RESUMO
OBJECTIVE: To assess the frequency, change in prevalence, and prognostic significance of dyspnea among contemporary patients referred for cardiac stress testing. PATIENTS AND METHODS: We evaluated the prevalence of dyspnea and its relationship to all-cause mortality among 33,564 patients undergoing stress/rest SPECT-MPI between January 1, 2002 and December 31, 2017. Dyspnea was assessed as a single-item question. Patients were divided into three temporal groups. RESULTS: The overall prevalence of dyspnea in our cohort was 30.2%. However, there was a stepwise increase in the temporal prevalence of dyspnea, which was present in 25.6% of patients studied between 2002 and 2006, 30.5% of patients studied between 2007 and 2011, and 38.7% of patients studied between 2012 and 2017. There was a temporal increase in the prevalence of dyspnea in each age, symptom, and risk factor subgroup. The adjusted hazard ratio for mortality was higher among patients with dyspnea vs those without dyspnea both among all patients, and within each chest pain subgroup. CONCLUSIONS: Dyspnea has become increasingly prevalent among patients referred for cardiac stress testing and is now present among nearly two-fifths of contemporary cohorts referred for stress-rest SPECT-MPI. Prospective study is needed to standardize the assessment of dyspnea and evaluate the reasons for its increasing prevalence.
Assuntos
Doença da Artéria Coronariana , Imagem de Perfusão do Miocárdio , Humanos , Teste de Esforço/efeitos adversos , Dor no Peito/diagnóstico , Prognóstico , Tomografia Computadorizada de Emissão de Fóton Único/efeitos adversos , Dispneia/diagnóstico , Dispneia/etiologia , Imagem de Perfusão do Miocárdio/efeitos adversos , Doença da Artéria Coronariana/complicaçõesRESUMO
Heart failure (HF), a clinical syndrome most commonly occurring due to ischemic heart disease, causes significant morbidity and mortality. The benefits of revascularization versus medical treatment for ischemic heart failure remain controversial. Thus, we assessed a patient diagnosed with ischemic heart failure before and 3 months after coronary artery bypass grafting by myocardial radionuclide imaging. Findings of Tc-99m sestamibi myocardial perfusion imaging revealed that the degree and area of ischemia were significantly reduced, and the systolic function of the left ventricle improved compared with the preoperative value. This suggests the benefit of revascularization in cases of ischemic heart failure.
Assuntos
Insuficiência Cardíaca , Imagem de Perfusão do Miocárdio , Humanos , Imagem de Perfusão do Miocárdio/efeitos adversos , Tomografia Computadorizada de Emissão de Fóton Único/efeitos adversos , Tomografia Computadorizada de Emissão de Fóton Único/métodos , Tecnécio Tc 99m Sestamibi , Insuficiência Cardíaca/cirurgia , Ponte de Artéria Coronária/efeitos adversos , IsquemiaRESUMO
Coronary microvascular dysfunction is present in two-thirds of patients showing symptoms and signs of myocardial ischemia. Their microcirculation has abnormalities due to endothelial and smooth muscle cell dysfunction. Impairment of this mechanism causes a high risk of adverse cardiovascular event. Diagnosing coronary microvascular dysfunction is challenging. Guidelines recommend the use of nuclear medicine procedures in the above-mentioned indications. Myocardial perfusion imaging with positron emission tomography is a novel procedure with high diagnostic accuracy and quality of images. It has short acquisition, low effective radiation dose and prognostic factors. There are still unknowns about this procedure and all its benefits.
