Reduction of Left Ventricular Dilation Beyond the First Year After Anterior Myocardial Infarction.

BACKGROUND: Reduction of left ventricular (LV) dilation (RD) beyond the first year after ST-segment-elevation myocardial infarction (STEMI) is unknown. We investigated its potential occurrence in comparison with stationary (SD) and progressive (PD) dilation. METHODS AND RESULTS: Perfusion gated SPECT features at 1 and 3 years were evaluated in 168 3-year survivors of a first anterior STEMI. Comparisons were made among patients with RD (≥15% reduction of LV end-systolic volume [LVESV]), SD (<15% reduction or increase), and PD (≥15% increase). There were 35 patients with RD (21%), 84 with SD (50%), and 49 with PD (29%). At 1 year, ejection fraction, wall motion and perfusion scores, and LV volumes were similar. In RD patients, the fall in LVESV, nearly 22%, was apparent in those with frank (>51 mL; P < .001) or little/moderate LV dilation at 1 year (LVESV ≤51 mL; P = .002) and was associated with increased ejection fraction (P values .008 and .009, respectively). In the 3 groups, however, LVESV changes were unrelated to 1-year LV volumes, ejection fraction, or contractility score. CONCLUSIONS: At 3 years following anterior STEMI there is reduction of LV dilation in about 21% of patients associated with increases in ejection fraction in those with or without clearly dilated ventricles at 1year. These findings add to the complexity of LV remodeling and possibly suggest very late changes in infarct size.

Puntualizaciones al documento de consenso en cardio-onco-hematología y a la revisión sobre técnicas de imagen cardiaca en detección de cardiotoxicidad / Remarks on the position paper on cardio-onco-hematology and remarks on the review of cardiac imaging modalities for the detection of cardiotoxicity

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A New Integrated Clinical-Biohumoral Model to Predict Functionally Significant Coronary Artery Disease in Patients With Chronic Chest Pain.

BACKGROUND: In patients with chronic angina-like chest pain, the probability of coronary artery disease (CAD) is estimated by symptoms, age, and sex according to the Genders clinical model. We investigated the incremental value of circulating biomarkers over the Genders model to predict functionally significant CAD in patients with chronic chest pain. METHODS: In 527 patients (60.4 years, standard deviation, 8.9 years; 61.3% male participants) enrolled in the European Evaluation of Integrated Cardiac Imaging (EVINCI) study, clinical and biohumoral data were collected. RESULTS: Functionally significant CAD-ie, obstructive coronary disease seen at invasive angiography causing myocardial ischemia at stress imaging or associated with reduced fractional flow reserve (FFR < 0.8), or both-was present in 15.2% of patients. High-density lipoprotein (HDL) cholesterol, aspartate aminotransferase (AST) levels, and high-sensitivity C-reactive protein (hs-CRP) were the only independent predictors of disease among 31 biomarkers analyzed. The model integrating these biohumoral markers with clinical variables outperformed the Genders model by receiver operating characteristic curve (ROC) (area under the curve [AUC], 0.70 [standard error (SE), 0.03] vs 0.58 [SE, 0.03], respectively, P < 0.001) and reclassification analysis (net reclassification improvement, 0.15 [SE, 0.07]; P = 0.04). Cross-validation of the ROC analysis confirmed the discrimination ability of the new model (AUC, 0.66). As many as 56% of patients who were assigned to a higher pretest probability by the Genders model were correctly reassigned to a low probability class (< 15%) by the new integrated model. CONCLUSIONS: The Genders model has a low accuracy for predicting functionally significant CAD. A new model integrating HDL cholesterol, AST, and hs-CRP levels with common clinical variables has a higher predictive accuracy for functionally significant CAD and allows the reclassification of patients from an intermediate/high to a low pretest likelihood of CAD.

Colonic responses to gas loads in subgroups of patients with abdominal bloating.

