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AIM: To evaluate the efficacy and safety of the advanced technique for positioning the endocardial electrodes of a cardiac contractility modulation (CCM) device. MATERIALS AND METHODS: The CCM system was implanted in 100 patients, of which 60 CCM electrodes were positioned in the most optimal zones of myocardial perfusion, in particular, in the zone of the minor focal-scar/fibrotic lesion (the Summed Rest Score of 0 to 1-2, the intensity of the radiopharmaceutical at least 30%), and in 40 patients according to the standard procedure. Before the implantation of the CCM system, 60 patients underwent tomography (S-SPECT) of the myocardium with 99mTc-methoxy-isobutyl-isonitrile at rest to determine the most optimal electrode positioning zones and 100 patients underwent transthoracic echocardiography at baseline and after 12 months to assess the effectiveness of surgical treatment. RESULTS: Improved ventricular electrode positioning technique is associated with the best reverse remodeling of the left ventricular myocardium, especially in patients with ischemic chronic heart failure, with less radiation exposure to the surgeon and the patient, and without electrode-related complications. CONCLUSION: At the preoperative stage, it is recommended to perform a synchronized single-photon emission computed tomography of the myocardium with 99mTc-methoxy-isobutyl-isonitrile at rest before implantation of the CCM device to assess the presence of scar zones/myocardial fibrosis in the anterior and inferior septal regions of the interventricular septum of the left ventricle, followed by implantation of ventricular electrodes in the zone of the minor scar/fibrous lesion, which will allow to achieve optimal stimulation parameters, increase the effectiveness of CCM therapy, reduce the radiation exposure on medical personnel and the patient during surgery.
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Fibrilação Atrial , Insuficiência Cardíaca , Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Insuficiência Cardíaca/fisiopatologia , Insuficiência Cardíaca/terapia , Fibrilação Atrial/fisiopatologia , Fibrilação Atrial/terapia , Fibrilação Atrial/cirurgia , Idoso , Resultado do Tratamento , Eletrodos Implantados , Volume Sistólico/fisiologia , Tomografia Computadorizada de Emissão de Fóton Único/métodos , Ecocardiografia/métodos , Contração Miocárdica/fisiologiaRESUMO
This analytical review focuses on large international studies on diagnostics of ischemic heart disease and addresses the role of radionuclide methods in evaluating myocardial perfusion and transient ischemia. Based on the reviewed data, the authors proposed a comprehensive instrumental approach to selecting a tactics for the management of patients with suspected or documented ischemic heart disease and for evaluating their prognosis.
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Isquemia Miocárdica , Humanos , Prognóstico , IsquemiaRESUMO
The utility of positron emission tomography in cardiology currently goes beyond the ischemic heart disease and covers an increasingly wider range of non-coronary pathology, which requires timely expert diagnostics, including chronic heart disease of any etiology, valvular and electrophysiology disorders, cardiooncology. Authors emphasize the importance of the development of positron emission tomography technologies in the Russian Federation. This includes the development and implementation of new radiopharmaceuticals for the diagnosis of pathological processes of the cardiovascular system, systemic and local inflammation, including atherosclerosis, impaired perfusion and myocardial metabolism, and also for solving specific diagnostic tasks in comorbid pathology.
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Cardiologia , Sistema Cardiovascular , Doença da Artéria Coronariana , Cardiopatias , Isquemia Miocárdica , Imagem de Perfusão do Miocárdio , Humanos , Tomografia por Emissão de Pósitrons/métodos , Isquemia Miocárdica/diagnóstico por imagem , Imagem de Perfusão do Miocárdio/métodos , Tomografia Computadorizada de Emissão de Fóton Único/métodosRESUMO
The article presents a clinical case describing a complex differential diagnosis of cardiac amyloidosis types and verification of the diagnosis of AL-amyloidosis.
