RESUMO
OBJECTIVES: We sought to prospectively determine whether patients with congestive heart failure (CHF) at risk for paroxysmal atrial fibrillation (PAF) could be identified by clinical and study variables including the P-wave signal-averaged electrocardiogram (P-SAECG). BACKGROUND: Although it is important to assess the risk of developing PAF in patients with CHF, it still remains difficult to predict the PAF appearance in patients with CHF clinically. METHODS: The study group consisted of 75 patients in sinus rhythm without a history of PAF, whose left ventricular ejection fraction, as measured by radionuclide angiography, was <40%. These patients underwent P-SAECG, echocardiography and 24-h Holter monitoring; in addition, the plasma concentration of atrial natriuretic peptide (ANP) was measured at study entry. RESULTS: An abnormal P-SAECG was found at study entry in 29 of 75 patients. In the follow-up period of 21 +/- 9 months, the PAF attacks documented on the ECG significantly more frequently occurred in patients with (32%) rather than without an abnormal P-SAECG (2%) (p = 0.0002). The plasma ANP level was significantly higher in patients with rather than without PAF attacks (75 +/- 41 vs. 54 +/- 60 pg/ml, p = 0.01), although there were no significant differences in age, left atrial dimension or high grade atrial premature beats between the groups. The multivariate Cox analysis identified that the variables significantly associated with PAF development were an abnormal P-SAECG (hazard ratio 19.1, p = 0.0069) and elevated ANP level > or =60 pg/ml (hazard ratio 8.6, p = 0.018). CONCLUSIONS: An abnormal P-SAECG and elevated ANP level could be predictors of PAF development in patients with CHF.
Assuntos
Fibrilação Atrial/diagnóstico , Insuficiência Cardíaca/complicações , Taquicardia Paroxística/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Fibrilação Atrial/sangue , Fibrilação Atrial/etiologia , Fator Natriurético Atrial/sangue , Cromatografia Líquida de Alta Pressão , Ecocardiografia , Eletrocardiografia Ambulatorial , Feminino , Insuficiência Cardíaca/diagnóstico por imagem , Insuficiência Cardíaca/fisiopatologia , Frequência Cardíaca , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Modelos de Riscos Proporcionais , Estudos Prospectivos , Ventriculografia com Radionuclídeos , Volume Sistólico , Taquicardia Paroxística/sangue , Taquicardia Paroxística/etiologiaRESUMO
We report a case of hypertensive-diabetic cardiomyopathy demonstrating left ventricular regional wall motion abnormality, with a normal coronary artery documented on coronary arteriography. Dipyridamole-infusion 201Tl scintigraphy demonstrated transient perfusion defects in the infero-posterior wall of the left ventricle, where reduced wall motion was demonstrated on contrast left ventriculography. Myocardial SPECT (single photon emission tomography) imaging with [123I] beta-methyliodophenylpentadecanoic acid (BMIPP) and 201Tl demonstrated reduced [123I]BMIPP uptake compared with 201Tl uptake in the infero-posterior wall of left ventricle. These results suggest that the impairment of myocardial free fatty acid metabolism is an etiologic or contributory factor for regional wall motion abnormality, together with small-vessel coronary artery disease, in this patient.
