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2.
Isr Med Assoc J ; 21(9): 603-606, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31542905

RESUMO

BACKGROUND: With the recent introduction of high-sensitivity troponin (hsTn), the incremental benefit of stress myocardial perfusion imaging (MPI) in the evaluation of patients who present to the emergency department (ED) with acute coronary syndrome (ACS) is unclear. OBJECTIVES: To assess the added value of stress MPI in low-risk ACS patients with normal range hsTnI. METHODS: We analyzed all patients who were hospitalized at our medical center from February 2016 to November 2017, who presented with low-risk ACS and underwent stress MPI, and in whom hsTnI was in the normal range after the introduction of hsTnI. RESULTS: During the study period, 161 patients were admitted with a diagnosis of unstable angina (i.e., ACS with normal range hsTnI) and underwent stress MPI during index admission. The study population included 52/161 patients (31.7%) with low-risk ACS who had no indication for initial invasive strategy. No patients had positive MPI. One patient underwent coronary angiography due to suggestive history; however, he did not have a significant coronary artery disease and had no indication for percutaneous coronary intervention. CONCLUSIONS: In patients with low-risk ACS and normal range hsTnI without additional high-risk features, stress MPI has little additional value for the correct diagnosis and management. Prospective studies are warranted to confirm whether resting hsTnI could serve as a powerful triage tool in chest pain patients in the ED before diagnostic testing and thus, improve patient management.


Assuntos
Síndrome Coronariana Aguda/sangue , Síndrome Coronariana Aguda/diagnóstico por imagem , Imagem de Perfusão do Miocárdio/métodos , Troponina/sangue , Idoso , Estudos de Coortes , Feminino , Coração/diagnóstico por imagem , Humanos , Masculino , Estudos Retrospectivos , Medição de Risco
3.
World J Pediatr Congenit Heart Surg ; 10(3): 360-363, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-31084306

RESUMO

Anomalous origin of a coronary artery from the opposite aortic sinus of Valsalva can present in various ways, ranging from a benign and incidental finding to sudden cardiac death. The variant with an intraseptal subpulmonary course (sometimes referred to as intraconal), is widely perceived to carry a low risk of ischemia and has been considered to be a benign variant, not requiring surgical treatment. In one of our recent patients, however, nuclear scintigraphy highlighted a myocardial perfusion deficit in the territory supplied by the allegedly benign anomalous coronary artery, prompting the need for a more aggressive surgical approach.


Assuntos
Procedimentos Cirúrgicos Cardíacos/métodos , Circulação Coronária/fisiologia , Anomalias dos Vasos Coronários/cirurgia , Vasos Coronários/diagnóstico por imagem , Imagem de Perfusão do Miocárdio/métodos , Criança , Anomalias dos Vasos Coronários/diagnóstico , Vasos Coronários/cirurgia , Ecocardiografia , Humanos , Masculino , Tomografia Computadorizada por Raios X
4.
Int J Cardiovasc Imaging ; 35(7): 1319-1325, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31093894

RESUMO

To demonstrate the potential for differentiating normal and diseased myocardium without Gadolinium using rest and stress T1-mapping. Patients undergoing 1.5T magnetic resonance imaging (MRI) as part of clinical work-up due to suspicion of coronary artery disease (CAD) were included. Adenosine stress perfusion MRI and late gadolinium enhancement (LGE) imaging were performed to identify ischemic and infarcted myocardium. Patients were retrospectively categorized into an ischemic, infarct and control group based on conventional acquisitions. Patient with both ischemic and infarcted myocardium were excluded. A total of 64 patients were included: ten with myocardial ischemia, 15 with myocardial infarction, and 39 controls. A native Modified Look-Locker Inversion Recovery (MOLLI) T1-mapping acquisition was performed at rest and stress. Pixel-wise myocardial T1-maps were acquired in short-axis view with inline motion-correction. Short-axis T1-maps were manually contoured using conservative septal sampling. Regions of interest were sampled in ischemic and infarcted areas detected on perfusion and LGE images. T1 reactivity was calculated as the percentage difference in T1 values between rest and stress. Remote myocardium was defined as myocardium without defects in the ischemic and infarcted group whereas normal myocardium is found in the control group only. Native T1-values were significantly higher in infarcted myocardium in rest and stress [median 1044 ms (interquartile range (IQR) 985-1076) and 1053 ms (IQR 989-1088)] compared to ischemic myocardium [median 961 ms (IQR 939-988) and 958 ms (IQR 945-988)]. T1-reactivity was significantly lower in ischemic and infarcted myocardium [median 0.00% (IQR - 0.18 to 0.16) and 0.41% (IQR 0.09-0.86)] compared to remote myocardium [median 3.54% (IQR 1.48-5.78) and 3.21% (IQR 1.95-4.79)]. Rest-stress T1-mapping is able to distinguish between normal, ischemic, infarcted and remote myocardium using native T1-values and T1-reactivity, and holds potential as an imaging biomarker for tissue characterization in MRI.


