measuring myocardial metabolism. 4 normal individuals and 6 patients with cardiac disease received i.v. 1-2 mCi ω-123-I-heptadecanoic acid. Immediately fast serial scintigrams of the myocardium were taken for 30 minutes. Disappearance of the tracer, and appearance of anorganic 123-I, was measured in the peripheral blood. The myocardial images were of high quality later than 5 minutes after injection. By correcting for anorganic 123-I in the peripheral blood and the interstitium, the turnover of tracer in the myocardial cells could be measured. Activity was lost from the myocardium with a half time between 14 and 32 minutes. Within regions of old myocardials infarctions the half time of tracer loss was prolonged. The data clearly indicate the feasibility of using ω-123-I-heptadecanoic acid for measuring myocardial metabolism. (author)

  11. The clinical application value of myocardial perfusion imaging in evaluating coronary artery myocardial bridge patients with symptoms

    Wang Yuetao; Fu Ning; Ding Xuemei; Lu Cunzhi; Zhu Feng; Wang Guanmin; Huang Yijie; Wang Linguang

    2008-01-01

    Objective: Myocardial bridge is a common inborn coronary artery anomaly, myocardial bridge may be associated with myocardial ischemia. Only a few patients with coronary artery myocardial bridge were evaluated with nuclear medicine techniques. The aim of this study was to investigate the role of nuclear cardiology with myocardial perfusion technique in symptomatic myocardial bridge patients. Methods Nineteen myocardial bridge patients with the symptoms of chest pain and chest distress were analyzed retrospectively. 99 Tc m -methoxyisobutylisonitrile (MIBI) myocardial perfusion images (both exercise and rest) were performed in all. Imaging results were compared with the results of movement electrocardiogram (ECG) and coronary arteriography. The t test or χ 2 test was used to statistically analyze the data with Stata 7.0 software. Results: Of the 19 patients, 18 patients had myocardial bridge locating at the left anterior descending artery, 1 patient at the left anterior descending and left circumflex artery, the mean angiographic systolic occlusion within the myocardial bridge was (65.4 ± 22.1)%. Of these 19 patients, Exercise-rest 99 Tc m -MIBI myocardial perfusion imaging defined positive myocardial ischemia in 10 and negative in 9 patients. Of the 10 patients with 99 Tc m -MIBI myocardial perfusion imaging defined myocardial ischemia, 8 had reversible radioactive defect of partial anterior wall and (or) apex, 1 had reversible defect of post lateral wall and post septal wall, and 1 had reversible defect of inferior wall. The positive predictive value of myocardial perfusion imaging was 52.6% (10/19), which was higher than movement ECG [21.1% (4/19), χ 2 = 4.07, P 99 Tc m -MIBI myocardial periusion imaging defined myocardial ischemia. Six cases with Grade II stenosis, two were 99 Tc m -MIBI myocardial perfusion imaging defined myocardial ischemia. Eight cases with Grade III stenosis, seven were 99 Tc m -MIBI myocardial perfusion imaging defined myocardial

  12. Radioiodinated carnitine and acylcarnitine analogs as potential myocardial imaging agents

    McConnell, D.S.

    1991-01-01

    R-carnitine is extremely important in mammalian energy metabolism. Gamma-butyrobetaine, the immediate biosynthetic precursor to R-carnitine, is synthesized in many organs. However, only liver can hydroxylate gamma-butyrobetaine to carnitine. Thus the transport of carnitine from its site of synthesis to the site of utilization is of utmost importance. Carnitine is found in highest concentration in cardiac and skeletal muscle, where it is required for the transport of fatty acids into the mitochondria. Before fatty acids are utilized as fuel for the myocyte by beta-oxidation, they are bound to carnitine as an acylcarnitine ester at the 3-hydroxyl, and transported across the micochondrial membranes. R,S-Carnitine has been shown to be taken up by myocytes. The author has begun a study on the use of carnitine derivatives as potential carriers for the site-specific delivery of radioiodine to bidning sites in the myocardium. Such agents labeled with a gamma-emitting nuclide such as iodine-123 would be useful for the noninvasive imaging of these tissues. The aim was to synthesize a variety of radiolabeled analogs of carnitine and acylcarnitine to address questions of transport, binding and availability for myocardial metabolism. These analogs consist of N-alkylated derivatives of carnitine, acylcarnitine esters as well as carnitine amides and ethers. One C-alkylated derivative showed interesting biodistribution, elevated myocardial uptake and competition with carnitine for binding in the myocardium

  13. Assessment of myocardial perfusion and metabolism for assessment of myocardial viability

    Beller, G.

    1996-01-01

    Identifying preserved myocardial viability in the presence of severe regional left ventricular dysfunction is becoming increasingly more important for clinical decision-making to better select those patients with coronary artery disease who will benefit most from revascularization. 201 Tl remains the most commonly employed radionuclide for detecting both ischemia and viability. A severe persistent defect with 201 Tl uptake compared to peak to improved perfusion and corresponding improved function after revascularisation. Detection of defect reversibility on 201 Tl imaging is enhanced by 'reinjection' of a second 201 Tl dose after acquisition of redistribution images. Initial and 4-hour rest/redistribution imaging has proven most usefull for detection of viability in the resting state in patients with ischemic cardiomyopathy. The greater the extent of preoperative viability, the greater is the improvement in regional and global function after revascularisation. 99 Tc sestamibi has also been demonstrated to be extracted by myocardial cells in proportion to regional blood flow in the presence of viable myocities. Although this agrnt does not redistribute after intravenous injection, its >50% uptake of the tracer implies viablility and predicts improved regional function after revascularisation. Finally positron emission tomography with 18 F fluorodeoxoglucose (FDG) is perhaps the most sensitive noninvasive imaging technique for detection of viability in stunned or hibernating myocardium. A mismatch pattern between regional flow and FDG uptake as approximately an 80-85% positive preicted value for predicting improved function in asynergic myocardial regions after revascualarisation

  14. Localization and quantification of acute myocardial infarction by myocardial perfusion tomographic imaging

    Lin Xiufang; Min Changgeng; Lin Zhihu; Ke Ruoyi

    1994-01-01

    The authors reported the result of the quantification and localization of 30 clinically confirmed acute myocardial infarction patients in comparison with that of ECG. A left ventricle model was used to correct the area calculated by the method of Bull's eye. The result indicated that the infarction area calculated by the corrected Bull's eye method correlated closely with that determined by the ECG QRS scoring method (r = 0.706, P<0.01). Myocardial infarctions of all 30 patients were detected by both ECG and myocardial perfusion tomographic imaging. The accuracy of localization of myocardial infarction by myocardial perfusion imaging was similar to that of ECG in the anterior wall, anterior septum, anterior lateral and inferior wall, but superior to that of ECG in the apex, posterior lateral, posterior septum, and posterior wall

  15. Regional myocardial metabolism in patients with acute myocardial infarction assessed by positron emission tomography

    Schwaiger, M.; Brunken, R.; Grover-McKay, M.; Krivokapich, J.; Child, J.; Tillisch, J.H.; Phelps, M.E.; Schelbert, H.R.

    1986-01-01

    Positron emission tomography has been shown to distinguish between reversible and irreversible ischemic tissue injury. Using this technique, 13 patients with acute myocardial infarction were studied within 72 hours of onset of symptoms to evaluate regional blood flow and glucose metabolism with nitrogen (N)-13 ammonia and fluorine (F)-18 deoxyglucose, respectively. Serial noninvasive assessment of wall motion was performed to determine the prognostic value of metabolic indexes for functional tissue recovery. Segmental blood flow and glucose utilization were evaluated using a circumferential profile technique and compared with previously established semiquantitative criteria. Relative N-13 ammonia uptake was depressed in 32 left ventricular segments. Sixteen segments demonstrated a concordant decrease in flow and glucose metabolism. Regional function did not change over time in these segments. In contrast, 16 other segments with reduced blood flow revealed maintained F-18 deoxyglucose uptake consistent with remaining viable tissue. The average wall motion score improved significantly in these segments (p less than 0.01), yet the degree of recovery varied considerably among patients. Coronary anatomy was defined in 9 of 13 patients: patent infarct vessels supplied 8 of 10 segments with F-18 deoxyglucose uptake, while 10 of 13 segments in the territory of an occluded vessel showed concordant decreases in flow and metabolism (p less than 0.01). Thus, positron emission tomography reveals a high incidence of residual tissue viability in ventricular segments with reduced flow and impaired function during the subacute phase of myocardial infarction. Absence of residual tissue metabolism is associated with irreversible injury, while preservation of metabolic activity identifies segments with a variable outcome.(ABSTRACT TRUNCATED AT 250 WORDS)

  16. [Myocardial perfusion imaging by digital subtraction angiography].

    Kadowaki, H; Ishikawa, K; Ogai, T; Katori, R

    1986-03-01

    Several methods of digital subtraction angiography (DSA) were compared to determine which could better visualize regional myocardial perfusion using coronary angiography in seven patients with myocardial infarction, two with angina pectoris and five with normal coronary arteries. Satisfactory DSA was judged to be achieved if the shape of the heart on the mask film was identical to that on the live film and if both films were exactly superimposed. To obtain an identical mask film in the shape of each live film, both films were selected from the following three phases of the cardiac cycle; at the R wave of the electrocardiogram, 100 msec before the R wave, and 200 msec before the R wave. The last two were superior for obtaining mask and live films which were similar in shape, because the cardiac motion in these phases was relatively small. Using these mask and live films, DSA was performed either with the continuous image mode (CI mode) or the time interval difference mode (TID mode). The overall perfusion of contrast medium through the artery to the vein was adequately visualized using the CI mode. Passage of contrast medium through the artery, capillary and vein was visualized at each phase using TID mode. Subtracted images were displayed and photographed, and the density of the contrast medium was adequate to display contour lines as in a relief map. Using this DSA, it was found that regional perfusion of the contrast medium was not always uniform in normal subjects, depending on the typography of the coronary artery.(ABSTRACT TRUNCATED AT 250 WORDS)

  17. The diagnosis of silent myocardial ischemia. Motion-Frozen (or morphing) myocardial perfusion imaging.

    Chang, Cheng; Ye, Bo; Xie, Wenhui; Zhang, Daoliang; Lei, Bei; Ye, Xiaodan

    2016-01-01

    Silent myocardial ischemia is typically defined as objective evidence of myocardial ischemia in patients without subjective ischemia symptoms. Currently, coronary artery angiography is the gold standard for diagnosis of asymptomatic coronary artery disease (CAD). Computed tomography coronary angiography (CTCA) can visually demonstrate the morphology, trend and extent of coronary stenosis and is commonly used in clinical screening of CAD. Myocardial perfusion imaging can be used not only to identify whether anatomical stenosis causes myocardial dysfunction, but to also assess the risk stratification and prognosis of myocardial disease (MD). Myocardial perfusion imaging using morphing combined with CTCA can simultaneously show the relationship between CAD and myocardial ischemia from an anatomical and functional aspect. This allows earlier diagnosis of asymptomatic CAD myocardial ischemia, accurate identification of the culprit vessels, and could prevent unnecessary interventional therapy. The 1-day dobutamine stress/resting met-hod is also one of the methods used. The combination of CTCA and the morphing technique can provide anatomical and functional information on coronary arteries at the same time, significantly improving the diagnostic sensitivity, specificity, and accuracy of MD.

  18. Regional myocardial blood flow, metabolism and function assessed noninvasively by positron emission tomography

    Schelbert, H.R.; Phelps, M.E.; Hoffman, E.; Huang, S.; Kuhl, D.E.

    1979-01-01

    Positron emission computed tomography is a new technique for the noninvasive measure of myocardial blood flow, mechanical function and, in particular, metabolism. The capability of this new study means is due to the technological innovations of the imaging device and the availability of radioactive tracers that are specific for blood flow and metabolism. The device permits recording of cross-sectional images of the left ventricular myocardium that reflect quantitatively regional tracer tissue concentrations. By employing tracer kinetic models this new technique permits the measurement of regional glucose and fatty acid metabolism of the heart. While already an important new tool for investigative studies into cardiac physiology and pathophysiology, the clinical utility of positron emission tomography remains to be defined.

  19. Regional myocardial blood flow, metabolism and function assessed noninvasively by positron emission tomography

    Schelbert, H.R.; Phelps, M.E.; Hoffman, E.; Huang, S.; Kuhl, D.E.

    1979-01-01

    Positron emission computed tomography is a new technique for the noninvasive measure of myocardial blood flow, mechanical function and, in particular, metabolism. The capability of this new study means is due to the technological innovations of the imaging device and the availability of radioactive tracers that are specific for blood flow and metabolism. The device permits recording of cross-sectional images of the left ventricular myocardium that reflect quantitatively regional tracer tissue concentrations. By employing tracer kinetic models this new technique permits the measurement of regional glucose and fatty acid metabolism of the heart. While already an important new tool for investigative studies into cardiac physiology and pathophysiology, the clinical utility of positron emission tomography remains to be defined

  20. Measurement of left ventricular ejection fraction from gated technetium-99m sestamibi myocardial images

    Boonyaprapa, S.; Ekmahachai, M.; Thanachaikun, N.; Jaiprasert, W.; Sukthomya, V.; Poramatikul, N.

    1995-01-01

    Sixty patients underwent SPET imaging with MIBI. Immediately after SPET acquisition ECG-gated 99m Tc-MIBI perfusion images were acquired using 24 planar images per R-R interval. A new method for measurement of LVEF from the ECG-gated 99m Tc-MIBI perfusion images was developed. To validate the method, LVEF derived from MIBI perfusion images was compared with that from conventional radionuclide ventriculography in all 60 patients. Forty patients had evidence of myocardial infarction and 20 had normal perfusion on MIBI imaging. There was no statistically significant difference between LVEF computed from 99m Tc-MIBI perfusion images and that from radionuclide ventriculography (r=0.7062, P 99m Tc-MIBI perfusion images can be obtained at the same time as assessment of myocardial perfusion and in the same orientation and metabolism of the myocardium, thereby permitting more accurate and realistic prognosis and diagnosis in patients with coronary artery disease. (orig.)

  1. Technetium-99m-pyrophosphate myocardial imaging in unstable angina

    Willerson, J.T.; Parkey, R.W.; Lewis, S.E.; Buja, L.M.; Bonte, F.J.

    1980-01-01

    The authors have found that approximately one third of patients with the syndrome of unstable angina pectoris have abnormal 99mTc-pyrophosphate myocardial scintigrams even in the absence of abnormal enzymes and electrocardiographic confirmation of the presence of acute myocardial necrosis. Thus, 99mTc-pyrophosphate myocardial imaging technique appears to represent a sensitive means to detect acute multicellular injury associated with the clinical syndrome of unstable angina pectoris even when cardiac enzymes are normal and the electrocardiogram does not definitively document the presence of acute myocardial necrosis. (Auth.)

  2. In vivo metabolic phenotyping of myocardial substrate metabolism in rodents: differential efficacy of metformin and rosiglitazone monotherapy.

    Shoghi, Kooresh I; Finck, Brian N; Schechtman, Kenneth B; Sharp, Terry; Herrero, Pilar; Gropler, Robert J; Welch, Michael J

    2009-09-01

    Cardiovascular disease is the leading cause of death among diabetic patients, with alteration in myocardial substrate metabolism being a likely contributor. We aimed to assess noninvasively the efficacy of metformin and rosiglitazone monotherapy in normalizing myocardial substrate metabolism in an animal model of type 2 diabetes mellitus. The study used 18 male ZDF rats (fa/fa) with 6 rats in each group: an untreated group; a group treated with metformin (16.6 mg/kg/d), and a group treated with rosiglitazone (4 mg/kg). Each rat was scanned at age 14 weeks (baseline) and subsequently at 19 weeks with small-animal positron emission tomography to estimate myocardial glucose utilization (MGU) and myocardial utilization (MFAU), oxidation (MFAO), and esterification (MFAE). Treatment lasted for 5 weeks after baseline imaging. At week 19, rats were euthanized and hearts were extracted for expression analysis of select genes encoding for GLUT transporters and fatty acid transport and oxidation genes. In addition, echocardiography measurements were obtained at weeks 13 and 18 to characterize cardiac function. Metformin had no significant effect on either MGU or MFAU and MFAO. In contrast, rosiglitazone tended to enhance MGU and significantly reduced MFAU and MFAO. Rosiglitazone-induced increase in glucose uptake correlated significantly with increased expression of GLUT4, whereas diminished MFAO correlated significantly with decreased expression of FATP-1 and MCAD. Finally, changes in fractional shortening as a measure of cardiac function were unchanged throughout the study. Treatment with rosiglitazone enhanced glucose utilization and diminished MFAO, thus reversing the metabolic phenotype of the diabetic heart.

  3. Noninvasive measurement of regional myocardial glucose metabolism by positron emission computed tomography

    Schelbert, H.R.; Phelps, M.E.

    While the results of regional myocardial glucose metabolism measurements using positron emission computed tomography ( 13 N-ammonia) are promising, their utility and value remains to be determined in man. If this technique can be applied to patients with acute myocardial ischemia or infarction it may permit delineation of regional myocardial segments with altered, yet still active metabolism. Further, it may become possible to evaluate the effects of interventions designed to salvage reversibly injured myocardium by this technique

  4. The expression of myocardial injury in cold induced myocardial imaging and echocardiography of systematic scleroderma

    Liang Jiugen; Zhu Xiaojun; Jiang Ningyi; Chen Shaoxiong

    1999-01-01

    The study was performed with cold-induced 99m Tc(MIBI) myocardial imaging (MI) in 23 patients with systematic scleroderma. The left ventricular function and wall motion were also observed by dimensional echocardiography (UCG). 14 patients had myocardial perfusion abnormalities visualized by MI, including 5 cases with fixed defects of 9 segments, 3 cases with reversible defects of 6 segments and 6 cases with both fixed and reversible one of 14 segments. The positive rate in myocardial imaging had no significant differences between patients with and without Raynaud's phenomenon (0.5>P>0.25). Compared with baseline, the ejection fraction, stroke volume, cardiac output were significantly decreased during cold-induced in patients with abnormal myocardial scintigraphy (P<0.05), and had significant difference compared with normal group (P<0.05). 4 cases with cold-induced reversible perfusion defects had anatomically correlated regional ventricular hypokinesia in UCG

  5. Radioiodinated free fatty acids; can we measure myocardial metabolism

    Visser, F.C.; Eenige, M.J. van; Duwel, C.M.B.; Roos, J.P.

    1986-01-01

    To investigate the feasibility of radioiodinated free fatty acids for ''metabolic imaging'', the kinetics and distribution pattern of metabolites of heptadecanoic acid I 131 (HDA I 131) were studied in canine myocardium throughout metabolic interventions. In control dogs and in dogs during glucose/insulin and sodium lactate infusion, biopsy specimens were taken during a go-min period after HDA I 131 administration and analyzed. Clearly distinct patterns of distribution and elimination were seen during the metabolic interventions, indicating the usefulness of iodinated fatty acids for metabolic studies. (orig.)

  6. Investigation of 18F-2-deoxyglucose for the measure of myocardial glucose metabolism

    Phelps, M.E.; Hoffman, E.J.; Selin, C.; Huang, S.C.; Robinson, G.; MacDonald, N.; Schelbert, H.R.; Kuhl, D.E.

    1977-01-01

    18 F labeled 2-deoxyglucose ( 18 FDG) was studied as a glucose analog. Myocardial uptake and retention, blood clearance, species (dog, monkey, man) dependence and effect of diet on uptake were investigated. Normal myocardial uptake of 18 FDG was 3 to 4% in dog and monkey and 1 to 4% of injected dose in man compared to brain uptake of 2% in dog, 5 to 6% in monkey and 4 to 8% in man. The metabolic rate (MR) for glucose in non-fasting (glycolytic state) was 2.8 times greater than in fasting (ketogenic state). Human subjects showed higher myocardial uptake after a normal meal than after meal containing mostly free fatty acids (FFA). Blood clearance was rapid with initial clearance t 1 / 2 of 0.2 to 0.3 min followed by a t 1 / 2 of 8.4 +- 1.2 min in dog and 11.6 +- 1.1 min in man. A small third component had a t 1 / 2 of 59 +- 10 min and 88 +- 4 min in dog and man, respectively. High image contrast ratios between heart and blood (dog 3.5/1; man 14/1), heart and lung (dog 9/1; man 20/1), heart and liver (dog 15/1; man 10/1) were found with the ECAT positron tomograph. 18 FDG was found to be rapidly taken up by the myocardium without any significant tissue clearance over a 4 hour period. 18 FDG is transported, phosphorylated to 18 FDG-6-PO 4 and trapped in myocardial cells in the same manner as has been found for brain and exhibits excellent imaging properties. Determination of glucose and FFA MR in vivo with ECT provides a method for investigation and assessment of changing aerobic and anaerobic metabolic rates in ischemic heart disease in man

  7. L-[4-11C]aspartic acid: enzymatic synthesis, myocardial uptake, and metabolism

    Barrio, J.R.; Egbert, J.E.; Henze, E.; Schelbert, H.R.; Baumgartner, F.J.

    1982-01-01

    Sterile, pyrogen-free L-[4- 11 C]aspartic acid was prepared from 11 CO 2 using phosphoenolpyruvate carboxylase and glutamic/oxaloacetic acid transaminase immobilized on Sepharose supports to determine if it is a useful indicator for in vivo, noninvasive determination of myocardial metabolism. An intracoronary bolus injection of L-[4- 11 C]aspartic acid into dog myocardium showed a triexponential clearance curve with maximal production of 11 CO 2 100 s after injection. Inactivation of myocardial transaminase activity modified the tracer clearance and inhibited the production of 11 CO 2 . Positron-computed tomography imaging showed that the 11 C activities retained in rhesus monkey myocardium are higher than those observed in dog heart after intravenous injection of L-[4- 11 C]aspartic acid. These findings demonstrated the rapid incorporation of the carbon skeleton of L-aspartic acid into the tricarboxylic acid cycle after enzymatic transamination in myocardium and suggested that L-[4- 11 C]aspartic acid could be of value for in vivo, noninvasive assessment of local myocardial metabolism

  8. Effects of human immunodeficiency virus and metabolic complications on myocardial nutrient metabolism, blood flow, and oxygen consumption: a cross-sectional analysis

    Cade W Todd

    2011-12-01

    Full Text Available Abstract Background In the general population, peripheral metabolic complications (MC increase the risk for left ventricular dysfunction. Human immunodeficiency virus infection (HIV and combination anti-retroviral therapy (cART are associated with MC, left ventricular dysfunction, and a higher incidence of cardiovascular events than the general population. We examined whether myocardial nutrient metabolism and left ventricular dysfunction are related to one another and worse in HIV infected men treated with cART vs. HIV-negative men with or without MC. Methods Prospective, cross-sectional study of myocardial glucose and fatty acid metabolism and left ventricular function in HIV+ and HIV-negative men with and without MC. Myocardial glucose utilization (GLUT, and fatty acid oxidation and utilization rates were quantified using 11C-glucose and 11C-palmitate and myocardial positron emission tomography (PET imaging in four groups of men: 23 HIV+ men with MC+ (HIV+/MC+, 42 ± 6 yrs, 15 HIV+ men without MC (HIV+/MC-, 41 ± 6 yrs, 9 HIV-negative men with MC (HIV-/MC+, 33 ± 5 yrs, and 22 HIV-negative men without MC (HIV-/MC-, 25 ± 6 yrs. Left ventricular function parameters were quantified using echocardiography. Results Myocardial glucose utilization was similar among groups, however when normalized to fasting plasma insulin concentration (GLUT/INS was lower (p Conclusion Men with metabolic complications, irrespective of HIV infection, had lower basal myocardial glucose utilization rates per unit insulin that were related to left ventricular diastolic impairments, indicating that well-controlled HIV infection is not an independent risk factor for blunted myocardial glucose utilization per unit of insulin. Trial Registration NIH Clinical Trials NCT00656851

  9. Myocardial imaging with thallium-201: an experimental model for analysis of the true myocardial and background image components

    Narahara, K.A.; Hamilton, G.W.; Williams, D.L.; Gould, K.L.

    1977-01-01

    The true myocardial and background components of a resting thallium-201 myocardial image were determined in an experimental dog model. True background was determined by imaging after the heart had been removed and replaced with a water-filled balloon of equal size and shape. In all studies, the background estimated from the region surrounding the heart exceeded true background activity. Furthermore, the relationship between true myocardial background and that estimated from the pericardiac region was inconsistent. Background estimates based on the activity surrounding the heart were not accurate predictors of true background activity

  10. Gadolinium-enhanced magnetic resonance imaging in acute myocardial infarction

    Dijkman, P.R.M. van; Wall, E.E. van der; Roos, A. de; Doornbos, J.; Laarse, A. van der; Voorthuisen, A.E. van; Bruschke, A.V.G.; Rossum, A.C. van

    1990-01-01

    To evaluate he usefulness of the paramagnetic contrast agent Gadolinium-DTPA (diethylenetriaminepentaacetic acid) in Magnetic Resonance. Imaging of acute myocardial infarction, we studied a total of 45 patients with a first acute myocardial infarction by ECG-gated magnetic resonance imaging before and after intravenous administration of 0.1 mmol/kg Gadolinium-DTPA. All patients received thrombolytic treatment by intravenous streptokinase. The magnetic resonance imaging studies were preformed after a meam of 88 h (range 15-241) after the acute onset of acute myocardial infarction. Five patients without evidence of cardiac disease served as controls. Spin-echo measurements (TE 30 ms) were made using a Philips Gyroscan (0.5 Tesla) or a Teslacon II (0.6 Tesla). The 45 patients were divided into four groups of patients. In Group I( patients) Gadolinium-DTPA improved the detection of myocardial infarction by Gadolinium-DTPA. In Group II (20 patients) the magnetic resonance imaging procedure was repeated every 10 min for up to 40 min following administration of Gadolinium-DTPA. Optimal contrast enhancement was obtained 20-25 min after Gadolinium-DTPA. In Group III (27 patients) signal intensities were significantly higher in the patients who underwent the magnetic resonance imaging study more than 72 h (mean 120) after the acute event, suggesting increased acculumation of Gadolinium-DTPA in a more advanced stage of the infarction process. In Group IV (45 patients) Gadolinium-DTPA was administered in an attempt to distinguish between reperfused and nonreperfused myocardial areas after thrombolytic treatment for acute myocardial infarction. The signal intensities did not differ, but reperfused areas showed a more homogeneous aspect whereas nonreperfused areas were visualized as a more heterogeneous contrast enhancement. It is concluded that magnetic resonance imaging using the contrast agent Gadolinium-DTPA significantly improves the detection of infarcted myocardial areas

  11. Myocardial images in nonacute coronary and noncoronary heart diseases

    Poe, N.D.; Eber, L.M.; Norman, A.S.; Selin, C.E.; Terao, E.N.

    1977-01-01

    To determine the variables that might affect interpretability of myocardial perfusion images in patients with acute myocardial infarctions, images obtained following intravenous administration of potassium-43 or cesium-129 were evaluated in 68 patients with nonacute coronary or noncoronary heart diseases, who were undergoing cardiac catheterization. Severe coronary arterial disease usually produces no distinctive perfusion defects in the resting state. Remote infarcts likewise tend to remain undetectable unless accompanied by wall-motion disturbances that can be detected by ventriculography. Left ventricular hypertrophy or cardiac dilatation can produce perfusion patterns indistinguishable from the ischemic defects of infarction. Right ventricular hypertrophy can cause image alterations that mimic infarcts in the left ventricle. In patients with acute myocardial infarction, sequential imaging studies with perfusion indicators should be of value in determining the effects of various therapeutic maneuvers on regional myocardial perfusion, but variations caused by conditions other than acute vascular occlusion limit the usefulness of perfusion imaging for diagnosing acute infarction. In suspected acute infarction, perfusion imaging will be used most effectively in conjunction with other imaging or nonimaging procedures that show the presence of damaged or necrotic myocardium. The information derived from this study should be generally applicable to the interpretation of imaging results obtained with the newer indicators of myocardial perfusion now in use or under development

  12. Parallel imaging for first-pass myocardial perfusion

    Irwan, Roy; Lubbers, Daniel D.; van der Vleuten, Pieter A.; Kappert, Peter; Gotte, Marco J. W.; Sijens, Paul E.

    Two parallel imaging methods used for first-pass myocardial perfusion imaging were compared in terms of signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR) and image artifacts. One used adaptive Time-adaptive SENSitivity Encoding (TSENSE) and the other used GeneRalized Autocalibrating

  13. Usefulness of myocardial parametric imaging to evaluate myocardial viability in experimental and in clinical studies.

    Korosoglou, G; Hansen, A; Bekeredjian, R; Filusch, A; Hardt, S; Wolf, D; Schellberg, D; Katus, H A; Kuecherer, H

    2006-03-01

    To evaluate whether myocardial parametric imaging (MPI) is superior to visual assessment for the evaluation of myocardial viability. Myocardial contrast echocardiography (MCE) was assessed in 11 pigs before, during, and after left anterior descending coronary artery occlusion and in 32 patients with ischaemic heart disease by using intravenous SonoVue administration. In experimental studies perfusion defect area assessment by MPI was compared with visually guided perfusion defect planimetry. Histological assessment of necrotic tissue was the standard reference. In clinical studies viability was assessed on a segmental level by (1) visual analysis of myocardial opacification; (2) quantitative estimation of myocardial blood flow in regions of interest; and (3) MPI. Functional recovery between three and six months after revascularisation was the standard reference. In experimental studies, compared with visually guided perfusion defect planimetry, planimetric assessment of infarct size by MPI correlated more significantly with histology (r2 = 0.92 versus r2 = 0.56) and had a lower intraobserver variability (4% v 15%, p < 0.05). In clinical studies, MPI had higher specificity (66% v 43%, p < 0.05) than visual MCE and good accuracy (81%) for viability detection. It was less time consuming (3.4 (1.6) v 9.2 (2.4) minutes per image, p < 0.05) than quantitative blood flow estimation by regions of interest and increased the agreement between observers interpreting myocardial perfusion (kappa = 0.87 v kappa = 0.75, p < 0.05). MPI is useful for the evaluation of myocardial viability both in animals and in patients. It is less time consuming than quantification analysis by regions of interest and less observer dependent than visual analysis. Thus, strategies incorporating this technique may be valuable for the evaluation of myocardial viability in clinical routine.

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

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

    1993-01-01

    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)

  15. Early diagnosis of interferon-induced myocardial disorder in patients with chronic hepatitis C. Evaluation by myocardial imaging with {sup 123}I-BMIPP

    Kondo, Yuki; Yukinaka, Michiko; Nomura, Masahiro; Nakaya, Yutaka; Ito, Susumu [Tokushima Univ. (Japan). School of Medicine

    2000-02-01

    Interferon (IFN) therapy for chronic hepatitis C is sometimes associated with cardiac complications. In the present study, we performed myocardial imaging with {sup 123}I-labeled {beta}-methyl-p-iodophenylpentadecanoic acid ({sup 123}I-BMIPP) in order to evaluate myocardial disorders caused by IFN. We studied 40 healthy subjects (H group) and 25 patients with chronic hepatitis C who had been treated with IFN (IFN group). A Holter electrocardiogram (ECG) was performed and the autonomic nervous function was assessed by analyzing the spectral variability and 1/f fluctuation of heart rate. Myocardial planner imaging with {sup 123}I-BMIPP was performed to obtain the time activity curve for 20 min immediately after administration of {sup 123}I-BMIPP (dynamic study). Early and delayed myocardial single photon emission computed tomography (SPECT) images were expressed as Bull's eyes and the myocardium was divided into four segments to calculate the washout rate for each segment on early and late SPECT images (early and late SPECT study). No significant differences in autonomic nervous function were observed between the two groups in heart rate variability. In a dynamic study, the reduction rate from the time activity curve was significantly higher in the IFN group compared with the H group (reduction rate, IFN group, 5.3{+-}3.7% vs H group, 1.2{+-}3.3%; P<0.05). In the early and delayed myocardial SPECT study, the washout rate for the IFN group was significantly increased in all myocardial areas compared to that in the H group. However, the metabolic disorder of fatty acids caused by IFN was reversed on the second {sup 123}I-BMIPP myocardial scintigraphy examination several months after IFN therapy. These results indicate that metabolic disorders of fatty acids caused by IFN therapy can be detected before abnormalities are observed by Holter-ECG or echocardiography. (author)

  16. The characteristics of myocardial fatty acid metabolism in patients with left ventricular hypertrophy

    Isobe, Naoki; Toyama, Takuji; Hoshizaki, Hiroshi

    1999-01-01

    We evaluated the characteristics of myocardial fatty acid metabolism in patients with left ventricular hypertrophy (LVH). Myocardial imaging with 123 I-beta-methyl iodophenyl pentadecanoic acid (BMIPP) was performed in 28 patients with hypertrophic cardiomyopathy (HCM), 15 patients with hypertensive heart disease (HHD), 13 patients with aortic stenosis (AS) and 8 normal controls (NC). The patients with HCM consisted of 13 patients of asymmetric septal hypertrophy (ASH), 7 patients of diffuse hypertrophy (Diffuse-HCM) and 8 patients of apical hypertrophy (APH). Planar and SPECT images of BMIPP were acquired 15 minutes and 4 hours after tracer injection. Resting 201 Tl SPECT images and echocardiography were also performed on other days. We calculated heart/mediastinum count ratio and washout rate of BMIPP by using planar image. In patients with LVH, the incidence of reduced BMIPP uptake was more frequent than that of reduced 201 Tl uptake. In delayed images, more than 60% of patients with LVH reduced BMIPP uptake, especially remarkable for patients with ASH and APH. The washout rate of all cardiac hypertrophic disorders was tended to be higher than that of normal subjects. Reduced BMIPP uptake was frequently found in septal portion of anterior and inferior wall in patients with ASH, in inferior wall in patients with Diffuse-HCM and HHD, in apex in patients with APH and AS. These results suggest that BMIPP scintigraphy can differentiate three types of cardiac hypertrophy. (author)

  17. Automatic extraction of left ventricle in SPECT myocardial perfusion imaging

    Liu Li; Zhao Shujun; Yao Zhiming; Wang Daoyu

    1999-01-01

    An automatic method of extracting left ventricle from SPECT myocardial perfusion data was introduced. This method was based on the least square analysis of the positions of all short-axis slices pixels from the half sphere-cylinder myocardial model, and used a iterative reconstruction technique to automatically cut off the non-left ventricular tissue from the perfusion images. Thereby, this technique provided the bases for further quantitative analysis

  18. Creatine Depletion and Altered Fatty Acid Metabolism in Diseased Human Hearts: Clinical Investigation Using 1H Magnetic Resonance Spectroscopy and 123I BMIPP Myocardial Scintigraphy

    Nakae, I.; Mitsunami, K.; Matsuo, S.; Horie, M.

    2007-01-01

    Background: In the heart, the creatine kinase system plays an important role in energy reserves, and myocardial energy production essentially depends upon fatty acid metabolism. Purpose: To examine myocardial creatine (CR) concentration and altered cardiac fatty acid metabolism in various forms of heart disease. Material and Methods: Myocardial CR concentration of the septum was measured by gated 1 H magnetic resonance spectroscopy (MRS), applying a point-resolved spectroscopy (PRESS) sequence in 34 patients with heart disease. Of these patients, 14 underwent 123 I BMIPP (radioactive fatty acid analogue) myocardial scintigraphy to evaluate myocardial fatty acid metabolism. Cardiac 123 I BMIPP uptake was calculated as the heart-to-mediastinum count ratio. Results: Myocardial CR concentration correlated positively with the left ventricular ejection fraction (LVEF) by echocardiography (R = 0.61, P 123 I BMIPP uptake also correlated positively with LVEF (initial image, R 0.60, P 123 I BMIPP uptake (initial image, R = 0.77, P<0.01; delayed image, R = 0.82, P<0.001; n = 14). Conclusion: Our study suggests an association between CR depletion and impaired fatty acid metabolism in various forms of heart diseases

  19. MRS algorithm: a new method for searching myocardial region in SPECT myocardial perfusion images.

    He, Yuan-Lie; Tian, Lian-Fang; Chen, Ping; Li, Bin; Mao, Zhong-Yuan

    2005-10-01

    First, the necessity of automatically segmenting myocardium from myocardial SPECT image is discussed in Section 1. To eliminate the influence of the background, the optimal threshold segmentation method modified for the MRS algorithm is explained in Section 2. Then, the image erosion structure is applied to identify the myocardium region and the liver region. The contour tracing method is introduced to extract the myocardial contour. To locate the centriod of the myocardium, the myocardial centriod searching method is developed. The protocol of the MRS algorithm is summarized in Section 6. The performance of the MRS algorithm is investigated and the conclusion is drawn in Section 7. Finally, the importance of the MRS algorithm and the improvement of the MRS algorithm are discussed.

  20. 201Tl myocardial imaging in patients with pulmonary hypertension

    Cohen, H.A.; Baird, M.G.; Rouleau, J.R.; Fuhrmann, C.F.; Bailey, I.K.; Summer, W.R.; Strauss, H.W.; Pitt, B.

    1976-01-01

    The appearance of the right ventricular myocardium on thallium 201 myocardial perfusion images was evaluated in patients with chronic pulmonary hypertension and compared to patients without pulmonary hypertension. Four groups of patients were studied: (1) eight normals, (2) five patients with angiographically documented coronary artery disease and normal pulmonary artery pressures, (3) ten patients with moderate to severe pulmonary parenchymal or vascular disease and documented pulmonary hypertension and (4) eight patients with chronic left ventricular dysfunction and pulmonary hypertension discovered during cardiac catheterization. The right ventricular free wall was visualized on the thallium 201 myocardial perfusion image in only one of eight normals (group 1) and in only one of the five patients with coronary artery disease (group 2) and measured 0.5 cm and 0.9 cm in thickness, respectively. In patients with documented pulmonary hypertension the right ventricle was visualized on low contrast thallium 201 myocardial perfusion image in all patients. The apparent right ventricular free wall thickness measured from the ungated thallium 201 myocardial perfusion images was 1.7 +- 0.3 cm in group 3 and 1.5 +- 0.2 cm in group 4. Right ventricular hypertrophy was detected by electrocardiography in only five of ten patients in group 3 and only one of eight patients in group 4. Thallium 201 myocardial perfusion imaging appears to be a useful technique for assessing the effects of chronic pulmonary hypertension on the right ventricular myocardium

  1. Detecting Myocardial Ischemia With 99mTechnetium-Tetrofosmin Myocardial Perfusion Imaging in Ischemic Stroke.

    Giannopoulos, Sotirios; Markoula, Sofia; Sioka, Chrissa; Zouroudi, Sofia; Spiliotopoulou, Maria; Naka, Katerina K; Michalis, Lampros K; Fotopoulos, Andreas; Kyritsis, Athanassios P

    2017-10-01

    To assess the myocardial status in patients with stroke, employing myocardial perfusion imaging (MPI) with 99m Technetium-tetrofosmin ( 99m Tc-TF)-single-photon emission computed tomography (SPECT). Fifty-two patients with ischemic stroke were subjected to 99m Tc-TF-SPECT MPI within 1 month after stroke occurrence. None of the patients had any history or symptoms of coronary artery disease or other heart disease. Myocardial perfusion imaging was evaluated visually using a 17-segment polar map. Myocardial ischemia (MIS) was defined as present when the summed stress score (SSS) was >4; MIS was defined as mild when SSS was 4 to 8, and moderate/severe with SSS ≥9. Patients with SSS >4 were compared to patients with SSS SSS >9 were compared to patients with SSS SSS, with the oldest age exhibiting the highest SSS ( P = .01). The association of age with SSS remained statistically significant in the multivariate analysis ( P = .04). The study suggested that more than half of patients with stroke without a history of cardiac disease have MIS. Although most of them have mild MIS, we suggest a thorough cardiological evaluation in this group of patients for future prevention of severe myocardial outcome.

  2. Fatty acid myocardial imaging using 123I-β-methyl iodophenyl pentadecanoic acid (BMIPP)

    Nishimura, Tsunehiko; Sago, Masayoshi; Kihara, Koichi

    1988-01-01

    To evaluate myocardial perfusion and fatty acid metabolism in canine myocardial infarction (occlusion and reperfusion model), 16 dogs were studied using thallium and 123 I-β-methyliodophenyl pentadecanoic acid (BMIPP). There were 2 dogs with normal control, 8 dogs with left anterior coronary arterial occlusion (6 hr ligation) and 6 dogs with reperfusion (3 hr ligation and 1 hr reperfusion). BMIPP was considered as an excellent myocardial imaging agent, because of its higher uptake and longer retention in myocardium. Reperfused myocardium demonstrated marked prolongation of mean half-time value which was generated from BMIPP myocardial clearance curve. The gammacamera imaging of the excised heart showed the uncoupling of BMIPP and thallium (BMIPP uptake greater than thallium) in 5 of 6 dogs. On the other hand, BMIPP and thallium had persistent defect at occluded myocardium. These uncoupling at reperfused myocardium may be caused by the increase of triglyceride content. Our data suggests that the combination of BMIPP and thallium may supply different information about zone of infarction and ischemia and should be performed in clinical study for the assessment of myocardial viability. (author)

  3. A serial changes of thallium-201 myocardial images in a patient with nontransmural myocardial infarction

    Tanaka, Takeshi; Itoh, Yukiyoshi; Takayama, Yasuo

    1986-01-01

    A 66 year old man had suffered from inferior myocardial infarction one year ago and then suffered from effort angina. Recently rest angina attack frequently occurred and he was admitted because of angina attack refractory to TNG. The patient was diagnosed as broad nontransmural infarction. A serial thallium-201 myocardial imagings at rest and thallium-201 lung uptake imagings were performed and some interesting findings were obtained as followings. Myocardial imagings on 3rd day after admission showed no significant deffect, however EF was 34 %. Immediately after severe ischemic attack marked defect was noted at posterolateral region and ECG showed prominent precordial ST depression without accompanying significant ST change in II, III, aVF. On 3rd day after severe attack under hemodynamically and electrocardiographically stable state posterolateral defect improved, though still persisted. EF was 28 %. On 3rd day postop no marked defects were noted in myocardial imagings, so posterolateral defect at rest after severe ischemic attack was proved to be transient defect. In this case thallium-201 lung uptake was not noted before attack. Immediately after severe attack thallium lung uptake increased and maximal uptake was noted at basal zone of lung, however in chest X-P typical butterfly shadow was noted at upper zone of lung. On 3rd day after severe attack hemodynamics improved and butterfly shadow ceased, though thallium lung uptake increased and noted at upper zone of lung. After operation thallium lung uptake improved. (J.P.N.)

  4. Imaging metabolic heterogeneity in cancer.

    Sengupta, Debanti; Pratx, Guillem

    2016-01-06

    As our knowledge of cancer metabolism has increased, it has become apparent that cancer metabolic processes are extremely heterogeneous. The reasons behind this heterogeneity include genetic diversity, the existence of multiple and redundant metabolic pathways, altered microenvironmental conditions, and so on. As a result, methods in the clinic and beyond have been developed in order to image and study tumor metabolism in the in vivo and in vitro regimes. Both regimes provide unique advantages and challenges, and may be used to provide a picture of tumor metabolic heterogeneity that is spatially and temporally comprehensive. Taken together, these methods may hold the key to appropriate cancer diagnoses and treatments in the future.

  5. Impact of glucagon-like peptide-1 on myocardial glucose metabolism revisited

    Hansen, Jan; Brock, Birgitte; Bøtker, Hans Erik

    2014-01-01

    . The potentially beneficial effect of GLP-1 stimulation may rely on, among others, improved myocardial glucose metabolism. This review focuses on the dogma that GLP-1 receptor stimulation may provide beneficial cardiovascular effects, possibly due to enhanced myocardial energetic efficiency, by increasing...

  6. CT myocardial perfusion imaging. Ready for prime time?

    Takx, Richard A.P.; Celeng, Csilla [University Medical Center Utrecht, Department of Radiology, Utrecht (Netherlands); Schoepf, U.J. [Medical University of South Carolina, Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Charleston, SC (United States); Medical University of South Carolina, Ashley River Tower, Heart and Vascular Center, Charleston, SC (United States)

    2018-03-15

    The detection of functional coronary artery stenosis with coronary CT angiography (CCTA) is suboptimal. Additional CT myocardial perfusion imaging (CT-MPI) may be helpful to identify patients with myocardial ischaemia in whom coronary revascularization therapy would be beneficial. CT-MPI adds incremental diagnostic and prognostic value over obstructive disease on CCTA. It allows for the quantitation of myocardial blood flow and calculation of coronary flow reserve and shows good correlation with {sup 15}O-H{sub 2}O positron emission tomography and invasive fractional flow reserve. In addition, patients prefer CCTA/CT-MPI over SPECT, MRI and invasive coronary angiography. CT-MPI is ready for clinical use for detecting myocardial ischaemia caused by obstructive disease. Nevertheless, the clinical utility of CT-MPI to identify ischaemia in patients with non-obstructive/microvascular disease still has to be established. (orig.)

  7. Myocardial hipertrophy in hypertensive patients with and without metabolic syndrome

    Ivanović Branislava

    2008-01-01

    Full Text Available Background/Aim. Beside arterial hypertension as the most important factor of a myocardial hypertension development, very important risk factors are obesity, hypercholesterolemia, insulin resistance, etc. The aim of the study was to examine the influence of metabolic syndrome (MetS on left ventricular hypertrophy in patients with arterial hypertension. Methods. We checked medical records for 138 patients with arterial hypertension, and compared them with the control group of 44 normotensive subjects. The patients with arterial hypertension were divided into two groups considering the presence of MetS: with MetS (59 patients, and without MetS (79 patients. We defined MetS as presence of three (or more within five criteria: central obesity (> 102 cm male, > 88 cm female, raised triglycerides (> 1.7 mmol/L, or drug treatment for elevated triglycerides, reduced high density lipoprotein (HDL cholesterol (< 1.03 mmol/L male, < 1.3 mmol/L female, raised blood pressure (> 130 mmHg systolic, > 90 mmHg diastolic, raised fasting glucose (> 6.11 mmol/L, or drug treatment for elevated glucose level. In each group routine laboratory, echocardiography and 24-hour ambulatory blood pressure monitoring were performed. Results. We found statisticaly significant higher left ventricular mass in both subgroups hypertensive patients in comparison with the control group (p < 0.05. We did not find statistically significant difference (227.31±63.44 vs 219±59.5, p > 0.05 in left ventricular mass between these two groups of patients. In the patients with arterial hypertension and MetS we found hypertrophy more frequently than in the subgroup without MetS (43/57 vs 34/69, p < 0.001. Conclusion. Our results suggest that associated cardiometabolic risks increase the prevalence of myocardial hypertrophy, but do not influence left ventricular mass.

  8. Myocardial imaging in acute myocardial infarction using β-methyl-p-(123I)-iodophenylpentadecanoic acid

    Naruse, Hitoshi; Itano, Midoriko; Kondo, Tomohiro

    1992-01-01

    Myocardial imaging using β-methyl-p-( 123 I)-iodophenylpentadecanoic acid (BMIPP) was performed in 11 patients with acute myocardial infarction. The left ventricular images were divided into 12 segments, and myocardial images with BMIPP were compared with coronary angiography (CAG), thallium-201 myocardial scintigraphy (Tl) and wall motion obtained by two-dimensional echocardiography (WM). When the culprit lesion was at the proximal point of the left anterior descending artery (LAD), all segments showed depressed uptake. In 3 cases with single vessel disease of the LAD, inferior wall of the basis showed reduced uptake of BMIPP despite the location of the culprit lesion. In cases with discordant uptake between the two tracers, BMIPP frequently showed more severely depressed uptake than Tl in the subacute phase, although the uptake of BMIPP correlated with that of Tl (τ=0.82, p<0.001). In such cases, the discordance was related to the improvement in WM from the acute phase to the convalescent phase. BMIPP uptake correlated with WM in the subacute phase (τ=0.50, p<0.001). BMIPP showed more severely depressed uptake while WM showed mild asynergy in most cases in which discordance was found between the BMIPP and WM findings. However, there was no correlation between the change in WM from the acute to subacute phases, or the uptakes of BMIPP and Tl alone. We concluded that the myocardial condition can be evaluated in detail in acute myocardial infarction by comparing the findings of BMIPP with those of Tl and WM. (author)

  9. 5 years prognostic value of dipyridamole-thallium myocardial imaging

    Yang Yifeng; Qian Zhonghao; Jiang Changying

    1993-01-01

    A prognostic study of dipyridamole-thallium myocardial imaging was conducted with the use of logistic regression. Over a 5 years follow-up period, cardiac events occurred in 13 patients within the 41 patients tested, death in 5 and myocardial infarction in 8. The results of this study indicates that dipyridamole-thallium imaging has significant prognostic utility and that an abnormal scan increased the relative risk for the development of subsequent myocardial infarction or cardiac death (O.R. 18.54). The presence of transient multiple thallium defects further increased the risk of a cardiac event. In conclusion , intravenous dipyridamole thallium imaging is a potentially useful diagnostic test to determine the presence and severity of coronary diseases, and this noninvasive method is also beneficial for prognosis

  10. Usefulness of 123I-BMIPP myocardial imaging in patients with stable effort angina and unstable angina

    Inoue, Seiji; Kobayashi, Hideki; Oka, Toshiaki; Kawaguchi, Masao; Momose, Mitsuru; Kasanuki, Hiroshi; Kusakabe, Kiyoko; Hosoda, Saichi

    1995-01-01

    We evaluated the clinical significance of myocardial imaging using 123 I-15-(p-iodophenyl)-3-methyl pentadecanoic acid (BMIPP) scintigraphy in patients with stable effort angina pectoris (SAP) and unstable angina pectoris (UAP). Thirty-three patients with SAP were studied using rest BMIPP and stress 201 TlCl (Tl) myocardial scintigraphy, and 13 patients with worsening effort type of UAP were also examined using both rest BMIPP and Tl scintigraphy. We compared those BMIPP findings with myocardial perfusion images obtained with Tl and the regional wall motion determined by left ventriculography. In 45% of 282 segments of myocardial ischemia of SAP, the degree of myocardial uptake of BMIPP was concordant with that of stress Tl and the defect score of Tl was higher than that of BMIPP. On the other hand, in 32% of 62 segments of ischemia of UAP, the degree of myocardial BMIPP and Tl uptake was concordant and BMIPP defect score was higher than Tl score. In SAP, the decrease in regional wall motion agreed better with the decrease in myocardial uptake of BMIPP than that of Tl. These results suggest that myocardial ischemic regions decreased BMIPP uptake show the disturbance of fatty acid metabolism and lead to abnormal wall motions. Such ischemic regions may be clinically severe state in patients with angina pectoris. (author)

  11. Evaluation of myocardial involvement in Duchenne progressive muscular dystrophy with thallium-201 myocardial perfusion imaging

    Kawai, Naoki; Yamamoto, Shuhei; Okada, Mitsuhiro (Nagoya Univ. (Japan). Faculty of Medicine)

    1983-12-01

    Myocardial involvement in progressive muscular dystrophy of the Duchenne type was evaluated in 19 patients using thallium-201 myocardial perfusion imaging. The qualitative analysis was performed in anterior, 3 left anterior oblique and left lateral projection images by three experienced physicians. Distinct perfusion defects were shown in 13 patients, especially in LV posterolateral or posterior walls (11 patients). There was no significant relationship between the presence of perfusion defects and the skeletal muscle changes or thoracic deformities assessed by transmission computed tomography. Slightly increased thallium-201 activity in RV free wall and lungs was shown in nine and one patient, respectively. The extensive perfusion defects were shown in 2 patients who died of congestive heart failure 1 to 2 years after the scintigraphic study. The myocardial scintigraphic changes were considered to be minimal in 7 of 9 patients who underwent two serial scintigraphic studies in 2 to 3 years. It was concluded that the thallium myocardial perfusion imaging was a useful clinical technique to evaluate the cardiomyopathy in Duchenne progressive muscular dystrophy.

  12. Evaluation of myocardial involvement in Duchenne progressive muscular dystrophy with thallium-201 myocardial perfusion imaging

    Kawai, Naoki; Yamamoto, Shuhei; Okada, Mitsuhiro

    1983-01-01

    Myocardial involvement in progressive muscular dystrophy of the Duchenne type was evaluated in 19 patients using thallium-201 myocardial perfusion imaging. The qualitative analysis was performed in anterior, 3 left anterior oblique and left lateral projection images by three experienced physicians. Distinct perfusion defects were shown in 13 patients, especially in LV posterolateral or posterior walls (11 patients). There was no significant relationship between the presence of perfusion defects and the skeletal muscle changes or thoracic deformities assessed by transmission computed tomography. Slightly increased thallium-201 activity in RV free wall and lungs was shown in nine and one patient, respectively. The extensive perfusion defects were shown in 2 patients who died of congestive heart failure 1 to 2 years after the scintigraphic study. The myocardial scintigraphic changes were considered to be minimal in 7 of 9 patients who underwent two serial scintigraphic studies in 2 to 3 years. It was concluded that the thallium myocardial perfusion imaging was a useful clinical technique to evaluate the cardiomyopathy in Duchenne progressive muscular dystrophy. (author)

  13. Serial Myocardial Imaging after a Single Dose of Thallium-201

    Takahiko Kamata

    2014-10-01

    Full Text Available Although thallium-201 exercise scintigraphy has been established for the detection of myocardial ischemia and viability, little is known regarding the myocardial thallium-201 kinetics during angioplasty. Herein, we report a 77-year old man with angina pectoris, in whom serial myocardial imaging after a single dose of thallium-201 was helpful in identifying not only the culprit lesion and myocardial viability, but also the dynamic changes in myocardial perfusion during angioplasty. Thallium-201 images after exercise showed a perfusion defect in the inferior wall, with a trivial redistribution 3 hours after the exercise and a marked improvement 24 hours later. Coronary angiography, performed 27 hours after exercise scintigraphy, showed severe stenosis in the right coronary artery. Guidewire crossing of the lesion interrupted the antegrade flow, which was restored after balloon dilation and stent implantation. Thallium-201 images, 2 hours after angioplasty (i.e., 30 hours after exercise, showed a decreased tracer uptake in the inferior wall, which improved the next day (i.e., 48 hours after exercise. Cardiac biomarkers were negative in the clinical course.

  14. Quantitative Myocardial Perfusion Imaging Versus Visual Analysis in Diagnosing Myocardial Ischemia: A CE-MARC Substudy.

    Biglands, John D; Ibraheem, Montasir; Magee, Derek R; Radjenovic, Aleksandra; Plein, Sven; Greenwood, John P

    2018-05-01

    This study sought to compare the diagnostic accuracy of visual and quantitative analyses of myocardial perfusion cardiovascular magnetic resonance against a reference standard of quantitative coronary angiography. Visual analysis of perfusion cardiovascular magnetic resonance studies for assessing myocardial perfusion has been shown to have high diagnostic accuracy for coronary artery disease. However, only a few small studies have assessed the diagnostic accuracy of quantitative myocardial perfusion. This retrospective study included 128 patients randomly selected from the CE-MARC (Clinical Evaluation of Magnetic Resonance Imaging in Coronary Heart Disease) study population such that the distribution of risk factors and disease status was proportionate to the full population. Visual analysis results of cardiovascular magnetic resonance perfusion images, by consensus of 2 expert readers, were taken from the original study reports. Quantitative myocardial blood flow estimates were obtained using Fermi-constrained deconvolution. The reference standard for myocardial ischemia was a quantitative coronary x-ray angiogram stenosis severity of ≥70% diameter in any coronary artery of >2 mm diameter, or ≥50% in the left main stem. Diagnostic performance was calculated using receiver-operating characteristic curve analysis. The area under the curve for visual analysis was 0.88 (95% confidence interval: 0.81 to 0.95) with a sensitivity of 81.0% (95% confidence interval: 69.1% to 92.8%) and specificity of 86.0% (95% confidence interval: 78.7% to 93.4%). For quantitative stress myocardial blood flow the area under the curve was 0.89 (95% confidence interval: 0.83 to 0.96) with a sensitivity of 87.5% (95% confidence interval: 77.3% to 97.7%) and specificity of 84.5% (95% confidence interval: 76.8% to 92.3%). There was no statistically significant difference between the diagnostic performance of quantitative and visual analyses (p = 0.72). Incorporating rest myocardial

  15. Evaluation of carbohydrate cardiac metabolism by the 18FDG and positron emission tomography in the myocardial infarction with healthy coronaries

    Agostini, D.; Quennelle, F.; Babatasi, G.; Grollier, G.; Potier, J.C.; Bouvard, G.

    1997-01-01

    The aim of this study was to evaluate the regional myocardial metabolism of glucose (RMMG) by positron emission tomography (PET) with fluoro-de-oxy-glucose ( 18 FDG) in patients having myocardial infarction with healthy coronaries (MIHC). Four patients (4M, age: 41 ± 12 years) have presented: MI with a coronarography showing no significant lesions on the epicardial arteries, an irreversible anterior hypo-perfusion, moderated at 201 Tl scintigraphy and an isotopic FEVG 18 FDG. The dynamical images allow measuring RMMG and the static image to define the regions of interest on ventricular transaxial cross sections. A myocardial region embodying the totality of VG, including the septal, anterior and lateral regions and an intracavitary region are handy delimited. A model with 3 compartments is applied to the time-activity curves measured in the VG (input function) and in the myocardium (Patlak's method) and allows measuring the RMMG. The mean value of RMMG, measured along the VG, is significantly diminished as compared with that measured in healthy subjects. In conclusion, the PET based on 18 FDG shows that the myocardial carbohydrate metabolism is altered in patients afflicted with MIHC

  16. The cardiomyopathy in Friedreich's ataxia: isotopic ventriculography and myocardial imaging with thallium-201

    Therriault, L.; Lamoureux, G.; Cote, M.; Plourde, G.; Lemieux, B.

    1984-01-01

    Myocardial scanning after the intravenous administration of Thallium 201 was used to evaluate regional myocardial perfusion in 14 patients with Friedreich's ataxia. Isotopic ventriculography was also used to assess left ventricular contractility. Myocardial images in patients with Friedreich's ataxia were found to be precociously abnormal irrespective of the degree of neurological impairment or of the severity of myocardial hypertrophy

  17. Use of myocardial imaging in the evaluation of patients with cardiovascular disease

    Pitt, B.; Strauss, H.W.; Trhall, J.H.

    1980-01-01

    The role of radioisotope tracer techniques in the evaluation of patients with congenital heart disease, valvular heart disease, suspected myocardial infarction, ischemia or suspected ventricular dysfunction is reviewed. Thallium-201 myocardial imaging and exercise blood pool imaging and Technetium-88m pyrophosphate imaging of myocardial infarction are most commonly used.

  18. Detection of myocardial ischemia of hypertrophic cardiomyopathy with gated 99Tcm-MIBI myocardial perfusion imaging

    Jia Peng; Guo Wanhua; Du Minghua; Gao Ling

    2010-01-01

    Objective: To evaluate the value of gated 99 Tc m -methoxyisobutylisonitrile (MIBI) myocardial perfusion imaging in detection of myocardial ischemia in hypertrophic cardiomyopathy. Methods: Sixty-nine patients with clinically proven hypertrophic cardiomyopathy were divided into 2 groups using coronary angiogram as 'gold standard': positive group (n=19, narrowing ≥ 50%) and negative group (n=50, narrowing 99 Tc m -MIBI myocardial perfusion imaging was performed and positive in all 69 patients (41 males, 28 females, aged 35-75 years). Comparative analysis between the two groups was carried out using t-test. Results: In the positive group, reversible and irreversible perfusion defects were detected in 9 and 10 patients, respectively. Left ventricular ejection fraction (LVEF) increased to (69.1 ± 2.8)% in 8 patients and decreased to (42.8 ± 2.1)% in 11 patients. In the negative group, reversible and irreversible perfusion defects were found in 37 and 13 patients, respectively. LVEF increased to (70.8 ± 4.0)% in 38 patients and decreased to (48.9 ± 2.7)% in 12 patients. The values of ischemic area, severity and extent of perfusion defect, and LVEF were significantly different between the two groups (t=9.28, 16.51, 2.65; P 99 Tc m -MIBI myocardial perfusion imaging is valuable in assessing patients with hypertrophic cardiomyopathy. Detection for the presence or absence of coexisting coronary artery disease and myocardial ischemia has an important prognostic indication and management indication for these patients. (authors)

  19. Mouse myocardial first-pass perfusion MR imaging

    Coolen, Bram F.; Moonen, Rik P. M.; Paulis, Leonie E. M.; Geelen, Tessa; Nicolay, Klaas; Strijkers, Gustav J.

    2010-01-01

    A first-pass myocardial perfusion sequence for mouse cardiac MRI is presented. A segmented ECG-triggered acquisition combined with parallel imaging acceleration was used to capture the first pass of a Gd-DTPA bolus through the mouse heart with a temporal resolution of 300-400 msec. The method was

  20. Mouse myocardial first-pass perfusion MR imaging

    Coolen, B.F.; Moonen, R.P.M.; Paulis, L.E.M.; Geelen, T.; Nicolay, K.; Strijkers, G.J.