Assuntos
Cardiomiopatias/fisiopatologia , Diabetes Mellitus Tipo 2/fisiopatologia , Angiopatias Diabéticas/fisiopatologia , Hipertensão/fisiopatologia , Disfunção Ventricular Esquerda , Cardiomiopatias/diagnóstico por imagem , Angiografia Coronária , Dipiridamol , Eletrocardiografia , Humanos , Masculino , Pessoa de Meia-Idade , Cintilografia , Radioisótopos de Tálio , Disfunção Ventricular Esquerda/diagnóstico por imagemRESUMO
OBJECTIVE: To elucidate whether impairment of the myocardial free fatty acid (FFA) metabolism and small vessel abnormalities in the myocardium are etiologic or contributory factors of myocardial dysfunction in patients with NIDDM without any significant coronary artery disease. RESEARCH DESIGN AND METHODS: We performed myocardial imaging with 123I-labeled beta-methyl-p-iodophenyl pentadecanoic acid (BMIPP), a branched analog of FFA, and dipyridamole-infusion 201thallium scintigraphy (Dip) in nine patients who demonstrated left ventricular wall motion abnormalities without any significant coronary artery disease and in fifteen control cases. As an index of myocardial FFA metabolism, the heart-to-mediastinum count ratio (H/M) of BMIPP was calculated from the mean count in the regions of interest at the heart and the upper mediastinum. RESULTS: Nine patients with reduced wall motion documented by left ventriculography (LVG), (hypokinetic group) demonstrated significantly lower BMIPP uptake (2.1 +/- 0.2, mean +/- SD) than fifteen patients with normal wall motion (normokinetic group) (2.3 +/- 0.2, P < 0.05). Regional ventricular wall motion observed by LVG, regional BMIPP uptake, and regional redistribution phenomenon (RD) were evaluated for five regions of the left ventricle: anterior, septal, apical, lateral, and inferoposterior regions. Wall motion was abnormal in 24 out of 120 regions. Regional BMIPP uptake was reduced in 47 regions. RD in Dip was observed in 23 regions. In regional analysis, the existence of defect in the BMIPP image showed significant correlation with wall motion abnormality (P < 0.01), but there was no significant relationship between the RD in Dip and regional wall motion abnormality (P = 0.16). Myocardial biopsy specimens obtained from the right ventricle of 20 patients showed no pathologic changes, with the exception of two patients. CONCLUSIONS: Our findings suggest that impairment of myocardial FFA metabolism rather than small vessel abnormalities in the myocardium is responsible for modest left ventricular dysfunction in patients with diabetes.
Assuntos
Diabetes Mellitus Tipo 2/fisiopatologia , Coração/diagnóstico por imagem , Disfunção Ventricular Esquerda/fisiopatologia , Adulto , Idoso , Glicemia/análise , Colesterol/sangue , Angiografia Coronária , Doença das Coronárias , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/diagnóstico por imagem , Ácidos Graxos , Feminino , Hemoglobina A/análise , Humanos , Radioisótopos do Iodo , Iodobenzenos , Masculino , Pessoa de Meia-Idade , Radioisótopos de Tálio , Tomografia Computadorizada de Emissão de Fóton Único , Disfunção Ventricular Esquerda/diagnóstico por imagemRESUMO
To elucidate the changes in oxidative metabolism in hibernating myocardium after coronary revascularization, we performed myocardial single-photon emission computed tomography with a free fatty acid analog, I-123 beta-methyliodophenylpentadecanoic acid (BMIPP), and thallium-201 before and 1 month after percutaneous transluminal coronary angioplasty (PTCA) in 11 patients with angina pectoris caused by single artery stenosis. All patients had improvement in wall motion after PTCA at the region with coronary stenosis; the wall motion abnormality score evaluated by left ventriculography decreased from 5.5+/-0.8 (mean +/- SE) to 2.1+/-0.9, p <0.01) after PTCA. The defect score of I-123 BMIPP images was significantly larger than that of thallium-201 images either before (14+/-1.3 vs 8.9+/-1.1, p <0.01) or 1 month after (7.4+/-1.5 vs 3.7+/-0.8, p <0.01) PTCA. The decrease in the defect score of both images was significant (p <0.01). Changes in the wall motion abnormality score showed a significant correlation with both the change in the defect score of thallium-201 images (r = 0.58, p < 0.01) and that of I-123 BMIPP images (r = 0.75, p <0.01). These results indicate that the metabolism of free fatty acid is impaired in hibernating myocardium, and that improvement in left ventricular function after successful PTCA is strongly associated with the recovery of oxidative metabolism.