Assuntos
Doença da Artéria Coronariana/diagnóstico por imagem , Imagem Cinética por Ressonância Magnética , Infarto do Miocárdio/diagnóstico por imagem , Isquemia Miocárdica/diagnóstico por imagem , Imagem de Perfusão do Miocárdio/métodos , Miocárdio/patologia , Adenosina/administração & dosagem , Idoso , Meios de Contraste/administração & dosagem , Doença da Artéria Coronariana/patologia , Doença da Artéria Coronariana/fisiopatologia , Circulação Coronária , Diagnóstico Diferencial , Feminino , Gadolínio DTPA/administração & dosagem , Hemodinâmica , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/patologia , Infarto do Miocárdio/fisiopatologia , Isquemia Miocárdica/patologia , Isquemia Miocárdica/fisiopatologia , Valor Preditivo dos Testes , Estudos Retrospectivos , Sobrevivência de Tecidos , Vasodilatadores/administração & dosagem
5.
Int J Cardiovasc Imaging ; 35(10): 1823-1829, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31079287

RESUMO

In this study, we aimed to investigate the predictive value of early systolic lengthening duration in differentiating myocardial ischemia from scar tissue in patients with chronic coronary total occlusion. A total of 69 patients were included in the study. The participating patients were divided into two groups as 35 patients with ischemia and 34 patients with scar tissue based on the results of the myocardial perfusion scintigraphy. In the scar group compared to the ischemia group; LVEF, GLS, SRS', and the duration of early systolic lengthening were significantly lower; whereas, EDV, ESV, and WMSI were significantly higher in the scar group compared to the ischemia group. In the multivariate logistic regression test, LVEF (OR 1.150, 95% CI 1.044-1.268, p = 0.005) and duration of early systolic lengthening (OR 1.021, 95% CI 1.004-1.039, p = 0.016) were determined as independent predictive parameters for ischemia detected by myocardial perfusion scintigraphy. Duration of early systolic lengthening obtained by speckle tracking echocardiography in patients with chronic total occlusion lesions may be useful in differentiating ischemia from scar tissue detected in myocardial perfusion scintigraphy. Prolonged duration of early systolic lengthening in patients with chronic total occlusion lesions was related to the presence of ischemia detected by myocardial perfusion scintigraphy.


Assuntos
Cicatriz/diagnóstico por imagem , Oclusão Coronária/diagnóstico por imagem , Ecocardiografia Doppler , Miocárdio/patologia , Função Ventricular Esquerda , Idoso , Doença Crônica , Cicatriz/patologia , Cicatriz/fisiopatologia , Oclusão Coronária/patologia , Oclusão Coronária/fisiopatologia , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Imagem de Perfusão do Miocárdio/métodos , Valor Preditivo dos Testes , Estudos Prospectivos , Fatores de Risco , Volume Sistólico , Sístole , Fatores de Tempo , Tomografia Computadorizada de Emissão de Fóton Único
6.
J Cardiovasc Comput Tomogr ; 13(3): 11-20, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31040061

RESUMO

AIMS: This study describes the real-world referral pattern of patients to a CT myocardial perfusion service, the technical issues associated with providing the service, the results of the studies, and the subsequent downstream utilization of other investigations, and patient outcomes. METHODS AND RESULTS: 115 consecutive patients underwent CTA, dynamic rest and dipyridamole-stress perfusion scanning. There were 29 (25%) and 14 (12%) patients who had reversible defects and fixed defects respectively, indicating abnormal flow reserve and previous infarction respectively. In the patients with fixed defects, delayed hyperenhancement was noted in all, indicative of prior infarction, scarring and non-viability. With the existing CTA Appropriateness Criteria, the categorization of "Appropriate," "Of Uncertain Appropriateness", and "Inappropriate" would have been applied to 25%, 25% and 50% of the present studies respectively. Up to 72% could have been referred for ischemia evaluation with other modalities of functional imaging after the non-diagnostic CT angiogram. Follow up was complete in 113 subjects (98%) over a period of 14 ±â€¯8 months. In the 29 patients with abnormal flow reserve and CAD, 62% underwent invasive angiography and 94%, angioplasty within a 90-day period. In the patients who underwent angioplasty, all remained free of myocardial infarction or death and 88% remained free of myocardial infarction, death or readmission over a mean of 14 ±â€¯8 months. CONCLUSION: A CT-myocardial perfusion service provided measures of ischemia and infarct detection over that of CTA alone. The information was utilized clinically by doctors to support a strategy of referral to revascularization versus conservative medical management.


