La cardiología nuclear en la pandemia COVID-19 / Nuclear Cardiology in the COVID-19 pandemic

La infección por SARS-CoV-2 tiene una relación muy importante con la patología cardiovascular. Desde el inicio de la pandemia se objetivó una relación estrecha entre la comorbilidad cardiovascular y un peor pronóstico de los pacientes COVID-19. El estudio de la fisiopatología de la infección por SARS-CoV-2 y la enfermedad cardiovascular sugieren varias hipótesis concomitantes: el daño miocárdico directo por el virus, la hipoxemia secundaria a la insuficiencia respiratoria, la respuesta inflamatoria a la infección y/o los fenómenos tromboembólicos. El daño cardiovascular se puede manifestar en la fase aguda de la infección con cuadros de infarto agudo de miocardio, miocarditis, arritmias…, durante esta fase los procedimientos de Cardiología Nuclear no han tenido un papel determinante en el diagnóstico y manejo de estos pacientes. En cambio, en la fase subaguda de la infección y en el síndrome del COVID post-agudo la Cardiología Nuclear parece ofrecer luz a lo que sucede en el sistema cardiovascular en esta fase de la enfermedad. La pandemia de la COVID-19 ha representado un gran reto para los sistemas de salud constatándose una reducción importante de pruebas diagnósticas no urgentes con el objetivo de disminuir el riesgo de transmisión a pacientes y personal sanitario. La Cardiología Nuclear no ha sido una excepción. Además de la priorización de pruebas urgentes/preferentes y las medidas generales de screening, higiene y distancia, los principales organismos y sociedades científicas de Medicina Nuclear y Cardiología Nuclear han elaborado recomendaciones y guías para su práctica segura introduciendo notables cambios en los protocolos SPECT de perfusión miocárdica (AU)

SARS-CoV-2 infection has a very important relationship with cardiovascular disease. Since the beginning of the pandemic, a close relationship has been observed between cardiovascular comorbidity and a worse prognosis in COVID-19 patients. The study of the pathophysiology of SARS-CoV-2 infection and cardiovascular disease suggests several concomitant hypotheses: direct myocardial damage by the virus, hypoxemia secondary to respiratory failure, inflammatory response to infection and/or thromboembolic phenomena. Cardiovascular damage can manifest in the acute phase of infection with acute myocardial infarction, myocarditis, arrhythmias..., during this phase Nuclear Cardiology procedures have not played a determining role in the diagnosis and management of these patients. On the other hand, in the subacute phase of the infection and in the post-acute COVID syndrome, Nuclear Cardiology seems to shed light on what happens in the cardiovascular system in this phase of the disease. The COVID-19 pandemic has represented a great challenge for health systems, with a significant reduction in non-urgent diagnostic procedures with the aim of reducing the risk of transmission to patients and health personnel. Nuclear Cardiology has not been an exception. In addition to the prioritization of urgent/non-deferrable procedures and general screening, hygiene and distance measures, the main organizations and scientific societies of Nuclear Medicine and Nuclear Cardiology released recommendations and guidelines for safe practice, introducing significant changes in myocardial perfusion SPECT protocol (AU)

[Nuclear Cardiology in the COVID-19 pandemic]. / La cardiología nuclear en la pandemia COVID-19.

SARS-CoV-2 infection has a very important relationship with cardiovascular disease. Since the beginning of the pandemic, a close relationship has been observed between cardiovascular comorbidity and a worse prognosis in COVID-19 patients. The study of the pathophysiology of SARS-CoV-2 infection and cardiovascular disease suggests several concomitant hypotheses: direct myocardial damage by the virus, hypoxemia secondary to respiratory failure, inflammatory response to infection and/or thromboembolic phenomena. Cardiovascular damage can manifest in the acute phase of infection with acute myocardial infarction, myocarditis, arrhythmias..., during this phase Nuclear Cardiology procedures have not played a determining role in the diagnosis and management of these patients. On the other hand, in the subacute phase of the infection and in the post-acute COVID syndrome, Nuclear Cardiology seems to shed light on what happens in the cardiovascular system in this phase of the disease.The COVID-19 pandemic has represented a great challenge for health systems, with a significant reduction in non-urgent diagnostic procedures with the aim of reducing the risk of transmission to patients and health personnel. Nuclear Cardiology has not been an exception. In addition to the prioritization of urgent/non-deferrable procedures and general screening, hygiene and distance measures, the main organizations and scientific societies of Nuclear Medicine and Nuclear Cardiology released recommendations and guidelines for safe practice, introducing significant changes in myocardial perfusion SPECT protocols.

[Adrenal cortex scintigraphy with and without dexamethasone suppression in the study of primary aldosteronism]. / Gammagrafía suprarrenal cortical con frenación y supresión de la frenación con dexametasona en el estudio del hiperaldosteronismo primario.

AIM OF THE STUDY: To evaluate the diagnostic performance and efficacy of adrenal scintigraphy in primary aldosteronism following the protocol that combines adrenal suppression scintigraphy plus non-suppression study. METHODS AND PROCEDURES: 20 patients referred to our service with the suspicion of primary aldosteronism were studied by combined scintigraphy. Thirteen men and 7 women, mean age of 52 years, aged from 31 to 73 years, were included. Uptake of free iodine by the thyroid was inhibited by oral Lugol 5 % administration. Dexamethasone 4 mg per day was administered from day 7 to the third day of detection, when administration was stopped. Adrenal scintigraphy was performed after intravenous injection of I-131-norcolesterol (37 MBq). Images were taken at 24 and/or 48 hours and on the third day. Afterwards, dexamethasone administration was stopped and late images on 5th and/or 7th days were obtained. The scintigraphic result was confirmed with the final clinical evaluation (FCE) of the patient. RESULTS: 11 patients presented pathological studies, 9 adenomas (8TP + 1FP) and 2 bilateral adrenal hyperplasia (2TP); 7 normal scintigraphies (6TN and 1 non-conclusive FCE) and 2 non-conclusive scintigraphies (1 incidentaloma and 1 non-conclusive FCE). Normal adrenal glands were visualized in all cases on the 5th and/or 7th day scintigraphy. CONCLUSION: The study of adrenal functionalism by the combined protocol of adrenal suppression study plus later non-suppression study made it possible to identify with high precision primary aldosteronism and to confirm the function of normal adrenal glands.