Assuntos
Angioplastia Coronária com Balão , Metabolismo Energético/fisiologia , Ácidos Graxos não Esterificados/metabolismo , Miocárdio Atordoado/diagnóstico por imagem , Tomografia Computadorizada de Emissão de Fóton Único , Função Ventricular Esquerda/fisiologia , Adulto , Idoso , Circulação Coronária/fisiologia , Ácidos Graxos , Feminino , Seguimentos , Humanos , Iodobenzenos , Masculino , Pessoa de Meia-Idade , Contração Miocárdica/fisiologia , Miocárdio Atordoado/terapia , Miocárdio/metabolismo , Radioisótopos de TálioRESUMO
OBJECTIVE: To determine whether the effectiveness of long-term beta blocker treatment for idiopathic dilated cardiomyopathy can be predicted by signal averaged electrocardiography (ECG). PATIENTS: 31 patients with dilated cardiomyopathy and without bundle branch block were included in a retrospective study and 16 in a prospective study. METHODS: A signal averaged ECG was recorded before beta blocker treatment, and three variables were measured from the vector magnitude: QRS duration, root mean square voltage for the last 40 ms (RMS40), and duration of the terminal low amplitude signals (< 40 microV) (LAS40). In the retrospective study, these variables were compared among good responders (showing > or = 0.10 increase in ejection fraction 12 months after start of beta blocker treatment) and poor responders without such improvement. The validity of the signal averaged ECG criteria for prediction of the response to beta blocker treatment was examined in the prospective study. RESULTS: In the retrospective study, good responders (n = 16) had a shorter QRS duration (mean (SD): 122.9 (11) v 138 (14.4) ms, p < 0.005) and LAS40 (33.1 (8.9) v 42.5 (7.8) ms, p < 0.005), and a higher RMS40 (31.6 (16.3) v 19.0 (10.3) microV, p < 0.02) than poor responders (n = 15). Signal averaged ECG criteria for good response were defined as two or more of the following: QRS duration < 130 ms, RMS40 > 20 microV, LAS40 < 40 ms (sensitivity 81%, specificity 73%). In the prospective study, six of seven patients who met these criteria showed a good response to the beta blocker treatment, while eight of nine who did not showed a poor response (chi 2 = 6.1, p < 0.02). The signal averaged ECG criteria gave a sensitivity of 86% and a specificity of 89% for predicting the effectiveness of beta blocker treatment. CONCLUSIONS: A signal averaged ECG might be useful in predicting the effectiveness of beta blocker treatment for dilated cardiomyopathy.
Assuntos
Antagonistas Adrenérgicos beta/uso terapêutico , Cardiomiopatia Dilatada/tratamento farmacológico , Eletrocardiografia , Metoprolol/uso terapêutico , Processamento de Sinais Assistido por Computador , Cardiomiopatia Dilatada/fisiopatologia , Feminino , Previsões , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Prospectivos , Estudos Retrospectivos , Resultado do TratamentoRESUMO
15 cases of primary pulmonary hypertension were classified into two groups by patterns of perfusion lung scintigraphy. Perfusion scintigrams showed multiple, small, ill-defined defects (mottled + ve) pattern in eight cases, and the remaining seven cases had a normal (mottled - ve) pattern. The mean pulmonary arterial pressure in patients with a mottled pattern (54 +/- 10 mmHg) was higher than in those with a normal pattern (42 +/- 9 mmHg, p < 0.05). There were no significant differences between the two groups in right ventricular ejection fraction, partial pressures of oxygen in the arterial blood or alveolo-arterial oxygen difference. All the patients with a mottled pattern died within 2 years following the lung scintigraphy. There was a significant difference in the survival curves between the two groups. Although our statistical analysis must be evaluated with caution because of small numbers of patients it is suggested that perfusion lung scintigraphy is useful in assessing the prognosis in primary pulmonary hypertension.
Assuntos
Hipertensão Pulmonar/diagnóstico por imagem , Pulmão/diagnóstico por imagem , Adulto , Cateterismo Cardíaco , Feminino , Humanos , Hipertensão Pulmonar/mortalidade , Masculino , Prognóstico , Pressão Propulsora Pulmonar/fisiologia , Cintilografia , Estudos Retrospectivos , Taxa de Sobrevida , Agregado de Albumina Marcado com Tecnécio Tc 99m , Relação Ventilação-Perfusão/fisiologiaRESUMO
To test the hypothesis that there are discrepancies between 201Tl- and 123I-beta-methylpentadecanoic acid (BMIPP) distribution in the left ventricular myocardium and to assess whether BMIPP is a useful tracer agent for the assessment of left ventricular function in hypertrophic cardiomyopathy (HCM), myocardial single photon emission computed tomography (SPECT) was performed with 201Tl and BMIPP in five normal subjects and 12 patients with asymmetric septal hypertrophy. Tracer uptake in the left ventricular myocardium was scored using a four-point grading system. A homogenous distribution of the tracer with no discrepancy between 201Tl and BMIPP uptake in the left ventricular myocardium was observed in each normal subject. In contrast, BMIPP uptake was reduced compared to 201Tl in 58 segments (40%) of the 144 myocardial segments in patients with HCM. Such discordant BMIPP uptake was observed in 15 segments (42%) of the septal segments, in 19 segments (53%) of the anterior segments, in eight segments (22%) of the lateral segments, and in 16 segments (44%) of the inferior segments. There was no significant correlation between 201Tl perfusion score and left ventricular ejection fraction, whereas there was a significant correlation between BMIPP perfusion score and left ventricular ejection fraction (r = 0.748; P < 0.01). The results indicated that there were discrepancies between 201Tl and BMIPP uptake in a significant proportion of myocardial segments, suggesting the impairment of fatty acid metabolism and that BMIPP is a useful tracer agent for the assessment of left ventricular function in hypertrophic cardiomyopathy.