Assuntos
Angiografia por Tomografia Computadorizada/métodos , Angiografia Coronária/métodos , Circulação Coronária , Vasos Coronários/diagnóstico por imagem , Hemodinâmica , Isquemia Miocárdica/diagnóstico por imagem , Imagem de Perfusão do Miocárdio/métodos , Idoso , Tomada de Decisão Clínica , Vasos Coronários/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Isquemia Miocárdica/fisiopatologia , Isquemia Miocárdica/terapia , Valor Preditivo dos Testes , Prognóstico , Encaminhamento e Consulta , Sistema de Registros , Reprodutibilidade dos Testes , Fatores de Tempo
7.
Int J Cardiovasc Imaging ; 35(9): 1733-1743, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31073698

RESUMO

Vasodilator-stress CT perfusion imaging in addition to CT coronary angiography (CTCA) may provide a single-test alternative to nuclear stress testing, commonly used to assess hemodynamic significance of stenosis. Another alternative is fractional flow reserve (FFR) calculated from cardiac CT images. We studied the concordance between these two approaches and their relationship to outcomes. We prospectively studied 150 patients with chest pain, who underwent CTCA and regadenoson CT. CTCA images were interpreted for presence and severity of stenosis. Fused 3D displays of subendocardial X-ray attenuation with coronary arteries were created to detect stress perfusion defects (SPD) in each coronary territory. In patients with stenosis > 25%, CT-FFR was quantified. Significant stenosis was determined by: (1) combination of stenosis > 50% with an SPD, (2) CT-FFR ≤ 0.80. Patients were followed-up for 36 ± 25 months for death, myocardial infarction or revascularization. After excluding patients with normal arteries and technical/quality issues, in final analysis of 76 patients, CTCA depicted stenosis > 70% in 13/224 arteries, 50-70% in 24, and < 50% in 187. CT-FFR ≤ 0.80 was found in 41/224 arteries, and combination of SPD with > 50% stenosis in 31/224 arteries. Inter-technique agreement was 89%. Despite high incidence of abnormal CT-FFR (30/76 patients), only 7 patients experienced adverse outcomes; 6/7 also had SPDs. Only 1/9 patients with CT-FFR ≤ 0.80 but normal perfusion had an event. Fusion of CTCA and stress perfusion can help determine the hemodynamic impact of stenosis in one test, in good agreement with CT-FFR. Adding stress CT perfusion analysis may help risk-stratify patients with abnormal CT-FFR.


Assuntos
Angiografia por Tomografia Computadorizada/métodos , Angiografia Coronária/métodos , Doença da Artéria Coronariana/diagnóstico por imagem , Estenose Coronária/diagnóstico por imagem , Reserva Fracionada de Fluxo Miocárdico , Hemodinâmica , Imagem Tridimensional/métodos , Imagem de Perfusão do Miocárdio/métodos , Interpretação de Imagem Radiográfica Assistida por Computador/métodos , Adulto , Idoso , Doença da Artéria Coronariana/mortalidade , Doença da Artéria Coronariana/fisiopatologia , Doença da Artéria Coronariana/terapia , Estenose Coronária/mortalidade , Estenose Coronária/fisiopatologia , Estenose Coronária/terapia , Progressão da Doença , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Imagem Multimodal , Valor Preditivo dos Testes , Prognóstico , Estudos Prospectivos , Reprodutibilidade dos Testes , Medição de Risco , Fatores de Risco , Índice de Gravidade de Doença , Fatores de Tempo , Vasodilatadores/administração & dosagem
8.
Clin Imaging ; 56: 81-87, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31026682

RESUMO

PURPOSE: To use adenosine-induced stress CT myocardial perfusion imaging (CT-MPI) to determine normal reference values for left ventricle (LV) wall thickness (WT) and motion parameters. METHODS: This study included 106 Korean subjects (52 men and 54 women) who underwent CT-MPI due to chest pain, but were not found to have any detectable mild or severe coronary artery disease or myocardial perfusion defect. The following quantitative parameters were assessed on the CT-MPI according to a 17-segment model: LV myocardial thickness at end-systolic (WTES) and end-diastolic (WTED) phases, systolic wall thickening (SWT), and wall motion (WM). The associations of the measured parameters with the subjects' demographic characteristics and comorbidities were also analyzed. RESULTS: Septal wall (7.2 mm) and basal-level (7.7 mm) LV myocardium demonstrated significantly higher WT (p < 0.001). SWT was highest in lateral (77.8%, p < 0.014) and apical (78.9%, p = 0.009) myocardium, while lateral (7.7 mm) and basal (6.7 mm) myocardium exhibited the greatest WM (p < 0.001). WT was significantly higher in men and younger (<60 years) subjects (all, p < 0.001). Hypertensive individuals presented with significantly higher SWT (79.9%, p = 0.024). LV WT exhibited statistically significant correlations (all positive, except for age) with age, height, weight, body surface area, body mass index, and systolic blood pressure (all, p < 0.010). CONCLUSIONS: The present study provides CT-MPI reference values for LV myocardial WT, SWT, and WM measured on an adult Korean population. Knowledge of such normal reference measurements would be beneficial for the efficient interpretation of CT-MPI examinations in populations of Asian ethnicity.