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Neuropatias Amiloides Familiares , Humanos , Neuropatias Amiloides Familiares/diagnóstico , Diagnóstico DiferencialRESUMO
This review provides a chronology of major international studies of the effect of evaluating transient myocardial ischemia, including with radionuclide methods, and coronary stenosis on the choice of therapeutic strategy and prognosis for patients with ischemic and coronary disease. The authors discussed the rationales for using anatomic, functional, and perfusion visualization methods of noninvasive diagnostics in evaluation of patients with suspected or established ischemic heart disease.
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Doença da Artéria Coronariana , Estenose Coronária , Isquemia Miocárdica , Humanos , Isquemia Miocárdica/diagnóstico , IsquemiaRESUMO
The article summarizes the current experience of the nuclear medicine department of the Chazov National Medical Research Center of Cardiology in the implementation of myocardium scintigraphy with 99mTc-pyrophosphate with the differential diagnosis of the types of cardiac amyloidosis. Causes of false-positive, equivocal and non-diagnostic results, are analyzed. Possible ways to eliminate mistakes, including by modifying protocols of planar and tomographic research and optimizing the whole diagnostic algorithm for amyloidosis of the heart, are discussed.
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Amiloidose , Cardiomiopatias , Imagem de Perfusão do Miocárdio , Humanos , Pirofosfato de Tecnécio Tc 99m , Difosfatos , Cardiomiopatias/diagnóstico por imagem , Cintilografia , Amiloidose/diagnóstico por imagem , AlgoritmosRESUMO
This paper summarizes the data from updated international protocols and guidelines for diagnosis of transthyretin amyloid cardiomyopathy (ATTR-CM). The invasive and non-invasive diagnosis techniques and their combinations are briefly reviewed; the evidentiary foundations for each diagnostic option and tool are analyzed. The paper describes a customized algorithm for sequential diagnosis and differential diagnosis of patients with suspected ATTR-CM with allowance for the combination of clinical signs and diagnostic findings. Along with the awareness of primary care providers about the red flags of the disease and visualization criteria, as well as providing information to the patients about the possibility of performing therapy of ATTR amyloidosis and the risks of delayed diagnosis, the proposed algorithm enables timely patient routing and prescribing specific treatment.
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Amiloidose , Cardiomiopatias , Humanos , Pré-Albumina , Amiloidose/diagnóstico , Amiloidose/terapia , Algoritmos , Diagnóstico Diferencial , Cardiomiopatias/diagnóstico , Cardiomiopatias/etiologia , Cardiomiopatias/terapiaRESUMO
Aim To analyze first results of using the Aterostop calculator for a comprehensive evaluation of the risk for cardiovascular diseases (CVD).Material and methods A cross-sectional study analyzed major and additional risk factors in 460 subjects without apparent disease and in patients with documented CVD of atherosclerotic origin using the application (calculator) Aterostop developed in the National Medical Research Center of Cardiology in Moscow, Russia.Results 45.4% of evaluated persons belonged to the categories of very high and extreme risk. Age and frequencies of smoking, arterial hypertension, and diabetes mellitus (DM) increased with the increase in risk; the growth of DM was exponential. 129 (28%) individuals used lipid-lowering medications at the time of study. Their plasma levels of low-density lipoprotein cholesterol (LDL-C) were significantly lower than in those who did not received this treatment. However, achieving the target level was inversely proportional to the risk: the greatest proportion of individuals who reached the LDL-C target was in the category of low risk and the smallest proportion was in the category of extreme risk (75â% vs. 3.7â%, respectively).Conclusion The results obtained with the calculator Aterostop were consistent with earlier reports of insufficient effectiveness of primary and secondary prevention of atherosclerotic CVDs, which requires more tight and fruitful cooperation of the physician and the patient.
