Position statement on the non-invasive diagnosis of patients with ATTR pardiac amyloidosis, endorsed by the Hellenic Society of Nuclear Cardiology, for the Nuclear Medicine practitioners.

Cardiac amyloidosis is a rare condition characterized by the accumulation of abnormal proteins called amyloids in the heart tissue. These amyloids can disrupt the normal functioning of the heart and lead to a variety of symptoms and complications.

Nuclear Cardio-Oncology.

Nuclear cardio-oncology is a specialized field that combines aspects of nuclear medicine, cardiology, and oncology to diagnose and manage cardiovascular complications in cancer patients. It focuses on the assessment of cardiovascular health and the detection of potential heart-related side effects caused by cancer treatments.

Transthyretin (Pro24Ser) variant amyloidosis: A case report of the first patient in Greece.

Objective: Transthyretin cardiac amyloidosis (ATTR-CA) is a rare and potentially fatal disease caused by the accumulation of insoluble transthyretin (TTR) amyloid fibrils in the heart. The symptoms of ATTR-CA are often non-specific, often leading to underdiagnosis. Early diagnosis and treatment have a significant impact on disease progression and mortality.

Spleen visualization in both TTR and AL amyloidosis during Tc-DPD scintigraphy. Do we have to deal with a different than the myocardial uptake mechanism?

Technetium-99m- diphosphono-1,2-propanodicarboxylic acid (Tc-DPD) is currently used in Europe for the diagnosis of cardiac amyloidosis, being able to distinguish light chain (AL) from transthyretin (TTR) type. We are reporting obvious spleen visualization in two patients suffering the first from proven TTR and the second from AL type of cardiac amyloidosis, with myocardial uptake-as anticipated-only in the first one. We raise the hypothesis that a common uptake mechanism exists for the spleen amyloid regardless of the type of the disease (AL or TTR), and is possibly different than the cardiac uptake mechanism.

Unusually seen pattern of Tc-DPD soft tissue uptake in a patient with AL amyloidosis. Is it an amyloid type indicator in specific cases?

Technetium-99m (Tc)-labeled pyrophosphate (PYP) and 3,3-diphosphono-1,2-propanodicarboxylic acid (DPD) are currently the most established imaging agents for the diagnosis of cardiac amyloidosis, being able to distinguish light chain (AL) from transthyretin (TTR) type of the disease. We present a pattern of increased uptake in all soft tissues, sparing the organs that are usually most affected.

The prognostic significance of stress-only myocardial perfusion scan: A 5 year observational study.

Objective: Stress-only myocardial perfusion imaging protocol has a prognostic value similar to that of a stress-rest protocol. The aim of the study was to assess stress myocardial perfusion by gated single photon emission computed tomography (SPECT) myocardial perfusion imaging (GSMPI) in patients who had a normal stress-only study 4.9 years (mean time) before and assess the possible influence of various factors on the results.

Gender-related differences in side-effects and hemodynamic response to regadenoson in patients undergoing SPECT myocardial perfusion imaging.

Purpose: To evaluate differences in side-effects and hemodynamic response between men and women undergoing regadenoson-stress SPECT myocardial perfusion imaging (MPI).

Methods: The initial population of the study included 858 consecutive patients who underwent regadenoson-stress MPI at our institution. These patients underwent prospective assessment and classification of regadenoson-induced side-effects in six categories and recording of heart rate (HR) and blood pressure (BP) before and after regadenoson administration.

Tumor Protein p53 (TP53) Gene and Left Main Coronary Artery Disease.

Patients with left main (LM) coronary artery disease (CAD) are at the highest risk of cardiovascular events. We evaluated possible gene polymorphisms of tumor protein 53 ( TP53, rs1042522, p.Arg72Pro) that can differentiate LM-CAD from patients with more peripheral CAD (MP-CAD) and healthy participants (control group) in 520 individuals (LM-CAD, n = 175; MP-CAD, n = 185; and control group, n = 160).

Stronger correlation with myocardial ischemia of high-sensitivity troponin T than other biomarkers.

Background: Acute myocardial infarction (AMI) is considered a major cause of death and disability. Myocardial perfusion scintigraphy (MPS) as a non-invasive diagnostic imaging procedure and certain biomarkers associated with myocardial ischemia (ISCH), such as ischemia-modified albumin (IMA), neuropeptide Y (NPY), N-terminal pro b-type natriuretic peptide (NT-proBNP), and high-sensitivity troponin T (hsTnT) could probably aid in the detection of myocardial infarction.

