RESUMO
BACKGROUND: There are limited data on the impact of the imaging protocol (single-day stress-rest, SD, vs. dual-day, DD) on the change in left ventricular (LV) ejection fraction (EF) (post-stress-rest) in relation to ischemia and on outcome. METHODS: Using propensity score matching procedure, 490 of 1121 patients with known CAD, undergoing a SD or a DD in a multicenter study, were evaluated. Stress and rest gated-SPECT myocardial perfusion imaging was used to quantify LV perfusion, EF, and volumes. Outcome was assessed at an average follow-up time of 3.2 years. RESULTS: Post-stress LVEF in SD and DD were comparable across all degrees of ischemia. The change in LVEF in patients with severe ischemia was, however, higher in the DD protocol, independent of the extent of CAD. At follow-up, 240 patients (49.0%) required coronary revascularization (CR) and 52 patients (10.6%) had hard events. The ischemic burden was independently associated with CR and hard-events; the post-stress LVEF was associated with CR but the change in EF was not predictive of either CR or hard events. CONCLUSIONS: In patients with severe ischemia, underestimation of post-stress myocardial stunning could be observed with the SD protocol. Post-stress LVEF and the extent ischemia, but not the change in EF, are predictive of CR and hard events.
Assuntos
Tomografia Computadorizada por Emissão de Fóton Único de Sincronização Cardíaca/métodos , Protocolos Clínicos , Imagem de Perfusão do Miocárdio/métodos , Volume Sistólico , Função Ventricular Esquerda , Idoso , Doença da Artéria Coronariana/diagnóstico por imagem , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
PURPOSE: Clinical applicability of the appropriate use criteria for SPECT myocardial perfusion imaging has not yet been evaluated in Italy. We investigated the applicability of the Appropriate Use Criteria (AUC) in Italy. METHODS: The indications for testing were prospectively recorded in three different nuclear cardiology laboratories: a general hospital, an academic hospital, and a tertiary centre. Indications were categorized as appropriate, uncertain or inappropriate according to the 2009 AUC; the specialty of the ordering physician was also noted. SPECT results were classified as: normal, probably normal, uncertain, probably abnormal, abnormal. The presence and severity of ischaemia were also noted. RESULTS: Over a 9-month period, 2,134 patients (age 67 ± 10 years, 68 % men) were evaluated (62 % exercise stress test). On average, there were 700 (84 %) appropriate, 73 (7 %) inappropriate and 93 (9 %) uncertain tests. The rates for the appropriateness of indications were comparable in men and women (84 % and 83 %, not significant). As expected, the rate of nonnormal studies was higher (58 %) for appropriate than for inappropriate (33 %) indications. Appropriateness was lower in the tertiary centre (74 %), and uncertain (16 %) and inappropriate (10 %) indications were more common; this was related to the higher rate of outpatients scheduled by nonhospital cardiologists (37 %). The most common indications associated with inappropriate testing were: chest pain, low likelihood of coronary artery disease, interpretable ECG and able to exercise (29 %), and asymptomatic <2 years after percutaneous coronary intervention (24 %). CONCLUSION: In this preliminary evaluation of the AUC in Italy, the majority of studies were classified as appropriate, but a consistent proportion of scheduled SPECT studies, particularly by nonhospital cardiologists, were still categorized as uncertain or inappropriate. Educational approaches should be implemented to reduce the rate of less appropriate examinations. However, a substantial proportion (33 %) of inappropriate studies were classified as nonnormal, with 26 % of these patients having ischaemia.
