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1.
Br J Radiol ; 93(1113): 20200349, 2020 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-32783626

RESUMO

The aim of this review is to provide an overview of different functional cardiac CT techniques which can be used to supplement assessment of the coronary arteries to establish the significance of coronary artery stenoses. We focus on cine-CT, CT-FFR, CT-myocardial perfusion and how developments in machine learning can supplement these techniques.


Assuntos
Doença da Artéria Coronariana/diagnóstico por imagem , Estenose Coronária/diagnóstico por imagem , Aprendizado de Máquina , Imagem de Perfusão do Miocárdio/métodos , Tomografia Computadorizada por Raios X/métodos , Ensaios Clínicos como Assunto , Angiografia por Tomografia Computadorizada/métodos , Angiografia Coronária/métodos , Reserva Fracionada de Fluxo Miocárdico , Humanos , Volume Sistólico , Calcificação Vascular/diagnóstico por imagem , Função Ventricular Esquerda
2.
Int Heart J ; 61(4): 685-694, 2020 Jul 30.
Artigo em Inglês | MEDLINE | ID: mdl-32684598

RESUMO

Left ventricular (LV) mechanical dyssynchrony assessed with phase analysis of electrocardiogram (ECG) -gated single photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) is useful for predicting major cardiac events (MCEs) in patients with cardiac dysfunction. However, there is no report on its usefulness in Japanese patients with known or suspected stable coronary artery disease (CAD) with preserved LV ejection fraction (LVEF).We retrospectively investigated 3,374 consecutive patients with known or suspected CAD who underwent rest 201Tl and stress 99mTc-tetrofosmin ECG-gated SPECT MPI and had preserved LVEF (≥ 45%), and followed them up to confirm their prognosis for three years. The composite endpoint was the onset of MCEs consisting of cardiac death, non-fatal myocardial infarction (MI), unstable angina pectoris, and severe heart failure requiring hospitalization. LV mechanical dyssynchrony was evaluated with phase analysis with the Heart Risk View-F software to obtain the phase bandwidth and standard deviation.During the follow-up, 179 patients experienced MCEs: cardiac death (n = 42); non-fatal MI (n = 34); unstable angina pectoris (n = 54); and severe heart failure (n = 49). Results of the multivariate analysis showed age, a history of MI, diabetes mellitus, summed stress score, and stress phase bandwidth to be independent predictors for MCEs. In Kaplan-Meier analysis, prognoses were significantly stratified with the tertiles of stress phase bandwidth.LV mechanical dyssynchrony assessed with ECG-gated SPECT MPI is useful for predicting a prognosis and stratifying the risk of MCEs in Japanese patients with known or suspected stable CAD with preserved LVEF.


Assuntos
Tomografia Computadorizada por Emissão de Fóton Único de Sincronização Cardíaca , Doença da Artéria Coronariana/complicações , Imagem de Perfusão do Miocárdio , Disfunção Ventricular Esquerda/diagnóstico por imagem , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Volume Sistólico , Disfunção Ventricular Esquerda/complicações
3.
Methodist Debakey Cardiovasc J ; 16(2): 77-85, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32670467

RESUMO

Cardiac computed tomography angiography (CCTA) has evolved into a versatile imaging modality that can depict atherosclerosis burden, determine functional significance of a stenotic lesion, and guide the management and treatment of stable coronary artery disease.1 With newer-generation scanners, diagnostic CCTA can be obtained in the majority of patients with a very acceptable radiation dose. We discuss the ability of CCTA to provide comprehensive assessment of a patient with suspected CAD, including functional techniques of stress-rest myocardial perfusion assessment using a vasodilator and a purely post-processing approach that assesses fractional flow reserve derived by CCTA. In addition, recent data validated the role of CCTA in managing stable patients with chest pain and suspected CAD, serving as a gatekeeper for invasive coronary angiogram as well as optimizing the preprocedural planning of percutaneous coronary revascularization and coronary artery bypass surgery.


Assuntos
Angiografia por Tomografia Computadorizada , Angiografia Coronária , Doença da Artéria Coronariana/diagnóstico por imagem , Estenose Coronária/diagnóstico por imagem , Reserva Fracionada de Fluxo Miocárdico , Imagem de Perfusão do Miocárdio , Tomada de Decisão Clínica , Ponte de Artéria Coronária , Doença da Artéria Coronariana/fisiopatologia , Doença da Artéria Coronariana/terapia , Estenose Coronária/fisiopatologia , Estenose Coronária/terapia , Humanos , Intervenção Coronária Percutânea , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Índice de Gravidade de Doença
4.
Methodist Debakey Cardiovasc J ; 16(2): 114-121, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32670471