Methods: Between December 2011 and June 2012, we prospectively analyzed patients who underwent a MPS study with the clinical question of myocardial ISCH.

Long-term prognostic implications of myocardial perfusion imaging in octogenarians: an all-comer, cohort study.

Purpose: Evaluation of the long-term prognostic value of myocardial perfusion imaging (MPI) in octogenarians.

Methods: Six hundred and twenty-nine octogenarians [51% previous myocardial infarction (MI) or revascularization] who underwent single-isotope MPI (78% Tl, 22% Tc-tetrofosmin) with exercise (38% Bruce, 2% leg ergometry) or pharmacologic (58% adenosine, 2% dobutamine) stress were studied. All patients had LVEF determined by echocardiography within 1 month from MPI.

Adenosine stress myocardial perfusion imaging in octogenarians: Safety, tolerability, and long-term prognostic implications of hemodynamic response and SPECT-related variables.

Background: Evaluation of tolerability, safety, and prognostic implications of adenosine stress myocardial perfusion imaging (MPI) in octogenarians.

Methods: 370 octogenarians (49% known coronary artery disease) were studied. Hemodynamic response, MPI-related data, and rest-left ventricular ejection fraction (LVEF) based on echocardiography were registered per patient, and prospective follow-up was performed to document all-cause death (ACD), cardiac death (CD), myocardial infarction (MI), and late revascularization.

Fast myocardial perfusion imaging with Tc in challenging patients using conventional SPECT cameras.

Background: We attempted to validate the performance of a fast myocardial perfusion imaging (MPI) protocol in diagnostically challenging patients.

Methods: 78 patients with ΒΜΙ > 24.9, LVH or three vessels disease underwent two sequential gated-MPI studies.

Risk stratification for large artery or chronic coronary artery disease-related ischemic stroke in octogenarians undergoing exercise stress myocardial perfusion imaging: A cohort study.

Objectives: To test, if in octogenarians, treadmill exercise with myocardial perfusion imaging (exercise-MPI) can risk stratify for large artery or chronic CAD-related ischemic stroke (LACCIS).

Methods: Exercise-MPI-related data of 237 octogenarians (55% prior MI or revascularization) without previous stroke were registered and prospective follow-up was performed to document LACCIS. LACCIS was defined as acute onset of neurological symptoms with CT/MRI findings of non-lacunar-type infarcts in the absence of atrial fibrillation or intracardiac embolic sources.

Atherosclerotic and Non-Atherosclerotic Coronary Heart Disease in Women.

Atherosclerotic Coronary heart disease (CHD) and non-atherosclerotic CHD in individuals less than 50 years of age is considered a "men's case". Undoubtedly, premenopausal women develop atherosclerotic/non-atherosclerotic CHD relatively rarely compared with men. This is attributed mostly to the cardioprotective role of estrogens (mainly estradiol).

Long-term prognostic value of myocardial perfusion imaging in octogenarians able to undergo treadmill exercise stress testing.

Background: Although the use of myocardial perfusion imaging (MPI) for prognostic purposes in general population is well understood, its role in very elderly patients is not extensively studied.

Methods: 247 octgogenarians (79% male, 56% previous myocardial infarction-MI or revascularization) who underwent treadmill exercise testing (TET) with MPI were studied. TET and MPI-related data were registered per patient and prospective follow-up was performed to document all cause death (ACD), cardiac death (CD), non-fatal MI, and late revascularization (LR).

Prognostic value of the Duke treadmill score in octogenarians undergoing myocardial perfusion imaging.

Objectives/background: Although Duke treadmill score (DTS) is the most widely used risk stratification method in younger patients undergoing exercise treadmill test (ETT) its specific value in the elderly is not established.

Methods: 137 patients aged ≥80 years who underwent ETT myocardial perfusion imaging (MPI) were studied. DTS and MPI (including summed stress scores, SSS) related data were registered per patient and follow up was performed to document cardiac death (CD), myocardial infarction (MI) and late (>3 months) revascularization (LR).

Reversible reduction of cardiac sympathetic innervation after coronary artery bypass graft surgery: an observational study using serial iodine 123-labeled meta-iodobenzyl-guanidine (MIBG) imaging.