Assuntos
Cardiomiopatia Hipertrófica/diagnóstico por imagem , Circulação Coronária/fisiologia , Ácidos Graxos não Esterificados/metabolismo , Ácidos Graxos , Iodobenzenos , Cardiomiopatia Hipertrófica/fisiopatologia , Humanos , Tomografia Computadorizada de Emissão de Fóton ÚnicoRESUMO
Noninvasive first-pass radionuclide ventriculography may permit the assessment of global and regional left ventricular function during dipyridamole infusion. Twenty patients with > or = 75% stenosis of at least one coronary artery were studied to assess the sensitivity of the technique in detecting coronary artery disease. Seven (35%) had regional dysfunction after dipyridamole infusion, and 16 (80%) developed lower than normal response in left ventricular ejection fraction (an increase of less than 5%) after dipyridamole infusion. When both regional dysfunction and subnormal rejection fraction were considered together, the sensitivity was 80%. Eight normal subjects were studied to assess specificity. None developed regional dysfunction, and left ventricular ejection fraction invariably increased after dipyridamole infusion in all normal subjects, with an increase of less than 5% in only one subject; therefore, the specificity was 88%. It is concluded that the assessment of regional dysfunction with dipyridamole infusion itself is not sensitive, whereas the assessment of changes in left ventricular ejection fraction is sensitive and specific in detecting coronary artery disease.
Assuntos
Doença das Coronárias/diagnóstico por imagem , Dipiridamol , Ventriculografia de Primeira Passagem , Doença das Coronárias/fisiopatologia , Dipiridamol/administração & dosagem , Feminino , Hemodinâmica/fisiologia , Humanos , Infusões Intravenosas , Masculino , Pessoa de Meia-Idade , Sensibilidade e Especificidade , Volume Sistólico/fisiologia , Função Ventricular Esquerda/fisiologiaRESUMO
To test the hypothesis that myocardial sympathetic denervation reflects silent myocardial ischaemia early after infarction, 12 patients with myocardial infarction but without post-infarction angina pectoris underwent single photon emission tomography (SPET) at rest with 201Tl and 123I-metaiodobenzylguanidine (MIBG) shortly after and 3 months after infarction. Short-axis SPET images at the basal, mid-ventricular and apical portions of the left ventricle were selected, and each short-axis image was divided into eight segments. Tracer uptake in each of the 24 segments was scored using a 4-point scale. The total score in each segment was calculated as the defect score for each image, and the difference between the total defect score for the 201Tl and 123I-MIBG images was calculated as the delta defect score. All 12 patients underwent exercise stress 201Tl scintigraphy 1 month after infarction, and they were divided into two groups: those patients with (Group A, n = 7) and those patients without (Group B, n = 5) transient perfusion defects in the peri-infarcted region without chest pain. For the 123I-MIBG defect score, a marked reduction at 3 months was observed in Group A (24 +/- 12 vs 13 +/- 6; P < 0.01), whereas the defect score remained unchanged in Group B (25 +/- 7 vs 23 +/- 8; N.S.). The delta defect score was significantly reduced in Group A (10 +/- 5 vs 6 +/- 4; P < 0.05), whereas it remained unchanged in Group B. The 123I-MIBG defect score early after infarction was higher than the exercise-induced 201Tl defect score (24 +/- 12 vs 20 +/- 9; P < 0.01), whereas at 3 months post-infarction it was lower than the exercise-induced 201Tl defect score (13 +/- 6 vs 20 +/- 9; P < 0.05). Moreover, effort chest pain during daily activities was noted in 5 of the 7 (71%) patients in Group A within 3 months post-infarction. The results of this study suggest that viable but denervated myocardium (mismatched 123I-MIBG defects) is present in peri-infarcted regions, and that myocardial sensory nervous disturbance, which may co-exist with sympathetic nervous denervation, may induce silent myocardial ischaemia in patients with myocardial infarction.