RESUMO

Coronary artery disease (CAD), also known as ischemic heart disease, is a major cause of morbidity and mortality worldwide, and timely noninvasive diagnosis of clinical and subclinical CAD is imperative to mitigate its burden on individual patients and populations. Positron emission tomography (PET) is a versatile tool that can perform relative myocardial perfusion imaging (MPI) with high accuracy; furthermore, it provides valuable information about the coronary microvasculature using rest and stress myocardial blood flow (MBF) and coronary flow reserve (CFR) measurements. Several radiotracers are approved by the US Food and Drug Administration to help with MPI, MBF, and CFR evaluation. A large body of evidence indicates that evaluation of the coronary microcirculation using MBF and CFR provides strong diagnostic and prognostic data in a multitude of patient populations. This review describes the technical aspects of PET compared to other modalities and discusses its clinical uses for diagnosis and prognosis of coronary arterial epicardial and microcirculatory disease.


Assuntos
Doença da Artéria Coronariana/diagnóstico por imagem , Reserva Fracionada de Fluxo Miocárdico , Microcirculação , Imagem de Perfusão do Miocárdio/métodos , Tomografia por Emissão de Pósitrons , Doença da Artéria Coronariana/fisiopatologia , Humanos , Valor Preditivo dos Testes
5.
Ther Umsch ; 77(2): 47-52, 2020.
Artigo em Alemão | MEDLINE | ID: mdl-32633225

RESUMO

Non-invasive Imaging of Chronic Coronary Syndromes - CT Coronary Angiography and Stress Perfusion Cardiac MRI Abstract. Coronary artery disease (CAD) is amongst the leading causes of death worldwide. The European Society of Cardiology (ESC) has recently published new guidelines on diagnosis and management of chronic coronary syndromes. These guidelines emphasize the use of non-invasive imaging tests to assess CAD. Compared to previous versions of these guidelines, the pre-test probabilities of CAD based on age, sex and symptoms have been adjusted downward. Unless obstructive CAD can be excluded by clinical assessment alone, various strategies to diagnose CAD in symptomatic patients may be used: coronary CT angiography, non-invasive functional imaging for myocardial ischaemia, or invasive coronary angiography combined with functional evaluation. This review summarizes strengths and weaknesses of non-invasive cardiac imaging modalities with emphasize on coronary CT angiography and stress perfusion cardiac magnetic resonance (CMR) imaging.


Assuntos
Angiografia por Tomografia Computadorizada , Imagem de Perfusão do Miocárdio , Angiografia Coronária , Humanos , Imagem por Ressonância Magnética , Valor Preditivo dos Testes , Síndrome , Tomografia Computadorizada por Raios X
7.
Ter Arkh ; 92(4): 76-79, 2020 May 19.
Artigo em Russo | MEDLINE | ID: mdl-32598702

RESUMO

The presented clinical observation demonstrates the diagnostic capabilities of cardiac volumetric computed tomography (CT) with a pharmacological test by a vasodilator adenosine triphosphate (ATP) in the simultaneous assessment of coronary anatomy and changes in left ventricular myocardial perfusion (LV) in a patient with painless myocardial ischemia and coronary atherosclerosis. A 68-year-old patient with coronary heart disease (CHD) and atherosclerotic changes in the coronary arteries underwent cardiac volumetric CT in combination with a ATP pharmacological test. The study was performed on a Aquilion ONE 640 Vision Edition computer tomograph (Toshiba, Japan). Assessment of LV myocardial perfusion was carried out in comparison with other clinical, laboratory and instrumental examination methods. The results of clinical and instrumental examination of a patient with a low pre-test probability of coronary heart disease are presented. From the standpoint of modern recommendations on stable coronary heart disease, false-negative results of single-photon emission computed tomography of the heart and stress-echocardiography are discussed. Clinical observation demonstrates the feasibility of diagnosing LV myocardial ischemia by cardiac volumetric CT combined with ATP pharmacological test, confirmed by an invasive determination of the fractional flow reserve. The given clinical example represents the advantage of cardiac volumetric CT, combined with the ATP pharmacological test, as a method for visualizing LV myocardial perfusion in detecting myocardial ischemia.


Assuntos
Aterosclerose , Doença da Artéria Coronariana , Isquemia Miocárdica , Imagem de Perfusão do Miocárdio , Trifosfato de Adenosina , Idoso , Tomografia Computadorizada de Feixe Cônico , Angiografia Coronária , Vasos Coronários , Humanos , Valor Preditivo dos Testes , Tomografia Computadorizada de Emissão de Fóton Único
8.
Medicine (Baltimore) ; 99(26): e20804, 2020 Jun 26.
Artigo em Inglês | MEDLINE | ID: mdl-32590765