OBJECTIVES: We sought to evaluate colonic gas accommodation, ileocecal competence, and colonic clearance in subgroups patients with abdominal bloating. METHODS: Thirty-six patients complaining of abdominal bloating (12 constipation-predominant irritable bowel syndrome (IBS-C), 12 diarrhea-predominant irritable bowel syndrome (IBS-D), and 12 functional bloating) and 18 healthy controls were studied. Abdominal perception and girth were measured during: (i) 1 h continuous infusion of gas at 24 ml/min into the rectum (accommodation period) and (ii) 30 min free rectal gas evacuation (clearance period). In eight patients and eight healthy subjects, the gas infused was labeled with radioactive xenon (74 MBq (133)Xe), and gas distribution was determined by scintigraphy. RESULTS: Colonic gas accommodation produced significantly more abdominal symptoms and distension in patients than in healthy subjects (3.8+/-0.2 vs. 2.4+/-0.3 perception score; P<0.001; 10.9+/-0.6 vs. 8.3+/-0.5 mm girth increment; P=0.009). Scintigraphy showed no differences in colonic gas distribution and no ileal gas reflux, but patients exhibited impaired gas clearance from the proximal colon (63%+/-10% clearance in 30 min vs. 80%+/-2% in health; P=0.042), resulting in more residual gas (506+/-46 vs. 174+/-47 ml; P<0.001), perception (1.9+/-0.2 vs. 1.0+/-0.2 score; P=0.015), and girth increment (4.2+/-0.7 vs. 2.2+/-0.5 mm; P=0.024); IBS-C patients exhibited increased sensation and objective distension, as opposed to sensation only in IBS-D and distension only in functional bloating. CONCLUSIONS: Patients with abdominal bloating have normal colonic accommodation and ileocecal competence but impaired gas clearance from the proximal colon after retrograde infusion, and the consequences of this dysfunction are related to bowel habit.

Automatic construction of 3D-ASM intensity models by simulating image acquisition: application to myocardial gated SPECT studies.

Active shape models bear a great promise for model-based medical image analysis. Their practical use, though, is undermined due to the need to train such models on large image databases. Automatic building of point distribution models (PDMs) has been successfully addressed and a number of autolandmarking techniques are currently available. However, the need for strategies to automatically build intensity models around each landmark has been largely overlooked in the literature. This work demonstrates the potential of creating intensity models automatically by simulating image generation. We show that it is possible to reuse a 3D PDM built from computed tomography (CT) to segment gated single photon emission computed tomography (gSPECT) studies. Training is performed on a realistic virtual population where image acquisition and formation have been modeled using the SIMIND Monte Carlo simulator and ASPIRE image reconstruction software, respectively. The dataset comprised 208 digital phantoms (4D-NCAT) and 20 clinical studies. The evaluation is accomplished by comparing point-to-surface and volume errors against a proper gold standard. Results show that gSPECT studies can be successfully segmented by models trained under this scheme with subvoxel accuracy. The accuracy in estimated LV function parameters, such as end diastolic volume, end systolic volume, and ejection fraction, ranged from 90.0% to 94.5% for the virtual population and from 87.0% to 89.5% for the clinical population.

Nuclear magnetic resonance-based metabolomics predicts exercise-induced ischemia in patients with suspected coronary artery disease.

The purpose of this study was to develop a (1)H-nuclear magnetic resonance metabolomic approach capable of predicting the occurrence of exercise-induced ischemia in patients with suspected coronary artery disease and to identify the metabolite patterns that contribute most importantly to the prediction. In 31 patients with suspected effort angina and without previous myocardial infarction, serum was obtained just prior to a stress single-photon emission computed tomography. Serum NMR spectra were acquired with pulse-and-acquire and T(2)-edited sequences. The region between 0.50 and 4.25 ppm was used for analysis. Twenty-two patients had reversible myocardial perfusion defects and nine did not. Both groups had similar age and clinical profile, except for more smokers and diabetics in the ischemia group, and attained a similar peak heart rate. The best separation was achieved with long T(2)-edited spectra, 84% of patients being correctly classified based on the partial least square discriminant analysis. The main contributors to discrimination were lactate, glucose, as well as methyl and methylene moieties of lipids and long-chain amino acids. Metabolomic analysis of serum can predict exercise-inducible ischemia in patients with suspected coronary artery disease. This capability could be useful in screening and risk stratification of patients with coronary risk factors.