Assuntos
Ventrículos do Coração/diagnóstico por imagem , Imagem de Perfusão do Miocárdio/métodos , Tomografia Computadorizada por Raios X/métodos , Função Ventricular Esquerda/fisiologia , Adenosina , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valores de Referência
9.
Clin Imaging ; 56: 93-101, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31026684

RESUMO

BACKGROUND: The relationship between shot-to-shot sampling rates for dynamic myocardial computed tomography perfusion (CTP) and robustness of CTP-derived myocardial blood flow (CT-MBF) is debatable. We retrospectively investigated the influence of a reduced sampling rate for dynamic CTP on CT-MBF computation and diagnostic performance for detecting myocardial perfusion abnormalities. METHODS: Pharmacological stress dynamic whole-heart CTP was performed in 120 patients suspected with coronary artery disease. Dynamic CTP data were obtained for 30 continuous heartbeats during the R-peak to R-peak (1RR) interval on electrocardiography. Three additional datasets were created with sub-sampling acquisitions every 2, 3, and 4 heartbeats from the original dataset as interval times of 2RR, 3RR, and 4RR, respectively. CT-MBF was calculated using deconvolution analysis and determined as the mean value of the whole heart (global CT-MBF) and using the 16-segment model (segmental CT-MBF). The diagnostic performance of segmental CT-MBF for detecting perfusion abnormalities was compared to that of cardiac magnetic resonance imaging as the gold standard in 32 of 120 patients. These results were compared among the four CTP datasets. RESULTS: Global CT-MBFs for 1RR, 2RR, 3RR, and 4RR sampling were 1.57 ±â€¯0.34, 1.54 ±â€¯0.36, 1.51 ±â€¯0.37, and 1.41 ±â€¯0.33 mL/g/min, respectively. Areas under the receiver operating characteristic curves of segmental CT-MBF for 1RR, 2RR, 3RR, and 4RR sampling were 0.84, 0.83, 0.79, and 0.76, respectively (1RR versus [vs.] 2RR, non-significant; 1RR vs. 3RR or 4RR, p < 0.05). CONCLUSION: CT-MBF with 2RR sampling has similar performance with regard to quantification and detecting myocardial perfusion abnormalities as that with 1RR sampling.


Assuntos
Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/fisiopatologia , Tomografia Computadorizada por Raios X/métodos , Idoso , Feminino , Coração/diagnóstico por imagem , Coração/fisiopatologia , Humanos , Masculino , Imagem de Perfusão do Miocárdio/métodos , Curva ROC , Reprodutibilidade dos Testes , Estudos Retrospectivos
10.
Int J Cardiovasc Imaging ; 35(6): 1111-1118, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30963352

RESUMO

The purpose of this study was to compare invasively measured aorta flow with 2D phase contrast flow and 4D flow measurements by cardiovascular magnetic resonance (CMR) imaging in a large animal model. Nine swine (mean weight 63 ± 4 kg) were included in the study. 4D flow CMR exams were performed on a 1.5T MRI scanner. Flow measurements were performed on 4D flow images at the aortic valve level, in the ascending aorta, and main pulmonary artery. Simultaneously, flow was measured using an invasive flow probe, placed around the ascending aorta. Additionally, standard 2D phase contrast flow and 2D left ventricular (LV) volumetric data were used for comparison. The correlations of cardiac output (CO) between the invasive flow probe, and CMR modalities were strong to very strong. CO measured by 4D flow CMR correlated better with the CO measured by the invasive flow probe than 2D flow CMR flow and volumetric LV data (4D flow CMR: Spearman's rho = 0.86 at the aortic valve level and 0.90 at the ascending aorta level; 2D flow CMR: 0.67 at aortic valve level; LV measurements: 0.77). In addition, there tended to be a correlation between mean pulmonary artery flow and aorta flow with 4D flow (Spearman's rho = 0.65, P = 0.07), which was absent in measurements obtained with 2D flow CMR (Spearman's rho = 0.40, P = 0.33). This study shows that aorta flow can be accurately measured by 4D flow CMR compared to simultaneously measured invasive flow. This helps to further validate the quantitative reliability of this technique.


Assuntos
Aorta/diagnóstico por imagem , Cateterismo Cardíaco , Hemodinâmica , Imagem por Ressonância Magnética/métodos , Imagem de Perfusão do Miocárdio/métodos , Artéria Pulmonar/diagnóstico por imagem , Circulação Pulmonar , Animais , Aorta/fisiologia , Velocidade do Fluxo Sanguíneo , Cateterismo Cardíaco/instrumentação , Cateteres Cardíacos , Humanos , Interpretação de Imagem Assistida por Computador , Modelos Animais , Valor Preditivo dos Testes , Artéria Pulmonar/fisiologia , Fluxo Sanguíneo Regional , Reprodutibilidade dos Testes , Sus scrofa , Fatores de Tempo , Transdutores de Pressão
11.
Int J Cardiovasc Imaging ; 35(9): 1709-1720, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31016502