RESUMO

The aim of this study was to evaluate the effect of a novel 4-dimensional similarity filter (4DSF) on quantitative and qualitative parameters of low-dose dynamic myocardial computed tomography perfusion (CTP) images.In this retrospective study, medical records of 32 patients with suspected or known coronary artery disease who underwent dynamic myocardial CTP at 80 kV were included. The 4DSF reduces noise by averaging voxels that have similar dynamic behavior after adaptive iterative dose reduction 3D (AIDR3D) and deformable image registration were applied. Qualitative (artefact, contour sharpness, and myocardial homogeneity [1 = poor; 2 = intermediate; 3 = good]) and quantitative measurement (standard deviation [SD] and signal-to-noise ratio [SNR]) were compared between the 4DSF and AIDR3D. Contrast-to-noise ratio (CNR) between ischemic and normal remote myocardium was also assessed using myocardial perfusion magnetic resonance imaging as the reference standard in seven patients.The 4DSF was successfully applied to all the images. Improvement in subjective image quality yielded by 4DSF was higher than that yielded by AIDR3D (homogeneity, 1.0 [3 vs 2]; artefact, 1.5 [3 vs 1.5]; P < .001) in all patients. The 4DSF significantly decreased the SD by 59% (AIDR3D vs 4DSF: 33.5 ±â€Š0.4 vs 13.8 ±â€Š0.4, P < .001), increased the SNR by 134% (AIDR3D vs 4DSF: 4.4 ±â€Š0.2 vs 10.3 ±â€Š0.2, P < .001), and increased the CNR by 131% (AIDR3D vs 4DSF: 1.6 ±â€Š0.2 vs 3.7 ±â€Š0.2, P < .001).The 4DSF improved the qualitative and quantitative parameters of low-dose dynamic myocardial CTP images.


Assuntos
Doença da Artéria Coronariana/diagnóstico , Imagem de Perfusão do Miocárdio/métodos , Tomografia Computadorizada por Raios X , Feminino , Humanos , Japão , Masculino , Registros Médicos/estatística & dados numéricos , Pessoa de Meia-Idade , Melhoria de Qualidade , Intensificação de Imagem Radiográfica/métodos , Saúde Radiológica , Estudos Retrospectivos , Tomografia Computadorizada por Raios X/instrumentação , Tomografia Computadorizada por Raios X/métodos
9.
Magn Reson Med ; 84(5): 2871-2884, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32426854

RESUMO

PURPOSE: Cardiovascular magnetic resonance first-pass perfusion for the pixel-wise detection of coronary artery disease is rapidly becoming the clinical standard, yet no widely available method exists for its assessment and validation. This study introduces a novel phantom capable of generating spatially dependent flow values to enable assessment of new perfusion imaging methods at the pixel level. METHODS: A synthetic multicapillary myocardial phantom mimicking transmural myocardial perfusion gradients was designed and manufactured with high-precision 3D printing. The phantom was used in a stationary flow setup providing reference myocardial perfusion rates and was scanned on a 3T system. Repeated first-pass perfusion MRI for physiological perfusion rates between 1 and 4 mL/g/min was performed using a clinical dual-sequence technique. Fermi function-constrained deconvolution was used to estimate pixel-wise perfusion rate maps. Phase contrast (PC)-MRI was used to obtain velocity measurements that were converted to perfusion rates for validation of reference values and cross-method comparison. The accuracy of pixel-wise maps was assessed against simulated reference maps. RESULTS: PC-MRI indicated excellent reproducibility in perfusion rate (coefficient of variation [CoV] 2.4-3.5%) and correlation with reference values (R2 = 0.985) across the full physiological range. Similar results were found for first-pass perfusion MRI (CoV 3.7-6.2%, R2 = 0.987). Pixel-wise maps indicated a transmural perfusion difference of 28.8-33.7% for PC-MRI and 23.8-37.7% for first-pass perfusion, matching the reference values (30.2-31.4%). CONCLUSION: The unique transmural perfusion pattern in the phantom allows effective pixel-wise assessment of first-pass perfusion acquisition protocols and quantification algorithms before their introduction into routine clinical use.


Assuntos
Doença da Artéria Coronariana/diagnóstico por imagem , Imagem por Ressonância Magnética/métodos , Imagem de Perfusão do Miocárdio/métodos , Desenho de Equipamento , Humanos , Processamento de Imagem Assistida por Computador , Imagens de Fantasmas , Impressão Tridimensional , Reprodutibilidade dos Testes
10.
Cardiovasc Diabetol ; 19(1): 52, 2020 05 06.
Artigo em Inglês | MEDLINE | ID: mdl-32375795

