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Objective To investigate the relationship between myocardial injury and damage of me-chanical synchrony in the left ventricle of patients with ischemic cardiomyopathy ( ICM) using 99 Tcm-MIBI MPI and gated 18 F-FDG myocardial metabolic PET imaging. Methods A total of 113 ICM patients ( 100 males, 13 females;average age (58±10) years) underwent 99Tcm-MIBI MPI and gated 18F-FDG myocardial metabolic PET imaging from July 2015 to December 2015 in Fu Wai Hospital were retrospectively analyzed. Three-point scoring system was used for quantitative assessment of myocardial ischemia and myocardial in-farction in each segment. Total ischemic score ( TIS) and total scar score ( TSS) of 17 segments were calcu-lated in each patient. The phase bandwidth ( BW) and phase SD were derived from phase analysis. Pearson correlation analysis and logistic regression analysis were used. Results TSS were correlated with BW and SD in all 93 patients with myocardial infarction ( r values:0. 517, 0.470, both P<0.01) and also in a sub-group of 34 patients with myocardial infarction and without myocardial ischemia ( r values: 0. 647, 0. 578, both P<0.01) . There were significant correlations between TIS and BW, SD in 79 patients with myocardial is-chemia ( r values:0.392, 0.378, both P<0.01) , but no significant correlation was found in a subgroup of 20 patients with myocardial ischemia and without myocardial infarction ( r values: 0. 002, -0. 003, both P>0. 05) . Logistic regression analysis showed that the number of myocardial infarction segments and TSS were as-sociated with mechanical dyssynchrony. Conclusion Myocardial infarction is the main factor of left ventricu-lar mechanical dyssynchrony in ICM patients, but chronic myocardial ischemia has no significant influence on mechanical dyssynchrony.
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Objective: To assess the effect of coronary collateral circulation (CCC) on myocardial viabilityin patients with chronic total occlusion of left anterior descending (LAD) artery. Methods: A total of 101 consecutive patients with confirmed diagnosis of total LAD occlusion in our hospital were enrolled. Rest 99mTc-MIBISPECT myocardial perfusion and 18F-FDG PET were performed, in addition all patients received coronary angiography (CAG) at 3 months front and back. Both images were reconstructed in the same machine and QPS software was used to obtain the summed rest score (SRS), abnormal resting total perfusion defect (TPD), viable and non-viable myocardium, LVEDV, LVESV and LVEF in relevant patients. Based on CAG result, the patients were divided into 2 groups: CCC group, n=39 and No CCC group, n=62; according to existing old myocardial infarctionand location of LAD occlusion, the patients were further divided into 4 subgroups. The above parameters were compared among different groups. Results: There were 86 male and 15 female patients with the mean age at (59.92±11.43) years. Relevant parameters in CCC group and No CCC groupwere as in SRS: (21.23±9.68) vs (28.56±8.76), TPD: (30.03±13.69) %vs (40.37±12.50) %, viable myocardium: (21.77±13.12) % vs (13.66±9.23) %, non-viable myocardium (8.28±8.58) %vs (27.40±12.97) %, all P<0.05; in LVEDV: (109.82±30.01) ml vs (173.71±57.69) ml, LVESV: (62.82±22.39) ml vs (122.53±51.66) ml, LVEF: (43.85±8.46) % vs (31.03±8.30) %, all P<0.05. Conclusion: Our preliminary study found that CCC could maintain left ventricular rest perfusion, myocardial viability and protect cardiac function in patients with chronic total LAD occlusion.
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Objective To derive reference limits of cardiac functional parameters (CFP) determined by gated myocardial SPECT imaging, and to analyze the influence of gender, age and weight on CFP. Methods One hundred and seventy-five consecutive outpatients (89 males with age of (48.3±10.7) years and 86 females with age of (49.8±10.4) years) were defined as patients with low-likelihood coronary heart disease (LCHD). All patients underwent adenosine or exercise stress 99Tcm-MIBI G-MPI from February 2008 to April 2011. The EF, EDV and ESV of the left ventricle were measured by quantitative gated SPECT (QGS) software. The reference limits were derived by means of Gaussian distribution or percentiles. The influence of gender, age and weight on CFP was analyzed by multiple regressions for linear models. Two-sample t test was used to analyze data of 2 groups. Parameters between different age groups were compared by one-way analysis of variance. Results The lower reference limit of EF for males was 50%, the upper limit of EDV and ESV was 112 ml and 49 ml respectively. For females, the corresponding reference limits were 54%, 77 ml and 30 ml. Men had higher EDV, ESV (EDV: (75.8±18.3) ml vs (53.3±11.7) ml, t=9.35, P0.05). For females, EDV was not different (F=2408, P>005), while ESV and EF were significantly different among 3 groups (F values: 5.010, 6.229, both P<0.05). Conclusions The CFP determined by G-MPI in LCHD patients are significantly affected by gender and age. The age-related changes of CFP in males are different from those in females.
