Equilibrium Radionuclide Ventriculography Research Articles

The Role of Modi­fiable and Non-Modifiable Factors in the Development of Right and Left Ventricular Myocardial Dysfunction in High-Risk Patients

Aim To study early manifestations of left ventricular (LV) and right ventricular (RV) myocardial remodeling in high-risk patients.Material and methods Intracardiac hemodynamics was studied by equilibrium radionuclide ventriculography (ERVG) in 83 patients (mean age, 61.1±8.9 years) with preserved LV ejection fraction according to echocardiography data, a body weight index (BWI) >25 kg /m2, obesity, and type 2 diabetes mellitus (DM2). Parameters of intracardiac hemodynamics were compared in patients with different degrees of obesity and DM2 durations in age groups of younger and older than 60 years.Results All patients had both LV and RV diastolic dysfunction. The diastolic dysfunction progressed with age and DM2 duration, primarily by the restrictive type. The increase in BWI, in contrast, was associated with increases in ventricular volumetric parameters. It was noted that specifically modifiable risk factors (obesity and DM2), but not the age, mostly facilitated the impairment of RV relaxation.Conclusion The strategy of normalizing the body weight and carbohydrate metabolism is priority in combatting the development and progression of chronic heart failure in high-risk group patients.

Prominent aortic radiotracer activity on equilibrium radionuclide ventriculography (ERNV) due to anterior transposition of aorta: A clue to diagnosing levo-transposition of great arteries (L-TGA) ?

Levo-transposition of great arteries (L-TGA) is a rare acyanotic congenital heart anomaly characterized by transposition of morphological left and right ventricles along with their corresponding atrio-ventricular valves in addition to transposition of primary arteries. Many cases of L-TGA are asymptomatic and are diagnosed accidently in adulthood during workup of other conditions. We hereby report a patient with incidentally diagnosed L-TGA who was subjected to Equilibrium Radionuclide Ventriculography (ERNV) for assessment of ventricular function. Planar ERNV images in best septal view showed prominent tracer activity in the anteriorly transposed aorta which can be a helpful clue to raise the suspicion of L-TGA in an asymptomatic adult undergoing ERNV.

Quantitative assessment of tricuspid regurgitation using right and left ventricular stroke volumes obtained from tomographic equilibrium radionuclide ventriculography

BackgroundQuantitative assessment of valve regurgitation using volumetric method by comparing right and left ventricular stroke volumes is still under investigations. AimsTo investigate the accuracy of tomographic equilibrium radionuclide ventriculography (t-ERV) for the quantification of tricuspid regurgitation (TR). Methods and ResultsSixty-one patients (44 men; mean age 59 ± 12 years) who underwent both t-ERV and transthoracic echocardiography (TTE) studies within 2 weeks for right ventricular systolic function assessment were eligible for inclusion. A sub-group of 22 patients underwent both t-ERV and CMR. Patients with mitral/aortic regurgitation by TTE were excluded of the study. TR regurgitant volume (RVol) was calculated using the proximal isovelocity surface area (PISA) method from TTE and the volumetric method (right ventricular stroke volume minus left ventricular stroke volume) from t-ERV. There was a significant correlation between RVol as assess by ERV and by TTE (R = 0.95, P < 0.0001). Intraclass correlation coefficient between TTE and ERV for TR quantification was 0.95 (P < 0.0001). Among patients who underwent CMR, the correlation between RVol obtained by TTE and by t-ERV and CMR were R = 0.81 and R = 0.75, respectively (all P < 0.0001). ConclusionTR assessment using the t-ERV correlates well with PISA from TTE in patients referred for right ventricular systolic function assessment.

The impact of overweight and obesity on the development of systolic and diastolic myocardial dysfunction in patients with type 2 diabetes mellitus