Assuntos
Doença da Artéria Coronariana , Isquemia Miocárdica , Imagem de Perfusão do Miocárdio , Angiografia Coronária/métodos , Doença da Artéria Coronariana/complicações , Circulação Coronária/fisiologia , Humanos , Microcirculação/fisiologia , Isquemia Miocárdica/diagnóstico por imagem , Imagem de Perfusão do Miocárdio/efeitos adversos , Imagem de Perfusão do Miocárdio/métodosRESUMO
BACKGROUND: Pulmonary arterial hypertension (PAH) is a complex and severe complication of connective tissue disease (CTD). We aimed to evaluate the application value of myocardial perfusion imaging (MPI) in evaluating CTD-associated PAH (CTD-PAH). METHODS: We retrospectively included 88 patients who were diagnosed with CTD between January 2018 and December 2020 at our hospital. Fifty-eight patients had PAH and were included into the CTD-PAH group. Thirty patients without PAH were included in the control group. All patients received routine physical examination, biochemical tests and cardiac function evaluation, right heart catheterization (RHC), and 99m Tc-MIBI MPI. PAH patients were divided into the mild, moderate, and severe PAH group according to their mean pulmonary artery pressures by RHC. Pearson correlation analysis was used to calculate the correlation between the right ventricle target/background (T/B) and right ventricle stroke volume (RV-SV), total pulmonary resistance (TPR), pulmonary vascular resistance (PVR), mean pulmonary arterial pressure (mPAP), 6-minute walk distance (6-MWD), and N-terminal B-type natriuretic peptide (NT-proBNP). The ROC curves of T/B and pulmonary artery pressure classification were plotted and the sensitivity and specificity of T/B in diagnosing PAH of different severities were analyzed. RESULTS: The analysis of correlation revealed that T/B correlated negatively with 6-MWD and positively with NT-proBNP and exhibited good positive correlation with mPAP, TPR, and PVR by RHC and negative correlation with RV-SV. T/B was of the most diagnostic value for severe PAH, and its correlation with severe PAH was stronger than that with mild PAH and moderate PAH. CONCLUSIONS: Target/background is a noninvasive method that can simultaneously evaluate pulmonary arterial pressure and myocardial perfusion of CTD-CHD patients and is particularly of relatively high value for severe PAH patients.
Assuntos
Doenças do Tecido Conjuntivo , Hipertensão Pulmonar , Imagem de Perfusão do Miocárdio , Hipertensão Arterial Pulmonar , Pressão Arterial , Doenças do Tecido Conjuntivo/diagnóstico , Doenças do Tecido Conjuntivo/diagnóstico por imagem , Eletrocardiografia/efeitos adversos , Hipertensão Pulmonar Primária Familiar/complicações , Humanos , Hipertensão Pulmonar/complicações , Hipertensão Pulmonar/diagnóstico por imagem , Imagem de Perfusão do Miocárdio/efeitos adversos , Hipertensão Arterial Pulmonar/diagnóstico , Hipertensão Arterial Pulmonar/diagnóstico por imagem , Estudos RetrospectivosRESUMO
We aimed to establish the feasibility and safety of dynamic computed tomography perfusion (CTP) in patients with chronic total occlusion (CTO) undergoing percutaneous coronary intervention (PCI). Ten consecutive CTO patients with preserved left ventricular ejection fraction (≥50%) underwent regadenoson dynamic CTP prior to and at least 3 months after successful CTO recanalization. Quantitative absolute and indexed values of stress myocardial blood flow (MBF) were measured for each myocardial segment, and perfusion defect size was defined by the number of segments with indexed MBF ≤0.78. The control group comprised 10 subjects without ischemia on CTP. Out of 20 CTP studies with 320 segments, 311 segments (97.2%) were interpretable. The dose-length product for CTP was 589.5 â± â144.3 mGy cm, and no severe adverse reactions to either regadenoson or contrast were observed. Successful PCI resulted in a significant increase in stress MBF in CTO (101.8 [82.9-127.1] vs. 158.4 [132.6-172] ml/100ml/min, p â= â0.004). Overall, there were significant reductions in both CTO and total defect size post-PCI (5 [5-6] vs. 1 [0.3-2] and 6 [5-8.5] vs. 1.5 [1-3.8] segments, both p â= â0.002). In segment analysis, the indexed MBF was lowest in the pre-PCI CTO group (0.90 [0.53-1.0]), followed by post-PCI CTO group (0.96 [0.88-1.0]) and the control group (0.98 [0.94-1.0]). Dynamic CTP is feasible and safe, and shows large perfusion defects in patients with CTO. While ischemic burden can be significantly improved after successful CTO PCI, it is still larger as compared with normal myocardium. NCT04465526: The Influence of Coronary Chronic Total Occlusion on Myocardial Perfusion on Computed Tomography (COPACABANA).