Assuntos
Radioisótopos do Iodo , Iodobenzenos , Infarto do Miocárdio/diagnóstico por imagem , Isquemia Miocárdica/diagnóstico por imagem , Radioisótopos de Tálio , Tomografia Computadorizada de Emissão de Fóton Único/métodos , 3-Iodobenzilguanidina , Estudos de Casos e Controles , Meios de Contraste , Teste de Esforço , Feminino , Seguimentos , Coração/diagnóstico por imagem , Coração/inervação , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/complicações , Isquemia Miocárdica/etiologia , Isquemia Miocárdica/fisiopatologia , Sistema Nervoso Simpático/fisiopatologia , Fatores de TempoRESUMO
We evaluated the usefulness of dipyridamole-thallium imaging for the detection of ischaemic heart disease in 257 patients with atherosclerotic vascular disease (80 patients with arteriosclerosis obliterans, 81 patients with aneurysm of the abdominal aorta, 60 patients with aneurysm of the thoracic aorta and 36 patients with dissecting aortic aneurysm). Clinical evidence of ischaemic heart disease was found in 69 of 257 (27%) patients, including 32 patients with arteriosclerosis obliterans, 23 with aneurysm of the abdominal aorta, 9 with aneurysm of the thoracic aorta and 5 with dissecting aortic aneurysm. Dipyridamole-thallium imaging identified myocardial ischaemia in 49 of 69 (71%) patients with clinical evidence of ischaemic heart disease. Dipyridamole-thallium imaging showed positive results in 67 of 81 (83%) patients with aneurysm of the abdominal aorta. In patients with no clinical evidence of ischaemic heart disease, the results of dipyridamole-thallium imaging were positive in 39 of 188 (21%) patients. Dipyridamole-thallium imaging was positive in 90 of the 257 (35%) patients as a whole. When we combined the patients with positive dipyridamole-thallium imaging with those with negative dipyridamole-thallium imaging but who had clinical evidence of ischaemic heart disease, 42% of all patients had evidence of ischaemic heart disease. Our findings suggest that atherosclerotic vascular disease is strongly associated with ischaemic heart disease and that dipyridamole-thallium imaging is useful for the detection of ischaemic heart disease.
Assuntos
Arteriosclerose/diagnóstico por imagem , Doença da Artéria Coronariana/diagnóstico por imagem , Dipiridamol , Radioisótopos de Tálio , Doenças Vasculares/diagnóstico por imagem , Idoso , Idoso de 80 Anos ou mais , Dissecção Aórtica/diagnóstico por imagem , Aneurisma da Aorta Abdominal/diagnóstico por imagem , Aneurisma da Aorta Torácica/diagnóstico por imagem , Arteriosclerose/epidemiologia , Arteriosclerose Obliterante/diagnóstico por imagem , Angiografia Coronária , Doença da Artéria Coronariana/epidemiologia , Feminino , Hemodinâmica , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Cintilografia , Estudos Retrospectivos , Fatores de Risco , Doenças Vasculares/epidemiologiaRESUMO
In an investigation of myocardial metabolic abnormalities in hypertrophic myocardium, the myocardial glucose metabolism was evaluated with F-18-fluorodeoxyglucose (FDG) positron emission tomography (PET) in 32 patients with hypertrophic cardiomyopathy, and the results were compared with those in 9 patients with hypertensive heart disease. F-18-FDG PET study was performed in the fasting and glucose-loading states. The myocardial regional %dose uptake was calculated quantitatively. The average regional %dose uptake in the fasting state in the patients with asymmetric septal hypertrophy and dilated-phase hypertrophic cardiomyopathy was significantly higher than that in the patients with hypertensive heart disease (0.75 +/- 0.34%, 0.65 +/- 0.25%, and 0.43 +/- 0.22%/100 g myocardium, respectively). In contrast, the average %dose uptake in the glucose-loading state in the patients with asymmetric septal hypertrophy and dilated-phase hypertrophic cardiomyopathy was not significantly different from that in patients with hypertensive heart disease (1.17 +/- 0.49%, 0.80 +/- 0.44% and 0.99 +/- 0.45%, respectively). The patients with apical hypertrophy had also low %dose uptake in the fasting state (0.38 +/- 0.21%) as in the hypertensive heart disease patients, so that the characteristics of asymmetric septal hypertrophy and dilated-phase hypertrophic cardiomyopathy are considered to be high FDG uptake throughout the myocardium in the fasting state. Patients with apical hypertrophy are considered to belong to other disease categories metabolically. F-18-FDG PET study is useful in the evaluation of the pathophysiologic diagnosis of patients with hypertrophic cardiomyopathy.