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Objective To evaluate the clinical application of pulmonary high-resolution CT (HRCT) and radionuclide pulmonary V/Q scan in pediatric patients with bronchiolitis obliterans (BO).Methods From February 2005 to April 2011,30 BO pediatric patients (18 males,12 females,age range:7 months-14 years) in Beijing Children's Hospital Affiliated to Capital Medical University were recruited for pulmonary HRCT and radionuclide pulmonary V/Q scan.Kappa test was used to describe the consistency between "Mosaic perfusion pattern" in pulmonary HRCT and radionuclide pulmonary ventilation abnormalities.Results "Mosaic perfusion patterns" in pulmonary HRCT were showed in 30 cases (100％).Ventilation defects were found in 27 cases (90.0％) and perfusion defects in 25 cases (83.3％).The Kappa value between "Mosaic perfusion pattern" in pulmonary HRCT and pulmonary ventilation defects was 0.201 (0.1340.268),which was slightly higher than that between "Mosaic perfusion pattern" in pulmonary HRCT and pulmonary perfusion defects (0.147 (0.061-0.233)),but there was no statistical difference.Conclusions " Mosaic perfusion pattern" in pulmonary HRCT cannot distinguish between pulmonary ventilation and perfusion abnormalities.V/Q scan could be a useful tool for BO.
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Objective To investigate the relationship between myocardial injury and damage of me-chanical synchrony in the left ventricle of patients with ischemic cardiomyopathy ( ICM) using 99 Tcm-MIBI MPI and gated 18 F-FDG myocardial metabolic PET imaging. Methods A total of 113 ICM patients ( 100 males, 13 females;average age (58±10) years) underwent 99Tcm-MIBI MPI and gated 18F-FDG myocardial metabolic PET imaging from July 2015 to December 2015 in Fu Wai Hospital were retrospectively analyzed. Three-point scoring system was used for quantitative assessment of myocardial ischemia and myocardial in-farction in each segment. Total ischemic score ( TIS) and total scar score ( TSS) of 17 segments were calcu-lated in each patient. The phase bandwidth ( BW) and phase SD were derived from phase analysis. Pearson correlation analysis and logistic regression analysis were used. Results TSS were correlated with BW and SD in all 93 patients with myocardial infarction ( r values:0. 517, 0.470, both P<0.01) and also in a sub-group of 34 patients with myocardial infarction and without myocardial ischemia ( r values: 0. 647, 0. 578, both P<0.01) . There were significant correlations between TIS and BW, SD in 79 patients with myocardial is-chemia ( r values:0.392, 0.378, both P<0.01) , but no significant correlation was found in a subgroup of 20 patients with myocardial ischemia and without myocardial infarction ( r values: 0. 002, -0. 003, both P>0. 05) . Logistic regression analysis showed that the number of myocardial infarction segments and TSS were as-sociated with mechanical dyssynchrony. Conclusion Myocardial infarction is the main factor of left ventricu-lar mechanical dyssynchrony in ICM patients, but chronic myocardial ischemia has no significant influence on mechanical dyssynchrony.
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Objective: To assess the feasibility of coronary lfow reserve (CFR) detection by SPECT myocardial perfusion imaging using a self developed software with preliminary clinical veriifcation. Methods: CFR calculation software was developed according to Mat lab guide. A total of 16 patients were enrolled including 13 male and 3 female at the mean age of (58±11) years . CAG conifrmed that 25 coronary branches were with stenosis>50% and 23 branches were without stenosis. 2-day ATP/rest99mTc-sestamibi dynamic SPECT myocardial perfusion imaging was conducted to detect CFR. First transit counts were used to sketch the interested pulmonary artery segments and to obtain the arterial input curve of contrast agent as total PAC reached to heart. Reconstructed short-axis images were divided into 3 sections to sketch interested territories (ROI) and to obtain RMC at each territory. Estimated CFR was expressed by the ratio of MBF=RMC/PAC followed by calculating the ratio of MFR=MBFstress/MBFrest. Results: The difference between simulated value and true value could be ignored which conifrmed that our program may accurately measure CFR. The reproducibility by different operators (r=0.986) and the same operator (r=0.983) was good. CFR value in non-stenosis branches were higher than stenosis branches (1.28 ± 0.19) vs (1.10 ± 0.27),P=0.008 and CFR value in stenosis branches was negatively related to stenosis degree (r=-0.5,P=0.02). Conclusion: Our self developed software is reliable for CFR detection by SPECT myocardial perfusion imaging; preliminary study showed good application prospect in clinical practice.
