Myocardial perfusion scintigraphy during chest pain: An atypical presentation of takotsubo cardiomyopathy?

Although Takotsubo cardiomyopathy (TCM) knowledge is increasing, the exact pathophysiology remains unclear. TCM represents 1%-2% of all troponin positive acute coronary syndromes, affects predominantly postmenopausal women, and is commonly preceded by exposure to severe physical or emotional stress. Transient wall motion abnormalities mimicking ST-elevation myocardial infarction is expected as well as increase of troponin levels and echocardiography alterations.

Effect of Nebivolol on MIBG Parameters and Exercise in Heart Failure with Normal Ejection Fraction.

Background: More than 50% of the patients with heart failure have normal ejection fraction (HFNEF). Iodine-123 metaiodobenzylguanidine (123I-MIBG) scintigraphy and cardiopulmonary exercise test (CPET) are prognostic markers in HFNEF. Nebivolol is a beta-blocker with vasodilating properties.

BNP was associated with ischemic myocardial scintigraphy and death in patients at chest pain unit.

Background: Recent studies have suggested that B-type Natriuretic Peptide (BNP) is an important predictor of ischemia and death in patients with suspected acute coronary syndrome. Increased levels of BNP are seen after episodes of myocardial ischemia and may be related to future adverse events.

Objectives: To determine the prognostic value of BNP for major cardiac events and to evaluate its association with ischemic myocardial perfusion scintigraphy (MPS).

Applicability of the Appropriate use Criteria for Myocardial Perfusion Scintigraphy.

Background: Appropriateness Criteria for nuclear imaging exams were created by American College of Cardiology (ACC) e American Society of Nuclear Cardiology (ASNC) to allow the rational use of tests. Little is known whether these criteria have been followed in clinical practice. Objective: To evaluate whether the medical applications of myocardial perfusion scintigraphy (MPS) in a private nuclear medicine service of a tertiary cardiology hospital were suitable to the criteria of indications proposed by the American medical societies in 2005 and 2009 and compare the level of indication of both.

Cardiac 123I-MIBG uptake in de novo Brazilian patients with Parkinson's disease without clinically defined dysautonomia.

Myocardial scintigraphy with meta-iodo-benzyl-guanidine (123I cMIBG) has been studied in Parkinson's disease (PD), especially in Asian countries, but not in Latin America. Most of these studies include individuals with PD associated to a defined dysautonomia. Our goal is to report the cardiac sympathetic neurotransmission in de novo Brazilian patients with sporadic PD, without clinically defined dysautonomia.

Cardiac I123-MIBG correlates better than ejection fraction with symptoms severity in systolic heart failure.

Background: The association of autonomic activation, left ventricular ejection fraction (LVEF) and heart failure functional class is poorly understood.

Objective: Our aim was to correlate symptom severity with cardiac sympathetic activity, through iodine-123-metaiodobenzylguanidine (123I-MIBG) scintigraphy and with LVEF in systolic heart failure (HF) patients without previous beta-blocker treatment.

Methods: Thirty-one patients with systolic HF, class I to IV of the New York Heart Association (NYHA), without previous beta-blocker treatment, were enrolled and submitted to 123I-MIBG scintigraphy and to radionuclide ventriculography for LVEF determination.

Correlation between myocardial scintigraphy and CT angiography in the evaluation of coronary disease.

Background: Coronary multidetector CT angiography (CTA) has shown good accuracy for detection of coronary stenosis. Although this is a promising technique for the evaluation of CAD, its correlation with the functional expression of the disease is not yet well established.

Objective: To evaluate whether the presence of CAD and the degree of coronary stenosis assessed by CT angiography are associated with changes in the Myocardial Perfusion Scintigraphy (MPS).

Do interleukin-1β levels correlate with MIBG and exercise parameters in heart failure?

Background: Interleukin 1β (IL 1β) levels are associated with prognosis in heart failure. The cardiac adrenergic activity as assessed by metaiodobenzylguanidine (I123 MIBG) scintigraphy along with exercise parameters are important predictors of prognosis. The relationship between these variables is not fully established.

Is abnormal adrenergic activation associated with abnormal Heart Rate Recovery?

Background: Heart Rate Recovery (HRR) reflects the capacity of the cardiovascular system to reverse the vagal withdrawal caused by exercise. Scintigraphy with metaiodobenzylguanidine (I(123) MIBG) evaluates innervation and cardiac adrenergic activation. The association of these two methods is not well established.

Effects of short-term carvedilol on the cardiac sympathetic activity assessed by 123I-MIBG scintigraphy.

Background: Autonomic alterations in heart failure are associated with an increase in morbimortality. Several noninvasive methods have been employed to evaluate the sympathetic function, including the Meta-Iodobenzylguanidine (123I-MIBG) scintigraphy imaging of the heart.