Assuntos
Oclusão Coronária , Imagem de Perfusão do Miocárdio , Intervenção Coronária Percutânea , Tomografia Computadorizada por Raios X , Humanos , Doença Crônica , Angiografia Coronária , Circulação Coronária/fisiologia , Oclusão Coronária/diagnóstico por imagem , Oclusão Coronária/terapia , Estudos de Viabilidade , Imagem de Perfusão do Miocárdio/efeitos adversos , Imagem de Perfusão do Miocárdio/métodos , Valor Preditivo dos Testes , Volume Sistólico , Tomografia Computadorizada por Raios X/efeitos adversos , Resultado do Tratamento , Função Ventricular EsquerdaRESUMO
Patients with illicit drug use may have deleterious acute and chronic cardiac effects. We present a case of a 42-year-old man, former alcohol and various illicit drugs user, who was admitted to the psychiatric unit for management of psychosis. Because of his previous drug and alcohol history, a cardiological evaluation was performed which revealed silent severe myocardial ischemia detected by myocardial perfusion imaging (MPI). The myocardial ischemia was attributed to coronary microvascular dysfunction, occurring several years after quitting the illicit drugs. This study highlights the potential myocardial ischemia that may occur in patients with previous alcohol and illicit drug use, and the role of MPI, a non-invasive test that can provide important information regarding the myocardial status of such patients, even without obvious cardiac symptoms or findings.
Assuntos
Doença da Artéria Coronariana , Drogas Ilícitas , Isquemia Miocárdica , Imagem de Perfusão do Miocárdio , Masculino , Humanos , Adulto , Drogas Ilícitas/efeitos adversos , Isquemia Miocárdica/diagnóstico por imagem , Isquemia Miocárdica/etiologia , Imagem de Perfusão do Miocárdio/efeitos adversos , Imagem de Perfusão do Miocárdio/métodosRESUMO
Regadenoson, a selective A2A receptor agonist, is widely used for vasodilator stress myocardial perfusion imaging and has a superior adverse effect profile when compared with other agents. However, with widespread use, there have been several reported cases of Regadenoson induced bradyarrhythmias and even asystole in patients with no known conduction system disease. In this article, we report a case of asystole following Regadenoson administration, evaluate mechanisms and risk factors for Regadenoson induced bradyarrhythmias to better identify patients at risk. We also review the available treatment options and propose recommendations for limiting its risk.
Assuntos
Parada Cardíaca/etiologia , Parada Cardíaca/terapia , Purinas/efeitos adversos , Pirazóis/efeitos adversos , Idoso de 80 Anos ou mais , Teste de Esforço/efeitos adversos , Teste de Esforço/métodos , Feminino , Humanos , Imagem de Perfusão do Miocárdio/efeitos adversos , Imagem de Perfusão do Miocárdio/métodos , Purinas/uso terapêutico , Pirazóis/uso terapêutico , Fatores de RiscoRESUMO
BACKGROUND: Patients with heart failure with reduced ejection fraction (HFrEF; heart failure with reduced left ventricular ejection fraction <40%) referred for stress cardiovascular magnetic resonance (CMR) may have a less optimal hemodynamic response to intravenous vasodilator. The aim was to assess the prognostic value of vasodilator stress perfusion CMR in patients with HFrEF. METHODS: Between 2008 and 2018, consecutive patients with HFrEF defined by left ventricular ejection fraction <40% prospectively referred for vasodilator stress perfusion CMR were followed for the occurrence of major adverse cardiovascular events (MACE), defined by cardiovascular death or nonfatal myocardial infarction. Univariable and multivariable Cox regressions were performed to determine the prognostic value of inducible ischemia or late gadolinium enhancement by CMR. RESULTS: Of 1053 patients with HFrEF (65±11 years, median [interquartile range] left ventricular ejection fraction 38.7% [37.2-39.0]), 1018 (97%) completed the CMR protocol and 950 (93%) completed the follow-up (median [interquartile range], 5.6 [3.6-7.3] years); 117 experienced a MACE (12.3%). Stress CMR was well tolerated without any adverse events. Patients without ischemia or late gadolinium enhancement experienced a lower annual event rate of MACE (1.8%) than those with both ischemia and late gadolinium enhancement (12.0%; P<0.001). Using Kaplan-Meier analysis, inducible ischemia and late gadolinium enhancement were significantly associated with the occurrence of MACE (hazard ratio, 2.46 [95% CI, 1.69-3.60]; and hazard ratio, 2.92 [95% CI, 1.77-4.83], respectively, both P<0.001). In multivariable Cox regression, inducible ischemia was an independent predictor of a higher incidence of MACE (hazard ratio, 2.26 [95% CI, 1.52-3.35]; P<0.001). CONCLUSIONS: Stress CMR is safe and has a good discriminative prognostic value to predict the occurrence of MACE in patients with HFrEF.