    2010-01-01

    A first-pass myocardial perfusion sequence for mouse cardiac MRI is presented. A segmented ECG-triggered acquisition combined with parallel imaging acceleration was used to capture the first pass of a Gd-DTPA bolus through the mouse heart with a temporal resolution of 300–400 msec. The method was

  1. Fatty acid myocardial imaging using iodine-123-beta-methyl-para-iodophenyl pentadecanoic acid (BMIPP) in patients with hypertrophic cardiomyopathy (HCM)

    Wada, Toyofumi

    1993-01-01

    Myocardial ischemia has been shown to develop during exercise and to play an important role on the pathophysiology in patients with hypertrophic cardiomyopathy (HCM). However, it is known whether or not myocardial ischemia is present under basal condition. BMIPP myocardial imaging has been proven to be useful for the detection of regional abnormalities of fatty acid metabolism induced by myocardial ischemia. We therefore performed BMIPP and Tl myocardial imagings in 18 patients with HCM. Six patients with chest pain syndrome or idiopathic ventricular arrhythmia served as controls. BMIPP and Tl scintigraphies were performed at least five days apart for avoiding cross talk and after overnight fasting. Six control subjects presented BMIPP images similar to Tl images without appreciable discrepancy. Of 18 patients with HCM, 15 manifested segments of reduced BMIPP uptakes as compared with those of Tl images. These segments of reduced BMIPP in patients with HCM were mainly observed in segments of increased Tl uptake, and suggested that myocardial ischemia was present under basal condition. Since the reduction of BMIPP uptake were often localized to parts of segments of increased Tl uptake, small coronary disease seemed to be a mechanism responsible for myocardial ischemia developing during resting condition. Four patients with apical hypertrophy showed reduction of BMIPP uptake in the hypertrophied apical segments. The observation suggests that abnormal myocardial energy metabolism is in progress during resting state, although the condition is generally considered to be benign. (author)

  2. Time-course of myocardial perfusion and fatty acid metabolism after coronary reperfusion

    Sochor, H.; Pachinger, O.; Ogris, E.; Probst, P.; Kaindl, F.

    1985-01-01

    To investigate the relationship and time-course of myocardial perfusion and behaviour of fatty acid uptake and clearance following reperfusion, the authors studied 19 patients after successful intracoronary thrombolysis with Tl-201 and I-123 hepta-decanoic acid (HDA) and planar imaging. Pts were studied acute (A: 48 hours), early (E:6-8 days) and late (L:6-12 months). %-defect size and relative tracer uptake were determined for both markers as well as t1/2 of the early clearance phase for HDA. Late Tl was done as stress test study after dipyridamole infusion. As in a previous report acute HDA uptake-defects were larger than Tl (38 +- 10% vs 24 +- 9%, p<0.05) suggesting a larger area of metabolic impairment than outlined by perfusion. HDA and Tl uptake at A correlated significantly (p<0.01, r=0.86) but HDA uptake was 19% lower than Tl and not different at E and L. Tl stress studies exhibited in 74% reversible ischemia in the area of ''metabolic recovery''. The authors conclude that early after reperfusion uptake of HDA is frequently impaired despite improved perfusion suggesting metabolic derangement showing a slow recovery over time. A multiple tracer approach including metabolic markers may improve the characterization of reperfused myocardium

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

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

    1992-04-01

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

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

    Kihara, Koichi; Nakajo, Masayuki; Shono, Hirohisa

    1992-01-01

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

  5. Imaging QRS complex and ST segment in myocardial infarction

    Bacharova, Ljuba; Bang, Lia E; Szathmary, Vavrinec

    2014-01-01

    BACKGROUND: Acute myocardial infarction creates regions of altered electrical properties of myocardium resulting in typical QRS patterns (pathological Q waves) and ST segment deviations observed in leads related to the MI location. The aim of this study was to present a graphical method for imaging...... the changes in the sequence of depolarization and the ST segment deviations in myocardial infarction using the Dipolar ElectroCARdioTOpography (DECARTO) method. MATERIAL AND METHODS: Simulated ECG data corresponding to intramural, electrically inactive areas encircled by transmural areas with slowed impulse...... propagation velocity in anteroseptal and inferior locations were used for imaging the altered sequence of depolarization and the ST vector. The ECGs were transformed to areas projected on the image surface so as to image the process of ventricular depolarization based on the orientation and magnitude...

  6. Impact of metabolic syndrome on ST segment resolution after thrombolytic therapy for acute myocardial infarction

    Ayşe Saatçı Yaşar

    2010-09-01

    Full Text Available Objectives: It has been shown that metabolic syndrome is associated with poor short-term outcome and poor long-term survival in patients with acute myocardial infarction. We aimed to investigate the effect of metabolic syndrome on ST segment resolution in patients received thrombolytic therapy for acute myocardial infarction.Materials and methods: We retrospectively analyzed 161 patients, who were admitted to our clinics with acute ST-elevated-myocardial infarction and received thrombolytic therapy within 12 hours of chest pain. Metabolic syndrome was diagnosed according to National Cholesterol Education Program Adult Treatment Panel III criteria. Resolution of ST segment elevation was assessed on the baseline and 90-minute electrocardiograms. ST segment resolution ≥70% was defined as complete resolution.Results: Metabolic syndrome was found in 56.5% of patients. The proportion of patients with metabolic syndrome who achieved complete ST segment resolution after thrombolysis was significantly lower than that of patients without metabolic syndrome (32.9% versus 58.6%, p=0.001. On multivariate analysis metabolic syndrome was the only independent predictor of ST segment resolution (p=0.01, Odds ratio=2.543, %95 CI:1.248-5.179Conclusion: The patients with metabolic syndrome had lower rates of complete ST segment resolution after thrombolytic therapy for acute myocardial infarction. This finding may contribute to the higher morbidity and mortality of patients with metabolic syndrome.

  7. Assessment of myocardial metabolism with iodine-123 heptadecanoic acid: effect of decreased fatty acid oxidation on deiodination

    Luethy, P.C.; Chatelain, P.; Papageorgiou, I.; Schubiger, A.; Lerch, R.A.

    1988-01-01

    Terminally radioiodinated fatty acid analogs are of potential use for the noninvasive delineation of regional alterations of fatty acid metabolism by gamma imaging. Since radioactivity from extracted iodine-123 heptadecanoic acid [( 123I]HDA) is released from the myocardium in form of free radioiodide (123I-) the present study was performed to determine whether deiodination of [123I]HDA is related to free fatty acid metabolism. Myocardial production of free radioiodide was measured in rat hearts in vitro and in vivo both under control conditions and after inhibition of fatty acid oxidation. In isolated rat hearts perfused at constant flow with a medium containing [123I]HDA, release of 123I- was markedly reduced during cardioplegia and pharmacologic inhibition of mitochondrial fatty acid transfer with POCA by 67% (p less than 0.005) and 72% (p less than 0.005), respectively. In fasted rats in vivo, 1 min after i.v. injection of [123I]HDA, 51 +/- 5% of myocardial radioactivity was recovered in the aqueous phase, containing free iodide, of myocardial lipid extracts. Aqueous activity was significantly decreased in fed (20 +/- 2%; p less than 0.002) and POCA pretreated (30 +/- 3.7%; p less than 0.05) animals exhibiting reduced oxidation of [14C]palmitate. Thus, deiodination of [123I]HDA was consistently reduced during inhibition of fatty acid oxidation in vitro and in vivo. The results apply to the interpretation of myocardial clearance curves of terminally radioiodinated fatty acid analogs

  8. Hypercholesterolemia and Myocardial function evaluated via Tissue Doppler Imaging

    Kotaru Pavan

    2009-11-01

    Full Text Available Abstract Objective To establish a link between hypercholesterolemia and myocardial dysfunction. Background Heart failure is a complex disease involving changes in systolic and diastolic function. Newer echocardiographic imaging modalities may be able to detect discreet changes in myocardial function associated with hypercholesterolemia. Therefore we sought to establish a link between hypercholesterolemia and myocardial dysfunction with tissue Doppler imaging (TDI. Methods Twenty-seven rabbits were studied: 7 were fed normal chow (group 1 and 20 a high cholesterol diet (10 with ezetimibe, 1 mg/kg/day; group 2 and 10 without, group 3. Echocardiographic images were obtained under general anesthesia. Serum cholesterol levels were obtained at baseline, 3 and 6 months and myocardial cholesterol levels measured following euthanasia. Results Doppler measurements, including E/A, E'/A' and S' were significantly lower in group 3 compared to both groups 1 and 2 but no significant differences were noted in chamber sizes or ejection fraction among the groups. Average serum cholesterol was higher in group 3 compared to groups 1 and 2 respectively (495 ± 305 mg/dl vs. 114 ± 95 mg/dl and 87 ± 37 mg/dl; p 2 = 0.17 p = 0.04, r2 = 0.37 p = 0.001 and r2 = 0.24 p = 0.01. Conclusion Cholesterol load in the serum and myocardium was significantly associated with decreased systolic and diastolic function by TDI. Moreover, lipid lowering was protective.

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

    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.)

  10. Imaging regional metabolic changes in the ischemic rat heart in vivo using hyperpolarized(1-13C)Pyruvate

    Lauritzen, Mette Hauge; Magnusson, Peter; Laustsen, Christoffer

    2017-01-01

    in the in vivo rat heart in an open-chest model of ischemia reperfusion. Hyperpolarized MRI enables new possibilities for evaluating changes in cardiac metabolism noninvasively and in real time, which potentially could be used for research to evaluate new treatments and metabolic interventions for myocardial......We evaluated the use of hyperpolarized 13C magnetic resonance imaging (MRI) in an open-chest rat model of myocardial infarction to image regional changes in myocardial metabolism. In total, 10 rats were examined before and after 30 minutes of occlusion of the left anterior descending coronary...

  11. Clinical significance of myocardial 123I-BMIPP imaging in patients with myocardial infarction

    Narita, Michihiro; Kurihara, Tadashi; Shindoh, Takashi; Honda, Minoru

    1997-01-01

    We studied 55 patients with myocardial infarction (MI), 14 patients with recent MI (RMI) and 41 patients with old MI (OMI), and myocardial images were divided into 17 segments and myocardial uptake of the radionuclide was graded from 0 (normal) to 3 (maximal abnormality). In 28 patients we compared segmental defect score (SDS) with wall motion index (WMI) which were obtained by centerline method at the corresponded segments. As a whole, the mean total defect scores (TDSs) of BMIPP and exercise stress (Ex) were similar and they were greater than the mean TDS of resting perfusion. In 30 patient TDS of BMIPP was greater than that of TDS of resting perfusion. In 24 patients perfusion abnormality developed by Ex and the location of BMIPP abnormality coincided with the abnormality of Ex. But in the other 6 patients Ex did not induce any abnormality and they were all RMI and infarcted coronary artery was patent. However in the group with TDS of BMIPP identical to TDS of resting perfusion (25 patients), 92% did not show myocardial perfusion abnormality after Ex. In the comparison of SDS and WMI, myocardial segments were divided into 3 groups; both SDSs of BMIPP and resting perfusion were normal or borderline abnormality (Group 1, 82 segments), SDS of resting perfusion was normal or borderline and SDS of BMIPP was definitely abnormal (Group 2, 10 segments) and both SDSs of BMIPP and resting perfusion were definitely abnormal (Group 3, 48 segments). In Group 1, WMS was significantly greater than those of Group 2 and Group 3. But there was no difference between Group 2 and 3. These findings suggested that in the segments with mismatch between BMIPP and resting perfusion reflects stunned myocardium. (K.H.)

  12. The values of myocardial tomography imaging and gated cardiac blood pool imaging in detecting left ventricular aneurysm

    Zhu Mei; Pan Zhongyun; Li Jinhui

    1992-01-01

    The sensitivity and specificity of myocardial tomography imaging and gated cardiac blood-pool imaging in detecting LVA were studied in 36 normal subjects and 68 patients with myocardial infarction. The sensitivities of exercise and rest myocardial imaging in detecting LVA were 85% and 77.3% respectively. The specificity of both is 95.5%. The sensitivity of cinema display, phase analysis and left ventricular phase shift in evaluating LVA were 86.7%, 86.7%, 100% respectively. Their specificity were all 100%. It is concluded that blood pool imaging is of choice for the diagnosis of LVA, and that myocardial imaging could also demonstrate LVA during diagnosing myocardial infarction

  13. Radioiodinated BMIPP for myocardial imaging - current status and future perspectives

    Knapp, F.F. Jr.; Kropp, J.; Franken, P.R.

    1998-01-01

    Since the 1970's both basic research applications and clinical use of radioiodinated free fatty acids has continued to be of interest in nuclear cardiology. Clinical use of iodine-123-labeled fatty acids offers a unique opportunity for direct or indirect evaluation of alterations in myocardial metabolism by single photon computed tomography (SPECT). The relationship between the negative 'mismatches' often observed between regional fatty acid uptake and perfusion tracer distribution (i.e. BMIPP defect larger than flow tracer defect) has been an important observation which can often provide information on myocardial viability. Although the widespread use of the iodine-123-labeled 15-(p-iodophenyl)-3-(R, S)-methylpentadecanoic acid (BMIPP) analogue in Japan continues to provide extensive clinical data defining indications for the use of this agent, it remains to be seen, however, if iodine-123-labeled fatty acids such as BMIPP will enter routine clinical use in other countries, since their commercial availability as approved radiopharmaceuticals will be required. In this paper further studies describing the resolution and evaluation of the metabolism and myocardial uptake and release kinetics of the 3R- and 3S-BMIPP isomers are described. Although it is beyond the scope of this brief paper to review and discuss the voluminous data which have been published concerning both clincial applications and research studies with BMIPP over the last several years, the issues associated with the broader clinical use of BMIPP and other iodine-123-labeled fatty acid agents are discussed. (orig.) [de

  14. Assessment of myocardial viability in patients with myocardial infarction using twenty-four hour thallium-201 late redistribution imaging

    Yang Xiangjun; He Yongming; Zhang Bin; Wu Yiwei; Hui Jie; Jiang Tingbo; Song Jianping; Liu Zhihua; Jiang Wenping

    2006-01-01

    Rest thallium-201 ( 201 Tl) myocardial perfusion imaging has been widely used for evaluation of myocardial ischemia/viability after myocardial infarction, but the ideal timing for imaging after injection to maximally estimate viability is not well established. Thirty-six patients with myocardial infarction underwent the initial, 3 h, and 24 h redistribution imaging after intravenous injection of 148-185 MBq 201 Tl. The initial and 3 h images, the initial and 24 h images, and the 3 and 24 h images were compared double-blinded. Out of the 184 abnormal segments based on the initial imaging, 56 (30%) segments improved by at least 1 grade on the 3 h imaging while 78 (42%) segments improved by at least 1 grade on the 24 h imaging. The 24 h late imaging detected more viable myocardium than the 3 h imaging did, with a significant difference (χ 2 =5.680, p=0.017). There were 158 abnormal segments on the 3 h imaging, with average 28% (44) segments improved by at least 1 grade on the 24 h imaging. There were 128 initial abnormal segments with no improvement on the 3 h imaging. Out of these segments, the 24 h late redistribution imaging detected additional redistribution in 26 segments, taking up 20%. Twenty-four hour late 201 Tl imaging will demonstrated additional redistribution in patients who have incompletely reversible defects on early redistribution imaging at 3 h. (author)

  15. Assessment of myocardial metabolism by PET - a sophisticated dream or clinical reality

    Schelbert, H.R.

    1986-01-01

    This symposium reviewed radionuclide techniques for the noninvasive study of regional myocardial metabolism and spanned a wide range of topics. New radiotracers for probing different metabolic pathways or selected biochemical reaction steps were presented. New information on tracers already in use was forthcoming. Because the imaging device can measure only concentrations of radiolabel in tissue, other studies examined relationships between uptake and turnover of radioactivity in tissue as an externally observed signal, the chemical fate of the label, and the biologic process under study. Other studies formulated these relationships through tracer compartment models, which are fundament to quantifying regional physiologic processes externally. Other investigations applied radiotracer methods to experimental models of cardiac disease to patients. They described findings of regional or global alterations in substrate metabolism. These observations highlighted the potential clinical value of this new methodology. At the same time, several of these observations remain at present without mechanistic explanation; yet they form the foundation on which working hypotheses can be built, which in turn can be tested in vivo. (orig.)

  16. Assessment of myocardial metabolism by PET - a sophisticated dream or clinical reality

    Schelbert, H R

    1986-08-01

    This symposium reviewed radionuclide techniques for the noninvasive study of regional myocardial metabolism and spanned a wide range of topics. New radiotracers for probing different metabolic pathways or selected biochemical reaction steps were presented. New information on tracers already in use was forthcoming. Because the imaging device can measure only concentrations of radiolabel in tissue, other studies examined relationships between uptake and turnover of radioactivity in tissue as an externally observed signal, the chemical fate of the label, and the biologic process under study. Other studies formulated these relationships through tracer compartment models, which are fundament to quantifying regional physiologic processes externally. Other investigations applied radiotracer methods to experimental models of cardiac disease to patients. They described findings of regional or global alterations in substrate metabolism. These observations highlighted the potential clinical value of this new methodology. At the same time, several of these observations remain at present without mechanistic explanation; yet they form the foundation on which working hypotheses can be built, which in turn can be tested in vivo.

  17. Prognostic value of normal exercise myocardial perfusion imaging

    Lin Jinghui; Zhu Mei; Wu Shuyan

    1996-01-01

    To assess the prognostic implications, patients with a normal exercise myocardial imaging were followed up. 54 patients underwent exercise myocardial perfusion imaging and exercise ECG test. The images of all of them were normal. Coronary arteriography was performed in 50 patients. Among them 4 patients had single vessel lesion. Follow-up period of all the patients was >1 year (12∼90 Mo.). Likelihood of coronary artery disease (CAD, CAD LK) was estimated before and after test by Bayesian analysis. Mean of the pretest CAD LK was 19% and after test decreased to 13%. The difference between the CAD LK pre- and after test was significant (U = 6.0198, P<0.01). During the follow-up period cardiac event (CE) occurred in only one patient. The CE rate was 0.2% per year. No CE occurred in the 4 patients with CAD and in the 55 patients with positive exercise ECG. The data confirm that a normal stress myocardial imaging predicts an excellent prognosis even in patients with CAD or a high pretest CAD LK or a positive exercise ECG

  18. Clinical estimation of myocardial infarct volume with MR imaging

    Johns, J.A.; Leavitt, M.B.; Field, B.D.; Yasuda, T.; Gold, H.; Leinbach, R.C.; Brady, T.J.; Dinsmore, R.E.

    1987-01-01

    MR imaging has not previously been used to assess infarct size in humans. Short-axis spin-echo cardiac MR imaging was performed in 20 patients who had undergone intravenous thrombolytic therapy and angiography, 10 days after myocardial infarct. A semi-automated computer program was used to outline the infarct region on each section. The outlines were algorithmically stacked and a three-dimensional representation of the infarct was created. The MR imaging infarct volume was then computed using the Simpson rule. Comparison with ventriculographic infarct size as determined by the computed severely hypokinetic segment length showed excellent correlation (r = .84, P < .001)

  19. Dobutamine cine magnetic resonance imaging after myocardial infarction

    Giovagnoni, A.; Ligabue, G.; Romagnoli, R.; Reggio Emilia Univ., Reggio Emilia; Rossi, R.; Muia, N.; Modena, M.G.; Reggio Emilia Univ.

    1999-01-01

    Dobutamine Cine MRI is a new diagnostic imaging technique in the pretreatment (revascularization) assessment of myocardial infarction patients. In this issue are reported the result of a comparative study of the diagnostic yield of dobutamine Cine MRI with that of stress echocardiography in the assessment of viable myocardium. A new method for analysis of Cine MR images, employing digital subtraction, aimed at decreasing subjectivity in the quantitative assessment of myocardial wall thickening. Twenty-six patients (21 men and 5 women) with a history of myocardial infarction who were scheduled for revascularization were submitted to stress echocardiography and dobutamine Cine MRI to evaluate contractile recovery of the segments considered akinetic or hypo kinetic at baseline echocardiography. Dobutamine was administered in growing doses (5, 10, 15γ/kg/min). 16 segments of the left ventricle in each patient were considered. In the 416 segments studied, it was found that 307 normo kinetic, 64 scarred and 45 viable segments with stress echocardiography, versus 302 normo kinetic, 83 scarred and 31 viable segments with dobutamine MRI. Three months after revascularization 15 patients were examined to check contractile recovery of the segments considered as viable. Echocardiography had 79% sensitivity and 97% specificity, while Cine MRI had 96% and 86%, respectively. In patients with anteroseptal wall myocardial infarction stress echocardiography had 75% sensitivity and 97% specificity. Echocardiography permits to distinguish viable myocardium and scarred myocardial tissue with good sensitivity and specificity, but Cine MRI performs better. Cine MRI has much higher sensitivity than stress echocardiography and thus makes the technique of choice to evaluate viable myocardium in these sites. The digital subtraction technique is as accurate as manual measurements, but reduces the error rate and permits quicker evaluation, particularly in subendocardial thickening [it

  20. Myocardial infarction after dipyridamole-assisted thallium-201 imaging

    Biddle, P.; Lanspa, T.J.; Mohiuddin, S.M.; Malesker, M.A.; Hilleman, D.E.

    1989-01-01

    A 77-year-old woman with suspected coronary artery disease underwent an oral dipyridamole/thallium-201 myocardial imaging study. Approximately 75 minutes after ingestion of dipyridamole 300 mg suspension, the patient developed chest pain, hypotension, nausea, and diaphoresis. An electrocardiogram revealed ST-T wave changes suggestive of inferior ischemia. Appropriate therapeutic measures, including aminophylline and nitroglycerin, were instituted. Delayed thallium images revealed reversible ischemia in the anteroseptal and posterobasal regions with a fixed defect in the inferobasal region. Cardiac enzyme studies were also indicative of acute myocardial injury. The patient subsequently underwent coronary arteriography and four-vessel coronary artery bypass grafting and was discharged without further complication. This report raises concerns about the potential danger of dipyridamole in patients with severe coronary artery stenosis and collateral circulation. Prophylactic aminophylline should be considered in these patients

  1. Evaluation of the specificity of radionuclide myocardial imaging for detecting CAD

    Liu Xiujie

    1992-01-01

    In order to evaluate the specificity of radionuclide myocardial perfusion imaging for detecting coronary artery disease (CAD), 50 patients with normal coronary arteriography and radionuclide myocardial perfusion scintigraphy were analysed. The results from 201 T1 (20 cases) and 99m Tc-MIBI (30 cases) studies showed that out of 33 patients with no organic cardiovascular disease, 29 had normal myocardial imaging, and the specificity of radionuclide myocardial imaging for detecting CAD was 87.8%. 4 normal young women had false positive myocardial imaging. Out of 17 patients with cardiovascular disease and normal coronary arteriography, 15 patients had abnormal myocardial imaging. The final clinical diagnoses of these 15 patients were: 4 patients with hypertrophic cardiomyopathy, 3 with old myocardial infarction, 2 with myocarditis, 3 with small coronary vessel disease, 1 with congestive cardiomyopathy, and 2 with other cardiac disorder. The points of differentiation between CAD and other cardiovascular disease using radionuclide techniques were discussed

  2. 123I-BMIPP fatty acid analogue imaging is a novel diagnostic and prognostic approach following acute myocardial infarction.

    Biswas, S K; Sarai, M; Hishida, H; Ozaki, Y

    2009-10-01

    Fatty acid oxidation is the most efficient mode of myocardial energy production which requires a large amount of oxygen. Thus, alteration of fatty acid oxidation is considered to be a sensitive marker of ischaemia and myocardial damage. (123)I-BMIPP ([123]I-beta-methyl-p-iodophenylpentadecanoic acid) is a newly-investigated single-photon branching free fatty acid radiopharmaceutical with slow metabolism; thus, it is well-suited for single-photon emission computed tomography (SPECT). Assessment of fatty acid metabolism by radionuclide techniques has a potential role for the early detection of myocardial ischaemia and the assessment of the severity of ischaemic heart disease. Although stable patients with a healed myocardial infarction may have a relatively good prognosis, risk stratification in the predischarge period should be valuable for deciding upon appropriate management. In this respect, the presence of discordant BMIPP uptake relative to (201)Tl perfusion appears to be the best predictor of future cardiac events among all other cardiovascular imaging modalities. Since discordant BMIPP uptake correlates well with redistribution on stress (201)Tl imaging and perfusion-metabolism mismatch on positron emission tomography, it is considered that such BMIPP and (201)Tl discordance may identify a high-risk subgroup among patients with acute myocardial infarction. A BMIPP scan may reflect prior severe ischaemia after recovery of perfusion, the so-called "ischaemic memory". Gated BMIPP SPECT has been recently introduced for simultaneous assessment of myocardial metabolism and ventricular function. Such a new technique seems to be valuable for a better understanding of the pathophysiological state of heart failure and cardiomyopathy.

  3. Clinical usefulness of technetium-99m pyrophosphate and Tl-201 myocardial imaging for the estimation of myocardial infarction

    Suzuki, Akio; Sato, Akihiko; Miyakoda, Hiroyuki; Watanabe, Toshiya; Itatsu, Hidetaka; Ueda, Osamu; Sakurai, Kuniteru; Kawai, Naoki; Sotobata, Iwao

    1985-04-01

    A correlative study was performed between the infarct size estimated by either technetium-99 pyrophosphate (Tc-PYP) or Tl-201 myocardial imaging, and the cumulative total creatinine phosphokinase activity (..sigma..CPK) or left ventricular ejection fraction (LVEF) in 40 patients with acute myocardial infarction. Tc-PYP infarct area (TcIA) and mean Tl-201 uptake ratio (MUR) were calculated as indices of myocardial infarct size. LVEF was evaluated by first pass method using Tc-PYP in the acute phase of myocardial infraction. In 23 patients with anterior myocardial infarction, a significant correlation was shown between either TcIA or anterior-wall MUR and ..sigma..CPK (r=0.81 and r=-0.69, respectively) and also between either TcIA or anterior-wall MUR and LVEF (r=-0.84 and r=0.80, respectively). In 17 patients with inferior myocardial infarction without additional involvement of right ventricular wall, inferior-wall MUR correlated with ..sigma..CPK (r=-0.74). No statically significant correlation was shown between TcIA and ..sigma..CPK, and also between either TcIA or inferior-wall MUR and LVEF. In conclusion, the infarct size estimated with Tc-PYP or Tl-201 myocardial imaging could be a useful clinical indicator of the severity of acute myocardial infarction especially in anterior wall. (author).

  4. Tc99m-sestamibi dosimetry in myocardial perfusion imaging

    Toledo, Janine M.; Trindade, Bruno M.; Campos, Tarcisio P.R.

    2015-01-01

    This paper addressed myocardial perfusion imaging providing a spatial dosimetric investigation of the 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 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 99m Tc activity, which can contribute to future deterministic effect investigations. (author)

  5. Early diagnosis of interferon-induced myocardial disorder in patients with chronic hepatitis C. Evaluation by myocardial imaging with 123I-BMIPP

    Kondo, Yuki; Yukinaka, Michiko; Nomura, Masahiro; Nakaya, Yutaka; Ito, Susumu

    2000-01-01

    Interferon (IFN) therapy for chronic hepatitis C is sometimes associated with cardiac complications. In the present study, we performed myocardial imaging with 123 I-labeled β-methyl-p-iodophenylpentadecanoic acid ( 123 I-BMIPP) in order to evaluate myocardial disorders caused by IFN. We studied 40 healthy subjects (H group) and 25 patients with chronic hepatitis C who had been treated with IFN (IFN group). A Holter electrocardiogram (ECG) was performed and the autonomic nervous function was assessed by analyzing the spectral variability and 1/f fluctuation of heart rate. Myocardial planner imaging with 123 I-BMIPP was performed to obtain the time activity curve for 20 min immediately after administration of 123 I-BMIPP (dynamic study). Early and delayed myocardial single photon emission computed tomography (SPECT) images were expressed as Bull's eyes and the myocardium was divided into four segments to calculate the washout rate for each segment on early and late SPECT images (early and late SPECT study). No significant differences in autonomic nervous function were observed between the two groups in heart rate variability. In a dynamic study, the reduction rate from the time activity curve was significantly higher in the IFN group compared with the H group (reduction rate, IFN group, 5.3±3.7% vs H group, 1.2±3.3%; P 123 I-BMIPP myocardial scintigraphy examination several months after IFN therapy. These results indicate that metabolic disorders of fatty acids caused by IFN therapy can be detected before abnormalities are observed by Holter-ECG or echocardiography. (author)

  6. Early diagnosis of interferon-induced myocardial disorder in patients with chronic hepatitis C: evaluation by myocardial imaging with 123I-BMIPP.

    Kondo, Y; Yukinaka, M; Nomura, M; Nakaya, Y; Ito, S

    2000-01-01

    Interferon (IFN) therapy for chronic hepatitis C is sometimes associated with cardiac complications. In the present study, we performed myocardial imaging with 123I-labeled beta-methyl-p-iodophenylpentadecanoic acid (123I-BMIPP) in order to evaluate myocardial disorders caused by IFN. We studied 40 healthy subjects (H group) and 25 patients with chronic hepatitis C who had been treated with IFN (IFN group). A Holter electrocardiogram (ECG) was performed and the autonomic nervous function was assessed by analyzing the spectral variability and 1/f fluctuation of heart rate. Myocardial planner imaging with 123I-BMIPP was performed to obtain the time activity curve for 20min immediately after administration of 123I-BMIPP (dynamic study). Early and delayed myocardial single photon emission computed tomography (SPECT) images were expressed as Bull's eyes and the myocardium was divided into four segments to calculate the washout rate for each segment on early and late SPECT images (early and late SPECT study). No significant differences in autonomic nervous function were observed between the two groups in heart rate variability. In a dynamic study, the reduction rate from the time activity curve was significantly higher in the IFN group compared with the H group (reduction rate, IFN group, 5.3 +/- 3.7% vs H group, 1.2 +/- 3.3%; P acids caused by IFN was reversed on the second 123I-BMIPP myocardial scintigraphy examination several months after IFN therapy. These results indicate that metabolic disorders of fatty acids caused by IFN therapy can be detected before abnormalities are observed by Holter-ECG or echocardiography.

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

    Knapp, F.F. Jr.; Kropp, J.

    1994-01-01

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

  8. Clinical evaluation of myocardial perfusion imaging with 99mTc-CPI

    Liu Xiujie

    1988-01-01

    10 normal subjects and 55 cases of patients with heart diseases were studied with 99m Tc-CPI myocardial perfusion imaging. The 99m Tc-CPI myocarbial imaging is superior to 99m Tc-TBI, because the uptake of 99m Tc-CPI in both lung and liver is lower. The imaging quality of 99m Tc-CPI is nearly as good as that of 201 Tl. 16 patients had both 99m Tc-CPI myocardial imaging and coronary artery angiography. The sensitivity of 99m Tc-CPI myocardial imaging for detecting coronary artery disease (CAD) was 92%, whereas the sensitivity of ECG was 84.6%. 99m Tc-CPI myocardial tomography was obtained in 17 patients using Toshiba 90B SPECT system. The imaging quality of myocardial tomography using 99m Tc-CPI is very good and superior to planar imaging for detecting myocardial infarction

  9. Time course of regional myocardial glucose metabolism after transient ischemia assessed by positron emission tomography

    Hoshizaki, Hiroshi (Gunma Univ., Maebashi (Japan). School of Medicine)

    1992-11-01

    The purpose of this study was to examine the significance of glucose metabolism in ischemic canine myocardium after reperfusion. Transient ischemia was induced by 90 or 180 minutes occlusion of the left anterior descending coronary artery. Twelve hours and 4 weeks after reperfusion, myocardial blood flow (MBF) and glucose metabolism were assessed (with H[sub 2][sup 15]O and [sup 18]F-FDG, respectively) by positron emission tomography (PET) under the fasting state, and the metabolic findings were compared with the histologic examination. Glucose metabolism in ischemic regions was inversely related to the amount of tissue necrosis 12 hours and 4 weeks after reperfusion (r=-0.89 and r=-0.82, respectively). The perfusion-metabolism mismatch pattern was seen in the area with less than 10 percent necrosis 12 hours after reperfusion, but this pattern disappeared after 4 weeks. The area with 10 to 50 percent necrosis showed the mismatch pattern until 4 weeks after reperfusion, and in the area with more than 50 percent necrosis, perfusion-metabolism concordantly decreased. Thus, metabolic index assessed early after reperfusion by PET identified myocardial viability, and the perfusion-metabolism mismatch pattern sustained in relation to the degree of ischemic injury. Since some regions estimated to be irreversible by PET were viable by the histologic examination, PET study might underestimate the myocardial viability. (author).

  10. Alteration in metabolic signature and lipid metabolism in patients with angina pectoris and myocardial infarction.

    Park, Ju Yeon; Lee, Sang-Hak; Shin, Min-Jeong; Hwang, Geum-Sook

    2015-01-01

    Lipid metabolites are indispensable regulators of physiological and pathological processes, including atherosclerosis and coronary artery disease (CAD). However, the complex changes in lipid metabolites and metabolism that occur in patients with these conditions are incompletely understood. We performed lipid profiling to identify alterations in lipid metabolism in patients with angina and myocardial infarction (MI). Global lipid profiling was applied to serum samples from patients with CAD (angina and MI) and age-, sex-, and body mass index-matched healthy subjects using ultra-performance liquid chromatography/quadruple time-of-flight mass spectrometry and multivariate statistical analysis. A multivariate analysis showed a clear separation between the patients with CAD and normal controls. Lysophosphatidylcholine (lysoPC) and lysophosphatidylethanolamine (lysoPE) species containing unsaturated fatty acids and free fatty acids were associated with an increased risk of CAD, whereas species of lysoPC and lyso-alkyl PC containing saturated fatty acids were associated with a decreased risk. Additionally, PC species containing palmitic acid, diacylglycerol, sphingomyelin, and ceramide were associated with an increased risk of MI, whereas PE-plasmalogen and phosphatidylinositol species were associated with a decreased risk. In MI patients, we found strong positive correlation between lipid metabolites related to the sphingolipid pathway, sphingomyelin, and ceramide and acute inflammatory markers (high-sensitivity C-reactive protein). The results of this study demonstrate altered signatures in lipid metabolism in patients with angina or MI. Lipidomic profiling could provide the information to identity the specific lipid metabolites under the presence of disturbed metabolic pathways in patients with CAD.

  11. The myocardial perfusion imaging of bone marrow mesenchymal stem cell transplantation treated acute myocardial infarction in pig

    He Miao; Hou Xiancun; Li Yaomei; Zhou Peng; Qi Chunmei; Wu Weihuan; Li Li

    2006-01-01

    Objective: To evaluate the clinical value of bone marrow mesenchymal stem cell transplantation on acute myocardial infarction in pig with myocardial perfusion imaging. Methods: Acute myocardial infarction models were established by 21 minitype Chinese pigs and were divided into two groups. After 10 days, experimental group (n=11) was transplanted with bone marrow mesenchymal stem cell at the infarct areas, and the control group (n=10) with incubation solution. Before and eight weeks after transplantation, both groups were examined by 99 Tc m -methoxyisobutylisonitrile (MIBI) myocardial perfusion imaging and with semi-quantitative analysis. Besides, echocardiogram and immunohistochemistry were also performed. Results: There was significant difference of total myocardial perfusion abnormal segments (46 vs 26), infarct areas [(34±12)% vs (21±10)%] and myocardial ischemia score [(20.0±4.3) vs (12.1±3.6)] between two groups (P<0.05). Also, there were accordant results with echocardiogram and immunohistochemistry findings. Conclusions: Bone marrow mesenchymal stem cell transplantation may improve blood perfusion and viability of the ischemic areas: Myocardial perfusion imaging can accurately observe the survival of bone marrow mesenchymal stem cell transplanted at the infarct areas. (authors)

  12. Correlation between myocardial Thallium-201 kinetics, myocardial lactate metabolism and coronary angiographic findings in hypertrophic cardiomyopathy

    Hanrath, P.; Mathey, D.; Thiel, U.; Kupper, W.; Bleifeld, W.; Mantz, R.; Vorbringer, H.; Schneider, C.

    1980-01-01

    In 20 patients with idiopathic hypertrophic obstructive and nonobstructive cardiomyopathy (IHSS), biphasic Thallium-201 myocardial scintigraphy was performed. Regional myocardial Thallium-201 kinetics of these patients were analysed by a semiquantitative computerized method and compared with those of 6 normal subjects. In 12 of 18 with IHSS and no coronary artery disease 26 regions of interest with irreversible and 6 regions of interest with reversible Thallium-201 defects could be detected. Most of the Thallium-201 defects were localized in the interventricular septum. The defects were not related to the age of the patients and there was no relationship between the occurence of reversible Thallium-201 defects and pathological myocardial lactate extraction rate during maximal atrial pacing measured in 14 patients. The percentage (6.8%) of irreversible defect regions in patients with LV outflow obstruction at rest (n = 13) was more than twice higher compared to those (n = 5, 3.2%) without LV outflow obstruction or no provocative pressure gradient, resp. These data suggest that IHSS often associated with regional ischemic myocardial fibrosis despite normal coronary arteries. Therefore in these patients Thallium scintigraphy cannot be used as a noninvasive screening method to exclude or prove coronary artery disease. (orig.) [de

  13. Technetium and rhenium complexes with modified fatty acid ligands 4. Evaluation of two new classes of 99mTc-labelled fatty acids as potential tracers for myocardial metabolism imaging

    Heintz, A.; Kropp, J.; Deussen, A.; Jung, C.M.; Spies, H.

    2002-01-01

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

  14. Fluorine-18 heart dosimetry in myocardial perfusion imaging

    Toledo, Janine M.; Trindade, Bruno; Campos, Tarcísio P.R., E-mail: janine.toledo@gmail.com [Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG (Brazil). Programa de Pós-Graduação em Ciências e Técnicas Nucleares

    2017-07-01

    This paper conducts a recalling in myocardial perfusion imaging (MPI) followed by a spatial dosimetric investigation of the Fluorine-18 distributed at the myocardium by self-absorption of the heart uptake. Methods and Results: Radiological data manipulation was prepared and a computational heart voxelized model was assembled. A set of images from the abdominal aorta and angiotomography of the thorax was set up providing anatomic and functional information for heart modeling in SISCODES code. A homogeneous distribution of fluorine-18 was assumed into the heart myocardial wall. MCNP – Monte Carlo Code was used to provide the photon transport into the heart model taken in consideration the interactions into the tissues. The spatial dose distribution and histogram dose versus volume are presented. An analytical alternative model was addressed to the data validation. The present developed tools can produce spatial dose distribution in MPI at heart. Specially, the dosimetry performed elucidates imparted dose in the myocardial muscle per unit of injected Fluorine-18 activity by self-absorption of the heart uptake, which can contribute to future deterministic effect investigations. (author)

  15. Fluorine-18 heart dosimetry in myocardial perfusion imaging

    Toledo, Janine M.; Trindade, Bruno; Campos, Tarcísio P.R.

    2017-01-01

    This paper conducts a recalling in myocardial perfusion imaging (MPI) followed by a spatial dosimetric investigation of the Fluorine-18 distributed at the myocardium by self-absorption of the heart uptake. Methods and Results: Radiological data manipulation was prepared and a computational heart voxelized model was assembled. A set of images from the abdominal aorta and angiotomography of the thorax was set up providing anatomic and functional information for heart modeling in SISCODES code. A homogeneous distribution of fluorine-18 was assumed into the heart myocardial wall. MCNP – Monte Carlo Code was used to provide the photon transport into the heart model taken in consideration the interactions into the tissues. The spatial dose distribution and histogram dose versus volume are presented. An analytical alternative model was addressed to the data validation. The present developed tools can produce spatial dose distribution in MPI at heart. Specially, the dosimetry performed elucidates imparted dose in the myocardial muscle per unit of injected Fluorine-18 activity by self-absorption of the heart uptake, which can contribute to future deterministic effect investigations. (author)

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

    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 pvalues 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.

  17. Metabolic Imaging in Parkinson Disease.

    Meles, Sanne K; Teune, Laura K; de Jong, Bauke M; Dierckx, Rudi A; Leenders, Klaus L

    2017-01-01

    This review focuses on recent human 18 F-FDG PET studies in Parkinson disease. First, an overview is given of the current analytic approaches to metabolic brain imaging data. Next, we discuss how 18 F-FDG PET studies have advanced understanding of the relation between distinct brain regions and associated symptoms in Parkinson disease, including cognitive decline. In addition, the value of 18 F-FDG PET studies in differential diagnosis, identifying prodromal patients, and the evaluation of treatment effects are reviewed. Finally, anticipated developments in the field are addressed. © 2017 by the Society of Nuclear Medicine and Molecular Imaging.

  18. Estimation of regional myocardial sympathetic neuronal function with I-123 metaiodobenzylguanidine (MIBG) myocardial images in patients with cardiomyopathy

    Tanaka, Takeshi; Aizawa, Tadanori; Kato, Kazuzo; Nakano, Hajime; Igarashi, Masaki; Ueno, Takashi; Hirosawa, Koshichiro; Kusakabe, Kiyoko.

    1989-01-01

    Myocardial SPECT images with I-123 metaiodobenzylguanidine (MIBG) were obtained in 10 patients with cardiomyopathy under stable state. For myocardial imaging, MIBG and Tl-201 (Tl) were simultaneously injected and collected. The ratio of MIBG to Tl (M/T ratio) in ROI was obtained with 50% cut off levels in order to eliminate background activity. The patients were divided into three major groups: (l) those who had the M/T ratio ranging from 0.8 to l.20 at rest and had marked defects in the infero-lateral region on delayed MIBG images, where pathophysiologically accelerated regional sympathetic neuronal function was suspected (n=5), (II) those who had increased M/T ratios (l.6 and l.7) in the basal septal wall (n=3), and (III) those who had decreased M/T ratios (0.7 and 0.75) in the apical septal wall, where depletion of myocardial norepinephrine was suspected (n=2). These findings indicate the potential of myocardial MIBG images to evaluate myocardial distribution of norepinephrine, i.e. myocardial sympathetic neuronal function. Certain shortcomings, such as an increased background due to dual isotopes and an increased pulmonary uptake of MIBG, require further study on quantitative methods. (Namekawa, K)

  19. Effects of hepatic triglyceride content on myocardial metabolism in type 2 diabetes

    Rijzewijk, Luuk J.; Jonker, Jacqueline T.; van der Meer, Rutger W.; Lubberink, Mark; de Jong, Hugo W.; Romijn, Johannes A.; Bax, Jeroen J.; de Roos, Albert; Heine, Robert J.; Twisk, Jos W.; Windhorst, Albert D.; Lammertsma, Adriaan A.; Smit, Johannes W. A.; Diamant, Michaela; Lamb, Hildo J.

    2010-01-01

    The purpose of this study was to investigate the relationship between hepatic triglyceride content and both myocardial function and metabolism in type 2 diabetes mellitus (T2DM). Heart disease is the leading cause of mortality in T2DM. Central obesity and hepatic steatosis, both hallmark

  20. Metabolic imaging of patients with cardiomyopathy

    Geltman, E.M.

    1991-01-01

    The cardiomyopathies comprise a diverse group of illnesses that can be characterized functionally by several techniques. However, the delineation of derangements of regional perfusion and metabolism have been accomplished only relatively recently with positron emission tomography (PET). Regional myocardial accumulation and clearance of 11C-palmitate, the primary myocardial substrate under most conditions, demonstrate marked spatial heterogeneity when studied under fasting conditions or with glucose loading. PET with 11C-palmitate permits the noninvasive differentiation of patients with nonischemic from ischemic dilated cardiomyopathy, since patients with ischemic cardiomyopathy demonstrate large zones of intensely depressed accumulation of 11C-palmitate, probably reflecting prior infarction. Patients with hypertrophic cardiomyopathy and Duchenne's muscular dystrophy demonstrate relatively unique patterns of myocardial abnormalities of perfusion and metabolism. The availability of new tracers and techniques for the evaluation of myocardial metabolism (11C-acetate), perfusion (H2(15)O), and autonomic tone (11-C-hydroxyephedrine) should facilitate further understanding of the pathogenesis of the cardiomyopathies

  1. Myocardial strains from 3D displacement encoded magnetic resonance imaging

    Kindberg, Katarina; Haraldsson, Henrik; Sigfridsson, Andreas; Engvall, Jan; Ingels, Neil B Jr; Ebbers, Tino; Karlsson, Matts

    2012-01-01

    The ability to measure and quantify myocardial motion and deformation provides a useful tool to assist in the diagnosis, prognosis and management of heart disease. The recent development of magnetic resonance imaging methods, such as harmonic phase analysis of tagging and displacement encoding with stimulated echoes (DENSE), make detailed non-invasive 3D kinematic analyses of human myocardium possible in the clinic and for research purposes. A robust analysis method is required, however. We propose to estimate strain using a polynomial function which produces local models of the displacement field obtained with DENSE. Given a specific polynomial order, the model is obtained as the least squares fit of the acquired displacement field. These local models are subsequently used to produce estimates of the full strain tensor. The proposed method is evaluated on a numerical phantom as well as in vivo on a healthy human heart. The evaluation showed that the proposed method produced accurate results and showed low sensitivity to noise in the numerical phantom. The method was also demonstrated in vivo by assessment of the full strain tensor and to resolve transmural strain variations. Strain estimation within a 3D myocardial volume based on polynomial functions yields accurate and robust results when validated on an analytical model. The polynomial field is capable of resolving the measured material positions from the in vivo data, and the obtained in vivo strains values agree with previously reported myocardial strains in normal human hearts

  2. Myocardial strains from 3D displacement encoded magnetic resonance imaging

    Kindberg Katarina

    2012-04-01

    Full Text Available Abstract Background The ability to measure and quantify myocardial motion and deformation provides a useful tool to assist in the diagnosis, prognosis and management of heart disease. The recent development of magnetic resonance imaging methods, such as harmonic phase analysis of tagging and displacement encoding with stimulated echoes (DENSE, make detailed non-invasive 3D kinematic analyses of human myocardium possible in the clinic and for research purposes. A robust analysis method is required, however. Methods We propose to estimate strain using a polynomial function which produces local models of the displacement field obtained with DENSE. Given a specific polynomial order, the model is obtained as the least squares fit of the acquired displacement field. These local models are subsequently used to produce estimates of the full strain tensor. Results The proposed method is evaluated on a numerical phantom as well as in vivo on a healthy human heart. The evaluation showed that the proposed method produced accurate results and showed low sensitivity to noise in the numerical phantom. The method was also demonstrated in vivo by assessment of the full strain tensor and to resolve transmural strain variations. Conclusions Strain estimation within a 3D myocardial volume based on polynomial functions yields accurate and robust results when validated on an analytical model. The polynomial field is capable of resolving the measured material positions from the in vivo data, and the obtained in vivo strains values agree with previously reported myocardial strains in normal human hearts.

  3. Follow-up of regional myocardial T2 relaxation times in patients with myocardial infarction evaluated with magnetic resonance imaging

    Krauss, X.H.; Wall, E. van der; Laarse, A. van der; Dijkman, P.R.M. van; Bruschke, A.V.G.; Doornbos, J.; Roos, A. de; Voorthuisen, A.E. van

    1990-01-01

    Multi-echo spin-echo cardiac magnetic resonance imaging studies (echo times 30, 60, 90 and 120 ms) were performed in 19 patients with a 7-14-day (mean 10) old myocardial infarction and were repeated in 13 patients 4-7 months (mean 6) later. Also, 10 normal subjects were studied with magnetic resonance imaging. T2 relaxation times of certain left ventricular segments were calculated from the signal intensities at echo times of 30 and 90 ms. Compared to normal individuals, the mean T2 values on the early magnetic resonance images of the patients with inferior infarction showed significantly prolonged T2 times in the inferiorly localized segments, while on the follow-up magnetic resonance images the T2 times had almost returned to the normal range. Also the patients with anterior infarction showed significantly prolonged T2 times in the anteriorly localized segments on the early nuclear magnetic resonance images, but the T2 times remained prolonged at the follow-up magnetic resonance images. For every patient a myocardial damage score was determined, which was defined as the sum of the segmental T2 values in the patients minus the upper limit of normal T2 values obtained from the normal volunteers (= mean normal+2SD). The damage score on both the early and late magnetic resonance imaging study correlated well with the infarction size determined by myocardial enzyme release. Only the patients with an inferior infarction showed a significant decrease in damage score at follow-up magnetic resonance imaging. It is concluded that the regional T2 relaxation times are increased in infarcted myocardial regions and may remain prolonged for at least up to 7 months after the acute event, particularly in patients with an anterior infarction. These findings demonstrate the clinical potential of T2-weighted magnetic resonance imaging studies for detecting myocardial infarction, and estimating infarct size for an extended period after acute myocardial infarction. (author). 29 refs

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

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

    2002-01-01

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

  5. Noninvasive and simple method for the estimation of myocardial metabolic rate of glucose by PET and 18F-FDG

    Takahashi, Norio; Tamaki, Nagara; Kawamoto, Masahide

    1994-01-01

    To estimate regional myocardial metabolic rate of glucose (rMRGlu) with positron emission tomography (PET) and 2-[ 18 F] fluoro-2-deoxy-D-glucose (FDG), non invasive simple method has been investigated using dynamic PET imaging in 14 patients with ischemic heart disease. This imaging approach uses a blood time-activity curve (TAC) derived from a region of interest (ROI) drawn over dynamic PET images of the left ventricle (LV), left atrium (LA) and aorta. Patlak graphic analysis was used to estimate k 1 k 3 /(k 2 +k 3 ) from serial plasma and myocardial radioactivities. FDG counts ratio between whole blood and plasma was relatively constant (0.91±0.02) both throughout the time and among different patients. Although TACs derived from dynamic PET images gradually increased at later phase due to spill over from the myocardium into the cavity, three were good agreements between the estimated K complex values obtained from arterial blood sampling and dynamic PET imaging (LV r=0.95, LA r=0.96, aorta r=0.98). These results demonstrate the practical usefulness of a simplified and noninvasive method for the estimation of rMRGlu in humans by PET. (author)

  6. Danqi Pill regulates lipid metabolism disorder induced by myocardial ischemia through FATP-CPTI pathway.

    Wang, Yong; Li, Chun; Wang, Qiyan; Shi, Tianjiao; Wang, Jing; Chen, Hui; Wu, Yan; Han, Jing; Guo, Shuzhen; Wang, Yuanyuan; Wang, Wei

    2015-02-21

    Danqi Pill (DQP), which contains Chinese herbs Salvia miltiorrhiza Bunge and Panax notoginseng, is widely used in the treatment of myocardial ischemia (MI) in China. Its regulatory effects on MI-associated lipid metabolism disorders haven't been comprehensively studied so far. We aimed to systematically investigate the regulatory mechanism of DQP on myocardial ischemia-induced lipid metabolism disorders. Myocardial ischemia rat model was induced by left anterior descending coronary artery ligation. The rat models were divided into three groups: model group with administration of normal saline, study group with administration of DanQi aqueous solution (1.5 mg/kg) and positive-control group with administration of pravastatin aqueous solution (1.2 mg/kg). In addition, another sham-operated group was set as negative control. At 28 days after treatment, cardiac function and degree of lipid metabolism disorders in rats of different groups were measured. Plasma lipid disorders were induced by myocardial ischemia, with manifestation of up-regulation of triglyceride (TG), low density lipoprotein (LDL), Apolipoprotein B (Apo-B) and 3-hydroxy-3-methyl glutaryl coenzyme A reductase (HMGCR). DQP could down-regulate the levels of TG, LDL, Apo-B and HMGCR. The Lipid transport pathway, fatty acids transport protein (FATP) and Carnitine palmitoyltransferase I (CPTI) were down-regulated in model group. DQP could improve plasma lipid metabolism by up-regulating this lipid transport pathway. The transcription factors peroxisome proliferator-activated receptor α (PPARα) and retinoid X receptors (RXRs), which regulate lipid metabolism, were also up-regulated by DQP. Furthermore, DQP was able to improve heart function and up-regulate ejection fraction (EF) by increasing the cardiac diastolic volume. Our study reveals that DQP would be an ideal alternative drug for the treatment of dyslipidemia which is induced by myocardial ischemia.

  7. Evaluation of initial uptake and redistribution on stress thallium-201 myocardial perfusion images in patients with myocardial infarction

    Watanabe, Yoshihiko; Tonooka, Ichiroh; Kanaya, Tohru; Tsuiki, Kai; Yasui, Shouji.

    1984-01-01

    Stress thallium-201 myocardial perfusion imaging was performed on 29 patients with previous myocardial infarction and 29 patients with angina pectoris at exercise to evaluate thallium-201 kinetics in ischemic heart disease. Four views of thallium-201 images (right anterior oblique, antero-posterior, left anterior oblique and left lateral views) were obtained at 5 min after treadmill exercise with administration of 2 mCi of thallium-201 chloride (initial image) and at 3 hours later (delayed image). Myocardial images were divided into 6 segments (anterior, lateral, inferior, posterior, apical and septal segments) and initial uptake (IU) and redistribution index (RDI, the ratio of the maximal washout rate to a washout rate in each segment) were calculated in order to assess the relations of thallium-201 kinetics to wall motion abnormality and coronary artery stenosis. In myocardial infarction, IU and RDI were decreased in proportion to the severity of wall motion abnormality and coronary artery stenosis. Contrarily, in angina pectoris, IU was decreased but RDI was increased proportionally to the severity of coronary arterial stenosis. In conclusion, IU and redistribution of thallium-201 were affected essentially by both the grade of coronary arterial stenosis and the amount of residual viable heart muscle in patients with ischemic myocardial disease. (author)

  8. Milrinone and levosimendan during porcine myocardial ischemia -- no effects on calcium overload and metabolism.

    Axelsson, B; Johansson, G; Abrahamsson, P; Gupta, A; Tydén, H; Wouters, P; Haney, M

    2013-07-01

    Although inotropic stimulation is considered harmful in the presence of myocardial ischaemia, both calcium sensitisers and phosphodiesterase inhibitors may offer cardioprotection. We hypothesise that these cardioprotective effects are related to an acute alteration of myocardial metabolism. We studied in vivo effects of milrinone and levosimendan on calcium overload and ischaemic markers using left ventricular microdialysis in pigs with acute myocardial ischaemia. Anaesthetised juvenile pigs, average weight 36 kg, were randomised to one of three intravenous treatment groups: milrinone 50 μg/kg bolus plus infusion 0.5 μg/kg/min (n = 7), levosimendan 24 μg/kg plus infusion 0.2 μg/kg/min (n = 7), or placebo (n = 6) for 60 min prior to and during a 45 min acute regional coronary occlusion. Systemic and myocardial haemodynamics were assessed, and microdialysis was performed with catheters positioned in the left ventricular wall. (45) Ca(2+) was included in the microperfusate in order to assess local calcium uptake into myocardial cells. The microdialysate was analysed for glucose, lactate, pyruvate, glycerol, and for (45) Ca(2+) recovery. During ischaemia, there were no differences in microdialysate-measured parameters between control animals and milrinone- or levosimendan-treated groups. In the pre-ischaemic period, arterial blood pressure decreased in all groups while myocardial oxygen consumption remained stable. These findings reject the hypothesis of an immediate energy-conserving effect of milrinone and levosimendan during acute myocardial ischaemia. On the other hand, the data show that inotropic support with milrinone and levosimendan does not worsen the metabolic parameters that were measured in the ischaemic myocardium. © 2013 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

  9. Applications of radionuclide myocardial perfusion imaging in acute coronary syndrome

    Han Pingping; Tian Yueqin

    2008-01-01

    In recent years, acute coronary syndrome(ACS) has been getting more and more attentions. Radionuclide myocardial perfusion imaging (MPI) can make a quick accurate diagnosis for patients with acute chest pain who cann't be diagnosed by conventional methods. The sensitivity and negative predictive value of MPI are relatively high. Besides, MPI can be applicated in the detection of ischemic and infarct size and degree, the risk stratification and the assessment of prognosis of the patients with ACS, and the appraisal of the effect of strategies. (authors)

  10. Thallium-201 exercise myocardial imaging to evaluate myocardial perfusion after coronary artery bypass surgery

    Hirzel, H.O.; Nuesch, K.; Sialer, G.; Horst, W.; Krayenbuehl, H.P.

    1980-01-01

    To assess the usefulness of thallium-201 exercise scintigraphy in evaluating myocardial perfusion after coronary artery bypass surgery, imaging was performed after submaximal bicycle ergometry and at rest in 54 patients before and within 24 +- 10 (SD) weeks after operation. Scintigraphy identified 8 out of 20 patients who were symptom free after operation and showed normal exercise electrocardiograms as still having exercise-induced ischaemia and thus as having not truly benefited from the surgical intervention. In contrast, improvement in perfusion was documented in 17 out of 31 patients despite further complaints of chest pain and persistence of a pathological exercise electrocardiogram in 6 of them. Bypass graft patency rate paralleled the scintigraphic findings in the 35 patients who were restudied arteriographically. It was concluded that thallium-201 exercise scintigraphy is a useful technique to document changes in regional perfusion after surgery and is definitely superior to the clinical evaluation of patients including the exercise electrocardiogram. (author)

  11. Evaluating the effect of PTCA by exercise stress myocardial perfusion imaging

    Lin Jinghui

    1992-01-01

    In this study, 44 patients after successful percutaneous transluminal coronary angioplasty (PTCA) were followed up by exercise stress myocardial perfusion imaging. In 28 patients with myocardial ischemia after PTCA, myocardial imaging of 75.0% patients reverted to normal or approximately normal. In 16 patients of myocardial infarction with ischemia after PTCA, myocardial imaging of only 37.5% patients reverted to normal or approximately normal, significantly less than myocardial ischemia. But the general efficacious incidence was similar in both groups. Most of 77 myocardial segments with complete or obvious redistribution returned to normal imaging after PTCA. During the follow-up coronary artery restenosis occurred in 6 cases, 5 of which were confirmed by coronary arteriography. Restenosis may be discovered as soon as possible, if a patient was reexamined by myocardial imaging 2-6 months after PTCA. The results of this study indicated that myocardial imaging is a noninvasive and reliable method for the assessment of PTCA therapeutic effect and follow up studies

  12. Impact of type 2 diabetes and the metabolic syndrome on myocardial structure and microvasculature of men with coronary artery disease

    Yii Michael

    2011-09-01

    Full Text Available Abstract Background Type 2 diabetes and the metabolic syndrome are associated with impaired diastolic function and increased heart failure risk. Animal models and autopsy studies of diabetic patients implicate myocardial fibrosis, cardiomyocyte hypertrophy, altered myocardial microvascular structure and advanced glycation end-products (AGEs in the pathogenesis of diabetic cardiomyopathy. We investigated whether type 2 diabetes and the metabolic syndrome are associated with altered myocardial structure, microvasculature, and expression of AGEs and receptor for AGEs (RAGE in men with coronary artery disease. Methods We performed histological analysis of left ventricular biopsies from 13 control, 10 diabetic and 23 metabolic syndrome men undergoing coronary artery bypass graft surgery who did not have heart failure or atrial fibrillation, had not received loop diuretic therapy, and did not have evidence of previous myocardial infarction. Results All three patient groups had similar extent of coronary artery disease and clinical characteristics, apart from differences in metabolic parameters. Diabetic and metabolic syndrome patients had higher pulmonary capillary wedge pressure than controls, and diabetic patients had reduced mitral diastolic peak velocity of the septal mitral annulus (E', consistent with impaired diastolic function. Neither diabetic nor metabolic syndrome patients had increased myocardial interstitial fibrosis (picrosirius red, or increased immunostaining for collagen I and III, the AGE Nε-(carboxymethyllysine, or RAGE. Cardiomyocyte width, capillary length density, diffusion radius, and arteriolar dimensions did not differ between the three patient groups, whereas diabetic and metabolic syndrome patients had reduced perivascular fibrosis. Conclusions Impaired diastolic function of type 2 diabetic and metabolic syndrome patients was not dependent on increased myocardial fibrosis, cardiomyocyte hypertrophy, alteration of the

  13. Preoperative evaluation of myocardial viability by thallium-201 imaging in patients with old myocardial infarction who underwent coronary revascularization

    Naruse, Hitoshi; Ohyanagi, Mitsumasa; Iwasaki, Tadaaki; Miyamoto, Takashi; Fukuchi, Minoru

    1992-01-01

    The myocardial uptake and redistribution in thallium scintigraphy and the regional wall motion by echocardiography were evaluated by a semi-quantitative method in 42 patients who previously had myocardial infarction (50 target vessels) and underwent coronary revascularization. The aim of this study was to elucidate the significance of the initial image, delayed image and redistribution on thallium-201 scintigraphy for clinical diagnosis of the myocardial viability. As a semi-quantitative analysis, we used a bull's-eye display for thallium image and centerline method for echocardiographic wall motion, and compared the results before and after revascularization. As a result, the thallium grade improved postoperatively in all 17 areas which preoperatively had showed redistribution, and also in 11 of the 32 areas without preoperative redistribution. The sensitivity, specificity and accuracy of preoperative thallium redistribution for predicting myocardial viability were 61%, 100% and 78%, respectively, when the postoperative improvement in the thallium grade was used as the standard. The postoperative probability of improvement in the thallium grade increased in proportion to the preoperative grade (delayed image)(p<0.01). There was no correlation between the preoperative thallium delayed image and postoperative improvement in wall motion. Postoperative improvement in thallium image and wall motion could not be predicted from the preoperative wall motion. Thus, postoperative improvement in thallium images can be anticipated if redistribution is present on the preoperative thallium image, and the preoperative thallium delayed image is useful for predicting myocardial viability. Improvement in wall motion could not be predicted preoperatively by these methods. (author)

  14. Thallium-201 myocardial imaging in children with heart disease

    Mitomori, Toshihiro; Ono, Yasuo; Kamiya, Tetsuro; Nishimura, Tsunehiko; Kozuka, Takahiro; Kohata, Tohru; Tanimoto, Takeshi.

