Ischemia-guided vs routine non-culprit vessel angioplasty for patients with ST segment elevation myocardial infarction and multi-vessel disease: the IAEA SPECT STEMI trial.

Background: In patients with multi-vessel disease presenting with ST elevation myocardial infarction (STEMI), the efficacy and safety of ischemia-guided, vs routine non-culprit vessel angioplasty has not been adequately studied.

Methods: We conducted an international, randomized, non-inferiority trial comparing ischemia-guided non-culprit vessel angioplasty to routine non-culprit vessel angioplasty, following primary PCI for STEMI. The primary outcome was the between-group difference in percent ischemic myocardium at follow-up stress MPI.

Intraventricular synchronism assessment by gated-SPECT myocardial perfusion imaging in cardiac resynchronization therapy. Does cardiomyopathy type influence results?

Purpose: To analyze the evolution post-cardiac resynchronization therapy (CRT) in left ventricular non-compaction (LVNC) cardiomyopathy (CM) patients compared to other types of CM, according to clinical and functional variables, by using gated-SPECT myocardial perfusion imaging (MPI).

Methods: Ninety-three patients (60 ± 11 years, 28% women) referred for pre-CRT assessment were studied and divided into three groups: 1 (non-ischemic CM with LVNC, 11 patients), 2 (ischemic CM, 28 patients), and 3 (non-ischemic CM, 53 patients). All were studied by a Tc-MIBI gated-SPECT MPI at rest pre-CRT implantation and 6 ± 1 months after, including intraventricular dyssynchrony assessment by phase analysis.

Could myocardial viability be related to left ventricular dyssynchrony? Simultaneous evaluation by gated SPECT-MPI.

Background: Left ventricular contraction dyssynchrony (LVCD) has been related to induced ischemia and transmural scar but the interplay of myocardial viability and dyssynchrony is unknown. The aim of the present study was to establish the role of dyssynchrony in the context of a viability study performed with nitrate augmentation gated single photon emission computed tomography (GSPECT) myocardial perfusion imaging (MPI).

Methods: Fifty-four consecutive patients with ischemic dilated cardiomyopathy (IDC) and depressed left ventricular ejection fraction (LVEF) were included.

Left ventricular mechanical dyssynchrony in patients with chest pain and normal epicardial coronary arteries.

Background: To detect ischemia in patients with angina and normal coronaries frequently represents a complex diagnosis.

Methods: To investigate whether left ventricular mechanical dyssynchrony by phase analysis contributes in the evaluation of patients with chest pain and normal coronaries, gated-SPECT myocardial perfusion imaging (MPI) at rest and 30 minutes post-stress was performed in 218 patients with normal epicardial coronaries, who were divided into two groups: those with summed difference score (SDS) ≥ 4 (54 patients, Group 1), and those with SDS < 4 (164 patients, Group 2). Intraventricular synchronism-phase standard deviation (PSD) and histogram bandwidth (HBW)-was evaluated by phase analysis.

Association between non-perfusion parameters and presence of ischemia in gated-SPECT myocardial perfusion imaging studies.

Background: Combined assessment of perfusion and function improves diagnostic and prognostic power of gated-SPECT in patients with coronary artery disease. The aim of this study was to investigate whether the presence of stress-induced ischemia is associated with abnormal resting left ventricular (LV) function and intraventricular dyssynchrony.

Methods And Results: Gated-SPECT myocardial perfusion imaging (MPI) at rest and 15 min post-stress was performed in 101 patients, who were divided into three groups: those with stress-induced ischemia (Group 1, n = 58), those with normal scans (Group 2, n = 28), and those with scar but no ischemia (Group 3, n = 15).

Stress-rest myocardial perfusion scintigraphy and adverse cardiac events in heart failure patients.

Introduction: Heart failure, primarily in the elderly, is a growing epidemic in today's world. It leads to high rates of disability and mortality, as well as significant health care expenditures, making it important to assess possible predictors of adverse cardiac events. In Cuba, heart failure mortality is 19.

Cardiac outcomes 3 years after screening for asymptomatic coronary artery disease in patients with type 2 diabetes: value of myocardial perfusion imaging and coronary calcium score.

Objective: The aim of the study was to identify the possible association among myocardial perfusion imaging (MPI) variables, coronary calcium score (CCS), and adverse events at medium term in type 2 asymptomatic diabetes mellitus patients.

