Uncontrolled risk factors and worsening perfusion pattern on SPECT myocardial perfusion imaging in medically treated patients with stable chronic ischaemic heart disease.

Purpose: Few data exist on the correlation between the effectiveness of risk factor control and the evolution of myocardial perfusion over time in patients with stable ischaemic heart disease. The aim of the study was to evaluate the changes in stress-rest myocardial perfusion in medically treated patients with stable chronic ischaemic heart disease and the relationship with risk factor control.

Methods: The study cohort included 174 consecutive patients (age 60 ± 9 years, 68 % men) undergoing stress-rest myocardial perfusion imaging (MPI) (study 1), who also underwent repeat evaluation (study 2) and who were clinically stable on medical therapy.

1-23I-MIBG thyroid uptake: Implications for MIBG imaging of the heart.

Background: 123I-MIBG has been widely used in patients with heart failure and neurological disorders. The patients are pre-treated with Lugol's oral solution or potassium perchlorate to prevent thyroid uptake of unlabeled 123I to limit the thyroid radiation exposure. However, despite the inhibition of the iodide pump, the thyroid is frequently visualized.

Long-term echocardiographic and cardioscintigraphic effects of growth hormone treatment in adults with Prader-Willi syndrome.

Context: In Prader-Willi syndrome (PWS), an altered GH secretion has been related to reduced cardiac mass and systolic function compared to controls.

Objective: The objective was to evaluate the cardiovascular response to a 4-year GH therapy in adult PWS patients.

Study Participants: Study participants were nine severely obese PWS adults (three females, six males) and 13 age-, gender-, and body mass index-matched obese controls.

Applicability of the appropriate use criteria for SPECT myocardial perfusion imaging in Italy: preliminary results.

Purpose: Clinical applicability of the appropriate use criteria for SPECT myocardial perfusion imaging has not yet been evaluated in Italy. We investigated the applicability of the Appropriate Use Criteria (AUC) in Italy.

Methods: The indications for testing were prospectively recorded in three different nuclear cardiology laboratories: a general hospital, an academic hospital, and a tertiary centre.

Comparative analysis of iterative reconstruction algorithms with resolution recovery for cardiac SPECT studies. A multi-center phantom study.

Background: This investigation used image data generated by a physical phantom over a wide range of count statistics to evaluate the effectiveness of several of the newer commercially available SPECT reconstruction iterative algorithms (IRR) in improving perfusion defect contrast and spatial resolution, while controlling image noise.

Methods: A cardiac phantom was imaged using four different gamma cameras over a wide range of counts statistics (from 6 to 0.8 Mcounts).

Temporal evolution of administered activity in cardiac gated SPECT and patients' effective dose: analysis of an historical series.

Purpose: Myocardial perfusion imaging contributes >20 % of the average medical radiation exposure to the population in the USA. Imaging protocols able to achieve a radiation exposure ≤9 mSv in 50 % of the studies by 2014 have been recommended. The aim of this study was to analyse the temporal evolution of administered activities in patients scheduled for dual-day (99m)Tc tracer gated single photon emission computed tomography (SPECT) and to compare different dose administration protocols in terms of patients' effective dose.

Wide beam reconstruction for half-dose or half-time cardiac gated SPECT acquisitions: optimization of resources and reduction in radiation exposure.

Purpose: A new iterative reconstruction algorithm (WBR™) has been recently proposed for cardiac single photon emission computed tomography (SPECT). The WBR™ technology is designed to reduce noise, improving lesion identification without affecting the image resolution, allowing SPECT studies with reduced count statistic. This allows for either half-time (HT) or half-dose (HD) cardiac SPECT, with image quality and quantitative data comparable to standard-time (ST) or standard-dose (SD) SPECT.

Assessment of cardiac asynchrony by radionuclide phase analysis: correlation with ventricular function in patients with narrow or prolonged QRS interval.

Background: Conflicting data exist on the relation between the synchronism of cardiac contraction and ventricular function.

Aim And Methods: A resting radionuclide ventriculography (RNV) was performed in 380 consecutive patients to evaluate the relationship between the synchronism of cardiac contraction and ventricular function.