    1985-01-01

    201-TlCl myocardial imaging studies were performed to evaluate systolic pressure of right ventricle on 107 patients including 89 patients with congenital cardiac disease, patients with primary pulmonary hypertension and 13 patients with history of MCLS with the age range of 2 months to 17 years. The congenital cardiac disease group included 30 patients with tetralogy of Fallot, 8 patients with pulmonary stenosis (included 1 patient with double chambered right ventricle), 20 patients with ventricular septal defect, 10 patients with patent ductus arteriosus, 9 patients with atrial septal defect and 12 patients with complete transposition of greate arteries. None of the patients with history of MCLS had coronary involvement. 50 μCi/kg of 201-TlCl was infused intravenously and after 15 minutes the images were obtained from 5 directions (anterior, LAO 30, LAO 45, LAO 60 and lateral). The angle was determined to demonstrate the intraventricular septum and ventricular free walls cleary separated. The image of end-diastolic phase was obtained with ECG syncronized gated method from that direction. The ROI (region of interest) was defined as a slice line by drawing two lines perpendicular to the septum and the counts of the left and right ventricular free wall (Cl and Cr) were analized to evaluate the pressure of right ventricle. The pressure of ventricles were obtained by cardiac catheterization performed at the same time with myocardial imaging. The ratio of Cl and Cr (Cr/Cl) had good correlation with the ratio of peak systolic pressure of left ventricle and right ventricle (regression equation Y=0.84X+0.08, r=0.87). In each congenital heart disease group, very good corelation was also demonstrated (Y=1.46X-0.30, r=0.96 in PS ; Y=0.70X0.20, r=0.91 in VSD ; Y=0.86X+0.15, r=0.78 in ASD and Y=0.72X+0.24, r=0.80 in PDA). Thus 201-TlCl myocardial imaging was useful method to evaluate right ventricular pressure noninvasively in congenital cardiac disease. (author)

  15. Role of myocardial perfusion imaging in acute coronary syndrome

    Aleem, M.

    2007-01-01

    Full text: In the cardiac emergency department, a number of patients present with acute chest pain. In case of non diagnostic ECG and enzymes, accurately categorizing the patient in high and low probability is difficult. Aim of study was to evaluate the role of resting myocardial perfusion imaging (MPI) in patients with acute coronary syndrome (ACS) and then to compare the results with subsequent stress imaging. Material and Methods. A total of 34 patients were selected for the study, which were divided into three groups on the basis of respective probabilities of having ACS. This probability was decided on the basis of nature of chest pain, ECG findings, enzymes levels, and age and sex. Arbitrary score was given to patient's condition. This score ranged from 1 to 14. Patients with score between 1-6 were assigned low probability, from 7-10 were assigned intermediate probability and patients having score greater than 11 were placed in high probability groups. Patients in the low and intermediate probability groups were injected with Tc 99 m- MIBI within 6 hours of onset of chest pain and were undergone resting myocardial perfusion imaging (MPI) 3 to five hours after injection.. Imaging in high probability group was performed at discharge. Four weeks after the acute event all the patients underwent stress myocardial perfusion imaging. Results: All patients (100%) with low probability of ACS (n=10) showed negative resting scans. On stress MPI two patients (20%) showed new defects. Patient with high probability of ACS (n=12), all were positive 100% on resting MPI. On stress MPI, three showed (25%) no change from rest MPI, while nine patients (75%) showed augmentation of defects and four out of these nine patients (33%) also showed new perfusion defects. Patients with intermediate probability of ACS (n=12), three showed positive rest MPI (25%). On stress MPI out of these three cases, one showed (8%) no change from rest MPI and two showed (17%) augmentation of defect

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

    Schad, N.; Vattimo, A.; Bertelli, P.

    1990-01-01

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

  17. Regional rates of myocardial fatty acid metabolism: comparison with coronary angiography and ventriculography.

    Schad, N; Wagner, R K; Hallermeier, J; Daus, H J; Vattimo, A; Bertelli, P

    1990-01-01

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

  18. Dynamic low dose I-123-iodophenylpentadecanoic acid metabolic cardiac imaging

    Murray, G.L.; Magill, H.L.; Schad, N.C.

    1993-01-01

    Recognition of stunned and hibernating myocardium is essential in this era of cardiac revascularization. Positron emission tomography (PET) accurately identifies viability but is costly and unavailable to most patients. Dynamic low dose I-123-iodophenylpentadecanoic acid (IPPA) metabolic cardiac imaging is a potentially cost-effective alternative to PET. Using transmural myocardial biopsies obtained during coronary bypass surgery as the viability gold standard, resting IPPA imaging agreed with 39/43 (91%) biopsies, with a sensitivity for viability of 33/36(92%) and a specificity of 6/7 (86%) in patients with severe ischemic cardiomyopathy. Eighty percent of IPPA viable, infarcted segments improved wall motion postoperatively. Furthermore, when compared to reinjection thallium (SPECT-Tl) scans after myocardial infarction, there was IPPA-Tl concordance in 27/35 (77%)(Kappa=0.536, p=0.0003). Similar to PET, IPPA demonstrated more viability than SPECT-Tl, 26/35 (74%) vs. 18/35 (51%)(p=0.047). Finally, when compared to transvenous endomyocardial biopsy for detecting rejection following cardiac transplantation, IPPA sensitivity for ≥Grade II rejection was 100%, and IPPA screening assessment for the necessity of biopsy could result in a 31% cost-savings. Therefore, IPPA metabolic cardiac imaging is a safe, inexpensive technique with a promising future. (author)

  19. Role of redistribution and 24 hour reinjection images to assess myocardial viability in patients with acute myocardial infarction

    Yoon, Seok Nam; Pai, Moon Sun; Park, Chan H.; Yoon, Myung Ho; Choi, Byung Il

    1998-01-01

    We evaluated the importance of redistribution and 24 hour reinjection images in Tl-201 SPECT assessment of myocardial viability after acute myocardial infarction (AMI). We performed dipyridamole stress-4 hour redistribution-24 hour reinjection Tl-201 SPECT in 43 patients with recent AMI (4-16 days). The myocardium was divided into 16 segments and perfusion grade was measured visually with 4 point score from 0 to 3 (absent uptake to normal uptake). A perfusion defect with stress score 2 was considered moderate. A defect was considered severe if the stress score was 0 or 1 (absent uptake or severe perfusion decrease). Moderate defect on stress image were considered viable and and segments with severe defect were considered viable if they showed improvement of 1 score or more on redistribution or reinjection images. We compared the results of viability assessment in stress-redistribution and stress-reinjection images. On visual analysis, 344 of 688 segments (50%) had abnormal perfusion. Fify two (15%) had moderate perfusion defects and 292 (85%) had severe perfusion defects on stress image. Of 292 severe stress defects, 53 were irreversible on redistribution and reversible on reinjection images, and 15 were reverseble on redistribution and irreversible on reinjection images. Two hundred twenty four of 292 segments (76.7%) showed concordant results on stress-redistribution and stress- reinjection images. Therefore 24 hour reinjection image changed viability status from necrotic to viable in 53 segments of 292 severe stress defect (18%). However, myocardial viability was underestimated in only 5% (15/292) of severe defects by 24 hour reinjection. The 24 hour reinjection imaging is useful in the assessment of myocardial viability. It is more sensitive than 4 hour redistribution imaging. However, both redistribution and reinjection images are needed since they complement each other

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

    Padua, Rodrigo Donizete Santana de [Universidade de Sao Paulo (USP), Ribeirao Preto, SP (Brazil). Faculdade de Medicina. Div. de Cardiologia]. E-mail: rodrigo_dsp@hcrp.fmrp.usp.br; Oliveira, Lucas Ferrari de [Universidade Federal de Pelotas (UFPel), RS (Brazil). Inst. de Fisica e Matematica. Dept. de Tecnologia da Informacao; Marques, Paulo Mazzoncini de Azevedo [Universidade de Sao Paulo (USP), Ribeirao Preto, SP (Brazil). Faculdade de Medicina. Centro de Ciencias das Imagens e Fisica Medica; Groote, Jean-Jacques Georges Soares de [Instituto de Ensino Superior COC, Ribeirao Preto, SP (Brazil). Lab. of Artifical Intelligence and Applications; Castro, Adelson Antonio de [Universidade de Sao Paulo (USP), Ribeirao Preto, SP, (Brazil). Faculdade de Medicina; Ana, Lauro Wichert [Universidade de Sao Paulo (USP), Ribeirao Preto, SP (Brazil). Faculdade de Medicina. Centro de Ciencias das Imagens e Fisica Medica; Simoes, Marcus Vinicius [Universidade de Sao Paulo (USP), Ribeirao Preto, SP, (Brazil). Faculdade de Medicina. Divisao de Cardiologia

    2008-11-15

    To develop an atlas of myocardial perfusion scintigraphy and evaluating its applicability in computer-aided detection of myocardial perfusion defects in patients with ischemic heart disease. The atlas was created with rest-stress myocardial perfusion scintigraphic images of 20 patients of both genders with low probability of coronary artery disease and considered as normal by two experienced observers. Techniques of image registration and mathematical operations on images were utilized for obtaining template images depicting mean myocardial uptake and standard deviation for each gender and physiological condition. Myocardial perfusion scintigraphy images of one male and one female patient were aligned with the corresponding atlas template image, and voxels with myocardial uptake rates two standard deviations below the mean voxel value of the respective region in the atlas template image were highlighted on the tomographic sections and confirmed as perfusion defects by both observe. The present study demonstrated the creation of an atlas of myocardial perfusion scintigraphy with promising results of this tool as an aid in the detection of myocardial perfusion defects. However, further prospective validation with a more representative sample is recommended. (author)

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

    Padua, Rodrigo Donizete Santana de; Oliveira, Lucas Ferrari de; Marques, Paulo Mazzoncini de Azevedo; Groote, Jean-Jacques Georges Soares de; Castro, Adelson Antonio de; Ana, Lauro Wichert; Simoes, Marcus Vinicius

    2008-01-01

    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)

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

    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

  3. Myocardial Infarction and Ischemic Heart Disease in Overweight and Obesity With and Without Metabolic Syndrome

    Thomsen, Mette; Nordestgaard, Børge G

    2014-01-01

    IMPORTANCE: Overweight and obesity likely cause myocardial infarction (MI) and ischemic heart disease (IHD); however, whether coexisting metabolic syndrome is a necessary condition is unknown. OBJECTIVE: To test the hypothesis that overweight and obesity with and without metabolic syndrome...... syndrome. MAIN OUTCOMES AND MEASURES: Hazard ratios for incident MI and IHD according to combinations of BMI category and absence or presence of metabolic syndrome. RESULTS: During a median of 3.6 years' follow-up, we recorded 634 incident MI and 1781 incident IHD events. For MI, multivariable adjusted...... hazard ratios vs normal weight individuals without metabolic syndrome were 1.26 (95% CI, 1.00-1.61) in overweight and 1.88 (95% CI, 1.34-2.63) in obese individuals without metabolic syndrome and 1.39 (95% CI, 0.96-2.02) in normal weight, 1.70 (95% CI, 1.35-2.15) in overweight, and 2.33 (95% CI, 1...

  4. Polarization image segmentation of radiofrequency ablated porcine myocardial tissue.

    Iftikhar Ahmad

    Full Text Available Optical polarimetry has previously imaged the spatial extent of a typical radiofrequency ablated (RFA lesion in myocardial tissue, exhibiting significantly lower total depolarization at the necrotic core compared to healthy tissue, and intermediate values at the RFA rim region. Here, total depolarization in ablated myocardium was used to segment the total depolarization image into three (core, rim and healthy zones. A local fuzzy thresholding algorithm was used for this multi-region segmentation, and then compared with a ground truth segmentation obtained from manual demarcation of RFA core and rim regions on the histopathology image. Quantitative comparison of the algorithm segmentation results was performed with evaluation metrics such as dice similarity coefficient (DSC = 0.78 ± 0.02 and 0.80 ± 0.02, sensitivity (Sn = 0.83 ± 0.10 and 0.91 ± 0.08, specificity (Sp = 0.76 ± 0.17 and 0.72 ± 0.17 and accuracy (Acc = 0.81 ± 0.09 and 0.71 ± 0.10 for RFA core and rim regions, respectively. This automatic segmentation of parametric depolarization images suggests a novel application of optical polarimetry, namely its use in objective RFA image quantification.

  5. Myocardial perfusion imaging, coronary angiography and histological examination in experimental treatment of Ad-HGF for myocardial infarction

    Li Jianhua; Feng Jianlin; Cheng Xu; Li Dianfu; Zhang Youfu

    2007-01-01

    Objective: Gene therapy has drawn a great attention. A swine model of adenovirus hepatocyte growth factor(Ad-HGF) treated myocardial infarction(MI) was utilized, with the effect being assessed by rest myocardial perfusion imaging, coronary angiography and histological examination. Methods: Three groups of MI swine treated with Ad-HGF at low dose [n=5, Ad-HGF 10 8 plague forming unit (PFU)/ site], medium dose(n=5, 4 x 10 8 PFU/site), and high dose (n=5, 5 x 10 9 PFU/site), a control group treated with normal saline(NS, n=5) and a blank control group (n=5) underwent rest myocardial perfusion imaging and coronary angiography before and after treatment. The imaging results were analyzed along with histological findings in each group. Results: The state of myocardial perfusion and Rentrop scores remained unchanged in the blank control and NS groups after treatment. Whereas there was a significant improvement in the two variables in all three groups treated with Ad-HGF. The scores of left circumflex coronary artery (LCX) before and after treated were 7.8 ± 1.3 and 16.4 ± 1.1 (low-dose), 8.2 ± 1.6 and 17.6 ± 0.9 (medium-dose), 8.4 ± 1.5 and 19.0 ± 0.7 (high-dose), respectively. No significant differences were noted among the 3 groups. The number of vessels of NS group was markedly less than that of other groups. Conclusion: Myocardial perfusion imaging seems to be more accurate than coronary angiography and histological examination in evaluating the effects of Ad-HGF on myocardial infarction. (authors)

  6. Myocardial imaging with a radioiodinated norepinephrine storage analog

    Wieland, D.M.; Brown, L.E.; Rogers, W.L.; Worthington, K.C.; Wu, J.L.; Clinthorne, N.H.; Otto, C.A.; Swanson, D.P.; Beierwaltes, W.H.

    1981-01-01

    Meta-iodobenzylguanidine (M-IBG), an iodinated aromatic analog of the hypotensive drug guanethidine, localizes in the heart of the rat, dog, and rhesus monkey. A comparative study of tissue distribution in the dog has been performed with five myocardiophilic agents: thallium-201, I-125 16-iodohexadecanoic acid, H-3 norepinephrine, C-14 guanethidine and I-125 M-IBG. The last two compounds give heart concentrations and heart-to-blood concentration ratios similar to those of thallium-201. Planar and tomographic images of the hearts of the dog and rhesus monkey were obtained using I-131 or I-123 labeled M-IBG. Blocking studies with reserpine suggest that a major component of myocardial retention of M-IBG is sequestration within the norepinephrine storage vesicles of the adrenergic nerves. The localization of M-IBG in other organs with rich sympathetic innervation and the relative insensitivity of myocardial uptake to a wide range of loading doses lend additional support for a neuronal mode of retention

  7. Imaging of cocaine-induced global and regional myocardial ischemia

    Oster, Z.H.; Som, P.; Wang, G.J.; Weber, D.A.

    1991-01-01

    Severe and often fatal cardiac complications have been reported in cocaine users with narrowed coronary arteries caused by atherosclerosis as well as in young adults with normal coronaries. The authors have found that in normal dogs cocaine induces severe temporary hypoperfusion of the left ventricle as indicated by a significantly lower 201Tl concentration compared to the baseline state. The most significant decrease in uptake occurred 5 min after injection and was more pronounced in the septal and apical segments. Following intravenous administration of cocaine, instead of gradual disappearance of 201Tl from the left ventricle, there was continuous increase in 201Tl concentration in the left ventricle. These imaging experiments indicate that the deleterious effects of cocaine on the heart are probably due to spasm of the coronaries and decreased myocardial perfusion. Since spasm of the large subpericardial vessels does not seem to explain the magnitude of the increased coronary resistance and decreased coronary flow after cocaine as described in the literature, it is suggested that microvascular spasm of smaller vessels plays a major role in the temporary decrease in perfusion. The data may also suggest that severe temporary myocardial ischemia is probably the initiating factor for the cardiac complications induced by cocaine

  8. Thallium-201 myocardial imaging for evaluation of pulmonary hypertension

    Ikuno, Yoshiyasu

    1979-01-01

    Thallium-201 ( 201 Tl) myocardial scintigraphy (TMS) was performed in 54 patients. The images were analysed semi-quantitatively by measuring the extent of radioisotope concentration in the right ventricular free wall and the size of the right ventricular cavity. The extent of radioisotope concentration (four degrees) was expressed as the right ventricular activity score (RVAS) and the size of the right ventricular cavity (three degrees) was expressed as the right ventricular cavity score (RVCS). The scores were added for a right ventricular total score (RVTS). To establish criteria for the diagnosis of pulmonary hypertension (PH) by means of TMS, these scores were compared with the values of pulmonary arterial mean pressure (PAMP). The criteria were evaluated by comparing them with conventional criteria for electrocardiographic diagnosis of right ventricular hypertrophy. Patients with a 2-point RVAS had a significantly higher PAMP than those with a 0 or 1-point RVAS (p 201 Tl myocardial scintigrams is a useful non-invasive method for evaluating PH and its severity. (J.P.N.)

  9. A comparison of adenosine and arbutamine for myocardial perfusion imaging

    Anagnostopoulos, C.; Pennell, D.; Francis, J.; Serup-Hansen, K.; Davies, G.; Underwood, R.

    1998-01-01

    We have compared our standard stress protocol (adenosine combined with exercise) with the new stress agent arbutamine, for thallium-201 myocardial perfusion imaging (MPI) in order to assess the comparative value of arbutamine. We studied 23 patients referred for MPI, and each patient had two studies (18 males, median age 66 years, five with previous myocardial infarction). Uptake scores were assigned to each of nine segments, and the extent and severity of defects were measured using a polar plot. Haemodynamic changes were greater with arbutamine (rate-pressure product increase 78% vs 51%, P = 0.003). Symptoms were experienced by 21 patients with arbutamine and 16 with adenosine (P = 0.07). Agreement between the techniques for classification of patients as normal or as having reversible, fixed or mixed defects was good (19 of 23 studies, 83%, κ = 0.76). Agreement for similar classification of segments was also good (82%, κ = 0.71). Segmental agreement for stress scores was good (86%, κ = 0.77). However, mean size of stress defect was larger with adenosine (83±52 pixels vs 65±48 pixels, P<0.05), though severity and reversibility were similar (P = NS). We conclude that arbutamine provides comparable results to those obtained with adenosine and exercise and that the observed differences are not clinically significant. (orig.)

  10. Significance of 99mTc-MIBI myocardial SPECT imaging in diagnosis of syndrome X

    Tian Yueqing; Liu Xiujie; Jiao Shubin

    1996-01-01

    To assess the value of myocardial imaging in the diagnosis of syndrome X, the study was performed with 99m Tc-MIBI myocardial SPECT imaging in 64 patients. The patients were divided into three groups: group 1 had 21 patients diagnosed as syndrome X, group 2 had 17 patients with chest pain and normal coronary arteries without ST segment depression during exercise, group 3 had 26 patients with the angina pectoris and coronary stenoses≥50%. The myocardial SPECT imaging of the three groups was compared qualitatively and semi-quantitatively. Myocardial imaging identified 11 cases of myocardial ischemia from 21 patients with syndrome X. The ischemic score of myocardial imaging was 1.1 +- 0.3 for syndrome X and 1.8 +- 0.7 for patients with coronary heart disease (CHD) angina pectoris (t = 3.1746, P<0.01). Myocardial imaging may partly show myocardial ischemia in patients with syndrome X. The extent of ischemia in patients with syndrome X was significantly less than that in patients with CHD angina pectoris

  11. Beta-methyl[1-11C]heptadecanoic acid: a new myocardial metabolic tracer for positron emission tomography

    Livni, E.; Elmaleh, D.R.; Levy, S.; Brownell, G.L.; Strauss, W.H.

    1982-01-01

    We have tagged heptadecanoic acid with C-11 at the carboxyl group and have inserted a methyl radical in the beta position to inhibit beta oxidation of the fatty acid; we have then explored the tracer's potential as an indicator of myocardial metabolism for use with the positron tomograph. In this preliminary evaluation, biodistribution studies were made in rats and dogs, and imaging of normal and infarcted dogs was performed. At 30 min the tissue distribution studies in rats and dogs showed, respectively. 1.9% and 8.3% uptake in the heart. Sequential images of the canine heart exhibited a remarkable uptake, peaking at 16-18 min and retaining the same level of activity over the one-hour study period. Images of the heart after LAD ligation showed an area of diminished uptake corresponding to the region of infarction. Thus this agent has the basic properties required for potential use in the assessment and quantitation of free fatty-acid metabolism in the heart in a manner similar to the measurement of glucose metabolism in the brain with 2-[ 18 F]fluoro-2-deoxy-D-glucose

  12. Supervising PTCA treatment with a scheme of steps combination SPECT 99Tcm-MIBI myocardial imaging

    Luan Zhaosheng; Tian Jiahe; Peng Yong; Zhou Wen; Gai Luyue; Sun Zhijun; Su Yuwen; Liu Xiaohu

    2001-01-01

    Objective: To set up a useful supervising method around PTCA treatment. Methods: A scheme of steps combination SPECT 99 Tc m -MIBI myocardial imaging was devised. 87 patients with coronary artery disease were selected into the study. 3-step imaging, exercise, rest and intravenous infusion of nitroglycerine (NTG) imaging, was performed at 1 week before PTCA. 2-step imaging, exercise and rest imaging, was performed 1-2 weeks after PTCA. All of the indexes obtained from steps combination imaging before and after PTCA were contrasted with each other in pairs. Results: 1) Compared with outcome of clinical assessing, the imaging after PTCA could correctly assess PTCA outcome. 2) The myocardial defects showed in 3-step imaging before PTCA appeared to be ameliorated after PTCA and the amelioration showed in exercise imaging was more evident than that in rest imaging. The myocardial perfusion state revealed by NTG imaging was similar to that revealed by rest imaging after PTCA. 3) The 3-step imaging findings correlated with PTCA outcome, the best correlation was found between indexes of myocardial defect changes showed by NTG and exercise imaging and indexes of PTCA outcome (r = 0.9470, P 99 Tc m -MIBI myocardial SPECT imaging scheme is a very useful supervising method around PTCA. 2-step imaging after PTCA could assess outcome correctly, and 3-step imaging before it could predict outcome correctly, too

  13. A comparison of resting images from two myocardial perfusion tracers

    Anagnostopoulos, C.; Laney, R.; Pennell, D.; Proukakis, H.; Underwood, R.

    1995-01-01

    We have compared stress-redistribution and delayed rest thallium-201 with rest technetium-99m methoxyisobutylisonitrile (MIBI) tomograms in order to compare the tracers for the assessment of myocardial viability and to validate a rapid protocol combining the two tracers. We studied 30 consecutive patients with known or suspected coronary artery disease [group 1: 16 with normal left ventricular function, mean left ventricular ejection fraction (LVEF) 55%, SD 6%; group 2: 14 with abnormal function, mean LVEF 28%, SD 8%]. 201 Tl was injected during infusion of adenosine followed by acquisition of conventional stress and redistribution tomograms. On a separate day, 201 Tl was injected at rest with imaging 4 h later. 99m Tc-MIBI was then given at rest and imaging was performed. Three images were compared: redistribution 201 Tl, rest 201 Tl, and rest 99m Tc-MIBI. Tracer activity was classified visually and quantitatively in nine segments and segments with>50% activity were defined as containing clinically significant viable myocardium. Mean global tracer uptake as a percentage of maximum was similar in group 1 (rest 201 Tl 69%±12%, redistribution 201 Tl 69%±15%, rest 99m Tc-MIBI 70%±13%), but in group 2 mean tracer uptake was significantly greater in the rest 201 Tl images (59%±16%) than in redistribution 201 Tl images (53%±17%) or rest 99m Tc-MIBI images (53%±19%). Overall agreement for regional uptake score was excellent (κ from 0.79 to 0.84), although there were a significant number of segments with less uptake shown by redistribution 201 Tl and by rest 99m Tc-MIBI than by rest 201 Tl in group 2. The number of segments with significant viable myocardium in group 1 was very similar between the three images but in group 2 rest 201 Tl identified significantly more segments as viable than the other images. (orig./MG) (orig.). With 1 fig., 7 tabs

  14. First-pass myocardial perfusion MR imaging with gadolinium-enhanced turbo FLASH

    Teresi, L.M.; Smith, C.; Messenger, J.; Watanabe, A.; Herbst, M.; O'Sullivan, R.M.; Lee, R.; Remer, J.; Rappaport, A.; Bradley, W.G.

    1990-01-01

    This paper determines the efficacy of MR first-pass myocardial perfusion imaging using gadolinium-enhanced Turbo--fast low-angle shot (FLASH) ultrafast imaging combined with MR systolic wall thickening data for the determination of myocardial viability. Five normal volunteers and five patients with remote myocardial infarction were studied on a 1.5-T imaging system (Siemans, Ehrlangen, NJ). Turbo-FLASH imaging utilized a 180 degrees inversion pulse followed by a rapid gradient-echo sequence (TI 400 msec, TE2 msec, TR 4.9 msec, FA 8 degrees) with a complete 64 x 64 matrix image (300 mm FOV) being acquired in 300 msec. First-pass myocardial perfusion imaging was performed in the short-axis and long-axis oblique projections with a concantenated series of Turbo-FLASH images triggered to end-systole acquired immediately before and during a rapid bolus injection of 5cc gadolinium-DTPA

  15. Detecting culprit vessel of coronary artery disease with SPECT 99Tcm-MIBI myocardial imaging

    Luan Zhaosheng; Zhou Wen; Peng Yong; Su Yuwen; Tian Jianhe; Gai lue; Sun Zhijun

    2002-01-01

    Objective: To assess the value of detecting culprit vessel of coronary artery disease (CAD) with SPECT 99 Tc m -MIBI myocardial imaging. Methods: Forty-six patients with CAD were studied. Every patients had multiple-vessel lesion showed by coronary arteriography and was treated by revascularization as percutaneous transluminal angioplasty (PTCA), coronary artery bypass graft (CABG) or laser holing. Exercise (EX), rest (RE) and intravenous infusion of nitroglycerine (NTG) SPECT 99 Tc m -MIBI myocardial imagings were performed before revascularization. Exercise and rest images revealed the myocardial ischemia. NTG images revealed myocardial viability. Culprit vessels were detected according to the defects showed by above mentioned images. The veracity of detected culprit vessels was tested with the outcome of the reperfusion therapy. Results: In this group, the coronary arteriography revealed 107 lesioned coronary arteries. Myocardial imaging detected 46 culprit vessels including 23 left anterior descending (LAD), 19 left circumflex coronary artery (LCX) and 4 right coronary artery (RCA). All 46 culprit vessels underwent revascularization and had nice outcome. The veracity of 99 Tc m -MIBI myocardial imaging detected culprit vessels was high according to patients' outcome. Conclusion: Exercise, rest and NTG 99 Tc m -MIBI myocardial imaging is a great method for detecting culprit vessels in multivessel coronary disease

  16. Myocardial perfusion imaging for the detection of coronary heart disease

    Strauss, H.W.; Cook, D.J.; Bailey, I.; Rouleau, J.; Pitt, B.

    1976-01-01

    A method of myocardial perfusion imaging using 201 Tl is described. Thallium is able to substitute for potassium in biological systems including transport by the sodium--potassium ATP-ase system. The high extraction efficiency of the heart for 201 Tl offers a method whereby a tracer may be administered intravenously and is concentrated to a significant degree by the heart. However, only about 3 to 4 percent of the dose administered lodges in the myocardium. Experiments with dogs indicated that the regional distribution of Tl in the heart reflects the regional distribution of blood flow. The goal is to develop a procedure that can detect those patients with significant disease prior to the onset of a catastrophic event and studies are being undertaken to improve the sensitivity of the method for the detection of smaller lesions in the myocardium

  17. Thallium-201 for myocardial imaging: appearance of the normal heart

    Cook, D.J.; Bailey, I.; Strauss, H.W.; Rouleau, J.; Wagner, H.N. Jr.; Pitt, B.

    1976-01-01

    Thallium-201 myocardial perfusion images were obtained from 13 healthy adults after tracer administration both at rest and at maximal stress. On the rest-injected scan, tracer was seen in left ventricular myocardium, liver, and spleen. In two subjects with resting tachycardia, the right ventricular myocardium was slightly visualized after tracer injection at rest. When tracer was administered at stress, the left ventricular activity was more nearly homogeneous and the left ventricle was better defined on the scan. The left-ventricle-to-lung-background activity ratio increased from 2.4 at rest to 3.4 at stress. The right ventricular myocardium was seen on the stress-injected scan. Phantom studies, performed to define the optimum position for visualization of lesions, showed that small lesions were best defined when seen either en face or in tangent. Scans should be performed at stress whenever possible and multiple views are essential

  18. [Modifications in myocardial energy metabolism in diabetic patients

    Grynberg, A

    2001-11-01

    The capacity of cardiac myocyte to regulate ATP production to face any change in energy demand is a major determinant of cardiac function. Because FA is the main heart fuel (although the most expensive one in oxygen, and prompt to induce deleterious effects), this process is based on a balanced fatty acid (FA) metabolism. Several pathological situations are associated with an accumulation of FA or derivatives, or with an excessive b-oxidation. The diabetic cardiomyocyte is characterised by an over consumption of FA. The control of the FA/glucose balance clearly appears as a new strategy for cytoprotection, particularly in diabetes and requires a reduced FA contribution to ATP production. Cardiac myocytes can control FA mitochondrial entry, but display weak ability to control FA uptake, thus the fate of non beta-oxidized FA appear as a new impairment for the cell. Both the trigger and the regulation of cardiac contraction result from membrane activity, and the other major FA function in the myocardium is their role in membrane homeostasis, through the phospholipid synthesis and remodeling pathways. Sudden death, hypercatecholaminemia, diabetes and heart failure have been associated with an altered PUFA content in cardiac membranes. Experimental data suggest that the 2 metabolic pathways involved in membrane homeostasis may represent therapeutic targets for cytoprotection. The drugs that increase cardiac phospholipid turnover (trimétazidine, ranolazine,...) display anti-ischemic non hemodynamic effect. This effect is based on a redirection of FA utilization towards phospholipid synthesis, which decrease their availability for energy production. A nutritional approach gave also promising results. Besides its anti-arrhythmic effect, the dietary docosahexaenoic acid is able to reduce FA energy consumption and hence oxygen demand. The cardiac metabolic pathways involving FA should be considered as a whole, precariously balanced. The diabetic heart being characterised by

  19. Influence of abnormal glucose metabolism on coronary microvascular function after a recent myocardial infarction

    Løgstrup, Brian B; Høfsten, Dan E; Christophersen, Thomas B

    2009-01-01

    OBJECTIVES: This study sought to assess the association between abnormal glucose metabolism and abnormal coronary flow reserve (CFR) in patients with a recent acute myocardial infarction (AMI). BACKGROUND: Mortality and morbidity after AMI is high among patients with abnormal glucose metabolism, ...... (140 microg/kg/min) to obtain the hyperemic flow profiles. The CFR was defined as the ratio of hyperemic to baseline peak diastolic coronary flow velocities. RESULTS: Median CFR was 1.9 (interquartile range [IQR] 1.4 to 2.4], and 109 (60%) patients had a CFR...

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

    Abdullah, A.Z.; Hawkins, L.A.; Britton, K.E.; Elliott, A.T.; Stephens, J.D.

    1981-01-01

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

  1. Myocardial Oxidative Metabolism and Protein Synthesis during Mechanical Circulatory Support by Extracorporeal Membrane Oxygenation

    Priddy, MD, Colleen M.; Kajimoto, Masaki; Ledee, Dolena; Bouchard, Bertrand; Isern, Nancy G.; Olson, Aaron; Des Rosiers, Christine; Portman, Michael A.

    2013-02-01

    Extracorporeal membrane oxygenation (ECMO) provides mechanical circulatory support essential for survival in infants and children with acute cardiac decompensation. However, ECMO also causes metabolic disturbances, which contribute to total body wasting and protein loss. Cardiac stunning can also occur which prevents ECMO weaning, and contributes to high mortality. The heart may specifically undergo metabolic impairments, which influence functional recovery. We tested the hypothesis that ECMO alters oxidative. We focused on the amino acid leucine, and integration with myocardial protein synthesis. We used a translational immature swine model in which we assessed in heart (i) the fractional contribution of leucine (FcLeucine) and pyruvate (FCpyruvate) to mitochondrial acetyl-CoA formation by nuclear magnetic resonance and (ii) global protein fractional synthesis (FSR) by gas chromatography-mass spectrometry. Immature mixed breed Yorkshire male piglets (n = 22) were divided into four groups based on loading status (8 hours of normal circulation or ECMO) and intracoronary infusion [13C6,15N]-L-leucine (3.7 mM) alone or with [2-13C]-pyruvate (7.4 mM). ECMO decreased pulse pressure and correspondingly lowered myocardial oxygen consumption (~ 40%, n = 5), indicating decreased overall mitochondrial oxidative metabolism. However, FcLeucine was maintained and myocardial protein FSR was marginally increased. Pyruvate addition decreased tissue leucine enrichment, FcLeucine, and Fc for endogenous substrates as well as protein FSR. Conclusion: The heart under ECMO shows reduced oxidative metabolism of substrates, including amino acids, while maintaining (i) metabolic flexibility indicated by ability to respond to pyruvate, and (ii) a normal or increased capacity for global protein synthesis, suggesting an improved protein balance.

  2. Magnetic resonance imaging in patients with unstable angina: comparison with acute myocardial infarction and normals

    Ahmad, M.; Johnson, R.F. Jr.; Fawcett, H.D.; Schreiber, M.H.

    1988-01-01

    The role of magnetic resonance imaging in characterizing normal, ischemic and infarcted segments of myocardium was examined in 8 patients with unstable angina, 11 patients with acute myocardial infarction, and 7 patients with stable angina. Eleven normal volunteers were imaged for comparison. Myocardial segments in short axis magnetic resonance images were classified as normal or abnormal on the basis of perfusion changes observed in thallium-201 images in 22 patients and according to the electrocariographic localization of infarction in 4 patients. T2 relaxation time was measured in 57 myocardial segments with abnormal perfusion (24 with reversible and 33 with irreversible perfusion changes) and in 25 normally perfused segments. T2 measurements in normally perfused segments of patients with acute myocardial infarction, unstable angina and stable angina were within normal range derived from T2 measurements in 48 myocardial segments of 11 normal volunteers (42 +/- 10 ms). T2 in abnormal myocardial segments of patients with stable angina also was not significantly different from normal. T2 of abnormal segments in patients with unstable angina (64 +/- 14 in reversibly ischemic and 67 +/- 21 in the irreversibly ischemic segments) was prolonged when compared to normal (p less than 0.0001) and was not significantly different from T2 in abnormal segments of patients with acute myocardial infarction (62 +/- 18 for reversibly and 66 +/- 11 for irreversibly ischemic segments). The data indicate that T2 prolongation is not specific for acute myocardial infarction and may be observed in abnormally perfused segments of patients with unstable angina

  3. Role of myocardial perfusion imaging in evaluating thrombolytic therapy for acute myocardial infarction

    Beller, G.A.

    1987-01-01

    Myocardial thallium-201 scintigraphy is being increasingly employed as a method for assessing the efficacy of coronary reperfusion in acute myocardial infarction. New thallium uptake after intracoronary tracer administration after successful recanalization indicates that nutrient blood flow has been successfully restored. One may also presume that some myocardial salvage occurred if thallium administered in this manner is transported intracellularly by myocytes with intact sarcolemmal membranes. However, if one injects thallium by way of the intracoronary route immediately after reperfusion, the initial uptake of thallium in reperfused myocardium may predominantly represent hyperemic flow and regional thallium counts measured may not be proportional to the mass of viable myocytes. When thallium is injected intravenously during the occlusion phase the degree of redistribution after thrombolysis is proportional to the degree of flow restoration and myocardial viability. When thallium is injected for the first time intravenously immediately after reperfusion, an overestimation of myocardial salvage may occur because of excess thallium uptake in the infarct zone consequent to significant hyperemia. Another approach to myocardial thallium scintigraphy in patients undergoing thrombolytic therapy is to administer two separate intravenous injections before and 24 hours or later after treatment. Finally, patients with acute myocardial infarction who receive intravenous thrombolytic therapy are candidates for predischarge exercise thallium-201 scintigraphy for risk stratification and detection of residual ischemia

  4. 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

    Matsuo, Shinro; Nakamura, Yasuyuki; Takahashi, Masayuki; Mitsunami, Kenichi; Kinoshita, Masahiko

    1998-01-01

    Reversible thallium-201 ( 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 201 Tl and rest 123 I-15-(p-iodophenyl)-3-methyl pentadecanoic acid (BMIPP) scintigraphy. Perfusion abnormalities were observed by exercise 201 Tl in 19/28 patients with HCM. 123 I-BMIPP uptake was decreased compared with delayed 201 Tl in 106/364 (29%) of the total myocardial segments (p 123 I-BMIPP and 201 Tl was observed more often in the 49/75 (65%) segments with reversible exercise 201 Tl defects (p 123 I-BMIPP and 201 Tl suggests that myocardial ischemia may play an important role in metabolic abnormalities in HCM. (author)

  5. Cardiovascular outcomes after pharmacologic stress myocardial perfusion imaging.

    Lee, Douglas S; Husain, Mansoor; Wang, Xuesong; Austin, Peter C; Iwanochko, Robert M

    2016-04-01

    While pharmacologic stress single photon emission computed tomography myocardial perfusion imaging (SPECT-MPI) is used for noninvasive evaluation of patients who are unable to perform treadmill exercise, its impact on net reclassification improvement (NRI) of prognosis is unknown. We evaluated the prognostic value of pharmacologic stress MPI for prediction of cardiovascular death or non-fatal myocardial infarction (MI) within 1 year at a single-center, university-based laboratory. We examined continuous and categorical NRI of pharmacologic SPECT-MPI for prediction of outcomes beyond clinical factors alone. Six thousand two hundred forty patients (median age 66 years [IQR 56-74], 3466 men) were studied and followed for 5963 person-years. SPECT-MPI variables associated with increased risk of cardiovascular death or non-fatal MI included summed stress score, stress ST-shift, and post-stress resting left ventricular ejection fraction ≤50%. Compared to a clinical model which included age, sex, cardiovascular disease, risk factors, and medications, model χ(2) (210.5 vs. 281.9, P statistic (0.74 vs. 0.78, P stress score, stress ST-shift and stress resting left ventricular ejection fraction). SPECT-MPI predictors increased continuous NRI by 49.4% (P 3% annualized risk of cardiovascular death or non-fatal MI, yielded a 15.0% improvement in NRI (95% CI 7.6%-27.6%, P stress MPI substantially improved net reclassification of cardiovascular death or MI risk beyond that afforded by clinical factors. Copyright © 2016 Elsevier Inc. All rights reserved.

  6. Clinical Significance of Reverse Redistribution Phenomenon on Delayed Tc-99m Tetrofosmin Myocardial Perfusion Imaging in Patients with Acute Myocardial Infarction

    Park, Soon Ah; Kim, Dae Weung; Kim, Chang Guhn; Jeong, Jin Won; Kim, Nam Ho; Yun, Kyeong Ho

    2009-01-01

    This study was performed to investigate the clinical significance of reverse redistribution (RR) phenomenon detected on delayed Tc-99m tetrofosmin myocardial single photon emission computed tomography (SPECT) in patients with acute myocardial infarction after revascularization. A Tc-99m tetrofrosmin myocardial SPECT was performed in 67 consecutive patients after revascularization for acute myocardial infarction. Myocardial SPECT imaging was performed for early imaging at 40 min and for delayed imaging at 180 min after reinjection at myocardial stress. Regional myocardial uptakes were scored by 4-point scoring in the left ventricular wall divided into 17 segments. Reverse redistribution was defined as an increase of more than 2 point in the activity score on the delayed image. Follow-up myocardial SPECT and coronary angiography (CAG) were performed 9 months later. On myocardial SPECT performed following revascularization, RR was observed in 100 of all 319 segments (31%) and in 43 patients (64%). The abnormalities of perfusion and regional wall motion were more severe in the patients with RR compared to those without RR (p<0.05). On follow-up myocardial SPECT, the myocardial perfusion, regional wall motion, and myocardial thickness were significantly improved in the patients with RR (p<0.05) however, these changes were not significant in those without RR. There was no significant difference between the patients with RR and those without RR in the occurrence of restenosis on CAG. In patients with acute myocardial infarction, the regions showing the RR phenomenon on delayed Tc-99m tetrofosmin SPECT may reflect viable myocardium and indicate recovery of salvaged myocardium

  7. The metabolic disturbances of isoproterenol induced myocardial infarction in rats based on a tissue targeted metabonomics.

    Liu, Yue-tao; Jia, Hong-mei; Chang, Xing; Ding, Gang; Zhang, Hong-wu; Zou, Zhong-Mei

    2013-11-01

    Myocardial infarction (MI) is a leading cause of morbidity and mortality but the precise mechanism of its pathogenesis remains obscure. To achieve the most comprehensive screening of the entire metabolome related to isoproterenol (ISO) induced-MI, we present a tissue targeted metabonomic study using an integrated approach of ultra-performance liquid chromatography/quadrupole time-of-flight mass spectrometry (UPLC-Q/TOF MS) and proton nuclear magnetic resonance (1H NMR). Twenty-two metabolites were detected as potential biomarkers related to the formation of MI, and the levels of pantothenic acid (), lysoPC(18:0) (), PC(18:4(6Z,9Z,12Z,15Z)/18:0) (), taurine (), lysoPC(20:3(8Z,11Z,14Z)) (), threonine (), alanine (), creatine (), phosphocreatine (), glucose 1-phosphate (), glycine (), xanthosine (), creatinine () and glucose () were decreased significantly, while the concentrations of histamine (), L-palmitoylcarnitine (), GSSG (), inosine (), arachidonic acid (), linoelaidic acid (), 3-methylhistamine () and glycylproline () were increased significantly in the MI rats compared with the control group. The identified potential biomarkers were involved in twelve metabolic pathways and achieved the most entire metabolome contributing to the injury of the myocardial tissue. Five pathways, including taurine and hypotaurine metabolism, glycolysis, arachidonic acid metabolism, glycine, serine and threonine metabolism and histidine metabolism, were significantly influenced by ISO-treatment according to MetPA analysis and suggested that the most prominent changes included inflammation, interference of calcium dynamics, as well as alterations of energy metabolism in the pathophysiologic process of MI. These findings provided a unique perspective on localized metabolic information of ISO induced-MI, which gave us new insights into the pathogenesis of MI, discovery of targets for clinical diagnosis and treatment.

  8. The Endocannabinoid System Affects Myocardial Glucose Metabolism in the DOCA-Salt Model of Hypertension

    Agnieszka Polak

    2018-03-01

    Full Text Available Background/Aims: Recent interest in the use of cannabinoids as therapeutic agents has revealed the involvement of the endogenous cannabinoid system (ECS in the regulation of the cardiovascular system in hypertension. Abnormalities in glucose metabolism and insulin action are commonly detected in hypertensive animals. Thus, potential antihypertensive drugs should be investigated with respect to modulation of glucose homeostasis. Therefore, the aim of the present study was to evaluate the effects of the ECS activation after chronic fatty acid amide hydrolase inhibitor (URB597 administration on plasma glucose and insulin concentrations as well as parameters of myocardial glucose metabolism in the deoxycorticosterone acetate (DOCA-salt hypertensive rats, an animal model of secondary hypertension. Methods: Hypertension was induced by DOCA (25mg/kg injections and addition of 1% NaCl in the drinking water for six weeks. Chronic activation of the ECS was performed by URB597 (1mg/kg injections for two weeks. We examined fasting plasma levels of insulin (ELISA, glucose and intramyocardial glycogen (colorimetric method. Expressions of glucose transporters (GLUT1, 4 and selected proteins engaged in GLUT translocation as well as glucose metabolism were determined using Western blotting. Results: Hypertension induced hypoinsulinemia with concomitant lack of significant changes in glycemia, reduced intramyocardial glycogen content and increased pyruvate dehydrogenase (PDH expression in the cardiac muscle. Importantly, chronic URB597 administration in the hypertensive rats increased insulin concentration, elevated plasmalemmal GLUT1 and GLUT4 expression and concomitantly improved myocardial glycogen storage. Conclusion: Chronic administration of fatty acid amide hydrolase (FAAH inhibitor has potential protective properties on myocardial glucose metabolism in hypertension.

  9. [Markers for early detection of alterations in carbohydrate metabolism after acute myocardial infarction].

    de Gea-García, J H; Benali, L; Galcerá-Tomás, J; Padilla-Serrano, A; Andreu-Soler, E; Melgarejo-Moreno, A; Alonso-Fernández, N

    2014-03-01

    Undiagnosed abnormal glucose metabolism is often seen in patients admitted with acute myocardial infarction, although there is no consensus on which patients should be studied with a view to establishing an early diagnosis. The present study examines the potential of certain variables obtained upon admission to diagnose abnormal glucose metabolism. A prospective cohort study was carried out. The Intensive Care Unit of Arrixaca University Hospital (Murcia), Spain. A total of 138 patients admitted to the Intensive Care Unit with acute myocardial infarction and without known or de novo diabetes mellitus. After one year, oral glucose tolerance testing was performed. Clinical and laboratory test parameters were recorded upon admission and one year after discharge. Additionally, after one year, oral glucose tolerance tests were made, and a study was made of the capacity of the variables obtained at admission to diagnose diabetes, based on the ROC curves and multivariate analysis. Of the 138 patients, 112 (72.5%) had glucose metabolic alteration, including 16.7% with diabetes. HbA1c was independently associated with a diagnosis of diabetes (RR: 7.28, 95%CI 1.65 to 32.05, P = .009), and showed the largest area under the ROC curve for diabetes (0.81, 95%CI 0.69 to 0.92, P = .001). In patients with acute myocardial infarction, HbA1c helps identify those individuals with abnormal glucose metabolism after one year. Thus, its determination in this group of patients could be used to identify those subjects requiring a more exhaustive study in order to establish an early diagnosis. Copyright © 2012 Elsevier España, S.L. and SEMICYUC. All rights reserved.

  10. Sustained postinfarction myocardial oedema in humans visualised by magnetic resonance imaging

    Nilsson, J C; Nielsen, G; Grønning, Bjørn Aaris

    2001-01-01

    OBJECTIVE: To demonstrate postinfarction myocardial oedema in humans with particular reference to the longitudinal course, using magnetic resonance imaging (MRI). DESIGN: Prospective observational study. Subjects were studied one week, one month, three months, six months, and one year after...... presenting with a myocardial infarct. SETTING: Cardiology and magnetic resonance departments in a Danish university hospital. PATIENTS: 10 patients (three women, seven men), mean (SEM) age 58.2 (3.20) years, with a first transmural myocardial infarct. MAIN OUTCOME MEASURES: Location and duration...... of postinfarction myocardial oedema. RESULTS: All patients had signs of postinfarction myocardial oedema. The magnetic resonance images were evaluated by two blinded procedures, employing two MRI and two ECG observers: (1) MRI determined oedema location was compared with the ECG determined site of infarction...

  11. Effect of unsaturated fatty acids on myocardial performance, metabolism and morphology

    M.F. Pinotti

    2006-02-01

    Full Text Available Diets rich in saturated fatty acids are one of the most important causes of atherosclerosis in men, and have been replaced with diets rich in unsaturated fatty acids (UFA for the prevention of this disorder. However, the effect of UFA on myocardial performance, metabolism and morphology has not been completely characterized. The objective of the present investigation was to evaluate the effects of a UFA-rich diet on cardiac muscle function, oxidative stress, and morphology. Sixty-day-old male Wistar rats were fed a control (N = 8 or a UFA-rich diet (N = 8 for 60 days. Myocardial performance was studied in isolated papillary muscle by isometric and isotonic contractions under basal conditions after calcium chloride (5.2 mM and ß-adrenergic stimulation with 1.0 µM isoproterenol. Fragments of the left ventricle free wall were used to study oxidative stress and were analyzed by light microscopy, and the myocardial ultrastructure was examined in left ventricle papillary muscle. After 60 days the UFA-rich diet did not change myocardial function. However, it caused high lipid hydroperoxide (176 ± 5 vs 158 ± 5, P < 0.0005 and low catalase (7 ± 1 vs 9 ± 1, P < 0.005 and superoxide-dismutase (18 ± 2 vs 27 ± 5, P < 0.005 levels, and discrete morphological changes in UFA-rich diet hearts such as lipid deposits and mitochondrial membrane alterations compared to control rats. These data show that a UFA-rich diet caused myocardial oxidative stress and mild structural alterations, but did not change mechanical function.

  12. Ischaemic memory imaging using metabolic radiopharmaceuticals: overview of clinical settings and ongoing investigations

    Yoshinaga, Keiichiro [Hokkaido University Graduate School of Medicine, Department of Molecular Imaging, Sapporo (Japan); Naya, Masanao [Hokkaido University Graduate School of Medicine, Department of Cardiology, Sapporo (Japan); Shiga, Tohru; Suzuki, Eriko; Tamaki, Nagara [Hokkaido University Graduate School of Medicine, Department of Nuclear Medicine, Sapporo (Japan)

    2014-02-15

    ''Ischaemic memory'' is defined as a prolonged functional and/or biochemical alteration remaining after a particular episode of severe myocardial ischaemia. The biochemical alteration has been reported as metabolic stunning. Metabolic imaging has been used to detect the footprint left by previous ischaemic episodes evident due to delayed recovery of myocardial metabolism (persistent dominant glucose utilization with suppression of fatty acid oxidation). β-Methyl-p-[{sup 123}I]iodophenylpentadecanoic acid (BMIPP) is a single-photon emission computed tomography (SPECT) radiotracer widely used for metabolic imaging in clinical settings in Japan. In patients with suspected coronary artery disease but no previous myocardial infarction, BMIPP has shown acceptable diagnostic accuracy. In particular, BMIPP plays an important role in the identification of prior ischaemic insult in patients arriving at emergency departments with acute chest pain syndrome. Recent data also show the usefulness of {sup 123}I-BMIPP SPECT for predicting cardiovascular events in patients undergoing haemodialysis. Similarly, SPECT or PET imaging with {sup 18}F-FDG injected during peak exercise or after exercise under fasting conditions shows an increase in FDG uptake in postischaemic areas. This article will overview the roles of ischaemic memory imaging both under established indications and in ongoing investigations. (orig.)

  13. Ischaemic memory imaging using metabolic radiopharmaceuticals: overview of clinical settings and ongoing investigations

    Yoshinaga, Keiichiro; Naya, Masanao; Shiga, Tohru; Suzuki, Eriko; Tamaki, Nagara

    2014-01-01

    ''Ischaemic memory'' is defined as a prolonged functional and/or biochemical alteration remaining after a particular episode of severe myocardial ischaemia. The biochemical alteration has been reported as metabolic stunning. Metabolic imaging has been used to detect the footprint left by previous ischaemic episodes evident due to delayed recovery of myocardial metabolism (persistent dominant glucose utilization with suppression of fatty acid oxidation). β-Methyl-p-[ 123 I]iodophenylpentadecanoic acid (BMIPP) is a single-photon emission computed tomography (SPECT) radiotracer widely used for metabolic imaging in clinical settings in Japan. In patients with suspected coronary artery disease but no previous myocardial infarction, BMIPP has shown acceptable diagnostic accuracy. In particular, BMIPP plays an important role in the identification of prior ischaemic insult in patients arriving at emergency departments with acute chest pain syndrome. Recent data also show the usefulness of 123 I-BMIPP SPECT for predicting cardiovascular events in patients undergoing haemodialysis. Similarly, SPECT or PET imaging with 18 F-FDG injected during peak exercise or after exercise under fasting conditions shows an increase in FDG uptake in postischaemic areas. This article will overview the roles of ischaemic memory imaging both under established indications and in ongoing investigations. (orig.)

  14. Ischaemic memory imaging using metabolic radiopharmaceuticals: overview of clinical settings and ongoing investigations.

    Yoshinaga, Keiichiro; Naya, Masanao; Shiga, Tohru; Suzuki, Eriko; Tamaki, Nagara

    2014-02-01

    "Ischaemic memory" is defined as a prolonged functional and/or biochemical alteration remaining after a particular episode of severe myocardial ischaemia. The biochemical alteration has been reported as metabolic stunning. Metabolic imaging has been used to detect the footprint left by previous ischaemic episodes evident due to delayed recovery of myocardial metabolism (persistent dominant glucose utilization with suppression of fatty acid oxidation). β-Methyl-p-[(123)I]iodophenylpentadecanoic acid (BMIPP) is a single-photon emission computed tomography (SPECT) radiotracer widely used for metabolic imaging in clinical settings in Japan. In patients with suspected coronary artery disease but no previous myocardial infarction, BMIPP has shown acceptable diagnostic accuracy. In particular, BMIPP plays an important role in the identification of prior ischaemic insult in patients arriving at emergency departments with acute chest pain syndrome. Recent data also show the usefulness of (123)I-BMIPP SPECT for predicting cardiovascular events in patients undergoing haemodialysis. Similarly, SPECT or PET imaging with (18)F-FDG injected during peak exercise or after exercise under fasting conditions shows an increase in FDG uptake in postischaemic areas. This article will overview the roles of ischaemic memory imaging both under established indications and in ongoing investigations.

  15. Myocardial metabolism of 123I-BMIPP during low-flow ischaemia in an experimental model: comparison with myocardial blood flow and 18F-FDG

    Hosokawa, Ryohei; Nohara, Ryuji; Hirai, Taku; Fujita, Masatoshi; Sasayama, Shigetake; Fujibayashi, Yasuhisa; Magata, Yasuhiro; Tadamura, Eiji; Konishi, Junji

    2001-01-01

    Risk stratification of coronary artery disease may provide a basis for selection of treatment to prevent myocardial events and to assist functional recovery. Iodine-123 (ρ-iodophenyl)-3-R,S-methylpentadecanoic acid ( 123 I-BMIPP) is a radioiodinated fatty acid analogue for single-photon emission tomographic (SPET) imaging, and several reports have demonstrated that the abnormal uptake of 123 I-BMIPP is associated with wall motion abnormality and severe coronary artery stenosis. Clarification of the contribution of fatty acids to myocardial metabolism would be highly valuable in recognising this critical condition. In this study, we investigated the myocardial uptake of 123 I-BMIPP under low-flow ischaemia, and compared it with the uptake of fluorine-18 fluorodeoxyglucose ( 18 F-FDG). Using open chest dogs, the flow of the left anterior descending coronary artery was controlled using a pneumatic occluder in order to maintain a 30%-40% reduction of Doppler flow. 123 I-BMIPP and 18 F-FDG were injected into the left atrium after 90 min of ischaemia (protocols 1 and 3). Canine hearts were excised after 120 min of ischaemia for the measurement of radioactivity. In protocol 2, 123 I-BMIPP alone was injected and hearts were excised 8 min after the injection. A time-course biopsy study was also performed at the same time (protocol 3). Wall thickening was evaluated using a wall tracker module. The uptake of 18 F-FDG increased significantly in the ischaemic region (232%±135% vs non-ischaemic, P 18 F-FDG did not correlate well with the severity of MBF. On the other hand, 123 I-BMIPP uptake decreased gradually (78.9%±23.6%, P 123 I-BMIPP was associated not only with wall motion abnormality but also with the severity of MBF. In the biopsy study (protocol 3), the radioactivity of either 123 I-BMIPP or 18 F-FDG correlated well with the MBF at the time of tracer injection and was similar to post-mortem analysis. It is concluded that 18 F-FDG is a valid tool for identifying

  16. Deoxyglucose method for the estimation of local myocardial glucose metabolism with positron computed tomography

    Ratib, O.; Phelps, M.E.; Huang, S.C.; Henze, E.; Selin, C.E.; Schelbert, H.R.

    1981-01-01

    The deoxyglucose method originally developed for measurements of the local cerebral metabolic rate for glucose has been investigated in terms of its application to studies of the heart with positron computed tomography (PCT) and FDG. Studies were performed in dogs to measure the tissue kinetics of FDG with PCT and by direct arterial-venous sampling. The operational equation developed in our laboratory as an extension of the Sokoloff model was used to analyze the data. The FDG method accurately predicted the true MMRGlc even when the glucose metabolic rate was normal but myocardial blood flow (MBF) was elevated 5 times the control value or when metabolism was reduced to 10% of normal and MBF increased 5 times normal. Improvements in PCT resolution are required to improve the accuracy of the estimates of the rate constants and the MMRGlc

  17. The impact of exercise myocardial perfusion SPECT imaging on the selection of patients for coronary angiography

    Song Liping; He Zuoxiang; Liu Xiujie; Shi Rongfang; Liu Yunzhong; Tian Yueqin; Zhang Xiaoli; Qin Xuewen; Chen Jilin; Gao Runlin

    2001-01-01

    Objective: Exercise 99 Tc m -MIBI myocardial perfusion SPECT is accurate for the diagnosis of coronary artery disease (CAD). This study assessed the impact of exercise myocardial perfusion imaging on the selection of patients for coronary angiography. Methods: 2188 consecutive patients who underwent exercise myocardial perfusion SPECT in authors' department in 1999 were retrospectively analyzed. Among them, 1807 were men, 381 women (average age: 53.5 +- 7.2 years). Overall, exercise myocardial SPECT was normal in 1731 patients, abnormal in 359 cases, and equivocal in 98 patients. There were 141 patients who underwent CAG within 60 days after myocardial SPECT. Results: Overall, 12% of the patients with abnormal SPECT imaging underwent coronary angiography, but only 5% of the patients with a normal SPECT imaging did (P < 0.001). Among these 141 patients who underwent coronary angiography, significant coronary stenosis was present in 91% of the patients who had had an abnormal SPECT imaging, but only 8% of those who had had a normal SPECT imaging (P < 0.001). In those patients who underwent coronary angiography, revascularization rate was 25% for the patients with abnormal SPECT imaging, but only 1% for the patients with a normal SPECT imaging. Conclusion: The results of exercise myocardial perfusion SPECT have a significant impact on the selection of patients for coronary angiography and revascularization

  18. Imaging of acute myocardial infarction in pigs with Indium-111 monoclonal antimyosin scintigraphy and MRI

    Kate, C.I.; Kroonenburgh, M.J. van; Schipperheyn, J.J.; Doornbos, J.; Hoedemaeker, P.J.; Maes, A.; Nat, K.H. van der; Camps, J.A.; Huysmans, H.A.; Pauwels, E.K.

    1990-01-01

    Indium-111 antimyosin F(ab')2 was used in a series of scintigraphic studies on experimentally induced myocardial infarctions in pigs. Antimyosin distribution recorded by planar images of in vivo pigs and by single photon emission computed tomography (SPECT) of excised hearts delineated areas of myocardial necrosis if infarct volume exceeded 3.3 cm3. Scintigraphic images were compared with magnetic resonance images (MRI) obtained from excised hearts and with photographs of slices of the hearts. Infarct size and localization determined with antimyosin were compared. The MR images, with or without gadolinium-DTPA (Gd-DTPA), of the in vivo pigs were all false-negative; some myocardial wall thinning and high bloodpool signals were visible. Results show that both the antimyosin and the MR technique are specific methods for the visualization of induced myocardial necrosis in this animal model. However, the use of antimyosin is limited to a period ranging from 24 to 72 hours after infarction

  19. Automatic Detection of Myocardial Boundaries in MR Cardio Perfusion Images

    Spreeuwers, Luuk; Breeuwer, Marcel

    2001-01-01

    Cardiovascular diseases often result in reduced blood perfusion of the myocardium (MC). Recent advances in MR allow fast recordingof contrast enhanced myocardial perfusion scans. For perfusion analysis the myocardial boundaries must be traced. Currently this is done manually. In this paper a method

  20. Myocardial imaging in coronary heart disease with radionuclides, with emphasis on thallium-201

    Wackers, F J.Th.; Sokole, E B; Samson, G; van der Schoot, J B; Wellens, H J.J. [Amsterdam Univ. (Netherlands). Academisch Ziekenhuis

    1976-09-01

    During the past few years there has been an increasing interest in cardiology for myocardial imaging with radionuclides. At present the experience with both negative (thallium-201) and positive (sup(99m)Tc-pyrophosphate) imaging of myocardial infarction is increasing rapidly. Since 1974, over 1100 patient studies with thallium-201 were performed. In this article a survey is presented of experience with thallium-201 in patients with acute and chronic coronary artery disease. In patients with acute myocardial infarction data from studies with sup(99m)Tc-pyrophosphate will be discussed as well.

  1. Study of new 113mIn-BAT complexes for myocardial imaging agents

    Zhu Lin; Liu Boli; Kojima, M.