Effect of clinical variables on the correlation between amount of ST elevation and myocardial scintigraphic perfusion defect during coronary occlusion.

PURPOSE: We investigated if the correlation between the amount of ST elevation (STE) and myocardial ischemia could be altered by variables such as hypertension or body mass index (BMI). METHODS: A 12-lead electrocardiogram and a technetium-99m tetrofosmin injection were performed during balloon coronary occlusion in 34 patients with single-vessel disease. RESULTS: The sum of STE correlated with scintigraphic extent of ischemia (r = 0.441; P = .009), but this correlation improved significantly in men and patients with BMI of 28 kg/m2 or less and was highest in nonhypertensive patients (r = 0.763; P < .001). In contrast, it was poor in women and patients with BMI greater than 28 kg/m2 or arterial hypertension, being lowest in the latter subset (r = 0.110; P = .664). Moreover, 8 (80%) of 10 patients with extensive hypoperfusion but with low SigmaSTE (< or =20 mm) were hypertensive. CONCLUSIONS: If confirmed by larger studies, electrocardiographic underestimation of transmural ischemia during coronary occlusion in patients with hypertension or increased BMI may lead to adjustments in STE criteria for reperfusion therapy.

Impaired viscerosomatic reflexes and abdominal-wall dystony associated with bloating.

BACKGROUND & AIMS: Abdominal bloating is a frequent complaint in irritable bowel syndrome (IBS), but its underlying mechanism remains uncertain. Our aim was to determine whether the abdominal wall, specifically its adaptation to intra-abdominal volumes, plays a role. METHODS: In 12 patients complaining of abdominal bloating (8 IBS and 4 functional bloating) and in 12 healthy controls, the effect of colonic gas load (24 mL/min rectal gas infusion for 1 hour) on perception (measured by a 0-6 scale), abdominal girth, and muscular activity was tested. With the participants sitting on an ergonomic chair and the trunk erect, multichannel electromyography was measured via bipolar surface electrodes located over the upper and lower rectus abdominis, and the external and internal oblique bilaterally. RESULTS: In healthy controls, colonic gas loads produced subjective symptoms (score, 3.0 +/- 0.3), objective abdominal distention (girth increment, 6 +/- 1 mm), and increased the activity of the abdominal muscles (external oblique activity, 11% +/- 3% in; P < .05 vs basal). At the same infused gas volumes, the patients developed significantly more symptoms (score, 4.5 +/- 0.4) and abdominal distention (11 +/- 1 mm; P < .05 vs healthy for both). These abnormal responses were associated with failed tonic contraction of the abdominal wall (external oblique activity change, -1% +/- 4%; P value not significant vs basal) and paradoxic relaxation of the internal oblique (activity reduction, 26% +/- 7%; P < .01 vs basal). CONCLUSIONS: In patients with bloating, abdominal perception and distention in response to intra-abdominal volume increments are exaggerated markedly and associated with muscular dystony of the abdominal wall.

Relation of myocardial perfusion defects and nonsignificant coronary lesions by angiography with insights from intravascular ultrasound and coronary pressure measurements.