Assuntos
Dipiridamol/administração & dosagem , Insuficiência Cardíaca/diagnóstico por imagem , Imagem Cinética por Ressonância Magnética , Imagem de Perfusão do Miocárdio , Volume Sistólico , Vasodilatadores/administração & dosagem , Função Ventricular Esquerda , Idoso , Meios de Contraste , Dipiridamol/efeitos adversos , Feminino , Insuficiência Cardíaca/complicações , Insuficiência Cardíaca/mortalidade , Insuficiência Cardíaca/fisiopatologia , Humanos , Infusões Intravenosas , Estudos Longitudinais , Imagem Cinética por Ressonância Magnética/efeitos adversos , Masculino , Meglumina , Pessoa de Meia-Idade , Infarto do Miocárdio/etiologia , Imagem de Perfusão do Miocárdio/efeitos adversos , Compostos Organometálicos , Valor Preditivo dos Testes , Prognóstico , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Vasodilatadores/efeitos adversosRESUMO
The objective of our study is to assess change in QTc interval with Regadenoson administration during myocardial perfusion imaging (MPI). We conducted a retrospective, observational analysis of 1497 consecutive patients who underwent pharmacological radionuclide MPI. On multivariate logistic regression analyses, there was no statistical significance of QTc prolongation when adjusted for ischemia/fixed perfusion defect on MPI and QT prolonging medications being taken prior to stress testing. However, a positive stress ECG after Regadenoson injection had a statistical significance (p value 0.0004). Regadenoson is a safe drug for use in MPI with little, if any, side effects of major clinical significance.
Assuntos
Eletrocardiografia/efeitos dos fármacos , Síndrome do QT Longo/tratamento farmacológico , Imagem de Perfusão do Miocárdio/efeitos adversos , Purinas/administração & dosagem , Pirazóis/administração & dosagem , Agonistas do Receptor A2 de Adenosina/administração & dosagem , Feminino , Humanos , Síndrome do QT Longo/etiologia , Masculino , Pessoa de Meia-Idade , Estudos RetrospectivosRESUMO
In 2019, the Journal of Nuclear Cardiology published excellent articles pertaining to imaging in patients with cardiovascular disease. In this review, we will summarize a selection of these articles to provide a concise review of the main advancements that have recently occurred in the field and provide the reader with an opportunity to review a wide selection of articles. In the first article of this 2-part series, we focused on publications dealing with positron emission tomography, computed tomography, and magnetic resonance. This review will place emphasis on myocardial perfusion imaging using single-photon emission computed tomography summarizing advances in the field including in diagnosis and prognosis, non-perfusion variables, safety of testing, imaging in patients with heart failure and renal disease.