    1991-01-01

    Some new BAT derivatives are designed and synthesized in order to find some ideal myocardial imaging agents. These ligands form pentacoordinated complexes with indium cation. The structures of ligand BAT-TE and complexes In-BAT-TE and In-BAT-ETE are determined by X-ray crystallography at first. Biodistribution shows that the higher lipophilicity of complex induces apparently higher myocardial accumulation. Up to date, complex B is the best 113m In-labeled myocardial imaging agent. It is also suited to 111 In

  2. Myocardial glucose metabolism in patients with hypertrophic cardiomyopathy. Assessment by F-18-FDG PET study

    Uehara, Toshiisa; Ishida, Yoshio; Hayashida, Kohei

    1998-01-01

    In an investigation of myocardial metabolic abnormalities in hypertrophic myocardium, the myocardial glucose metabolism was evaluated with F-18-fluorodeoxyglucose (FDG) positron emission tomography (PET) in 32 patients with hypertrophic cardiomyopathy, and the results were compared with those in 9 patients with hypertensive heart disease. F-18-FDG PET study was performed in the fasting and glucose-loading states. The myocardial regional %dose uptake was calculated quantitatively. The average regional %dose uptake in the fasting state in the patients with asymmetric septal hypertrophy and dilated-phase hypertrophic cardiomyopathy was significantly higher than that in the patients with hypertensive heart disease (0.75±0.34%, 0.65±0.25%, and 0.43±0.22%/100 g myocardium, respectively). In contrast, the average %dose uptake in the glucose-loading state in the patients with asymmetric septal hypertrophy and dilated-phase hypertrophic cardiomyopathy was not significantly different from that in patients with hypertensive heart disease (1.17±0.49%, 0.80±0.44% and 0.99±0.45%, respectively). The patients with apical hypertrophy had also low %dose uptake in the fasting state (0.38±0.21%) as in the hypertensive heart disease patients, so that the characteristics of asymmetric septal hypertrophy and dilated-phase hypertrophic cardiomyopathy are considered to be high FDG uptake throughout the myocardium in the fasting state. Patients with apical hypertrophy are considered to belong to other disease categories metabolically. F-18-FDG PET study is useful in the evaluation of the pathophysiologic diagnosis of patients with hypertrophic cardiomyopathy. (author)

  3. Myocardial glucose metabolism assessed by positron emission tomography and the histopathologic findings of microvessels in syndrome X

    Satake, Osamichi; Kajinami, Kouji; Ishikawa, Yoshimaro; Ueda, Tadashi; Tsugawa, Hiroichi; Kanemitsu, Seiyu; Okubo, Shinji; Takekoshi, Noboru

    2004-01-01

    Syndrome X has been recognized as a disease that is primarily reflected in the cardiac microvasculature. Myocardial metabolism in this condition has been studied, but not in relation to small vessel pathology. In order to examine the relationship between myocardial metabolism and small vessel pathology, 24 consecutive patients with syndrome X (7 men, 17 women; mean age 58 years) were evaluated by the thallium exercise stress test, positron emission tomography using F-18 fluoro-deoxyglucose (FDG), and an endomyocardial biopsy. All patients showed either diffuse or focal increase in the myocardial uptake of FDG, but only 17 patients (71%) showed hypoperfused areas with partial or complete redistribution in the thallium study. Quantification of myocardial FDG uptake revealed that the value in syndrome X patients was 10-fold higher than in controls (p<0.0001). Histopathological examination revealed that in syndrome X there is an extensive increase in smooth muscle cells and thickening of the vascular wall, even in capillary vessels, and the small vessel lumen was markedly narrowed. There was a significant inverse correlation between FDG myocardial uptake and the microvessel luminal area. In syndrome X patients, myocardial FDG uptake is increased extensively, which is strongly associated with narrowed myocardial microvasculature. (author)

  4. Kit for preparing a technetium-99m myocardial imaging agent

    Woulfe, S.R.; Deutsch, E.A.; Dyszlewski, M.; Neumann, W.L.

    1992-01-01

    This patent describes a kit for preparing a technetium 99m myocardial imaging agent. It comprises a first vial containing a lyophilized pyrogen free, sterile mixture of an effective reducing agent and a first ligand having the following general formula: wherein the R 1 groups may be the same or different and are selected from the group consisting of hydrogen, hydroxy, C 1 - C 5 alkyl, C 1 - C 5 alkyl substituted by hydroxyl, ether, ester, amide, ketone, aldehyde and nitrile; the R 2 groups may be the same or different and are selected from the group consisting of hydrogen, hydroxy, C 1 - C 5 alkyl, C 1 - C 5 alkyl substituted by hydroxyl, ether, ester, amide, ketone, aldehyde, and nitrile; the X and Y groups may be the same or different and are selected from the group consisting of oxygen and sulfur; and n is equal to 1 or 2; and a second vial containing a lyophilized pyrogen free, sterile protected salt of a phosphine ligand

  5. Spectral analysis for evaluation of myocardial tracers for medical imaging

    Huesman, Ronald H.; Reutter, Bryan W.; Marshall, Robert C.

    2000-01-01

    Kinetic analysis of dynamic tracer data is performed with the goal of evaluating myocardial radiotracers for cardiac nuclear medicine imaging. Data from experiments utilizing the isolated rabbit heart model are acquired by sampling the venous blood after introduction of a tracer of interest and a reference tracer. We have taken the approach that the kinetics are properly characterized by an impulse response function which describes the difference between the reference molecule (which does not leave the vasculature) and the molecule of interest which is transported across the capillary boundary and is made available to the cell. Using this formalism we can model the appearance of the tracer of interest in the venous output of the heart as a convolution of the appearance of the reference tracer with the impulse response. In this work we parameterize the impulse response function as the sum of a large number of exponential functions whose predetermined decay constants form a spectrum, and each is required only to have a nonnegative coefficient. This approach, called spectral analysis, has the advantage that it allows conventional compartmental analysis without prior knowledge of the number of compartments which the physiology may require or which the data will support

  6. Evaluation of myocardial viability with 99Tcm-tetrofosmin after nitrate administration: comparison with FDG PET imaging

    He Wei; Cuocolo, A.

    2007-01-01

    Objective: The purpose of this study was to assess the relationship between tetrofosmin uptake after nitrate administration and the metabolic activity assessed by 18 F-FDG PET in patients with ischemic left ventricular (LV) dysfunction. Methods: A baseline 99 Tc m -tetrofosmin SPECT at rest and a repeated study after sublingual administration of 10 mg isosorbide dinitrate within two days were undertaken in 36 patients with chronic myocardial infarction and LV dysfunction. All patients underwent metabolic PET imaging with 18 F-FDG in the following week. 99 Tc m -tetrofosmin uptake and metabolic activity in 13 segments of myocardium were measured in every patient. A 55% peak activity on tetrofosmin and 50% peak activity on FDG were used as the differential threshold in evaluating myocardial viability, and the uptakes compared with regional LV function assessed by echocardiography. Results: Fifty-three (40%) of the 131 akinetic or dyskinetic segments had reduced tracer uptake. Of those segments, 14 (26%) segments showed increased tetrofosmin uptake after nitrate intervention (>10% vs baseline), 39 (74%) segments remained no change. The sensitivity and specificity of baseline tetrofosmin SPECT for detecting preserved metabolic activity were 69% and 86%, respectively. After nitrate administration, the sensitivity increased to 81% (P 99 Tc m -tetrofosmin SPECT after nitrate administration may improve the identification of ischemic but still viable myocardium in patients with chronic ischemic LV dysfunction. (authors)

  7. Atorvastatin Improves Ventricular Remodeling after Myocardial Infarction by Interfering with Collagen Metabolism

    Reichert, Karla; Pereira do Carmo, Helison Rafael; Galluce Torina, Anali; Diógenes de Carvalho, Daniela; Carvalho Sposito, Andrei; de Souza Vilarinho, Karlos Alexandre; da Mota Silveira-Filho, Lindemberg; Martins de Oliveira, Pedro Paulo

    2016-01-01

    Purpose Therapeutic strategies that modulate ventricular remodeling can be useful after acute myocardial infarction (MI). In particular, statins may exert effects on molecular pathways involved in collagen metabolism. The aim of this study was to determine whether treatment with atorvastatin for 4 weeks would lead to changes in collagen metabolism and ventricular remodeling in a rat model of MI. Methods Male Wistar rats were used in this study. MI was induced in rats by ligation of the left anterior descending coronary artery (LAD). Animals were randomized into three groups, according to treatment: sham surgery without LAD ligation (sham group, n = 14), LAD ligation followed by 10mg atorvastatin/kg/day for 4 weeks (atorvastatin group, n = 24), or LAD ligation followed by saline solution for 4 weeks (control group, n = 27). After 4 weeks, hemodynamic characteristics were obtained by a pressure-volume catheter. Hearts were removed, and the left ventricles were subjected to histologic analysis of the extents of fibrosis and collagen deposition, as well as the myocyte cross-sectional area. Expression levels of mediators involved in collagen metabolism and inflammation were also assessed. Results End-diastolic volume, fibrotic content, and myocyte cross-sectional area were significantly reduced in the atorvastatin compared to the control group. Atorvastatin modulated expression levels of proteins related to collagen metabolism, including MMP1, TIMP1, COL I, PCPE, and SPARC, in remote infarct regions. Atorvastatin had anti-inflammatory effects, as indicated by lower expression levels of TLR4, IL-1, and NF-kB p50. Conclusion Treatment with atorvastatin for 4 weeks was able to attenuate ventricular dysfunction, fibrosis, and left ventricular hypertrophy after MI in rats, perhaps in part through effects on collagen metabolism and inflammation. Atorvastatin may be useful for limiting ventricular remodeling after myocardial ischemic events. PMID:27880844

  8. Intravenous streptokinase therapy in acute myocardial infarction: Assessment of therapy effects by quantitative 201Tl myocardial imaging (including SPECT) and radionuclide ventriculography

    Koehn, H.; Bialonczyk, C.; Mostbeck, A.; Frohner, K.; Unger, G.; Steinbach, K.

    1984-01-01

    To evaluate a potential beneficial effect of systemic streptokinase therapy in acute myocardial infarction, 36 patients treated with streptokinase intravenously were assessed by radionuclide ventriculography and quantitative 201 Tl myocardial imaging (including SPECT) in comparison with 18 conventionally treated patients. Patients after thrombolysis had significantly higher EF, PFR, and PER as well as fewer wall motion abnormalities compared with controls. These differences were also observed in the subset of patients with anterior wall infarction (AMI), but not in patients with inferior wall infarction (IMI). Quantitative 201 Tl imaging demonstrated significantly smaller percent myocardial defects and fewer pathological stress segments in patients with thrombolysis compared with controls. The same differences were also found in both AMI and IMI patients. Our data suggest a favorable effect of intravenous streptokinase on recovery of left ventricular function and myocardial salvage. Radionuclide ventriculography and quantitative 201 Tl myocardial imaging seem to be reliable tools for objective assessment of therapy effects. (orig.)

  9. A review of 99mTc labeled myocardial imaging agents for tumor-positive imaging

    Xing Shian; Zhang Yongxue; An Rui

    2002-01-01

    The tumor-positive imaging with high sensitivity and specificity was useful in primary tumor and recurrences and metastases. The 99m Tc labeled myocardial imaging agents are easily available and stable and the radiochemical purity is high. 99m Tc is the preferred choice in routine works because its physical properties. The preparation, quality control, mechanism of accumulation and the clinical use of 99m Tc-sestamibi, 99m Tc-tetrofosmin, 99m Tc-furifosmin, and 99m Tc-N-NOET were reviewed

  10. An attempt of thallium-201 myocardial perfusion imaging during transient coronary arterial occlusion by PTCA

    Nakagawa, Tatsuya; Sugihara, Hiroki; Katahira, Toshio

    1989-01-01

    To evaluate the myocardial perfusion during transient coronary occlusion, we attempted to obtain the myocardial scintigraphy during percutaneous transluminal coronary angioplasty (PTCA). Tl-201 was injected at the last inflation of angioplastic balloon and occlusion was kept on for 60 sec. Planar images or SPECT were obtained immediately after PTCA. With this protocol, myocardial perfusion defects were observed during PTCA and fully redistributed 3 hours after Tl injection. Extent of ischemic lesions were almost same as that observed during exercise in two cases without collateral vessels. In a case with well visualized collateral vessels, perfusion defect was smaller in PTCA images than that in exercise stressed images. We conclude that intravenous injection of Tl-201 during PTCA is useful to assess the alteration of myocardial perfusion due to transient coronary occlusion without increasing the risk of angioplastic procedure. (author)

  11. The additional value of first pass myocardial perfusion imaging during peak dose of dobutamine stress cardiac MRI for the detection of myocardial ischemia

    Lubbers, Daniel D.; Janssen, Caroline H. C.; Kuijpers, Dirkjan; Van Dijkman, Paul R. M.; Overbosch, Jelle; Willems, Tineke P.; Oudkerk, Matthijs

    Purpose of this study was to assess the additional value of first pass myocardial perfusion imaging during peak dose of dobutamine stress Cardiac-MR (CMR). Dobutamine Stress CMR was performed in 115 patients with an inconclusive diagnosis of myocardial ischemia on a 1.5 T system (Magnetom Avanto,

  12. Myocardial imaging by direct injection of thallium-201 into coronary artery

    Sugihara, Hiroki; Inagaki, Suetsugu; Kubota, Yasushi

    1988-01-01

    Myocardial perfusion images were evaluated by direct injection of Thallium (Tl)-201 into coronary artery. Approximately 0.5 - 1 mCi of Tl-201 were instilled into the right coronary artery and/or the left coronary artery after coronary arteriography. Three images were obtained in the anterior, left anterior oblique and left lateral projections. Myocardial perfusion images of single photon emission computed tomography were also acquired in some patients. An image of supreme quality could be obtained in spite of small dose of Tl-201 since there was a lack of interference from background activity. Myocardial perfusion images corresponded to areas which were supplied by left or right coronary artery respectively. And the regional myocardial blood flow distribution of a coronary artery bypass graft could be revealed by instilling Tl-201 into the graft. Further, contribution of collateral channels to myocardial perfusion was showed. Not only left ventricle but also right ventricle was clearly visualized by injection of Tl-201 into right coronary artery. But in a case with arrhythmogenic right ventricular dysplasia, there was an area of decreased tracer uptake in the apex of the right ventricle which was identified as the site of dysplasia by electrophysiologic study. We conclude that direct injection of Tl-201 into coronary artery is an useful method to clarify the correlation between coronary anatomical findings and coronary perfusion and contribution of collaterals to myocardial perfusion, and also to detect the right ventricular myopathic site. (author)

  13. Clinical evaluation of adenosine and exercise stress 99Tcm-MIBI myocardial imaging in detection of myocardial ischemia in patients with untypical chest pain

    Tian Yueqin; He Zuoxiang; Wang Qi; Hu Fenghuan; Yang Weixian; Qiao Shubing; Liu Xiujie

    2005-01-01

    Objective: To evaluate the value of adenosine and exercise stress 99 Tc m -methoxyisobutylisonitrile (MIBI) myocardial imaging for the diagnosis of myocardial ischemia in patients with untypical chest pain. Methods: Two groups included. Group 1: 67 cases of adenosine 99 Tc m -MIBI myocardial imaging. Group 2: 81 cases of exercise stress 99 Tc m -MIBI myocardial imaging. All of the patients had coronary angiography (CAG). The results of them were compared. Results: 23 out of 67 patients in group 1 had significant coronary stenosis after CAG, 16 showed reversible perfusion abnormalities in adenosine imaging. 41 of 44 patients with normal CAG showed normal adenosine imaging. The sensitivity, specificity and accuracy of adenosine imaging for coronary artery disease detection were 70%, 93% and 85%, respectively. Group 2: 22 out of 31 patients with significant coronany stenosis after CAG showed reversible perfusion abnormalities, 48 of 50 patients with normal CAG showed normal exercise imaging. The sensitivity, specificity and accuracy of exercise imaging for coronary artery disease detection were 71%, 96% and 86%, respectively. Conclusion: Reversible perfusion abnormalities found both in adenosine and exercise stress 99 Tc m -MIBI myocardial imaging were the key point for diagnosis of myocardial ischemia in patients with untypical chest pain. (authors)

  14. Effect of propranolol on myocardial imaging with radioiodinated hexadecenoic acid in the dog heart

    Comet, M.; Wolf, J.E.; Pilichowfski, P.

    1982-01-01

    After I.V. injection of 16- 123 I 9-hexadecenoic acid, the following is noted: among dogs, there are important differences in the values of the half-life of the myocardial radioactivity curves without any significant differences in the biological constants; for a given dog, the value of the half-life is reproducible when there are no modifications in the physiological condition; propranolol brings about twofold increase in the value of the half-life of the myocardial radioactivity curve. On the myocardial scintigraphy, performed after an I.V. injection of a fatty acid (F.A.) labelled with 123 I, ischaemia appears as an hypoactive area which reveals a failure in the capture of the F.A. and also an abnormal lengthening of the half-life of the myocardial activity curve. It is probable that, in some cases, on the evolution curve of myocardial activity would allow a detection of metabolism anomalies of the F.A. The cause of variation of the half-life are poorly understood. Given the influence of catecholamines on normal and pathological myocardial metabolism, the influence of a #betta# blocker Propranolol, on the curve half-life after the injection of 16 123 I 9-hexadecenoic acid (I.F.A.) was studied in the dog. In order to assess the effect of the drug, the reproducibility of the curve half-lives was tested, in the absence of marked variations in the physiological condition of the animal

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

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

    1986-08-01

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

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

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

    1986-01-01

    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 14 C and IPPA. This change is reflected by increased metabolite production released into the perfusate and radioactivity clearance recorded externally. Lactate in high concentrations exerts the opposite effect on cardiac free fatty acid oxidation. IPPA is stored in this condition preferentially in tissue phospholipids and triglycerides. (orig.)

  17. A possible relationship between gluconeogenesis and glycogen metabolism in rabbits during myocardial ischemia

    RAQUEL R. DE AGUIAR

    2017-08-01

    Full Text Available ABSTRACT Ischemia is responsible for many metabolic abnormalities in the heart, causing changes in organ function. One of modifications occurring in the ischemic cell is changing from aerobic to anaerobic metabolism. This change causes the predominance of the use of carbohydrates as an energy substrate instead of lipids. In this case, the glycogen is essential to the maintenance of heart energy intake, being an important reserve to resist the stress caused by hypoxia, using glycolysis and lactic acid fermentation. In order to study the glucose anaerobic pathways utilization and understand the metabolic adaptations, New Zealand white rabbits were subjected to ischemia caused by Inflow occlusion technique. The animals were monitored during surgery by pH and lactate levels. Transcription analysis of the pyruvate kinase, lactate dehydrogenase and phosphoenolpyruvate carboxykinase enzymes were performed by qRT-PCR, and glycogen quantification was determined enzymatically. Pyruvate kinase transcription increased during ischemia, followed by glycogen consumption content. The gluconeogenesis increased in control and ischemia moments, suggesting a relationship between gluconeogenesis and glycogen metabolism. This result shows the significant contribution of these substrates in the organ energy supply and demonstrates the capacity of the heart to adapt the metabolism after this injury, sustaining the homeostasis during short-term myocardial ischemia.

  18. Evaluation of myocardial fatty acid metabolism in the area of fill-in after thallium reinjection in patients with prior myocardial infarction

    Matsunari, Ichiro; Fujino, Susumu; Nishikawa, Takahiro; Ichiyanagi, Kenji; Taki, Junichi; Nakajima, Kenichi; Tonami, Norihisa; Hisada, Kinichi.

    1995-01-01

    Myocardial fatty acid utilization in the area with thallium fill-in after reinjection was assessed using 123 I-labeled 15-(p-iodophenyl) 3R, S-methylpentadecanoic acid (BMIPP). We studied 22 patients with prior myocardial infarction that revealed persistent defects on standard exercise-redistribution thallium imaging. In each patient, exercise-redistribution-reinjection thallium imaging was performed. Within two weeks of the thallium study, resting BMIPP imaging was performed 20 min after injection of BMIPP (148 MBq). Following qualitative analysis of the obtained thallium and BMIPP images, quantitative analysis was performed on the basis of relative regional uptake. Of 199 myocardial segments that showed persistent defects on exercise-redistribution images, 73 segments showed apparent fill-in on the reinjection images (fill-in positive), and the remaining 126 segments did not (fill-in negative). When BMIPP images were compared with the corresponding thallium reinjection images, reduced BMIPP uptake compared with thallium was frequently observed in the area of fill-in positive segments (65 of 73 segments, 89%). Quantitative analysis also showed decrease in BMIPP activity compared to thallium activity in the area of fill-in (49.7±16.1 vs. 65.8±16.0%, p<0.001). In contrast, only 24 of the 126 fill-in negative segments (19%) showed lower BMIPP uptake than thallium. These results suggest that impaired fatty acid utilization in the area of thallium new fill-in after reinjection already exists at resting condition. Thus, BMIPP imaging combined with exercise-redistribution-reinjection thallium imaging provides insights to understanding fatty acid utilization in ischemic but viable myocardium identified by thallium reinjection in patients with prior myocardial infarction. (author)

  19. Assessment of Myocardial Infarction by Cardiac Magnetic Resonance Imaging and Long-Term Mortality

    Petriz, João Luiz Fernandes, E-mail: jlpetriz@cardiol.br [Universidade Federal do Rio de Janeiro (UFRJ) / Instituto do Coração Edson Saad - Programa de Pós Graduação em Medicina (Cardiologia), Rio de Janeiro, RJ (Brazil); Hospital Barra D’Or, Rio de Janeiro, RJ (Brazil); Instituto D’Or de Pesquisa e Ensino, Rio de Janeiro, RJ (Brazil); Gomes, Bruno Ferraz de Oliveira; Rua, Braulio Santos [Hospital Barra D’Or, Rio de Janeiro, RJ (Brazil); Azevedo, Clério Francisco [Instituto D’Or de Pesquisa e Ensino, Rio de Janeiro, RJ (Brazil); Hadlich, Marcelo Souza [Universidade Federal do Rio de Janeiro (UFRJ) / Instituto do Coração Edson Saad - Programa de Pós Graduação em Medicina (Cardiologia), Rio de Janeiro, RJ (Brazil); Instituto D’Or de Pesquisa e Ensino, Rio de Janeiro, RJ (Brazil); Mussi, Henrique Thadeu Periard [Universidade Federal do Rio de Janeiro (UFRJ) / Instituto do Coração Edson Saad - Programa de Pós Graduação em Medicina (Cardiologia), Rio de Janeiro, RJ (Brazil); Hospital Barra D’Or, Rio de Janeiro, RJ (Brazil); Taets, Gunnar de Cunto [Instituto D’Or de Pesquisa e Ensino, Rio de Janeiro, RJ (Brazil); Nascimento, Emília Matos do; Pereira, Basílio de Bragança; Silva, Nelson Albuquerque de Souza e [Universidade Federal do Rio de Janeiro (UFRJ) / Instituto do Coração Edson Saad - Programa de Pós Graduação em Medicina (Cardiologia), Rio de Janeiro, RJ (Brazil)

    2015-02-15

    Cardiac magnetic resonance imaging provides detailed anatomical information on infarction. However, few studies have investigated the association of these data with mortality after acute myocardial infarction. To study the association between data regarding infarct size and anatomy, as obtained from cardiac magnetic resonance imaging after acute myocardial infarction, and long-term mortality. A total of 1959 reports of “infarct size” were identified in 7119 cardiac magnetic resonance imaging studies, of which 420 had clinical and laboratory confirmation of previous myocardial infarction. The variables studied were the classic risk factors – left ventricular ejection fraction, categorized ventricular function, and location of acute myocardial infarction. Infarct size and acute myocardial infarction extent and transmurality were analyzed alone and together, using the variable named “MET-AMI”. The statistical analysis was carried out using the elastic net regularization, with the Cox model and survival trees. The mean age was 62.3 ± 12 years, and 77.3% were males. During the mean follow-up of 6.4 ± 2.9 years, there were 76 deaths (18.1%). Serum creatinine, diabetes mellitus and previous myocardial infarction were independently associated with mortality. Age was the main explanatory factor. The cardiac magnetic resonance imaging variables independently associated with mortality were transmurality of acute myocardial infarction (p = 0.047), ventricular dysfunction (p = 0.0005) and infarcted size (p = 0.0005); the latter was the main explanatory variable for ischemic heart disease death. The MET-AMI variable was the most strongly associated with risk of ischemic heart disease death (HR: 16.04; 95%CI: 2.64-97.5; p = 0.003). The anatomical data of infarction, obtained from cardiac magnetic resonance imaging after acute myocardial infarction, were independently associated with long-term mortality, especially for ischemic heart disease death.

  20. Myocardial imaging in acute myocardial infarction using. beta. -methyl-p-( sup 123 I)-iodophenylpentadecanoic acid; Comparison with sup 201 Tl imaging and wall motion

    Naruse, Hitoshi; Itano, Midoriko; Kondo, Tomohiro (Hyogo College of Medicine, Nishinomiya (Japan)) (and others)

    1992-01-01

    Myocardial imaging using {beta}-methyl-p-({sup 123}I)-iodophenylpentadecanoic acid (BMIPP) was performed in 11 patients with acute myocardial infarction. The left ventricular images were divided into 12 segments, and myocardial images with BMIPP were compared with coronary angiography (CAG), thallium-201 myocardial scintigraphy (Tl) and wall motion obtained by two-dimensional echocardiography (WM). When the culprit lesion was at the proximal point of the left anterior descending artery (LAD), all segments showed depressed uptake. In 3 cases with single vessel disease of the LAD, inferior wall of the basis showed reduced uptake of BMIPP despite the location of the culprit lesion. In cases with discordant uptake between the two tracers, BMIPP frequently showed more severely depressed uptake than Tl in the subacute phase, although the uptake of BMIPP correlated with that of Tl ({tau}=0.82, p<0.001). In such cases, the discordance was related to the improvement in WM from the acute phase to the convalescent phase. BMIPP uptake correlated with WM in the subacute phase ({tau}=0.50, p<0.001). BMIPP showed more severely depressed uptake while WM showed mild asynergy in most cases in which discordance was found between the BMIPP and WM findings. However, there was no correlation between the change in WM from the acute to subacute phases, or the uptakes of BMIPP and Tl alone. We concluded that the myocardial condition can be evaluated in detail in acute myocardial infarction by comparing the findings of BMIPP with those of Tl and WM. (author).

  1. [Myocardial imaging in acute myocardial infarction using beta-methyl-p-(123I)-iodophenylpentadecanoic acid: comparison with 201Tl imaging and wall motion].

    Naruse, H; Itano, M; Kondo, T; Kogame, T; Yamamoto, J; Morita, M; Kawamoto, H; Fukutake, N; Ohyanagi, M; Iwasaki, T

    1992-01-01

    Myocardial imaging using beta-methyl-p-(123I)-iodophenylpentadecanoic acid (BMIPP) was performed in 11 patients with acute myocardial infarction. The left ventricular images were divided into 12 segments, and myocardial imagings with BMIPP were compared with coronary angiography (CAG), thallium-201 myocardial scintigraphy (TL) and wall motion obtained by two-dimensional echocardiography (WM). When the culprit lesion was at the proximal point of the left anterior descending artery (LAD), all segments showed depressed uptake. In 3 cases with single vessel disease of the LAD, inferior wall of the basis showed reduced uptake of BMIPP despite the location of the culprit lesion. In cases with discordant uptake between the two tracers, BMIPP frequently showed more severely depressed uptake than TL in the subacute phase, although the uptake of BMIPP correlated with that of TL (tau = 0.82, p less than 0.001). In such cases, the discordance was related to the improvement in WM from the acute phase to the convalescent phase. BMIPP uptake correlated with WM in the subacute phase (tau = 0.50, p less than 0.001). BMIPP showed more severely depressed uptake while WM showed mild asynergy in most cases in which discordance was found between the BMIPP and WM findings. However, there was no correlation between the change in WM from the acute to subacute phases, or the uptakes of BMIPP and TL alone. We concluded that the myocardial condition can be evaluated in detail in acute myocardial infarction by comparing the findings of BMIPP with those of TL and WM.

  2. Evaluation of multi-gated myocardial perfusion imaging in various heart diseases

    Nishimura, Tsunehiko; Uehara, Toshitake; Kozuka, Takahiro

    1980-01-01

    Multi-gated myocardial perfusion imaging were studied in a hundred cases of various heart diseases. In normal cases, ED ES images showed thinning and thickening of wall motion respectively to compare with static images. In the myocardial infarction cases, the dynamic changes of wall motion was decreased at infarcted areas in all cases. In congestive cardiomyopathy, the change of wall motion is smaller than normal cases in all cases, while in hypertrophic cardiomyopathy, the change is not so hyperdynamic to compare with normal cases and by multi-gated images, asymmetric hypertrophy was clearly detected in HCM than static images. In conclusion, these methods were useful to detect the myocardial contraction stage in various heart diseases. (author)

  3. The need for standardisation of cardiac FDG PET imaging in the evaluation of myocardial viability in patients with chronic ischaemic left ventricular dysfunction

    Kuuti, J.; Schelbert, H.R.; Bax, J.J.

    2002-01-01

    The evaluation of myocardial glucose utilisation with fluorine-18 fluorodeoxyglucose (FDG) and positron emission tomography is currently considered the most reliable tool for the identification of myocardial viability. However, the investigations using FDG imaging to predict improvement in left ventricular (LV) function after revascularisation have reported wide ranges for sensitivity (71%-100%) and, in particular, for specificity (33%-91%). The variable results may be related to differences in study populations but also to differences in the imaging protocols employed. Detailed analysis of the published studies has revealed differences in study populations, patient selection criteria, the methods for assessing changes in LV function post revascularisation and the timing of these assessments. Even more importantly, protocols have varied substantially with regard to imaging equipment, perfusion tracers, metabolic conditions, data analysis and interpretation of results. In addition, evaluation of patients with insulin resistance appears to represent a specific challenge. This review examines the different study protocols and methodologies used for myocardial FDG imaging in order to draw conclusions concerning optimal imaging protocols. It appears that the optimisation and standardisation of study protocols and analysis of FDG images for the assessment of myocardial viability are critical. In addition, multi-centre trials seem warranted on prediction of long-term function, congestive heart failure symptoms, survival and quality of life

  4. Clinical evaluation of the 99mTc-labelled myocardial imaging agent, hexakis (t-butylisonitrile)-technetium

    Liu Xiujie; Shi Rongfang; Wang Yanquen; Guo Xiuzhen; He Zuoxiang; Wang Xuebin; Liu Boli; Chinese Academy of Medical Sciences, Beijing. Div. of Nuclear Cardiology; Chinese Academy of Medical Sciences, Beijing. Cardiovascular Inst.; Beijing Normal Univ.

    1987-01-01

    99m Tc-TBI myocardial perfusion imaging has been studied in 7 normal subjects and 24 patients with coronary artery disease. Scintigraphic data revealed that 99m Tc-TBI myocardial perfusion imaging is more sensitive than ECG in detecting myocardial infarction. In comparing 99m Tc-TBI imaging with contrast angiography, its' sensitivity for the diagnosis of coronary artery disease was 91.7%. (orig.)

  5. Myocardial lipid content in Fabry disease: a combined 1H-MR spectroscopy and MR imaging study at 3 Tesla.

    Petritsch, B; Köstler, H; Weng, A M; Horn, M; Gassenmaier, T; Kunz, A S; Weidemann, F; Wanner, C; Bley, T A; Beer, M

    2016-10-28

    Fabry disease is characterized by a progressive deposition of sphingolipids in different organ systems, whereby cardiac involvement leads to death. We hypothesize that lysosomal storage of sphingolipids in the heart as occurring in Fabry disease does not reflect in higher cardiac lipid concentrations detectable by 1 H magnetic resonance spectroscopy (MRS) at 3 Tesla. Myocardial lipid content was quantified in vivo by 1 H-MRS in 30 patients (12 male, 18 female; 18 patients treated with enzyme replacement therapy) with genetically proven Fabry disease and in 30 healthy controls. The study protocol combined 1 H-MRS with cardiac cine imaging and LGE MRI in a single examination. Myocardial lipid content was not significantly elevated in Fabry disease (p = 0.225). Left ventricular (LV) mass was significantly higher in patients suffering from Fabry disease compared to controls (p = 0.019). Comparison of patients without signs of myocardial fibrosis in MRI (LGE negative; n = 12) to patients with signs of fibrosis (LGE positive; n = 18) revealed similar myocardial lipid content in both groups (p > 0.05), while the latter showed a trend towards elevated LV mass (p = 0.076). This study demonstrates the potential of lipid metabolic investigation embedded in a comprehensive examination of cardiac morphology and function in Fabry disease. There was no evidence that lysosomal storage of sphingolipids influences cardiac lipid content as measured by 1 H-MRS. Finally, the authors share the opinion that a comprehensive cardiac examination including three subsections (LGE; 1 H-MRS; T 1 mapping), could hold the highest potential for the final assessment of early and late myocardial changes in Fabry disease.

  6. Magnetic resonance imaging of myocardial infarction during prothrombin complex concentrate therapy of hemophilia A

    Gruen, D.R.; Winchester, P.H.; Brill, P.W.; Ramirez, E.

    1997-01-01

    In patients with hemophilia, prothrombin complex concentrates (PCCs) have been successfully used to bypass inhibitors to fctor VIII during bleeding episodes. The use of PCCS, including FEIBA (factor eight inhibitor bypassing activity), has been associated with thromboembolic complications. Myocardial infarction (MI) is a rare but serious complication, reported in 13 previous cases, six in the pediatric age group. In all four patients who died during the acute MI, autopsy revealed extensive myocardial hemorrhage. The hearts of three other patients examined at least 5 months after the acute MI showed no evidence of prior hemorrhage. Magnetic resonance (MR) imaging has been shown to be able to evaluate the sequelae of myocardial infarction in adults with coronary artery disease and in children with Kawasaki syndrome. We report the first case of the used of MR imaging in the evaluation of myocardial damage during the acute stage of a FEIBA-associated MI in a 10-year-old boy. (orig.)

  7. Magnetic resonance imaging of myocardial infarction during prothrombin complex concentrate therapy of hemophilia A

    Gruen, D.R. [Dept. of Radiology, The New York Hospital-Cornell Medical Center, New York, NY (United States); Winchester, P.H. [Dept. of Radiology, The New York Hospital-Cornell Medical Center, New York, NY (United States); Brill, P.W. [Dept. of Radiology, The New York Hospital-Cornell Medical Center, New York, NY (United States); Ramirez, E. [Dept. of Radiology, The New York Hospital-Cornell Medical Center, New York, NY (United States)

    1997-03-01

    In patients with hemophilia, prothrombin complex concentrates (PCCs) have been successfully used to bypass inhibitors to fctor VIII during bleeding episodes. The use of PCCS, including FEIBA (factor eight inhibitor bypassing activity), has been associated with thromboembolic complications. Myocardial infarction (MI) is a rare but serious complication, reported in 13 previous cases, six in the pediatric age group. In all four patients who died during the acute MI, autopsy revealed extensive myocardial hemorrhage. The hearts of three other patients examined at least 5 months after the acute MI showed no evidence of prior hemorrhage. Magnetic resonance (MR) imaging has been shown to be able to evaluate the sequelae of myocardial infarction in adults with coronary artery disease and in children with Kawasaki syndrome. We report the first case of the used of MR imaging in the evaluation of myocardial damage during the acute stage of a FEIBA-associated MI in a 10-year-old boy. (orig.)

  8. Profile of MIBI liquid phase radiopharmaceutical for myocardial imaging

    I Daruwati; ME Sriyani; NK Oekar; N Zainuddin; KA Hanafiah

    2016-01-01

    The 99m Tc-MIBI radiopharmaceutical has been used in nuclear medicine in Indonesia for myocardial imaging. BATAN researchers have mastered the technology to manufacture MIBI as a lyophilized kit. A reformulation of MIBI radiopharmaceutical has been conducted to improve the stability of the kit especially in the liquid-phase kit. Basically, radiopharmaceuticals in liquid form are not different from the dry kit. However in the manufacturing of liquid-phase kit, lyophilization process was not done. To improve the stability of liquid kit, a reformulation of the components was conducted by using two separate vials (Formulation 2) and the characteristics were compared with the one-vial formulation (Formulation 1). The MIBI Formulation 2 consists of two vials, vial A containing 0.06 mg of SnCl 2 2H 2 O and 2.6 mg Sodium Citrate 2H 2 O and vial B containing 0.5 mg of [Cu(MIBI) 4 ]BF 4 , 1 mg of cysteine hydrochloride, and 20 mg of mannitol. The purposes of this study were to determine the stability of two different formulations of MIBI as a liquid-phase kit, to compare their stability in different storage condition such as in refrigerator and freezer, and to compare the ratio of activities attained between target and nontarget organs after injection to animal model. As a diagnostic agent, MIBI was reconstituted with Technetium-99m as radionuclide tracer to 99m Tc-MIBI labeled compound. The radiochemical purity of 99m Tc-MIBI was determined by chromatography method using alumina thin-layer chromatography paper as the stationary phase and ethanol 95% as the mobile phase. The results showed MIBI Formulation 2 has a higher stability than Formulation 1. Formulation 2 also maintained a 96.68% radiochemical purity under 52-day storage and attained a target-to-nontarget activity ratio of 8.22. (author)

  9. Digital imaging of regional glucose metabolism of the heart with a MWPC

    Bellazzini, R.; Camici, P.; Coppini, G.; Del Guerra, A.; Massai, M.M.; Ragadini, M.; Spandre, G.; Tonelli, G.

    1983-01-01

    The digital imaging of carbohydrate consumption in myocardial tissue has been performed by using a deposit tracer of glucose metabolism ( 3 H-deoxyglucose) and a specially designed Multiwire Proportional Chamber (MWPC) that acts as a position sensitive radioactivity detector. The resolving power (approx. =1.5 mm FWHM), sensitivity (approx. =10 -1 Bq/cm 2 ), efficiency (approx. =10%) and uniformity (+ or -4%) of the system are shown and MWPC digital autoradiographs of canine heart in different pathophysiological conditions are presented

  10. Quantitative thallium-201 myocardial imaging in assessing right ventricular pressure in patients with congenital heart defects

    Rabinovitch, M.; Fischer, K.C.; Treves, S.

    1981-01-01

    Thallium-201 myocardial scintigraphy was performed in patients with congenital heart defects to determine whether, by quantification of right ventricular isotope uptake, one could assess the degree of right ventricular hypertrophy and so predict the level of right ventricular pressure. It is shown that quantitative analysis of myocardial imaging with thallium-201 is of use clinically in patients with congenital heart defects, in assessing the severity of pulmonary stenosis or the presence of pulmonary artery hypertension. (author)

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

    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.

  12. Cardiac MRI. T2-mapping versus T2-weighted dark-blood TSE imaging for myocardial edema visualization in acute myocardial infarction

    Nassenstein, K.; Nensa, F.; Schlosser, T.; Umutlu, L.; Lauenstein, T.; Bruder, O.; Maderwald, S.; Ladd, M.E.

    2014-01-01

    Purpose: To assess the diagnostic accuracy of T2 mapping for the detection of myocardial edema in acute myocardial infarction (AMI), and to compare this diagnostic accuracy with that of the current standard for myocardial edema imaging, which is T2w dark-blood TSE imaging. Materials and Methods: 29 patients with AMI were examined at 1.5 T. For the visualization of myocardial edema, T2 maps, calculated from three T2w SSFP images, and T2w dark-blood TSE images were acquired in standard short- and long-axis views. Cine SSFP images were acquired for the analysis of left ventricular (LV) function and late gadolinium enhancement images (LGE) for the visualization of myocardial necrosis. The T2 maps as well as the T2w dark-blood TSE images were evaluated twice independently from the cine SSFP and LGE images. The presence or absence of myocardial edema was rated visually for each LV segment. As the standard of reference, the infarct zone was defined based on the cine SSFP and the LGE images. Results: In this segment-based analysis, T2 mapping showed a sensitivity of 82 % and a specificity of 94 % for the detection of edema in the infarct zone. T2w dark-blood TSE imaging revealed a sensitivity of 50 % and a specificity of 98 %. T2 mapping showed a higher intra-rater agreement compared to T2w dark-blood TSE imaging (κ: 0.87 vs. 0.76). Conclusions: T2 mapping allows for the visualization of myocardial edema in AMI with a high sensitivity and specificity, and features better diagnostic accuracy in terms of a higher sensitivity compared to T2w dark-blood TSE imaging. (orig.)

  13. Fenofibrate Therapy Restores Antioxidant Protection and Improves Myocardial Insulin Resistance in a Rat Model of Metabolic Syndrome and Myocardial Ischemia: The Role of Angiotensin II

    Luz Ibarra-Lara

    2016-12-01

    Full Text Available Renin-angiotensin system (RAS activation promotes oxidative stress which increases the risk of cardiac dysfunction in metabolic syndrome (MetS and favors local insulin resistance. Fibrates regulate RAS improving MetS, type-2 diabetes and cardiovascular diseases. We studied the effect of fenofibrate treatment on the myocardic signaling pathway of Angiotensin II (Ang II/Angiotensin II type 1 receptor (AT1 and its relationship with oxidative stress and myocardial insulin resistance in MetS rats under heart ischemia. Control and MetS rats were assigned to the following groups: (a sham; (b vehicle-treated myocardial infarction (MI (MI-V; and (c fenofibrate-treated myocardial infarction (MI-F. Treatment with fenofibrate significantly reduced triglycerides, non-high density lipoprotein cholesterol (non-HDL-C, insulin levels and insulin resistance index (HOMA-IR in MetS animals. MetS and MI increased Ang II concentration and AT1 expression, favored myocardial oxidative stress (high levels of malondialdehyde, overexpression of nicotinamide adenine dinucleotide phosphate (NADPH oxidase 4 (NOX4, decreased total antioxidant capacity and diminished expression of superoxide dismutase (SOD1, SOD2 and catalase and inhibited expression of the insulin signaling cascade: phosphatidylinositol 3-kinase (PI3K/protein kinase B (PkB, also known as Akt/Glut-4/endothelial nitric oxide synthase (eNOS. In conclusion, fenofibrate treatment favors an antioxidant environment as a consequence of a reduction of the Ang II/AT1/NOX4 signaling pathway, reestablishing the cardiac insulin signaling pathway. This might optimize cardiac metabolism and improve the vasodilator function during myocardial ischemia.

  14. Magnetic resonance imaging using paramagnetic contrast agents in the clinical evaluation of myocardial infarction. Chapter 15

    Dijkman, P.R.M. van; Wall, E.E. van der

    1992-01-01

    MRI is noninvasive and specific method for production of high resolution tomographic images in blocks of 3D information. Apart from scintigraphic techniques and computed tomography for evaluation of myocardial ischemia and infarcts, MRI has emerged as a new diagnostic technique to study the extent of anatomical and functional abnormalities in patients with coronary artery disease. Conventional noncontrast MRI can identify acute-infarcted myocardial areas, although the difficulty in identifying myocardial ischemia and infarct with noncontrast MRI suggests a potential role for contrast enhanced MRI. Use of the paramagnetic contrast agent gadolinium diethylene triamine pentaacetic acid (Gd-DTPA) improves depiction of infarcted myocardium on T1-weighted spin -echo MR images that are obtained soon after acute myocardial infarction. This is of particular interest for the estimation of myocardial infarct size. Furthermore, ultrafast subsecond imaging, in combination with Gd-DTPA, offers the potential to analyze cardiac first pass and myocardial perfusion. The development of nontoxic paramagnetic contrast agents which are selectively taken up by viable myocardium would be helpful in assessing the presence of ischemic/infarcted myocardium salvage by MRI following reperfusion. (author). 58 refs., 6 figs

  15. New software for raw data mask processing increases diagnostic ability of myocardial SPECT imaging.

    Tanaka, Ryo; Yoshioka, Katsunori; Seino, Kazue; Ohba, Muneo; Nakamura, Tomoharu; Shimada, Katsuhiko

    2011-05-01

    Increased activity of myocardial perfusion tracer technetium-99m in liver and hepatobiliary system causes streak artifacts, which may affect clinical diagnosis. We developed a mask-processing tool for raw data generated using technetium-99m as a myocardial perfusion tracer. Here, we describe improvements in image quality under the influence of artifacts caused by high accumulation in other organs. A heart phantom (RH-2) containing 15 MBq of pertechnetate was defined as model A. Model B was designed in the same phantom containing ten times of cardiac radioactivity overlapping with other organs. Variance in the vertical profile count in the lower part of the myocardial inferior wall and in the myocardial circumferential profile curve were investigated in a phantom and clinical cases using our raw data masking (RDM) software. The profile variances at lower parts of myocardial inferior walls were 965.43 in model A, 1390.11 in model B and 815.85 in B-RDM. The mean ± SD of myocardial circumferential profile curves were 83.91 ± 7.39 in model A, 69.61 ± 11.45 in model B and 82.68 ± 9.71 in model B-RDM. For 11 clinical images with streak artifacts, the average of the variance significantly differed between with and without RDM (3.95 vs. 21.05; P software. The waiting time between infusion and image acquisition should be decreased, thus reducing patient burden and improving the diagnostic ability of the procedure.

  16. Effects of smoking on lung uptake of 201Tl during exercise myocardial perfusion imaging

    Ouyang Wei; He Guorong; Liu Jinhua

    2004-01-01

    Objective: To investigate the influence of smoking on lung uptake of 201 Tl during myocardial perfusion imaging. Methods: Ninety-two healthy subjects, with normal 201 Tl myocardial perfusion imaging findings but no evidence of left ventricular hypertrophy and pulmonary disease, were divided into three groups, smoker, nonsmoker and quitted smoker groups. Exercise/delay 201 Tl myocardial perfusion imaging was performed on all subjects included. Lung/heart ratio was defined on the anterior planar image obtained during exercise tomography. Results: Both the lung/heart ratios during exercise in smoker (0.40 ± 0.07, F=10.635, P 201 Tl lung/heart ratios in smokers are higher than in nonsmokers and this must be kept in mind when 201 Tl lung/heart ratios are used clinically, even in quitted smokers

  17. Prognostic value of gated 201Tl myocardial perfusion SPECT imaging in patients with coronary artery disease

    Li Zicheng; Chen Xiaoming; Xu Hao

    2006-01-01

    Objective: To study the prognostic value of gated 201 Tl myocardial perfusion SPECT imaging in patients with coronary artery disease and assessment of therapy strategy for the individual patient. Methods: Eighty-four patients underwent rest and exercise stress 201 Tl gated myocardial perfusion SPECT imaging and were followed up for (32.92 ± 16.77) months. Images were studied using 17 segments and 1 to 4 scoring. Global summed stress score (SSS), summed rest score (SRS) and summed difference score (SDS=SSS-SRS) were also calculated. Post-stress and rest ejection fraction (EF) were automatically measured. Results: Nine cardiac events occurred (3.90% per year). SSS, SDS, SRS and EF were the independent predictors of cardiac events (P 201 Tl myocardial perfusion SPECT imaging can provide prognostic assessment for the patients with coronary artery disease and guide in selection of therapeutic strategy. Among all of the indices SSS is the best predictors of cardiac events. (authors)

  18. Prognostic importance of silent myocardial ischemia detected by intravenous dipyridamole thallium myocardial imaging in asymptomatic patients with coronary artery disease

    Younis, L.T.; Byers, S.; Shaw, L.; Barth, G.; Goodgold, H.; Chaitman, B.R.

    1989-01-01

    One hundred seven asymptomatic patients who underwent intravenous dipyridamole thallium imaging were evaluated to determine prognostic indicators of subsequent cardiac events over an average follow-up period of 14 +/- 10 months. Univariate analysis of 18 clinical, scintigraphic and angiographic variables revealed that a reversible thallium defect, a combined fixed and reversible thallium defect, number of segmental thallium defects and extent of coronary artery disease were significant predictors of subsequent cardiac events. Of the 13 patients who died or had a nonfatal infarction, 12 had a reversible thallium defect. Stepwise logistic regression analysis selected a reversible thallium defect as the only significant predictor of cardiac events. When death or myocardial infarction was the outcome variable, a combined fixed and reversible thallium defect was the only predictor of outcome. In patients without previous myocardial infarction, the cardiac event rate was significantly greater in those with an abnormal versus normal thallium scan (55% versus 12%, p less than 0.001). Thus, intravenous dipyridamole thallium scintigraphy is a useful noninvasive test to risk stratify asymptomatic patients with coronary artery disease. A reversible thallium defect most likely indicates silent myocardial ischemia in a sizable fraction of patients in this clinical subset and is associated with an unfavorable prognosis

  19. Quantification of Regional Myocardial Oxygenation by Magnetic Resonance Imaging: Validation with Positron Emission Tomography

    McCommis, Kyle S.; Goldstein, Thomas A.; Abendschein, Dana R.; Herrero, Pilar; Misselwitz, Bernd; Gropler, Robert J.; Zheng, Jie

    2011-01-01

    Background A comprehensive evaluation of myocardial ischemia requires measures of both oxygen supply and demand. Positron emission tomography (PET) is currently the gold standard for such evaluations, but its use is limited due to its ionizing radiation, limited availability, and high cost. A cardiac magnetic resonance imaging (MRI) method was developed for assessing myocardial oxygenation. The purpose of this study was to evaluate and validate this technique compared to PET during pharmacologic stress in a canine model of coronary artery stenosis. Methods and Results Twenty-one beagles and small mongrel dogs without coronary artery stenosis (controls), or with moderate to severe acute coronary artery stenosis underwent MRI and PET imaging at rest and during dipyridamole vasodilation or dobutamine stress to induce a wide range of changes in cardiac perfusion and oxygenation. MRI first-pass perfusion imaging was performed to quantify myocardial blood flow (MBF) and volume (MBV). The MRI blood-oxygen-level-dependent (BOLD) technique was used to determine the myocardial oxygen extraction fraction (OEF) during pharmacologic hyperemia. Myocardial oxygen consumption (MVO2) was determined by Fick’s law. In the same dogs, 15O-water and 11C-acetate were used to measure MBF and MVO2, respectively, by PET. Regional assessments were performed for both MR and PET. MRI data correlated nicely with PET values for MBF (R2 = 0.79, P < 0.001), MVO2 (R2 = 0.74, P < 0.001), and OEF (R2 = 0.66, P < 0.01). Conclusions Cardiac MRI methods may provide an alternative to radionuclide imaging in settings of myocardial ischemia. Our newly developed quantitative MRI oxygenation imaging technique may be a valuable non-invasive tool to directly evaluate myocardial energetics and efficiency. PMID:19933371

  20. Direct myocardial perfusion imaging in valvular heart disease

    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.

  1. Direct myocardial perfusion imaging in valvular heart disease

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

    1981-01-01

    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. (orig.) [de

  2. Effects of simultaneous and optimized sequential cardiac resynchronization therapy on myocardial oxidative metabolism and efficiency.

    Christenson, Stuart D; Chareonthaitawee, Panithaya; Burnes, John E; Hill, Michael R S; Kemp, Brad J; Khandheria, Bijoy K; Hayes, David L; Gibbons, Raymond J

    2008-02-01

    Cardiac resynchronization therapy (CRT) can improve left ventricular (LV) hemodynamics and function. Recent data suggest the energy cost of such improvement is favorable. The effects of sequential CRT on myocardial oxidative metabolism (MVO(2)) and efficiency have not been previously assessed. Eight patients with NYHA class III heart failure were studied 196 +/- 180 days after CRT implant. Dynamic [(11)C]acetate positron emission tomography (PET) and echocardiography were performed after 1 hour of: 1) AAI pacing, 2) simultaneous CRT, and 3) sequential CRT. MVO(2) was calculated using the monoexponential clearance rate of [(11)C]acetate (k(mono)). Myocardial efficiency was expressed in terms of the work metabolic index (WMI). P values represent overall significance from repeated measures analysis. Global LV and right ventricular (RV) MVO(2) were not significantly different between pacing modes, but the septal/lateral MVO(2) ratio differed significantly with the change in pacing mode (AAI pacing = 0.696 +/- 0.094 min(-1), simultaneous CRT = 0.975 +/- 0.143 min(-1), and sequential CRT = 0.938 +/- 0.189 min(-1); overall P = 0.001). Stroke volume index (SVI) (AAI pacing = 26.7 +/- 10.4 mL/m(2), simultaneous CRT = 30.6 +/- 11.2 mL/m(2), sequential CRT = 33.5 +/- 12.2 mL/m(2); overall P simultaneous CRT = 4.29 +/- 1.72 mmHg*mL/m(2)*10(6), sequential CRT = 4.79 +/- 1.92 mmHg*mL/m(2)*10(6); overall P = 0.002) also differed between pacing modes. Compared with simultaneous CRT, additional changes in septal/lateral MVO(2), SVI, and WMI with sequential CRT were not statistically significant on post hoc analysis. In this small selected population, CRT increases LV SVI without increasing MVO(2), resulting in improved myocardial efficiency. Additional improvements in LV work, oxidative metabolism, and efficiency from simultaneous to sequential CRT were not significant.

  3. Depressive disorder and gastrointestinal dysfunction after myocardial infarct are associated with abnormal tryptophan-5-hydroxytryptamine metabolism in rats.

    Lu, Xiaofang; Wang, Yuefen; Liu, Chunyan; Wang, Yangang

    2017-01-01

    In this study, we investigated the relationship between tryptophan-5-hydroxytryptamine metabolism, depressive disorder, and gastrointestinal dysfunction in rats after myocardial infarction. Our goal was to elucidate the physiopathologic bases of somatic/psychiatric depression symptoms after myocardial infarction. A myocardial infarction model was established by permanent occlusion of the left anterior descending coronary artery. Depression-like behavior was evaluated using the sucrose preference test, open field test, and forced swim test. Gastric retention and intestinal transit were detected using the carbon powder labeling method. Immunohistochemical staining was used to detect indoleamine 2,3-dioxygenase expression in the hippocampus and ileum. High-performance liquid chromatography with fluorescence and ultraviolet detection determined the levels of 5-hydroxytryptamine, its precursor tryptophan, and its metabolite 5-hydroxyindoleacetic acid in the hippocampus, distal ileum, and peripheral blood. All data were analyzed using one-way analyses of variance. Three weeks after arterial occlusion, rats in the model group began to exhibit depression-like symptoms. For example, the rate of sucrose consumption was reduced, the total and central distance traveled in the open field test were reduced, and immobility time was increased, while swimming, struggling and latency to immobility were decreased in the forced swim test. Moreover, the gastric retention rate and gastrointestinal transit rate were increased in the model group. Expression of indoleamine 2,3-dioxygenase was increased in the hippocampus and ileum, whereas 5-hydroxytryptamine metabolism was decreased, resulting in lower 5-hydroxytryptamine and 5-hydroxyindoleacetic acid levels in the hippocampus and higher levels in the ileum. Depressive disorder and gastrointestinal dysfunction after myocardial infarction involve abnormal tryptophan-5-hydroxytryptamine metabolism, which may explain the somatic, cognitive

  4. Depressive disorder and gastrointestinal dysfunction after myocardial infarct are associated with abnormal tryptophan-5-hydroxytryptamine metabolism in rats.

    Xiaofang Lu

    Full Text Available In this study, we investigated the relationship between tryptophan-5-hydroxytryptamine metabolism, depressive disorder, and gastrointestinal dysfunction in rats after myocardial infarction. Our goal was to elucidate the physiopathologic bases of somatic/psychiatric depression symptoms after myocardial infarction. A myocardial infarction model was established by permanent occlusion of the left anterior descending coronary artery. Depression-like behavior was evaluated using the sucrose preference test, open field test, and forced swim test. Gastric retention and intestinal transit were detected using the carbon powder labeling method. Immunohistochemical staining was used to detect indoleamine 2,3-dioxygenase expression in the hippocampus and ileum. High-performance liquid chromatography with fluorescence and ultraviolet detection determined the levels of 5-hydroxytryptamine, its precursor tryptophan, and its metabolite 5-hydroxyindoleacetic acid in the hippocampus, distal ileum, and peripheral blood. All data were analyzed using one-way analyses of variance. Three weeks after arterial occlusion, rats in the model group began to exhibit depression-like symptoms. For example, the rate of sucrose consumption was reduced, the total and central distance traveled in the open field test were reduced, and immobility time was increased, while swimming, struggling and latency to immobility were decreased in the forced swim test. Moreover, the gastric retention rate and gastrointestinal transit rate were increased in the model group. Expression of indoleamine 2,3-dioxygenase was increased in the hippocampus and ileum, whereas 5-hydroxytryptamine metabolism was decreased, resulting in lower 5-hydroxytryptamine and 5-hydroxyindoleacetic acid levels in the hippocampus and higher levels in the ileum. Depressive disorder and gastrointestinal dysfunction after myocardial infarction involve abnormal tryptophan-5-hydroxytryptamine metabolism, which may explain the

  5. Clinical correlations, lactate extraction, coronary venous bloodflow and Thallium-201 myocardial imaging in patients with isolated left anterior descending muscle brigdes: Normal variant or obstruction

    Voss, H.; Kupper, W.; Hanrath, P.; Mathey, D.; Montz, R.; Buecking, J.; Hamburg Univ.; Hamburg Univ.

    1980-01-01

    In 848 coronary arteriograms performed in a two-years period 21 patients (2.5%) showed a myocardial bridging of the left anterior descending artery. Resting- and/or stress-ECG were abnormal in half of the patients. Regional lactate-metabolism measured in the great cardiac vein at rest and during maximal atrial pacing was normal (29 +- 12 resp. 24 +- 9%). Thermodilution of great cardiac vein bloodflow at rest and during atrial pacing also demonstrated normal values (94 +- 33 resp. 138 +- 30 ml/min). Biphasic 201-Thallium myocardial imaging revealed no case of reversible perfusion defect, but surprisingly frequent (5 of 16 patients) clearly irreversible defects limited to the interventricular septum. We conclude that muscle bridges do not cause myocardial ischemia at rest or during exercice. (orig.) [de

  6. Synthesis and evaluation of radioiodinated (E)-18-iodo-17-octadecenoic acid as a model iodoalkenyl fatty acid for myocardial imaging

    Knapp, F.F. Jr.; Goodman, M.M.; Kabalka, G.W.; Sastry, K.A.

    1984-01-01

    125 I-labeled (E)-18-iodo-17-octadecenoic acid (13) has been prepared and evaluated in rats to determine the myocardial uptake and retention and degree of in vivo deiodination of this model iodovinyl-substituted fatty acid, which contains no structural perturbation to inhibit metabolism. This new agent was prepared by NaI-chloramine-T treatment of (17-carbomethoxyheptadec-1-en-1-yl)boronic acid (11) prepared by catecholborane treatment of methyl 17-octadecynoate (10), followed by basic hydrolysis to the free acid (13). The pivotal substrate, 17-octadecynoic acid (9), was prepared by two new routes. The 125 I-labeled acid 13 showed high myocardial uptake (1 h, 1.90-2.28% dose/g) with 45% washout after 2 h but lower heart/blood ratios in comparison to analogues containing the tellurium heteroatom. Deiodination was low for the first 2 h after injection (2 h, 61% dose/g). Excellent myocardial images were obtained in a dog with the 123 I-labeled agent

  7. Adding attenuation corrected images in myocardial perfusion imaging reduces the need for a rest study

    Trägårdh, Elin; Valind, Sven; Edenbrandt, Lars

    2013-01-01

    The American Society of Nuclear Cardiology and the Society of Nuclear Medicine conclude that incorporation of attenuation corrected (AC) images in myocardial perfusion scintigraphy (MPS) will improve diagnostic accuracy. The aim was to investigate the value of adding AC stress-only images for the decision whether a rest study is necessary or not. 1,261 patients admitted to 99m Tc MPS were studied. The stress studies were interpreted by two physicians who judged each study as “no rest study necessary” or “rest study necessary”, by evaluating NC stress-only and NC + AC stress-only images. When there was disagreement between the two physicians, a third physician evaluated the studies. Thus, agreement between 2 out of 3 physicians was evaluated. The physicians assessed 214 more NC + AC images than NC images as “no rest study necessary” (17% of the study population). The number of no-rest-study-required was significantly higher for NC + AC studies compared to NC studies (859 vs 645 cases (p < 0.0001). In the final report according to clinical routine, ischemia or infarction was reported in 23 patients, assessed as “no rest study necessary” (22 NC + AC cases; 8 NC cases), (no statistically significant difference). In 11 of these, the final report stated “suspected/possible ischemia or infarction in a small area”. Adding AC stress-only images to NC stress-only images reduce the number of unnecessary rest studies substantially

  8. Parametric techniques for characterizing myocardial tissue by magnetic resonance imaging (part 1): T1 mapping.

    Perea Palazón, R J; Ortiz Pérez, J T; Prat González, S; de Caralt Robira, T M; Cibeira López, M T; Solé Arqués, M

    2016-01-01

    The development of myocardial fibrosis is a common process in the appearance of ventricular dysfunction in many heart diseases. Magnetic resonance imaging makes it possible to accurately evaluate the structure and function of the heart, and its role in the macroscopic characterization of myocardial fibrosis by late enhancement techniques has been widely validated clinically. Recent studies have demonstrated that T1-mapping techniques can quantify diffuse myocardial fibrosis and the expansion of the myocardial extracellular space in absolute terms. However, further studies are necessary to validate the usefulness of this technique in the early detection of tissue remodeling at a time when implementing early treatment would improve a patient's prognosis. This article reviews the state of the art for T1 mapping of the myocardium, its clinical applications, and its limitations. Copyright © 2016 SERAM. Published by Elsevier España, S.L.U. All rights reserved.