Several studies have demonstrated a correlation between myocardial ischemia and severity of coronary lesions as determined by intravascular ultrasound (IVUS) and fractional flow reserve (FFR) measurements. However, their value for the assessment of mild coronary stenoses that are associated with myocardial perfusion abnormalities has not been well studied. The objective of this study was to prospectively compare the results of myocardial perfusion as determined by exercise/dipyridamole myocardial single-photon emission computed tomography with IVUS and FFR measurements in patients who had angiographically mild coronary stenosis (< 50% diameter stenosis by quantitative coronary angiography). Forty-eight patients who had stable coronary disease (61 +/- 11 years of age; 6 women) were included. All had mild coronary stenosis in the proximal/middle segment of > or = 1 coronary artery and had undergone maximal exercise myocardial technetium-99m tetrofosmin single-photon emission computed tomography within 48 hours before coronary angiography. IVUS measurements included lesion lumen area, external elastic membrane area, lesion plaque burden (calculated as external elastic membrane minus lumen area, divided by external elastic membrane, and multiplied by 100), and lumen area stenosis (calculated as reference lumen area minus lesion lumen area, divided by reference lumen area, multiplied by 100). Fifty-three coronary lesions were studied, with a mean percent diameter stenosis of 34.9 +/- 7.9% on angiography. Myocardial perfusion defects were demonstrated by single-photon emission computed tomography in 11 patients (12 myocardial regions) with no differences in lesion percent diameter stenosis compared with those without perfusion defects. The presence of reversible perfusion defects was associated with a higher lesion plaque burden as evaluated by IVUS (67.4 +/- 8.1% vs 60.2 +/- 9.3%, p = 0.01). FFR values did not differ in the presence or absence of perfusion defects (0.90 +/- 0.06 vs 0.92 +/- 0.07, respectively; p = NS). In conclusion, plaque burden as determined by IVUS may partly explain the presence of myocardial perfusion defects in cases of angiographically nonsignificant coronary lesions. However, the high FFR values associated with these lesions suggest that other mechanisms, such as endothelial/microvascular dysfunction, might also account for perfusion abnormalities in these patients.

Origin of gas retention and symptoms in patients with bloating.

BACKGROUND & AIMS: Patients reporting abdominal bloating exhibit impaired tolerance to intestinal gas loads. The aim of this study was to identify the gut compartment responsible for gas retention. METHODS: In 30 patients predominantly reporting abdominal bloating (24 with irritable bowel syndrome and 6 with functional bloating) and 22 healthy subjects, gas (nitrogen, carbon dioxide, and oxygen) was infused into the intestine for 2 hours while measuring rectal gas outflow. First, in 12 patients and 10 healthy subjects, gas transit (24 mL/min jejunal infusion labeled with 74 MBq bolus of 133 Xe) was measured by scintigraphy. Second, in groups of patients and healthy subjects, the effects of gas infusion (12 mL/min) in the jejunum versus ileum, jejunum versus cecum, and jejunum versus sham infusion (n=6 each) were compared by paired tests. RESULTS: In patients, total gut transit of gas was delayed (50% clearance time, 33 +/- 4 min vs 23 +/- 4 min in healthy subjects; P <.05) owing to impaired small bowel transit (50% clearance time, 20 +/- 2 min vs 12 +/- 3 min in healthy subjects; P <.05), whereas colonic transit was normal (50% clearance time, 13 +/- 2 min vs 11 +/- 2 min in healthy subjects; not significant). Furthermore, jejunal gas infusion in patients was associated with gas retention (329 +/- 81 mL vs 88 +/- 79 mL in healthy subjects; P <.05), whereas direct ileal or colonic infusion was not (61 +/- 103 mL and -143 +/- 87 mL retention, respectively). CONCLUSIONS: In patients reporting bloating, the small bowel is the gut region responsible for ineffective gas propulsion.

Do myocardial perfusion SPECT and radionuclide angiography studies in adult patients with hypertrophic cardiomyopathy have prognostic implications?