Assuntos
Imagem de Perfusão do Miocárdio/métodos , Tomografia Computadorizada de Emissão de Fóton Único/métodos , Doença da Artéria Coronariana/diagnóstico por imagem , Insuficiência Cardíaca/diagnóstico por imagem , Humanos , Nefropatias/diagnóstico por imagem , Imagem de Perfusão do Miocárdio/efeitos adversos , Tomografia Computadorizada de Emissão de Fóton Único/efeitos adversosRESUMO
BACKGROUND: Cardiovascular magnetic resonance (CMR) studies in patients with implanted cardioverter/defibrillators (ICD) are increasingly required in daily clinical practice. However, the clinical experience regarding the feasibility as well as clinical value of CMR studies in patients with subcutaneous ICD (S-ICD) is still limited. Besides safety issues, image quality and analysis can be impaired primarily due the presence of image artefacts associated with the generator. METHODS: Twenty-three patients with an implanted S-ICD (EMBLEM, Boston Scientific, Marlborough, Massachusetts, USA; MR-conditional) with suspected cardiomyopathy and/or myocarditis underwent multi-parametric CMR imaging. Studies were performed on a 1.5 T CMR scanner after device interrogation and comprised standard a) balanced steady state free precession cine, b) T2 weighted-edema, c) velocity-encoded cine flow, d) myocardial perfusion, e) late-gadolinium-enhancement (LGE)-imaging and f) 3D-CMR angiography of the aorta. In case of substantial artefacts, alternative CMR techniques such as spoiled gradient-echo cine-sequences and wide-band inversion-recovery LGE (wb-LGE) sequences were applied. RESULTS: Successful CMR studies could be performed in all patients without any case of unexpected early termination or relevant technical complication other than permanent loss of the S-ICD system beeper volume in 52% of our patients. Assessment of cine-CMR images was predominantly impaired in the left ventricular (LV) anterior, lateral and inferior wall segments and a switch to spoiled gradient echo-based cine-CMR allowed an accurate assessment of cine-images in N = 17 (74%) patients with only limited artefacts. Hyperintensity artefacts in conventional LGE-images were predominantly observed in the LV anterior, lateral and inferior wall segments and image optimisation by use of the wb-LGE was helpful in 15 (65%) cases. Aortic flow measurements and 3D-CMR angiography were assessable in all patients Perfusion imaging artefacts precluded a meaningful assessment in at least one half of the patients. A benefit in clinical-decision making was documented in 17 (74%) patients in the present study. CONCLUSION: Safe 1.5 T CMR imaging was possible in all patients with an S-ICD, though the majority had permanent loss of the S-ICD beeper volume. Achieving good image quality may be challenging in some patients - particularly for perfusion imaging. Using spoiled gradient echo-based cine-sequences and wb-LGE sequences may help to reduce the extent of artefacts, thereby allowing accurate cardiac assessment. Thus, 1.5 T CMR studies should not be withhold in patients with S-ICD for safety concerns and/or fear of extensive imaging artefacts precluding successful image analysis.
Assuntos
Cardiomiopatias/diagnóstico por imagem , Desfibriladores Implantáveis , Cardioversão Elétrica/instrumentação , Imagem Cinética por Ressonância Magnética , Imagem de Perfusão do Miocárdio/métodos , Miocardite/diagnóstico por imagem , Adulto , Idoso , Artefatos , Cardiomiopatias/fisiopatologia , Cardiomiopatias/terapia , Tomada de Decisão Clínica , Circulação Coronária , Cardioversão Elétrica/efeitos adversos , Feminino , Humanos , Imagem Cinética por Ressonância Magnética/efeitos adversos , Masculino , Pessoa de Meia-Idade , Imagem de Perfusão do Miocárdio/efeitos adversos , Miocardite/fisiopatologia , Miocardite/terapia , Segurança do Paciente , Valor Preditivo dos Testes , Prognóstico , Desenho de Prótese , Falha de Prótese , Reprodutibilidade dos Testes , Medição de Risco , Fatores de Risco , Função Ventricular EsquerdaRESUMO
Contrast echocardiography microbubbles are ultrasound-enhancing agents that were originally designed to help improve endocardial border definition, known as left ventricle opacification, and to enhance Doppler signals. Over time, contrast microbubbles are used to assess myocardial perfusion because they travel through the capillaries of the cardiac circulation. Current research provides good evidence that myocardial perfusion echocardiography improves comprehensive echocardiographic evaluations of ischemic heart disease. The approval of regulatory authorities and the availability of quantitative operator-independent analysis software will hopefully prompt physicians and sonographers to implement myocardial perfusion echocardiography into the daily workflow of echo laboratories. New diagnostic and therapeutic applications will result in improved patient care, especially in the area of sonothrombolysis, where preliminary data have already shown utilization in ST elevation myocardial infarction, improving left ventricular systolic function and reducing the need for implantable defibrillators at 6-mo follow-up. This review gives an overview of the applications of myocardial perfusion imaging with ultrasound. Each cited study had institutional review board/institutional animal care and use approval.