Results: A significant, non-linear, relation was found between LVEF and intra-ventricular asynchrony or QRS, but not between inter-ventricular asynchrony and LVEF.

Conditional cardiovascular response to growth hormone therapy in adult patients with Prader-Willi syndrome.

Context: In Prader-Willi syndrome (PWS), an altered GH secretion has been related to reduced cardiac mass and systolic function when compared with controls.

Objectives: The objective of the study was to evaluate the cardiovascular response to GH therapy in adult PWS patients.

Study Participants: Thirteen obese PWS adults (seven males and six females, aged 26.

The impact of growth hormone/insulin-like growth factor-I axis and nocturnal breathing disorders on cardiovascular features of adult patients with Prader-Willi syndrome.

Context: Adult patients with Prader-Willi syndrome (PWS) are prone to develop obesity, GH deficiency (GHD), and their related complications, with cardiopulmonary failure explaining more than half of PWS fatalities. OBJECTIVE AND STUDY PARTICIPANTS: This study was undertaken to examine the effect of GHD and sleep breathing disorders on cardiovascular risk factors and heart features of 13 PWS (age 26.9 +/- 1.

Posttraumatic hydrocephalus: a clinical, neuroradiologic, and neuropsychologic assessment of long-term outcome.

Objectives: To detect the clinical and radiologic characteristics of posttraumatic hydrocephalus (PTH), to define its prognostic value, and to assess the effects of shunt surgery.

Design: Correlational study on a prospective cohort.

Setting: Brain injury rehabilitation center.

Posttraumatic epilepsy: neuroradiologic and neuropsychological assessment of long-term outcome.

Purpose: We sought to detect the incidence and the risk factors of posttraumatic epilepsy (PTE) in rehabilitation patients; to define the influence of PTE for late clinical and functional outcome; and to assess the cognitive and behavioral features of the patients with PTE.

Methods: Patients were examined with (a) cognitive and behavioral examinations, which included a clinical interview and psychometric tests performed by an expert clinical psychologist; (b) single-photon emission computed tomography (SPECT) and magnetic resonance imaging (MRI); and (c) functional evaluation including the Glasgow Outcome Scale (GOS) and the Functional Independence Measure (FIM).

Results: Of the 143 patients examined in this study, in 27 (19%), seizures developed after a mean time from trauma of 11.

Differential systolic and diastolic effects of beta-adrenergic stimulation in patients with severe left ventricular dysfunction: a radionuclide ventriculographic study.

Background: An attenuated inotropic response to beta-adrenergic stimulation has been documented in patients with severely depressed left ventricular (LV) function. Scant data exist regarding the effect of beta-adrenergic stimulation on LV diastolic function in human beings. Our objective was to evaluate the effect of dobutamine infusion on LV systolic and diastolic function in patients with severe ventricular dysfunction.

Electrocardiographic evolution after Q-wave anterior myocardial infarction: correlations between QRS score and changes in left ventricular perfusion and function.

Background: In the thrombolytic era, conflicting data have been reported on the usefulness of the QRS score in estimating the amount of left ventricular (LV) damage after acute myocardial infarction (MI).

Methods And Results: We correlated the QRS score with the extent of LV hypoperfusion and ejection fraction (EF) in 95 consecutive male patients with a first anterior Q-wave MI; the 6-month evolution of QRS score and changes in LV perfusion and function were also compared. The Selvester-Wagner QRS score was computed from the digitized 12-lead electrocardiogram, both at predischarge and 6 months later; at the same time, resting sestamibi first-pass ventriculography and single photon emission computed tomography imaging were performed.

Independent and incremental prognostic value of (201)Tl lung uptake at rest in patients with severe postischemic left ventricular dysfunction.

Background: An elevated (201)Tl lung uptake after stress is related to an adverse prognosis.

Methods And Results: The functional and prognostic significance of resting (201)Tl lung uptake was assessed in 124 consecutive patients with ischemic heart disease and ejection fraction View Article and Find Full Text PDF

Transient left ventricular dilation at quantitative stress-rest sestamibi tomography: clinical, electrocardiographic, and angiographic correlates.