  9. Parametric methods for characterizing myocardial tissue by magnetic resonance imaging (part 2): T2 mapping.

    Perea Palazón, R J; Solé Arqués, M; Prat González, S; de Caralt Robira, T M; Cibeira López, M T; Ortiz Pérez, J T

    2015-01-01

    Cardiac magnetic resonance imaging is considered the reference technique for characterizing myocardial tissue; for example, T2-weighted sequences make it possible to evaluate areas of edema or myocardial inflammation. However, traditional sequences have many limitations and provide only qualitative information. Moreover, traditional sequences depend on the reference to remote myocardium or skeletal muscle, which limits their ability to detect and quantify diffuse myocardial damage. Recently developed magnetic resonance myocardial mapping techniques enable quantitative assessment of parameters indicative of edema. These techniques have proven better than traditional sequences both in acute cardiomyopathy and in acute ischemic heart disease. This article synthesizes current developments in T2 mapping as well as their clinical applications and limitations. Copyright © 2014 SERAM. Published by Elsevier España, S.L.U. All rights reserved.

  10. Comparative study of 201Tl reinjection mycoardial imaging and late imaging after reinjection for detecting myocardial viability

    Lin Jinghui; Chai Xiaofeng; Zhu Mei

    1997-01-01

    PURPOSE: To compare 201 Tl reinjection imaging with late imaging in detecting myocardial viability. METHODS: 62 patients with myocardial infarction underwent 201 Tl exercise, 3∼5 hours redistribution, 16∼35 minutes and 12∼19 hours post 201 Tl reinjection mycoardial tomography imaging. After imaging, percutaneous transluminal coronary angioplasty (PTCA) were performed in 15 patients, and then exercise-redistribution myocardial imaging were repeated. RESULTS: 62 patients had 126 segments of irreversible defects on stress-redistribution imaging, 48 segments showed radioactive filling at 16∼35 minutes post-reinjection. The detecting rate of myocardial viability was 38.1% (48/126). 51 segments presented redistribution on 12∼19 hours late imaging, the detecting rate of myocardial viability was 40.5% (51/126). There were no significant difference in the detecting rate between them (x 2 0.16, P>0.05). But in combination of both methods, there were 62 segments refilling, thereby detecting rate was enhanced to 49.2% (62/126). In 15 patients who had PTCA, out of 17 segments were discovered to be viable before PTCA. After PTCA 12 segments had an improved perfusion of 201 Tl, the positive predictive accuracy was 70.6%. Out of 11 segments were discovered to be infarcted, 9 segments had non-improved 201 Tl perfusion after PTCA, the negative predictive accuracy was 81.8%. CONCLUSION: There were no significant difference in the detecting rate of myocardial viability between 2 '0 1 Tl reinjection and late imaging. In combination of both methods the detecting rate can be enhanced

  11. Myocardial strain assessment by cine cardiac magnetic resonance imaging using non-rigid registration.

    Tsadok, Yossi; Friedman, Zvi; Haluska, Brian A; Hoffmann, Rainer; Adam, Dan

    2016-05-01

    To evaluate a novel post-processing method for assessment of longitudinal mid-myocardial strain in standard cine cardiac magnetic resonance (CMR) imaging sequences. Cine CMR imaging and tagged cardiac magnetic resonance imaging (TMRI) were performed in 15 patients with acute myocardial infarction (AMI) and 15 healthy volunteers served as control group. A second group of 37 post-AMI patients underwent both cine CMR and late gadolinium enhancement (LGE) CMR exams. Speckle tracking echocardiography (STE) was performed in 36 of these patients. Cine CMR, TMRI and STE were analyzed to obtain longitudinal strain. LGE-CMR datasets were analyzed to evaluate scar extent. Comparison of peak systolic strain (PSS) measured from CMR and TMRI yielded a strong correlation (r=0.86, pcine CMR data. The method was found to be highly correlated with strain measurements obtained by TMRI and STE. This tool allows accurate discrimination between different transmurality states of myocardial infarction. Copyright © 2015 Elsevier Inc. All rights reserved.

  12. Improved detection of chronic myocardial infarction with Fourier amplitude and phase imaging in two projections

    Akins, E.W.; Scott, E.A.; Williams, C.M.

    1987-01-01

    Twenty-seven patients with 33 chronic myocaridal infarctions underwent MR imaging and radionuclide ventriculography at rest. The radionuclide ventriculographs, in left anterior oblique (LAO) and left posterior oblique (LPO) projections, were analyzed by two independent observers by visual inspection and combined Fourier-transformed amplitude and phase imaging. Only 15 (45%) of the 33 infarctions were detected by visual inspection, but 21 (64%) were detected on the LAO Fourier-transformed images along. Thirty (91%) were detected by using both LAO and LPO Fourier-transformed images. On MR imaging, 28 (85%) of the myocardial infarctions appeared as areas of focal wall thinning. Combined Fourier-transformed amplitude and phase imaging in both LAO and LPO views discloses more myocardial infarctions than visual inspection or LAO Fourier-transformed images alone because inferior infarctions, which are frequently missed in the LAO view, are easily seen in the LPO view

  13. NMR studies of myocardial energy metabolism and ionic homeostasis during ischemia and reperfusion

    Kirkels, J.H.

    1989-01-01

    In this study several aspects of myocardial energy metabolism and ionic homeostasis during ischemia and reperfusion were investigated in isolated perfused rat hearts, regionally ischemic rabbit hearts, and ex vivo human donor hearts during long term hypothermic cardioplegia. Phosphorus-31 nuclear magnetic resonance ( 31 P NMR) spectroscopy was used as a powerful tool to non-destructively follow the time course in changes in intracellular high-energy phosphates, (creatine phosphate and ATP), inorganic phosphate, and pH. In addition, changes in intracellular free magnesium were followed during ischemia and reperfusion. Sodium-23 ( 23 Na) NMR spectroscopy was used to study intracellular sodium during ischemia and reperfusion and during calcium-free perfusion. (author). 495 refs.; 33 figs.; 11 tabs

  14. The evaluation of dobutamine 99mTc-MIBI myocardial perfusion imaging in the diagnosis of coronary heart disease

    He Qing; Qu Wanying; Gong Junhui; Zhou Ying

    1996-01-01

    The method and the clinical value of dobutamine stress test as a substitute for exercise test in 99m Tc-MIBI myocardial perfusion imaging was investigated. 40 Patients were intravenously infused with dobutamine through IVAC syringe pumps by incremental doses, and 99m Tc-MIBI was injected at the peak dobutamine heart rate. The myocardial imaging was then performed. The rest myocardial imaging was done after 48 hours. 30 of the 31 patients with coronary heart disease showed reversible perfusion defects in dobutamine 99m Tc-MIBI myocardial perfusion images and 7 of the 9 patients without coronary heart disease showed normal images. The sensitivity of this test was 96.8% and the specificity 77.8%. None of the studies was discontinued due to dobutamine side effect. Dobutamine 99m Tc-MIBI myocardial perfusion imaging is a safe and sensitive method in the diagnosis of coronary heart disease

  15. Evaluation of Parallel and Fan-Beam Data Acquisition Geometries and Strategies for Myocardial SPECT Imaging

    Qi, Yujin; Tsui, B. M. W.; Gilland, K. L.; Frey, E. C.; Gullberg, G. T.

    2004-06-01

    This study evaluates myocardial SPECT images obtained from parallel-hole (PH) and fan-beam (FB) collimator geometries using both circular-orbit (CO) and noncircular-orbit (NCO) acquisitions. A newly developed 4-D NURBS-based cardiac-torso (NCAT) phantom was used to simulate the /sup 99m/Tc-sestamibi uptakes in human torso with myocardial defects in the left ventricular (LV) wall. Two phantoms were generated to simulate patients with thick and thin body builds. Projection data including the effects of attenuation, collimator-detector response and scatter were generated using SIMSET Monte Carlo simulations. A large number of photon histories were generated such that the projection data were close to noise free. Poisson noise fluctuations were then added to simulate the count densities found in clinical data. Noise-free and noisy projection data were reconstructed using the iterative OS-EM reconstruction algorithm with attenuation compensation. The reconstructed images from noisy projection data show that the noise levels are lower for the FB as compared to the PH collimator due to increase in detected counts. The NCO acquisition method provides slightly better resolution and small improvement in defect contrast as compared to the CO acquisition method in noise-free reconstructed images. Despite lower projection counts the NCO shows the same noise level as the CO in the attenuation corrected reconstruction images. The results from the channelized Hotelling observer (CHO) study show that FB collimator is superior to PH collimator in myocardial defect detection, but the NCO shows no statistical significant difference from the CO for either PH or FB collimator. In conclusion, our results indicate that data acquisition using NCO makes a very small improvement in the resolution over CO for myocardial SPECT imaging. This small improvement does not make a significant difference on myocardial defect detection. However, an FB collimator provides better defect detection than a

  16. Myocardial uptake characteristics of three 99mTc-labeled tracers for myocardial perfusion imaging one hour after rest injection

    Manka-Waluch, A.; Palmedo, H.; Reinhardt, M.J.; Joe, A.Y.; Manka, C.; Guhlke, S.; Biersack, H.J.; Bucerius, J.

    2006-01-01

    99m Tc-tetrofosmin and 99m Tc-sestamibi are approved tracers for myocardial perfusion studies. Recently, a 99m Tc-methoxyisobutylisonitrile (MIBI) preparation from a different manufacturer ( 99m Tc-cardiospect-MIBI) has been introduced to the market. Therefore, the aim of this study was the evaluation of 99m Tc-tetrofosmin as well as of two different 99m Tc-labeled MIBI tracers with regard to differences in imaging quality under resting conditions. Sixty patients (mean age 63.8 years±1.25) with known or suspected coronary artery disease but without evidence of rest-ischemia were included. Twenty patients in each group were examined by a two-day-rest-stress protocol using the three 99m Tc-labeled tracers. Visual analysis of all images was performed by two experienced physicians blinded with regard to the applied tracer. Regions of interest (ROI) were defined over the heart, lung and whole body only in the rest imaging in order to calculate heart-to-lung, lung-to-whole body-, and heart-to-whole body-ratios. The heart-to-lung ratio was statistically significant higher for 99 m T c-cardiospect-MIBI as compared to 99m Tc-sestamibi as well as to 99m Tc-tetrofosmin. Furthermore, a significantly higher heart-to-lung ratio was found for 99m Tc-sestamibi as compared to 99m Tc-tetrofosmin. The heart-to-whole body-ratio and the lung-to-whole body-ratio were equivalent between all tracers. Visual analysis revealed only slight differences regarding image quality between all tracers. ROI analysis surprisingly revealed a significant higher myocardial uptake and consequently a higher heart-to-lung ratio for 99m Tc-cardiospect-MIBI. Whether this leads to a better visual image quality has to be evaluated in future studies with larger study populations as well as semiquantitative segmental analysis of the myocardial perfusion images. (author)

  17. Metabolic Syndrome, Strain, and Reduced Myocardial Function: Multi-Ethnic Study of Atherosclerosis

    Almeida, André Luiz Cerqueira de, E-mail: andrealmeida@cardiol.br [Johns Hopkins University, Baltimore, MD (United States); Universidade Estadual de Feira de Santana, Bahia (Brazil); Teixido-Tura, Gisela; Choi, Eui-Young; Opdahl, Anders; Fernandes, Verônica R. S. [Johns Hopkins University, Baltimore, MD (United States); Wu, Colin O. [National Heart, Lung and Blood Institute, Bethesda, MD (United States); Bluemke, David A. [National Institutes of Health Clinical Center, National Institute for Biomedical Imaging and Bioengineering, Bethesda, MD (United States); Lima, João A. C. [Johns Hopkins University, Baltimore, MD (United States)

    2014-04-15

    Subclinical cardiovascular disease is prevalent in patients with Metabolic Syndrome (MetSyn). Left ventricular (LV) circumferential strain (ε{sub CC}) and longitudinal strain (ε{sub LL}), assessed by Speckle Tracking Echocardiography (STE), are indices of systolic function: shortening is indicated by negative strain, and thus, the more negative the strain, the better the LV systolic function. They have been used to demonstrate subclinical ventricular dysfunction in several clinical disorders. We hypothesized that MetSyn is associated with impaired myocardial function, as assessed by STE. We analyzed Multi-Ethnic Study of Atherosclerosis (MESA) participants who underwent STE and were evaluated for all MetSyn components. Among the 133 participants included [women: 63%; age: 65 ± 9 years (mean ± SD)], the prevalence of MetSyn was 31% (41/133). Individuals with MetSyn had lower ε{sub CC} and lower ε{sub LL} than those without MetSyn (-16.3% ± 3.5% vs. -18.4% ± 3.7%, p < 0.01; and -12.1% ± 2.5% vs. -13.9% ± 2.3%, p < 0.01, respectively). The LV ejection fraction (LVEF) was similar in both groups (p = 0.09). In multivariate analysis, MetSyn was associated with less circumferential myocardial shortening as indicated by less negative ε{sub CC} (B = 2.1%, 95%CI:0.6 3.5, p < 0.01) even after adjusting for age, ethnicity, LV mass, and LVEF). Likewise, presence of MetSyn (B = 1.3%, 95%CI:0.3 2.2, p < 0.01) and LV mass (B = 0.02%, 95% CI: 0.01-0.03, p = 0.02) were significantly associated with less longitudinal myocardial shortening as indicated by less negative ε{sub LL} after adjustment for ethnicity, LVEF, and creatinine. Left ventricular ε{sub CC} and ε{sub LL}, markers of subclinical cardiovascular disease, are impaired in asymptomatic individuals with MetSyn and no history of myocardial infarction, heart failure, and/or LVEF < 50%.

  18. Metabolic Syndrome, Strain, and Reduced Myocardial Function: Multi-Ethnic Study of Atherosclerosis

    Almeida, André Luiz Cerqueira de; Teixido-Tura, Gisela; Choi, Eui-Young; Opdahl, Anders; Fernandes, Verônica R. S.; Wu, Colin O.; Bluemke, David A.; Lima, João A. C.

    2014-01-01

    Subclinical cardiovascular disease is prevalent in patients with Metabolic Syndrome (MetSyn). Left ventricular (LV) circumferential strain (ε CC ) and longitudinal strain (ε LL ), assessed by Speckle Tracking Echocardiography (STE), are indices of systolic function: shortening is indicated by negative strain, and thus, the more negative the strain, the better the LV systolic function. They have been used to demonstrate subclinical ventricular dysfunction in several clinical disorders. We hypothesized that MetSyn is associated with impaired myocardial function, as assessed by STE. We analyzed Multi-Ethnic Study of Atherosclerosis (MESA) participants who underwent STE and were evaluated for all MetSyn components. Among the 133 participants included [women: 63%; age: 65 ± 9 years (mean ± SD)], the prevalence of MetSyn was 31% (41/133). Individuals with MetSyn had lower ε CC and lower ε LL than those without MetSyn (-16.3% ± 3.5% vs. -18.4% ± 3.7%, p < 0.01; and -12.1% ± 2.5% vs. -13.9% ± 2.3%, p < 0.01, respectively). The LV ejection fraction (LVEF) was similar in both groups (p = 0.09). In multivariate analysis, MetSyn was associated with less circumferential myocardial shortening as indicated by less negative ε CC (B = 2.1%, 95%CI:0.6 3.5, p < 0.01) even after adjusting for age, ethnicity, LV mass, and LVEF). Likewise, presence of MetSyn (B = 1.3%, 95%CI:0.3 2.2, p < 0.01) and LV mass (B = 0.02%, 95% CI: 0.01-0.03, p = 0.02) were significantly associated with less longitudinal myocardial shortening as indicated by less negative ε LL after adjustment for ethnicity, LVEF, and creatinine. Left ventricular ε CC and ε LL , markers of subclinical cardiovascular disease, are impaired in asymptomatic individuals with MetSyn and no history of myocardial infarction, heart failure, and/or LVEF < 50%

  19. Increases in myocardial workload induced by rapid atrial pacing trigger alterations in global metabolism.

    Aslan T Turer

    Full Text Available To determine whether increases in cardiac work lead to alterations in the plasma metabolome and whether such changes arise from the heart or peripheral organs.There is growing evidence that the heart influences systemic metabolism through endocrine effects and affecting pathways involved in energy homeostasis.Nineteen patients referred for cardiac catheterization were enrolled. Peripheral and selective coronary sinus (CS blood sampling was performed at serial timepoints following the initiation of pacing, and metabolite profiling was performed by liquid chromatography-mass spectrometry (LC-MS.Pacing-stress resulted in a 225% increase in the median rate·pressure product from baseline. Increased myocardial work induced significant changes in the peripheral concentration of 43 of 125 metabolites assayed, including large changes in purine [adenosine (+99%, p = 0.006, ADP (+42%, p = 0.01, AMP (+79%, p = 0.004, GDP (+69%, p = 0.003, GMP (+58%, p = 0.01, IMP (+50%, p = 0.03, xanthine (+61%, p = 0.0006], and several bile acid metabolites. The CS changes in metabolites qualitatively mirrored those in the peripheral blood in both timing and magnitude, suggesting the heart was not the major source of the metabolite release.Isolated increases in myocardial work can induce changes in the plasma metabolome, but these changes do not appear to be directly cardiac in origin. A number of these dynamic metabolites have known signaling functions. Our study provides additional evidence to a growing body of literature on metabolic 'cross-talk' between the heart and other organs.

  20. Angiographically demonstrated coronary collaterals predict residual viable myocardium in patients with chronic myocardial infarction. A regional metabolic study

    Fukai, Masumi; Ii, Masaaki; Nakakoji, Takahiro

    2000-01-01

    Angiographical demonstration of coronary collateral circulation may suggest the presence of residual viable myocardium. The development of coronary collaterals was judged according to Rentrop's classification in 37 patients with old anteroseptal myocardial infarction and 13 control patients with chest pain syndrome. The subjects with myocardial infarction were divided into 2 groups: 17 patients with the main branch of the left coronary artery clearly identified by collateral blood flow from the contralateral coronary artery [Coll (+) group, male/female 10/7, mean age 56.6 years] and 20 patients with obscure coronary trunk [Coll (-) group, male/female 16/4, mean age 54.9 years]. Thallium-201 myocardial scintigraphy and examination of local myocardial metabolism were carried out by measuring the flux of lactic acid under dipyridamole infusion load. Coronary stenosis of 99% or total occlusion was found in only 5 of 20 patients (25%) in the Coll (-) group but in 16 of 17 patients (94%) in the Coll (+) group (p<0.001). Redistribution of myocardial scintigraphy was found in 11 of 15 patients (73%) in the Coll (+) group, but only 3 of 18 patients (17%) in the Coll (-) group (p<0.01). The myocardial lactic acid extraction rate was -13.2±17.0% in the Coll (+) group, but 9.1±13.2% in the Coll (-) group (p<0.001). These results suggest that coronary collateral may contribute to minimizing the infarct area and to prediction of the presence of viable myocardium. (author)

  1. Transient mitral regurgitation: An adjunctive sign of myocardial ischemia during dipyridamole-thallium imaging

    Lette, J.; Gagnon, A.; Lapointe, J.; Cerino, M.

    1989-01-01

    A patient developed transient exacerbation of a mitral insufficiency murmur and a reversible posterior wall perfusion defect during dipyridamole-thallium imaging. Coronary angiography showed significant stenoses of both the right and the circumflex coronary arteries that supply the posterior papillary muscle. Cardiac auscultation for transient mitral incompetence, a sign of reversible papillary muscle dysfunction, is a simple and practical adjunctive test for myocardial ischemia during dipyridamole-thallium imaging. It may confirm that an isolated reversible posterior wall myocardial perfusion defect is truly ischemic in nature as opposed to an artifact resulting from attenuation by the diaphragm

  2. Optimal timing of image acquisition for arterial first pass CT myocardial perfusion imaging

    Pelgrim, G.J., E-mail: g.j.pelgrim@umcg.nl [University of Groningen, University Medical Center Groningen, Center for Medical Imaging North East Netherlands (CMI-nen), Hanzeplein 1, 9713 GZ Groningen (Netherlands); Nieuwenhuis, E.R., E-mail: e.r.nieuwenhuis@student.utwente.nl [University of Groningen, University Medical Center Groningen, Center for Medical Imaging North East Netherlands (CMI-nen), Hanzeplein 1, 9713 GZ Groningen (Netherlands); University of Twente, P.O. Box 217, 7500 AE, Enschede (Netherlands); Duguay, T.M., E-mail: duguay@musc.edu [Medical University of South Carolina, Dept. of Radiology, 25 Courtenay Drive, SC 29425, Charleston (United States); Geest, R.J. van der, E-mail: R.J.van_der_Geest@lumc.nl [Leiden University Medical Center, Dept. of Radiology, Postbus 9600, 2300 RC, Leiden (Netherlands); Varga-Szemes, A., E-mail: vargaasz@musc.edu [Medical University of South Carolina, Dept. of Radiology, 25 Courtenay Drive, SC 29425, Charleston (United States); Slump, C.H., E-mail: c.h.slump@utwente.nl [University of Groningen, University Medical Center Groningen, Center for Medical Imaging North East Netherlands (CMI-nen), Hanzeplein 1, 9713 GZ Groningen (Netherlands); University of Twente, P.O. Box 217, 7500 AE, Enschede (Netherlands); Fuller, S.R., E-mail: fullerst@musc.edu [Medical University of South Carolina, Dept. of Radiology, 25 Courtenay Drive, SC 29425, Charleston (United States); Oudkerk, M., E-mail: m.oudkerk@umcg.nl [University of Groningen, University Medical Center Groningen, Center for Medical Imaging North East Netherlands (CMI-nen), Hanzeplein 1, 9713 GZ Groningen (Netherlands); Schoepf, U.J., E-mail: schoepf@musc.edu [Medical University of South Carolina, Dept. of Radiology, 25 Courtenay Drive, SC 29425, Charleston (United States); and others

    2017-01-15

    Highlights: • Optimal timing of static, single-shot CT perfusion scans is important to differentiate ischemic from non-ischemic myocardial segments. • Time delay between reaching 150 and 250 HU thresholds in the ascending aorta and optimal contrast in the myocardium are 4 and 2 s, respectively. • Attenuation difference of more than 15 HU between normal and ischemic myocardium is present during approximately 8 s. - Abstract: Purpose: To determine the optimal timing of arterial first pass computed tomography (CT) myocardial perfusion imaging (CTMPI) based on dynamic CTMPI acquisitions. Methods and materials: Twenty-five patients (59 ± 8.4 years, 14 male)underwent adenosine-stress dynamic CTMPI on second-generation dual-source CT in shuttle mode (30 s at 100 kV and 300 mAs). Stress perfusion magnetic resonance imaging (MRI) was used as reference standard for differentiation of non-ischemic and ischemic segments. The left ventricle (LV) wall was manually segmented according to the AHA 16-segment model. Hounsfield units (HU) in myocardial segments and ascending (AA) and descending aorta (AD) were monitored over time. Time difference between peak AA and peak AD and peak myocardial enhancement was calculated, as well as the, time delay from fixed HU thresholds of 150 and 250 HU in the AA and AD to a minimal difference of 15 HU between normal and ischemic segments. Furthermore, the duration of the 15 HU difference between ischemic and non-ischemic segments was calculated. Results: Myocardial ischemia was observed by MRI in 10 patients (56.3 ± 9.0 years; 8 male). The delay between the maximum HU in the AA and AD and maximal HU in the non-ischemic segments was 2.8 s [2.2–4.3] and 0.0 s [0.0–2.8], respectively. Differentiation between ischemic and non-ischemic myocardial segments in CT was best during a time window of 8.6 ± 3.8 s. Time delays for AA triggering were 4.5 s [2.2–5.6] and 2.2 s [0–2.8] for the 150 HU and 250 HU thresholds, respectively. While for

  3. Myocardial Infarction Area Quantification using High-Resolution SPECT Images in Rats

    Oliveira, Luciano Fonseca Lemos de [Divisão de Cardiologia, Departamento de Clínica Médica, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP (Brazil); Mejia, Jorge [Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto, SP (Brazil); Carvalho, Eduardo Elias Vieira de; Lataro, Renata Maria; Frassetto, Sarita Nasbine [Divisão de Cardiologia, Departamento de Clínica Médica, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP (Brazil); Fazan, Rubens Jr.; Salgado, Hélio Cesar [Departamento de Fisiologia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP (Brazil); Galvis-Alonso, Orfa Yineth [Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto, SP (Brazil); Simões, Marcus Vinícius, E-mail: msimoes@fmrp.usp.br [Divisão de Cardiologia, Departamento de Clínica Médica, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP (Brazil)

    2013-07-15

    Imaging techniques enable in vivo sequential assessment of the morphology and function of animal organs in experimental models. We developed a device for high-resolution single photon emission computed tomography (SPECT) imaging based on an adapted pinhole collimator. To determine the accuracy of this system for quantification of myocardial infarct area in rats. Thirteen male Wistar rats (250 g) underwent experimental myocardial infarction by occlusion of the left coronary artery. After 4 weeks, SPECT images were acquired 1.5 hours after intravenous injection of 555 MBq of 99mTc-Sestamibi. The tomographic reconstruction was performed by using specially developed software based on the Maximum Likelihood algorithm. The analysis of the data included the correlation between the area of perfusion defects detected by scintigraphy and extent of myocardial fibrosis assessed by histology. The images showed a high target organ/background ratio with adequate visualization of the left ventricular walls and cavity. All animals presenting infarction areas were correctly identified by the perfusion images. There was no difference of the infarct area as measured by SPECT (21.1 ± 21.2%) and by histology (21.7 ± 22.0%; p=0.45). There was a strong correlation between individual values of the area of infarction measured by these two methods. The developed system presented adequate spatial resolution and high accuracy for the detection and quantification of myocardial infarction areas, consisting in a low cost and versatile option for high-resolution SPECT imaging of small rodents.

  4. Clinical utility and problem of thallium myocardial imaging after coronary angioplasty

    Konishi, Tokuji; Tamai, Takuya; Nakamura, Mashio; Miyahara, Masatoshi; Isaka, Naoki; Nakano, Takeshi.

    1995-01-01

    The purpose of this study was twofold: (1) to assess the value and limits of stress thallium myocardial imaging in the diagnosis of reclosure after percutaneous transluminal coronary angioplasty (PTCA) and (2) to determine how myocardial viability, as determined on thallium imaging, influenced the therapeutic option. In study 1, 117 segments, which were treated with PTCA, were examined. Of 52 segments that showed thallium defects, 27 were treated with repeated PTCA. Of the other 25 segments, 12 were found to be reclosed. On the other hand, 65 other segments showed redistribution on thallium imaging, and 60 of these had no reclosure. The remaining 5 segments that were reclosed reflected no evidence of myocardial viability. These findings suggest that coronary arteriography may omitted when redistribution is seen on stress thallium imaging after PTCA. The population in Study 2 included 39 patients who were diagnosed as having myocardial necrosis on thallium imaging. In 22 of these patients, thallium findings ruled out coronary revascularization. One other patient did not undergo coronary revascularization because of technical problems. Thus, the remaining 16 patients were treated with coronary revascularization combined with bypass surgery for necrotic zones (n=10) or with PTCA for preserved collateral circulation (n=6). For necrotic zones evidenced on thallium imaging, factors other than necrosis were considered in determining coronary revascularization. (N.K.)

  5. Thallium-201 myocardial imaging in the detection of coronary artery disease

    McKillop, J.H.; Murray, R.G.; Turner, J.G.; Gray, H.W.; Bessent, R.G.; Lorimer, A.R.; Greig, W.R.

    1978-01-01

    Thallium-201 myocardial imaging can detect abnormalities of myocardial perfusion. Visual interpretation of the images is complicated by some inhomogeneity of tracer uptake normally present. Using a quantitative approach we have established the regional variation of Thallium-201 uptake present in 23 normal controls and applied the same technique to 49 patients who had undergone selective coronary arteriography with left ventriculography because of chest pain. Half of the patients with significant coronary artery disease had abnormal rest Thallium-201 images, usually corresponding to areas of abnormal wall motion at ventriculography. Stress Thallium-201 images were abnormal in over 90% of patients with coronary artery disease. The stress image abnormalities and the arteriographic lesions correlated well in most patients with single and double vessel disease but in triple vessel disease the correspondence between the two studies was poor. Two of a group of patients with normal coronary arteriograms had abnormal Thallium-201 images due to other myocardial pathology. Our technique was highly sensitive in the non-invasive detection of significant coronary artery disease in a group of patients with chest pain. A small number of positive studies were also encountered due to other myocardial disorders. (author)

  6. A comparative study of 99Tcm-tetrofosmin and 99Tcm-MIBI myocardial imaging

    Zhao Kui; Chen Peng; Zhang Furong; Shen Wenhua

    2001-01-01

    Objective: To evaluate the value of 99 Tc m -tetrofosmin myocardial imaging for detecting coronary artery disease. Methods: Twenty-seven patients underwent 99 Tc m -tetrofosmin SPECT, twenty-six patients underwent 99 Tc m -MIBI SPECT; coronary angiography was performed on patients included in both groups (≥50% luminal diameter stenosis was considered significant coronary stenosis). Results: 99 Tc m -tetrofosmin produced high quality myocardial images from 30 min to several hours postinjection, the outlines of myocardial perfusion images provided by 99 Tc m -tetrofosmin imaging were clearly discernible. One-day exercise/rest 99 Tc m -tetrofosmin myocardial perfusion imaging was feasible and had a high sensitivity for detection of coronary artery disease. Sensitivities of 99 Tc m -tetrofosmin SPECT and 99 Tc m -MIBI SPECT for detecting coronary artery disease were 90% and 94%, respectively. The 95% confidence limits of both sensitivities were 68.65% - 98.77% and 72.33% - 99.86%, respectively; the positive predictive values of both imaging agents were 90.0% and 89.5%, respectively, the 95% confidence limits of those were 68.38% - 98.77% and 72.33% - 99.86% respectively; the positive predictive values of both imaging agents were 90.0% and 89.5%, respectively, the 95% confidence limits of those were 68.38% - 98.77% and 66.38% - 98.70%, respectively; efficiencies of both imaging agents were 85.2% and 88.5%, respectively. The 95% confidence limits of both efficiencies were 65.81% - 95.78% and 69.44 - 98.70%, respectively. The specificity for both imaging agents was 71% and 75%. There was no significant difference among above results (P > 0.05). No ECG abnormalities were found following the injection of 99 Tc m -tetrofosmin SPECT. There were no drug-related effects on blood pressure, heart rate and body temperature. This experiment failed to provide the negative predictive value of the myocardial perfusion imaging with 99 Tc m -tetrofosmin because that few patients with

  7. Noninvasive quantification of myocardial perfusion heterogeneity by Markovian analysis in SPECT nuclear imaging

    Pons, G.

    2011-01-01

    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)

  8. Evaluation in dogs of a new double-dose technique for imaging changes in myocardial perfusion

    Rothendler, J.A.; Okada, R.D.; Strauss, H.W.; Chesler, D.A.; Pohost, G.M.

    1984-01-01

    Assessment of myocardial perfusion with thallium immediately before and after an intervention that alters blood flow has been difficult due to presence of residual activity from the first tracer dose at the time of the second imaging. In a canine model the authors investigated a technique using two separate thallium injections during an intervention and after its reversal. Images were obtained after each injection, and a difference image was obtained by subtracting the first from the second image to correct for tracer persisting from the first injection. Interventions on coronary blood flow included: transient occlusion, subcritical stenosis with dipyridamole infusion, and permanent occlusion. The first images showed defects corresponding to the occlusion or stenosis, while the ''difference'' images correlated with myocardial perfusion at the time of the second injection

  9. Myocardial imaging with sup 99m Tc-2-methoxyisobutilisonitrile in the assessment of reperfusion after intravenous thrombolytic treatment for acute myocardial infarction

    Vattimo, A.; Favilli, R.; Bertelli, P.; Burroni, L.; Gaddi, R.; Ferretti, A.; Baldi, L. (Siena Univ. (Italy). Nuclear Medicine Unit)

    1989-08-01

    The effect of reperfusion with intravenous streptokinase for acute myocardial infarction (AMI) was assessed by myocardial scintigraphy in 6 patients using {sup 99m}Tc-MIBI injected before and 48 hours after the thrombolysis. All patients showed 3 to 4 segmental defects consistent for AMI in the baseline study. The post-thrombolytic study showed an intense reperfusion in 3 patients, a moderate reperfusion in 2 patients and absence of reperfusion in one patient. These findings indicate that the dual imaging strategy with {sup 99m}Tc-MIBI is an effective non-invasive technique to assess the effectiveness of reperfusion in acute myocardial infarcted areas. (orig.).

  10. Myocardial imaging with 99mTc-2-methoxyisobutilisonitrile in the assessment of reperfusion after intravenous thrombolytic treatment for acute myocardial infarction

    Vattimo, A.; Favilli, R.; Bertelli, P.; Burroni, L.; Gaddi, R.; Ferretti, A.; Baldi, L.

    1989-01-01

    The effect of reperfusion with intravenous streptokinase for acute myocardial infarction (AMI) was assessed by myocardial scintigraphy in 6 patients using 99m Tc-MIBI injected before and 48 hours after the thrombolysis. All patients showed 3 to 4 segmental defects consistent for AMI in the baseline study. The post-thrombolytic study showed an intense reperfusion in 3 patients, a moderate reperfusion in 2 patients and absence of reperfusion in one patient. These findings indicate that the dual imaging strategy with 99m Tc-MIBI is an effective non-invasive technique to assess the effectiveness of reperfusion in acute myocardial infarcted areas. (orig.) [de

  11. Experimental basis of metabolic imaging of the myocardium with radioiodinated aromatic free fatty acids

    Reske, S.N.; Knapp, F.F. Jr.; Winkler, C.

    1986-01-01

    For the investigation of myocardial perfusion and left ventricular pump function, advanced radioisotopic techniques have been established. New developments in radiopharmacology and single-photon emission computed tomography have recently enabled the investigation of parameters of regional energy metabolism in well defined areas of the heart muscle. For this purpose, various iodine ( 123 I)-labeled free fatty acids (FFA) have been synthesized. The diagnostic application of labeled FFA in heart disease may be important, since FFA are the preferred substrates for cardiac energy production at rest in the fasting state. In addition, regional myocardial FFA uptake and regional myocardial blood flow are tightly coupled in normal myocardium with beta-oxidation which is extremely sensitive to oxygen deprivation. This article outlines the basic physiologic pathways of FFA in normal and ischemic myocardium and reviews the results of animal experiments validating the application of these principles for metabolic imaging of the heart by means of the aromatic radioiodinated FFA, 15-(p-iodophenyl)pentadecanoic acid. In addition, the development, physiologic properties, and potential applications of a new generation of 3-methyl-substituted radioiodinated fatty acids that show high myocardial uptake but prolonged retention are discussed. 64 references

  12. Post-mortem cardiac diffusion tensor imaging: detection of myocardial infarction and remodeling of myofiber architecture.

    Winklhofer, Sebastian; Stoeck, Christian T; Berger, Nicole; Thali, Michael; Manka, Robert; Kozerke, Sebastian; Alkadhi, Hatem; Stolzmann, Paul

    2014-11-01

    To investigate the accuracy of post-mortem diffusion tensor imaging (DTI) for the detection of myocardial infarction (MI) and to demonstrate the feasibility of helix angle (HA) calculation to study remodelling of myofibre architecture. Cardiac DTI was performed in 26 deceased subjects prior to autopsy for medicolegal reasons. Fractional anisotropy (FA) and mean diffusivity (MD) were determined. Accuracy was calculated on per-segment (AHA classification), per-territory, and per-patient basis, with pathology as reference standard. HAs were calculated and compared between healthy segments and those with MI. Autopsy demonstrated MI in 61/440 segments (13.9 %) in 12/26 deceased subjects. Healthy myocardial segments had significantly higher FA (p Analysis of HA distribution demonstrated remodelling of myofibre architecture, with significant differences between healthy segments and segments with chronic (p  0.05). Post-mortem cardiac DTI enables differentiation between healthy and infarcted myocardial segments by means of FA and MD. HA assessment allows for the demonstration of remodelling of myofibre architecture following chronic MI. • DTI enables post-mortem detection of myocardial infarction with good accuracy. • A decrease in right-handed helical fibre indicates myofibre remodelling following chronic myocardial infarction. • DTI allows for ruling out myocardial infarction by means of FA. • Post-mortem DTI may represent a valuable screening tool in forensic investigations.

  13. Myocardial first pass perfusion imaging with gadobutrol: impact of parallel imaging algorithms on image quality and signal behavior.

    Theisen, Daniel; Wintersperger, Bernd J; Huber, Armin; Dietrich, Olaf; Reiser, Maximilian F; Schönberg, Stefan O

    2007-07-01

    To implement parallel imaging algorithms in fast gradient recalled echo sequences for myocardial perfusion imaging and evaluate image quality, signal-to-noise ratio (SNR), contrast-enhancement ratio (CER), and semiquantitative perfusion parameters. In 20 volunteers, myocardial perfusion imaging with gadobutrol was performed at rest using an accelerated TurboFLASH sequence (TR 2.3 milliseconds, TE 0.93 milliseconds, flip angle [FA] 15 degrees) with GRAPPA, R=2. A nonaccelerated TurboFLASH sequence with similar scan parameters served as standard of reference. Artifacts were assessed qualitatively. SNR, CER, and CNR were calculated and semiquantitative perfusion parameters were determined from fitted SI-time curves. Phantom measurements yielded significant higher SNR for nonaccelerated images (Pimages (Pimages for artifacts by 2 board-certified radiologists yielded a significant reduction in dark rim artifacts with GRAPPA, R=2 (P<0.001). The application of GRAPPA with an acceleration factor of R=2 leads to a significant reduction of dark rim artifacts in fast gradient recalled echo sequences.

  14. Dual-isotope myocardial imaging: feasibility, advantages and limitations. Preliminary report on 231 consecutive patients

    Weinmann, P.; Foult, J.M.; Le Guludec, D.; Tamgac, F.; Rechtman, D.; Neuman, A.; Caillat-Vigneron, N.; Moretti, J.L.

    1994-01-01

    Two hundred and thirty-one patients underwent dual-isotope myocardial imaging (rest thallium-201 followed by stress technetium-99m sestamibi). The feasibility of the procedure was excellent: camera scheduling flexibility was improved and the duration of the procedure was less than that of a classical stress-redistribution procedure. Interpretation of defects due to image attenuation was facilitated by the different attenuation properties of 201 Tl and 99m Tc-sestamibi in 11 of 19 patients. 201 Tl cross-over on 99m Tc was found to be 15% ± 3% with doses of 201 Tl and 99m Tc-sestamibi of 3 and 10 mCi, respectively, and 7% ± 2% with doses of 3 and 20 mCi. This protocol should preferentially be reserved for patients with a history of myocardial infarction and/or a basal left ventricular dysfunction, in whom assessment of myocardial viability is of major interest. (orig./MG)

  15. Serial thallium-201 imaging after dipyridamole for coronary disease detection: quantitative analysis using myocardial clearance

    Okada, R.D.; Dai, Y.H.; Boucher, C.A.; Pohost, G.M.

    1984-01-01

    After dipyridamole, canine studies have demonstrated a slower rate of myocardial thallium-201 clearance from zones distal to a coronary artery stenosis compared to normal zones. To determine if criteria based on canine myocardial thallium-201 clearance rates could be applied clinically, 40 patients with and 26 patients without coronary artery disease (CAD) had serial thallium-201 images obtained for 2 to 5 hours after dipyridamole. Regions of interest were manually placed over six left ventricular segments in two projections for each of three imaging times. The myocardial thallium-201 clearance rate was calculated for each of the six segments and, using the clearance rate criterion found in canine studies, was considered abnormal if less than 6.5%/hr. Using this criterion alone, 22 of 26 patients (85%) without CAD had normal and 30 of 40 patients (75%) with CAD had abnormal myocardial thallium-201 clearance rates. A quantitative analysis of regional inhomogeneity in tracer distribution (normal was greater than or equal to 25% difference between segments) was negative in 24 of 26 patients (92%) without CAD and positive in 20 of 40 patients (50%) with CAD. When both clearance rate and regional inhomogeneity were considered, 21 of 26 patients (81%) without CAD had negative and 36 of 40 patients (90%) with CAD had positive results. Thus, post-dipyridamole myocardial clearance rate criteria derived from canine studies can be applied to clinical thallium imaging. Quantitative analysis of serial thallium-201 images after dipyridamole is optimized by using myocardial thallium-201 clearance rates. Such an approach is independent of regional inhomogeneities in tracer distribution

  16. Assmentment of myocardial perfusion by magnetic resonance imaging: on the way to clinical application

    Fischer, S.E.; Lorenz, C.H.

    1997-01-01

    Magnetic resonance imaging detects the flow of contrast - enhanced blood and even allows the quantitative assessment of myocardial perfusion. The clinical application of this method is being held back by the difficulties in image evaluation and the limitation of standard techniques to the acquisition of a single slice per heart beat cycle. Recent developments in scanner hardware as well as in image acquisition techniques open up the possibility of assessing myocardial perfusion over the entire heart with a spatial resolution in the range of 2 mm. As an example of such a new scanning strategy, a segmented gradient-echo recalled echo planar imaging sequence with preceding saturation is discussed and results in a patient with an infarction are presented. The clinical use of perfusion assessment covering the entire heart for the diagnosis of coronary artery disease is enhanced by the flexibility of magnetic resonance imaging for the assessment of functional cardiac parameters. (orig.) [de

  17. Characteristics of myocardial perfusion imaging and coronary artery angiography in patients of NIDDM complicated with AMI

    Zhao Peiqin; Zhao Jinhua; Qin Mingzhao; Dai HaoJie; Zhang Runwu; Xiao Fen

    2001-01-01

    Objective: To investigate the characteristic changes of myocardial perfusion imaging and coronary artery angiography in patients of acute myocardial infarction (AMI) with underlined type 2 diabetes mellitus. Methods: 25 type 2 diabetes mellitus patients were enrolled for having clinical manifestation of AMI. Ten inpatients with AMI of simple coronary heart disease origin were served as controls. All subjects underwent both myocardial perfusion imagings (resting and nitroglycerine invention) and coronary artery angiography. Results: Compared to controls (40%), type 2 diabetes mellitus + AMI group had higher rate of multivessel disease (60%). For type 2 diabetes mellitus + AMI patients, 129/400 segments (32.25%) showed fixed defect, 25/160 segments (15.62%) in controls. Conclusions: For type 2 diabetes mellitus + AMI group, myocardial perfusion defects are widely distributed and multivessel or severe stenosis is more often presented. Good correlation exists between abnormal segments and angiographic lesions in both the number of segments involved and the severity of the lesions. Radionuclide myocardial perfusion is therefore considered a useful screening test not inferior to angiography, especially for those who are not tolerant enough to undergoing angiography

  18. Thrombolytic therapy for myocardial infarction: Assessment of efficacy by myocardial perfusion imaging with technetium-99m sestamibi

    Wackers, F.J.

    1990-01-01

    Technetium-99m (Tc-99m) sestamibi has been used to evaluate the efficacy of thrombolytic therapy. Improved image quality due to the higher photon energy of Tc-99m and the increased allowable doses of this radiopharmaceutical along with its lack of redistribution makes Tc-99m sestamibi an acceptable imaging agent for such studies. This imaging agent was used for serial quantitative planar and tomographic imaging to assess the initial risk area of infarction, its change over time and the relation to infarct-related artery patency in patients with a first acute myocardial infarction. Twenty-three of 30 patients were treated with recombinant tissue-type plasminogen activator (rt-PA) within 4 hours after onset of acute chest pain. Seven patients were treated in the conventional manner and did not receive thrombolytic therapy. The initial area at risk varied greatly both in patients treated with rt-PA and in those who received conventional therapy. Patients with successful thrombolysis and patient infarct arteries had a significantly greater reduction of Tc-99m sestamibi defect size than patients who had persistent coronary occlusion. Serial imaging with Tc-99m sestamibi could find important application in future clinical research evaluating the efficacy of new thrombolytic agents. Direct measurements of the amount of hypoperfused myocardium before and after thrombolysis could provide rapid and unequivocal results using fewer patients and avoiding the use of mortality as an end point. This approach has not yet been widely tested in the clinical arena

  19. Comparison of initial and delayed myocardial imaging with beta-methyl-p-[123I]-iodophenylpentadecanoic acid in acute myocardial infarction

    Naruse, Hitoshi; Yoshimura, Noriko; Yamamoto, Juro; Morita, Masato; Fukutake, Naoshige; Ohyanagi, Mitsumasa; Iwasaki, Tadaaki; Fukuchi, Minoru

    1994-01-01

    Myocardial imaging using β-methyl-p-[ 123 I]-iodophenylpentadecanoic acid (BMIPP) of 15 patients with acute myocardial infarction was performed to assess 'fill-in' and 'washout' defects in the delayed myocardial image. The initial and delayed images were evaluated by a visual and quantitative washout rate method. Visual judgement found 8/180 (4%) segments showed 'fill-in' defects, and 24/180 segments (13%) showed 'washout' defects. There was no relationship between days from onset to the study and the frequency of fill-in and washout defects. The mean washout rate in the segments with 'fill-in' defects was 9.0±16.6%, and that of 'washout' defects was 24.9±18.1% which was significantly higher than in controls (8.7±15.4%, p<0.05). There was no correlation between mean washout rate and total blood lipids, total cholesterol, triglyceride and HDL-cholesterol. Therefore, neither time from onset nor blood lipids level was related to changes from the initial image to the delayed image. These changes may be due to relative (false) findings due to changes in circumference, and may be based on myocardial characteristics after myocardial infarction and/or reperfusion. (author)

  20. Comparison of initial and delayed myocardial imaging with beta-methyl-p-[[sup 123]I]-iodophenylpentadecanoic acid in acute myocardial infarction

    Naruse, Hitoshi; Yoshimura, Noriko; Yamamoto, Juro; Morita, Masato; Fukutake, Naoshige; Ohyanagi, Mitsumasa; Iwasaki, Tadaaki; Fukuchi, Minoru (Hyogo Coll. of Medicine, Nishinomiya (Japan))

    Myocardial imaging using [beta]-methyl-p-[[sup 123]I]-iodophenylpentadecanoic acid (BMIPP) of 15 patients with acute myocardial infarction was performed to assess 'fill-in' and 'washout' defects in the delayed myocardial image. The initial and delayed images were evaluated by a visual and quantitative washout rate method. Visual judgement found 8/180 (4%) segments showed 'fill-in' defects, and 24/180 segments (13%) showed 'washout' defects. There was no relationship between days from onset to the study and the frequency of fill-in and washout defects. The mean washout rate in the segments with 'fill-in' defects was 9.0[+-]16.6%, and that of 'washout' defects was 24.9[+-]18.1% which was significantly higher than in controls (8.7[+-]15.4%, p<0.05). There was no correlation between mean washout rate and total blood lipids, total cholesterol, triglyceride and HDL-cholesterol. Therefore, neither time from onset nor blood lipids level was related to changes from the initial image to the delayed image. These changes may be due to relative (false) findings due to changes in circumference, and may be based on myocardial characteristics after myocardial infarction and/or reperfusion. (author).

  1. [Comparison of initial and delayed myocardial imaging with beta-methyl-p-[123I]-iodophenylpentadecanoic acid in acute myocardial infarction].

    Naruse, H; Yoshimura, N; Yamamoto, J; Morita, M; Fukutake, N; Ohyanagi, M; Iwasaki, T; Fukuchi, M

    1994-01-01

    Myocardial imaging using beta-methyl-p-[123I]-iodophenylpentadecanoic acid (BMIPP) of 15 patients with acute myocardial infarction was performed to assess "fill-in" and "washout" defects in the delayed myocardial image. The initial and delayed images were evaluated by a visual and quantitative washout rate method. Visual judgement found 8/180 (4%) segments showed "fill-in" defects, and 24/180 segments (13%) showed "washout" defects. There was no relationship between days from onset to the study and the frequency of fill-in and washout defects. The mean washout rate in the segments with "fill-in" defects was 9.0 +/- 16.6%, and that of "washout" defects was 24.9 +/- 18.1% which was significantly higher than in controls (8.7 +/- 15.4%, p < 0.05). There was no correlation between mean washout rate and total blood lipids, total cholesterol, triglyceride and HDL-cholesterol. Therefore, neither time from onset nor blood lipids level was related to changes from the initial image to the delayed image. These changes may be due to relative (false) findings due to changes in circumference, and may be based on myocardial characteristics after myocardial infarction and/or reperfusion.

  2. The role of pharmacological stress Tc-99m sestamibi myocardial perfusion imaging in an Australian population

    Howarth, D.M.; Booker, J.A.; Tan, T.S.K.; Bellamy, G.R.; Hardy, D.B.; Howarth, G.C.

    2003-01-01

    This observational study was performed in order to assess the exercise-related incremental diagnostic accuracy of Tc-99m sestamibi myocardial perfusion imaging (MPI) in a hospital-based Australian population, and to assess the relative roles of exercise and pharmacological stress in myocardial perfusion imaging (MPI). Two hundred and eight adult patients who had both Tc-99m sestamibi myocardial perfusion imaging and coronary angiography within a median time of 16 weeks were studied. The diagnostic end-point was coronary artery lesions of ≥50% and >70% stenosis detected on angiography. Using receiver operating characteristic curve analysis, the overall diagnostic accuracy was calculated, as well as the comparative accuracies in patients who undertook various levels of exercise stress testing (n=130) and those who received pharmacological (dipyridamole) stress testing (n=78). The overall respective diagnostic accuracy of Tc-99m sestamibi MPI for the diagnosis of coronary artery disease (>70% stenosis) was 81% and 76% when using the diagnostic criterion of ≥50% stenosis. On direct comparison of perfusion defects with angiographic stenoses, the respective sensitivity and specificity for the detection of >70% stenosis in each coronary artery territory was 73% and 79%. Pharmacological MPI showed a significantly greater sensitivity for the detection of localised stenoses compared to the overall group who had exercise MPI performed. Consequently, exercise stress MPI showed significantly more false negative lesions compared to dipyridamole stress imaging (p<0.003). However, a large proportion of patients were unable to perform to adequate exercise levels in this patient sample. We conclude that Tc-99m sestamibi myocardial perfusion imaging is an accurate non-invasive test for the diagnosis of coronary artery disease. Where any doubt exists as to the patient's ability to achieve exercise levels at or above 85% of the predicted value for age and gender, pharmacological

  3. Application of 99mTc-MIBI myocardial tomography imaging for the diagnosis of coronary heart disease

    Wu Kegui; Chen Daguang; Chen Jinshui

    1992-01-01

    99m Tc-MIBI myocardial tomography imaging was obtained from 119 cases with Sopha Medical SPECT system. 38 cases of coronary heart diseases, 33 cases of coronary heart diseases combined with hypertension and 48 cases of myocardial infarction were diagnosed according to clinical symptoms and signs, ECG, exercise ECG (treadmill test) and other laboratory studies. The results showed that positive rate of myocardial thermography imaging for detecting coronary heart disease was 70.21% at rest, and the positivity can be further increased by myocardial tomography imaging with exercise test. On the contrary the positivity of exercise ECG was only 63.8%. It was concluded that radionuclide myocardial tomography imaging was noninvasive and more sensitive and specific than the exercise ECG in detecting coronary heart disease

  4. Minimizing Patient-Specific Tracer Dose in Myocardial Perfusion Imaging Using CZT SPECT

    van Dijk, Joris David; Jager, Pieter L.; Ottervanger, Jan Paul; Slump, Cornelis H.; de Boer, Jaep; Oostdijk, Adrianus H.J.; van Dalen, Jorn A.

    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)

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

    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 ...

  6. Persistent chest pain following oral dipyridamole for thallium 201 myocardial imaging

    Kwai, A.H.; Jacobson, A.F.; McIntyre, K.M.; Williams, W.H.; Tow, D.E.

    1990-01-01

    A patient was admitted to the hospital with acute chest pain. After acute myocardial infarction was ruled out, he underwent a stress thallium 201 scintigraphy using oral dipyridamole and developed persistent angina with sedimentation time segement elevation. This complication has not been reported previously. It is recommended that appropriate intervention be available if severe ischemia develops following administration of dipyridamole for diagnostic imaging. (orig.)

  7. Effects of respiratory alkalosis and acidosis on myocardial blood flow and metabolism in patients with coronary artery disease.

    Kazmaier, S; Weyland, A; Buhre, W; Stephan, H; Rieke, H; Filoda, K; Sonntag, H

    1998-10-01

    Variation of the arterial carbon dioxide partial pressure (PaCO2) is not uncommon in anesthetic practice. However, little is known about the myocardial consequences of respiratory alkalosis and acidosis, particularly in patients with coronary artery disease. The aim of the current study was to investigate the effects of variation in PaCO2 on myocardial blood flow (MBF), metabolism, and systemic hemodynamics in patients before elective coronary artery bypass graft surgery. In 10 male anesthetized patients, measurements of MBF, myocardial contractility, metabolism, and systemic hemodynamics were made in a randomized sequence at PaCO2 levels of 30, 40, and 50 mmHg, respectively. The MBF was measured using the Kety-Schmidt technique with argon as a tracer. End-diastolic left ventricular pressure and the maximal increase of left ventricular pressure were assessed using a manometer-tipped catheter. The cardiac index significantly changed with varying PaCO2 levels (hypocapnia, - 9%; hypercapnia, 13%). This reaction was associated with inverse changes in systemic vascular resistance index levels. The MBF significantly increased by 15% during hypercapnia, whereas no change was found during hypocapnia. Myocardial oxygen and glucose uptake and the maximal increase of left ventricular pressure were not affected by varying PaCO2 levels. In anesthetized patients with coronary artery disease, short-term variations in PaCO2 have significant effects on MBF but do not influence global myocardial oxygen and glucose uptake. Changes in systemic hemodynamics associated with respiratory alkalosis and acidosis are caused by changes in systemic vascular resistance rather than by alterations in myocardial contractility.

  8. Evaluation of myocardial glucose metabolism in hypertrophic cardiomyopathy using 18F-fluorodeoxyglucose positron emission tomography.

    Rie Aoyama

    Full Text Available The purposes of this study were to assess the usefulness of myocardial 18F-fluorodeoxyglucose (18F-FDG positron emission tomography (PET/computed tomography (CT for evaluating myocardial metabolic status in hypertrophic cardiomyopathy (HCM and the therapeutic efficacy of alcohol septal ablation (ASA in hypertrophic obstructive cardiomyopathy (HOCM.Thirty HCM patients (64.4±10.5 years, 14 male, 12 hypertrophic non-obstructive cardiomyopathy [HNCM], 16 HOCM, and 2 dilated phase of HCM underwent 18F-FDG-PET/CT. 18F-FDG uptake was semi-quantitatively evaluated using an uptake score in each 17 segment and the entire LV or regional standardized uptake value (SUV.18F-FDG uptake was observed mostly in a hypertrophied myocardium in HNCM patients, whereas 18F-FDG was extensively accumulated beyond the hypertrophied myocardium in HOCM patients. There was a positive correlation between the summed uptake score of 18F-FDG and high-sensitive troponin T level in HNCM patients (r = 0.603, p = 0.049, whereas the score was positively correlated with brain natriuretic peptide level (r = 0.614, p = 0.011 in HOCM patients. In 10 patients who received ASA, the maximum SUV of the entire LV was significantly reduced from 5.6±2.6 to 3.2±2.1 (p = 0.040 after ASA. Reduction of that maximum SUV was particularly significant in the lateral region (from 5.5±2.6 to 2.9 ±2.2, p = 0.024 but not significant in the anteroseptal region (from 4.5±2.6 to 2.9±1.6, p = 0.12.Extensive 18F-FDG uptake beyond the hypertrophied myocardium was observed in HOCM. ASA attenuates 18F-FDG uptake in a remote lateral myocardium.

  9. CT myocardial perfusion imaging: current status and future perspectives.

    Yang, Dong Hyun; Kim, Young-Hak

    2017-07-01

    Computed tomography myocardial perfusion (CTP) combined with coronary computed tomography angiography (CCTA) may constitute a "1-stop shop" for the noninvasive diagnosis of hemodynamically significant coronary stenosis during a single CT examination. CTP shows high diagnostic performance and provides incremental value over CCTA for the detection of hemodynamically significant coronary stenosis in patients with a high Agatston calcium score or coronary artery stents. Future studies should determine the optimal protocol and clinical value of CTP for guiding revascularization strategy and prognostication. In this article, we review the current status and future perspectives of CTP, focusing on technical considerations, clinical applications, and future research topics.

  10. Lung uptake of thallium-201 on resting myocardial imaging in assessment of pulmonary edema

    Tamaki, N.; Yonekura, Y.; Yamamoto, K. (Kyoto Univ. (Japan). Hospital)

    1981-03-01

    We have noted increased lung uptake of thallium-201 on resting myocardial images in patients with congestive heart failure. To evaluate this phenomenon, lung uptake of thallium on resting myocardial imaging was examined in 328 patients with various cardiovascular diseases. Increased lung uptake was observed in 117 cases (78%) with myocardial infarction, 32 (37%) with angina pectoris, 6 (27%) with hypertensive heart disease, 7 (30%) with hypertrophic cardiomyopathy, 6 (100%) with congestive cardiomyopathy, 11 (100%) with valvular heart disease, and 7 (71%) with congenital heart disease, however, only one (5%) of normal subjects revealed increased uptake. Left ventricular ejection fraction was evaluated in 32 cases with ischemic heart disease on the same day and it was significantly decreased as the lung uptake of thallium increased. Increased thallium activity in the lung seemed to be another noninvasive marker of lift heart failure in ischemic heart disease. Lung uptake of thallium was compared with pulmonary congestive signs on chest X-ray in 29 cases. The uptake was well correlated with the degree of pulmonary edema, and thallium myocardial image revealed remarkably increased lung uptake in all the patients accompanied with pulmonary interstitial edema on chest X-ray. Therefore, this phenomenon will demonstrate pulmonary edema, since thallium may be extracted to the increased interstitial distribution space of the lung as well as the myocardium in a patient with pulmonary edema. We conclude that thallium myocardial scintigraphy is useful not only in identification and localization of myocardial ischemia or infarction, but also in evaluation of pulmonary edema at the same time.

  11. Lung uptake of thallium-201 on resting myocardial imaging in assessment of pulmonary edema

    Tamaki, Nagara; Yonekura, Yoshiharu; Yamamoto, Kazutaka

    1981-01-01

    We have noted increased lung uptake of thallium-201 on resting myocardial images in patients with congestive heart failure. To evaluate this phenomenon, lung uptake of thallium on resting myocardial imaging was examined in 328 patients with various cardiovascular diseases. Increased lung uptake was observed in 117 cases (78%) with myocardial infarction, 32 (37%) with angina pectoris, 6 (27%) with hypertensive heart disease, 7 (30%) with hypertrophic cardiomyopathy, 6 (100%) with congestive cardiomyopathy, 11 (100%) with valvular heart disease, and 7 (71%) with congenital heart disease, however, only one (5%) of normal subjects revealed increased uptake. Left ventricular ejection fraction was evaluated in 32 cases with ischemic heart disease on the same day and it was significantly decreased as the lung uptake of thallium increased. Increased thallium activity in the lung seemed to be another noninvasive marker of lift heart failure in ischemic heart disease. Lung uptake of thallium was compared with pulmonary congestive signs on chest X-ray in 29 cases. The uptake was well correlated with the degree of pulmonary edema, and thallium myocardial image revealed remarkably increased lung uptake in all the patients accompanied with pulmonary interstitial edema on chest X-ray. Therefore, this phenomenon will demonstrate pulmonary edema, since thallium may be extracted to the increased interstitial distribution space of the lung as well as the myocardium in a patient with pulmonary edema. We conclude that thallium myocardial scintigraphy is useful not only in identification and localization of myocardial ischemia or infarction, but also in evaluation of pulmonary edema at the same time. (author)

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

    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...... with the advice of the DSS showed less inter-observer variability than those made without advice. CONCLUSION: This study shows that a DSS can improve performance and reduces the inter-observer variability of interpretations in myocardial perfusion imaging. Both experienced and, especially, inexperienced...

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

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

    2014-01-01

    %, respectively, for SPECT. CONCLUSION: The overall performance of myocardial CT perfusion imaging in the diagnosis of anatomic CAD (stenosis ≥50%), as demonstrated with the Az, was higher than that of SPECT and was driven in part by the higher sensitivity for left main and multivessel disease.......PURPOSE: To compare the diagnostic performance of myocardial computed tomographic (CT) perfusion imaging and single photon emission computed tomography (SPECT) perfusion imaging in the diagnosis of anatomically significant coronary artery disease (CAD) as depicted at invasive coronary angiography....... 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...

  14. Contrast agents and cardiac MR imaging of myocardial ischemia: from bench to bedside

    Croisille, Pierre; Revel, Didier; Saeed, Maythem

    2006-01-01

    This review paper presents, in the first part, the different classes of contrast media that are already used or are in development for cardiac magnetic resonance imaging. A classification of the different types of contrast media is proposed based on the distribution of the compounds in the body, their type of relaxivity and their potential affinity to particular molecules. In the second part, the different uses of the extracellular type of T1-enhancing contrast agent for myocardial imaging is covered from the detection of stable coronary artery disease to the detection and characterization of chronic infarction. A particular emphasis is placed on the clinical use of gadolinium-chelates, which are the universally used type of MRI contrast agent in the clinical routine. Both approaches, first-pass magnetic resonance imaging (FP-MRI) as well as delayed-enhanced magnetic resonance imaging (DE-MRI), are covered in the different situations of acute and chronic myocardial infarction. (orig.)