Assuntos
Meios de Contraste , Ecocardiografia/métodos , Imagem de Perfusão do Miocárdio/métodos , Animais , Meios de Contraste/efeitos adversos , Ecocardiografia/efeitos adversos , Humanos , Trombólise Mecânica/métodos , Microbolhas , Isquemia Miocárdica/diagnóstico por imagem , Imagem de Perfusão do Miocárdio/efeitos adversos , VasodilataçãoAssuntos
Agonistas do Receptor A2 de Adenosina/efeitos adversos , Doença da Artéria Coronariana/diagnóstico por imagem , Imagem de Perfusão do Miocárdio/efeitos adversos , Apoplexia Hipofisária/induzido quimicamente , Purinas/efeitos adversos , Pirazóis/efeitos adversos , Tomografia Computadorizada de Emissão de Fóton Único/efeitos adversos , Doença da Artéria Coronariana/complicações , Feminino , Humanos , Pessoa de Meia-Idade , Apoplexia Hipofisária/diagnósticoAssuntos
Angina Pectoris/diagnóstico por imagem , Angiografia por Tomografia Computadorizada/efeitos adversos , Angiografia Coronária/efeitos adversos , Tomografia Computadorizada Multidetectores/efeitos adversos , Imagem de Perfusão do Miocárdio/efeitos adversos , Neoplasias Induzidas por Radiação/etiologia , Doses de Radiação , Exposição à Radiação/efeitos adversos , Adulto , Serviço Hospitalar de Cardiologia , Serviço Hospitalar de Emergência , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Induzidas por Radiação/diagnóstico , Valor Preditivo dos Testes , Medição de Risco , Fatores de Risco , Fatores de TempoRESUMO
DNA double-strand breaks (DSBs) of peripheral blood lymphocyte were prospectively assessed in 9 patients who were injected with 201Tl-chloride and 123I-beta-methyl-p-iodophenyl-pentadecanoic acid in dual-isotope imaging. Phosphorylated H2AX (γH2AX) was used as a biomarker for detecting DSBs, and the mean number of γH2AX foci per cell was measured microscopically. Mean γH2AX foci before administration of radiopharmaceuticals and at 3, 6, and 24â¯h following administration were 0.22⯱â¯0.34, 0.10⯱â¯0.14, 0.59⯱â¯0.46, and 0.52⯱â¯0.40, respectively (pâ¯=â¯n.s. for all combinations).
Assuntos
Dano ao DNA , Linfócitos/metabolismo , Linfócitos/efeitos da radiação , Imagem de Perfusão do Miocárdio/efeitos adversos , Tomografia Computadorizada de Emissão de Fóton Único/efeitos adversos , Idoso , Biomarcadores/sangue , Quebras de DNA de Cadeia Dupla , Ácidos Graxos , Feminino , Histonas/sangue , Humanos , Radioisótopos do Iodo/efeitos adversos , Iodobenzenos , Masculino , Pessoa de Meia-Idade , Imagem de Perfusão do Miocárdio/métodos , Estudos Prospectivos , Compostos Radiofarmacêuticos/efeitos adversos , Radioisótopos de Tálio/efeitos adversos , Tomografia Computadorizada de Emissão de Fóton Único/métodosRESUMO
SUBJECT AND METHODS: A total of 40 patients (M:F::26:14; age range: 37-84yrs; mean: 64.1yrs) with known chronic obstructive pulmonary disease (COPD) (ranging from mild to severe), referred for a stress myocardial perfusion study, were included in this study over a period of one year. All patients underwent adenosine stress in a titrated protocol and pre-infusion of short acting bronchodilator salbutamol 2 puffs few minutes prior to start adenosine infusion. In a fraction of 26 patients, pulmonary function tests (PFT) were performed and used in addition to clinical examination to classify the severity of pulmonary obstruction. On the basis of forced expiratory volume in one second (FEV1) on PFT, 4 patients had a mild disease (FEV1 60%-80%), 17 had a moderate obstructive disease (FEV1 41%-59%) and 4 had severe COPD/asthma (FEV1 <40%) while 2 patients had normal >95% FEV1. Post-stress questionnaire to assess subjective tolerance and symptoms were undertaken for all patients. RESULTS: The results demonstrated an excellent tolerance to adenosine infusion in this group of patients, with adequate stress achieved in all. None had complaints of severe dyspnoea or respiratory distress requiring medical intervention. Thirteen patients had mild to moderate degree dyspnoea during infusion. The study included a significant number of 23 elderly patients (>65 years), who showed better tolerance than the younger patients. CONCLUSION: In this pilot study in patients with COPD who referred for myocardial perfusion scintigraphy, the feasibility and safety of adenosine in a graded protocol along with a good pre-stress assessment and a short acting bronchodilator treatment was documented.