Abstract Funding Acknowledgements Type of funding sources: None. OnBehalf I.M. Sechenov First Moscow State Medical University Background Obesity and type 2 diabetes mellitus (DM) promote the development of systolic and diastolic myocardial dysfunction. The method of equilibrium radionuclide ventriculography (ERVG) can be used to estimate these dysfunctions. Purpose We conducted a comparative ERVG evidence-based analysis in patients with type 2 diabetes mellitus and varying degree of overweight. We analyzed the correlation between body mass index (BMI) and ERVG data. Methods The study included 42 patients (8 male and 34 female): group 1 – 12 patients with BMI 25.0-29.9 kg / m2, group 2 – 16 patients with BMI 30.0-34.9 kg / m2, group 3 – 14 patients with BMI 35.0-39.9 kg / m2. The average duration of type 2 diabetes mellitus was 11 ± 3.8 years. The average age of patients in each group was 65.8 ± 5 y.o., 57.7 ± 6 y.o., 64.6 ± 8 y.o. respectively. The groups were comparable in duration of type 2 diabetes mellitus, level of glycated hemoglobin, presence and severity of combined pathology. The patients with postinfarction cardiosclerosis and decompensated heart failure were excluded. The following ERVG indices of left ventricle (LV) and right ventricle (RV) were examined: systolic function – ejection fraction (EF), peak (PER) and average (AER) ejection rates, ejection within 1/3 of systole (ejec.1/3 s.), end-systolic volume (ESV), stroke volume (SV), diastolic function – peak filling rate (PFR), filling within 1/3 diastole (fil. 1/3 d.), end-diastolic volume (EDV). Results the EF of the LV in all examined patients was more than 40%. In group 2 we discovered an increase in the EDV and ESV indices of the LV, ESV of the RV compared to group 1 (123.8 ± 23.6 ml, 52.4 ± 14.5 ml, 66.3 ± 21.6 ml - in group 2 and 96.5 ± 22.7 ml, 37.9 ± 10.7 ml, 50.2 ± 16.7 ml - in group 1, respectively, p &amp;lt;0.05). SV of the LV in group 3 was considerably larger compared to group 1 (76.4 ± 17.8 ml vs 59.1 ± 15.6 ml, p &amp;lt;0.05). In all groups fil. 1/3 d. for LV and RV was below normal equal to 50% of EF. The correlation analysis revealed a negative association between fil. 1/3 d. of the RV and BMI (r = -0.46, p &amp;lt;0.05) in group 1. Conclusions As long as BMI increases in patients with type 2 diabetes mellitus, there is a significant increase in the ESV of both ventricles and EDV of the LV. The most sensitive ERVG indices during the obesity progression are ESV, EDV, and filling within 1/3 diastole. The revealed diastolic dysfunctions in absence of a significant decrease in EF are a manifestation of a myocardial stiffness. Early diagnosis of these disorders and correction of treatment can improve the prognosis of patients with type 2 diabetes mellitus and varying degree of overweight.

What is the most useful imaging parameter to explore the prognostic value of the right ventricular function at the time of multimodality cardiovascular imaging?

Right ventricular (RV) function is a powerful independent predictor of adverse heart failure outcomes. The aim of this study was to compare the predictive value of main RV systolic imaging parameters for outcome. Seventy-nine patients underwent comprehensive cardiovascular imaging modalities including transthoracic echocardiography, cardiac magnetic resonance (CMR) imaging, and tomographic equilibrium radionuclide ventriculography (ERV) for the assessment of RV function. The composite primary endpoint (CPE) was defined by the occurrence of death, heart transplantation, implantation of a left ventricular assist device, or new-onset acute heart failure. During a mean follow-up of 13±9months, 15 (19%) patients reached the CPE. The areas under the receiver operator characteristic curves for the prediction of the CPE were 0.922 (P<.001), 0.913 (P<.001), 0.906 (P<.001), 0.849 (P=.002), 0.837 (P=.003), 0.799 (P=.009), 0.792 (P=.011), 0.753 (P=.026), 0.720 (P=.053), and 0.608 (P=.346) for integral systolic S' wave tricuspid annular velocity, RV free wall longitudinal strain (RVFWLS), RV fractional area change, tricuspid annular plane systolic excursion, RV ejection fraction (RVEF) by CMR using the 4-chamber slices, peak systolic S' wave tricuspid annular velocity, RVEF by CMR using short-axis slices, RVEF by ERV, RV myocardial performance index, and RV myocardial acceleration during isovolumic contraction, respectively. Echocardiographic parameters, and particularly integral systolic S' wave tricuspid annular velocity and RVFWLS, have the best prognostic performance.