  15. Magnetic resonance myocardial perfusion imaging-First experience at 3.0 T

    Klumpp, B. [Eberhard-Karls-University Tuebingen, University Hospital Tuebingen, Department of Diagnostic Radiology, Hoppe-Seyler-Str. 3, 72076 Tuebingen (Germany)], E-mail: bernhard.klumpp@med.uni-tuebingen.de; Hoevelborn, T. [Eberhard-Karls-University Tuebingen, University Hospital Tuebingen, Department of Cardiology, Otfried-Mueller-Str. 10, 72076 Tuebingen (Germany)], E-mail: tobias.hoevelborn@gmx.de; Fenchel, M. [Eberhard-Karls-University Tuebingen, University Hospital Tuebingen, Department of Diagnostic Radiology, Hoppe-Seyler-Str. 3, 72076 Tuebingen (Germany)], E-mail: michael.fenchel@med.uni-tuebingen.de; Stauder, N.I. [Eberhard-Karls-University Tuebingen, University Hospital Tuebingen, Department of Diagnostic Radiology, Hoppe-Seyler-Str. 3, 72076 Tuebingen (Germany)], E-mail: norbert.stauder@stgag.ch; Kramer, U. [Eberhard-Karls-University Tuebingen, University Hospital Tuebingen, Department of Diagnostic Radiology, Hoppe-Seyler-Str. 3, 72076 Tuebingen (Germany)], E-mail: ulrich.kramer@med.uni-tuebingen.de; May, A. [Eberhard-Karls-University Tuebingen, University Hospital Tuebingen, Department of Cardiology, Otfried-Mueller-Str. 10, 72076 Tuebingen (Germany)], E-mail: andreas.may@med.uni-tuebingen.de; Gawaz, M.P. [Eberhard-Karls-University Tuebingen, University Hospital Tuebingen, Department of Cardiology, Otfried-Mueller-Str. 10, 72076 Tuebingen (Germany)], E-mail: meinrad.gawaz@med.uni-tuebingen.de; Claussen, C.D. [Eberhard-Karls-University Tuebingen, University Hospital Tuebingen, Department of Diagnostic Radiology, Hoppe-Seyler-Str. 3, 72076 Tuebingen (Germany)], E-mail: claus.claussen@med.uni-tuebingen.de; Miller, S. [Eberhard-Karls-University Tuebingen, University Hospital Tuebingen, Department of Diagnostic Radiology, Hoppe-Seyler-Str. 3, 72076 Tuebingen (Germany)], E-mail: stephan.miller@med.uni-tuebingen.de

    2009-01-15

    Objective: MR myocardial perfusion imaging (MRMPI) is an established technique for the evaluation of the hemodynamical relevance of coronary artery disease. Perfusion imaging at 3.0 T provides certain advantages compared to 1.5 T. Aim of this study was to evaluate myocardial MR perfusion imaging at 3.0 T. Materials and methods: Twelve patients with stable Angina pectoris and known or suspected coronary artery disease were examined at 3.0 T. Myocardial perfusion was assessed using a saturation recovery gradient echo 2D sequence (TR 1.9 ms, TE 1.0 ms, FA 12 deg.) with 0.05 mmol Gd-DTPA per kg body weight at stress during injection of 140 {mu}g adenosine/kg body weight/min and at rest in short axis orientation. Perfusion analysis was based on a least square fit of the signal/time curve (peak signal intensity, slope). Perfusion series were assessed by two independent observers. Reference for the presence of relevant coronary artery stenoses was invasive coronary angiography. Two experienced observers evaluated the coronary angiograms in biplane projections for the presence and grade of stenoses. Results were compared with the MR perfusion analysis. Results: All MR examinations could be safely performed and yielded high image quality. In eight patients stress-induced hypoperfusion was detected (stenosis >70% in coronary angiography). In four patients myocardial hypoperfusion was ruled out (stenosis <70%). The myocardial perfusion reserve index was significantly reduced in hypoperfused myocardium with 1.9 {+-} 1.6 compared to 2.5 {+-} 1.6 in regularly perfused myocardium (p < 0.05). In coronary angiography, eight patients were found to suffer from coronary artery disease, whereas in four patients coronary artery disease was ruled out. Conclusion: Our initial results show that MRMPI at 3.0 T provides reliably high-image quality and diagnostic accuracy.

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

    Ohlson, Maria; Gustafsson, Agnetha; Gretarsdottir, Jakobina; Olsson, Eva; Johansson, Lena

    2008-04-01

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

  17. Diagnosis of acute myocardial infarction in patients undergoing open heart surgery: a comparison of serial myocardial imaging with cardiac enzymes, electrocardiography, and vectocardiography

    Lowenthal, I.S.; Parisi, A.F.; Tow, D.E.; Barsamian, E.M.; Sasahara, A.A.; McCaughan, D.; Clemson, H.C.

    1977-01-01

    In 44 consecutive patients undergoing elective open heart surgery (OHS), serial electrocardiograms (ECG), vectorcardiograms (VCG), serum CPK, cardiac isoenzymes (CPKMB), and myocardial images using Tc-99m pyrophosphate were obtained, before and after the operation, for the detection of acute myocardial infarction (AMI). Twenty-nine patients developed one or more positive tests postoperatively. Two patients had positive myocardial scintiscans; both had other evidence of infarction. Conversely, the appearance of CPKMB, or new ECG and VCG changes, occurred frequently without evidence of infarction, and were not associated with the development of a positive scintiscan. The results show that false-negative results are infrequent in patients imaged early after OHS, and that cardiac surgical procedures do not cause a high incidence of false-positive scintigrams. Consequently, radionuclide imaging for AMI offers an important adjunct for excluding acute infarction following open heart surgery

  18. Assessment of myocardial infarction by magnetic resonance imaging with the aid of contrast agents

    Roos, A. de; Doornbos, J.

    1991-01-01

    The potential of MR imaging in myocardial ischemia with low-temporal-resolution spin-echo techniques both with and without MR contrast agents has been explored. There are indications that early MR imaging after administration of Gd-DTPA is capable to differentiate reperfused from non-reperfused infarcts. Furthermore, MR infarct sizing using Gd-DTPA is feasible to demonstrate infarct size reduction in patients with successful reperfusion. (H.W.). 50 refs.; 9 figs

  19. A framework to measure myocardial extracellular volume fraction using dual-phase low dose CT images

    Liu, Yixun; Summers, Ronald M.; Yao, Jianhua; Liu, Songtao; Sibley, Christopher T.; Bluemke, David A.; Nacif, Marcelo S.

    2013-01-01

    Purpose: Myocardial extracellular volume fraction (ECVF) is a surrogate imaging biomarker of diffuse myocardial fibrosis, a hallmark of pathologic ventricular remodeling. Low dose cardiac CT is emerging as a promising modality to detect diffuse interstitial myocardial fibrosis due to its fast acquisition and low radiation; however, the insufficient contrast in the low dose CT images poses great challenge to measure ECVF from the image. Methods: To deal with this difficulty, the authors present a complete ECVF measurement framework including a point-guided myocardial modeling, a deformable model-based myocardium segmentation, nonrigid registration of pre- and post-CT, and ECVF calculation. Results: The proposed method was evaluated on 20 patients by two observers. Compared to the manually delineated reference segmentations, the accuracy of our segmentation in terms of true positive volume fraction (TPVF), false positive volume fraction (FPVF), and average surface distance (ASD), were 92.18% ± 3.52%, 0.31% ± 0.10%, 0.69 ± 0.14 mm, respectively. The interobserver variability measured by concordance correlation coefficient regarding TPVF, FPVF, and ASD were 0.95, 0.90, 0.94, respectively, demonstrating excellent agreement. Bland-Altman method showed 95% limits of agreement between ECVF at CT and ECVF at MR. Conclusions: The proposed framework demonstrates its efficiency, accuracy, and noninvasiveness in ECVF measurement and dramatically advances the ECVF at cardiac CT toward its clinical use

  20. Magnetic resonance imaging goes postmortem: noninvasive detection and assessment of myocardial infarction by postmortem MRI

    Jackowski, Christian; Warntjes, Marcel J.B.; Persson, Anders; Berge, Johan; Baer, Walter

    2011-01-01

    To investigate the performance of postmortem magnetic resonance imaging (pmMRI) in identification and characterization of lethal myocardial infarction in a non-invasive manner on human corpses. Before forensic autopsy, 20 human forensic corpses were examined on a 1.5-T system for the presence of myocardial infarction. Short axis, transversal and longitudinal long axis images (T1-weighted; T2-weighted; PD-weighted) were acquired in situ. In subsequent autopsy, the section technique was adapted to short axis images. Histological investigations were conducted to confirm autopsy and/or radiological diagnoses. Nineteen myocardial lesions were detected and age staged with pmMRI, of which 13 were histologically confirmed (chronic, subacute and acute). Six lesions interpreted as peracute by pmMRI showed no macroscopic or histological finding. Five of the six peracute lesions correlated well to coronary pathology, and one case displayed a severe hypertrophic alteration. pmMRI reliably demonstrates chronic, subacute and acute myocardial infarction in situ. In peracute cases pmMRI may display ischemic lesions undetectable at autopsy and routine histology. pmMRI has the potential to substantiate autopsy and to counteract the loss of reliable information on causes of death due to the recent disappearance of the clinical autopsy. (orig.)

  1. Preparation of new 99TcmN complexes for myocardial imaging and their biodistribution in mice

    Miao Yubin; Liu Boli

    1999-01-01

    In order to seek new myocardial imaging agents labelled with 99 Tc m N core, two new 99 Tc m N complexes 99 Tc m N(CYM) 2 (L-cysteine methyl ester hydrochloride) and 99 Tc m N(CYP) 2 (L-cysteine propyl ester hydrochloride) have been prepared and evaluated for potential use in myocardial perfusion imaging. Their labelling conditions are also investigated. In their biodistribution studies in mice, high myocardial uptake and rapid clearance from blood are demonstrated. The clearance half-life of both 99 Tc m N complexes are less than 15 min. However, the retention of activity in heart of two 99 Tc m N complexes are not long. At 30 min post injection, only 0.19%(ID) of 99 Tc m N(CYM) 2 and 0.27% (ID) of 99 Tc m N(CYP) 2 retained respectively in heart. The formation of two 99 Tc m N complexes are rapid with high yield (>90%). This study could be valuable to design of new 99 Tc m N myocardial imaging agents

  2. A framework to measure myocardial extracellular volume fraction using dual-phase low dose CT images

    Liu, Yixun; Summers, Ronald M.; Yao, Jianhua, E-mail: JYao@cc.nih.gov [Clinical Image Processing Service, Radiology and Imaging Sciences, NIH Clinical Center, Bethesda, Maryland 20892 (United States); Liu, Songtao; Sibley, Christopher T.; Bluemke, David A. [Radiology and Imaging Sciences, NIH Clinical Center, Bethesda, Maryland 20892-1182 and Molecular Biomedical Imaging Laboratory, National Institute of Biomedical Imaging and Bioengineering, NIH Clinical Center, Bethesda, Maryland 20892 (United States); Nacif, Marcelo S. [Radiology and Imaging Sciences, NIH Clinical Center, Bethesda, Maryland 20892-1182 (United States)

    2013-10-15

    Purpose: Myocardial extracellular volume fraction (ECVF) is a surrogate imaging biomarker of diffuse myocardial fibrosis, a hallmark of pathologic ventricular remodeling. Low dose cardiac CT is emerging as a promising modality to detect diffuse interstitial myocardial fibrosis due to its fast acquisition and low radiation; however, the insufficient contrast in the low dose CT images poses great challenge to measure ECVF from the image. Methods: To deal with this difficulty, the authors present a complete ECVF measurement framework including a point-guided myocardial modeling, a deformable model-based myocardium segmentation, nonrigid registration of pre- and post-CT, and ECVF calculation. Results: The proposed method was evaluated on 20 patients by two observers. Compared to the manually delineated reference segmentations, the accuracy of our segmentation in terms of true positive volume fraction (TPVF), false positive volume fraction (FPVF), and average surface distance (ASD), were 92.18% ± 3.52%, 0.31% ± 0.10%, 0.69 ± 0.14 mm, respectively. The interobserver variability measured by concordance correlation coefficient regarding TPVF, FPVF, and ASD were 0.95, 0.90, 0.94, respectively, demonstrating excellent agreement. Bland-Altman method showed 95% limits of agreement between ECVF at CT and ECVF at MR. Conclusions: The proposed framework demonstrates its efficiency, accuracy, and noninvasiveness in ECVF measurement and dramatically advances the ECVF at cardiac CT toward its clinical use.

  3. Objective evaluation of Tl-201 image efficacy for detection of myocardial infarction

    Nagai, Teruo; Murata, Kazuhiko; Torizuka, Kanji

    1982-01-01

    As the 3rd report of the objective analysis of radioactive 201 Tl scintigraphy of myocardial infarction, detection of infarction and extent of the lesion was discussed. In 114 cases with relatively definite findings, their images were rereaded and evaluated by 2 physicians. Segmental analysis in each direction was employed for localization of perfusion defects. Comparison between the sites of myocardial infarction on ECG and that of perfusion defects by segmental analysis revealed that, in infarction of the anterior wall, many segments showed defects, and that the lesions of the posterior and lateral wall had a few segments showing defects. This standard of correlation was applied to other cases of myocardial infarction, and the result suggested possible improvement in detection of infarction. As regards the extent of the lesion, no significant correlation between number of segments with defect and ECG and/or the serum enzyme levels were seen. (Ueda, J.)

  4. Post-mortem cardiac diffusion tensor imaging: detection of myocardial infarction and remodeling of myofiber architecture

    Winklhofer, Sebastian; Berger, Nicole; Stolzmann, Paul; Stoeck, Christian T.; Kozerke, Sebastian; Thali, Michael; Manka, Robert; Alkadhi, Hatem

    2014-01-01

    To investigate the accuracy of post-mortem diffusion tensor imaging (DTI) for the detection of myocardial infarction (MI) and to demonstrate the feasibility of helix angle (HA) calculation to study remodelling of myofibre architecture. Cardiac DTI was performed in 26 deceased subjects prior to autopsy for medicolegal reasons. Fractional anisotropy (FA) and mean diffusivity (MD) were determined. Accuracy was calculated on per-segment (AHA classification), per-territory, and per-patient basis, with pathology as reference standard. HAs were calculated and compared between healthy segments and those with MI. Autopsy demonstrated MI in 61/440 segments (13.9 %) in 12/26 deceased subjects. Healthy myocardial segments had significantly higher FA (p 0.05). Post-mortem cardiac DTI enablesdifferentiation between healthy and infarcted myocardial segments by means of FA and MD. HA assessment allows for the demonstration of remodelling of myofibre architecture following chronic MI. (orig.)

  5. Value of planar 201Tl imaging in risk stratification of patients recovering from acute myocardial infarction

    Gibson, R.S.; Watson, D.D.

    1991-01-01

    Although exercise ECG testing has been shown to have important prognostic value after acute myocardial infarction, exercise 201Tl scintigraphy offers several potential advantages, including: (1) increased sensitivity for detecting residual myocardial ischemia; (2) the ability to localize ischemia to a specific area or areas subtended by a specific coronary artery; (3) the ability to identify exercise-induced left ventricular dysfunction, which is manifested by increased lung uptake or transient left ventricular dilation; and (4) more reliable risk stratification of individual patients. The more optimal prognostic efficiency of 201Tl scintigraphy partially results from the fact that the error rate in falsely classifying patients as low risk is significantly smaller with 201Tl scintigraphy than with stress ECG. Because of these substantial advantages, there seems to be adequate rationale for recommending exercise perfusion imaging rather than exercise ECG alone as the preferred method for evaluating mortality and morbidity risks after acute myocardial infarction

  6. Acute myocardial infarction associated with intravenous dipyridamole for rubidium-82 PET imaging

    Marwick, T.H.; Hollman, J.

    1990-01-01

    This report describes the occurrence of chest pain and electrocardiographic features of acute myocardial infarction following intravenous dipyridamole-handgrip stress. Myocardial perfusion imaging (Rb-82 PET) demonstrated a stress-induced perfusion defect. Following failure to respond to medical therapy, urgent cardiac catheterization demonstrated total occlusion of the left anterior descending coronary artery. The vessel was revascularized, with limitation of myocardial damage evidenced by failure to develop anterior Q waves and only modest elevation of cardiac enzyme levels. Complications of intravenous dipyridamole stress are rare, this case constituting the first major problem in over 500 such procedures at this institution. However, this experience demonstrates the importance of vigilant observation during the performance of this technique

  7. Homocysteine plasma levels in patients suspected coronary artery disease: Relation to myocardial perfusion image

    Yao, Z.Y.; He, Q.; Qu, W.

    2002-01-01

    Purpose: Although there is considerable epidemiologic evidence for a relationship between plasma homocysteine (Hcy) levels and coronary artery disease (CAD), not all studies, especially prospective ones have shown such a relationship. The purpose of this study was to investigate a possible association between Hcy plasma levels and myocardial perfusion defect by SPECT in patients suspected CAD. Methods and Materials: A cohort of 238 patients suspected CAD (age: 60.65±10.43, male to female: 172: 66) was examined for Hcy, tetrahydrofolic acid (FH4), vitamine B12 and coronary angiography (CAG). Furthermore, 42 patients also underwent 99m Tc-MIBI myocardial perfusion images (MPI) to assess the myocardial perfusion. Results: There were 69 patients with normal CAG and 63, 60, 42 and 4 patients with 1 vessel, two vessel, 3 vessel and left main coronary stenosis. The plasma Hcy of this group was significantly increased, p 0.05. In patients with >=3 segments myocardial perfusion defect, 10 of them had normal Hcy, and 7 with hyperhomocysteinemia, in patients with 0.05). Conclusion: Our data may indicate that hyperhomocysteinemia represents an independent risk factor in patients with high possibility of CAD rather than a mark of myocardial ischemia or coronary stenosis

  8. The use of coronary vasodilators in myocardial imaging with 43K

    Markov, A.K.; Smith, R.O.; Oglethorpe, N.C.; Lehan, P.H.; Hellems, H.K.

    1980-01-01

    As an alternative procedure to the exercise stress test used in myocardial scanning, vasoactive drugs were employed to elicit deficits in blood flow to myocardial regions supplied by stenotic arteries. The data were collected from 35 dogs, some of which had partial stenosis on either major branch of the left coronary artery, and others which had Ameroid constrictor implants. The effects of lidoflazine, dipyridamole, and nitroglycerin on coronary hemodynamics and myocardial dispersion of 43 K in animals with partial stenosis were evaluated in ten acute experiments. In the pilot studies, four rapid serial rectilinear control scans from 43 K (750 μCi) were reported; dipyridamole, lidoflazine, or nitroglycerin were then administered intravenously. When the selected drug reached a peak vasodilatative effect, a second equal bolus of 43 K was given and four additional scans recorded. The control scans from dogs with partial stenosis or an Ameroid constrictor showed homogeneous distribution of the myocardial 43 K. When drugs were used, the region supplied by compromised circulation became apparent because of lower counts when compared to the normally perfused ones. Coronary vasodilators, as opposed to postexercise in myocardial imaging, have a lesser effect on cardiac dynamics, peripheral hemodynamics, and also double the 43 K uptake in normally perfused myocardium. (orig.) [de

  9. Thallium-201 myocardial perfusion imaging during transient coronary occlusion at the time of PTCA

    Nakagawa, Tatsuya; Sugihara, Hiroki; Inagaki, Suetsugu

    1989-01-01

    To evaluate myocardial perfusion during transient coronary arterial occlusion, thallium-201 was administered intravenously during percutaneous transluminall coronary angioplasty (PTCA) in 12 patients with effort angina, and the resulting perfusion images were compared with those of exercise stress obtained before PTCA. Thallium-201 was injected at the last inflation of an angioplastic baloon and occlusion was maintained for 60 to 90 sec. Three projections of planar images were obtained immediately after PTCA, using a portable gamma camera in an angiography room. These perfusion images obtained during PTCA and exercise were visually interpreted and compared. Myocardial perfusion defects due to the responsible vessel occlusion were observed at early imaging after PTCA, and were fully redistributed three hrs post injection. In 10 patients without angiographically imaged collateral vessels, there were no significatn differences in perfusion between images during PTCA and during exercise. Two patients whose collaterals were observed during coronary angiography before PTCA had higher perfusion scores during PTCA than during exercise. We concluded that intravenous injection of thallium-201 during PTCA is a useful means for assessing alteration of myocardial perfusion due to transient coronary occlusion without increasing the risk of angioplastic procedures, and that it provides more precise information about the jeopardized myocardium, perfused by antegrade blood flow. (author)

  10. Development of Tc-99m labeled myocardial imaging agent

    Jeong, J. M.; Jang, Y. S.; Kim, Y. J.; Lee, Y. S.; Kim, H. W.; Ray, G.; Lee, M. S.

    2006-02-01

    Lipophilic cations have been widely used for myocardial SPECT. We synthesized novel +1 charged lipophilic Tc-99m-labeled N,N'-disubstituted N2S2 derivatives and investigated their biodistribution. The N,N'-dimethyl-, N,N'-diethyl-, N,N'-bis(methoxyethyl)-, and N,N'-bis(ethoxyethyl)N2S2 derivatives were synthesized by alkylating disulfide form of N2S2 with corresponding alkyl halides and subsequently reduced with LAH in THF. To label with Tc-99m, 50% gluconic acid (0.1 ml), SnCl2·2H2O (10 μg), Tc-99m-pertechnetate (370 MBq/2.5 ml) and 0.5 M Na2CO3 (0.3 ml) were added to the compounds. These mixtures were reacted in boiling water bath for 30∼60 min. Radiochemical purities were checked by Whatman No.1 chromatography (normal saline, Rf 0.3∼0.4). Biodistribution of each compound was investigated after injecting 74 kBq (0.1 ml) of each Tc-99m-labeled compound to ICR-mice through the tail vein. Chemical structures of synthesized compounds were confirmed by GC-MSD and 1H-NMR spectroscopy. All of the Tc-99m-labeled compound showed labeling efficiencies of higher than 93%. In biodistribution study, the myocardial uptake of Tc-99m-N,N'-dimethylN2S2, Tc-99m-N,N'-diethylN2S2, Tc-99m-N,N'-bis(methoxyethyl)N2S2 and Tc-99m-N,N'-bis(ethoxyethyl)N2S2 were 5.38 ±0.96, 2.98 ±0.16, 4.27 ±0.47, 7.24 ±1.01% ID/g at 10 min and 5.34 ±1.57, 2.05 ±0.40, 1.02 ±0.16, 1.69 ±0.04% ID/g at 2 hr, respectively. We successfully synthesized Tc-99m-labeled N,N-disubstituted N2S2 derivatives that are novel lipophilic +1 charged compounds. We thought our results prove the feasibility of these compounds to use for myocardial SPECT agent

  11. Myocardial area at risk after ST-elevation myocardial infarction measured with the late gadolinium enhancement after scar remodeling and T2-weighted cardiac magnetic resonance imaging

    Lønborg, Jacob; Engstrøm, Thomas; Mathiasen, Anders B

    2011-01-01

    To evaluate the myocardial area at risk (AAR) measured by the endocardial surface area (ESA) method on late gadolinium enhancement (LGE) cardiovascular magnetic resonance (CMR) when applied after scar remodeling (3 months after index infarction) compared to T2-weighted CMR imaging. One hundred...... and sixty nine patients with ST-elevation myocardial infarction, treated with primary percutaneous coronary intervention, underwent one CMR within 1 week after index treatment to determine the AAR with T2-weighted imaging and a second scan 3 months after to measure AAR with the ESA method...

  12. Myocardial area at risk after ST-elevation myocardial infarction measured with the late gadolinium enhancement after scar remodeling and T2-weighted cardiac magnetic resonance imaging

    Lønborg, Jacob; Engstrøm, Thomas; Mathiasen, Anders B

    2012-01-01

    To evaluate the myocardial area at risk (AAR) measured by the endocardial surface area (ESA) method on late gadolinium enhancement (LGE) cardiovascular magnetic resonance (CMR) when applied after scar remodeling (3 months after index infarction) compared to T2-weighted CMR imaging. One hundred...... and sixty nine patients with ST-elevation myocardial infarction, treated with primary percutaneous coronary intervention, underwent one CMR within 1 week after index treatment to determine the AAR with T2-weighted imaging and a second scan 3 months after to measure AAR with the ESA method...

  13. Myocardial glucose metabolism is different between hypertrophic cardiomyopathy and hypertensive heart disease associated with asymmetrical septal hypertrophy

    Shiba, Nobuyuki; Kagaya, Yutaka; Ishide, Nobumasa; Takeyama, Daiya; Yamane, Yuriko; Chida, Masanobu; Otani, Hiroki; Shirato, Kunio; Ido, Tatsuo.

    1997-01-01

    Myocardial glucose metabolism has been shown to be heterogeneous in patients with hypertrophic cardiomyopathy (HCM). We tested the hypothesis that myocardial glucose metabolism differs between patients with HCM and those with hypertensive heart disease (HHD) associated with asymmetrical septal hypertrophy. We studied 12 patients with HCM, 7 HHD patients associated with asymmetrical septal hypertrophy using 18 F 2-deoxyglucose (FDG) and positron emission tomography. We calculated % FDG fractional uptake in the interventricular septum and posterolateral wall. Heterogeneity of FDG uptake was evaluated by % interregional coefficient of variation of FDG fractional uptake in each wall segment. In both the interventricular septum and posterolateral wall, % FDG fractional uptake was not significantly different between the two groups. The % interregional coefficient of variation for both interventricular septum (10.6±1.6 vs. 4.1±0.5, p<0.01) and posterolateral wall (5.9±0.7 vs. 3.8±0.5, p< 0.05) was significantly larger in patients with HCM than in HHD patients associated with asymmetrical septal hypertrophy. Echocardiography demonstrated that the degree of asymmetrical septal hypertrophy was similar between the two groups. These results suggest that myocardial glucose metabolism may be more heterogeneous in patients with HCM compared to HHD patients associated with asymmetrical septal hypertrophy, although the left ventricular shape is similar. The difference in the heterogeneity might have resulted from differences in the pathogeneses of the two diseases. (author)

  14. The clinical application of SPECT myocardial perfusion imaging with 99mTc-MIBI

    Dong Weiyu

    1992-01-01

    This paper reported 182 SPECT myocardial perfusion images with China made 99m Tc-MIBI and were compared with ECG and UCG. The sensitivity of SPECT in ischemic were 91.2% and was higher than ECG (74.9%)and UCG (61.8%) (P < 0.01). And its specificity, accuracy and positive predictive rate were 78.3%, 90% and 97% respectively. Besides 9 cases have reverse distribution after exercise and rest images. In some ICD patients had shown their SPECT images, the perfusion defects in exercise as well as in rest image

  15. Three-dimensional visualization of myocardial motion and blood flow with cine-MR images

    Oshiro, Osamu; Matani, Ayumu; Chihara, Kunihiro; Mikami, Taisei; Kitabatake, Akira.

    1997-01-01

    This paper describes a three-dimensional (3D) reconstruction and presentation method to visualize myocardial motion and blood flow in a heart using cine-MR (magnetic resonance) images. Firstly, the region of myocardium and blood were segmented with certain threshold gray values. Secondly, some slices were interpolated linearly to reconstruct a 3D static image. Finally, a 3D dynamic image was presented with displaying the 3D static images sequentially. The experimental results indicate that this method enables to visualize not only normal but also abnormal blood flow in cine-mode. (author)

  16. Comparative study of adenosine and exercise 201Tl myocardial perfusion tomographic imaging for detection of coronary heart disease

    Wang Xiong

    1997-01-01

    To compare diagnostic accuracy of adenosine and exercise 201 Tl myocardial perfusion tomographic imaging for detection of coronary heart disease (CHD) in patients with a normal rest ECG and no history of myocardial infarction, 81 patients with CHD and 10 normal control subjects underwent adenosine myocardial perfusion imaging, exercise nuclide myocardial perfusion imaging was performed in 117 patients with CHD and 16 normal control subjects, two groups also had coronary arteriography. Both exercise and adenosine testing parameters were analysed. It is shown: 1) The sensitivity and specificity for detection of CHD were 79% vs 80% for adenosine group and 81% vs 81% for exercise myocardial perfusion imaging group respectively. There was no significant difference in comparison with two matched groups (χ 2 = 1.13, χ 2 = 0.18, χ 2 = 0.12, P>0.05). 2) Side effects induced by adenosine accounted for 89% of patients, all symptoms were mild and disappeared quickly after the termination of the study except in 2 cases withdrawal of infusion needed because of severe angina pectoris. Adenosine myocardial perfusion imaging is a safe and sensitive method for detection of CHD. The diagnostic value of adenosine test is similar to that of exercise myocardial perfusion imaging and particularly useful in evaluating patients unable to perform exercise test or achieve adequate level of exercise

  17. Follow-up of acute myocardial infarction with Gd-DTPA-enhanced MR image

    Matheijssen, N.A.A.; Dijkman, P.; Rossum, A.C. van der; Laarse, A. van der; Voorthuisen, A. van; Bruschke, A.

    1990-01-01

    MR imaging with Gd-DTPA has been shown to be useful in the identification of acutely infarcted myocardium. The purpose of this paper is to assess the influence of Gd-DTPA on myocardial signal intensity (SI) at different intervals after acute myocardial infarction (SMI). The authors used Gd-DTPA-enhanced MR imaging to study 84 patients at different intervals after AMI. A total of 109 T1-weighted MR studies were performed with a Philips Gyroscan magnet (0.5T) before and 20 minutes after Gd-DTPA (0.15 mmol/kg given intravenously). Four groups were studied. Group 1 underwent MR imaging less than 1 week after AMI; group 2, 1-3 weeks; group 3, 3-6 weeks; and group 4, over 6 weeks after AMI

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

    Duwel, C.M.B.; Visser, F.C.; Eenige, M.J. van; Roos, J.P.; Westera, G.

    1990-01-01

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

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

    Kropp, J.; Krois, M.; Eichhorn, B.; Feske, W.; Likungu, J.; Kirchhoff, P.J.; Luederitz, B.; Biersack, H.J.; Knapp, F.F. Jr.

    1993-01-01

    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. [Influence of ademol on NO metabolism indices in rats with modeling myocardial infarction].

    Khodakivs'kyĭ, O A; Pavlov, S V; Bukhtiiarova, N V

    2013-01-01

    It was established in experiments on the rats in the acute period of modeling pituitrin-isadrin myocardial infarction the formation of nitrogen monoxide decreases along with its accelerated transformation into peroxynitrite. It was evidenced by more than double inhibition of NO synthase activity in the myocardium and by decreasing the amount of nitrates on the background of the increasing level of peroxynitrites' marker--nitrotyrosine by 246.6% at an average. Experimental therapy of rats by ademol which is a derivate of adamantan (1-adamantiloxy-3-morpholino-2 propanol hydrochloride) better than by corvitin normalizes the processes of synthesis of nitric oxide. At the same time ademol probably exceeded the reference drug in ability to increase NO synthase activity and amount of nitrate, and promoted a decrease of the level of nitrotyrosine in the myocardium on the average by 36.3; 50.6 and 12.7%, respectively. Corrective influence of ademol on indicators of metabolism in NO system under the conditions of acute cardiac ischemia indicates to promicing development of domestic cardioprotector on its base.

  1. Peritoneal fluid causing inferior attenuation on SPECT thallium-201 myocardial imaging in women

    Rab, S.T.; Alazraki, N.P.; Guertler-Krawczynska, E.

    1988-01-01

    On SPECT thallium images, myocardial left ventricular (LV) anterior wall attenuation due to breast tissue is common in women. In contrast, in men, inferior wall counts are normally decreased compared to anterior counts. The purpose of this report is to describe cases of inferior wall attenuation of counts in women caused by peritoneal fluid, not myocardial disease. Twelve consecutive SPECT thallium myocardial studies performed in women on peritoneal dialysis, being evaluated for kidney transplant, were included in this study. For all studies, 3.5 mCi 201Tl were injected intravenously. Thirty-two images were acquired over 180 degrees (45 degrees RAO progressing to 45 degrees LPO) at 40 sec per stop. SPECT images were reviewed in short axis, horizontal long and vertical long axes. Data were also displayed in bullseye format with quantitative comparison to gender-matched normal files. Ten of 12 female patients studied had inferior wall defects on images, confirmed by bullseye display. All patients had approximately 2 liters of peritoneal fluid. Review of planar rotational views showed diaphragm elevation and fluid margin attenuations affecting left ventricular inferior wall. Thus, peritoneal fluid is a cause of inferior attenuation on 201Tl cardiac imaging

  2. Dynamic CT myocardial perfusion imaging: performance of 3D semi-automated evaluation software

    Ebersberger, Ullrich [Medical University of South Carolina, Heart and Vascular Center, Charleston, SC (United States); Heart Center Munich-Bogenhausen, Department of Cardiology and Intensive Care Medicine, Munich (Germany); Marcus, Roy P.; Nikolaou, Konstantin; Bamberg, Fabian [University of Munich, Institute of Clinical Radiology, Munich (Germany); Schoepf, U.J.; Gray, J.C.; McQuiston, Andrew D. [Medical University of South Carolina, Heart and Vascular Center, Charleston, SC (United States); Lo, Gladys G. [Hong Kong Sanatorium and Hospital, Department of Diagnostic and Interventional Radiology, Hong Kong (China); Wang, Yining [Medical University of South Carolina, Heart and Vascular Center, Charleston, SC (United States); Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Department of Radiology, Beijing (China); Blanke, Philipp [Medical University of South Carolina, Heart and Vascular Center, Charleston, SC (United States); University Hospital Freiburg, Department of Diagnostic Radiology, Freiburg (Germany); Geyer, Lucas L. [Medical University of South Carolina, Heart and Vascular Center, Charleston, SC (United States); University of Munich, Institute of Clinical Radiology, Munich (Germany); Cho, Young Jun [Medical University of South Carolina, Heart and Vascular Center, Charleston, SC (United States); Konyang University College of Medicine, Department of Radiology, Daejeon (Korea, Republic of); Scheuering, Michael; Canstein, Christian [Siemens Healthcare, CT Division, Forchheim (Germany); Hoffmann, Ellen [Heart Center Munich-Bogenhausen, Department of Cardiology and Intensive Care Medicine, Munich (Germany)

    2014-01-15

    To evaluate the performance of three-dimensional semi-automated evaluation software for the assessment of myocardial blood flow (MBF) and blood volume (MBV) at dynamic myocardial perfusion computed tomography (CT). Volume-based software relying on marginal space learning and probabilistic boosting tree-based contour fitting was applied to CT myocardial perfusion imaging data of 37 subjects. In addition, all image data were analysed manually and both approaches were compared with SPECT findings. Study endpoints included time of analysis and conventional measures of diagnostic accuracy. Of 592 analysable segments, 42 showed perfusion defects on SPECT. Average analysis times for the manual and software-based approaches were 49.1 ± 11.2 and 16.5 ± 3.7 min respectively (P < 0.01). There was strong agreement between the two measures of interest (MBF, ICC = 0.91, and MBV, ICC = 0.88, both P < 0.01) and no significant difference in MBF/MBV with respect to diagnostic accuracy between the two approaches for both MBF and MBV for manual versus software-based approach; respectively; all comparisons P > 0.05. Three-dimensional semi-automated evaluation of dynamic myocardial perfusion CT data provides similar measures and diagnostic accuracy to manual evaluation, albeit with substantially reduced analysis times. This capability may aid the integration of this test into clinical workflows. (orig.)

  3. Validation of a model of left ventricular segmentation for interpretation of SPET myocardial perfusion images

    Aepfelbacher, F.C.; Johnson, R.B.; Schwartz, J.G.; Danias, P.G.; Chen, L.; Parker, R.A.; Parker, A.J.

    2001-01-01

    Several models of left ventricular segmentation have been developed that assume a standard coronary artery distribution, and are currently used for interpretation of single-photon emission tomography (SPET) myocardial perfusion imaging. This approach has the potential for incorrect assignment of myocardial segments to vascular territories, possibly over- or underestimating the number of vessels with significant coronary artery disease (CAD). We therefore sought to validate a 17-segment model of myocardial perfusion by comparing the predefined coronary territory assignment with the actual angiographically derived coronary distribution. We examined 135 patients who underwent both coronary angiography and stress SPET imaging within 30 days. Individualized coronary distribution was determined by review of the coronary angiograms and used to identify the coronary artery supplying each of the 17 myocardial segments of the model. The actual coronary distribution was used to assess the accuracy of the assumed coronary distribution of the model. The sensitivities and specificities of stress SPET for detection of CAD in individual coronary arteries and the classification regarding perceived number of diseased coronary arteries were also compared between the two coronary distributions (actual and assumed). The assumed coronary distribution corresponded to the actual coronary anatomy in all but one segment (3). The majority of patients (80%) had 14 or more concordant segments. Sensitivities and specificities of stress SPET for detection of CAD in the coronary territories were similar, with the exception of the RCA territory, for which specificity for detection of CAD was better for the angiographically derived coronary artery distribution than for the model. There was 95% agreement between assumed and angiographically derived coronary distributions in classification to single- versus multi-vessel CAD. Reassignment of a single segment (segment 3) from the LCX to the LAD

  4. Validation of a model of left ventricular segmentation for interpretation of SPET myocardial perfusion images

    Aepfelbacher, F.C.; Johnson, R.B.; Schwartz, J.G.; Danias, P.G. [Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA (United States); Chen, L.; Parker, R.A. [Biometrics Center, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA (United States); Parker, A.J. [Nuclear Medicine Division, Department of Radiology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA (United States)

    2001-11-01

    Several models of left ventricular segmentation have been developed that assume a standard coronary artery distribution, and are currently used for interpretation of single-photon emission tomography (SPET) myocardial perfusion imaging. This approach has the potential for incorrect assignment of myocardial segments to vascular territories, possibly over- or underestimating the number of vessels with significant coronary artery disease (CAD). We therefore sought to validate a 17-segment model of myocardial perfusion by comparing the predefined coronary territory assignment with the actual angiographically derived coronary distribution. We examined 135 patients who underwent both coronary angiography and stress SPET imaging within 30 days. Individualized coronary distribution was determined by review of the coronary angiograms and used to identify the coronary artery supplying each of the 17 myocardial segments of the model. The actual coronary distribution was used to assess the accuracy of the assumed coronary distribution of the model. The sensitivities and specificities of stress SPET for detection of CAD in individual coronary arteries and the classification regarding perceived number of diseased coronary arteries were also compared between the two coronary distributions (actual and assumed). The assumed coronary distribution corresponded to the actual coronary anatomy in all but one segment (3). The majority of patients (80%) had 14 or more concordant segments. Sensitivities and specificities of stress SPET for detection of CAD in the coronary territories were similar, with the exception of the RCA territory, for which specificity for detection of CAD was better for the angiographically derived coronary artery distribution than for the model. There was 95% agreement between assumed and angiographically derived coronary distributions in classification to single- versus multi-vessel CAD. Reassignment of a single segment (segment 3) from the LCX to the LAD

  5. Simultaneous estimates of regional myocardial blood flow and metabolism by the developing chick heart using [201]thallium and [14C] 2-deoxyglucose autoradiography

    Kostreva, D.R.; Wood, J.D.

    1990-01-01

    Little is known about regional myocardial blood flow and metabolism in the developing heart. Simultaneous estimates of regional myocardial blood flow and glucose metabolism have been made in the adult rat by Yonekura et al using [ 201 ] Thallium (THAL) and [ 14 C]2-deoxyglucose (DG) autoradiography. Since glucose is the primary cardiac metabolic substrate during development, glucose utilization is also an estimate of myocardial metabolism. Examination and comparison of the THAL and DG autoradiographs revealed that there is an uncoupling of blood flow and metabolism in the developing chick heart. Areas of the heart which had marked glucose utilization did not always have marked blood flow. Regions of the heart which had marked blood flow but very little glucose utilization were the interventricular septum and the apex. One explanation for this disparity is that although blood flow may be established in these regions, normal cardiac function requiring significant substrate utilization may not be fully developed

  6. Myocardial oxygenation and transmural lactate metabolism during experimental acute coronary stenosis in pigs.

    Gonschior, P; Gonschior, G M; Conzen, P F; Hobbhahn, J; Goetz, A E; Peter, K; Brendel, W

    1992-01-01

    Measurement of surface tissue pO2 (ptO2) with surface electrodes is increasingly applied in experimental medicine. Its use on the beating heart may seem to be problematic because transmural gradients of tissue pO2 would reduce the validity of pO2 determinations in the epicardial layers. This study attempted to determine whether ptO2 may be a valid and sensitive indicator of transmural myocardial oxygenation. In order to measure ptO2, two eight-channel Clark-type electrodes were placed on a beating porcine left ventricle (n = 13). Measurements were made at different degrees of acute stenosis of the left anterior descending artery (LAD). A 24-F cannula was inserted into the great cardiac vein, draining the poststenotic myocardium to obtain coronary venous blood samples. Transmural metabolic changes were detected simultaneously by coronary venous blood gas parameters and lactate levels. Epicardial tissue pO2 was 49 +/- 2 mm Hg (mean +/- SEM) before stenosis and decreased to a mean value of 25 +/- 2 mm Hg during stenosis. Different degrees of LAD stenosis (ptO2 range: 12-35 mm Hg) were substantial enough to alter arterio-coronary venous lactate difference (avd lactate) from +0.31 +/- 0.07 mmol/l (control) to -0.62 +/- 0.15 mmol/l (stenosis). A significant linear correlation between changes of ptO2 (delta ptO2) and changes of avd lactate (delta avd lactate) resulted (y = 0.59 + 0.62x; r = 0.86; p less than or equal to 0.001). However, linear regression analysis between delta ptO2 correlated with the corresponding data from coronary venous pO2 (delta pO2cv) oxygen content (delta O2contcv), and oxygen saturation (delta O2satcv) showed no significant correlations. We conclude that measurement of ptO2 is a sensitive and valuable indicator of transmural oxygenation in ischemic myocardium, whereas pO2cv, O2contcv and O2satcv do not seem to be valid predictors of ischemia in myocardial oxygenation.

  7. Thallium-201 myocardial imaging in unstable angina and variant angina

    Wackers, F.J.Th.; Lie, K.I.; Liem, K.L.; Sokole, E.B.; Schoot, J.B. van der

    1980-01-01

    It is of clinical relevance in the coronary care unit to evaluate the potential role of 201 Tl scintigraphy in patients with unstable angina. In the present chapter the authors discuss 1) the pattern of 201 Tl scintigraphy in patients with unstable angina; and 2) the potential predictive value of 201 Tl scintigraphy in identifying patients with unstable angina who have a poorer prognosis or greater tendency to subsequently develop acute myocardial infarction. All patients with unstable angina pectoris were purposely studied during the pain free period. It seemed conceivable that injecting 201 Tl during an anginal attack would result in a high percentage of scintigraphic defects and probably diminish a potential discriminative value of the method. Moreover in clinical practice the majority of patients arrive at the coronary care unit some time after the last anginal attack. If a diagnostic test performed at this time could distinguish high and low risk patients, important therapeutic decisions might be made at the earliest possible times. (Auth.)

  8. Gadolinium-DTPA-enhanced magnetic resonance imaging and functional outcome in patients with acute myocardial infarction

    Kitamura, Jun; Shimada, Toshio; Murakami, Yo; Ochiai, Koichi; Inoue, Shin-ichi; Ishibashi, Yutaka; Kinoshita, Yoshihisa; Sano, Kazuya; Murakami, Rinji

    1999-01-01

    This study was designed to test the hypothesis that Gadolinium-diethylenetriamine pentaacetic acid (Gd-DTPA)-enhanced magnetic resonance images (MRI) reflect the severity of ischemic injury during the acute and chronic phases of myocardial infarction (MI). Twenty-nine patients with their first acute MI underwent Gd-DTPA-enhanced MRI in the first week (4.2±0.3 days) and at 1 month after onset. Pairs of left ventriculograms were compared with Gd-DTPA-enhanced magnetic resonance images, classified into 3 pattern groups: hyper-enhancement, with and without a central hypo-enhanced region (P1 and P2, respectively), and non-enhancement (P3). In the acute phase of MI, P1 was found in 10, P2 in 11, and P3 in 8 patients. One month later, the image pattern had changed from P1 to P2 in a single patient, from P2 to P3 in 4 patients, and had remained identical in the others. Patients with P3 showed improvement of anterior wall motion in the 1-month follow-up study, and had higher TIMI flow grades and lower peak creatine kinase values than those without recovery. Thus, Gd-DTPA-enhanced magnetic resonance images, closely reflecting the severity of myocardial injury, are useful in predicting myocardial functional recovery after MI. (author)

  9. Thallium-201 myocardial imaging for evaluation of right-ventricular overloading

    Kondo, M.; Kubo, A.; Yamazaki, H.; Ohsuzu, F.; Handa, S.; Tsugu, T.; Masaki, H.; Kinoshita, F.; Hashimoto, S.

    1978-01-01

    This study evaluated the specificity and sensitivity of Tl-201 myocardial imaging in the detection of right-ventricular (RV) overloading. Right-ventricular visualization (RVV) after administration of Tl-201 chloride was studied on 99 patients with various heart diseases. Tracer uptake in the free wall of the RV was graded in four degrees. The degree of RVV was compared with the findings of cardiac catheterization. The comparisons indicated that the uptake increased in step with the inreases in RV systolic pressure, RV end-diastolic pressure, mean pulmonary arterial pressure, total pulmonary vascular resistance, and stroke-work index of the right ventricle (P < 0.05--P < 0.001). Of the patients with visible RV, all but three had RV overloading, and all but three of those without RVV had normal RV systolic pressure. Myocardial images also reflect the type of RV overloading. In patients with RV pressure overloading, the septum showed a tendency to appear straight. In patients with atrial septal defect leading to RV volume overloading, the RV cavity was dilated, the LV image small, and the septum convex toward the RV cavity. These results indicate that Tl-201 myocardial imaging is a sensitive and specific method for the study of RV overloading

  10. Myocardial imaging in the noninvasive evaluation of patients with suspected ischemic heart disease

    Pitt, B.; Strauss, H.W.

    1976-01-01

    Three noninvasive radioactive tracer techniques for evaluating patients with ischemic heart disease are described: (1) myocardial perfusion imaging, (2) acute infarct imaging, and (3) the gated blood pool scan. Myocardial perfusion imaging with tracers that distribute in the myocardium in relation to regional blood flow allows detection of patients with transmural and nontransmural infarction by the finding of decreased tracer concentration in the affected region of the myocardium. If these tracers are injected at the time of maximal stress to patients with significant coronary arterial stenosis but without infarction, areas of transient ischemia can be identified as zones of decreased tracer concentration not found when an examination is performed at rest. Acute infarct imaging with tracers that localize in acutely damaged tissue permits separation of patients with acute myocardial necrosis from those without infarction and those with more chronic damage. The gated blood pool scan permits assessment of left ventricular function and regional wall motion. The measurement of ventricular volumes, ejection fraction and regional wall motion adds significantly to the determination of hemodynamic variables in assessing patients with acute infarction. The technique also permits detection of right ventricular dysfunction. Performance of a combination of these radioactive tracer techniques is often advantageous, particularly in patients with suspected infarction. The techniques can establish whether infarction is present, whether it is acute, where the damage is located and how extensive it is; they can also provide a measure of the effect of this damage on left ventricular function

  11. Dynamic CT myocardial perfusion imaging identifies early perfusion abnormalities in diabetes and hypertension : Insights from a multicenter registry

    Vliegenthart, Rozemarijn; De Cecco, Carlo N.; Wichmann, Julian L.; Meinel, Felix G.; Pelgrim, Gert Jan; Tesche, Christian; Ebersberger, Ullrich; Pugliese, Francesca; Bamberg, Fabian; Choe, Yeon Hyeon; Wang, Yining; Schoepf, U. Joseph

    2016-01-01

    Background: To identify patients with early signs of myocardial perfusion reduction, a reference base for perfusion measures is needed. Objective: To analyze perfusion parameters derived from dynamic computed tomography perfusion imaging (CTPI) in patients with suspected coronary artery disease

  12. Short- and long-term changes in myocardial function, morphology, edema, and infarct mass after ST-segment elevation myocardial infarction evaluated by serial magnetic resonance imaging

    Ripa, Rasmus Sejersten; Nilsson, Jens Christian; Wang, Yongzhong

    2007-01-01

    undertaken. The aim of this study was to evaluate effects of therapy for STEMI on left ventricular function and perfusion and to test the hypothesis that myocardial perfusion by MRI predicts recovery of left ventricular function. METHODS: Cine MRI, edema, first-pass perfusion, and late enhancement imaging...

  13. Bull's-eye map of myocardial perfusion MR imaging. Comparison with SPECT

    Nomura, Yukihiro; Nanjo, Shuji; Yamazaki, Junichi; Yoshikawa, Kohki; Inoue, Yusuke

    2003-01-01

    When diagnosing heart disease, chest roentgenograms, ultrasonography, single-photon emission computed tomography (SPECT), and coronary arteriography are usually performed. Magnetic resonance (MR) imaging is not widely used for evaluating heart disease. Recent technological progress has allowed high quality images of the heart to be reliably obtained. A routine MR study taking about 30-40 minutes can provide a large amount of diagnostic information, such as cardiac structure, function, perfusion, and myocardial viability. The analysis software that can offer Bull's-eye maps from myocardial perfusion images has recently become commercially available. In this study, the characteristics of Bull's-eye mapping of MR imaging is compared with that of Bull's-eye mapping of SPECT using the same heart phantom. The difference in the image quality of the Bull's-eye maps was evaluated among the receiver coils of MR imaging. On Bull's-eye maps from both MR imaging and SPECT, decreased signal intensity was noted in the posterolateral wall. The degree of decrease in the signal of the MR imaging was more prominent than of SPECT. The decrease was severe for the general-purpose receive-only flexible (GPFLEX) coil, moderate for the cardiac and TORSO coil, and slight for the body coil. In the selection of a coil, it is necessary to take into consideration the trade-off between the distribution of signal intensity and the signal-to-noise ratio (SNR). (author)

  14. Myocardial scintigraphy: methods and indications

    Knapp, W.H.

    1993-01-01

    Myocardial scintigraphy comprises perfusion imaging using TI-201 or - more recently - Tc-99m-labeled compounds with high affinity to myocytes. Imaging with these agents has become an important procedure in the detection of coronary artery disease, particularly in patients with non-diagnostic stress-ECG, in the functional evaluation of coronary stenoses after angiographical documentation in order to meet the adequate therapy decision, in therapy monitoring and follow-up, in the post infarction assessment of myocardial viability and differentiation between severe ischemia and scar and, occasionally, in acute ischemia. The use of positron emitters does not offer significant advantages for mere perfusion imaging, but is indispensable for the scintigraphic investigation of certain aspects of myocardial metabolism, particularly for the differentiation of viable ischemic wall segments from irreversibly damaged tissue. Imaging of myocardial necrosis has been improved by the introduction of labeled antimyosin antibody fragments and offers a considerable clinical potential in the diagnosis of myocarditis and cardiac transplant rejection. Neurohumoral aspects are increasingly involved in our understanding of myocardial failure. Scintigraphy of innervation/neurotransmission contributes to the investigation of pathophysiological alterations in myocardial insufficiency and in heart transplants. (orig.) [de

  15. Objective evaluation of Tl-201 image efficacy for detection of myocardial infarction

    Nagai, Teruo; Murata, Kazuhiko; Torizuka, Kanji

    1982-01-01

    From 13 institutions, 343 cases were collected including 152 cases of myocardial infarction, 157 of heart diseases other than myocardial infarction, and 34 of undetermined heart diseases. Tl-201 image interpretation was conducted by 13 physicians specialized in nuclear medicine. They read twice with and without clinical information. In the reading without clinical information, sensitivity was 68.0 %; specificity, 86.3 %; accuracy, 78.0 %; in the reading with clinical information, these figures were 82.3 %, 91.5 %, and 84.7 %, respectively, showing an increase. Receiver operating characteristics analysis showed improved results in the reading with clinical information. Moreover, little variance among interpreters was suggested, but, much more effect of image quality on the results was demonstrated. (Ueda, J.)

  16. Myocardial perfusion imaging with thalium 201 during and after exercise in patients with coronary heart

    Bravo, P B; Villacorta, E V; Monzon, O P; Torres, Jr, J F; Guzman, S V

    1977-07-01

    A unique, non-invasive technique for the evaluation of the regional myocardial perfusion of patients with coronary heart disease has been developed. This entails the use of radionuclide, like thallium (Tl-201), which concentrates in the normal myocardium, leaving areas of ischemia or scarring or ''cold'' perfusion defects. Myocardial perfusion imaging in conjunction with graded exercise testing significantly increases the positivity of the stress test alone among patients with classic angina from 80% to 95%. It gives invaluable information as to the site and extent of the lesion and its reversibility. Among the patients with ECG Q waves indicative of previous infarction, image defects were detected in 93.7%; reversible ischemia co-existing with the infarction was also demonstrated.

  17. A new myocardial imaging agent: Synthesis, characterization, and biodistribution of gallium-68-BAT-TECH

    Kung, H.F.; Liu, B.L.; Mankoff, D.; Kung, M.P.; Billings, J.J.; Francesconi, L.; Alavi, A.

    1990-01-01

    In order to develop a new myocardial perfusion agent for positron emission tomography (PET), a new lipid-soluble gallium complex was evaluated. Synthesis, radiolabeling, characterization, and biodistribution of a unique gallium complex, [ 67 Ga]BAT-TECH (bis-aminoethanethiol-tetraethyl-cyclohexyl), are described. The complex formation between Ga+3 and BAT-TECH ligand is simple, rapid, and of high yield (greater than or equal to 95%). This process is amenable to kit formulation. The complex has a net charge of +1 and a Ga/ligand ratio of 1:1. Biodistribution in rats shows high uptake in the heart as well as in the liver. When [ 68 Ga] BAT-TECH was injected into a monkey, the heart and liver are clearly delineated by PET imaging, suggesting that this complex may be a possible tracer for myocardial perfusion imaging

  18. Effects of ranolazine on ischemic threshold, coronary sinus blood flow, and myocardial metabolism in coronary artery disease.

    Bagger, J P; Bøtker, H E; Thomassen, A; Nielsen, T T

    1997-07-01

    Cytoprotection or metabolic modulation is a new principle in the treatment of angina pectoris. The effect of ranolazine (a cytoprotective drug) on ischemic threshold, coronary sinus blood flow, and myocardial metabolism was evaluated by means of two pacing sequences in nine male patients with coronary artery disease (CAD) and in eight male controls. Ranolazine was given as an intravenous bolus followed by continuous infusion; the mean total dose was 32.7 mg and 31.7 mg in patients and controls, respectively. Angina pectoris was relieved in two patients after ranolazine but pacing time to pain was unchanged in the remaining patients. Maximal ST depression was lower (p = 0.02), but pacing time to maximal and to 1-mm ST depression remained unchanged after the drug. Ranolazine had no overall influence on coronary sinus blood flow, cardiac oxygen consumption, blood pressure, and heart rate. Cardiac uptake of free fatty acids (FFA) was reduced (p = 0.01), and net uptakes of glucose (p = 0.07) and lactate (p = 0.06) tended to be lower after ranolazine in CAD patients and controls. Ranolazine had no direct influence on cardiac exchange of glutamate, alanine, and citrate or on the arterial concentration of any metabolite. In the present study ranolazine had minimal clinical effects. A decrease in myocardial FFA utilization, however, allows greater myocardial glucose oxidation, which may increase the energy production in relation to oxygen availability.

  19. Assessment of myocardial metabolic flexibility and work efficiency in human type 2 diabetes using 16-[18F]fluoro-4-thiapalmitate, a novel PET fatty acid tracer.

    Mather, K J; Hutchins, G D; Perry, K; Territo, W; Chisholm, R; Acton, A; Glick-Wilson, B; Considine, R V; Moberly, S; DeGrado, T R

    2016-03-15

    Altered myocardial fuel selection likely underlies cardiac disease risk in diabetes, affecting oxygen demand and myocardial metabolic flexibility. We investigated myocardial fuel selection and metabolic flexibility in human type 2 diabetes mellitus (T2DM), using positron emission tomography to measure rates of myocardial fatty acid oxidation {16-[(18)F]fluoro-4-thia-palmitate (FTP)} and myocardial perfusion and total oxidation ([(11)C]acetate). Participants underwent paired studies under fasting conditions, comparing 3-h insulin + glucose euglycemic clamp conditions (120 mU·m(-2)·min(-1)) to 3-h saline infusion. Lean controls (n = 10) were compared with glycemically controlled volunteers with T2DM (n = 8). Insulin augmented heart rate, blood pressure, and stroke index in both groups (all P work efficiency was lower in T2DM (P = 0.006) and decreased in both groups with the insulin-induced increase in work and shift in fuel utilization (P = 0.01). Augmented fatty acid oxidation is present under baseline and insulin-treated conditions in T2DM, with impaired insulin-induced shifts away from fatty acid oxidation. This is accompanied by reduced work efficiency, possibly due to greater oxygen consumption with fatty acid metabolism. These observations suggest that improved fatty acid suppression, or reductions in myocardial fatty acid uptake and retention, could be therapeutic targets to improve myocardial ischemia tolerance in T2DM. Copyright © 2016 the American Physiological Society.

  20. Application of myocardial perfusion quantitative imaging for the evaluation of therapeutic effect in canine with myocardial infarction

    Liang Hong; Chen Ju; Liu Sheng; Zeng Shiquan

    2000-01-01

    Myocardial blood perfusion (MBP) ECT and quantitative analysis were performed in 10 canines with experimental acute myocardial infarct (AMI). The accuracy of main myocardial quantitative index, including defect volume (DV) and defect fraction (DF), was estimated and correlated with histochemical staining (HS) of infarcted area. Other 21/AMI canines were divided into Nd:YAG laser trans-myocardial revascularization treated group LTMR and control group. All canines were performed MBP ECT after experimental AMI. Results found that the infarcted volume (IV) measured by HS has well correlated (r 0.88) with DV estimated by myocardial quantitative analysis. But the DF values calculated by both methods was not significantly different (t = 1.28 P > 0.05). In LTMR group 27.5% +- 3.9%, the DF is smaller than control group 32.1% +- 4.6% (t = 2.49 P 99m Tc-MIBI myocardial perfusion SPECT and quantitative study can accurately predict the myocardial blood flow and magnitude of injured myocardium. Nd:YAG LTMR could improve myocardial blood perfusion of ischemic myocardium and decrease effectively the infarct areas

  1. Study of biodistribution properties of a new myocardial imaging agent 99Tcm-N-DBODC5

    Zhang Wanchun; Fang Wei; Wang Feng; Guo Feng; Guo Lin; He Zuoxiang; Wang Xuebin; Lin Bin; Tang Zhigang

    2007-01-01

    99 Tc m -N-DBODC5 for intravenous injection was prepared. The labelling yield was 95.0% ± 0.52%. Sixteen New Zealand rabbits were involved and planar gamma imaging was performed at 10 time-point after injection of 99 Tc m -N-DBODC5. The radioactivity changes of organs were calculated by regions of interest (ROI) analysis. The 16 rabbits were divided into 4 groups and were sacrificed at 30, 60, 120, and 180 min after iniection respectively. The activity for all excised organs were measured by γ-well counting for calculating radiouptake. Myocardial uptake for 99 Tc m -N-DBODC5 is high. Though myocardial uptake was lower than 99 Tc m -MIBI, the liver clearance for 99 Tc m -N-DBODC5 was more rapid than that of 99 Tc m MIBI. As early as 30 min after injection, 99 Tc m -N-DBODC5 heart-to-liver ratio is 0.98 ± 0.52 versus 0.56 ± 0.19 for 99 Tc m -MIBI (P 99 Tc m -N-DBODC5 heart-to-liver ratio improved to the peak value (1.18 ± 0.57), compared with 0.71 ± 0.29 for 99 Tc m -MIBI, P 99 Tc m - N-DBODC5 was keeping at a high level until 180 min. 99 Tc m -N-DBODC5 exhibited rapid lung clearance, similar to that of 99 Tc m -MIBI. The biodistribution in the isolated organs demonstrated the same trend. The rapid 99 Tc m -N-DBODC5 liver clearance may allow the earlier imaging, and overcome the photon scatter from the liver with high activity which interfered the inferoapical wall in myocardial images. 99 Tc m -N-DBODC5 is a promising new myocardial perfusion imaging agent with superior biodistribution properties. (authors)

  2. Recent Inferior Myocardial Infarction Complicated with a Right Ventricular Thrombus Detected by Three Cardiac Imaging Modalities.

    Kuno, Toshiki; Imaeda, Syohei; Hashimoto, Kenji; Ryuzaki, Toshinobu; Saito, Tetsuya; Yamazaki, Hiroyuki; Tabei, Ryota; Kodaira, Masaki; Hase, Manabu; Numasawa, Yohei

    2018-03-01

    We report the case of a 71-year-old woman diagnosed with recent inferior myocardial infarction complicated with right ventricular infarction and a right ventricular thrombus. Three-dimensional transthoracic echocardiography, contrast-enhanced computed tomography, and cardiac magnetic resonance imaging clearly detected a thrombus. We consider cases with a recent right ventricular infarction to require assessment for thrombus formations in the right ventricle. Fortunately, vigorous anticoagulation therapy resolved the thrombi in both the right ventricle and right coronary artery.