BACKGROUND: Some myocardial perfusion single photon emission computed tomography (SPECT) and radionuclide ventriculography studies have suggested that the presence of regional perfusion defects and diastolic abnormalities could have prognostic implications in patients with hypertrophic cardiomyopathy (HC). The aim of this prospective study was to analyze the prognostic value of these techniques in adult patients with HC. METHODS AND RESULTS: One hundred one patients with HC (44 women; mean age, 54 +/- 16 years; 55% obstructive) were prospectively studied by means of myocardial perfusion SPECT and radionuclide angiography. Of these patients, 55 (54.4%) had an abnormal myocardial perfusion SPECT study: 28 (27.7%) had fixed defects and 41 (40.6%) had reversible defects; 15 (14.8%) of these patients had both types of defect. Of the patients, 16% had left ventricular ejection fraction lower than 60%, 25.7% had an abnormal peak filling rate, and 51% had an abnormal time to peak filling rate. During 5.6 +/- 2.7 years of follow-up, 13 patients (12.8%) died (heart failure 8 and sudden death in 5) and 14 had one or more severe complications develop (syncope in 6, angina III-IV in 4, dyspnea III-IV in 10, and acute myocardial infarction in 3). The summed difference score was higher in patients with cardiac death (2.2 +/- 2.3 vs 1.1 +/- 1.3, P = .008), and fixed defects were more prevalent in patients with severe complications (57% vs 21%, P = .01). In the Kaplan-Meier survival plot analysis, severe complications were more likely in patients with fixed defects (P = .01) or ejection fraction lower than 60% ( P = .01). CONCLUSIONS: Prognostic information from myocardial perfusion SPECT and radionuclide angiography has limited clinical significance with regard to cardiac death in adult patients with HC. However, the presence of fixed defects and lower ejection fraction in these patients has an adverse prognostic meaning for severe complications.

Three-dimensional fusion of coronary arteries with myocardial perfusion distributions: clinical validation.

UNLABELLED: Clinical decisions regarding diagnosis and effective treatment of coronary artery disease frequently require integration of information from various imaging modalities, which are acquired, processed, and read at different physical locations and times. We have developed methods to integrate the information in 2 cardiac imaging studies, perfusion SPECT and coronary angiography. Three-dimensional (3D) models of the coronary artery tree created from biplane angiograms were automatically aligned with 3D models of the left ventricular epicardial surface created from perfusion SPECT. Myocardial mass at risk was used as a unique measure to validate the accuracy of the unification. METHODS: Thirty patients were injected with the perfusion agent (99m)Tc-tetrosfosmin during balloon occlusion while undergoing percutaneous transluminal coronary angioplasty for single-vessel coronary artery disease. Thus, a single, severe perfusion defect was induced by a single coronary artery occlusion of known severity and placement. The accuracy of the unification was measured by computing the overlap between physiologic area at risk, determined using SPECT perfusion quantification techniques only, and anatomic area at risk, determined using coronary artery anatomy aligned with the epicardial surface of the left ventricle. RESULTS: The unification resulted in an 80% overlap of areas at risk, and an overlap of 84% of normal areas, for all coronary artery distributions. The mass at risk measured based on the unified anatomic information correlated with the physiologically based mass at risk as y = 0.92x + 10.3 g; r = 0.76, SEE = 10.4 g. CONCLUSION: A unification algorithm for automatically registering 3D models of the epicardial surface from perfusion SPECT and 3D coronary artery trees from coronary angiography has been presented and validated in 30 patient studies.

Nebulized amphotericin B concentration and distribution in the respiratory tract of lung-transplanted patients.

BACKGROUND: A criticism of using nebulized amphotericin B (nAB) as prophylaxis against Aspergillus infection after lung transplantation is the lack of knowledge of its pharmacokinetics and distribution in the lung. The aim of this study was to ascertain the concentrations and distribution of nAB in the respiratory tract of patients receiving lung transplantations. METHODS: In the drug-concentration study, 120 bronchoscopies were performed in 39 patients receiving lung transplantions after administration of 6 mg of nAB once daily for a minimum of 7 days. Mean nAB concentration in bronchial aspirated secretions (BAS) and bronchoalveolar lavage (BAL) was determined at 4, 12, 24, and 48 hours postnebulization. In the distribution study, 17 patients inhaled 6 mg of 99m technetium-labeled AB, and pulmonary distribution was measured using a gamma camera. Pulmonary perfusion was also measured. Both tests were quantitatively evaluated. RESULTS: In the drug-concentration study, mean concentrations of 1.46 microg/mL in BAS and 15.75 microg/mL in BAL were reached at 4 hours. At 24 hours, concentrations were 0.37 microg/m and 11.02 microg/mL in BAS and BAL, respectively. In the distribution study, 99m technetium-labeled AB distribution was uniform in 12 of 13 allografts without bronchiolitis obliterans syndrome (BOS) and in 1 of 4 allografts with BOS. A close correlation was observed between regional drug distribution and regional perfusion (r=0.82, P<0.01). CONCLUSIONS: nAB concentrations remained high for the first 24 hours in BAL and for less time in BAS, with distribution of the drug being uniform in patients without BOS. Furthermore, lung-perfusion studies appear to be useful to ascertain nAB distribution in patients receiving lung transplantions.