RESUMO

BACKGROUND: The microvascular effects of obesity should be considered in diabetic individuals for elucidating underlying mechanisms and developing targeted therapies. This study aims to determine the effect of obesity on myocardial microvascular function in type 2 diabetes mellitus (T2DM) patients using cardiac magnetic resonance (CMR) first-pass perfusion imaging and assessed significant risk factors for microvascular dysfunction. MATERIALS AND METHODS: Between September 2016 and May 2018, 120 patients with T2DM (45.8% women [55 of 120]; mean age, 56.45 ± 11.97 years) and 79 controls (44.3% women [35 of 79]; mean age, 54.50 ± 7.79 years) with different body mass index (BMI) scales were prospectively enrolled and underwent CMR examination. CMR-derived perfusion parameters, including upslope, time to maximum signal intensity (TTM), maximum signal intensity (MaxSI), MaxSI (-baseline), and SI (baseline), and T2DM related risk factors were analyzed among groups/subgroups both in T2DM patients and controls. Univariable and multivariable linear and logistic regression analyses were performed to assess the potential additive effect of obesity on microvascular dysfunction in diabetic individuals. RESULTS: Compared with controls with comparable BMIs, patients with T2DM showed reduced upslope and MaxSI and increased TTM. For both T2DM and control subgroups, perfusion function gradually declined with increasing BMI, which was confirmed by all perfusion parameters, except for TTM (all P < 0.01). In multivariable linear regression analysis, BMI (ß = - 0.516; 95% confidence interval [CI], - 0.632 to - 0.357; P < 0.001), female sex (ß = 0.372; 95% CI, 0.215 to 0.475; P < 0.001), diabetes duration (ß = - 0.169; 95% CI, - 0.319 to - 0.025; P = 0.022) and glycated haemoglobin (ß = - 0.184; 95% CI, - 0.281 to - 0.039; P = 0.010) were significantly associated with global upslope in the T2DM group. Multivariable logistic regression analysis indicated that T2DM was an independent predictor of microvascular dysfunction in normal-weight (odds ratio[OR], 6.46; 95% CI, 2.08 to 20.10; P = 0.001), overweight (OR, 7.19; 95% CI, 1.67 to 31.07; P = 0.008) and obese participants (OR, 11.21; 95% CI, 2.38 to 52.75; P = 0.002). CONCLUSIONS: Myocardial microvascular function gradually declined with increasing BMI in both diabetes and non-diabetes status. T2DM was associated with an increased risk of microvascular dysfunction, and obesity exacerbated the adverse effect of T2DM.


Assuntos
Circulação Coronária , Diabetes Mellitus Tipo 2/complicações , Cardiomiopatias Diabéticas/diagnóstico por imagem , Imagem Cinética por Ressonância Magnética , Microcirculação , Imagem de Perfusão do Miocárdio/métodos , Obesidade/complicações , Idoso , Estudos de Casos e Controles , Diabetes Mellitus Tipo 2/diagnóstico , Cardiomiopatias Diabéticas/etiologia , Cardiomiopatias Diabéticas/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade/diagnóstico , Valor Preditivo dos Testes , Estudos Prospectivos , Medição de Risco , Fatores de Risco
11.
Int J Cardiovasc Imaging ; 36(9): 1781-1789, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32399762

RESUMO

We aimed to evaluate the effects of four-dimensional noise reduction filtering using a similarity algorithm (4D-SF) on the image quality and hemodynamic parameter of dynamic myocardial computed tomography perfusion (CTP). Sixty-eight patients who underwent dynamic myocardial CTP for the assessment of coronary artery disease were enrolled. Dynamic CTP was performed using a 320-row CT with low tube voltage scan (80 kVp). Two different datasets of dynamic CTP were reconstructed using iterative reconstruction (IR) alone and a combination of IR and 4D-SF. Qualitative (5-grade scale) and quantitative image quality scores were assessed, and the CT-derived myocardial blood flow (CT-MBF) was quantified. These results were compared between the two different CTP images. The qualitative image quality in CTP images reconstructed with IR and 4D-SF was significantly higher than that with IR alone (noise score: 4.7 vs. 3.4, p < 0.05). The signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) in CTP images reconstructed with IR and 4D-SF were significantly higher than those with IR alone (SNR: 20.6 vs. 9.7; CNR: 7.9 vs. 3.9, respectively; p < 0.05). There was no significant difference in mean CT-MBF between the two sets of CTP images (3.01 vs. 3.03 mL/g/min, p = 0.1081). 4D-SF showed incremental value in improving image quality in combination with IR without altering CT-MBF quantification in dynamic myocardial CTP imaging with a low tube potential.


