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1.
Circulation ; 107(4): 538-44, 2003 Feb 04.
Article in English | MEDLINE | ID: mdl-12566363

ABSTRACT

BACKGROUND: There are currently no data on the accuracy of intravenous myocardial contrast echocardiography (MCE) in detecting myocardial hibernation in man and its comparative accuracy to dobutamine echocardiography (DE) or thallium 201 (Tl(201)) scintigraphy. METHODS AND RESULTS: Twenty patients with coronary artery disease and ventricular dysfunction underwent MCE 1 to 5 days before bypass surgery and repeat echocardiography at 3 to 4 months. Patients also underwent DE (n=18) and rest-redistribution Tl(201) tomography (n=16) before revascularization. MCE was performed using continuous Optison infusion (12 to 16 cc/h) with intermittent pulse inversion harmonics and incremental triggering (1:1 to 1:8). Myocardial contrast intensity (MCI) replenishment curves were constructed to derive quantitative MCE indices of blood velocity and flow. Recovery of function occurred in 38% of dysfunctional segments. MCE parameters of perfusion in hibernating myocardium were similar to segments with normal function and higher than dysfunctional myocardium without recovery of function (P<0.001). The best MCE parameter for predicting functional recovery was Peak MCIxbeta, an index of myocardial blood flow (area under the curve, 0.83). MCE parameters were higher in segments with contractile reserve and Tl(201) uptake > or =60% (P<0.05) and identified viable segments without contractile reserve by DE. The sensitivity of Peak MCIxbeta >1.5 dB/s for recovery of function was 90% and was similar to Tl(201) scintigraphy (92%) and any contractile reserve (80%); specificity was higher than for Tl(201) and DE (63%, 45%, and 54%, respectively; P<0.05). CONCLUSIONS: MCE with intravenous contrast identifies myocardial hibernation in humans. Prediction of viable myocardium with MCE is best using quantification of myocardial blood flow and provides improved accuracy compared with DE and Tl(201) scintigraphy.


Subject(s)
Contrast Media/administration & dosage , Dobutamine , Echocardiography , Myocardial Stunning/diagnosis , Thallium Radioisotopes , Aged , Blood Flow Velocity , Coronary Artery Disease/complications , Coronary Artery Disease/diagnosis , Coronary Artery Disease/surgery , Coronary Circulation , Female , Humans , Injections, Intravenous , Male , Middle Aged , Myocardial Contraction , Myocardial Stunning/diagnostic imaging , Observer Variation , Predictive Value of Tests , ROC Curve , Radionuclide Imaging , Recovery of Function , Sensitivity and Specificity , Ventricular Dysfunction/diagnosis , Ventricular Dysfunction/etiology
6.
J Nucl Cardiol ; 12(1): 32-6, 2005.
Article in English | MEDLINE | ID: mdl-15682363

ABSTRACT

BACKGROUND: Limited data are available on the value of quantitative stress myocardial perfusion imaging (MPI) in patients with unstable angina. In this report we sought to study the long-term prognostic value of quantitative stress MPI in patients hospitalized with unstable angina with no new ischemic electrocardiographic changes and negative cardiac enzymes. METHODS AND RESULTS: The study population consisted of 136 patients who were hospitalized at the Methodist Hospital, Houston, Tex, with unstable angina and subsequently underwent MPI before discharge. Cox proportional hazards (regression) analysis was performed to identify clinical and MPI predictors of hard cardiac events (death or nonfatal myocardial infarction). During a mean follow-up of 31 +/- 17 months, 20 patients (15%) sustained either cardiac death (n = 12) or nonfatal myocardial infarction (n = 8). The significant multivariate predictors of cardiac events were the total perfusion defect size ( P = .002), the presence of reversible perfusion defects ( P = .01), and the presence of multiple perfusion defects ( P = .03). The perfusion defect size was significantly larger in patients with events than in those without events (21% +/- 20% vs 12% +/- 14%, P = .002). Kaplan-Meier analysis showed that cardiac events were much more likely to develop in patients with defects involving 15% or more of the left ventricle than in those with defects involving less than 15% of the left ventricle ( P = .003). CONCLUSIONS: In patients hospitalized with unstable angina with no new ischemic electrocardiographic changes and negative cardiac enzymes, quantitative stress MPI provides powerful prognostic information that can be used in the risk stratification of these patients.