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Aterosclerose , Doenças Cardiovasculares , Inibidores de Hidroximetilglutaril-CoA Redutases , Aterosclerose/epidemiologia , Doenças Cardiovasculares/epidemiologia , Estudos Transversais , Fatores de Risco de Doenças Cardíacas , Humanos , Moscou/epidemiologia , Medição de Risco , Fatores de Risco , Federação Russa/epidemiologiaRESUMO
Aim To study the effect of cardioprotective tactics on parameters of left ventricular myocardial perfusion and contractility as per data from single-photon emission computed tomography in oncological patients with signs of anthracycline-induced cardiotoxicity.Material and methods The study included patients with oncological diseases (n=61) referred to polychemotherapy (PCT). For patients with signs of anthracycline-induced cardiotoxicity, a cardioprotective tactics was used, which included changing the PCT schedule and administering beta-blockers and angiotensin-converting enzyme inhibitors. For all patients at baseline, after the first four PCH courses, after initiation of the cardioprotective tactics and the next four PTC courses, the level of N-terminal pro-brain natriuretic peptide was measured and echocardiography and perfusion single-photon emission computed tomography were performed with assessment of left ventricular (LV) perfusion heterogeneity, systolic and diastolic function.Results Following four PTC courses, signs of cardiotoxicity were detected in 13 (21.3â%) patients. On the background of the cardioprotective tactics, a further decrease in LV ejection fraction (EF) by -9±2â% (p<0.01) was observed in 4 (30.8â%) patients. In 9 (69.2â%) patients, LV EF increased by 4±2â% (p<0.01). Standard indexes of LV myocardial perfusion did not significantly change. In 7 patients, the cardioprotective tactics was associated with reduced severity of myocardial perfusion disorder, LV∆σТ = -1.37±1.29 (p<0.05), and in 4 patients, with reduced heterogeneity of myocardial perfusion, LV∆σÐ = -1.20±0.70 (p<0.05).Conclusion The cardioprotective tactics prevents both further disorder of perfusion and decreases in parameters of left ventricular myocardial contractility in patients with anthracycline-induced cardiotoxicity.
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Neoplasias , Disfunção Ventricular Esquerda , Cardiotoxicidade , Doxorrubicina/efeitos adversos , Humanos , Miocárdio , Neoplasias/complicações , Neoplasias/tratamento farmacológico , Perfusão , Disfunção Ventricular Esquerda/induzido quimicamente , Função Ventricular EsquerdaRESUMO
Over the past 40 years, nuclear medicine has grown to be the largest non-invasive diagnostic and therapeutic industry in the world, playing a pivotal role in various fields and disciplines of clinical practice and contributing to improved quality of life and patient prognosis. Over the first 20 years of the XXI century, the number of radionuclide procedures in the world has increased significantly, primarily due to innovations in radiopharmaceuticals, continuous improvement of the technical properties of equipment and the expansion of the boundaries of multimodal imaging. The review examines the historical and current trends in the development of nuclear medicine in the world and in Russia, including those related to radionuclide diagnostics, therapy and theranostics.
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The article provides an overview of an innovative software product for a comprehensive assessment of cardiovascular risk in cardiac patients in the Russian Federation. Based on the new recommendations of the Russian National Atherosclerosis Society (2020), the Aterostop application allows to assess cardiovascular risk, determine the patients achievement of target levels of low-density lipoprotein cholesterol, and also provides recommendations for correcting lipid-lowering therapy. The calculator is implemented as a web browser version, as well as a mobile application for Android and iOS platforms.