RESUMO

We aimed to identify factors influencing the sensitivity of perfusion imaging after an initial positive coronary computed tomography angiography (CCTA) using invasive coronary angiography (ICA) with conditional fractional flow reserve (FFR) as reference. Secondly we aimed to identify factors associated with revascularisation and to evaluate treatment outcome after ICA. We analysed 292 consecutive patients with suspected significant coronary artery disease (CAD) at CCTA, who underwent perfusion imaging with either cardiac magnetic resonance (CMR) or myocardial perfusion scintigraphy (MPS) followed by ICA with conditional FFR. Stratified analysis and uni- and multiple logistic regression analyses were performed to identify predictors of diagnostic agreement between perfusion scans and ICA and predictors of revascularisation. Myocardial ischemia evaluated with perfusion scans was present in 65/292 (22%) while 117/292 (40%) had obstructive CAD evaluated by ICA. Revascularisation rate was 90/292 (31%). The overall sensitivity for perfusion scans was 39% (30-48), specificity 89% (83-93), PPV 69% (57-80) and NPV 68% (62-74). Stratified analysis showed higher sensitivities in patients with multi-vessel disease at CCTA 49% (37-60) and typical chest pain 50% (37-60). Predictors of revascularisation were multi-vessel disease by CCTA (OR 3.51 [1.91-6.48]) and a positive perfusion scan (OR 4.69 [2.49-8.83]). The sensitivity for perfusion scans after CCTA was highest in patients with typical angina and multiple lesions at CCTA and predicted diagnostic agreement between perfusion scans and ICA. Abnormal perfusion and multi vessel disease at CCTA predicted revascularisation.


Assuntos
Angiografia por Tomografia Computadorizada , Angiografia Coronária/métodos , Doença da Artéria Coronariana/diagnóstico por imagem , Vasos Coronários/diagnóstico por imagem , Reserva Fracionada de Fluxo Miocárdico , Imagem por Ressonância Magnética , Imagem de Perfusão do Miocárdio/métodos , Cintilografia/métodos , Idoso , Doença da Artéria Coronariana/fisiopatologia , Doença da Artéria Coronariana/cirurgia , Vasos Coronários/fisiopatologia , Vasos Coronários/cirurgia , Dinamarca , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Revascularização Miocárdica , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Índice de Gravidade de Doença , Resultado do Tratamento
12.
Eur J Radiol ; 114: 1-5, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31005158

RESUMO

BACKGROUND: Vasodilator stress computed tomography perfusion (sCTP) imaging is complementary to coronary CT angiography (CCTA), used to determine the hemodynamic significance of coronary artery disease. However, it requires a separate image acquisition due to motion artifacts caused by higher heart rates during stress, resulting in increased iodine contrast dose and radiation. We sought to determine whether a novel motion correction algorithm applied to stress images would improve the visualization of the coronary arteries to potentially allow CCTA + sCTP evaluation in a single scan. METHODS: 28 patients referred for clinically indicated CCTA (iCT, Philips) underwent sCTP imaging (retrospective-gating with dose modulation; 100 kVp and 250 mA; 5.2 ± 4.3 mSv) after regadenoson (0.4 mg, Astellas). Stress images were reconstructed using standard filtered back-projection (FBP) and also processed to generate interaction-free coronary motion-compensated back-projection reconstructions (MCR). Each coronary artery from standard FBP and MCR images was viewed side-by-side by a reader blinded to the reconstruction technique, who graded severity of motion artifact by segment (scale 0-5, with 3 as the threshold for diagnostic quality) and to measure signal-to-noise and contrast-to-noise ratios (SNR, CNR). RESULTS: Visualization scores were higher with MCR for all coronary segments, including 14/86 (16%) segments deemed as non-diagnostic on FBP images. SNR (7 ± 2) and CNR (15 ± 8) were unchanged by motion-correction (7 ± 3, p = 0.88 and 15 ± 5, p = 0.94, respectively). CONCLUSIONS: MCR improves the visualization of coronary anatomy on sCTP images without degrading image characteristics. This algorithm is an important step towards the combined assessment of coronary anatomy and myocardial perfusion in a single scan, which will reduce study time, radiation exposure and contrast dose.


Assuntos
Doença da Artéria Coronariana/diagnóstico por imagem , Imagem de Perfusão do Miocárdio/métodos , Algoritmos , Artefatos , Angiografia por Tomografia Computadorizada/métodos , Meios de Contraste/farmacologia , Angiografia Coronária/métodos , Feminino , Frequência Cardíaca/efeitos dos fármacos , Humanos , Masculino , Pessoa de Meia-Idade , Movimento (Física) , Estudos Prospectivos , Doses de Radiação , Exposição à Radiação , Interpretação de Imagem Radiográfica Assistida por Computador/métodos , Tomografia Computadorizada por Raios X/métodos , Vasodilatadores/farmacologia
13.
Medicine (Baltimore) ; 98(8): e14657, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30813209