Assuntos
Cardiomiopatia Hipertrófica/diagnóstico por imagem , Cardiomiopatia Hipertrófica/metabolismo , Fluordesoxiglucose F18/farmacocinética , Glucose/metabolismo , Coração/diagnóstico por imagem , Miocárdio/metabolismo , Compostos Radiofarmacêuticos/farmacocinética , Glicemia/metabolismo , Ecocardiografia , Jejum , Ácidos Graxos não Esterificados/sangue , Feminino , Humanos , Hipertensão/diagnóstico por imagem , Hipertensão/metabolismo , Insulina/sangue , Lactatos/sangue , Masculino , Pessoa de Meia-Idade , Imagens de Fantasmas , Tomografia Computadorizada de Emissão/métodosRESUMO
UNLABELLED: Coronary pressure flow (P/F) relationship has been investigated mainly from the viewpoint of coronary resistance. However, recent experimental evidence suggests that the zero flow pressure intercept (Pzf) provides important characteristics of coronary circulation. Although Pzf is likely to provide meaningful information about characteristics of coronary circulation, no data are available about Pzf in humans. The authors attempted to determine Pzf in humans by analyzing P/F relationship during long cardiac pause. This relationship, provoked by intracoronary adenosine triphosphate (ATP) infusion, was analyzed in 9 patients (8 men, 1 woman) with coronary heart disease (ages: fifty-six +/- six years). After the diagnostic cardiac catheterization, ATP, 0.6 mg/3 mL, was administrated by bolus intracoronary injection during measurements of coronary blood flow velocity. Coronary blood flow velocity in the left anterior descending artery was measured with a 0.018-inch Doppler angioplasty guide wire (FloWire, Cariometrics, Inc., Mountain View, Calif.). The dynamic P/F relationship was obtained by correlation of the instantaneous aortic pressure and flow velocity with each other at constant intervals. The least square linear regression analysis was applied to the P/F data to yield the extrapolated Pzf axis. Immediately after intracoronary injection of ATP, long pause (5320 +/- 1498 msec) appeared and coronary blood flow velocity decreased to 11 +/- 8 cm/sec. Pzf calculated with P/F relationship was 14 +/- 7 mmHg. CONCLUSIONS: Thus, the results clearly demonstrate that Pzf is higher than right atrial and left ventricular end-diastolic pressure in humans, indicating the complexity of the determinants of the Pzf.
Assuntos
Circulação Coronária/fisiologia , Trifosfato de Adenosina/administração & dosagem , Trifosfato de Adenosina/farmacologia , Pressão Sanguínea , Circulação Coronária/efeitos dos fármacos , Doença das Coronárias/fisiopatologia , Feminino , Hemodinâmica , Humanos , Masculino , Pessoa de Meia-Idade , Análise de Regressão , Resistência VascularRESUMO
We encountered a primary cardiac tumor originated from the right atrium or pericardium with singular findings on cardiac radionuclide scintigraphy. The patient was 43-year-old female who showed asymptomatic cardiomegaly and abnormal cardiac silhouette by chest X-ray. First pass radionuclide angiography using Tc-99m pertechnetate revealed the abnormal stain filled from the stem of ascending aorta inner and outer portion of the right atrium. Selective angiography showed that the main feeding artery of the tumor was right coronary artery and right internal mammary artery. The pathological diagnosis of the surgically resected specimen was angiosarcoma. It was suggested that detail evaluation of first pass radionuclide angiography give us a useful clinical information linked the feeding artery of cardiac tumor in this case.