[Exercise-induced left bundle-branch block in patients with coronary artery disease versus patients with normal coronary arteries]. / El bloqueo de rama izquierda inducido por el ejercicio en pacientes con y sin enfermedad coronaria.

INTRODUCTION AND OBJECTIVES: Exercise-induced left bundle-branch block does not always denote the presence of underlying coronary artery disease. The aim of this study was to analyze the clinical characteristics and evolution of patients with rate-dependent left bundle-branch block. PATIENTS AND METHOD: 9,318 consecutive exercise stress studies were reviewed. The clinical characteristics and evolution (mean follow-up: 6.9 years) of 20 patients with exercise-induced left bundle-branch block in which coronary angiography had been performed were analyzed. RESULTS: Eight out of 20 patients had normal coronary arteries (group A) and 12 had coronary artery disease (group B). Peak O2 consumption, peak myocardial O2 consumption, and heart rate when block appeared (132 20 vs. 95.4 23 beats/min; p = 0.002) were significantly higher in group A. Seven of the 8 patients with normal coronary arteries had chest pain coinciding with the first beat of left bundle-branch block. There were no deaths during follow-up in group A, but permanent left bundle-branch block appeared in 5 patients of this group who experienced disappearance of exercise-related pain. There were 3 deaths in group B and 2 patients had acute myocardial infarction during follow-up. One patient in each group developed atrioventricular block and required pacemaker implantation. CONCLUSIONS: In contrast with patients with left bundle-branch block and coronary artery disease, the prognosis of patients with painful left bundle-branch block and normal coronary arteries is good. However, the development of permanent left bundle-branch block is frequent. Atrioventricular block, although rare, may occur.

El bloqueo de rama izquierda inducido por el ejercicio en pacientes con y sin enfermedad coronaria / Exercise-induced left bundle-branch block in patients with coronary artery disease versus patients with normal coronary arteries

Introducción y objetivos. La aparición de un bloqueo de rama izquierda inducido por el ejercicio no siempre significa presencia de enfermedad coronaria subyacente. El motivo de este estudio fue analizar las características clínicas y evolutivas de los pacientes con bloqueo de rama izquierda dependiente de la frecuencia. Pacientes y método. Se revisaron 9.318 estudios ergométricos de esfuerzo practicados de forma consecutiva y se estudiaron las características clínicas y evolutivas (seguimiento medio: 6,9 años) de los 20 pacientes que presentaron bloqueo de rama izquierda dependiente de frecuencia y en los que se disponía de coronariografía. Resultados. Un total de ocho de los 20 pacientes tenían coronarias normales (grupo A) y 12 tenían enfermedad coronaria (grupo B). El consumo máximo de O2, el consumo miocárdico de O2 y la frecuencia cardíaca en el momento de aparición del bloqueo (132 ñ 20 frente a 95,4 ñ 23 lat/min; p = 0,002) fueron significativamente superiores en el grupo A. Siete de los 8 pacientes del grupo A presentaron dolor precordial coincidiendo con el primer latido en que apareció el bloqueo. No hubo ningún caso de fallecimiento en el grupo A, y en cinco de los 8 pacientes de este grupo se observó evolución a bloqueo de rama izquierda permanente con desaparición del dolor inducido por el esfuerzo. En el grupo B, 3 pacientes fallecieron y dos presentaron un infarto durante el seguimiento. Un paciente de cada grupo evolucionó a bloqueo auriculoventricular completo. Conclusiones. A diferencia de los pacientes con bloqueo de rama izquierda dependiente de frecuencia y enfermedad coronaria, el pronóstico de los pacientes con bloqueo de rama izquierda doloroso y coronarias normales es muy bueno en cuanto a mortalidad, aunque pueden evolucionar a bloqueo de rama izquierda permanente y, excepcionalmente, a bloqueo auriculoventricular (AU)