Objective: to evaluate the cardiac sympathetic activity through 123I-MIBG scintigraphy, before and after three months of carvedilol therapy in patients with heart failure and left ventricular ejection fraction (LVEF) < 45%.

Prevalence of induced ischemia by mental distress.

Background: The myocardial radionuclide imaging with mental distress seems to induce ischemia through a particular physiopathology when compared to radionuclide imaging with physical or pharmacological distress.

Objective: To assess the prevalence of induced myocardial ischemia by mental distress in patients with thoracic pain and radionuclide imaging with normal conventional distress, with 99mTc-Sestamibi.

Methods: Twenty-two patients were admitted with thoracic pain at emergency or were referred to the nuclear medicine service of our institution, where myocardial radionuclide imaging of distress or rest without ischemic alterations was carried out.

Use of resting myocardial scintigraphy during chest pain to exclude diagnosis of acute myocardial infarction.

Background: Images of myocardial perfusion taken during an episode of chest pain have been used for patients in the emergency department.

Objective: To evaluate the operating characteristics of 99mTc-Tetrofosmin scintigraphy during an episode of chest pain to exclude the diagnosis of acute myocardial infarction.

Methods: One hundred and eight patients admitted with chest pain, or up to four hours after the end of symptoms and nondiagnostic electrocardiogram, underwent resting scintigraphy and measurement of troponin I concentrations.

Autologous bone-marrow mononuclear cell transplantation after acute myocardial infarction: comparison of two delivery techniques.

The objective of this study was to investigate safety and feasibility of autologous bone marrow mononuclear cells (BMMNC) transplantation in ST elevation myocardial infarction (STEMI), comparing anterograde intracoronary artery (ICA) delivery with retrograde intracoronary vein (ICV) approach. An open labeled, randomized controlled trial of 30 patients admitted with STEMI was used. Patients were enrolled if they 1) were successfully reperfused within 24 h from symptoms onset and 2) had infarct size larger than 10% of the left ventricle (LV).

Value of combining activated brain FDG-PET and cardiac MIBG for the differential diagnosis of dementia: differentiation of dementia with Lewy bodies and Alzheimer disease when the diagnoses based on clinical and neuroimaging criteria are difficult.

Dementia with Lewy bodies (DLB) is the second most common cause of dementia. The diagnosis of DLB is particularly important because these patients show good response to cholinesterase inhibitors. Clinical and neuroimaging criteria for DLB have not been acceptable for predictive accuracy.

Assessment of intra-arterial injected autologous bone marrow mononuclear cell distribution by radioactive labeling in acute ischemic stroke.

Objective: To evaluate the feasibility of monitoring the autologous mononuclear bone marrow (ABMMN) cells implanted into the brain after acute ischemic stroke by the technique of labeling with Tc-99m-HMPAO.

Case Report: A 37-year-old man presented with aphasia, right-side hypoesthesia, and right homonymous hemianopsia after an acute ischemic stroke of the left middle cerebral artery. He was included in an autologous bone marrow mononuclear cell-based therapy research protocol about the safety of intra-arterial autologous bone marrow mononuclear cell transplantation for acute ischemic stroke.

Medium term prognostic value of stress myocardial perfusion scintigraphy in a chest pain unit.

Objective: To evaluate the prognostic value of stress myocardial perfusion scintigraphy (MPS) applied to patients with suspected acute coronary syndrome (ACS).

Methods: Retrospective study. Patients with suspected acute coronary syndrome (ACS) admitted into the chest pain unit (CPU) from December 2002 to April 2004, after exclusion of acute myocardial infarction (AMI) and high risk unstable angina they underwent stress MPS.

[Clinical impact of positron emission tomography by coincidence system with 18F-FDG on therapeutic decision-making of patients with ischemic cardiomyopathy after myocardial infarction].

Objective: To evaluate the influence of the myocardium viability study by coincidence imaging using 18F-FDG in the clinical decision-making of patients with ischemic cardiomyopathy and left ventricular dysfunction.

Methods: Thirty-one patients were submitted to myocardial viability study with 18F-FDG by coincidence imaging between September 2003 and November 2004. The physician answered a questionnaire about the choice of therapeutic procedure before and after PET.

Gastrointestinal bleeding diagnosed by red blood cell scintigraphy in a patient with aortic stenosis: a case of Heyde syndrome.

The authors report a case of small bowel bleeding diagnosed by Tc-99m-labeled red blood cell (RBC) scintigraphy during the postoperative period after aortic valve replacement. There is a relationship between aortic valve stenosis and gastrointestinal bleeding in elderly patients, called Heyde syndrome. The described patient had chronic anemia that worsened after surgery.