Assuntos
Neoplasias Cardíacas/diagnóstico por imagem , Hemangiossarcoma/diagnóstico por imagem , Ventriculografia de Primeira Passagem , Adulto , Feminino , Neoplasias Cardíacas/irrigação sanguínea , Neoplasias Cardíacas/patologia , Hemangiossarcoma/irrigação sanguínea , Hemangiossarcoma/patologia , Humanos , Pertecnetato Tc 99m de SódioRESUMO
A quantitative index of left ventricular wall motion obtained from ECG-gated planar myocardial images has been developed. Five normal controls and 39 patients with heart disease received an injection of Tc-99m-MIBI (550-740 MBq) at rest, and ECG-gated planar scintigraphy (LAO view) was performed 3 h later. Mean End-diastolic (ED) and end-systolic (ES) myocardial activities were measured using circumferential profile analysis and %count increase (CI) was determined according to the following formula; (ES count-ED count)/(ED count) x 100. The global %CI was compared with the EF obtained from contrast ventriculography (LVG; n = 29) and radionuclide ventriculography using Tc-99m-labelled RBC (RNV; n = 24). The regional %CI was compared with left ventricular wall motion assessed by LVG. The global %CI was correlated well with EF by LVG (r = 0.70) and EF by RNV (r = 0.75). The regional %CI significantly decreased in accordance with wall motion on LVG worsened at impaired region. In conclusion, gated perfusion imaging with Tc-99m-MIBI provides useful information on ventricular function in addition to myocardial perfusion.
Assuntos
Imagem do Acúmulo Cardíaco de Comporta , Coração/diagnóstico por imagem , Nitrilas , Compostos de Organotecnécio , Função Ventricular Esquerda , Adulto , Idoso , Feminino , Cardiopatias/diagnóstico por imagem , Cardiopatias/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Volume Sistólico , Tecnécio Tc 99m SestamibiRESUMO
In order to evaluate myocardial viability, we developed a new method for quantification of redistributed area in Tl-201 myocardial SPECT, and it was applied to 71 patients with LAD lesion. Initial image was subtracted from delayed image, and redistributed area was displayed as an unfolded map (viability map). Extent and viability score, which correspond to extent and degree of the viable area, was also calculated. In the cases with prior myocardial infarction, viability score was widely distributed and extent score was smaller, while the cases with angina pectoris had larger extent score. Visual assessment of redistribution to the infarcted area was compared with % score, which was calculated as ratio to initial defect score. When the criteria of viability was defined as % viability score greater than 36 or % extent score greater than 16, quantitative evaluation agreed with visual assessment, and corresponded to clinical course. This method was considered to be effective for evaluation of extent and degree of myocardial viability, but further evaluation need to be done in comparison with reinjection, PET study, and so on, and usefulness in multi-vessel disease.
Assuntos
Coração/diagnóstico por imagem , Miocárdio/patologia , Radioisótopos de Tálio , Adulto , Idoso , Doença das Coronárias/diagnóstico por imagem , Doença das Coronárias/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Sobrevivência de Tecidos , Tomografia Computadorizada de Emissão de Fóton ÚnicoRESUMO
To assess the prognostic significance of right ventricular function in dilated cardiomyopathy (DCM), we studied consecutive 57 DCM patients. There were 41 men and 16 women, whose mean age was 48 ys. (range 3-68 ys.). The mean LVEF in all patients was 29 +/- 11%, and the mean interval from the onset of symptom of cardiac failure (CHF history) was 4 ys. (range 0-33 ys.). With follow-up of 3.8 ys., five patients had died until the first year, and 14 had died until the third year. By using multivariate regression analysis, there were no prognostic significance in clinical parameters such as age, CHF history, sex, atrial fibrillation, except for NYHA class, and medication at the third year. In survival curves according to Kaplan-Meier method, RVEF and mean PA had predictive value (p less than 0.05), while LVEF did not. The patients with RVEF less than 45% had poor survival rate compared to those with RVEF greater than or equal to 45%. The patients with RVEF less than 45% showed lower LVEF and LVESVI. RVEF may offer prognostic predictive value through the effect of not only mean PA but also left ventricular parameter. In conclusion, radionuclide assessment of right ventricular function should be valuable for the prognostic evaluation of DCM patients.