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AIM: To study the relationship between pretest probability (PTP) of ischemic heart disease (IHD), calculated according to the recommendations of the European Society of Cardiology (ESC) of 2013 and 2019, with the perfusion of the left ventricle of the myocardium according to the single-photon emission tomography (SPECT) and the results of the invasive coronary angiography (CAG). MATERIAL AND METHODS: The study included 220 patients with a preliminary diagnosis of ischemic heart disease and planned invasive CAG. All patients underwent rest-stress perfusion myocardial SPECT within 1 month prior to or after CAG, standard quantitative parameters of left ventricular perfusion were assessed. Retrospectively clinical data was analyzed and PTP of IHD was assessed according to ESC recommendations for 2013 and 2019. RESULTS: Invasive CAG revealed obstructive lesion of one or more coromary arteries in 204 of the 220 patients (92.7%). In a retrospective analysis, taking into account gender, age and nature of the complaints, as recommended by ESC in 2013, PTP was rated as low (15%) in 13 patients (5.9%), as intermediate (1585%) in 207 patients (94.1%). Following the comprehensive survey (SPECT and CAG) 8 patients with low PTP (61.5%) underwent coronary revascularization. Among patients with intermediate PTP significant transient ischemia according to SPECT was detected in 31 (15.0%), initial at 107 (51.7%). According CAG among patients with intermediate PTP obstructive lesion was found in 192 (92.7%), 113 patients (58.8%) underwent revascularization. According to ESC recommendations of 2019, PTP was rated as low (15%) in 117 patients (53.2%), including 514% in 98 (44.5%). According to a survey (SPECT and CAG) 68 of them (58.1%) underwent revascularization. CONCLUSION: PTP measurements proposed by ESC can not be applied to patients of the Russian population with suspected ischemic heart disease without significant corrections. 2013 ESC recommendations with higher PTP values for all categories of patients reflect Russian population better, while 2019 recommendations mistakenly attribute patients to low PTP in at least 58% of cases. These results are preliminary and will be expanded in subsequent studies with more detailed analysis of PTP in included patients with suspected IHD.
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Doença da Artéria Coronariana , Isquemia Miocárdica , Angiografia Coronária , Humanos , Probabilidade , Estudos Retrospectivos , Federação Russa , Tomografia Computadorizada de Emissão de Fóton ÚnicoRESUMO
AIM: The aim of the study was to assess cardiovascular risk in patients with elevated levels of total cholesterol and LDL-C and concomitant AH, a comparative analysis of adherence, efficacy and safety of various forms of combined therapy in outpatient practice, including promising lisinopril/amlodipine/rosuvastatin FC (Ekvamer®). MATERIALS AND METHODS: The ANICHKOV study included 702 patients in Moscow and the Moscow region over 18 years old with a -chole-sterol level ≥7.5 mmol/l and/or LDL-C ≥4.9 mmol/l from March 2017 to December 2018 based on 2 federal centers. According to the results of visit I, patients were prescribed with one of three therapy schemes. In the absence of AH, patients received scheme I -(Mertenil® at initial dosage of 10 mg/day). When history of AH existed or AH detected at visit I, patients were randomized to scheme II (Ekvamer® 5/10/10 mg/day) or III (Mertenil® 10 mg/day + Ekvator® 5/10 mg/day). During the observation, the treatment scheme remained unchanged, however, if the target levels of LDL-C and/or BP were not reached, the doses could be increased. The analysis of the main effects of the prescribed therapy were carried out for 12 months, and the frequency of MACE (CVD, ACS, stroke, or hospitalization to perform PCI) was also evaluated. RESULTS: Following the visit I, scheme I was assigned to 390 patients (55.6%), scheme II - 190 (27.1%), scheme III - 122 (17.4%). In 147 patients (20.9%), TG level was >2.3 mmol/l, which required additional fenofibrate intake in a dose of 145 mg/day. Adherence level was 89.5%, including scheme I - 91.7%, scheme II - 90.5%, scheme III - only 81.8%. In general, among compliant patients (n = 590), the decrease in TCh level was 41.0%, LDL-C - 47.4%. 16.6% of patients reached target levels of LDL-C <2.5 mmol/l, 5.6% - <1.8 mmol/l. In the fenofibrate subgroup, TG level decrease was 34.6%. During the follow-up period, 47 cases of side effects were observed in 27 patients (4.6%), that did not require modification of therapy. Systolic BP reduction in compliant patients of schemes II and III was 20 mm. Hg (13.1%), diastolic BP - 12 mm. Hg (13.6%), target BP levels (<140/90 mm. Hg) reached 83.7% and 80.8% of patients, respectively, target levels of BP and LDL-C <2.5 mmol/l reached 14.5% and 13.1% of patients, respectively, <1.8 mmol/l - 5.8% and 5.1%, respectively. During the observation period no deaths were recorded, other components of MACE were observed in 38 patients (5.8%), including 27 among compliant patients (4.6%) and 11 among non-compliant (15.9%, p<0.01). In 19 out of 38 patients (50%), hospitalization for routine PCI was the end point, ACS - in 12 (31.6%), and stroke - in 7 (18.4%). CONCLUSION: The results of the study demonstrated a sufficient hypolipidemic effect and high safety of Mertenil® and Ekvamer®. A higher adherence to the combined preparation than to two monodrugs was noted. Achieving target levels of BP and LDL-C is problematic, which dictates the expediency of using fixed combinations of drugs, especially in primary prevention.