[Unified three-dimensional images of myocardial perfusion and coronary angiography]. / Superposición en tres dimensiones de las imágenes de perfusión miocárdica y de la coronariografía.

INTRODUCTION AND OBJECTIVES: In everyday clinical practice, the cardiologist needs to integrate anatomical and functional information from patients with coronary artery disease. The aim of this study is to present a way to unify, in three-dimensional images, anatomical information from coronary angiography with physiological information from myocardial perfusion scintigraphy. METHODS: Three patients with one vessel disease (left anterior descending, right coronary and left circumflex arteries, respectively) scheduled for percutaneous coronary revascularization were selected. Two-dimensional angiographic images were obtained before and after revascularization. 99mTc-tetrofosmin was administered during coronary occlusion and tomographic images corresponding to the occlusion were detected after coronary dilatation. Control rest scintigraphic images were obtained after two days. The three-dimensional coronary tree from coronary angiography was superposed on the epicardial contours of the myocardial perfusion images following a method of our own. RESULTS: A correct three-dimensional reconstruction of myocardial contour and coronary tree was achieved for each patient. The three-dimensional unified images showed excellent concordance between the extent of perfusion defects and the anatomic distribution of the occluded vessel. CONCLUSIONS: Three-dimensional unification of myocardial perfusion images and coronary angiography is technically possible. This technology integrates anatomical and functional information to facilitate the cardiologist's decision-making and so improve coronary patient management.

Superposición en tres dimensiones de las imágenes de perfusión miocárdica y de la coronariografía / Unified three-dimensional images of myocardial perfusion and coronary angiography

Introducción y objetivos. Integrar la información anatómica y funcional en pacientes con cardiopatía isquémica es una tarea habitual en la práctica diaria del cardiólogo. El objetivo de este trabajo es presentar una metodología de unificación tridimensional de la información anatómica relativa a las coronarias epicárdicas, proveniente de la coronariografía, con la información fisiológica de perfusión tisular procedente de la tomogammagrafía de perfusión miocárdica. Métodos. Se seleccionaron 3 pacientes programados, por criterios clínicos, para revascularización coronaria percutánea y con enfermedad de un solo vaso (descendente anterior, coronaria derecha y circunfleja). Las imágenes coronariográficas biplanares se obtuvieron antes y después de la dilatación. Durante la oclusión coronaria se administró una dosis de 99mTc-tetrofosmina y, una vez finalizada la dilatación, se obtuvieron las imágenes de perfusión miocárdica correspondientes a la oclusión. La tomogammagrafía de control en reposo se repitió dos días después. Mediante una metodología propia se generaron los contornos epicárdicos de las imágenes de perfusión miocárdica y sobre ellos se superpuso el árbol coronario tridimensional proveniente de la coronariografía. Resultados. Se logró una correcta reconstrucción tridimensional del contorno epicárdico y del árbol coronario completo en los 3 pacientes. La imagen unificada en tres dimensiones presentó una excelente concordancia entre la extensión de los defectos de perfusión y la distribución anatómica del vaso ocluido. Conclusiones. La superposición tridimensional de las imágenes de perfusión miocárdica y de la coronariografía es técnicamente posible. Ello permite integrar la información anatómica y funcional de cara a facilitar la toma de decisiones por parte del cardiólogo y mejorar el manejo del paciente coronario (AU)