Assuntos
Cardiomiopatia Dilatada/fisiopatologia , Função Ventricular Direita , Adolescente , Adulto , Idoso , Cardiomiopatia Dilatada/diagnóstico por imagem , Cardiomiopatia Dilatada/mortalidade , Criança , Pré-Escolar , Feminino , Seguimentos , Imagem do Acúmulo Cardíaco de Comporta , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Análise de Regressão , Volume Sistólico , Taxa de SobrevidaRESUMO
Fifteen cases with primary pulmonary hypertension (PPH) were classified into two groups by using the perfusion lung scan pattern. Eight cases had multiple, small, ill-defined defects (mottled pattern), and remaining seven cases had no mottled pattern. These two groups were compared with mean pulmonary arterial pressure (mean PAP), right ventricular ejection fraction (RVEF), blood gas at room air (PaO2), and alveolar-arterial O2 difference (A-aDo2). The cases with mottled pattern showed a significant increase in mean PAP. There were no significant differences in RVEF, PaO2, and A-aDo2, between the groups. The survival rate of the patients with mottled pattern was significantly lower than that without mottled pattern (p less than 0.05). We concluded that perfusion lung scan is very useful for evaluation of the prognosis in primary pulmonary hypertension.
Assuntos
Hipertensão Pulmonar/diagnóstico por imagem , Pulmão/diagnóstico por imagem , Circulação Pulmonar , Adolescente , Adulto , Feminino , Humanos , Hipertensão Pulmonar/mortalidade , Hipertensão Pulmonar/fisiopatologia , Masculino , Pessoa de Meia-Idade , Prognóstico , Cintilografia , Volume Sistólico , Taxa de SobrevidaRESUMO
On exercise 201Tl scintigraphy in coronary artery disease, left ventricular transient dilatation (LVTD) and increased lung uptake were noted as a marker of multivessel critical stenosis. To compare the two markers of 99mTc-methoxyisobutyl isonitrile (MIBI) and 201Tl, planar and SPECT myocardial scintigraphy were performed with both radiopharmaceuticals in 27 patients with ischemic heart disease. Lung uptake (lung/max myocardial ratio) of MIBI was significantly lower than that of 201Tl, but the relationship of the lung uptake was linearly correlated (r = 0.77). The LVTD ratio (mean radial ratio = m-RR) was determined by the mean radius of the immediate postexercise short axial image by that of rest (redistribution) image. There was no significant correlation between the m-RR of 201Tl and that of MIBI (r = 0.27). We suggest that the mechanism of LVTD is due to not only subendmyocardial ischemia but also another factors.
Assuntos
Coração/diagnóstico por imagem , Hipertrofia Ventricular Esquerda/diagnóstico por imagem , Pulmão/diagnóstico por imagem , Tecnécio Tc 99m Sestamibi , Radioisótopos de Tálio , Idoso , Teste de Esforço , Feminino , Humanos , Hipertrofia Ventricular Esquerda/etiologia , Masculino , Pessoa de Meia-Idade , Isquemia Miocárdica/complicações , Isquemia Miocárdica/diagnóstico por imagem , Tomografia Computadorizada de Emissão de Fóton ÚnicoRESUMO
99mTc-MAA venography was performed in a patient with ruptured abdominal aortic aneurysm into inferior vena cava (IVC). Obstruction of lower portion of IVC was considered to be due to the compression by ruptured abdominal aortic aneurysm, which was confirmed at surgery. Subsequent scintigram revealed abnormally high RI uptake in the whole liver and a hot spot in the middle antero-inferior segment of liver, which may be characteristic for such a condition.
Assuntos
Aneurisma da Aorta Abdominal/complicações , Ruptura Aórtica/complicações , Agregado de Albumina Marcado com Tecnécio Tc 99m , Trombose/diagnóstico por imagem , Veia Cava Inferior/diagnóstico por imagem , Idoso , Humanos , Masculino , Embolia Pulmonar/diagnóstico por imagem , Embolia Pulmonar/etiologia , Cintilografia , Trombose/etiologiaRESUMO
To evaluate the left ventricular early diastolic function after dipyridamole infusion or during exercise, the first pass radionuclide angiocardiography (FPRA) by a multicrystal gamma camera (SIM-400) was performed in 32 patients with coronary artery disease (CAD) and 14 normal subjects. Dipyridamole was administered intravenously (0.56 mg/kg in 4 min). The first third filling fraction (FF 1/3) and the first third mean filling rate (MFR 1/3) were calculated from the time-activity curve. FF 1/3 decreased and MFR 1/3 increased in both normal subjects and patients with CAD during exercise. After dipyridamole infusion, FF 1/3 and MFR 1/3 unchanged in normal subjects, in contrast, FF 1/3 and MFR 1/3 decreased in patients with CAD. Thus, dipyridamole infusion FPRA is more sensitive method to detect early diastolic dysfunction in patients with CAD than FPRA during exercise.