RESUMO

Recent studies reported that high doses of short-acting loop diuretics are associated with poor outcomes in patients with heart failure (HF). Short-acting loop diuretics have been shown to activate the renin-angiotensin system (RAS) and have no favorable effects on cardiac sympathetic nervous system (SNS) activity. The goal of this study is to investigate the relationship between daily doses of furosemide and the outcomes of patients with left ventricular dysfunction (LVD) from the viewpoint of cardiac SNS abnormalities using iodine-123-labeled metaiodobenzylguanidine (l-MIBG) myocardial scintigraphy.We enrolled 137 hospitalized patients (62.5 ±â€Š14.2 years old, 103 men) with LVEF < 45% who underwent l-MIBG myocardial scintigraphy. A delayed heart-to-mediastinum ratio (delayed HMR) was assessed using l-MIBG scintigraphy. Cardiac events were defined as cardiac death or re-hospitalization due to the deterioration of HF. Cox proportional hazard analysis was used to identify predictors of cardiac events.Cardiac events occurred in 57 patients in a follow-up period of 33.1 ±â€Š30 months. In a multivariate Cox proportional hazard analysis, delayed HMR and furosemide doses were identified as independent predictors of cardiac events (P = .0042, P = .033, respectively). Inverse probability of treatment weighting Cox modeling showed that the use of furosemide (≥40 mg /day) was associated with cardiac events with a hazard ratio of 1.96 (P = .003). In the Kaplan-Mayer analysis, the cardiac event-free survival rate was significantly lower in patients treated with high doses of furosemide (≥60 mg/day vs 40-60 mg/day vs <40 mg/day, the Log-rank test P < .0001). In a receiver-operating characteristic (ROC) analysis, the cut-off value for cardiac events was 40 mg/day of furosemide. The cardiac event-free rate was significantly lower in patients with delayed HMR <1.8 (median value) and receiving furosemide ≥40 mg/day than in other patients (the Log-rank test P < .0001). Significant differences in cardiac event rates according to furosemide doses among patients with delayed HMR <1.8 were observed among patients without ß-blocker therapy (P = .001), but not among those with ß-blocker therapy (P = .127).The present results indicate that a relationship exists between higher doses of furosemide and poor outcomes. The prognosis of HF patients with severe cardiac SNS abnormalities receiving high-dose short-acting loop diuretics is poor.


Assuntos
Furosemida , Insuficiência Cardíaca , Coração , Sistema Nervoso Simpático/efeitos dos fármacos , Disfunção Ventricular Esquerda , 3-Iodobenzilguanidina/farmacologia , Idoso , Disponibilidade Biológica , Relação Dose-Resposta a Droga , Feminino , Furosemida/administração & dosagem , Furosemida/efeitos adversos , Furosemida/farmacocinética , Coração/diagnóstico por imagem , Coração/inervação , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/tratamento farmacológico , Insuficiência Cardíaca/fisiopatologia , Humanos , Japão , Masculino , Pessoa de Meia-Idade , Imagem de Perfusão do Miocárdio/métodos , Compostos Radiofarmacêuticos/farmacologia , Inibidores de Simportadores de Cloreto de Sódio e Potássio/administração & dosagem , Inibidores de Simportadores de Cloreto de Sódio e Potássio/efeitos adversos , Inibidores de Simportadores de Cloreto de Sódio e Potássio/farmacocinética , Volume Sistólico/efeitos dos fármacos , Disfunção Ventricular Esquerda/diagnóstico , Disfunção Ventricular Esquerda/tratamento farmacológico
14.
PET Clin ; 14(2): 211-221, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30826019

RESUMO

PET-based cardiac nuclear imaging plays a large role in the management of ischemic heart disease. Compared with conventional single-photon emission CT myocardial perfusion imaging, PET provides superior accuracy in diagnosis of coronary artery disease and, with the incorporation of myocardial blood flow and coronary flow reserve, adds value in assessing prognosis for established coronary and microvascular disease. This review describes these and other uses of PET in ischemic heart disease, including assessing myocardial viability in ischemic cardiomyopathy. Developments in novel PET flow tracers and molecular imaging tools to assess atherosclerotic plaque vulnerability, vascular calcification, and vascular remodeling also are described.


Assuntos
Isquemia Miocárdica/diagnóstico por imagem , Tomografia por Emissão de Pósitrons/métodos , Angiografia por Tomografia Computadorizada/economia , Angiografia por Tomografia Computadorizada/métodos , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/economia , Circulação Coronária/fisiologia , Análise Custo-Benefício , Reserva Fracionada de Fluxo Miocárdico/fisiologia , Humanos , Imagem Multimodal/economia , Imagem Multimodal/métodos , Isquemia Miocárdica/economia , Isquemia Miocárdica/fisiopatologia , Imagem de Perfusão do Miocárdio/economia , Imagem de Perfusão do Miocárdio/métodos , Prognóstico , Compostos Radiofarmacêuticos , Sensibilidade e Especificidade , Tomografia Computadorizada de Emissão de Fóton Único/economia , Tomografia Computadorizada de Emissão de Fóton Único/métodos
15.
PET Clin ; 14(2): 223-232, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30826020

RESUMO

The increasing implementation of advanced cardiovascular imaging in the form of cardiac PET/CT has had a significant impact on the management of cardiac sarcoidosis, which continues to evolve. This review summarizes the role of PET/CT imaging in sarcoidosis with a specific focus on (1) indications, (2) patient preparation, (3) test performance, (4) study interpretation, (5) clinical relevance of findings, (6) comparison to alternative imaging modalities, and finally (7) introduction of areas of anticipated development and research.