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Objective: To describe the clinical characteristics with long-term prognosis in patients with mid-ventricular obstructive hypertrophic cardiomyopathy (MVOHCM). Methods: A total of 66 MVOHCM patients treated in our hospital were retrospectively studied for their morbidity, clinical characteristics and mortality. The cumulative survival rate was calculated by Kaplan-Meier method; the risk factors for cardiac death and cardiovascular events were analyzed by uni- and multivariate Cox proportional hazard model. Results: There were 66 (2.74%) patients suffering from MVOHCM among 2413 patients of hypertrophic cardiomyopathy and the average diagnostic age was (40.16 ± 14.64) years. With (7.30 ± 6.25) years of follow-up study, the cardiovascular mortality was 13.6% and unexplained syncope (HR=13.37, 95% CI: 1.65-114.46, P=0.015) was the independent predictor for cardiovascular death. There were 45.45% (30/66) patients experienced at least 1 time of cardiovascular event and the most frequent one was non-sustained ventricular tachycardia (NSVT); 19.70% (13/66) of patients combined with apical aneurysms, and they were more inclined to experience NSVT. Conclusion: MVOHCM patients usually have unfavorable prognosis with the higher incidence of cardiovascular events, some patients may develop apical aneurysm. The early diagnosis of MVOHCM is important for appropriate treatment.
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Objective: To assess the impact of viable myocardium in left ventricular aneurysm (LVA) and ventricular arrhythmia on prognosis of LVA patients. Methods: A total of one hundred and sixty LVA patients who received99Tcm-MIBI SPECT and18F-FDG PET were enrolled, including 139 male and 21 female with the mean age of (58 ± 10) years.There were 42 (26.3%) patients combining ventricular arrhythmia. LVEDV, LVESV and LVEF were detected. Semi-quantitative analysis of myocardium perfusion imaging was conducted, viable myocardium in aneurysm was deifned as the perfusion-metabolism mismatch score (MMS) ≥ 2.0. According to myocardium viability, the patients were divided into 2 groups: No viability group,n=97 and With viability group,n=63;based on ventricular arrhythmia, the patients were divided into another 4 groups: Group①, viability-, ventricular arrhythmia-, n=68, Group②, viability-, ventricular arrhythmias+,n=29, Group③, viability+, ventricular arrhythmias-,n=50 and Group④, viability+,ventricular arrhythmias+,n=13. The average follow-up time was (50 ± 7) months, the end point was cardiac death. The survival curve was obtained by Kaplan-Meier method and survival rates were compared by Log-rank analysis. Results: The mean LVEF in 160 patients was (34 ± 11) %, cardiac death occurred in 19 (11.9%) patients. Long-term survival rates in Groups①,② and③ were 94.1%, 89.7% and 86.0%, respectively,P>0.05; while in Group④, the survival rate was 61.5%, which was lower than the other 3 groups,P=0.004. Multivariate Cox regression analysis showed that female (HR=5.101, 95% CI 1.853-14.044, P=0.002), GPET-ESV (HR=1.009, 95% CI 1.002-1.015,P=0.013), interaction between MMS and ventricular arrhythmia (HR=1.368, 95%CI 1.113-1.681,P=0.003) were independent risk factors for cardiac death;while surgical treatment (HR=0.199, 95% CI 0.054-0.742,P=0.016) could decrease the risk of cardiac death. Conclusion: Patients with viable aneurysm and ventricular arrhythmia had poor long-term prognosis; while early and active treatment is needed for them (surgery with anti-arrhythmic therapy).