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Anticolesterolemiantes/administração & dosagem , Doenças Cardiovasculares/tratamento farmacológico , Adesão à Medicação/estatística & dados numéricos , Adolescente , Anlodipino , Pressão Sanguínea/efeitos dos fármacos , Colesterol/sangue , LDL-Colesterol/sangue , LDL-Colesterol/efeitos dos fármacos , Combinação de Medicamentos , Humanos , Lipídeos , Lisinopril , Moscou , Resultado do TratamentoRESUMO
In this review, modern possibilities of nuclear imaging modalities in cardiology are considered. Perspectives of this branch of radiology are described according to the latest technological and methodological inventions and new clinical data.
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Cardiologia/métodos , Medicina Nuclear , Humanos , Medicina Nuclear/tendênciasRESUMO
In 58 patients with coronary heart disease, the count of CD34+CD133+CD309+ endothelial progenitor cells in the blood was determined and the dynamics of the content of endothelial progenitor cells, angiogenic growth factors, and lipid parameters over 3 months of atorvastatin therapy was analyzed. Atorvastatin was administered in daily doses of 10 mg (26 patients) and 40 mg (32 patients). Control group comprised 15 healthy volunteers. In patients with coronary heart disease, the count of endothelial progenitor cells was lower by 4 times, the level of VEGF was higher by 52%, and the level of endostatin was lower by 13% than in healthy volunteers. Atorvastatin therapy significantly reduced the levels of VEGF (by 11%), C-reactive protein (by 26%), total cholesterol (by 30%), LDL cholesterol (by 35%), and triglycerides (by 18%); the levels of endostatin, MCP-1, and HDL cholesterol remained unchanged. The count of endothelial progenitor cells increased significantly by 72% irrespectively on the statin dose, but the changes were more pronounced in patients with lower initial endothelial progenitor cell counts and in patients with more drastic decrease in LDL cholesterol.
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Atorvastatina/uso terapêutico , Doença das Coronárias/metabolismo , Células Progenitoras Endoteliais/efeitos dos fármacos , Células Progenitoras Endoteliais/metabolismo , Antígeno AC133/metabolismo , Adulto , Antígenos CD34/metabolismo , Proteína C-Reativa/metabolismo , HDL-Colesterol/metabolismo , Feminino , Citometria de Fluxo , Voluntários Saudáveis , Humanos , Masculino , Fator A de Crescimento do Endotélio Vascular/metabolismo , Receptor 2 de Fatores de Crescimento do Endotélio Vascular/metabolismo , Adulto JovemRESUMO
Assessment of perfusion, severity of ischemia and the volume of viable myocardium, including single-photon or positron emission tomography (SPECT and PET) is one of the most important stages of examination of patients with ischemic heart disease. However, in recent years "perfusion" prefix was added to other cardiologic modalities (echocardiography, magnetic resonance and computed tomography). Such a terminological uncertainty leads cardiologists to an erroneous evaluation of real possibilities of these methods. The review clarifies the definitions of terms "perfusion", "ischemia", and "viability" of the myocardium. Imaging modalities are compared from the perspective of compliance with the kinetics of the indicators used and actually visualized myocardial processes.