Subject(s)
Angina, Unstable/diagnostic imaging , Angina, Unstable/mortality , Exercise Test/statistics & numerical data , Myocardial Infarction/diagnostic imaging , Myocardial Infarction/mortality , Risk Assessment/methods , Angina, Unstable/blood , Angina, Unstable/diagnosis , Clinical Trials as Topic , Creatine Kinase/blood , Creatine Kinase, MB Form , Electrocardiography , Humans , Isoenzymes/blood , Myocardial Infarction/blood , Myocardial Infarction/diagnosis , Practice Patterns, Physicians' , Prognosis , Proportional Hazards Models , Radionuclide Imaging , Risk Factors , Survival Analysis , Texas/epidemiology , Troponin T/blood
7.
Breast Cancer Res Treat ; 74(2): 131-4, 2002 Jul.
Article in English | MEDLINE | ID: mdl-12186373

ABSTRACT

One of the newest agents used in the treatment of breast cancer is trastuzumab (Herceptin), a new recombinant DNA-derived humanized monoclonal antibody against the proto-oncogene, HER-2/neu gene product. However, despite its proven clinical efficacy, serious adverse effects leading to trastuzumab-induced cardiomyopathy have been described in up to 27% of patients receiving combination therapy with anthracyclines. There has been little published on the clinical syndrome of trastuzumab-induced cardiomyopathy. We describe three cases, of both reversible and irreversible cardiomyopathy, associated with the use of this novel and effective agent in HER-2 overexpressing breast cancer.


Subject(s)
Antibodies, Monoclonal/adverse effects , Antineoplastic Agents/adverse effects , Breast Neoplasms/drug therapy , Cardiomyopathies/chemically induced , Antibodies, Monoclonal/therapeutic use , Antibodies, Monoclonal, Humanized , Antineoplastic Agents/therapeutic use , Cardiomyopathies/pathology , Female , Humans , Middle Aged , Proto-Oncogene Mas , Trastuzumab
8.
J Nucl Cardiol ; 9(6): 594-600, 2002.
Article in English | MEDLINE | ID: mdl-12466783

ABSTRACT

BACKGROUND: Transcoronary ethanol septal ablation (TESA) is a novel treatment for obstructive hypertrophic cardiomyopathy (HOCM). Our objective was to evaluate the use of gated single photon emission computed tomography (SPECT) in patients with HOCM and the effects of TESA on myocardial perfusion. METHODS AND RESULTS: We performed gated SPECT and Doppler echocardiography before and 6 weeks after TESA in 30 patients with severe HOCM. The lung-to-heart and septal-to-lateral wall count-activity ratios were calculated. Before ablation, SPECT showed perfusion abnormalities in only 6 patients. Asymmetric septal hypertrophy was noted in 21 patients (70%). In patients with a lung-to-heart ratio greater than 0.50 before ablation, the ratio decreased from 0.56 +/- 0.04 to 0.45 +/- 0.08 after ablation (P <.01). The septal-to-lateral wall ratio also decreased significantly after ablation. Mean Doppler pressure gradient across the left ventricular outflow tract decreased from 52 +/- 39 mm Hg to 13 +/- 13 mm Hg (P <.01) immediately after ablation and to 10 +/- 21 mm Hg 6 weeks later (P <.01). There were no significant changes in left ventricular ejection fraction by gated SPECT after the procedure. SPECT studies done after ablation showed fixed septal defects in 29 of 30 patients (96.7%). The defects involved the basal and mid septum in 100% and 38% of patients, respectively, and ranged in size from 2% to 30% of the left ventricle (mean, 8.8% +/- 7.0%). CONCLUSIONS: TESA is an effective technique for relieving left ventricular outflow obstruction in patients with HOCM. Myocardial gated SPECT can identify the presence and location of infarction after TESA.


Subject(s)
Cardiomyopathy, Hypertrophic/diagnostic imaging , Cardiomyopathy, Hypertrophic/drug therapy , Ethanol/administration & dosage , Gated Blood-Pool Imaging/methods , Heart Septum/drug effects , Heart Septum/diagnostic imaging , Adolescent , Adult , Aged , Aged, 80 and over , Cardiac Catheterization/adverse effects , Cardiomyopathy, Hypertrophic/complications , Cardiomyopathy, Hypertrophic/diagnosis , Cohort Studies , Drug Delivery Systems/methods , Ethanol/adverse effects , Female , Humans , Male , Middle Aged , Myocardial Infarction/etiology , Reproducibility of Results , Sensitivity and Specificity , Treatment Outcome , Ventricular Dysfunction, Left/diagnosis , Ventricular Dysfunction, Left/drug therapy , Ventricular Dysfunction, Left/etiology
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