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Objective To investigate the clinical application of radionuclide pulmonary V/Q scan in the diagnosis,evaluation of the severity and prognosis of pediatric patients with bronchiolitis obliterans (BO).Methods From February 2005 to April 2011,30 BO pediatric patients (18 males,12 females,age range:7 months-14 years) were prospectively recruited for radionuclide pulmonary V/Q scan.The relationship between the radionuclide pulmonary V/Q scan and clinical presentations was analyzed.Results Perfusion defects were seen in 25 cases (83.3％) and ventilation defects in 27 cases(90.0％).Among the 27patients with abnormal V/Q scan,matched abnormalities were seen in 13 cases (48.1％),mismatched in 1 case (3.7％) and reverse mismatched in 13 cases (48.1％).Of the 3 patients with mild disease,1 had normal V/Q scan while 2 showed V/Q defect in 1 segment.In the 10 patients with moderate disease,the mean number of segments having perfusion and ventilation defects was 3.7 and 5.6,respectively.In the 17 patients with severe disease,the mean number of segments having perfusion and ventilation defects was 6.0 and 8.2,respectively.During follow-up,all 8 patients with progressive disease presented with severe impairment of pulmonary perfusion and ventilation;while the 16 patients with improvement had mild impairment of pulmonary perfusion and ventilation or normal V/Q scan.Conclusion Radionuclide pulmonary V/Q scan is valuable for diagnosis,evaluation of the disease severity,and prognosis in pediatric patients with BO.
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Objective To explore the clinical value of 18F-FDG PET/CT in differentiating between cardiac benign and malignant lesions.Methods From September 2009 to September 2012,a total of 9 (7males,2 females,average age (46± 22) years) patients with space-occupying lesions of the heart underwent whole body 18F-FDG PET/CT.18 F-FDG PET/CT diagnosis was made according to morphologic features and SUVmax of lesions.The final diagnoses were confirmed by either histopathology or clinical data and follow-up.Two-sample t test was used for data analysis.Results Among 9 cases of cardiac occupying lesions,4 cases were malignant tumors,4 cases were benign tumors (including 2 lipomas,1 myxoma,and 1 fibroma),1 case was thrombus.The average SUVmax of malignant tumors was 18.99±14.58,which was significantly higher than that of benign tumors (2.35±1.46,t=-2.58,P＜0.05).With a cut-off SUVmax of 4.6,18F-FDG PET/CT could be used to noninvasively detect malignant tumors with a sensitivity of 4/4,specificity of 4/5,and accuracy of 8/9.Only 1 thrombus was misdiagnosed.Conclusion 18F-FDG PET/CT can aid the noninvasive differential diagnosis of cardiac malignant tumors from benign lesions.
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Objective To explore the relationship between the index of SPECT myocardial viability teat of the left ventricle and long-term cardiovascular adverse events following the coronary artery bypass graft.Methods Clinical data were selected from the coronary-heart-disease patients with CABG and the isotopic SPECT test of myocardial viability prior to the operation in the Fuwai Cardiovascular Hospital,the Chinese Academy of Medical Science from January 1,1999 to December 31,2005.Total 709 patients were included in this study.Regular follow-up in patients was performed following operation.Investigate the nuclear medicine documents of the patients above;make the semi-quantitative scores of myocardial viability prior to operation by the 17-segment method of ventricle.Through the COX multi-factor analysis of the statistical methods to explore the relationship between the index of the myocardial viability and the long-term cardiac adverse events selected in advance.Results The mean duration of follow-up was(3.43±2.42)years.The COX multi-analysis revealed that the total score of left ventricular myocardial viability is the independent impact factors for long term cardiac death,long terrm re-hospitalization rate and long term composite end points events.The cut off values of total score of left ventricular myocardial viability for long term cardiac death,long term re-hospitalization rate and long term composite end points events is 15,9,13 respectively.Conclusion The total score of left ventricular myocardial viability of SPECT is independently associated with long-term events,and the cut values of myocardial viability total score for long-term cardiac death,re-hospitalization and composite MACE events are 15,9,and 13 respectively.For the groups with total scores above and below the cut off values,there is significant difference of long term cardiac events risk between groups.
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(0.05)). The sensitivity and the agreement rate were best at dose of Dob 10 ?g?kg~(-1)?min~(-1) with (86.5)% and (86.5)% (Kappa(0.71)), respectively. When Isoket combined with Dob 3,5 ?g?kg~(-1)?min~(-1), the sensitivities and the agreement rates were both significantly improved than either one used (both P