  3. Diagnostic value of transesophageal atrial pacing myocardial perfusion imaging in coronary artery disease

    Jia Yongping; Li Zhiling; Li Yunqian

    1994-01-01

    Transesophageal atrial pacing (TAP) SPECT myocardial perfusion imaging (MPI) with 99m Tc-MIBI was performed in 46 patients with coronary artery disease (CAD) and 15 normal subjects. The results were compared with exercise SPECT MPI. The results showed that the sensitivity and specificity of TAP SPECT to evaluate CAD were 86,96% and 93.33%. TAP SPECT MPI had a significant correlation with exercise SPECT MPI to detect ischemic segment of CAD (r = 0.95)

  4. The progress of research on myocardial perfusion imaging in diabetic coronary disease

    Zhao Qian; Li Juan

    2007-01-01

    The morbidity of diabetes mellitus is gradually increasing. It's most important complication is cardiovascular disease. The coronary disease is the main cause of death in patients with diabetes mellitus. The stress myocardial perfusion imaging help diagnose diabetic coronary disease and prognosis judgement and risk assessment. So it can improve the living standard of patients with diabetes mellitus, and decrease the mortality of diabetes mellitus. (authors)

  5. Prognostic value of combined CT angiography and myocardial perfusion imaging versus invasive coronary angiography and nuclear stress perfusion imaging in the prediction of major adverse cardiovascular events

    Chen, Marcus Y.; Rochitte, Carlos E.; Arbab-Zadeh, Armin

    2017-01-01

    Purpose: To compare the prognostic importance (time to major adverse cardiovascular event [MACE]) of combined computed tomography (CT) angiography and CT myocardial stress perfusion imaging with that of combined invasive coronary angiography (ICA) and stress single photon emission CT myocardial p...

  6. A quantitative analysis of Tl-201 myocardial perfusion image with special reference to circumferential profile method

    Miyanaga, Hajime

    1982-01-01

    A quantitative analysis of thallium-201 myocardial perfusion image (MPI) was attempted by using circumferential profile method (CPM) and the first purpose of this study is to assess the clinical utility of this method for the detection of myocardial ischemia. In patients with coronary artery disease, CPM analysis to exercise T1-MPI showed high sensitivity (9/12, 75%) and specificity (9/9, 100%), whereas exercise ECG showed high sensitivity (9/12, 75%), but relatively low specificity (7/9, 78%). In patients with myocardial infarction, CPM also showed high sensitivity (34/38, 89%) for the detection of myocardial necrosis, compared with visual interpretation (31/38, 81%) and with ECG (31/38, 81%). Defect score was correlated well with the number of abnormal Q waves. In exercise study, CPM was also sensitive to the change of perfusion defect in T1-MPI produced by exercise. So the results indicate that CPM is a good method not only quantitatively but also objectively to analyze T1-MPI. Although ECG is the most commonly used diagnostic tool for ischemic heart disease, several exercise induced ischemic changes in ECG have been still on discussion as criteria. So the second purpose of this study is to evaluate these ischemic ECG changes by exercise T1-MPI analized quantitatively. ST depression (ischemic 1 mm and junctional 2 mm or more), ST elevation (1 mm or more), and coronary T wave reversion in exercise ECG were though to be ischemic changes. (J.P.N.)

  7. Quantitative analysis of Tl-201 myocardial perfusion image with special reference to circumferential profile method

    Miyanaga, Hajime [Kyoto Prefectural Univ. of Medicine (Japan)

    1982-08-01

    A quantitative analysis of thallium-201 myocardial perfusion image (MPI) was attempted by using circumferential profile method (CPM) and the first purpose of this study is to assess the clinical utility of this method for the detection of myocardial ischemia. In patients with coronary artery disease, CPM analysis to exercise T1-MPI showed high sensitivity (9/12, 75%) and specificity (9/9, 100%), whereas exercise ECG showed high sensitivity (9/12, 75%), but relatively low specificity (7/9, 78%). In patients with myocardial infarction, CPM also showed high sensitivity (34/38, 89%) for the detection of myocardial necrosis, compared with visual interpretation (31/38, 81%) and with ECG (31/38, 81%). Defect score was correlated well with the number of abnormal Q waves. In exercise study, CPM was also sensitive to the change of perfusion defect in T1-MPI produced by exercise. So the results indicate that CPM is a good method not only quantitatively but also objectively to analyze T1-MPI. Although ECG is the most commonly used diagnostic tool for ischemic heart disease, several exercise induced ischemic changes in ECG have been still on discussion as criteria. So the second purpose of this study is to evaluate these ischemic ECG changes by exercise T1-MPI analized quantitatively. ST depression (ischemic 1 mm and junctional 2 mm or more), ST elevation (1 mm or more), and coronary T wave reversion in exercise ECG were though to be ischemic changes.

  8. The effect of right ventricular pacing on myocardial oxidative metabolism and efficiency: relation with left ventricular dyssynchrony

    Ukkonen, Heikki; Saraste, Antti; Koistinen, Juhani [Turku University Hospital, Department of Medicine, P.O. Box 52, Turku (Finland); Tops, Laurens; Bax, Jeroen [Leiden University Medical Center, Leiden (Netherlands); Naum, Alexander [University of Turku, Turku PET Centre, Turku (Finland); Knuuti, Juhani [University of Turku, Turku PET Centre, Turku (Finland); Turku University Hospital, Turku PET Centre, P.O. Box 52, Turku (Finland)

    2009-12-15

    Right ventricular (RV) apical pacing induces dyssynchrony by a left bundle branch block type electrical activation sequence in the heart and may impair left ventricular (LV) function. Whether these functional changes are accompanied by changes in myocardial perfusion, oxidative metabolism and efficiency, and the relation with the induction of LV dyssynchrony are unknown. Our study was designed to investigate the acute effects of RV pacing on these parameters. Ten patients with normal LV ejection fraction and VVI/DDD pacemaker were studied during AAI pacing/sinus rhythm without RV pacing (pacing-OFF) and with RV pacing (pacing-ON) at the same heart rate. Dynamic [{sup 15}O]water and [{sup 11}C]acetate positron emission tomography was used to measure perfusion and oxidative metabolism (k{sub mono}) of the LV. An echocardiographic examination was used to assess LV stroke volume (SV) and LV dyssynchrony. Myocardial efficiency of forward work was calculated as systolic blood pressure x cardiac output/LV mass/k{sub mono}. RV pacing decreased SV in all subjects (mean decrease 13%, from 76 {+-} 7 to 66 {+-} 7 ml, p = 0.004), but global perfusion and k{sub mono} were unchanged. The efficiency tended to be lower with pacing-ON (70 {+-} 20 vs 81 {+-} 21 mmHg l/g, p = 0.066). In patients with dyssynchrony during pacing (n = 6) efficiency decreased by 23% (from 78 {+-} 25 to 60 {+-} 14 mmHg l/g, p = 0.02), but in patients without dyssynchrony no change in efficiency was detected. Accordingly, heterogeneity in myocardial perfusion and oxidative metabolism was detected during pacing in patients with dyssynchrony but not in those without dyssynchrony. RV pacing resulted in a significant decrease in SV. However, deleterious effects on LV oxidative metabolism and efficiency were observed only in patients with dyssynchrony during RV pacing. (orig.)

  9. Development of 99Tcm-Q3 as a new type myocardial perfusion imaging agent

    Li Yunchun; Tan Tianzhi; Fan Chengzhong; Zhao Keqing; Wei Xihe; Li Quan

    1999-01-01

    Objective: To develop 99 Tc m -N,N'-ethylene-bis (acetylacetone iminato) bis [tris (3-methoxy-1-propyl) phosphine] ( 99 Tc m -Q 3 ) as a new type of myocardial perfusion imaging agent. Methods: After N,N'-ethylene-bis (acetylacetone iminato) and tris (3-methoxy-1-propyl) phosphine were made, N,N'-ethylene-bis (acetylacetone iminato) was labelled using reduced 99 Tc m O 4 - by SnCl 2 ·2H 2 O under the presence of alkali, then tris (3-methoxy-1-propyl) phosphine was added and reacted for ten minutes, 99 Tc m -Q 3 was obtained at the end. Biodistribution in mice, in vitro stability and acute toxicity of 99 Tc m -Q 3 were examined. Results: 99 Tc m -Q 3 was taken up rapidly by the heart, and the uptake rate was very high, by 5 minutes post injection, 24.66% of the injected dose was taken up in per gram heart, and no significant washout was shown up by 4 hours. But 99 Tc m -Q 3 was cleaned out rapidly from blood, lung and liver. No poisonousness and adverse effects were observed, and its stability lasted more than 6 hours. Conclusions: 99 Tc m -Q 3 is a fairly good myocardial perfusion imaging agent for improving the quality of myocardial perfusion imaging

  10. Regional Myocardial Blood Volume and Flow: First-Pass MR Imaging with Polylysine-Gd-DTPA

    Wilke, Norbert; Kroll, Keith; Merkle, Hellmut; Wang, Ying; Ishibashi, Yukata; Xu, Ya; Zhang, Jiani; Jerosch-Herold, Michael; Mühler, Andreas; Stillman, Arthur E.; Bassingthwaighte, James B.; Bache, Robert; Ugurbil, Kamil

    2010-01-01

    The authors investigated the utility of an intravascular magnetic resonance (MR) contrast agent, poly-L-lysine-gadolinium diethylenetriaminepentaacetic acid (DTPA), for differentiating acutely ischemic from normally perfused myocardium with first-pass MR imaging. Hypoperfused regions, identified with microspheres, on the first-pass images displayed significantly decreased signal intensities compared with normally perfused myocardium (P < .0007). Estimates of regional myocardial blood content, obtained by measuring the ratio of areas under the signal intensity-versus-time curves in tissue regions and the left ventricular chamber, averaged 0.12 mL/g ± 0.04 (n = 35), compared with a value of 0.11 mL/g ± 0.05 measured with radiolabeled albumin in the same tissue regions. To obtain MR estimates of regional myocardial blood flow, in situ calibration curves were used to transform first-pass intensity-time curves into content-time curves for analysis with a multiple-pathway, axially distributed model. Flow estimates, obtained by automated parameter optimization, averaged 1.2 mL/min/g ± 0.5 [n = 29), compared with 1.3 mL/min/g ± 0.3 obtained with tracer microspheres in the same tissue specimens at the same time. The results represent a combination of T1-weighted first-pass imaging, intravascular relaxation agents, and a spatially distributed perfusion model to obtain absolute regional myocardial blood flow and volume. PMID:7766986

  11. Review of cardiovascular imaging in the Journal of Nuclear Cardiology in 2017. Part 2 of 2: Myocardial perfusion imaging.

    Hage, Fadi G; AlJaroudi, Wael A

    2018-04-16

    In 2017, the Journal of Nuclear Cardiology published many high-quality articles. In this review, we will summarize a selection of these articles to provide a concise review of the main advancements that have recently occurred in the field. In the first article of this 2-part series, we focused on publications dealing with positron emission tomography, computed tomography, and magnetic resonance. This review will place emphasis on myocardial perfusion imaging using single-photon emission computed tomography summarizing advances in the field including prognosis, safety and tolerability, the impact of imaging on management, and the use of novel imaging protocols.

  12. Local experience on radionuclide myocardial imaging in the Philippines at the Philippine Heart Center for Asia

    Villacorta, E.V.

    1977-01-01

    The Nuclear Medicine Department of the Philippine Heart Center has introduced the detection of coronary heart disease through myocardiac perfusion imaging. The cardiovascular procedures are availed of free-of-charge to registered PHCA patients excepting for the costly TI-201 imaging. In summary, coronary perfusion in imaging should be an integral part of coronary arteriography. Barring the expensive cost of TI-120, myocardial perfusion imaging is ideal for detection of coronary heart disease. Experience shows better sensitivity of TI-201 than exercise ECG for detection of ischemia. Another non-invasive procedure for the detection of acute infarction is the radionuclide imaging using a bone radiopharmaceutical Tc99m prophosphate. In conclusion, acute infarct imaging is a valuable adjunct to ECG and enzyme studies. (RTD)

  13. Exercise supplementation of dipyridamole for myocardial perfusion imaging

    DePuey, E.G.

    1991-01-01

    The substitution of intravenous dipyridamole for symptom-limited treadmill exercise has provided a non-invasive means to diagnose coronary artery disease with 201Tl scintigraphy in patients unable to adequately exercise. Limitations of dipyridamole/thallium imaging are primarily due to suboptimal image quality secondary to hepatic tracer concentration and decreased test sensitivity in patients who are dipyridamole non-responders. Low-level treadmill exercise supplementation improves image quality, whereas handgrip has little, if any, benefit. The effect of low-level exercise in augmenting coronary blood flow is unknown and reports regarding the effect of handgrip are conflicting. The diagnostic benefit of these maneuvers in improving test sensitivity and decreasing the number of non-responders has not been documented. The combination of maximal, symptom-limited treadmill exercise and intravenous dipyridamole is a theoretically attractive option to improve overall test sensitivity, but the physiologic consequences and potential side effects should be more thoroughly investigated

  14. Gallium-67 myocardial imaging for the detection of bacterial endocarditis

    Wiseman, J.; Rouleau, J.; Rigo, P.; Strauss, H.W.; Pitt, B.

    1976-07-01

    Eleven patients with a clinical diagnosis of bacterial endocarditis underwent scintillation scanning of the precordial region 2--7 days after the intravenous administration of 3 mCi of gallium-67 citrate. Seven had positive scans, 3 of which were confirmed by postmortem imaging at autopsy. Serial images revealed the scans to be frequently negative at 48 hours and positive from 3 to 8 days following injection. Uptake was not seen in the region of the myocardium 48 hours or longer after the injection of 15 patients without endocarditis used as controls.

  15. Gallium-67 myocardial imaging for the detection of bacterial endocarditis

    Wiseman, J.; Rouleau, J.; Rigo, P.; Strauss, H.W.; Pitt, B.

    1976-01-01

    Eleven patients with a clinical diagnosis of bacterial endocarditis underwent scintillation scanning of the precordial region 2--7 days after the intravenous administration of 3 mCi of gallium-67 citrate. Seven had positive scans, 3 of which were confirmed by postmortem imaging at autopsy. Serial images revealed the scans to be frequently negative at 48 hours and positive from 3 to 8 days following injection. Uptake was not seen in the region of the myocardium 48 hours or longer after the injection of 15 patients without endocarditis used as controls

  16. Impact of metabolic disorders on the relation between overweight/obesity and incident myocardial infarction and ischaemic stroke in fertile women

    Andersen, S S; Andersson, C; Berger, S M

    2015-01-01

    and smoking, the risk of the composite outcome of myocardial infarction and ischaemic stroke was assessed with metabolic disorders (i.e. hypertensive conditions, abnormal glucose metabolism and/or dyslipidaemia) included as time-dependent variables. RESULTS: The population comprised 261,489 women with median...

  17. Molecular imaging of myocardial infarction with Gadofluorine P – A combined magnetic resonance and mass spectrometry imaging approach

    Fabian Lohöfer

    2018-04-01

    Full Text Available Background: Molecular MRI is becoming increasingly important for preclinical research. Validation of targeted gadolinium probes in tissue however has been cumbersome up to now. Novel methodology to assess gadolinium distribution in tissue after in vivo application is therefore needed. Purpose: To establish combined Magnetic Resonance Imaging (MRI and Mass Spectrometry Imaging (MSI for improved detection and quantification of Gadofluorine P deposition in scar formation and myocardial remodeling. Materials and methods: Animal studies were performed according to institutionally approved protocols. Myocardial infarction was induced by permanent ligation of the left ascending artery (LAD in C57BL/6J mice. MRI was performed at 7T at 1 week and 6 weeks after myocardial infarction. Gadofluorine P was used for dynamic T1 mapping of extracellular matrix synthesis during myocardial healing and compared to Gd-DTPA. After in vivo imaging contrast agent concentration as well as distribution in tissue were validated and quantified by spatially resolved Matrix-Assisted Laser Desorption Ionization (MALDI MSI and Laser Ablation – Inductively Coupled Plasma – Mass Spectrometry (LA-ICP-MS imaging. Results: Both Gadofluorine P enhancement as well as local tissue content in the myocardial scar were highest at 15 minutes post injection. R1 values increased from 1 to 6 weeks after MI (1.62 s−1 vs 2.68 s−1, p = 0.059 paralleled by an increase in Gadofluorine P concentration in the infarct from 0.019 mM at 1 week to 0.028 mM at 6 weeks (p = 0.048, whereas Gd-DTPA enhancement showed no differences (3.95 s−1 vs 3.47 s−1, p = 0.701. MALDI-MSI results were corroborated by elemental LA-ICP-MS of Gadolinium in healthy and infarcted myocardium. Histology confirmed increased extracellular matrix synthesis at 6 weeks compared to 1 week. Conclusion: Adding quantitative MSI to MR imaging enables a quantitative validation of Gadofluorine P distribution in the heart

  18. Association between abnormal myocardial fatty acid metabolism and cardiac-derived death among patients undergoing hemodialysis: results from a cohort study in Japan.

    Moroi, Masao; Tamaki, Nagara; Nishimura, Masato; Haze, Kazuo; Nishimura, Tsunehiko; Kusano, Eiji; Akiba, Takashi; Sugimoto, Tokuichiro; Hase, Hiroki; Hara, Kazuhiro; Nakata, Tomoaki; Kumita, Shinichiro; Nagai, Yoji; Hashimoto, Akiyoshi; Momose, Mitsuru; Miyakoda, Keiko; Hasebe, Naoyuki; Kikuchi, Kenjiro

    2013-03-01

    Detecting myocardial ischemia in hemodialysis patients is crucial given the high incidence of silent ischemia and the high cardiovascular mortality rates. Abnormal myocardial fatty acid metabolism as determined by imaging with (123)I-labeled BMIPP (β-methyl iodophenyl-pentadecanoic acid) might be associated with cardiac-derived death in hemodialysis patients. Prospective observational study. Asymptomatic hemodialysis patients with one or more cardiovascular risk factors, but without known coronary artery disease, were followed up for 3 years at 48 Japanese hospitals (406 men, 271 women; mean age, 64 years). Baseline BMIPP summed scores semiquantified using a 17-segment 5-point system (normal, 0; absent, 4). Cardiac-derived death, including cardiac and sudden death. HRs were estimated using a Cox model for associations between BMIPP summed scores and cardiac-derived death, adjusting for potential confounders of age, sex, body mass index, dialysis duration, and cardiovascular risk factors. Rates of all-cause mortality and cardiac-derived death were 18.5% and 6.8%, respectively. Cardiac-derived death (acute myocardial infarction [n = 10], congestive heart failure [n = 13], arrhythmia [n = 2], valvular heart disease [n = 1], and sudden death [n = 20]) accounted for 36.8% of all-cause deaths. Cardiac-derived death (n = 46) was associated with age, history of heart failure, and BMIPP summed scores of 4 or higher (HR, 2.9; P death-free survival rates were 95.7%, 90.6%, and 78.8% when BMIPP summed scores were 3 or lower, 4-8, and 9 or higher, respectively. BMIPP summed score also was a predictor of all-cause death (HR, 1.6; P = 0.009). Sudden death of unknown cause was considered to have been cardiac derived, although a coronary origin was not confirmed. Abnormal myocardial fatty acid metabolism is associated with cardiac-derived death in hemodialysis patients. BMIPP single-proton emission computed tomography appears clinically useful for predicting cardiac-derived death

  19. Diffusion-weighted echo planar imaging in patients with recent myocardial infarction

    Deux, Jean-Francois; Maatouk, Mezri; Luciani, Alain; Lenczner, Gregory; Mayer, Julie; Kobeiter, Hicham; Rahmouni, Alain; Vignaud, Alexandre; Lim, Pascal; Dubois-Rande, Jean-Luc

    2011-01-01

    To evaluate a diffusion-weighted (DW) black blood MR sequence for the detection of myocardium signal abnormalities in patients with recent myocardial infarction (MI). A DW black blood EPI sequence was acquired at 1.5 T in 12 patients with recent MI. One slice per patient was acquired with b = 0 and b = 50 s/mm 2 . A standard short tau inversion recovery (STIR) T2-weighted sequence was acquired at the same level. Viability was assessed with delayed-enhancement sequences. Images were analyzed qualitatively and quantitatively. A non parametric Wilcoxon test was used for statistical analysis, with a significance level of P <.05. The mean quality of blood suppression was higher on DW EPI images than on STIR T2-weighted images (3.9 ± 0.3 and 3.0 ± 0.7, respectively; P = 0.01). Myocardial high signal areas were detected in respectively 100% (12/12) and 67% (8/12) of the patients on DW EPI and STIR T2-weighted images. The four patients (33%) with false-negative STIR T2 findings all had high signal areas on DW EPI images corresponding to the location of the MI on the delayed-enhanced images. DW EPI sequences are a feasible alternative to standard STIR T2-weighted sequences for detecting myocardium high signal areas in patients with recent MI. (orig.)

  20. Supine versus upright anterior images: comparison in T1-201 myocardial scintigraphy

    Jacobson, A.F.; Parker, J.A.; Royal, H.D.; Silverman, K.J.; Gervino, E.V.; Kolodny, G.M.

    1987-01-01

    In patients undergoing exercise thallium-201 myocardial scintigraphy, activity in the inferior wall on anterior images may appear diminished when the standard supine view is used, but normal when the view is acquired with the patient upright. To determine the clinical significance of this observation, the distribution of thallium-201 activity was semiquantitatively assessed in supine and upright anterior images obtained immediately after exercise in 93 patients (65 men, 28 women). The presence of inferior wall and coronary artery disease was established with coronary angiography or from documentation of previous myocardial infarction. Supine and upright images were compared with use of receiver operating characteristic curves. In male patients diagnostic accuracy for identification of both inferior wall and coronary artery disease was improved through the use of the upright anterior image. In women, there was no significant difference in reader performance with upright and supine images. Upright anterior images should be routinely obtained in men in order to reduce the frequency of false-positive identification of inferior wall defects

  1. Thallium-201 myocardial imaging during coronary vasodilation induced by oral dipyridamole

    Gould, K.L.; Sorenson, S.G.; Albro, P.; Caldwell, J.H.; Chaudhuri, T.; Hamilton, G.W.

    1986-01-01

    Myocardial perfusion imaging of 201 TI injected during maximum exercise has been an important diagnostic tool for coronary artery disease. Pharmacologic coronary vasodilation by i.v. infusion of dipyridamole may be used in lieu of exercise stress for purposes of diagnostic perfusion imaging. However, i.v. dipyridamole is not currently available from commercial sources for widespread routine use. Accordingly, this study was carried out in order to determine whether high dose, oral dipyridamole would be useful as a coronary vasodilator for purposes of diagnostic perfusion imaging. Fifty-eight patients undergoing diagnostic coronary arteriography also had myocardial perfusion imaging with 201TI under conditions of rest, maximum exercise stress, and high dose oral dipyridamole. Of those patients who had a defect on exercise thallium images, 75% also had a perfusion defect on thallium images after high dose oral dipyridamole. These results indicate that oral dipyridamole causes sufficient coronary arteriolar vasodilation and increase of coronary flow in nonstenotic arteries to identify perfusion defects comparable to those seen on maximum exercise stress in at least 75% of cases. In 25% of patients with exercise defects, no perfusion defect was seen after oral dipyridamole. Thus, oral dipyridamole is a potent coronary vasodilator, comparable to exercise stress in most cases, but in a minority of patients may not be comparable to exercise stress

  2. Evaluation of effects of early intravenous thrombolytic therapy in acute myocardial infarction with 99mTc-MIBI tomography imaging

    Zhang Zhongzheng; Xue Zheng; Qin Fuzhong

    1997-01-01

    PURPOSE: To evaluate the effects of early intravenous thrombolytic therapy in acute myocardial infarction (AMI) with 99m Tc-MIBI tomography imaging. METHODS: 22 patients with AMI were observed using 99m Tc-MIBI rest myocardial tomography imaging. The semiquantitative score of myocardial 99m Tc-MIBI uptake was expressed with a four point scoring system. RESULTS: The findings showed in patients in whom reperfusion was achieved, mean scores decreased from 9.1 +- 3.3 before thrombolytic therapy to 3.7 +- 2.2 (t 4.085, P 99m Tc-MIBI perfusion defect segments correlated with that of the ECG-determined infarct site. The comparison between the first and the second myocardial imaging in the non-thrombolytic-treatment group was statistically insignificant. CONCLUSION: The potential advantages of rest myocardial imaging in AMI before and after thrombolytic therapy not only provide an information for assessing the extent of improvement of myocardial ischemia but also provide an imaging basis for determining coronary artery reperfusion

  3. The imaging research of myocardial damage in Duchenne muscular dystrophy

    Fu Peng; Wei Lingge; Hu Jing; Huang Jianmin; Liu Xiaomei

    2011-01-01

    It is common that Duchenne muscular dystrophy (DMD) patients can suffer from cardiac damage, which performed variously. Cardiac damage in DMD often be paid no attention in early stage,since the clinical symptoms is slight. With the decline of cardiac function, the quality of life, treatment and rehabilitation training of patients will be affected significantly. Furthermore, the progress of the disease will be speeded up and the difficulty of treatment will be increased. Therefore, there will be important significance in delaying the progression of cardiac damage and prolonging the life of patients by the early diagnosis and intervention treatment of cardiac damage in DMD. For the convenience of the clinician to choose suitable imaging methods, to improve the cardiac damage in patients of DMD, imaging researches which are applied to the DMD cardiac damage are reviewed. (authors)

  4. Clinical significance of increased lung/heart ratio in 210Tl stress myocardial image

    Liu Zaoli; Chang Fengqin; Zhang Fengge; Wang Xiaoyuan; Liu Liuhua

    1990-01-01

    230 cases were studied with 201 Tl stress image. The results showed that the lung/heart ratio closely correlated with the presence and severity of coronary heart disease (CHD). Among them, 18 cases (7.8%) showed significantly elevated lung/heart ratio (> 0.50). It was confirmed that all of the 18 cases have severe CHD with left ventricular insufficiency. The author emphasizes that measurement of the lung/heart ratio during 201 Tl stress myocardial image may be useful for the assessment of the severity, evalation of the left ventricular function and judgement of prognosis in CHD

  5. Normal nonuniformity of left ventricular contraction. Assessment by cine MR imaging with presaturation myocardial tagging

    Naito, H.; Arisawa, J.; Harada, K.; Yamagami, H.; Kozuka, T.; Tamura, S.

    1996-01-01

    Purpose: To identify the normal performance of left ventricular (LV) regional contraction using cine MR imaging with presaturation myocardial tagging. Material and Methods: Sixteen normal volunteers were examined on a 1.5 T MR system with tagging cine sequences. Tags were applied at end-diastole as 2 parallel black lines on short-axis and 4-chamber sections, and the fractional shortenings were calculated at 7 LV locations. Results: The following results were obtained with significance: A transmural gradient of contractility in the short-axis section; prolonged late-systolic endocardial shortening and epicardial early termination in the free wall; initial delay of shortening in the anterior wall; apical predominance of contractility; predominance of circumferential shortening in the free wall and of meridional shortening in the septum. These findings could be associated with myocardial fiber architecture, presumed wall stress and temporal asynergy of excitation. Conclusion: Cine MR imaging with myocardial tagging proved to be useful in assessing the nonuniformity of LV contraction. (orig.)

  6. CT imaging of myocardial perfusion and viability. Beyond structure and function

    Schoepf, U. Joseph [Medical University of South Carolina, Charleston, SC (United States). Dept. of Radiology and Radiological Sciences; Bamberg, Fabian [Muenchen Univ. (Germany); Bastarrika, Gorka [Sunnybrook Health Sciences Centre, Toronto, ON (Canada). Cardiothoracic Imaging Division; Ruzsics, Balazs [Royal Liverpool and Broadgreen Univ., Liverpool (United Kingdom). Dept. of Cardiology; Vliegenthart, Rozemarijn (ed.) [University Medical Center Groningen (Netherlands). Center for Medical Imaging

    2014-06-01

    First publication to be devoted to the subject. Reviews an advanced, promising application in healthcare. Spans multiple medical disciplines. The rapid evolution in cardiac computed tomography during the past decade has improved spatial and temporal resolution to the extent that cardiac CT is now an accepted alternative for the non-invasive interrogation of the heart. Beyond the assessment of cardiac structure and ventricular function, recent research has identified yet another promising CT application for the comprehensive diagnosis of coronary heart disease, namely the assessment of myocardial perfusion and viability. In this book, the first to be devoted to this novel application of CT, leading experts from across the world present up-to-date information and consider future directions. After short sections outlining the state of the art in the traditional applications of CT to image structure and function, the full range of CT techniques that may be employed to evaluate the myocardial blood supply are discussed in detail. Similarly, diverse CT approaches for the assessment of myocardial viability are described, with careful consideration of the available experimental and clinical evidence and the role of quantitative imaging.

  7. Normal myocardial perfusion imaging in the presence of significant coronary artery stenosis

    Tian Yueqin; He Zuoxiang; Fang Wei; Yang Minfu; Shen Rui

    2007-01-01

    Objective: The aim of this study was to investigate the factors which might result in normal myocardial perfusion imaging in the presence of significant coronary artery stenosis. Methods: One hundred and thirty-three patients [mean age of (59±10) years, 98 men, 35 women] who underwent coronary angiography and myocardial perfusion SPECT were retrospectively analyzed. Results: Forty-six (35%) patients performed adequate bicycle exercise testing and achieved more than 85% of their predicted maximal heart rates; while 87 (65%) patients did not. Eighty-four (63%) patients had single coronary stenosis, 31(23%) two-vessel and 17(13%) three-vessel diseases. The difference in stenosis severity among the vessels in 13 (76%) cases with three-vessel diseases was not more than 20%. There were totally 202 coronary artery stenosis: 93 (46%) in left anterior descending coronary artery (LAD), 52 (26%) left circumflex coronary artery (LCX), 52(26% ) right coronary artery (RCA) and 5 (2%) left main coronary artery (LM) disease. Eighty-six(43%) vessels had 50%-70% stenosis, 100 (49%) >70%-90% and 16(8% )more than 90%. Conclusion: Normal myocardial perfusion imaging with significant coronary artery stenosis can probably due to inadequate exercise, single vessel disease and mild to moderate stenotic lesion. (authors)

  8. Assessment of the metabolic effects of the ionophore grisorixin on myocardial cells in culture with 14-C-labelled substrates

    Maublant, J.C.; Gachon, P.; Ross, M.R.; Davidson, W.D.; Mena, I.

    1984-01-01

    Cultures of myocardial cells were utilized to verify the hypothesis that the ionophore grisorixin could facilitate the anaerobic and impair the aerobic metabolism in the myocardium. This was suggested by previous experiments in which the authors found an increase in the cardiac work without increase in the oxygen consumption, while the myocardial uptake of 123-Iodo-hexadecenoic acid was decreased. Tissue cultures were prepared by trypsinization of the myocardium of two to four-day old newborn mice. The cultures were incubated with 14-C-glucose (n=10), 14-C-octanoate (n=14) or 14-C-acetate (n=12). Except for the controls (n=19), they also received 1 μg/ml of an alcoholic solution of grisorixin or 200 μl of 60% alcohol. The cultures were then placed in a circuit with a closed circulation of air which passed through a vibrating reed electrometer for detection of the beta radiations of the 14-CO/sub 2/ liberated by the 14-C labelled substrates. The activity was permanently recorded for measurements of the rate of consumption of these substrates. Compared to the control values, the metabolic rate with grisorixin was significantly decreased for octanoate (77 +- 22 vs 169 +- 62 rho mole/min/mg prot, rho<0.01) and acetate (2.7 +- 1.0 vs 6.0 +- 1.3 rho mole/min/mg prot, rho<0.01). The results for glucose were 1.05 +- 0.24 vs 0.88 +- 0.24 n mole/min/mg prot, (rho<0.10). Alcohol alone produced no significant effect except on the octanoate consumption. These results provide direct evidence that grisorixin favors the anaerobic pathway in the metabolism of the myocardial cells

  9. Imaging the inflammatory response to acute myocardial infarction in man using indium-111-labeled autologous platelets

    Davies, R.A.; Thakur, M.L.; Berger, H.J.; Wackers, F.J.T.; Gottschalk, A.; Zaret, B.L.

    1981-01-01

    The feasibility of imaging the inflammatory response to acute transmural myocardial infarction in man using indium-111 ( 111 In)-labeled autologous leukocytes was assessed in 36 patients. Indium-111 leukocytes were injected i.v. 18 to 112 hs after the onset of chest pain. Cardiac imaging was performed 24 hs later with a mobile gamma camera. Twenty-one patients had positive images and 15 had negative images. The percent of positive images increased as the interval between infarction and 111 In-leukocyte injection shortened; all patients injected within 24 hs of infarction had positive images. Patients with positive images were injected with 111 In leukocytes earlier after infarction and were younger than those with negative images. Several other parameters that could possibly have affected the imaging results were examined and were not significantly different in patients with positive and negative images. These included peak serum creatine kinase, location of infarction, incidence of pericarditis, use of antiinflammatory drugs or membrane-active antiarrhythmic drugs, peripheral leukocyte count, and cell labeling efficiency. The function of the labeled cells was similar in patients with positive and negative images. Six patients with acute infarction serving as controls and given free 111 In-oxine and six patients with stable coronary artery disease given 111 In-leukocytes all had negative cardiac images

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

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

    2008-01-01

    BACKGROUND: The aim of this study was to explore the feasibility of using a technique based on artificial neural networks for quality assurance of image reporting. The networks were used to identify potentially suboptimal or erroneous interpretations of myocardial perfusion scintigrams (MPS......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...... cases. Forty-six of the 53 cases (87%) came from the group selected by the neural networks, and only seven (13%) were control cases (P

  11. Emission computed tomography using rotating gamma cameras for stress 201Tl myocardial imaging

    Takeda, Kan; Maeda, Hisato; Nakagawa, Tsuyoshi; Yamaguchi, Nobuo; Taguchi, Mitsuo

    1983-01-01

    The purpose of this study is to evaluate the efficacy of emission computed tomography (ECT) for stress 201 Tl myocardial imaging to localize coronary artery disease (CAD) in comparison with planar (PL) images. In a series of 14 normal subjects and 53 patients with CAD proved coronary arteriography, ECT and PL imaging were performed successively. ECT data were collected for 90 projections in a 64 x 64 matrix form with a total aquisition time of 6 munutes over 180 0 of opposed dual cameras ratation and tomographic sections oriented perpendicular and parallel to the long axis of left ventricle were reconstructed. PL images were obtained for left lateral, left anterior oblique (30 0 and 45 0 ) and anterior projections. Both ECT and PL myocardial images were divided into 8 segments and segmental analysis was performed by visual interpretation. The ECT images remarkably increased sensitivity over the PL images in left anterior descending (LAD) artery (from 56% to 76%), right coronary artery (RCA) (from 50% to 96%), and circumflex artery (CX) (from 56% to 69%) lesions. The specificity for ECT images, as compared with PL images, was higher in LAD (88% against 85%) but slightly lower in RCA (70% ag ainst 72%) and CX (84% against 88%). Overall accuracy, therefore, was improved in LAD (from 67% to 81%) and RCA (from 64% to 79%) but equal in CX (81%). We conclude that stress 201 Tl ECT imaging result in a remarkable improvement in the localization of CAD, especially in patients with RCA lesions and multi-vessel disease. (author)

  12. Canine study on myocardial ischemic memory with 18F-FDG PET/CT imaging

    Xie Boqia; Yang Minfu; Dou Kefei; Han Chunlei; Tian Yi; Zhang Ping; Yang Zihe; Yin Jiye; Wang Hao

    2012-01-01

    Objective: To explore whether the existence and duration of ischemia measured by dynamic 18 F-FDG PET/CT imaging correlated with the extent of myocardial ischemia in a canine model of myocardial ischemia-reperfusion. Methods: Canine coronary artery occlusion was carried out for 20 min (n=4) and for 40 min (n=4) followed by 24 h of open-artery reperfusion. All dogs underwent dynamic 18 F-FDG PET/CT and 99 Tc m -MIBI SPECT imaging at baseline and 1 h and 24 h after reperfusion.Quantitative analysis of myocardial 18 F-FDG uptake was performed using Carimas Core software,and the extraction ratio of 18 F-FDG (K) was calculated by the ratio of 18 F-FDG uptake rate in the ischemic area (k ischemia ) and normoperfused region (k normoperfused ). Echocardiographic data were also acquired between each PET/CT imaging study to detect the wall motion in the ischemic and normoperfused myocardium. Paired t test and non-parametric statistical tests, measured by SPSS 19.0, were used to analyze the data. Results: Coronary occlusion produced sustained, abnormal wall motion in the ischemic region for more than 1 h. Similar K values were demonstrated between the 20 min and 40 min groups at baseline (1.02 ±0.06 and 1.03 ±0.05, Z=-0.29, P>0.05). At 1 h after reperfusion, the reperfusion regions showed normal perfusion but with increased 18 F-FDG uptake, which was higher in the 40 min ischemic group than in the 20 min ischemic group (2.31 ±0.13 and 1.87 ±0.09, Z=-2.31, P<0.05). At 24 h after reperfusion, however, only the 40 min ischemic group showed slightly higher 18 F-FDG uptake than baseline (1.15 ± 0.02 and 1.03 ±0.05, t=4.32, P<0.05), whereas no significant difference was found in the 20 min ischemic group (1.05 ± 0.04 and 1.02 ± 0.06, t=0.87, P>0.05). Histological examination of the ischemic myocardium from both groups revealed neatly arranged cells without interstitial edema, hemorrhage nor inflammatory response. Conclusions: Myocardial 'ischemic memory' was

  13. Study of myocardial fatty acid metabolism of inactive sportsmen with 123-heptadecanoic acid (HDA) in the framework of complex cardiological examinations

    Horvath, Mihaly; Pszota, Agnes; Karman, Miklos; Szakacs, Agnes; Nemeth, Laszlo; Boeszermenyi, Ernoe; Erdelyi, Kalman; Buzassy, Gyoergy; Csendes, Eva

    1986-01-01

    8 inactive sportsmen and 8 heavy physical workers with similar mean age (36 years) and mean body surface (2 m 2 ) were analysed functionally and metabolically for myocardial hypertrophy. 123 I-heptadecanoic acid (HDA) scintigraphy and kinetics were carried out with methods of Feinendegen and Dudczak and using Hungarian gamma-camera. In both groups good correlation was found between the myocardial uptake of 123 I-HDA and 201 Tl. Regional alterations of myocardial perfusion during ergometric load were analyzed and compared to alterations of the ECG and echo. (author)

  14. Usefulness of rest-redistribution on thallium myocardial scintigraphy in patients with acute myocardial infarction by SPECT; Analysis by bull's eye and unfolded map images

    Tahara, Yorio; Taya, Makoto; Sasaki, Akira; Nishimura, Tooru; Shimoyama, Katsuya; Mizuno, Haruyoshi; Ono, Akifumi; Okada, Michio; Ishikawa, Kyozo (Kyorin Univ., Mitaka, Tokyo (Japan). School of Medicine)

    1990-01-01

    The purpose of this study was to clarify the clinical significance of rest-redistribution in myocardial scintigraphy (SPECT) in acute myocardial infarction (AMI). 30 patients with AMI within one week after the onset of attack were studied. SPECT images were obtained 10 min and 3hrs after injection of {sup 201}Tl. Bull's eye images and unfolded map images were prepared. A {sup 201}Tl uptake was studied at the infarct and non-infarct sites. Exercise SPECT and radionuclide angiography were performed in all patients one month after the onset of AMI, and the findings were compared with clinical and coronary angiographic (CAG) findings. Redistribution of Tl at rest was observed at the infarct sites in 9 of the 30 patients. Redistribution at rest was observed at the non-infarct sites in 8 patients. Redistribution at rest was observed during exercise SPECT one month after the onset of AMI in patients with redistribution at rest in the acute phase. In patients with redistribution at rest at the infarct site, left ventricular ejection fraction (EF) improved one month after the onset of AMI ({Delta}EF>5%), but it decreased slightly during exercise. Wall motion at the infarct site was not much impaired in patients who showed redistribution at rest at the infarct site. Angina pectoris and recurrence of myocardial infarction were observed more frequently on SPECT, but no characteristic findings were obtained on CAG in those with redistribution at rest. In conclusion, cardiac function and wall motion at the infarct site are better preserved in patients with redistribution of Tl at rest on SPECT in the acute stage of myocardial infarction, as compared with patients having fixed defects, but the EF decrease slightly during exercise and the frequency of post-infarction angina is greater in those patients. Resting SPECT in AMI is considered to provide useful information for predicting cardiac function and the clinical course following myocardial infarction. (author).

  15. Diagnostic value of rest and stress gated 82Rb PET myocardial perfusion imaging using quantitative software

    Shi Hongcheng; Gu Yusen; Liu Wenguan; Zhu Weimin; Halkar, R.K.; Santana, C.A.; Feng Yusheng

    2008-01-01

    Objective: Gated myocardial perfusion imaging (MPI) is regularly performed using SPECT. More recently, gated 82 Rb MPI has been used to assess left ventricular myocardial perfusion and function with new generation PET scanners. The objective of this study was to evaluate the value of rest and stress gated 82 Rb PET myocardial perfusion imaging and to determine whether the quantitative technique in- creased the confidence level of the interpreters. Methods: Thirty-two patients underwent rest and adenosine stress gated 82 Pb PET MPI. Emory Cardiac Toolbox quantitative software was used for processing and inter-predation. Left ventricular ejection fraction (LVEF), end-diastolic, end-systolic and transient ischemia dilation ratio were automatically generated. Three interpreters (nuclear medicine doctors) independently reviewed the studies. Visual scoring (1-5 scales: excellent, good, unsure, poor, uninterpretable) was used to assess the overall quality of the gated images and the added confidence level of interpretation. Visual assessment of the LVEF was compared to the automatically generated LVEF. Comparison between the visual assessment and software generated was graded on a 1- 5 scales (helpful, probably helpful, unsure, probably not helpful, definitely not helpful). The analysed items were divided into two groups (favorable group and negative group). The percentage and 95% confidence intervals of each group were calculated. Results: A total of 192 gated studies were evaluated (64 gated x 3 interpreters ). The overall quality of the gated images was good [excellent 40.1% (77/192), good 43.2% (83/192), unsure 3.1% (6/192), poor 13.6% (26/192), uninterpretable 0]. The 95% confidence intervals of good and excellent quality range from 78.1% to 88.6%. The interpreter's agreed with the automated LVEF on 85.4% of the gated images [agree 76.6% (147/192), probably agree 8.8% (17/192), unsure 3.1% (6/192), probably disagree 8.8% (17/192), disagree 2.6% (5/192)]. And its 95

  16. Image quality improvements using adaptive statistical iterative reconstruction for evaluating chronic myocardial infarction using iodine density images with spectral CT.

    Kishimoto, Junichi; Ohta, Yasutoshi; Kitao, Shinichiro; Watanabe, Tomomi; Ogawa, Toshihide

    2018-04-01

    Single-source dual-energy CT (ssDECT) allows the reconstruction of iodine density images (IDIs) from projection based computing. We hypothesized that adding adaptive statistical iterative reconstruction (ASiR) could improve image quality. The aim of our study was to evaluate the effect and determine the optimal blend percentages of ASiR for IDI of myocardial late iodine enhancement (LIE) in the evaluation of chronic myocardial infarction using ssDECT. A total of 28 patients underwent cardiac LIE using a ssDECT scanner. IDIs between 0 and 100% of ASiR contributions in 10% increments were reconstructed. The signal-to-noise ratio (SNR) of remote myocardia and the contrast-to-noise ratio (CNR) of infarcted myocardia were measured. Transmural extent of infarction was graded using a 5-point scale. The SNR, CNR, and transmural extent were assessed for each ASiR contribution ratio. The transmural extents were compared with MRI as a reference standard. Compared to 0% ASiR, the use of 20-100% ASiR resulted in a reduction of image noise (p ASiR images, reconstruction with 100% ASiR image showed the highest improvement in SNR (229%; p ASiR above 80% showed the highest ratio (73.7%) of accurate transmural extent classification. In conclusion, ASiR intensity of 80-100% in IDIs can improve image quality without changes in signal and maximizes the accuracy of transmural extent in infarcted myocardium.

  17. The value of myocardial perfusion imaging in differentiating between idiopathic dilated cardiomyopathy from the ischemic form

    Fad, A.; Emami, F.; Eftekhari, M.; Saghari, M.; Fallahi, B.; Beiki, D.; Tkavar, A.

    2004-01-01

    Introduction: differentiating between ischemic cardiomyopathy and idiopathic dilated cardiomyopathy is important as coronary revascularization can improve prognosis in the ischemic subgroup. Due to inherent problems of coronary angiography in patients with depressed ejection fraction introducing a noninvasive tool to diagnose those who will benefit from angiography seems to be rewarding. We examined usefulness of myocardial perfusion scan in this group of patients. Materials and methods: study was performed on 64 patients (62 male and 2 female) aged 57.1 ± 6.7 y (mean ± SD) all with dilation of the left ventricular cavity and ejection fraction less than 40 % by echocardiography. Myocardial perfusion scan was performed in stress and rest phases. All the patients had coronary angiography which was used as the gold standard test. On each set of images, heart was arbitrary divided into 17 segments and perfusion abnormality in each segment was scored by a 5 grade scoring system (0-4). Summed stress Score was used as the scan criteria to differentiate dilated ischemic from idiopathic cardiomyopathy. Scores more than 17 were considered ischemic, and less than that, idiopathic. Results were compared with angiography. Results: from total 40 cases of ischemic cardiomyopathy (proved by angiography) 39 were correctly diagnosed by scan and only one case was mis categorized as idiopathic dilated cardiomyopathy . All 24 cases of idiopathic dilated cardiomyopathy were correctly diagnosed by scintigraphy. Sensitivity, specificity, positive predictive value, and negative predictive value of myocardial perfusion imaging for discrimination between ischemic and idiopathic dilated cardiomyopathy were 97.5 %, 100 %, 100 %, and 96 % respectively. Conclusion: Considering excellent accuracy of myocardial perfusion scan with scoring system in discrimination of ischemic dilated cardiomyopathy from idiopathic cardiomyopathy, this noninvasive test could be considered the main diagnostic test

  18. Diagnostic performance of combined noninvasive coronary angiography and myocardial perfusion imaging using 320 row detector computed tomography

    Vavere, Andrea L; Simon, Gregory G; George, Richard T

    2013-01-01

    Multidetector coronary computed tomography angiography (CTA) is a promising modality for widespread clinical application because of its noninvasive nature and high diagnostic accuracy as found in previous studies using 64 to 320 simultaneous detector rows. It is, however, limited in its ability...... to detect myocardial ischemia. In this article, we describe the design of the CORE320 study ("Combined coronary atherosclerosis and myocardial perfusion evaluation using 320 detector row computed tomography"). This prospective, multicenter, multinational study is unique in that it is designed to assess...... the diagnostic performance of combined 320-row CTA and myocardial CT perfusion imaging (CTP) in comparison with the combination of invasive coronary angiography and single-photon emission computed tomography myocardial perfusion imaging (SPECT-MPI). The trial is being performed at 16 medical centers located in 8...

  19. Thallium-201 myocardial imaging in young adults with anomalous left coronary artery arising from the pulmonary artery

    Moodie, D.S.; Cook, S.A.; Gill, C.C.; Napoli, C.A.

    1980-01-01

    Anomalous origin of the left coronary artery from the pulmonary artery (Bland-Garland-White syndrome) may produce myocardial ischemia, infarction, and frequently death in infancy. Some patients, however, develop satisfactory coronary artery collaterals and are relatively asymptomatic into adulthood. Very little is known about their myocardial perfusion patterns. We studied three young adults with this condition using stress thallium-201 myocardial imaging. Electrocardiograms in two patients demonstrated old arterolateral myocardial infarctions. Preoperative stress exercise tests were positive in all three patients. Marked perfusion abnormalities were found in the proximal anterolateral wall in all patients, and one patient also had a posterolateral defect. Postoperatively, all stress tests returned to normal. Thallium imaging demonstrated improvement in ischemic areas, but old scars persisted

  20. Uptake of myocardial imaging agents by rejected hearts

    Bergsland, J.; Carr, E.A.; Carroll, M.; Wright, J.W.; Feldman, M.J.; Massucci, J.; Bhayana, J.N.; Gona, J.M.

    1985-01-01

    Technetium 99 m pyrophosphate, Gallium 67 and Thallium 201 uptakes were measured in heterotopically transplanted rat hearts. Five days after transplantation, Technetium 99 m pyrophosphate, and Gallium 67 uptakes were significantly higher in allogeneic grafts than in syngeneic grafts. At an early stage of rejection (three days after transplantation), only Technetium 99 m pyrophosphate uptake in the left ventricle of allogeneic grafts showed a significant difference (p less than 0.04). At five days, Thallium 201 uptake was significantly lower in allo- than syngeneic grafts. There was a positive correlation between radionuclide uptake and histologic degree of rejection for Technetium 99 m pyrophosphate and Gallium 67 while Thallium 201 uptake correlated negatively. Analysis of variance revealed that hearts with no or minimal rejection had statistically different uptakes than hearts with mild to moderate rejection. These results suggest that uptake of imaging agents might be useful in the diagnosis of rejection of the transplanted heart

  1. Myocardial imaging with 9-[Te-123m]tellurapheptadecanoic acid

    Elmaleh, D.R.; Knapp, F.F.; Yasuda, T.; Coffey, J.L.; Kopiwoda, S.; Okada, R.; Strauss, W.H.

    1981-01-01

    The distribution of radioactivity in the myocardium of rats and dogs infarcted by ligation of the left anterior coronary artery has been determined after intravenous injection of 9-[Te-123m]telluraheptadecanoic acid (Te-123m HDA). In rats the normal myocardium concentrated radioactivity (3.7% +/- 0.28 injected dose/g) to nearly three times that in the zones of infarction (1.12% +/- 0.18 dose/g). The focal defects detected in the gamma-camera images of rats and dogs correspond well with areas of infarction identified in the excised hearts by staining with triphenyltetrazolium chloride. The distribution of radioactivity from Te-123m HDA in dog hearts sectioned at autopsy showed a linear correlation (r = 0.94) with blood flow as determined with scandium-46-labeled microspheres

  2. Myocardial scintigraphy

    Bunko, Hisashi; Hisada, Kinichi

    1982-01-01

    Among the various methods of image diagnosis of the cardiovascular disorder, nuclear cardiology provides noninvasive means for evaluation of myocardial perfusion as well as morphological and functional informations. In this article, clinical application and image diagnosis of myocardial scintigraphy including Tl-201 myocardial perfusion scintigraphy, single photon emission computed tomography with Tl-201, acute myocardial infarction scintigraphy with Tc-99m-pyrophosphate and Ga-67 imaging of the heart, were discussed. Multiplanar imaging of the heart with Tl-201 after stress and at redistribution was the accepted method for detection and evaluation of the ischemic heart disease. Although it achieved high sensitivity and specificity for ischemic heart disease, detection of the small ischemia and quantation of the regional Tl-201 accumulation were difficult with conventional multiplanar imaging. Application of emission computed tomography improved detectability and quantitativity of the ischemia. However, 7-pinhole tomography did not increase the diagnostic accuracy significantly. It had limited clinical applicability due to poor quantitativity in spite of improved image contrast and its tomographic nature. Advantage and limitation of these tomographic imaging and multiplanar imaging were discussed. Problems and prognostic significance of pyrophosphate imaging of the acute myocardial infarction were also discussed. Visualization of the heart with Ga-67 was helpful for identification of the tumor or inflammation of the heart as well as evaluation of the effect of the therapy. (author)

  3. Thallium-201 myocardial imaging during pharmacologic coronary vasodilation: comparison of oral and intravenous administration of dipyridamole

    Taillefer, R.; Lette, J.; Phaneuf, D.C.; Leveille, J.; Lemire, F.; Essiambre, R.

    1986-01-01

    Although the diagnostic utility of thallium-201 myocardial imaging after dipyridamole infusion is well established, the intravenous form of the drug is not yet commercially available in North America. Fifty patients referred for coronary angiography were prospectively studied. Within a 2 week period, each patient underwent cardiac catheterization and thallium-201 myocardial imaging after both oral and intravenous dipyridamole administration. For the oral protocol, patients were randomly assigned to treatment with either 200 or 400 mg of dipyridamole in tablet form. Coronary artery stenoses of 70% or greater were considered significant. For the 25 patients who received a 200 mg oral dose of dipyridamole, the scintigraphic study showed perfusion defects in 65% of patients with significant coronary artery disease after the oral dose and in 85% of patients after the intravenous dose. For the 25 patients who received a 400 mg oral dose, the sensitivity of the scintigram was 84% after the oral dose and 79% after the intravenous dose. Except for headache and nausea, side effects were less severe and less frequent with oral (either 200 or 400 mg) than with intravenous dipyridamole. Because of the delayed and variable absorption of dipyridamole tablets, the oral studies required a longer period of medical supervision (45 to 60 minutes), and aminophylline was empirically administered after completion of the first set of thallium-201 images. It is concluded from this study that thallium-201 myocardial imaging after coronary vasodilation with a 400 mg oral dose of dipyridamole is a safe, widely available and reliable alternative for the evaluation of coronary artery disease in patients unable to achieve an adequate exercise level on stress testing

  4. Effects of Ropivacaine and Bupivacaine on Rabbit Myocardial Energetic Metabolism and Mitochondria Oxidation

    张诗海; 姚尚龙; 李晴

    2003-01-01

    Summary: To compare the cardiotoxicity induced by ropivacaine and bupivacaine and to investigatethe mechanism of cardiotoxicity, 24 mature New Zealand rabbits were divided randomly into controlgroup (group C), ropivacaine group (group R) and bupivacaine group (group B). Hearts were drawnout rapidly from the anesthetized animals and cardiac perfusion was performed immediately. Ropiva-caine 500 ng/ml (group R) or bupivacaine 500 ng/ml (group B) was added to the perfusion solution.Ventricular myocardial ATP, ADP and AMP were measured with high performance liquid chro-matogram. The ability of myocardial mitochondria oxidation to pyruvate or palmitoylcarnitine wasdetected with Clark electrode. Our results showed that myocardial ATP and ADP decreased signifi-cantly (P<0. 05) in group R and most significantly (P<0. 01) in group B as compared with groupC. Myocardial ATP and ADP decreased most significantly (P<0. 01) in group B as compared withgroup R. The changes of myocardial AMP revealed significant difference among three groups. Thechanges of pyruvate oxidation exibited no significant difference among the three groups. Palmitoyl-carnitine oxidation decreased markedly (P<0. 05) in group R and most significantly (P<0. 01) ingroup B as compared with group C. The present study indicated that the inhibition of lipid substrateoxidation may be responsible for the cardiotoxicity induced by bupivacaine and ropivacaine. The car-diotoxicity induced by ropivacaine is far more less than bupivacaine.

  5. Myocardial multilayer strain does not provide additional value for detection of myocardial viability assessed by SPECT imaging over and beyond standard strain.

    Orloff, Elisabeth; Fournier, Pauline; Bouisset, Frédéric; Moine, Thomas; Cournot, Maxime; Elbaz, Meyer; Carrié, Didier; Galinier, Michel; Lairez, Olivier; Cognet, Thomas

    2018-05-14

    The aim of this study was to evaluate the value of multilayer strain analysis to the assessment of myocardial viability (MV) through the comparison of both speckle tracking echocardiography and single-photon emission computed tomography (SPECT) imaging. We also intended to determine which segmental longitudinal strain (LS) cutoff value would be optimal to discriminate viable myocardium. We included 47 patients (average age: 61 ± 11 years) referred to our cardiac imaging center for MV evaluation. All patients underwent transthoracic echocardiography with measures of LS, SPECT, and coronary angiography. In all, 799 segments were analyzed. We correlated myocardial tracer uptake by SPECT with sub-endocardial, sub-epicardial, and mid-segmental LS values with r = .514 P Multilayer strain analysis does not evaluate MV with more accuracy than standard segmental LS analysis. © 2018 Wiley Periodicals, Inc.

  6. The value of gated myocardial perfusion imaging for the evaluation of early treatment effectiveness of ischemic heart disease using Ad-HGF myocardial injection

    Feng Jianlin; Cheng Xu; Li Jianhua; Xu Zhaoqiang; Li Dianfu; Yuan Biao; Zhang Yourong; Cao Kejiang; Huang Jun

    2008-01-01

    Objective: Hepatocyte growth factor (HGF) has multipotent actions mediated by c- Mesenchymal epithelial transition factor (Met) receptor. Preclinical studies in animal models of myocardial ischemia demonstrated that treatment with HGF could benefit myocardial perfusion, cardiac remodeling, angiogenesis and myocardial function. This study used gated 99 Tc m -methoxyisobutylisonitrile (MIBI) myocardial perfusion imaging (G-MPI) to assess the early treatment effectiveness of adenovirus HGF (Ad-HGF) directly administered in ischemic heart disease (IHD) patients. Methods: Eighteen patients with IHD were divided into 3 groups receiving low dose [5 x 10 8 plaque forming unit (PFU)/site], medium (1.5 x 10 9 PFU/site) and high dose (5 x l0 9 PFU/site) of Ad-HGF. And the Ad-HGF was injected at 10 sites in each patient. Rest G-MPI was performed before and after treatment for myocardial perfusion and left ventricular function measurement. Stata 7.0 was used to analyse the data. Results: (1) After Ad-HGF, myocardial perfusion was improved in 3/6, 5/6 and 6/6 patients in low, medium and high dosage groups. The dosage of AD-HGF was closely correlated with the improvement of myocardial perfusion (χ 2 =4.34, P<0.05). (2) Left ventricular ejection fraction (LVEF) was significantly increased [(50.1 ± 6.4)% vs (58.7 ± 5.6)%, t=6.1, P<0.01], end-diastolic volume [EDV, (137.7 ± 33.2) ml vs (123.7 ± 32.7) ml] and end-systolic volume [ESV, (70.2 ± 22.4) ml vs (51.9 ± 14.9) ml] were significantly reduced. (3) The LVEFs were increased in all groups, and the LVEF improvement in the high dosage group [(8.6 ± 5.9)%] was significantly greater than the other two groups [(4.3 ± l.2)%, (6.8 ± 5.7)%]. The difference of post-treatment improvement on LVEF between the low and medium dosage groups was not significant. The dosage of Ad-HGF was closely correlated with the improvement of LVEF (r=0.67, P< 0.01). Conclusion: G-MPI is a reliable method for evaluating the early effectiveness of

  7. A feed forward neural network for classification of bull's-eye myocardial perfusion images

    Hamilton, D.; Riley, P.J.; Miola, U.J.; Amro, A.A.

    1995-01-01

    Identification of hypoperfused areas in myocardial perfusion single-photon emission tomography studies can be aided by bull's-eye representation of raw counts, lesion extent and lesion severity, the latter two being produced by comparison of the raw bull's-eye data with a normal data base. An artificial intelligence technique which is presently becoming widely popular and which is particularly suitable for pattern recognition is that of artificial neural network. We have studied the ability of feed forward neural networks to extract patterns from bull's-eye data by assessing their capability to predict lesion presence without direct comparison with a normal data base. Studies were undertaken on both simulation data and on real stress-rest data obtained from 410 male patients undergoing routine thallium-201 myocardial perfusion scintigraphy. The ability of trained neural networks to predict lesion presence was quantified by calculating the areas under receiver operating characteristic curves. Figures as high as 0.96 for non-preclassified patient data were obtained, corresponding to an accuracy of 92%. The results demonstrate that neural networks can accurately classify patterns from bull's-eye myocardial perfusion images and detect the presence of hypoperfused areas without the need for comparison with a normal data base. Preliminary work suggests that this technique could be used to study perfusion patterns in the myocardium and their correlation with clinical parameters. (orig.)

  8. Impact of chronic kidney disease and stress myocardial perfusion imaging as a predictor of cardiovascular events

    Furuhashi, Tatsuhiko; Joki, Nobuhiko; Hase, Hiroki; Masai, Hirofumi; Kunimasa, Taeko; Nakazato, Ryo; Fukuda, Hiroshi; Sugi, Kaoru; Moroi, Masao

    2011-01-01

    Stress myocardial perfusion imaging (MPI) is an established means of predicting cardiovascular events and is suitable in chronic kidney disease (CKD) patients. We aimed to evaluate the prognostic value of CKD parameters and an abnormal stress MPI for cardiovascular events. A total of 495 patients with suspected coronary artery disease (CAD) or history of CAD including 130 CKD patients not undergoing hemodialysis, underwent stress MPI (313 males, mean age 70 years) and were followed up for 14 months (mean period). CKD was defined as an estimated GFR of 2 and/or persistent proteinuria. Cardiovascular events were defined as sudden cardiac death, acute coronary syndrome and congestive heart failure requiring hospitalization. Cardiovascular events occurred in 41 (8.3%) patients. Multivariate Cox regression analysis indicated that CKD [hazard ratio (HR) =3.76, p<0.001] and a stress MPI summed difference score (SDS) of ≥2 (HR=3.78, p<0.001) were independent predictors of cardiovascular events; CKD plus abnormal stress MPI was also a strong predictor of cardiovascular events (non-CKD and SDS <2 vs. CKD and SDS ≥2, HR=15.9, p<0.001). Both CKD and myocardial ischemia detected by stress MPI are independent predictors for cardiovascular events. Coexistence of CKD and myocardial ischemia detected by stress MPI is more useful for short-term risk stratification of cardiovascular events. (author)

  9. Imaging Three-Dimensional Myocardial Mechanics Using Navigator-gated Volumetric Spiral Cine DENSE MRI

    Zhong, Xiaodong; Spottiswoode, Bruce S.; Meyer, Craig H.; Kramer, Christopher M.; Epstein, Frederick H.