Assuntos
Adenosina/farmacologia , Asma/diagnóstico por imagem , Imagem de Perfusão do Miocárdio/efeitos adversos , Imagem de Perfusão do Miocárdio/métodos , Doença Pulmonar Obstrutiva Crônica/diagnóstico por imagem , Segurança , Estresse Fisiológico/efeitos dos fármacos , Adenosina/efeitos adversos , Adulto , Idoso , Idoso de 80 Anos ou mais , Asma/fisiopatologia , Estudos de Viabilidade , Feminino , Humanos , Processamento de Imagem Assistida por Computador , Masculino , Pessoa de Meia-Idade , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Tomografia Computadorizada de Emissão de Fóton ÚnicoAssuntos
Agonistas do Receptor A2 de Adenosina/efeitos adversos , Bradicardia/induzido quimicamente , Parada Cardíaca/induzido quimicamente , Frequência Cardíaca/efeitos dos fármacos , Imagem de Perfusão do Miocárdio/efeitos adversos , Purinas/efeitos adversos , Pirazóis/efeitos adversos , Idoso , Idoso de 80 Anos ou mais , Bradicardia/diagnóstico , Bradicardia/fisiopatologia , Bradicardia/terapia , Feminino , Parada Cardíaca/diagnóstico , Parada Cardíaca/fisiopatologia , Parada Cardíaca/terapia , Humanos , Masculino , Índice de Gravidade de DoençaRESUMO
Nuclear stress testing is being increasingly justified in the cardiovascular risk stratification of patients. Radiation is an important consideration, and attempts to minimize exposure should be implemented. Efficiency and cost effectiveness are cornerstones in the delivery of quality patient care and should also be considered when implementing change. Methods: We studied 88 consecutive patients who presented to our stress lab for pharmacologic nuclear stress testing. A single-day rest-and-stress protocol with low-level exercise was used for all patients. After the stress portion of the examination, we measured Geiger counter activity above the bladder area to establish a baseline. Patients were then allowed to void, and repeat measurements were taken. Results: We detected a 16.9% reduction from baseline radiation levels above the bladder area after voiding. Conclusion: Urinary voiding is a simple, cost-effective strategy at reducing radiation exposure in the nuclear stress lab.