Assuntos
Cardiomiopatias/diagnóstico por imagem , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons/métodos , Sarcoidose/diagnóstico por imagem , Tecnologia Biomédica/tendências , Fluordesoxiglucose F18 , Humanos , Imagem de Perfusão do Miocárdio/métodos , Imagem de Perfusão do Miocárdio/normas , Imagem de Perfusão do Miocárdio/tendências , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons/normas , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons/tendências , Compostos Radiofarmacêuticos , Sensibilidade e Especificidade , Tomografia Computadorizada de Emissão de Fóton Único/métodos , Tomografia Computadorizada de Emissão de Fóton Único/normas , Tomografia Computadorizada de Emissão de Fóton Único/tendências
16.
PET Clin ; 14(2): 233-244, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30826021

RESUMO

With the emergence of PET/MR imaging there have been some strides in replicating the cardiovascular imaging success of other hybrid imaging modalities such as PET/computed tomography (CT) and single-photon emission computed tomography/CT. Because of the combined molecular imaging capabilities of PET and high-spatial and high-contrast resolution of MR imaging, there remains the potential for increased diagnostic accuracy and development of novel applications. In this article, the authors review the most promising cardiac PET/MR imaging applications developed since the introduction of PET/MR imaging in 2010 and summarize the most recent technical developments.


Assuntos
Doenças Cardiovasculares/diagnóstico , Angiografia por Ressonância Magnética/métodos , Tomografia por Emissão de Pósitrons/métodos , Cardiomiopatias/diagnóstico , Meios de Contraste , Fluordesoxiglucose F18 , Humanos , Imagem Multimodal/métodos , Imagem de Perfusão do Miocárdio/métodos , Miocardite/diagnóstico , Placa Aterosclerótica/diagnóstico , Compostos Radiofarmacêuticos , Sensibilidade e Especificidade , Tomografia Computadorizada de Emissão de Fóton Único/métodos
17.
PET Clin ; 14(2): 271-279, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30826024

RESUMO

Cardiac PET provides high sensitivity and high negative predictive value in the diagnosis of coronary artery disease and cardiomyopathies. Cardiac, respiratory as well as bulk patient motion have detrimental effects on thoracic PET imaging, in particular on cardiovascular PET imaging where the motion can affect the PET images quantitatively as well as qualitatively. Gating can ameliorate the unfavorable impact of motion additionally enabling evaluation of left ventricular systolic function. In this article, the authors review the recent advances in gating approaches and highlight the advances in data-driven approaches, which hold promise in motion detection without the need for complex hardware setup.


Assuntos
Técnicas de Imagem de Sincronização Cardíaca/métodos , Cardiomiopatias/diagnóstico , Tomografia por Emissão de Pósitrons/métodos , Técnicas de Imagem de Sincronização Respiratória/métodos , Eletrocardiografia/métodos , Humanos , Angiografia por Ressonância Magnética/métodos , Angiografia por Ressonância Magnética/tendências , Imagem Multimodal/métodos , Imagem Multimodal/tendências , Imagem de Perfusão do Miocárdio/métodos , Imagem de Perfusão do Miocárdio/tendências , Tomografia por Emissão de Pósitrons/tendências , Sensibilidade e Especificidade
18.
Medicine (Baltimore) ; 98(9): e14716, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30817614

RESUMO

BACKGROUND: Rapid progress has been made in research of cadmium-zinc-telluride (CZT) technology in the last few years, which might serve as a new method to diagnose coronary artery disease. However, compared with coronary angiography, the diagnostic value of CZT is still controversial. We aimed to evaluate diagnosis value of coronary angiography versus CZT in coronary artery disease. METHODS: We searched the database for eligible researches associated with CZT- myocardial perfusion imaging (MPI) and invasive coronary angiography, extracted the relevant data, and rigorously screened it according to the inclusion and exclusion criteria. The accuracy indicators included sensitivity, specificity, accuracy, positive and negative likelihood ratios. RESULTS: According to the inclusion and exclusion criteria, we finally found 20 studies containing 2350 patients in this search. Pooled results showed that sensitivity of CZT-MPI was 0.84% and 95% confidence interval (95% CI): 0.78 to 0.89, specificity was 0.72, 95% CI (0.62-0.76), the specificity was lower apparently. The positive likelihood ratio was 3.0, 95% CI (2.4-3.8), the negative likelihood ratio was 0.22, 95% CI (0.16-0.31), diagnostic odds ratio was 14, 95% CI (7.84-17.42). CONCLUSION: This meta-analysis showed that CZT-MPI had satisfactory sensitivity and specificity for diagnosing coronary artery disease. Larger studies are required for further evaluation.


Assuntos
Angiografia Coronária/métodos , Doença da Artéria Coronariana/diagnóstico , Imagem de Perfusão do Miocárdio/métodos , Angiografia Coronária/normas , Doença da Artéria Coronariana/diagnóstico por imagem , Humanos , Imagem de Perfusão do Miocárdio/normas , Sensibilidade e Especificidade
19.
J Cardiovasc Comput Tomogr ; 13(3): 26-33, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30796003