P3360Quantitative assessment of tricuspid regurgitation using right and left ventricular stroke volumes obtained from tomographic equilibrium radionuclide ventriculography

Abstract Background Quantitative assessment of valve regurgitation using volumetric method by comparing right and left ventricular stroke volumes is still under investigations. Aims To investigate the accuracy of tomographic equilibrium radionuclide ventriculography (t-ERV) for the quantification of tricuspid regurgitation (TR). Methods and results Sixty-one patients (44 men; mean age 59±12 years) who underwent both t-ERV and transthoracic echocardiography (TTE) studies within 2 weeks for right ventricular systolic function assessment were eligible for inclusion. A sub-group of 22 patients underwent both t-ERV and CMR. Patients with mitral/aortic regurgitation by TTE were excluded of the study. TR regurgitant volume (RVol) was calculated using the proximal isovelocity surface area (PISA) method from TTE and the volumetric method (right ventricular stroke volume minus left ventricular stroke volume) from t-ERV. RVol tended to be higher using the ERV volumetric method as compared to PISA method (43±35 and 35±33 ml, respectively; P&lt;0.0001). There was a significant correlation between RVol as assess by ERV and by TTE (R=0.95, P&lt;0.0001). Intraclass correlation coefficient between TTE and ERV for TR quantification was 0.95 (P&lt;0.0001). Among patients who underwent CMR, the correlation between RVol obtained by TTE and by t-ERV and CMR were R=0.81 and R=0.75, respectively (all P&lt;0.0001), without difference between the two correlations (P=0.263). Linear regression (left) and Bland-Altma Conclusion TR assessment using the t-ERV correlates well with PISA from TTE in patients referred for right ventricular systolic function assessment.

Quantitative assessment of tricuspid regurgitation using right and left ventricular stroke volumes obtained from equilibrium radionuclide ventriculography

Background Quantitative assessment of valve regurgitation using volumetric method by comparing right and left ventricular stroke volumes is still under investigations. Aims To investigate the accuracy of equilibrium radionuclide ventriculography (ERV) for the quantification of tricuspid regurgitation (TR) severity. Methods Thirty-three patients (25 men; mean age 63 ± 10 years) who underwent both ERV and transthoracic echocardiography (TTE) studies within 2 weeks for right ventricular systolic function assessment were eligible for inclusion. Patients with significant mitral regurgitation by TTE were excluded of the study. TR was calculated using the proximal isovelocity surface area (PISA) method from TTE and the volumetric method (right ventricular stroke volume minus left ventricular stroke volume) from ERV. Results TR tended to be higher using the ERV volumetric method as compared to PISA method (48 ± 36 vs. 43 ± 31 mL, respectively; P = 0.06). There was a significant correlation between TR as assess by ERV and by TTE (R = 0.8, P Conclusion TR assessment using the ERV correlates well with PISA from TTE in patients referred for right ventricular systolic function assessment.

Quantitative assessment of tricuspid regurgitation using right and left ventricular stroke volumes obtained from equilibrium radionuclide ventriculography

Quantitative assessment of valve regurgitation using volumetric method by comparing right and left ventricular stroke volumes is still under investigations. To investigate the accuracy of equilibrium radionuclide ventriculography (ERV) for the quantification of tricuspid regurgitation (TR) severity. Thirty-three patients (25 men; mean age 63 ± 10 years) who underwent both ERV and transthoracic echocardiography (TTE) studies within 2 weeks for right ventricular systolic function assessment were eligible for inclusion. Patients with significant mitral regurgitation by TTE were excluded of the study. TR was calculated using the proximal isovelocity surface area (PISA) method from TTE and the volumetric method (right ventricular stroke volume minus left ventricular stroke stroke volume) from ERV. TR tended to be higher using the ERV volumetric method as compared to PISA method (48 ± 36 vs. 43 ± 31 ml, respectively; P = 0.06). There was a significant correlation between TR as assess by ERV and by TTE ( r = 0.8, P < 0.001; Fig. 1 ). Intraclass correlation coefficient between TTE and ERV for TR quantification was 0.9 ( P < 0.001). TR assessment using the ERV correlates well with PISA from TTE in patients referred for right ventricular systolic function assessment.

What is the best imaging technique to explore right ventricular function at the time of multimodality cardiovascular imaging?