Assuntos
Medicina Nuclear/instrumentação , Exposição à Radiação/prevenção & controle , Micção , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Imagem de Perfusão do Miocárdio/efeitos adversos , Exposição à Radiação/efeitos adversos , Bexiga Urinária/fisiologia , Bexiga Urinária/efeitos da radiaçãoRESUMO
The purpose of this study was to assess the prognostic value of ultra-low dose thallium myocardial perfusion imaging. Three hundred and sixty-six patients (245 men) underwent ultra-low dose stress-redistribution imaging on CZT SPECT camera GE Discovery NM 530c. The stress test was performed by bicycle ergometry or regadenoson injection. The activity of 0.5 MBq (0.014 mCi) Tl-201 chloride per kilogram of body weight was administered. The stress images were acquired immediately and redistribution images were taken after 3 h. Patient follow-up was focused on combined end-point (death, myocardial infarction, unstable angina, revascularization and hospitalization for heart failure). Data analysis was performed from hospital database, with a mean period 23 months. Patients with revascularization within 1 month after SPECT was excluded as revascularization for diagnosis. Ischaemia on SPECT was found in 72 patients, 294 patients were without ischaemia. In patients with ischaemia there were 21 (29.2%) subjects with cardiac events, and 23 (7.9%) in patients without ischaemia (HR 4.15, 95% CI 2.30-7.51, p < 0.0001). Ultra-low dose thallium perfusion imaging using CZT camera provides very good prognostic results in assessment of myocardial ischaemia.
Assuntos
Cádmio , Circulação Coronária , Câmaras gama , Isquemia Miocárdica/diagnóstico por imagem , Imagem de Perfusão do Miocárdio/instrumentação , Doses de Radiação , Compostos Radiofarmacêuticos/administração & dosagem , Telúrio , Radioisótopos de Tálio/administração & dosagem , Tomografia Computadorizada de Emissão de Fóton Único/instrumentação , Zinco , Idoso , Progressão da Doença , Desenho de Equipamento , Teste de Esforço , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Isquemia Miocárdica/mortalidade , Isquemia Miocárdica/fisiopatologia , Isquemia Miocárdica/terapia , Imagem de Perfusão do Miocárdio/efeitos adversos , Imagem de Perfusão do Miocárdio/métodos , Projetos Piloto , Valor Preditivo dos Testes , Prognóstico , Purinas/administração & dosagem , Pirazóis/administração & dosagem , Exposição à Radiação/efeitos adversos , Exposição à Radiação/prevenção & controle , Compostos Radiofarmacêuticos/efeitos adversos , Reprodutibilidade dos Testes , Radioisótopos de Tálio/efeitos adversos , Fatores de Tempo , Tomografia Computadorizada de Emissão de Fóton Único/efeitos adversos , Tomografia Computadorizada de Emissão de Fóton Único/métodos , Vasodilatadores/administração & dosagemRESUMO
OBJECTIVES: Cardiovascular magnetic resonance (CMR) provides information on myocardial ischemia through stress perfusion studies. In clinical practice, the grading of induced perfusion defects is performed by visual estimation of their extension. The aim of our study is to devise a score of the degree of ischemia and to test its prognostic value. METHODS: Between 2009 and 2011, patients with diagnosed or suspected coronary artery disease underwent stress perfusion CMR. A score of ischemic burden was calculated on the basis of (1) stress-induced perfusion defect, (2) persistence, (3) transmurality, and (4) stress-induced contractile defect. Follow-up was censored after 4 years and primary end-point was defined by a composite of death, heart failure episode, acute coronary syndrome, and ventricular arrhythmias. Univariate and multivariate logistic regressions were used to assess the strength of the association between the CMR ischemic variables, and the composite outcome. RESULTS: Forty-four of the 128 patients (34%) presented with adverse events, while 84 (66%) did not. Sixty-one patients (48%) had negative perfusion studies while 67 (52%) showed perfusion defect. Patients with positive perfusion studies and adverse events (n = 39) had higher number of segments with persistent defect (3.3 vs 1.3, p = 0.001) and highest score (19.6 vs 13.3 p = 0.012) than patients with positive perfusion studies and absence of events (n = 28). The number of segments with persistent defect showed the strongest predictive value of adverse events (OR 1.54; CI 1.19-2.00; p < 0.001). CONCLUSIONS: The score of ischemic burden proposed herein has prognostic value. Persistence of a perfusion defect has the strongest impact on prognosis. KEY POINTS: ⢠Cardiovascular magnetic resonance provides information on myocardial ischemia by visual estimation of the presence of perfusion defects induced by stress. ⢠There is not a standardized method for grading perfusion defects which, in practice, is performed by visual estimation of their extension. ⢠As proven in this study, the integration of several parameters of perfusion defects (in addition to extension) into a semiquantitative score has prognostic value.