Assuntos
Algoritmos , Angiografia por Tomografia Computadorizada , Angiografia Coronária , Doença da Artéria Coronariana/diagnóstico por imagem , Circulação Coronária , Tomografia Computadorizada Multidetectores , Imagem de Perfusão do Miocárdio/métodos , Interpretação de Imagem Radiográfica Assistida por Computador , Idoso , Doença da Artéria Coronariana/fisiopatologia , Bases de Dados Factuais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Estudos Retrospectivos , Razão Sinal-Ruído
12.
Curr Cardiol Rep ; 22(6): 43, 2020 05 25.
Artigo em Inglês | MEDLINE | ID: mdl-32451746

RESUMO

PURPOSE OF REVIEW: The most pertinent clinical question in post-coronary computed tomography angiography (CCTA) patients is the assessment of the physiological significance of an anatomically identified stenosis. The clinical application of radionuclide MPI using single-photon emission computed tomography (SPECT) versus positron emission tomography (PET) in the evaluation and management of patients with an inconclusive CCTA is reviewed using a case-based approach. RECENT FINDINGS: Recent evidence suggests that CCTA is the most sensitive non-invasive test to exclude angiographic CAD and may be an effective first-line test especially among symptomatic low-intermediate risk patients. However, in the presence of angiographic atherosclerosis, its specificity and positive predictive value for identifying flow-limiting stenosis are modest. Radionuclide myocardial perfusion imaging offers accurate quantitative assessment of myocardial ischemia, which helps with risk stratification and patient management especially the potential need for revascularization. Routine accurate quantifications of myocardial blood flow and flow reserve are major advantages of PET MPI, which are especially useful when used in patients at intermediate-high clinical risk.


Assuntos
Doença da Artéria Coronariana/diagnóstico por imagem , Imagem de Perfusão do Miocárdio/métodos , Tomografia Computadorizada de Emissão de Fóton Único/métodos , Angiografia Coronária , Humanos , Tomografia por Emissão de Pósitrons , Tomografia Computadorizada por Raios X
13.
J Cardiovasc Magn Reson ; 22(1): 30, 2020 05 04.
Artigo em Inglês | MEDLINE | ID: mdl-32366254

RESUMO

BACKGROUND: Hypertrophic cardiomyopathy (HCM) is thought to be associated with microvascular dysfunction. Adenosine stress-perfusion cardiovascular magnetic resonance imaging (CMR) is a sensitive method for assessing microvascular perfusion abnormalities. We evaluated the prevalence and clinical characteristics of HCM patients with adenosine-induced perfusion defects on CMR. METHODS: Among 189 consecutive patients with HCM who underwent adenosine-stress perfusion CMR, 115 patients who had clinical, echocardiography, 24-h Holter monitoring and treadmill exercise test data were analyzed. We calculated myocardial perfusion ratio index from the intensity-over-time curve to quantify perfusion defects. The presence and extent of the stress-induced perfusion defect were compared with clinical characteristics, presence and extent of late gadolinium enhancement (LGE), left ventricular (LV) mass index and volume, presence of non-sustained ventricular tachycardia (NSVT) and results of treadmill exercise test. RESULTS: The mean age of enrolled patients was 51.8 ± 11.3 years. Most patients were asymptomatic except 25 subjects presented with New York Heart Association Class II dyspnea and 16 patients with atypical non-exertional chest discomfort. LGE was present in 103 (89.6%) subjects. Adenosine stress-induced perfusion defects were present in 48 (42%) subjects. None of the perfusion defects corresponded with a single or multiple coronary artery territories, showing a multiple patchy pattern in 24 (50.0%), a concentric subendocardial pattern in 20 subjects (41.7%), and as a single blot-like defect in the remaining 4 (8.3%). A perfusion defect was associated with NSVT, LV apical aneurysm, higher LV mass index, and higher LGE volume on univariate analysis. Multivariate analysis revealed female gender (P = 0.008), presence of apical aneurysm and NSVT (P = 0.036 and 0.047, respectively), and LV mass index (P = 0.022) to be independently associated with adenosine stress-induced perfusion defects. CONCLUSIONS: In patients with HCM, adenosine-stress perfusion defects on CMR are present in more than 40% of subjects. This perfusion defect is associated with NSVT, higher LV mass index, and apical aneurysms. The prognostic value of this finding needs further elucidation.


Assuntos
Adenosina/administração & dosagem , Cardiomiopatia Hipertrófica/diagnóstico por imagem , Circulação Coronária , Imagem Cinética por Ressonância Magnética , Microcirculação , Imagem de Perfusão do Miocárdio/métodos , Vasodilatadores/administração & dosagem , Cardiomiopatia Hipertrófica/epidemiologia , Cardiomiopatia Hipertrófica/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prevalência , Estudos Prospectivos , Fatores de Risco , Seul/epidemiologia , Função Ventricular Esquerda , Remodelação Ventricular
14.
J Cardiovasc Magn Reson ; 22(1): 35, 2020 05 18.
Artigo em Inglês | MEDLINE | ID: mdl-32418537

RESUMO

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 Esquerda
15.
Clin Nucl Med ; 45(8): 588-593, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32404715