Right ventricular (RV) function is a powerful independent predictor of adverse heart failure outcomes. Several RV imaging parameters have been proposed to detect patients at risk new-onset acute heart failure. The objective of our study was to compare the predictive value of main RV systolic parameters for outcome. Seventy nine patients who underwent comprehensive cardiovascular imaging modalities including transthoracic echocardiography, cardiac magnetic resonance imaging (CMR) and tomographic equilibrium radio nuclide ventriculography (ERV) for the assessment of RV function were retrospectively included. The composite was defined by the occurrence of death, heart transplantation, implantation of a left ventricular assist device or new-onset acute heart failure. Mean NYHA class and left ventricular ejection fraction were 1.7 ± 0.9 and 46 ± 17%, respectively. During a mean follow-up of 13 ± 9 months, 13 (20%) patients reached the composite primary end-point. The areas under the receiver operator characteristic curves for the prediction of MACE were 0.922 ( P < 0.0001), 0.913 ( P < 0.0001), 0.906 ( P < 0.0001), 0.849 ( P = 0.002), 0.837 ( P = 0.003), 0,799 ( P = 0.009), 0.792 ( P = 0.011), 0.753 ( P = 0.026), 0.720 ( P = 0.053) and 0.608 (0.346) for integral systolic S’ wave tricuspid annular velocity, RV free wall longitudinal strain (RVFWLS), RV fractional area change, tricuspid annular plane systolic excursion, RV ejection fraction (RVEF) by CMR using the 4-chamber slices, peak systolic S’ wave tricuspid annular velocity, RVEF by CMR using short-axis slices, RVEF by ERV, RV myocardial performance index, and RV myocardial acceleration during isovolumic contraction, respectively. Among comprehensive cardiovascular imaging modalities allowing the assessment of RV function, echocardiographic parameters, and particularly integral systolic S’ wave tricuspid annular velocity and RVFWLS, have the best prognostic performance and the best rater reliabilities.

Spleno-hepatic index to predict portal hypertension by equilibrium radionuclide ventriculography.

Structural and morphological changes accompanying liver cirrhosis lead to portal hypertension (PHT), which is the first step of most of the complications in patients with liver cirrhosis. Therefore, the development of noninvasive techniques to detect PHT is crucial for prognosis and treatment. The aim of our study was to assess the diagnostic performance of a new spleno-hepatic index (SHI) measured from equilibrium radionuclide ventriculography (ERV) images in detecting patients with cirrhotic PHT. A total of 38 patients with PHT were compared with 30 controls without liver disease. The SHI was measured on the sum of the tomographic images from the ERV and calculated according to the following formula: SHI=(mean splenic count×longest hepatic length)/mean hepatic count. Mean SHI was 54±14 and 36±8 (P<0.001) among patients with PHT and controls, respectively. A cutoff value of 40 for the SHI allowed a sensitivity of 90% and specificity of 77% to detect PHT. SHI greater than 51 was 100% specific. In a subset of 25 patients, SHI was not correlated with hepatic venous pressure gradient measured invasively in the right hepatic vein (R=-0.08, P=0.70). Quantification of SHI derived from ERV could be used to detect liver cirrhosis with PHT although it is not linearly correlated with the hepatic venous pressure gradient. SHI should be considered as a useful index for the identification of PHT in patients referred for the detection/exploration of cirrhotic cardiomyopathy by ERV.

Impact of left ventricular assist device implantation on right and left ventricular volumes and functions

Because the right ventricle is not assisted, its function is a critical determinant of the hemodynamic inpatients with left ventricular (LV) assist devices (LVADs) and contributes significantly to postoperative morbidity and mortality. Right ventricular (RV) failure remains a challenge in the area of continuous-flow LVADs. The aim of this study was to evaluate the evolution of RV volumes and function before and after LVAD implantation. Ten patients underwent tomographic equilibrium radionuclide ventriculography for the assessment of LV and RV volumes and functions before and after LVAD implantation. Mean LV and RV ejection fractions before implantation were 20 ± 8 and 46 ± 14%, respectively. LVAD implantation had no impact on RV ejection fraction (46 ± 11% after implantation, P = 0.961) but tended to increase LV ejection fraction (31 ± 21% after implantation, P = 0.09). LVAD led to a decrease of LV end-diastolic volume (Δ = −136 ± 96 after implantation, P = 0.001) and RV end-diastolic volume (Δ = −59 ± 49 after implantation, P = 0.004) ( Fig. 1 ). Inpatients with preserved RV ejection fraction, LVAD implantation leads to a decrease of RV volumes without impact on RV ejection fraction. The increase of cardiac output induced by the LVAD does not increase RV volumes, which could be explained by the decrease of RV after load. These results highlight the importance of after load on the right ventricle inpatients with heart failure.