RESUMO

OBJECTIVES: The purpose of this study was to analyze the prognostic value of dynamic CT perfusion imaging (CTP) and CT derived fractional flow reserve (CT-FFR) for major adverse cardiac events (MACE). METHODS: 81 patients from 4 institutions underwent coronary computed tomography angiography (CCTA) with dynamic CTP imaging and CT-FFR analysis. Patients were followed-up at 6, 12, and 18 months after imaging. MACE were defined as cardiac death, nonfatal myocardial infarction, unstable angina requiring hospitalization, or revascularization. CT-FFR was computed for each major coronary artery using an artificial intelligence-based application. CTP studies were analyzed per vessel territory using an index myocardial blood flow, the ratio between territory and global MBF. The prognostic value of CCTA, CT-FFR, and CTP was investigated with a univariate and multivariate Cox proportional hazards regression model. RESULTS: 243 vessels in 81 patients were interrogated by CCTA with CT-FFR and 243 vessel territories (1296 segments) were evaluated with dynamic CTP imaging. Of the 81 patients, 25 (31%) experienced MACE during follow-up. In univariate analysis, a positive index-MBF resulted in the largest risk for MACE (HR 11.4) compared to CCTA (HR 2.6) and CT-FFR (HR 4.6). In multivariate analysis, including clinical factors, CCTA, CT-FFR, and index-MBF, only index-MBF significantly contributed to the risk of MACE (HR 10.1), unlike CCTA (HR 1.2) and CT-FFR (HR 2.2). CONCLUSION: Our study provides initial evidence that dynamic CTP alone has the highest prognostic value for MACE compared to CCTA and CT-FFR individually or a combination of the three, independent of clinical risk factors.


Assuntos
Angiografia por Tomografia Computadorizada/métodos , Angiografia Coronária/métodos , Doença da Artéria Coronariana/diagnóstico por imagem , Vasos Coronários/diagnóstico por imagem , Reserva Fracionada de Fluxo Miocárdico , Imagem de Perfusão do Miocárdio/métodos , Idoso , Inteligência Artificial , Ásia , Doença da Artéria Coronariana/mortalidade , Doença da Artéria Coronariana/fisiopatologia , Doença da Artéria Coronariana/terapia , Vasos Coronários/fisiopatologia , Europa (Continente) , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Estudos Prospectivos , Interpretação de Imagem Radiográfica Assistida por Computador , Sistema de Registros , Medição de Risco , Fatores de Risco , Estados Unidos
20.
J Cardiovasc Comput Tomogr ; 13(2): 86-91, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30718182

RESUMO

BACKGROUND: Myocardial CT perfusion imaging with dual energy (DE-CTP) can produce myocardial iodine perfusion maps. This study evaluated the accuracy of first pass myocardial iodine concentration in DE-CTP compared to CT derived dynamic myocardial blood flow (MBF) to determine regional myocardial ischemia in an animal model of coronary stenosis using invasive Fractional Flow Reserve (FFR). METHODS: Seven anaesthetised pigs (mean weight 51 ±â€¯4 kg) had a graded coronary artery stenosis produced in six vessels (plus one control animal) using a methacrylate plug with FFR recorded in the target artery (ischemia = FFR<0.80). During adenosine vasodilation, dynamic myocardial CTP and DE-CTP imaging was performed. Using vendor supplied applications, matching regions of interest (ROIs) were drawn in myocardial segments supplied by the target coronary artery to compare the two techniques. RESULTS: FFR correlated strongly to MBF (r = 0.81) and modestly to myocardial iodine concentration (r = 0.65) and myocardial CT attenuation (r = 0.62) (p < 0.0001 each). The correlation to FFR was stronger using relative ratios (absolute value/reference value of normal segments) than absolute values for MBF (r = 0.86), myocardial iodine concentration (r = 0.80) and CT number (r = 0.79) (p < 0.0001 each). Comparing normal and ischaemic territories there were significant differences in MBF (96 ±â€¯14 vs. 27 ±â€¯18 ml/100 ml of tissue/min, p < 0.0001), myocardial iodine concentration (3.5 ±â€¯1 vs. 1.0 ±â€¯0.7 mg/ml, p < 0.0001) and myocardial CT number (89 ±â€¯9 vs. 73 ±â€¯14 HU, p = 0.002). Myocardial iodine concentration had 91% sensitivity and 98% specificity for detecting FFR <0.8. CONCLUSION: Quantified myocardial iodine content from first pass DE-CTP correlates with CT derived myocardial blood flow and FFR and accurately discriminates ischemic territories in a porcine model. The accuracy and utility of myocardial iodine content in DE-CTP warrants further investigation in a clinical population with FFR as a reference standard.


Assuntos
Meios de Contraste/metabolismo , Estenose Coronária/diagnóstico por imagem , Reserva Fracionada de Fluxo Miocárdico , Iodo/metabolismo , Imagem de Perfusão do Miocárdio/métodos , Miocárdio/metabolismo , Tomografia Computadorizada por Raios X , Adenosina/administração & dosagem , Animais , Meios de Contraste/administração & dosagem , Estenose Coronária/metabolismo , Estenose Coronária/fisiopatologia , Modelos Animais de Doenças , Feminino , Valor Preditivo dos Testes , Interpretação de Imagem Radiográfica Assistida por Computador , Reprodutibilidade dos Testes , Índice de Gravidade de Doença , Sus scrofa , Vasodilatadores/administração & dosagem
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