RESUMO

PURPOSE: The aim of the study is to evaluate the impact of myocardial I-metaiodobenzylguanidine (MIBG) in the diagnosis, clinical management, and differential diagnosis of Parkinson disease (PD) and non-PD parkinsonism. METHODS: The study enrolled 41 patients with parkinsonism. An initial diagnosis was reached after thorough clinical and imaging evaluation. After 2 to 5 years of follow-up, a final diagnosis was established. All patients underwent, soon after their initial visit, presynaptic striatal DaT scintigraphy with I-FP-CIT (DaTscan) and I-MIBG myocardial scintigraphy. DaTscan is not specific to distinguish among different types of neurodegenerative parkinsonism. I-MIBG myocardial scintigraphy displays the functional status of cardiac sympathetic nerves, which is reduced in PD/dementia with Lewy bodies (DLB) and normal in atypical parkinsonian syndromes and secondary or nondegenerative parkinsonism. RESULTS: No patients showed adverse effects during or after both scintigraphies. A positive DaTscan was found in all patients in the PD/DLB group (17/17) and in 15 of 24 patients in the non-PD group. Myocardial I-MIBG scintigraphy was associated with lower sensitivity (82% vs 100%) but higher specificity than DaTscan (79% vs 38%) in diagnosis PD/DLB from non-PD parkinsonism. A positive scan result on both techniques, to confirm diagnosis of PD/DLB, significantly improved the specificity of DaTscan, from 38% to 75%, with no reduction in sensitivity. CONCLUSIONS: Myocardial I-MIBG imaging provides complementary value to I-FP-CIT in the proper diagnosis, treatment plan, and differential diagnosis between PD and other forms of parkinsonism.


Assuntos
Imagem de Perfusão do Miocárdio/métodos , Doença de Parkinson/diagnóstico por imagem , Tomografia Computadorizada de Emissão de Fóton Único/métodos , 3-Iodobenzilguanidina , Idoso , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Nortropanos , Compostos Radiofarmacêuticos , Tropanos
16.
Int J Cardiovasc Imaging ; 36(7): 1377-1384, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32246388

RESUMO

Transient ischemic dilation (TID), a marker of severe coronary artery disease (CAD), is the post-stress to rest left ventricular (LV) volume ratio quantified using non ECG gated single photon emission computerized tomography (SPECT). Although prone positioning causes physiological reduction of LV volume in normal subjects, we hypothesize this may not occur in TID with underlying severe CAD as cardiac hemodynamics worsen when prone. We aim to evaluate the utility of the non ECG gated supine to prone LV volume ratio (SPLVr) for identifying severe CAD. Retrospective data analysis from 130 patients with TID ratio ≥ 1.21 and both post-stress supine and prone images. SPLVr had a significant negative correlation with summed stress (r = - 0.221, p = 0.011) and rest (r = - 0.292, p = 0.001) scores. Of the 129 cases with follow-up invasive or computed tomography coronary angiography, 52 (40.3%) had severe CAD (left main ≥ 50% stenosis, 3-vessel with ≥ 70% stenosis or 2-vessel with proximal left anterior descending ≥ 70% stenosis). Mean SPLVr was significantly lower in severe CAD cases (1.05 ± 0.14 vs 1.12 ± 0.17, p = 0.012). SPLVr predicted severe CAD on univariate [OR 0.12 (95% CI 0.00-0.35) p = 0.01] but not in multivariate analysis. SPLVr is a novel marker that negatively correlates with extent of perfusion abnormalities and is lower amongst TID patients with severe CAD. Larger studies are needed to assess if SPLVr can reliably identify underlying severe CAD amongst TID cases.


Assuntos
Doença da Artéria Coronariana/diagnóstico por imagem , Estenose Coronária/diagnóstico por imagem , Imagem de Perfusão do Miocárdio/métodos , Posicionamento do Paciente , Decúbito Ventral , Volume Sistólico , Decúbito Dorsal , Tomografia Computadorizada de Emissão de Fóton Único , Função Ventricular Esquerda , Idoso , Angiografia por Tomografia Computadorizada , Angiografia Coronária , Doença da Artéria Coronariana/fisiopatologia , Estenose Coronária/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Estudos Retrospectivos , Índice de Gravidade de Doença
17.
Rev. Soc. Cardiol. Estado de Säo Paulo ; 30(2 Suppl. B): 169-169, abr-jun., 2020. tab.
Artigo em Português | Sec. Est. Saúde SP, SESSP-IDPCPROD, Sec. Est. Saúde SP | ID: biblio-1117056