Objectives: Various types of surgical and interventional procedures have been reported to cause cardiac sympathetic denervation. We aimed at evaluating the effects of coronary artery bypass grafting (CABG) in cardiac sympathetic innervation through meta-iodobenzyl-guanidine (MIBG) imaging.

Methods: MIBG imaging was performed in 21 patients with coronary artery disease (CAD) 1 day before and 1 week and 6 months after CABG with concomitant measurements of corrected QT interval.

Bone marrow stem cell adherence into old anterior myocardial infarction: a scintigraphic study using Tl-201 and Tc-99m-HMPAO.

Aim: The precise localization of bone marrow stem cells (SCs) into the necrotic tissue after intracoronary infusion (ICI) may be important for the therapeutic outcome. This study aims to examine the correlation between Tl-201 and Tc-99m-hexa-methyl-propylene-amine-oxime (HMPAO) images.

Methods: Thirteen patients, aged 36-62 years, with an old, nonviable, anterior myocardial infarction (MI) and reduced myocardial contractility (LVEF <40%), underwent ICI of selected CD133(+) and CD133(neg)CD34(+) SCs.

Heart type fatty acid binding protein in relation to pharmacologic scintigraphy in coronary artery disease.

Background: Heart-type fatty acid-binding protein (H-FABP) is a marker of myocardial necrosis, but whether it increases during myocardial ischemia is not known. This study investigated whether serum levels of H-FABP change during adenosine stress testing and nuclear imaging in patients with stable coronary artery disease.

Methods: Thirty stable patients with established coronary artery disease on their medications were studied.

Disorders of the autonomic nervous system in patients with Brugada syndrome: a pilot study.

Introduction: The aim of this study was to examine autonomic disorders in patients with Brugada syndrome by performing a cardiac sympathetic innervation evaluation, a head-up tilt-test (HUT) and heart rate variability (HRV) analysis.

Methods And Results: We enrolled 20 patients with Brugada syndrome (mean age 42.5 +/- 8.

Stress test with dual isotope studies for the documentation of classical ischemic preconditioning.

Objectives: We investigated whether myocardial perfusion imaging (MPI) can demonstrate the effect of classical preconditioning.

Methods: 21 patients with documented coronary artery disease (stenosis>or=70%) underwent two exercise stress tests (EST) with concomitant MPI, using TL-201 for the first and tetrofosmin-Tc-99m for the second. A third MPI was performed at rest, using Tc-99m.

Predictive value of cardiac autonomic indexes and MIBG washout in ICD recipients with mild to moderate heart failure.

Objective: We aimed at evaluating the combined use of heart rate variability (HRV), baroreflex sensitivity (BRS), and MIBG imaging in the risk stratification for sudden cardiac death (SCD) of patients with mild to moderate heart failure.

Methods: Twenty-five patients (17 male and 8 female, mean age 63 +/- 5 years, mean LVEF 36 +/- 3%) with a recently implanted defibrillator (ICD) and mild (NYHA I-II) heart failure due to either ischemic (n = 15) or dilated (n = 10) cardiomyopathy were studied. One week after ICD implantation they underwent (a) baroreflex sensitivity (BRS) evaluation to bolus phenylephrine by the Oxford method, (b) 24-h heart rate variability (HRV) assessment, and (c) MIBG imaging.

Ischaemia-modified albumin in dilated cardiomyopathy.

Background: Biomarkers of myocardial necrosis may be increased in patients with chronic heart failure. We investigated whether ischaemia-modified albumin (IMA), a marker of ischaemia, is also elevated in patients with compensated heart failure, due to dilated cardiomyopathy (DCM).

Methods: We studied 42 patients with DCM and an equal number of age-matched normal volunteers.

Level of patient and operator dose in the largest cardiac centre in Greece.

The objective of this study was to investigate the patient and staff doses in the most frequent interventional cardiology (IC) procedures performed in Onassio, the largest Cardiac Centre in Greece. Data were collected from three digital X-ray systems for 212 coronary angiographies, 203 percutaneous transluminal coronary angioplasties (PTCA) and 134 various electrophysiological studies. Patient skin dose was measured using suitably calibrated slow radiotherapy films and cardiologist dose using suitably calibrated thermoluminescent dosemeters placed on left arm, hand and foot.