Assuntos
Erros Médicos/estatística & dados numéricos , Imagem de Perfusão do Miocárdio/estatística & dados numéricos , Tomografia Computadorizada de Emissão de Fóton Único/estatística & dados numéricos , Idoso , Estudos de Coortes , Feminino , Humanos , Itália , Masculino , Controle de QualidadeRESUMO
The induction of cardiac effects in hard metal workers is uncertain. This study investigates cardiac function of a group of 31 hard metal workers with or without pulmonary disease. The average duration of exposure to cobalt containing dusts was 10.4 years (range 1-30), while the environmental levels of cobalt exposure ranged from 0.09 to 13.6 mg/m3 Co. Cardiac function has been studied by: ECG (electrocardiogram), exercise test (ET), ECG 24 h according to Holter (ECGH), echocardiogram (ECHO) and radionuclide angiocardiography with 99Tc (RNA). The aims of this work were (i) to show the existence of cobalt myocardiopathy in the workers analyzed and, (ii) to find an early indicator of cardiac dysfunction which could be used in the clinical examination of hard metal workers. Within the group of patients with hard metal lung disease, cases of myocardiopathy of doubtful aetiology have been found. The cardiac indexes obtained through RNA show ventricular dysfunction in healthy hard metal workers which could be a manifestation of initial pulmonary artery hypertension or of an early occult cor pulmonale due to an unknown fibrotic lung disease.
Assuntos
Cobalto/farmacologia , Coração/fisiologia , Metalurgia , Exposição Ocupacional , Adulto , Idoso , Cobalto/efeitos adversos , Eletrocardiografia , Exercício Físico , Feminino , Coração/efeitos dos fármacos , Frequência Cardíaca/efeitos dos fármacos , Humanos , Pneumopatias/induzido quimicamente , Pneumopatias/fisiopatologia , Masculino , Pessoa de Meia-Idade , Descanso , Volume Sistólico/efeitos dos fármacosRESUMO
To prevent delayed cardiomyopathy induced by adriamycin and subsequent severe congestive heart failure, a monitoring schedule with noninvasive techniques to measure cardiac performance (CPK-MB, electrocardiographic, systolic time intervals, echocardiography and quantitative radionuclide angiography) has been used. 15 patients, 33 to 65 years old, with metastatic breast carcinoma, previously treated with a polychemotherapy protocol not including adriamycin have been studied. Monitoring at 0 time allowed to exclude one patient with previous asymptomatic cardiomyopathy and to treat patients at risk with cardiovascular pathology, up to reach and even exceed the dosage of 550 mg/m2. Four of the treated patients showed positive findings of cardiomyopathy at different adriamycin dosage levels: 2 asymptomatic dilatative cardiomyopathies, 1 symptomatic and 1 with congestive heart failure remitted with medical therapy. No patient died because of cardiovascular complications. The results obtained show that of all noninvasive techniques used, only quantitative radionuclide angiocardiography allowed, when employed following an adequate monitoring schedule, to detect reliable findings of moderate and reversible cardiomyopathy thus indicating the appropriate time for drug discontinuation.
Assuntos
Cardiomiopatias/induzido quimicamente , Doxorrubicina/efeitos adversos , Adulto , Neoplasias da Mama/complicações , Neoplasias da Mama/tratamento farmacológico , Cardiomiopatias/diagnóstico , Cardiomiopatias/prevenção & controle , Terapia Combinada , Doxorrubicina/administração & dosagem , Feminino , Testes de Função Cardíaca , Humanos , Pessoa de Meia-Idade , Monitorização Fisiológica/métodos , Metástase NeoplásicaAssuntos