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Doença da Artéria Coronariana/diagnóstico por imagem , Isquemia Miocárdica/diagnóstico por imagem , Imagem de Perfusão do Miocárdio , Tomografia Computadorizada de Emissão de Fóton Único , Ecocardiografia , Humanos , Imageamento por Ressonância Magnética , Tomografia por Emissão de PósitronsRESUMO
OBJECTIVE: To compare the diagnostic accuracy of instantaneous wave-free ratio (iFR) and fractional flow reserve (FFR) with noninvasive methods in assessment of the functional significance of moderate coronary stenoses in patients with chronic ischemic heart disease (IHD). METHODS: We included in this study 50 patients with chronic or suspected IHD and moderate coronary stenoses (50-70%; 74 stenoses). Values of iFR and FFR were determined within 10 days after noninvasive stress tests (combination of stress-echo and SPECT). The values of iFR and FFR were compared with the results of noninvasive methods by ROC-analysis. Coronary artery stenosis was considered functionally important if at least one of noninvasive tests (stress-echo or SPECT) demonstrated positive result. RESULTS: The results of noninvasive stress-tests were positive in 14 patients (28%). ROC area under the curve (AUC) for iFR - 0.961±0.019 (95%CI 0.888-0.992). The best cut-off point for iFR is 0.92 (sensitivity 100, specificity 84%). ROC AUC for FFR - 0.893±0.041 (95%CI 0.79-0.96). The best cut-off point for FFR is 0.81 (sensitivity 100% and specificity 69%). There was no significant difference between iFR and FFR ROC-curves (Ñ=0.0845). CONCLUSION: The values of iFR and FFR have equivalent agreement with the results of noninvasive tests commonly used to detect myocardial ischemia in patients with moderate coronary stenoses.
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Doença da Artéria Coronariana/diagnóstico , Estenose Coronária/diagnóstico , Reserva Fracionada de Fluxo Miocárdico , Ecocardiografia sob Estresse , Teste de Esforço , Feminino , Hemodinâmica , Humanos , Masculino , Pessoa de Meia-Idade , Curva ROC , Sensibilidade e EspecificidadeRESUMO
AIM: To estimate the diagnostic value of measuring the momentary blood flow reserve (MBFR) versus the surrogate non-invasive standard (SNS) for myocardial ischemia verification (MIV) (a combination of stress echocardiography and single-photon emission computed tomography). SUBJECTS AND METHODS: The investigation enrolled 50 patients with stable angina in the presence of chronic coronary heart disease (CHD) or suspected CHD, in whom coronary angiography (CA) revealed borderline coronary stenoses (50-70% lumen diameters). The examination algorithm had two options. In one option, when included in the study, patients had already CA results not older than 1 month, and MBFR was measured 4-7 days after non-invasive stress tests. In the other option, MBFR in the area of borderline coronary artery stenosis was measured simultaneously with CA; and the noninvasive stress tests were carried out in the following week. A total of 74 coronary stenoses were examined. RESULTS: SNS for MIV was positive in 14 (28%) patients. When comparing with the non-invasive methods of myocardial ischemia verification, the area under the ROC curve for MBFR was 0.961±0.019 (95% confidence interval, 0.888-0.992). The optimal cut-point was 0.92, which is corresponded by a sensitivity of 100% and a specificity of 84%. CONCLUSION: When compared with SNS for MIV, the method for measuring MBFR has a high diagnostic accuracy.