Materials And Methods: Patients who participated in a first study that included a stress-rest MPI and a CCS assessment were asked to take part in this study. The present study protocol required a control single-photon emission computerized tomography after 3 years.

Gated SPECT myocardial perfusion imaging, intraventricular synchronism, and cardiac events in heart failure.

Purpose: The purpose of this study was to evaluate the ability of rest gated SPECT myocardial perfusion imaging (MPI) and intraventricular synchronism, to identify heart failure (HF) patients most likely to experience cardiac events.

Methods: We studied 165 patients with left ventricular ejection fraction of less than 40%, who were divided in 2 groups according to the diagnosis of coronary artery disease (group 1: 136 patients) or not (group 2: 29 patients). All underwent a rest gated SPECT MPI.

Myocardial perfusion imaging and cardiac involvement in the indeterminate phase of Chagas disease.

Background: Myocardial perfusion imaging (MPI) has been used in the assessment of chagasic heart disease.

Objective: To investigate the value of gated-single photon emission computed tomography (gated-SPECT) MPI to detect early cardiac involvement in chagasic patients in the indeterminate phase, who present segmental motion abnormalities detected by tissue Doppler imaging (TDI)-derived strain.

Methods: Forty individuals (mean age: 25±2 years, 50% males) from an endemic area of Chagas disease and with positive serologic diagnosis, were included.

Gated-SPECT myocardial perfusion imaging and coronary calcium score for evaluation of patients with acute chest pain and a normal or nondiagnostic electrocardiogram.

Objective: To assess the ability of rest myocardial perfusion imaging (MPI) to rule out an acute coronary syndrome (ACS) in emergency department patients, as well as to investigate whether there exists a concordance between MPI and coronary calcium.

Materials And Methods: Fifty-five patients with chest pain and a normal or nondiagnostic ECG were included. Clinical follow-up was carried out within 1 year.

Interrelationship between myocardial perfusion imaging, coronary calcium score, and endothelial function in asymptomatic diabetics and controls.

Background: Coronary artery disease is a leading cause of death among diabetics, and silent ischemia is a major concern in patients with diabetes mellitus (DM).

Methods: To detect the prevalence of ischemia in diabetics by myocardial perfusion imaging (MPI), and compare it to a control group without DM but with coronary risk factors, as well as to explore the relationship between silent ischemia, endothelial dysfunction, and coronary calcium, 59 patients (Group I) and 42 controls (Group II) were included. All underwent clinical and laboratory evaluations, gated MPI, brachial artery vasodilation measured by ultrasonography, and coronary calcium score (CCS).

Left ventricular dysfunction secondary to ischemia in women with angina and normal coronary angiograms.

Background: Microvascular disease is proposed as a cause of segmental myocardial blood flow abnormalities and heterogeneous myocardial perfusion in cardiac syndrome X.

Objective: To assess if myocardial ischemia can be evidenced through both perfusion abnormalities and poststress left ventricular ejection fraction (LVEF) reduction by gated single photon emission tomography (SPECT) myocardial scintigraphy in women with syndrome X in a similar way to those with epicardial coronary lesions.

Methods: Three groups of postmenopausal women were studied: group I, 20 women with angina, perfusion defects, and normal coronary angiography; group II, 20 women with epicardial coronary lesions (> or =50% of coronary lumen reduction); group III, 15 volunteers without signs or symptoms of ischemia (control group).

Ischemia in women with angina and normal coronary angiograms.

Background: Coronary artery disease is frequent in postmenopausal women. Myocardial ischemia has been induced with stress testing, and a relationship between endothelial dysfunction and perfusion defects has been reported.

Objective: To evaluate whether myocardial ischemia can be evidenced both by perfusion and function abnormalities using gated single-photon emission computed-tomography myocardial scintigraphy with technetium-labeled compounds in women with typical angina, normal coronary angiography, and endothelial dysfunction.

Mental stress-induced myocardial ischemia in women with angina and normal coronary angiograms.

Background: Coronary artery disease is frequent in postmenopausal women. Silent myocardial ischemia has been induced with mental stress testing.

Methods And Results: To evaluate whether mental stress can induce ischemia in women with typical angina and normal coronary angiography, postmenopausal patients (n = 16) were studied.