    2010-01-01

    A navigator-gated 3D spiral cine displacement encoding with stimulated echoes (DENSE) pulse sequence for imaging 3D myocardial mechanics was developed. In addition, previously-described 2D post-processing algorithms including phase unwrapping, tissue tracking, and strain tensor calculation for the left ventricle (LV) were extended to 3D. These 3D methods were evaluated in 5 healthy volunteers, using 2D cine DENSE and historical 3D myocardial tagging as reference standards. With an average scan time of 20.5 ± 5.7 minutes, 3D data sets with a matrix size of 128 × 128 × 22, voxel size of 2.8 × 2.8 × 5.0 mm3, and temporal resolution of 32 ms were obtained with displacement encoding in three orthogonal directions. Mean values for end-systolic mid-ventricular mid-wall radial, circumferential, and longitudinal strain were 0.33 ± 0.10, −0.17 ± 0.02, and −0.16 ± 0.02, respectively. Transmural strain gradients were detected in the radial and circumferential directions, reflecting high spatial resolution. Good agreement by linear correlation and Bland-Altman analysis was achieved when comparing normal strains measured by 2D and 3D cine DENSE. Also, the 3D strains, twist, and torsion results obtained by 3D cine DENSE were in good agreement with historical values measured by 3D myocardial tagging. PMID:20574967

  10. Post-mortem cardiac diffusion tensor imaging: detection of myocardial infarction and remodeling of myofiber architecture

    Winklhofer, Sebastian; Berger, Nicole; Stolzmann, Paul [University Hospital Zurich, Institute of Diagnostic and Interventional Radiology, Zurich (Switzerland); University of Zurich, Department of Forensic Medicine and Radiology, Institute of Forensic Medicine, Zurich (Switzerland); Stoeck, Christian T.; Kozerke, Sebastian [Institute for Biomedical Engineering University and ETH Zurich, Zurich (Switzerland); Thali, Michael [University of Zurich, Department of Forensic Medicine and Radiology, Institute of Forensic Medicine, Zurich (Switzerland); Manka, Robert [University Hospital Zurich, Institute of Diagnostic and Interventional Radiology, Zurich (Switzerland); Institute for Biomedical Engineering University and ETH Zurich, Zurich (Switzerland); University Hospital Zurich, Clinic for Cardiology, Zurich (Switzerland); Alkadhi, Hatem [University Hospital Zurich, Institute of Diagnostic and Interventional Radiology, Zurich (Switzerland)

    2014-11-15

    To investigate the accuracy of post-mortem diffusion tensor imaging (DTI) for the detection of myocardial infarction (MI) and to demonstrate the feasibility of helix angle (HA) calculation to study remodelling of myofibre architecture. Cardiac DTI was performed in 26 deceased subjects prior to autopsy for medicolegal reasons. Fractional anisotropy (FA) and mean diffusivity (MD) were determined. Accuracy was calculated on per-segment (AHA classification), per-territory, and per-patient basis, with pathology as reference standard. HAs were calculated and compared between healthy segments and those with MI. Autopsy demonstrated MI in 61/440 segments (13.9 %) in 12/26 deceased subjects. Healthy myocardial segments had significantly higher FA (p < 0.01) and lower MD (p < 0.001) compared to segments with MI. Multivariate logistic regression demonstrated that FA (p < 0.10) and MD (p = 0.01) with the covariate post-mortem time (p < 0.01) predicted MI with an accuracy of 0.73. Analysis of HA distribution demonstrated remodelling of myofibre architecture, with significant differences between healthy segments and segments with chronic (p < 0.001) but not with acute MI (p > 0.05). Post-mortem cardiac DTI enablesdifferentiation between healthy and infarcted myocardial segments by means of FA and MD. HA assessment allows for the demonstration of remodelling of myofibre architecture following chronic MI. (orig.)

  11. Safety of intravenous dipyridamole thallium myocardial perfusion imaging: experience in 435 patients

    Dubrey, S.W.; Noble, M.I.M.; Jewkes, R.F.; Bomanji, J.B.

    1993-01-01

    Dipyridamole stress 201 T1 scintigraphy is widely used in the investigation of myocardial ischaemia. We report our experience of adverse effects observed during this diagnostic procedure. A prospective study was undertaken of 435 consecutive patients referred to two nuclear medicine departments for assessment of myocardial perfusion. Patients were monitored prior to and following the infusion of dipyridamole. All symptomatic, haemodynamic and electrocardiographic changes were documented. No deaths occurred in this series. Adverse events were observed in 174 (40%) patients. Of these, three patients experienced 'major' adverse events (0.6%) requiring hospitalization (myocardial infarction = 1; chest pain = 1; simple partial seizure = 1). 'Moderate' adverse events occurred in 39 (8.9%) patients and required intravenous aminophylline to reverse effects (ST segment abnormalities = 26; nausea = 7; headache = 3; chest pain = 2; bronchospasm = 1; protracted vomiting = 1; diarrhoea = 1). 'Minor' adverse events were experienced by 132 (30.3%) patients and did not require aminophylline. Sixty per cent of our patients experienced no ill effects from dipyridamole given as an exercise substitute in conjunction with 201 T1 imaging. The rest had symptoms which were mostly mild, although a few patients found the experience unpleasant. Only one patient experienced a life-threatening episode. (Author)

  12. Thallium-201 myocardial imaging in evaluation of asymptomatic individuals with ischaemic ST segment depression on exercise electrocardiogram

    Caralis, D.G.; Bailey, I.; Kennedy, H.L.; Pitt, B.

    1979-01-01

    This study showed that asymptomatic adults with normal physical examination, normal resting electrocardiogram, and normal routine laboratory evaluation who had a positive exercise electrocardiogram and abnormal exercise thallium-201 myocardial image had a very high probability of angiographically significant coronary artery disease. If, on the other hand, the exercise electrocardiogram was positive for 'ischaemic' ST segment changes, but the exercise thallium image was normal, the probability for coronary disease was low. The exercise electrocardiogram combined with thallium-201 myocardial image are safe non-invasive methods which can be performed on an out-patient basis. (author)

  13. Story of rubidium-82 and advantages for myocardial perfusion PET imaging

    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 was directly proportional to myocardial blood flow, clinical studies were performed in the 80s leading to an approval in the USA in 1989. From that time thousands of patients have been tested and their results have been reported in 3 meta-analyses. Pooled patient-based sensitivity and specificity were respectively 0.91 and 0.90. By comparison with 99mTc-SPECT, 82Rb-PET had a much better diagnostic accuracy, especially in obese patients with BMI (Body Mass Index ≥30 kg/m2 (85% versus 67% with SPECT and in women with large breasts. A great advantage of 82Rb-PET is its capacity to accurately quantify myocardial blood flow. Quite importantly it has been recently shown that coronary flow reserve is associated with adverse cardiovascular events independently of luminal angiographic severity. Moreover coronary flow reserve is a functional parameter particularly useful in the estimate of microvascular dysfunction such as in diabetes mellitus. Due to the very short half-life of rubidium-82, the effective dose calculated for a rest/stress test is roughly equivalent to the annual natural exposure and even less when stress-only is performed with a low activity compatible with a good image quality with the last generation 3D PET scanners.There is still some debate on the relative advantages of 82Rb-PET with regard to 99mTc-SPECT. For the last ten years, great technological advances substantially improved performances of SPECT with its accuracy getting closer to this of 82Rb/PET. Currently the main advantages of PET are its capacity to accurately quantify myocardial blood flow and to deliver a low radiation exposure.

  14. Adenosine stress and exercise 99Tcm-MIBI myocardial perfusion imaging in the diagnosis and risk stratification of patients with unstable angina

    Jia Peng; Guo Wanhua; Xu Shoulin; Feng Xuefeng

    2008-01-01

    Objective: The aim of this study was to evaluate the clinical value of adenosine stress or exercise 99 Tc m -methoxyisobutylisonitrile (MIBI) myocardial perfusion imaging in the diagnosis and risk stratification of patients with unstable angina. Methods: Eighty-seven hospitalized patients with unstable angina [54 men and 33 women, aged of (56.5±12.5) years] underwent adenosine stress or exercise myocardial perfusion imaging and coronary angiography. Patients were followed up. Results: Fifty-seven patients had abnormal myocardial perfusion imaging and significant coronary artery stenosis. Ten patients had abnormal myocardial perfusion imaging but normal coronary angiography. Eight patients had normal myocardial perfusion imaging but significant coronary artery stenosis. Twelve patients had normal myocardial perfusion imaging and normal coronary angiography. Patients with abnormal myocardial perfusion imaging had worse prognosis. There was relationship between cardiac events and the extent and severity of myocardial ischemia. Conclusion: Adenosine stress and exercise myocardial perfusion imaging is of important clinical value in the diagnosis and risk stratification of patients with unstable angina. (authors)

  15. Disappearance of myocardial perfusion defects on prone SPECT imaging: Comparison with cardiac magnetic resonance imaging in patients without established coronary artery disease

    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.

  16. Effects of acquisition time and reconstruction algorithm on image quality, quantitative parameters, and clinical interpretation of myocardial perfusion imaging

    Enevoldsen, Lotte H; Menashi, Changez A K; Andersen, Ulrik B

    2013-01-01

    time (HT) protocols and Evolution for Cardiac Software. METHODS: We studied 45 consecutive, non-selected patients referred for a clinically indicated routine 2-day stress/rest (99m)Tc-Sestamibi myocardial perfusion SPECT. All patients underwent an FT and an HT scan. Both FT and HT scans were processed......-RR) and for quantitative analysis (FT-FBP, HT-FBP, and HT-RR). The datasets were analyzed using commercially available QGS/QPS software and read by two observers evaluating image quality and clinical interpretation. Image quality was assessed on a 10-cm visual analog scale score. RESULTS: HT imaging was associated......: Use of RR reconstruction algorithms compensates for loss of image quality associated with reduced scan time. Both HT acquisition and RR reconstruction algorithm had significant effects on motion and perfusion parameters obtained with standard software, but these effects were relatively small...

  17. [Myocardial single photon emission tomography imaging of reporter gene expression in rabbits].

    Liu, Ying; Lan, Xiao-li; Zhang, Liang; Wu, Tao; Jiang, Ri-feng; Zhang, Yong-xue

    2009-06-01

    To explore the feasibility of single photon emission computed tomography (SPECT) detection of heart reporter gene expression and observed the optimal transfecting titer and imaging time by using herpes simplex virus 1-thymidine kinase (HSV1-tk) as reporter gene and 131I-2'-fluoro-2'-deoxy-1-beta-D-arabinofuranosyl-5-iodouracil (131I-FIAU) as reporter probe in rabbit myocardium. The recombinant Ad-tk carrying HSV1-tk gene and adenovirus (Ad) as vector was constructed and intramyocardially injected to rabbits at various concentrations (1 x 10(9) pfu, 5 x 10(8) pfu, 1 x 10(8) pfu, 5 x 10(7) pfu, 1 x 10(7) pfu). Two days later, rabbits were injected with 600 microCi 131I-FIAU in ear-margin vein and then underwent SPECT myocardium imaging for detection of HSV1-tk expression at 6 h, 24 h, 48 h and 72 h after injection, rabbits with 1 x 10(9) pfu Ad-tk injection were imaged at 96 h and 120 h. Rabbits were sacrificed after imaging and the total myocardial 131I-FIAU accumulation was quantified in percent of injected dose per gram myocardium (% ID/g). The myocardial Ad-tk expression was determined with RT-PCR. Reporter gene was detected by SPECT imaging in the injection site while not detected in the control myocardium and site remote from injection. RT-PCR results also evidenced HSV1-tk express in the injection site. The SPECT target/nontarget ratio was correlated with ex vivo gamma-counting (r2 = 0.933, Ppfu by SPECT imaging. The cardiac SPECT reporter gene imaging with HSV1-tk as reporter gene and 131I-FIAU as reporter probe is feasible.

  18. Clinical application of heart rate-synchronized myocardial SPECT with {sup 99m}Tc-labeled imaging agents for myocardial blood flow

    Nishimura, Tsunehiko; Uehara, Toshiisa; Fukuchi, Kazuki; Tsujimura, Eiichiro; Hasegawa, Shinji; Ito, Yasushi; Hashimoto, Katsuji; Matsuda, Shinichi; Yutani, Kenji [Osaka Univ., Suita (Japan). Biomedical Research Center

    1996-11-01

    Application of gated SPECT to assess multiple heart functions simultaneously in authors` facility was reported. The myocardial SPECT at rest was performed 1 hr after intravenous administration of 740 MBq of {sup 99m}Tc-sestamibi with Toshiba 3-detector type gamma camera GCA9300/HG. R wave monitored by ECG was used as a trigger to record images of 360deg direction (90 sec/6deg direction, 20 directions x 3). Data were processed by Toshiba GMS-5500A or Hitachi-Medico RW3000. Percent CI (count increase at a myocardial region) was calculated by =(ES-ED)=/ED x 100, where ES and ED were computed by circumferential profile analysis of reconstruction images at the end-systole and end-diastole stages, respectively. Left ventricular ejection fraction was calculated from %AC (area change between areas of left ventricle at end-systolic and -diasystolic stages). Ventricular wall-motion was assessed by bullet display of the gated SPECT images. The present procedure is expected to be widely used as a routine test of the myocardial functions and is beneficial from a viewpoint of cost/performance. (K.H.)

  19. A long-acting calcium antagonist over one year did not improve BMIPP myocardial scintigraphic imagings in patients with pure coronary spastic angina

    Sueda, Shozo; Oshita, Akira; Izoe, Yousuke; Kohno, Hiroaki; Fukuda, Hiroshi; Ochi, Takaaki; Uraoka, Tadao

    2007-01-01

    Calcium antagonists (Ca) have been effective in reducing angina attacks in patients with variant angina. However, there are no reports regarding the effectiveness of Ca on myocardial fatty acid metabolic images in patients with pure coronary spastic angina (CSA). This study sought to examine the correlation between myocardial fatty acid metabolic images and the medical treatment of Ca in patients with pure CSA. This study included 35 consecutive patients (28 men, mean age of 66±10 years) with angiographically confirmed coronary spasm and no fixed stenosis. Long-acting Ca was administered to all 35 patients. Isosorbide dinitrate/nicorandil/another Ca/beta-blocker were administered when chest pain was not controlled. Using an iodinated fatty acid analogue, 15-(p-[iodine-123]iodophenyl)-3-(R,S)methylpentadecanoic acid (BMIPP), myocardial scintigraphies with intravenous adenosine triphosphate infusion were performed before cardiac catheterization and 12 mo after medical therapy. According to the medical control states, these 35 patients were classified into 3 groups; response (disappearance of angina attacks, 12 pts, 60±11 years), partial response (angina attacks <4/mo, 12 pts, 67±10 years), and no response to therapy (angina attacks ≥4/mo, 11 pts, 71±6 years). Reduced BMIPP uptake was observed in 24 (69%) of 35 patients before the treatment. Reduced BMIPP uptake was also found in 18 patients (51%) after 12 mo. Normal BMIPP uptake after 12 mo therapy was observed in about half (response: 42%, partial response: 58%, no response: 45%) of patients among the 3 groups. There was no difference regarding the value of washout rate (WOR) (response; 10±7 (before), 14±8% (12 mo)), partial response; 11±7, 10±5%, no response; 13±9, 14±8%) among the 3 groups. The defect scores of BMIPP in the three groups were not different during at least one year medical therapy. No difference regarding the distribution of other medical therapies (angiotensin converting enzyme

  20. Characterizing the inflammatory tissue response to acute myocardial infarction by clinical multimodality noninvasive imaging.

    Wollenweber, Tim; Roentgen, Philipp; Schäfer, Andreas; Schatka, Imke; Zwadlo, Caroline; Brunkhorst, Thomas; Berding, Georg; Bauersachs, Johann; Bengel, Frank M

    2014-09-01

    Myocardial infarction (MI) triggers a systemic inflammatory response which determines subsequent healing. Experimentally, cardiac positron emission tomography and magnetic resonance imaging have been used successfully to obtain mechanistic insights. We explored the translational potential in patients early after MI. Positron emission tomography/computed tomography and cardiac magnetic resonance were performed in 15 patients sources of inflammatory cells. Positron emission tomography and cardiac magnetic resonance multimodality characterization of the acutely infarcted, inflamed myocardium may provide multiparametric end points for clinical studies aiming at support of infarct healing. © 2014 American Heart Association, Inc.

  1. Myocardial response to a triathlon in male athletes evaluated by Doppler tissue imaging and biochemical parameters

    Leetmaa, T H; Dam, A; Glintborg, D

    2008-01-01

    (cTnT) and pro-brain natriuretic peptide (pro-BNP)] and echocardiography. Conventional echocardiography techniques and new Doppler tissue imaging (DTI) modalities were applied before and immediately after the competition. Blood samples were drawn 1 week before, immediately after and 12-24 h post...... and systolic velocities decreased, thus suggesting reversible cardiac fatigue. When using cardiac markers and echocardiographic findings, a triathlon was found to have no significant negative effects on left ventricular function or myocardial tissue in male athletes....

  2. Radiolabeled phosphonium salts as mitocondrial voltage sensors for positron emission tomography myocardial imaging agents

    Kim, Dong Yon; Min, Jung Joon [Dept. of Nuclear Medicine,Chonnam National University Medical School and Hwasun Hospital, Gwangju (Korea, Republic of)

    2016-09-15

    Despite substantial advances in the diagnosis of cardiovascular disease, {sup 18}F-labeled positron emission tomography (PET) radiopharmaceuticals remain necessary to diagnose heart disease because clinical use of current PET tracers is limited by their short half-life. Lipophilic cations such as phosphonium salts penetrate the mitochondrial membranes and accumulate in mitochondria of cardiomyocytes in response to negative inner-transmembrane potentials. Radiolabeled tetraphenyl phosphonium cation derivatives have been developed as myocardial imaging agents for PET. In this review, a general overview of these radiotracers, including their radiosynthesis, in vivo characterization, and evaluation is provided and clinical perspectives are discussed.

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

    Verberne, Hein J.; Eck-Smit, Berthe L.F. van; Wit, Tim C. de; Acampa, Wanda; Anagnostopoulos, Constantinos; Ballinger, Jim; Bengel, Frank; Bondt, Pieter De; Buechel, Ronny R.; Kaufmann, Philip A.; Cuocolo, Alberto; Flotats, Albert; Hacker, Marcus; Hindorf, Cecilia; Lindner, Oliver; Ljungberg, Michael; Lonsdale, Markus; Manrique, Alain; Minarik, David; Scholte, Arthur J.H.A.; Slart, Riemer H.J.A.; Traegaardh, Elin; 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 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 0 7 E ANM F INAL myocardial p erfusion g uideline.pdf. (orig.)

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

    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.)

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

    Sasaki, Akira

    1996-01-01

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

  6. Myocardial perfusion imaging: Lessons learned and work to be done-update.

    Iskandrian, Ami E; Dilsizian, Vasken; Garcia, Ernest V; Beanlands, Rob S; Cerqueira, Manuel; Soman, Prem; Berman, Daniel S; Cuocolo, Alberto; Einstein, Andrew J; Morgan, Charity J; Hage, Fadi G; Schelbert, Heinrich R; Bax, Jeroen J; Wu, Joseph C; Shaw, Leslee J; Sadeghi, Mehran M; Tamaki, Nagara; Kaufmann, Philipp A; Gropler, Robert; Dorbala, Sharmila; Van Decker, William

    2018-02-01

    As the second term of our commitment to Journal begins, we, the editors, would like to reflect on a few topics that have relevance today. These include prognostication and paradigm shifts; Serial testing: How to handle data? Is the change in perfusion predictive of outcome and which one? Ischemia-guided therapy: fractional flow reserve vs perfusion vs myocardial blood flow; positron emission tomography (PET) imaging using Rubidium-82 vs N-13 ammonia vs F-18 Flurpiridaz; How to differentiate microvascular disease from 3-vessel disease by PET? The imaging scene outside the United States, what are the differences and similarities? Radiation exposure; Special issues with the new cameras? Is attenuation correction needed? Are there normal databases and are these specific to each camera system? And finally, hybrid imaging with single-photon emission tomography or PET combined with computed tomography angiography or coronary calcium score. We hope these topics are of interest to our readers.

  7. Microvascular obstruction on delayed enhancement cardiac magnetic resonance imaging after acute myocardial infarction, compared with myocardial {sup 201}Tl and {sup 123}I-BMIPP dual SPECT findings

    Mori, Hiroaki [Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya (Japan); Department of Cardiology, Kainan Hospital, Yatomi (Japan); Isobe, Satoshi, E-mail: sisobe@med.nagoya-u.ac.jp [Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya (Japan); Sakai, Shinichi [Department of Cardiology, Kainan Hospital, Yatomi (Japan); Yamada, Takashi [Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya (Japan); Watanabe, Naoki; Miura, Manabu [Department of Cardiology, Kainan Hospital, Yatomi (Japan); Uchida, Yasuhiro; Kanashiro, Masaaki; Ichimiya, Satoshi [Department of Cardiology, Yokkaichi Municipal Hospital, Yokkaichi (Japan); Okumura, Takahiro; Murohara, Toyoaki [Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya (Japan)

    2015-08-15

    Highlights: • The percentage infarct size (%IS) was significantly greater in the microvascular obstruction (MO) group than in the non-MO group. • The percentage mismatch score (%MMS) on dual scintigraphy significantly correlated with the %IS and the percentage MO. • The %MMS was significantly greater in the non-MO group than in the MO group, and was an independent predictor for MO. - Abstract: Background: The hypo-enhanced regions within the hyper-enhanced infarct areas detected by cardiac magnetic resonance (CMR) imaging reflect microvascular obstruction (MO) after acute myocardial infarction (AMI). The combined myocardial thallium-201 ({sup 201}Tl)/iodine-123-15-(p-iodophenyl)-3-(R,S)-methylpentadecanoic acid ({sup 123}I-BMIPP) dual single-photon emission computed tomography (SPECT) is a useful tool for detecting myocardial reversibility after AMI. We evaluated whether MO could be an early predictor of irreversible myocardial damage in comparison with {sup 201}Tl and {sup 123}I-BMIPP dual SPECT findings in AMI patients. Methods: Sixty-two patients with initial AMI who successfully underwent coronary revascularization were enrolled. MO was defined by CMR imaging. Patients were divided into 2 groups as follows: MO group (n = 32) and non-MO group (n = 30). Scintigraphic defect scores were calculated using a 17-segment model with a 5-point scoring system. The mismatch score (MMS) was calculated as follows: the total sum of (Σ) {sup 123}I-BMIPP defect score minus Σ{sup 201}Tl defect score. The percentage mismatch score (%MMS) was calculated as follows: MMS/(Σ{sup 123}I-BMIPP score) × 100 (%). Results: The percentage infarct size (%IS) was significantly greater in the MO group than in the non-MO group (32.2 ± 13.8% vs. 18.3 ± 12.1%, p < 0.001). The %MMS significantly correlated with the %IS and the percentage MO (r = −0.26, p = 0.03; r = −0.45, p < 0.001, respectively). The %MMS was significantly greater in the non-MO group than in the MO group (45.4

  8. Myocardial metabolism during anaesthesia with propofol--low dose fentanyl for coronary artery bypass surgery

    Vermeyen, K. M.; de Hert, S. G.; Erpels, F. A.; Adriaensen, H. F.

    1991-01-01

    We have studied the haemodynamic and myocardial effects of propofol-fentanyl anaesthesia in 12 patients undergoing coronary artery bypass surgery during the pre-bypass period. The induction dose of propofol was 1.5 mg kg-1 and mean infusion rate during maintenance was 4.48 mg kg-1 h-1 (range

  9. Clinical studies on myocardial perfusion imaging in patients with right ventricular overload

    Abo, Kenji; Yamagata, Takashi; Nakajima, Masao; Fujita, Kimiaki; Morita, Nobuo

    1979-01-01

    Patients with heart disease which had been clinically diagnosed underwent 201 Tl myocardial perfusion imaging. The thickness of right ventricular wall measured from original images was directly proportional to systolic pressure of the right ventricle measured by cardiac catheterization, and 201 Tl activity in the right ventricle was more directly proportional to systolic pressure of the right ventricle. Imaging patterns of various diseases were also described. Images of patients with hypertrophic cardiomyopathy revealed that right ventricular wall was thin and right ventricular cavity was small, but the thickness of septal wall and left ventricular wall were maximal. Images of patients with mitral insufficiency revealed that the thickness of right ventricular wall, septal wall, and left ventricular wall was medium, and the right ventricular cavity was smaller than the left ventricular cavity. Images of patients with congestive cardiomyopathy and congestive cardiac failure showed that enlargement of both ventricular cavities was disproportionate to the thickness of each wall. Images of patients with arterial septal defect revealed that the thickness of each wall was comparatively normal, the right ventricular cavity was maximal, and the left ventricular cavity was minimal. Images of patients with primary pulmonary hypertention, pulmonary stenosis and tetralogy of Fallot in whom pressure overload was recognized revealed severe thickenings of right ventricular wall, moderate enlargement of the right ventricle, small left ventricle, and thin left ventricular wall. (Tsunoda, M.)

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

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

    2015-01-01

    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 82 Rb 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. (paper)

  11. Prognostic value of abnormal exercise myocardial perfusion imaging and its types in patients with coronary artery disease

    Zhu Mei; Pan Zhongyun; Lin JInghui; Zhang Chunli; Nie Tao; Wang Yanfu

    1998-01-01

    Purpose: To evaluate the prognostic value of abnormal exercise myocardial perfusion imaging and its types in patients with coronary artery disease (CAD). Methods: 69 patients with CAD underwent exercise myocardial perfusing imaging and exercise ECG test. The images of all of them were abnormal. 45 patients were angiographically proved CAD. Follow-up period ranged from 6∼110 months and even longer than 12 months for patients with no cardiac events (CE). Results: CE occurred in 15 patients during the follow-up period. The CE incidence was 8.7% per year. Cox regression analysis revealed that there was a good correlation between the number of myocardial segments with reversible defects and future CE. Comparing the results of 13 patients with small extent irreversible defects with the data obtained from normal subjects reported previously, there was no significant difference between two no-CE rates (x 2 = 0.09, P>0.05). Conclusions: Normal myocardial images and irreversible defects involving rather small areas predicted an excellent prognosis. The better predictor of future CE is the quantity of myocardial segments with reversible defect

  12. Use of blood-pool imaging in evaluation of diffuse activity patterns in technetium-99m pyrophosphate myocardial scintigraphy.

    Cowley, M J; Mantle, J A; Rogers, W J; Russell, R O; Rackley, C E; Logic, J R

    1979-06-01

    It has been suggested that diffuse Tc-99m pyrophosphate precordial activity may be due to persistent blood-pool activity in routine delayed views during myocardial imaging. To answer this question, we reviewed myocardial scintigrams recorded 60--90 min following the injection of 12--15 mCi of Tc-99m pyrophosphate for the presence of diffuse precordial activity, and compared these with early images of the blood pool in 265 patients. Diffuse activity in the delayed images was identified in 48 patients: in 20 with acute myocardial infarction and in 28 with no evidence of it. Comparison of these routine delayed images with early views of the blood pool revealed two types of patterns. In patients with acute infarction, 95% had delayed images that were distinguishable from blood pool either because the activity was smaller than the early blood pool, or by the presence of localized activity superimposed on diffuse activity identical to blood pool. In those without infarction, 93% had activity distribution in routine delayed views matching that in the early blood-pool images. The usefulness of the diffuse TcPPi precordial activity in myocardial infarction is improved when early blood-pool imaging is used to exclude persistence of blood-pool activity as its cause. Moreover, it does not require additional amounts of radioactivity nor complex computer processing, a feature that may be of value in the community hospital using the technique to "rule out" infarction 24--72 hr after onset of suggestive symptoms.

  13. Use of blood-pool imaging in evaluation of diffuse activity patterns in technetium-99m pyrophosphate myocardial scintigraphy

    Cowley, M.J.; Mantle, J.A.; Rogers, W.J.; Russell, R.O. Jr.; Rackley, C.E.; Logic, J.R.

    1979-01-01

    It has been suggested that diffuse 99m Tc pyrophosphate precordial activity may be due to persistent blood-pool activity in routine delayed views during myocardial imaging. To answer this question, we reviewed myocardial scintigrams recorded 60 to 90 min following the injection of 12 to 15 mCi of 99m Tc pyrophosphate for the presence of diffuse precordial activity, and compared these with early images of the blood pool in 265 patients. Diffuse activity in the delayed images was identified in 48 patients: in 20 with acute myocardial infarction and in 28 with no evidence of it. Comparison of these routine delayed images with early views of the blood pool revealed two types of patterns. In patients with acute infarction, 95% had delayed images that were distinguishable from blood pool either because the activity was smaller than the early blood pool, or by the presence of localized activity superimposed on diffuse activity identical to blood pool. In those without infarction, 93% had activity distribution in routine delayed views matching that in the early blood-pool images. The usefulness of the diffuse TcPPi precordial activity in myocardial infarction is improved when early blood-pool imaging is used to exclude persistence of blood-pool activity as its cause. Moreover, it does not require additional amounts of radioactivity nor complex computer processing, a feature that may be of value in the community hospital using the technique to rule out infarction 24 to 72 hr after onset of suggestive symptoms

  14. Analysis of glucose metabolism in patients with diabetes mellitus by using functional images derived from 18F-FDG PET

    Ohtake, Tohru; Yokoyama, Ikuo; Watanabe, Toshiaki; Kosaka, Noboru; Momose, Toshimitsu; Nishikawa, Jun-ichi; Serizawa, Takashi; Sasaki, Yasuhito

    1993-01-01

    Functional images of K complex (KC) and regional myocardial glucose utilization rates (rMGU), derived from F-18-fluoro-deoxy-glucose (F-18-FDG) positron emission computed tomography, were prepared. Using functional images obtained, myocardial glucose metabolism was examined in the fasting state, oral glucose loading (OG), and insulin clamp (IC) condition. The subjects were 10 patients with diabetes mellitus (DM), consisting of 8 with non-insulin dependent DM and 2 with insulin dependent DM, and 4 normal persons. Image quality, derived from both OG and IC approaches, was favorable in the normal group. In the groups of non-insulin dependent DM and insulin dependent DM patients, however, image quality was good with IC method but not with OG method. In the group of non-insulin dependent DM, rMGU derived by IC method was relatively high, but was significantly lower than that in the control group, suggesting a decreased function in glucose transporter. When using OG method, rMGU was even more decreased due to high blood sugar and low insulin. In the group of insulin dependent DM, both IC and OG approaches achieved the same rMGU as that in the control group, with the exception of KC derived by OG method that was decreased due to high blood sugar. In moderate or severe DM, myocardial viability seems to be difficult to evaluate because F-18-FDG uptake is decreased in the ischemic area associated with fasting high blood sugar. Mismatching between blood flow and metabolism is also difficult to detect due to high insulin or glucose load. Thus, myocardial viability should be evaluated in the condition of slightly loaded insulin by decreasing blood sugar. (N.K.)

  15. Dobutamine stress magnetic resonance imaging suffices for the demonstration of myocardial ischaemia and viability.

    Lamers, F P L; van Dijkman, P R M; Kuijpers, Th J A; van Herpen, G

    2003-02-01

    We report three patients in whom dobutamine stress magnetic imaging (DS-MRI) was essential in assessing myocardial ischaemia. Two patients were referred to the cardiologist because of chest pain. Patient A had typical exertional angina and a normal resting electrocardiogram (ECG). Patient B had typical exercise-induced angina and had recently experienced an attack of severe chest pain at rest for 15 minutes. The ECG showed a complete left bundle branch block (LBBB). Patient C was referred for heart failure of unknown origin. There were no symptoms of chest pain during rest or exercise. Echocardiography in this patient demonstrated global left ventricular (LV) dilatation, systolic dysfunction and a small dyskinetic segment in the inferior wall. In all these patients exercise stress testing had failed to demonstrate myocardial ischaemia. Patients A and C produced normal findings whereas in patient B the abnormal repolarisation due to pre-existent LBBB precluded a diagnosis of ischaemia. Breath-hold DS-MRI was performed to study LV wall motion and wall thickening at rest through increasing doses of dobutamine. A test was considered positive for myocardial ischaemia if wall motion abnormalities developed at high-dose levels of the drug (20 μg/kg/min or more with a maximum of 40 μg/kg/min) in previously normal vascular territories or worsened in a segment that was normal at baseline. Recovery of wall thickening in a previously hypokinetic or akinetic segment at a low dose of dobutamine (5-10 μg/kg/min) was taken as proof of viability. Patients A and B developed hypokinesia progressing into akinesia at high-dose dobutamine in the anteroseptal area of the LV indicative of ischaemia. These findings were corroborated by coronary angiography demonstrating severe coronary artery disease which led to coronary artery bypass grafting (CABG) in patient A and balloon angioplasty in patient B. In patient C global recovery of LV contractions during low-dose dobutamine was

  16. Assessment of the significance of coronary collateral vessel by using thallium-201 myocardial imaging

    Kanoh, Yasushi; Shiotani, Hideyuki; Fukuzaki, Hisashi; Maeda, Kazumi.

    1988-01-01

    For functional assessment of coronary collateral vessels, twenty-three patients with effort angina pectoris who had total coronary obstruction were studied. The patients were divided depending on the degree of development of collateral vessels into two groups, i.e. good collateral group I (n = 13) and poor collateral group II (n = 10). Thallium-201 scan was performed immediately (Ex-1 image), 20 minutes (Ex-2 image) after exercise and after nitroglycerin administration (NTG image) respectively. In all images, the relative percent activity of thallium-201 in the collateral-dependent ischemic area to the normal myocardium were calculated and were compaired between two groups. Relative percent activities in group I and II were as follows : Ex-1 image ; 75.8 ± 3.5 % vs. 77.2 ± 2.9 % (NS), Ex-2 images ; 85.3 ± 4.5 % vs. 79.3 ± 3.9 % (p < 0.005), NTG image ; 97.3 ± 3.1 % vs. 96.4 ± 5.2 % (NS). From these results, it was elucidated that good collateral induced early partial redistribution in its perfusion area, suggesting that good collateral circulation may provide rapid recovery from myocardial ischemia. (author)

  17. Safety of adenosine stress myocardial perfusion imaging by a one-route infusion protocol

    Kawai, Yuko; Kishino, Koh

    2006-01-01

    When adenosine stress testing is performed, a vein is generally accessed in each arm. To determine whether the one-route infusion protocol, that is, infusion via one upper arm vein, is safe, myocardial perfusion imaging was performed during adenosine stress testing in patients with angina pectoris. Sixty-six consecutive patients (43 men, 68±11 years of age) with suspected coronary artery disease were enrolled in this study. For the stress test, adenosine was injected at 120 μg/kg/min for 6 minutes. Systolic blood pressure, diastolic blood pressure, and heart rate did not show any significant changes after injection of the adenosine and radioisotope (RI) tracer. Adverse events during infusion of the adenosine were seen in 42 (64%) patients and included chest discomfort/oppression in 17 (26%) and dyspnea/throat discomfort in 15 (23%). On the other hand, adverse events just after infusion of the RI tracer occurred in 5 (8%) patients and included chest oppression in 2 (3%) and dyspnea in 1 (2%). Almost all adverse events disappeared quickly without treatment. Therefore, we concluded that adenosine stress myocardial perfusion imaging using a one-route infusion protocol is safe and useful to do for patients unable to secure veins in both arms. (author)

  18. Alterations in electrocardiogram of adenosine test for 99Tcm-MIBI myocardial perfusion imaging

    Xie Boqia; Tian Yueqin; Zheng Lihui

    2011-01-01

    Objective: To analyze alterations in electrocardiogram (ECG) of adenosine test in 99 Tc m -MIBI myocardial perfusion imaging(MPI)SPECT study. Methods: A total of 641 patients were included in the study. The patients each underwent 99 Tc m -MIBI MPI with adenosine test. The ECGs were taken before, during, and after adenosine infusion. Results: In all, abnormal ECGs were found in 205(32.0%) patients. During adenosine infusion, 20.6%(132/641) of patients suffered from arrhythmia, 29.5%(39/132) had atrial premature beats, 34.1% (45/132) had premature ventricular beats, and 6.1% (8/132) had sinoatrial block. In addition, 5.3% (7/132) had first-, 24.2% (32/132) had second-, and 0.8% (1/132) had third-degree atrioventricular block (AVB). After adenosine infusion, 4.4%( 28/641) of patients suffered from arrhythmia, 57.1% (16/28) had atrial premature beats, 39.3% (11/28) had premature ventricular beats, and 3.6% (1/28) had sinoatrial block. The perfusion images showed ischemia in 36 patients and infarction in 8 patients. Adenosine infusion was terminated in 39 patients (6.1%) because of poorly tolerated side effects. However, no death or acute myocardial infarction occurred in the study. Conclusions: Adenosine pharmacologic test for 99 Tc m -MIBI MPI may result in relatively high incidence of arrhythmia in ECG monitoring. (authors)

  19. Tellurium labeled analogues of the fatty acid hexadecenoic acid for imaging of myocardial tissue

    Mills, S.L.

    1980-01-01

    Non-invasive nuclear diagnostic procedures for the evaluation of acute myocardial infarction and ischemia are currently limited by problems associated with the availablity of radiopharmaceuticals, development of imaging equipment, and inherent characteristics of radionuclides. Myocardial tissue requires high levels of substrates which provide energy for the continuous functioning of this vital organ. Of the major sources of energy, the most utilized source is fatty acids. Tellurium-123m, with excellent gamma imaging characteristics was chosen as the radionuclide. A 16 carbon fatty acid, hexadecenoic acid, was chosen as the carrier molecule. The tellurium-123m fatty acid radiopharmaceuticals were formulated either in a solution of 20 percent ethanol, two percent polysorbate 80, and brought to volume with normal saline or in 12.5 percent human serum ablumin and brought to volume with normal saline. Biodistribution was performed in three animal species: Sprague-Dawley rats (three rats per time frame), Australian white rabbits (three rabbits per time frame), and mongrel dogs (one dog per time frame). Dosimetry calculations were performed to assess the radiation dose

  20. Value of 201-thallium serial myocardial imaging in coronary heart disease

    Sauer, E.; Sebening, H.; Dressler, J.; Lutilsky, L.; Ulm, K.; Hoer, G.; Papst, H.W.; Bloemer, H.; Technische Univ. Muenchen; Technische Univ. Muenchen

    1979-01-01

    There has been clinical evidence that a perfusion defect on a stress image fills overtime. The diagnostic value of initial and 120 min post exercise redistribution thallium-201 myocardial images (RMI) was determined in 120 pts, with suspected coronary heart disease (CAD), all of whom had coronary arteriography. Significant (>= 75%) lesions were present in 88 pts. 30 pts. without CAD showed a normal tracer uptake immediately after exercise. Scintigrams taken 120 min after exercise revealed a decrease of 201-Tl concentration in every area of the myocardium. 80 pts. with CAD showed an area of decreased tracer uptake in the inital scans. 120 min RMI in 51 pts. revealed a significant increase (p > 0.01) of countrate time ratio in previous underperfused areas. In 37 pts. persistent defects were present, in every case the defect correlated with the site of a myocardial infarction as determined by the finding of an akinetic area in the left ventricular angiogram. Thus RMI following a single dose of 201 Tl can differentiate between scar- and exercise-induced transient ischemia. (orig.) 891 AJ/orig. 892 MB [de

  1. High coronary artery calcium score affects clinical outcome despite normal stress myocardial perfusion imaging and normal left ventricular ejection fraction

    Madsen, Claus Juul; Andersen, Kim F; Zerahn, Bo

    2013-01-01

    Normal myocardial perfusion imaging (MPI) indicates a low risk for cardiac death and new ischaemic events. However, the impact of normal MPI combined with a high coronary artery calcium score (CACS) is not clear. The aims of this study were to evaluate the risk of severely elevated CACS and to id......Normal myocardial perfusion imaging (MPI) indicates a low risk for cardiac death and new ischaemic events. However, the impact of normal MPI combined with a high coronary artery calcium score (CACS) is not clear. The aims of this study were to evaluate the risk of severely elevated CACS...

  2. Thallium-201 myocardial imaging in children with heart disease. Quantitative assessment of right ventricular pressure

    Mitomori, Toshihiro; Ono, Yasuo; Kamiya, Tetsuro; Nishimura, Tsunehiko; Kozuka, Takahiro (National Cardiovascular Center, Suita, Osaka (Japan)); Kohata, Tohru; Tanimoto, Takeshi

    1985-02-01

    201-TlCl myocardial imaging studies were performed to evaluate systolic pressure of right ventricle on 107 patients including 89 patients with congenital cardiac disease, patients with primary pulmonary hypertension and 13 patients with history of MCLS with the age range of 2 months to 17 years. The congenital cardiac disease group included 30 patients with tetralogy of Fallot, 8 patients with pulmonary stenosis (included 1 patient with double chambered right ventricle), 20 patients with ventricular septal defect, 10 patients with patent ductus arteriosus, 9 patients with atrial septal defect and 12 patients with complete transposition of great arteries. None of the patients with history of MCLS had coronary involvement. 50 ..mu..Ci/kg of 201-TlCl was infused intravenously and after 15 minutes the images were obtained from 5 directions (anterior, LAO 30, LAO 45, LAO 60 and lateral). The angle was determined to demonstrate the intraventricular septum and ventricular free walls cleary separated. The image of end-diastolic phase was obtained with ECG synchronized gated method from that direction. The ROI (region of interest) was defined as a slice line by drawing two lines perpendicular to the septum and the counts of the left and right ventricular free wall (Cl and Cr) were analyzed to evaluate the pressure of right ventricle. The pressure of ventricles were obtained by cardiac catheterization performed at the same time with myocardial imaging. The ratio of Cl and Cr (Cr/Cl) had good correlation with the ratio of peak systolic pressure of left ventricle and right ventricle (regression equation Y=0.84X + 0.08, r=0.87). In each congenital heart disease group, very good correlation was also demonstrated (Y=1.46X - 0.30, r=0.96 in PS; Y=0.70X0.20, r=0.91 in VSD; Y=0.86X + 0.15, r=0.78 in ASD and Y=0.72X + 0.24, r=0.80 in PDA). Thus 201-TlCl myocardial imaging was useful method to evaluate right ventricular pressure noninvasively in congenital cardiac disease.

  3. Short-lived cyclotron produced radionuclides evaluation on the myocardial imaging agents

    Rikitake, Tomoyuki; Tateno, Yukio; Yamane, Akiko; Matsumoto, Touru; Umegaki, Youichiro

    1978-01-01

    Organ uptake after venous administration of 13 N-ammonia, 43 K, 86 Rb, 201 Tl and after rectal administration of 13 N-ammonia was studied. Each nuclides highly accumulated in myocardium after intravenous injection, but rectal administrated 13 N-ammonia did not show this tendency. Intravenously injected 13 N-ammonia showed very early myocardial uptake and early secretion from kidney. Rectal administrated 13 N-ammonia was less accumulated in myocardium. 43 KCl and 13 NH 4 Cl were injected intravenously and administrated from the rectum to the rabbits under imaging scintilator system. Whole-body scintiscanner with display-processing unit was used for a 43 KCl injected rabbit. A positroncamera with computer system (TOSBAC 3400 on line system) was used for 13 NH 4 Cl (i.v. and rectal ad.) rabbits. The dynamic studies of 43 KCl, 13 NH 4 Cl were made from these imaging data. The countratio of heart to the liver after 43 K injection was nearly equal or less than the liver. The peakcount was at 15 min after 13 NH 4 Cl intravenous injection. 13 N accumulated promptly at upper mediastinal part and kidney, and soon disappeared from these part. Uptake of the heat was high and that of the liver was low. When 13 NH 4 Cl was administrated from the rectum, 13 N trapped at the liver, and uptake of the heart was very low level. Scintiscanning after 13 KCl intravenously injected, did not show the high resolution. Rabbit heart was distinguishable from the liver, but there are no visibility of the detail. Seeing positronscintigram after 13 NH 4 Cl administration both from intravenously and from rectum, the detail was well visible. We concluded the positron scintigram after 13 NH 4 Cl injection should be a good myocardial imaging agent. Furthermore, 13 Nh 4 Cl has two eminent characters as a myocardial imaging agent comparing 201 TlCl. One is prompt making of image, the others is the very low radiation dose. (auth.)

  4. Differential Effects Of Octanoate And Heptanoate On Myocardial Metabolism During Extracorporeal Membrane Oxygenation In An Infant Swine Model

    Kajimoto, Masaki; Ledee, Dolena R.; Isern, Nancy G.; Olson, Aaron; Des Rosiers, Christine; Portman, Michael A.

    2015-10-01

    Background: Nutritional energy support during extracorporeal membrane oxygenation (ECMO) should promote successful myocardial adaptation and eventual weaning from the ECMO circuit. Fatty acids (FAs) are a major myocardial energy source, and medium-chain FAs (MCFAs) are easily taken up by cell and mitochondria without membrane transporters. Oddnumbered MCFAs supply carbons to the citric acid cycle (CAC) via anaplerotic propionyl-CoA as well as acetyl-CoA, the predominant betaoxidation product for even-numbered MCFA. Theoretically, this anaplerotic pathway enhances carbon entry into the CAC, and provides superior energy state and preservation of protein synthesis. We tested this hypothesis in an immature swine model undergoing ECMO. Methods: Fifteen male Yorkshire pigs (26-45 days old) with 8-hour ECMO were received either normal saline, heptanoate (odd-numbered MCFA) or octanoate (even-numbered MCFA) at 2.3 μmol/kg body wt/min as MCFAs systemically during ECMO (n = 5 per group). The 13-Carbon (13C)-labeled substrates ([2-13C]lactate, [5,6,7-13C3]heptanoate and [U-13C6]leucine) were systemically infused as metabolic markers for the final 60 minutes before left ventricular tissue extraction. Extracted tissues were analyzed for the 13C-labeled and absolute concentrations of metabolites by nuclear magnetic resonance and gas chromatography-mass spectrometry. Results: Octanoate produced markedly higher myocardial citrate concentration, and led to a higher [ATP]/[ADP] ratio compared with other http://mc.manuscriptcentral.com/jpen Journal of Parenteral and Enteral Nutrition For Peer Review groups. Unexpectedly, octanoate increased the flux of propionyl-CoA relative to acetyl-CoA into the CAC as well as heptanoate. MCFAs promoted increases in leucine oxidation, but were not associated with a difference in fractional protein synthesis rate. Conclusion: Octanoate provides energetic advantages to the heart over heptanoate, while preserving protein synthesis.

  5. Magnetic Nanoparticles for Targeting and Imaging of Stem Cells in Myocardial Infarction

    Michelle R. Santoso

    2016-01-01

    Full Text Available Stem cell therapy has broad applications in regenerative medicine and increasingly within cardiovascular disease. Stem cells have emerged as a leading therapeutic option for many diseases and have broad applications in regenerative medicine. Injuries to the heart are often permanent due to the limited proliferation and self-healing capability of cardiomyocytes; as such, stem cell therapy has become increasingly important in the treatment of cardiovascular diseases. Despite extensive efforts to optimize cardiac stem cell therapy, challenges remain in the delivery and monitoring of cells injected into the myocardium. Other fields have successively used nanoscience and nanotechnology for a multitude of biomedical applications, including drug delivery, targeted imaging, hyperthermia, and tissue repair. In particular, superparamagnetic iron oxide nanoparticles (SPIONs have been widely employed for molecular and cellular imaging. In this mini-review, we focus on the application of superparamagnetic iron oxide nanoparticles in targeting and monitoring of stem cells for the treatment of myocardial infarctions.

  6. Impaired myocardial blood flow reserve in subjects with metabolic syndrome analyzed using positron emission tomography and N-13 labeled ammonia

    Teragawa, Hiroki; Kihara, Yasuki [Hiroshima University Graduate School of Biomedical Sciences, Department of Cardiovascular Medicine, Hiroshima (Japan); Morita, Koichi; Tamaki, Nagara [Hokkaido University Graduate School of Medicine, Department of Nuclear Medicine, Sapporo (Japan); Shishido, Hiroki; Otsuka, Nobuaki; Hirokawa, Yutaka [Hiroshima Heiwa Clinic, Hiroshima (Japan); Chayama, Kazuaki [Hiroshima University Graduate School of Biomedical Sciences, Department of Molecular Science and Medicine, Hiroshima (Japan)

    2010-02-15

    Coronary vasomotor response might be impaired in metabolic syndrome (MS); however, the precise abnormality has not been elucidated. The aim of this study was to assess coronary-vasomotor response in MS subjects using N-13 labeled ammonia and positron emission tomography. Myocardial blood flow (MBF) was measured at rest and during adenosine infusion in MS subjects (n = 13, MS group) with no definite evidence of heart disease and in subjects without MS (n = 14, non-MS group). Coronary vascular resistance (CVR) was calculated by dividing the mean aortic blood pressure by MBF. Myocardial blood flow reserve (MFR) was calculated as the ratio of the MBF during adenosine infusion to that during rest. Blood chemical parameters were measured to evaluate their relationship with MFR. During adenosine infusion, MBF was lower (p = 0.0085) and CVR higher (p = 0.0128) in the MS group than in the non-MS group and MFR was significantly lower in the MS group than in the non-MS group (2.13 {+-} 0.99 vs. 3.38 {+-} 0.95, p = 0.0027). Multivariate analysis demonstrated that the homeostasis model assessment-insulin resistance (p < 0.05) and the presence of hypertension (p < 0.05) were independent determinants of MFR. The results indicate that MFR was impaired in MS subjects, suggesting that an abnormal coronary microvascular response occurred in these subjects. This abnormality may have been partially due to insulin resistance and hypertension. (orig.)

  7. Impaired myocardial blood flow reserve in subjects with metabolic syndrome analyzed using positron emission tomography and N-13 labeled ammonia

    Teragawa, Hiroki; Kihara, Yasuki; Morita, Koichi; Tamaki, Nagara; Shishido, Hiroki; Otsuka, Nobuaki; Hirokawa, Yutaka; Chayama, Kazuaki

    2010-01-01

    Coronary vasomotor response might be impaired in metabolic syndrome (MS); however, the precise abnormality has not been elucidated. The aim of this study was to assess coronary-vasomotor response in MS subjects using N-13 labeled ammonia and positron emission tomography. Myocardial blood flow (MBF) was measured at rest and during adenosine infusion in MS subjects (n = 13, MS group) with no definite evidence of heart disease and in subjects without MS (n = 14, non-MS group). Coronary vascular resistance (CVR) was calculated by dividing the mean aortic blood pressure by MBF. Myocardial blood flow reserve (MFR) was calculated as the ratio of the MBF during adenosine infusion to that during rest. Blood chemical parameters were measured to evaluate their relationship with MFR. During adenosine infusion, MBF was lower (p = 0.0085) and CVR higher (p = 0.0128) in the MS group than in the non-MS group and MFR was significantly lower in the MS group than in the non-MS group (2.13 ± 0.99 vs. 3.38 ± 0.95, p = 0.0027). Multivariate analysis demonstrated that the homeostasis model assessment-insulin resistance (p < 0.05) and the presence of hypertension (p < 0.05) were independent determinants of MFR. The results indicate that MFR was impaired in MS subjects, suggesting that an abnormal coronary microvascular response occurred in these subjects. This abnormality may have been partially due to insulin resistance and hypertension. (orig.)

  8. Subacute and Chronic Left Ventricular Myocardial Scar: Accuracy of Texture Analysis on Nonenhanced Cine MR Images.

    Baessler, Bettina; Mannil, Manoj; Oebel, Sabrina; Maintz, David; Alkadhi, Hatem; Manka, Robert

    2018-01-01

    Purpose To test whether texture analysis (TA) allows for the diagnosis of subacute and chronic myocardial infarction (MI) on noncontrast material-enhanced cine cardiac magnetic resonance (MR) images. Materials and Methods In this retrospective, institutional review board-approved study, 120 patients who underwent cardiac MR imaging and showed large transmural (volume of enhancement on late gadolinium enhancement [LGE] images >20%, n = 72) or small (enhanced volume ≤20%, n = 48) subacute or chronic ischemic scars were included. Sixty patients with normal cardiac MR imaging findings served as control subjects. Regions of interest for TA encompassing the left ventricle were drawn by two blinded, independent readers on cine images in end systole by using a freely available software package. Stepwise dimension reduction and texture feature selection based on reproducibility, machine learning, and correlation analyses were performed for selecting features, enabling the diagnosis of MI on nonenhanced cine MR images by using LGE imaging as the standard of reference. Results Five independent texture features allowed for differentiation between ischemic scar and normal myocardium on cine MR images in both subgroups: Teta1, Perc.01, Variance, WavEnHH.s-3, and S(5,5)SumEntrp (in patients with large MI: all P values cine MR images, with an area under the curve of 0.93 and 0.92, respectively. Conclusion This proof-of-concept study indicates that TA of nonenhanced cine MR images allows for the diagnosis of subacute and chronic MI with high accuracy. © RSNA, 2017 Online supplemental material is available for this article.

  9. Enhancement of dynamic myocardial perfusion PET images based on low-rank plus sparse decomposition.

    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 82 Rb 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 82 Rb 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 82 Rb 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.

  10. Noninvasive determination of myocardial blood flow, oxygen consumption and efficiency in normal humans by carbon-11 acetate positron emission tomography imaging

    Porenta, G.; Cherry, S.; Czernin, J.; Brunken, R.; Kuhle, W.; Hashimoto, T.; Schelbert, H.R.

    1999-01-01

    The aims of this study were: (1) to measure noninvasively and near simultaneously myocardial blood flow, oxygen consumption, and contractile function and (2) to analyze myocardial energy expenditure and efficiency at rest and during dobutamine stress in normal humans. Dynamic and gated carbon-11 acetate positron emission tomography (PET) imaging was performed in 11 normal subjects. The initial uptake of 11 C-acetate was measured to estimate myocardial blood flow. Oxygen consumption was derived from the monoexponential slope of the 11 C-clearance curve recorded during myocardial washout. ECG-gated systolic and diastolic images were acquired during the peak myocardial 11 C activity to measure left ventricular radius, myocardial wall thickness, and long axis length. Myocardial oxygen consumption and parameters of cardiac geometry were used to determine myocardial energetics and cardiac efficiency by tension-area area analysis. Myocardial blood flow averaged 0.8±0.06 ml min -1 g -1 at rest and 1.48±0.15 ml min -1 g -1 during dobutamine stress. Oxygen delivery and consumption were 151±13 and 88±15 μl O 2 min -1 g -1 at rest and increased to 291±31 and 216±31 μl O 2 min -1 g -1 , respectively, during pharmacological stress (P 11 C acetate imaging provides the unique capability to study noninvasively determinants of myocardial energy delivery, expenditure, and efficiency. (orig.)

  11. Remodeling after acute myocardial infarction: mapping ventricular dilatation using three dimensional CMR image registration

    O’Regan Declan P

    2012-06-01

    Full Text Available Abstract Background Progressive heart failure due to remodeling is a major cause of morbidity and mortality following myocardial infarction. Conventional clinical imaging measures global volume changes, and currently there is no means of assessing regional myocardial dilatation in relation to ischemic burden. Here we use 3D co-registration of Cardiovascular Magnetic Resonance (CMR images to assess the long-term effects of ischemia-reperfusion injury on left ventricular structure after acute ST-elevation myocardial infarction (STEMI. Methods Forty six patients (age range 33–77 years underwent CMR imaging within 7 days following primary percutaneous coronary intervention (PPCI for acute STEMI with follow-up at one year. Functional cine imaging and Late Gadolinium Enhancement (LGE were segmented and co-registered. Local left ventricular wall dilatation was assessed by using intensity-based similarities to track the structural changes in the heart between baseline and follow-up. Results are expressed as means, standard errors and 95% confidence interval (CI of the difference. Results Local left ventricular remodeling within infarcted myocardium was greater than in non-infarcted myocardium (1.6% ± 1.0 vs 0.3% ± 0.9, 95% CI: -2.4% – -0.2%, P = 0.02. One-way ANOVA revealed that transmural infarct thickness had a significant effect on the degree of local remodeling at one year (P 20% (4.8% ± 1.4 vs −0.15% ± 1.2, 95% CI: -8.9% – -0.9%, P = 0.017. Conclusions The severity of ischemic injury has a significant effect on local ventricular wall remodeling with only modest dilatation observed within non-ischemic myocardium. Limitation of chronic remodeling may therefore depend on therapies directed at modulating ischemia-reperfusion injury. CMR co-registration has potential for assessing dynamic changes in ventricular structure in relation to therapeutic interventions.

  12. Repeatability of regional myocardial blood flow calculation in 82Rb PET imaging

    Knešaurek, Karin; Machac, Josef; Zhang, Zhuangyu

    2009-01-01

    We evaluated the repeatability of the calculation of myocardial blood flow (MBF) at rest and pharmacological stress, and calculated the coronary flow reserve (CFR) utilizing 82 Rb PET imaging. The aim of the research was to prove high repeatability for global MBF and CFR values and good repeatability for regional MBF and CFR values. The results will have significant impact on cardiac PET imaging in terms of making it more affordable and increasing its use. 12 normal volunteers were imaged at rest and during pharmacological stress, with 2220 MBq of 82 Rb each. A GE Advance PET system was used to acquire dynamic 50-frame studies. MBF was calculated with a 2-compartmental model using a modified PMOD program (PMOD; University Hospital Zurich, Zurich, Switzerland). Two differential equations, describing a 2-compartmental model, were solved by numerical integration and using Levenberg-Marquardt's method for fitting data. The PMOD program defines 16 standard segments and calculates myocardial flow for each segment, as well as average septal, anterior, lateral, inferior and global flow. Repeatability was evaluated according to the method of Bland and Altman. Global rest and stress MBF, as well as global CFR, showed very good repeatability. No significant differences were found between the paired resting global MBF (0.63 ± 0.13 vs. 0.64 ± 0.13 mL/min/g; mean difference, -1.0% ± 2.6%) and the stress global MBF (1.37 ± 0.23 vs. 1.37 ± 0.24; mean difference, 0.1% ± 2.3%). Global CFR was highly reproducible (2.25 ± 0.56 vs. 2.22 ± 0.54, P = not statistically significant; mean difference, 1.3% ± 14.3%). Repeatability coefficients for global rest MBF were 0.033 (5.2%) and stress MBF 0.062 (4.5%) mL/min/g. Regional rest and stress MBF and CFR have shown good reproducibility. The average per sector repeatability coefficients for rest MBF were 0.056 (8.5%) and stress MBF 0.089 (6.3%) mL/min/g, and average repeatability coefficient for CFR was 0.25 (10.6%). The results

  13. Myocardial blood flow quantification for evaluation of coronary artery disease by positron emission tomography, cardiac magnetic resonance imaging, and computed tomography.

    Waller, Alfonso H; Blankstein, Ron; Kwong, Raymond Y; Di Carli, Marcelo F

    2014-05-01

    The noninvasive detection of the presence and functional significance of coronary artery stenosis is important in the diagnosis, risk assessment, and management of patients with known or suspected coronary artery disease. Quantitative assessment of myocardial perfusion can provide an objective and reproducible estimate of myocardial ischemia and risk prediction. Positron emission tomography, cardiac magnetic resonance, and cardiac computed tomography perfusion are modalities capable of measuring myocardial blood flow and coronary flow reserve. In this review, we will discuss the technical aspects of quantitative myocardial perfusion imaging with positron emission tomography, cardiac magnetic resonance imaging, and computed tomography, and its emerging clinical applications.

  14. A Tc-99m-labeled long chain fatty acid derivative for myocardial imaging.

    Magata, Yasuhiro; Kawaguchi, Takayoshi; Ukon, Misa; Yamamura, Norio; Uehara, Tomoya; Ogawa, Kazuma; Arano, Yasushi; Temma, Takashi; Mukai, Takahiro; Tadamura, Eiji; Saji, Hideo

    2004-01-01

    C-11- and I-123-labeled long chain fatty acid derivatives have been reported as useful radiopharmaceuticals for the estimation of myocardial fatty acid metabolism. We have reported that Tc-99m-labeled N-[[[(2-mercaptoethyl)amino]carbonyl]methyl]-N-(2-mercaptoethyl)-6-aminohexanoic acid ([(99m)Tc]MAMA-HA), a medium chain fatty acid derivative, is metabolized by beta-oxidation in the liver and that the MAMA ligand is useful for attaching to the omega-position of fatty acid derivatives as a chelating group for Tc-99m. On the basis of these findings, we focused on developing a Tc-99m-labeled long chain fatty acid derivative that reflected fatty acid metabolism in the myocardium. In this study, we synthesized a dodecanoic acid derivative, MAMA-DA, and a hexadecanoic acid derivative, MAMA-HDA, and performed radiolabeling and biodistribution s