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Angiografia Coronária , Doença da Artéria Coronariana , Estenose Coronária , Reserva Fracionada de Fluxo Miocárdico , Isquemia Miocárdica , Estenose Coronária/diagnóstico por imagem , Humanos , Isquemia Miocárdica/diagnóstico por imagem , Valor Preditivo dos Testes , Curva ROCRESUMO
OBJECTIVE: to specify frequency, patterns and diagnostic significance of extraosseous soft tissue findings in 99mTc-pyrophosphate skeletal scintigraphy. MATERIAL AND METHODS: Results of skeletal scintigraphy from 1060 patients (447 men, 613 women) were analyzed. Scanning in "whole body" mode started in 3-4 hours after 740 MBq of radiotracer activity intravenous administration, and performed in anterior and posterior projections in continuous table motion mode at rate of 6-8 cm per minute. Single photon emission computed tomography/computed tomography (SPECT/CT) was additionally performed when necessary. RESULTS: Extraosseous scintigraphic findings were discovered in 161 (15.2%) patients, they can be divided into three categories: nephrourological (7.7%), soft tissue (5.4%) and artifacts (2.1%). First category included anatomical and functional changes in the urinary system (kidney location anomalies and nonobstructive uropathies). SPECT/CT was performed to differentiate calycostasis in the projection of the upper group of calyces and focal changes of the ribs. Soft tissue extrarenal findings included diffuse or focal RP hyperfixation within breasts (29 patients), thyroid glands (15), myocardium (5), scrotum (4) and abdominal cavity (4). Symmetrical increased RP accumulation in breast or thyroid lobes was accepted as normal. Pathologic soft tissue findings in 11 patients were verified by history or instrumental data: breast cancer (2), testicular cancer (1), nodular goiter (2), uterine fibroids (2), primary cancer with liver metastases (1), association of "hot kidney" phenomenon with chemotherapy (2), and "superscan" phenomenon with myelofibrosis (1). Causes of radiotracer artifacts in the liver and spleen (14) were of radiopharmaceutical factors, in axillary lymph node (7)--partially infiltrative radiopharmaceuticals administration, in the colon (1)--previous myocardial perfusion scintigraphy. CONCLUSION: Analysis and interpretation of abnormal extraosseous findings in skeletal scintigraphy is an essential component of additional diagnostic information, that can influence subsequent diagnostic and therapeutic tactics.
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Osso e Ossos/diagnóstico por imagem , Cintilografia/métodos , Pirofosfato de Tecnécio Tc 99m/farmacologia , Tomografia Computadorizada de Emissão de Fóton Único/métodos , Adulto , Artefatos , Neoplasias da Mama/diagnóstico por imagem , Feminino , Humanos , Achados Incidentais , Masculino , Pessoa de Meia-Idade , Avaliação de Resultados em Cuidados de Saúde , Compostos Radiofarmacêuticos/farmacologia , Neoplasias de Tecidos Moles/diagnóstico por imagem , Doenças da Glândula Tireoide/diagnóstico por imagem , Neoplasias Urogenitais/diagnóstico por imagemRESUMO
Objective: to develop and implement a new processing approach of myocardial perfusion images obtained by single-photon emission computed tomography (SPECT) in patients with pulmonary hypertension (PH). Material and methods. 18 patients with idiopathic pulmonary hypertension underwent gated rest-stress perfusion SPECT with 99mTc-MIBI with CT-attenuation correction. Images were processed manually, with separate reorientation and semi-automatic contouring of both ventricles. MIBI intensity ratio in the right and left ventricles (RV/LV) was calculated using novel volumetric method, in comparison with other described approaches. Results. In patients with PH myocardial perfusion SPECT revealed abnormal RV visualization, dilation and reduced contractility, paradoxical motion and typical perfusion defects of interventricular septum. RV contouring in semi-automatic mode was possible in 100% of cases. The average values of RV/LV ratio in PH patients and normal group was 0.6097 ± 0.0090 and 0.2750 ± 0.0355, respectively (p<0.001). Conclusion. The new method of quantitative calculation of perfusion impairments allows to reveal the features of myocardial perfusion of the right and left ventricles in patients with pulmonary hypertension, with the potential to assess therapy effectiveness in these patients.> <0.001). Conclusion. The new method of quantitative calculation of perfusion impairments allows to reveal the features of myocardial perfusion of the right and left ventricles in patients with pulmonary hypertension, with the potential to assess therapy effectiveness in these patients.