Medula Óssea/efeitos da radiação , Neoplasias Ósseas/radioterapia , Neoplasias Ósseas/secundário , Neoplasias da Mama/patologia , Ácido Etidrônico/uso terapêutico , Dor/etiologia , Radioisótopos/uso terapêutico , Rênio/uso terapêutico , Adulto , Idoso , Plaquetas/efeitos da radiação , Neoplasias Ósseas/complicações , Neoplasias Ósseas/metabolismo , Neoplasias Ósseas/urina , Neoplasias da Mama/metabolismo , Neoplasias da Mama/urina , Ácido Etidrônico/efeitos adversos , Ácido Etidrônico/farmacocinética , Feminino , Humanos , Leucócitos/efeitos da radiação , Pessoa de Meia-Idade , Compostos Organometálicos , Medição da Dor , Radioisótopos/efeitos adversos , Radioisótopos/farmacocinética , Rênio/efeitos adversos , Rênio/farmacocinética , Resultado do TratamentoRESUMO
Chemodectoma is a rare, slow growing neoplasm with local aggressiveness and a high rate of residuals after surgery, arising from paraganglionic tissue (neural crest) and therefore able to take up Metaiodobenzylguanidine (MIBG). The aim of this study was to evaluate the diagnostic accuracy of 123I-MIBG Single Photon Emission Computed Tomography (SPECT) in comparison to Selective Digital Angiography (SDA), Computed Tomography (CT) and Magnetic Resonance Imaging (MRI). We studied 50 patients (41 women, 9 men) mean age 56 years (range 14-79), with diagnostic suspicion of chemodectoma (CH). There were 2 groups of patients: Group A (26 patients) examined before Surgery and Group B (24 patients) examined after surgery. SPECT of the head and neck region was performed 4 hours after i.v. administration of 185 MBq of 123I-MIBG. All patients were pre-treated with iodine solution. We performed a qualitative evaluation of the reconstructed slices. In Group A, all patients with CH (24) showed accumulation of MIBG in agreement with SDA, CT and MRI: 2 patients (histologically one had a cordoma, the other metastasis of papillary thyroid carcinoma), did not show any accumulation of 123I-MIBG. In Group B, 6 patients showed accumulation of 123I-MIBG in local residuals, and 9 were negative. Six patients with a lesion smaller than 1.5 cm were negative. Three patients had a positive scan but no lesion on SDA, CT and MRI. 123I-MIBG SPECT proved to be useful procedure in the diagnosis of untreated CH. During follow-up after surgery this procedure may assume a role in the perspective of radiometabolic therapy with 131I-MIBG.
Assuntos
Radioisótopos do Iodo , Iodobenzenos , Paraganglioma Extrassuprarrenal/diagnóstico por imagem , Compostos Radiofarmacêuticos , Tomografia Computadorizada de Emissão de Fóton Único , 3-Iodobenzilguanidina , Adolescente , Adulto , Idoso , Angiografia Digital , Carcinoma Papilar/secundário , Diagnóstico Diferencial , Feminino , Seguimentos , Neoplasias de Cabeça e Pescoço/diagnóstico por imagem , Neoplasias de Cabeça e Pescoço/patologia , Neoplasias de Cabeça e Pescoço/cirurgia , Humanos , Processamento de Imagem Assistida por Computador , Injeções Intravenosas , Radioisótopos do Iodo/administração & dosagem , Iodobenzenos/administração & dosagem , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Neoplasia Residual/diagnóstico por imagem , Neoplasia Residual/patologia , Paraganglioma Extrassuprarrenal/patologia , Paraganglioma Extrassuprarrenal/cirurgia , Compostos Radiofarmacêuticos/administração & dosagem , Neoplasias da Glândula Tireoide/patologia , Tomografia Computadorizada por Raios XRESUMO
Abnormally high uptake of technetium-99m hexakis-2-methoxyisobutylisonitrile (99mTc-SESTAMIBI) in the right ventricle and in the septum was observed in a 47-year-old woman initially presenting with dysarthria and left hemiparesis. Endomyocardial biopsy demonstrated a high-grade malignant non-Hodgkin's lymphoma. Complete remission was achieved by combined cyclophosphamide, doxorubicin, vincristine and prednisone (CHOP) chemotherapy and radiotherapy of the heart and mediastinum. The post-remission single photon emission tomography (SPET) 99mTc-SESTAMIBI study showed a homogeneous distribution pattern, in agreement with echocardiography computed tomography and magnetic resonance imaging. Increased uptake of 99mTc-SESTAMIBI, a myocardial perfusion agent, has been observed in some benign and malignant tumours. It may prove to be useful in the diagnosis and follow-up of malignancies.