Background: Few data are available regarding the incidence and significance of transient left ventricular (LV) dilation on stress sestamibi single photon emission computed tomography (SPECT), which is different from thallium-201 studies because images are acquired late after tracer injection.

Methods: We studied 234 patients with ischemic heart disease and interpretable electrocardiograms undergoing stress-rest sestamibi SPECT on separate days. Sestamibi uptake defect extent was quantified on SPECT polar maps.

Heterogeneous fate of perfusion and contraction after anterior wall acute myocardial infarction and effects on left ventricular remodeling.

After acute myocardial infarction, patency of infarct vessel and extent of left venticular (LV) dysfunction are major determinants of ventricular remodeling. Spontaneous, delayed reperfusion in the infarct zone occurs in a sizeable number of patients well after the subacute phase. The aim of this study was to determine the relation between the occurrence of this spontaneous, delayed reperfusion and LV remodeling.

Ischemic burden in silent and painful myocardial ischemia: a quantitative exercise sestamibi tomographic study.

Objectives: We sought to determine whether the amount of myocardial ischemic burden differs in patients with painful or silent myocardial hypoperfusion during exercise testing.

Background: Whether a lack of symptoms during ischemia reflects an alteration in pain perception or less myocardium in jeopardy remains a controversial issue.

Methods: We studied 300 consecutive patients with a well established history of ischemic heart disease and reversible hypoperfusion on exercise sestamibi tomography.

Residual exertional ischemia and unfavorable left ventricular remodeling in patients with systolic dysfunction after anterior myocardial infarction.

Objectives: This study investigated whether exercise-induced myocardial ischemia influences left ventricular remodeling after anterior myocardial infarction.

Background: The effects of acute and recurrent ischemia on ventricular function are well established. However, to our knowledge the role of exertional ischemia in the remodeling response after infarction has not been investigated.

Technetium-99m sestamibi tomographic evaluation of residual ischemia after anterior myocardial infarction.

Objectives: This study investigated the value of sestamibi scintigraphy in assessing residual ischemia after anterior myocardial infarction.

Background: Serial imaging with sestamibi, the uptake and retention of which correlate with regional myocardial blood flow and viability, has been used to estimate salvaged myocardium and risk area after acute infarction. We recently documented that recovery of perfusion and contraction in the infarcted area may continue well after the subacute phase, suggesting myocardial hibernation.

Evaluation of technetium-99m-sestamibi lung uptake: correlation with left ventricular function.

Unlabelled: Lung uptake of 201Tl is a reliable marker of left ventricular dysfunction. The goal of our study was to establish whether the evaluation of lung-to-heart uptake ratios (LHR) with 99mTc-sestamibi imaging may provide valuable information.

Methods: We studied 72 male subjects with recent anterior myocardial infarction undergoing 99mTc-sestamibi first-pass ventriculography and SPECT perfusion imaging.

Effects of nitroglycerin by technetium-99m sestamibi tomoscintigraphy on resting regional myocardial hypoperfusion in stable patients with healed myocardial infarction.

Myocardial sestamibi uptake reflects regional flow distribution and cellular integrity; however, some segments showing reduced tracer uptake at rest may consist of viable, although hypoperfused, myocardium. It is speculated that the administration of nitroglycerin (NTG) before the sestamibi injection would improve the tracer uptake in resting hypoperfused regions. Thirty-six stable patients with previous myocardial infarction (56 +/- 2 years; mean ejection fraction 42 +/- 2%), in whom perfusion defects could be seen at resting sestamibi tomography, repeated the scintigraphic study 2 to 6 days later, receiving NTG (0.

Effects of mental stress on myocardial perfusion in patients with ischemic heart disease.

The purpose of the present study was to determine whether and to what extent mental stress can reproduce the perfusion defects that are known to be induced by exercise. Twenty-four patients with recent myocardial infarction (New York Heart Association functional class I) and evidence of ischemic response were evaluated by means of SESTAMIBI scintigraphy performed once after exercise and then again within 2 days after mental arithmetic. Baseline, exercise, and mental stress planar scintigrams were divided into 15 segments, and each segment was reviewed and scored on a scale of 0 to 3 by experienced observers using circumferential profile analysis.