RESUMO

FUNDAMENTOS: O papel da cintilografia de perfusão miocárdica (CPM) em pacientes assintomáticos permanece restrito a situações clínicas muito específicas, muitas delas abordadas nos Critérios de Uso Apropriado (AUC) da cintilografia de perfusão miocárdica, publicados em 2009. OBJETIVOS: Realizar uma análise crítica da aplicação dos AUC nas solicitações de CPM para pacientes assintomáticos de um centro terciário de cardiologia, cuja população é notadamente de alto risco cardiovascular. MÉTODOS: Foram selecionados, através de análise de prontuário, pacientes assintomáticos que realizaram cintilografia de perfusão miocárdica. Os AUC foram aplicados retrospectivamente às indicações dos exames de maneira que elas fossem classificadas em apropriadas, inapropriadas ou incertas. Foram considerados como exames alterados aqueles que apresentassem ao menos um dos seguintes itens: hipocaptação fixa, hipocaptação transitória ou dilatação isquêmica transitória. Buscou-se avaliar a correlação entre o grau de recomendação das indicações e a presença de exames alterados. Análise estatística: Foi realizada com teste exato de Fisher, teste de Qui-quadrado, modelos de Regressão Logística e ajustes de Stepwise Backward. RESULTADOS: A partir de uma seleção inicial de 2999 prontuários, 2245 estavam disponíveis para análise. Destes, 490 eram assintomáticos e foram incluídos no estudo. O risco cardiovascular calculado foi alto em 87,3% dos pacientes, moderado em 10% e baixo em 2,7%. Apenas 9,8% das indicações foram inapropriadas, enquanto que 61,4% foram apropriadas e 28. 8% foram incertas. A hipocaptação fixa do radiofármaco ocorreu em 43,5% dos casos e a hipocaptação transitória em 16,1%. Embora não tenha sido encontrada correlação entre indicações adequadas (apropriadas ou incertas) e exames isquêmicos (hipocaptação transitória), a solicitação do exame de maneira adequada correlacionou-se com CPM alterada (tabela 1). CONCLUSÃO: A taxa encontrada de exames alterados foi elevada e a utilização dos AUC como guia para uma adequada indicação do exame mostrou-se uma estratégia e fica em predizer exames alterados nesta população de pacientes assintomáticos de alto risco cardiovascular. Adicionalmente, o grupo de pacientes com indicação incerta apresentou essa correlação de maneira mais intensa, e, embora os AUC valorizem também a utilidade do resultado do exame e não apenas o resultado em si, isso pode significar que algumas das indicações consideradas incertas pela literatura talvez sejam apropriadas para uma população de alto risco cardiovascular.


Assuntos
Cintilografia , Análise Estatística , Imagem de Perfusão do Miocárdio
18.
Phys Med Biol ; 65(14): 145010, 2020 07 20.
Artigo em Inglês | MEDLINE | ID: mdl-32244234

RESUMO

Myocardial perfusion (MP) PET imaging plays a key role in risk assessment and stratification of patients with coronary artery disease. In this work, we proposed a patch-based artificial neural network (ANN) fusion approach that integrates information from the ML and the post-smoothed ML reconstruction to improve MP PET imaging. The proposed method was applied to images reconstructed from different noise levels to enhance quantification and task-based MP defect detection. Using the XCAT phantom, we simulated three MP PET imaging cases, one with normal perfusion and the other two with non-transmural and transmural regionally reduced perfusion of the left ventricular (LV) myocardium. The proposed ANN fusion technique was quantitatively evaluated in terms of the noise versus bias and noise versus contrast tradeoff, and compared with the post-smoothed ML reconstruction. Using the channelized Hotelling observer, we evaluated the detectability of the non-transmural and transmural defects through the receiver operating characteristic analysis. The quantitative results demonstrated that the ANN enhancement method reduced bias and improved contrast while reaching comparable noise to what the post-smoothed ML reconstruction achieved. Moreover, the ANN fusion technique significantly improved the defect detectability of both the non-transmural and transmural defects. In addition to the simulation study, we further evaluated the proposed method using patient data. Compared with the post-smoothed ML reconstruction, the ANN fusion improved the tradeoff between noise and the mean value on the LV myocardium, indicating its potential clinical application in MP PET imaging.


Assuntos
Imagem de Perfusão do Miocárdio/métodos , Redes Neurais de Computação , Tomografia por Emissão de Pósitrons/métodos , Feminino , Ventrículos do Coração/diagnóstico por imagem , Humanos , Processamento de Imagem Assistida por Computador , Masculino , Imagens de Fantasmas , Curva ROC
19.
Cardiovasc Diabetol ; 19(1): 42, 2020 03 31.
Artigo em Inglês | MEDLINE | ID: mdl-32234045

RESUMO

BACKGROUND: Stress cardiovascular magnetic resonance (CMR) to screen for silent myocardial ischaemia in asymptomatic high risk patients with type 2 diabetes mellitus (DM) has never been performed, and its effectiveness is unknown. Our aim was to determine the feasibility of a screening programme using stress CMR by obtaining preliminary data on the prevalence of silent ischaemia caused by obstructive coronary artery disease (CAD) and quantify myocardial perfusion in asymptomatic high risk patients with type 2 diabetes. METHODS: In this prospective cohort study, we recruited 63 asymptomatic DM patients (mean age 66 years ± 4.4 years; 77.8% male); with Framingham risk score ≥ 20% from 3 sites from June 2017 to August 2018. Normal volunteers were recruited to determine normal global myocardial perfusion reserve index (MPRI). Adenosine stress CMR and global MPRI was performed and measured in all subjects. Positive stress CMR cases were referred for catheter coronary angiography (CCA) with/without fractional flow reserve (FFR) measurements. Positive CCA was defined as an FFR ≤ 0.8 or coronary narrowing ≥ 70%. Patients were followed up for major adverse cardiovascular events. Prevalence is presented as patient numbers and percentage. Mann-Whitney U test was used to compare global MPRI between patients and normal volunteers. RESULTS: 13 patients had positive stress CMR with positive CCA (20.6% of patient population), while 9 patients with positive stress CMR examinations had a negative CCA. 5 patients (7.9%) had infarcts detected of which 2 patients had no stress perfusion defects. 12 patients had coronary artery stents inserted, whilst 1 patient declined stent placement. DM patients had lower global MPRI than normal volunteers (n = 7) (1.43 ± 0.27 vs 1.83 ± 0.31 respectively; p < 0.01). After a median follow-up of 653 days, there was no death, heart failure, acute coronary syndrome hospitalisation or stroke. CONCLUSION: 20.6% of asymptomatic DM patients (with Framingham risk ≥ 20%) had silent obstructive CAD. Furthermore, asymptomatic patients have reduced global MPRI than normal volunteers. TRIAL REGISTRATION: ClinicalTrials.gov Registration Number: NCT03263728 on 28th August 2017; https://clinicaltrials.gov/ct2/show/NCT03263728.


Assuntos
Doença da Artéria Coronariana/diagnóstico por imagem , Circulação Coronária , Diabetes Mellitus Tipo 2/epidemiologia , Imagem Cinética por Ressonância Magnética , Infarto do Miocárdio/diagnóstico por imagem , Imagem de Perfusão do Miocárdio/métodos , Adenosina/administração & dosagem , Idoso , Idoso de 80 Anos ou mais , Doenças Assintomáticas , Estudos de Casos e Controles , Angiografia Coronária , Doença da Artéria Coronariana/epidemiologia , Doença da Artéria Coronariana/fisiopatologia , Doença da Artéria Coronariana/terapia , Diabetes Mellitus Tipo 2/diagnóstico , Estudos de Viabilidade , Feminino , Hong Kong/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/epidemiologia , Infarto do Miocárdio/fisiopatologia , Infarto do Miocárdio/terapia , Intervenção Coronária Percutânea/instrumentação , Projetos Piloto , Valor Preditivo dos Testes , Prevalência , Estudos Prospectivos , Reprodutibilidade dos Testes , Medição de Risco , Fatores de Risco , Stents , Fatores de Tempo , Resultado do Tratamento , Vasodilatadores/administração & dosagem
20.
Am J Cardiol ; 125(12): 1809-1814, 2020 06 15.
Artigo em Inglês | MEDLINE | ID: mdl-32345475

RESUMO

Evaluation of chest pain in the emergency department (ED) frequently employs a noninvasive strategy, including coronary computed tomography angiography (CCTA), stress echocardiography (SE), or myocardial perfusion imaging (MPI). We sought to report the real-world experience of utilizing CCTA compared with SE and MPI at an urban hospital ED. We conducted a retrospective cohort study of consecutively enrolled patients presenting with chest pain who had normal or nondiagnostic electrocardiogram (ECG), negative initial troponin-T, at least intermediate risk based on modified Diamond-Forrester criteria, and who underwent CCTA, SE, or MPI based on their individual test eligibility criteria. The primary outcome was ED discharge time. Secondary outcomes included test utilization and 30-days rehospitalization rates. The 2,143 patients who were included (mean age was 56 ± 12 years; 55% women) utilization rate (test performed/eligible) was lower for CCTA (n = 354/1,329) and MPI (n = 530/1,435) compared with SE (n = 1,259/1,650), p <0.001. Mean ED discharge times for both CCTA and SE were 12.5 ± 7.4 versus 16 ± 7.3 hours for MPI (p <0.0001). Patients with SE and CCTA were less likely to undergo coronary angiography (29%, 25%, vs 52% for MPI). There was a 1% cardiac-related 30-days rehospitalization rate in the CCTA group versus 1% in SE and 3% in the MPI group (p <0.01). In conclusion, CCTA and SE were associated with faster ED discharge and lower frequency of diagnostic coronary angiography. Notwithstanding its clinical utility, CCTA was underutilized at our large urban ED setting.


Assuntos
Dor no Peito/diagnóstico por imagem , Serviço Hospitalar de Emergência , Angiografia por Tomografia Computadorizada , Angiografia Coronária , Ecocardiografia sob Estresse , Eletrocardiografia , Feminino , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Imagem de Perfusão do Miocárdio , Estudos Retrospectivos
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