Feasibility and accuracy of gated blood pool SPECT equilibrium radionuclide ventriculography for the assessment of left and right ventricular volumes and function in patients with left ventricular assist devices

BackgroundLeft ventricular assist devices (LVADs) require serial assessment of right and left ventricular (RV & LV) volumes and function. Because the RV is not assisted, its function is a critical determinant of the hemodynamic and contributes significantly to postoperative morbidity and mortality. We evaluated the feasibility and the accuracy of tomographic-equilibrium radionuclide ventriculography (t-ERV) for the assessment of patients with LVADs. MethodsTwenty-four patients with LVAD underwent t-ERV. Because of the limited acoustic window, transthoracic echocardiography (TTE) was only feasible in 19 patients. Functional evaluation including six-minute walk test (6MWT) and peak oxygen consumption (POC) was performed in 18 patients. Nine patients underwent a cardiac multidetector computed tomography (MDCT). Eight patients underwent a second evaluation by ERV 4.3 ± 1.4 months later. ResultsReliability between t-ERV and MDCT for LV end-diastolic volume, LV end-systolic volume, LV ejection fraction, RV end-diastolic volume, RV end-systolic volume, and RV ejection fraction (RVEF) was 0.900 (P = .001), 0.911 (P = .001), 0.765 (P = .021), 0.728 (P = .042), 0.875 (P = .004), and 0.781 (P = .023), respectively. There was no correlation between t-ERV and RV systolic parameters assessed by TTE. RVEF was correlated with POC (R = 0.521; P = .027). A cut-off value of 40% for RVEF measured by t-ERV could discriminate patients with poor functional status (P = .048 for NYHA stage; P = .016 for 6MWT and P = .007 for POC). Conclusiont-ERV is a simple, reproducible, and an accurate technique for the assessment of RV function in patients with LVADs and warrants consideration in the evaluation and monitoring of symptomatic patients.

SPECT equilibrium radionuclide ventriculography for the assessment of ventricular volumes and function in patients with left ventricular assist devices

Objectives Left ventricular assist devices (LVADs) require serial assessment of right and left ventricular (RV & LV) volumes and function. Transthoracic echocardiography (TTE) is limited by acoustic window and cardiac multidetector computed tomography (MDCT) is considered as the best tool to monitor patients with LVADs. We evaluated the feasibility and the accuracy of tomographic equilibrium radionuclide ventriculography (t-ERV) for the assessment of LV and RV volumes and function in patients with LVADs. Materials and methods Twenty-four patients with LVAD (23 HeartMate II and 1 HeartWare) underwent ERV. Because of limited acoustic window, TTE was only feasible in 19 patients. Functional evaluation including six-minutes walk test (6MWT) and peak oxygen consumption (POC) was performed in 18 patients. Nine patients underwent a cardiac MDCT. Eight patients underwent a second evaluation by ERV 4.3 ± 1.4 months later for inter-scan reliability assessment. Results Reliability between t-ERV and MDCT for LV end-diastolic volume, LV end-systolic volume, LV ejection fraction, RV end-diastolic volume, RV end-systolic volume and RV ejection fraction (RVEF) was 0.900 (P = 0.001), 0.911 (P = 0.001), 0.765 (P = 0.021), 0.728 (P = 0.042), 0.875 (P = 0.004) and 0.781 (P = 0.023), respectively. There was no correlation between t-ERV and RV systolic parameters assessed by TTE. RVEF was correlated with POC (R = 0.521; P = 0.027). A cut-off value of 40% for RVEF measured by ERV could discriminate patients with poor functional status (P = 0.048 for NYHA stage; P = 0.016 for 6MWT and P = 0.007 for POC). Intra-, inter-rater and inter-scan reliabilities were over 0.9 for the assessment of LV and RV volumes and function by t-ERV. Conclusions t-ERV is a simple, reproducible and accurate technique for the assessment of RV function in patients with LVADs. Because of its good correlation with functional parameters and good inter-scan reliability, t-ERV warrants consideration in the evaluation and monitoring of symptomatic patients with LVADs.

Early Cardiac Changes Due to Doxorubicin Based Chemotherapy and Radiotherapy in Early and Locally Advanced Carcinoma Breast Patients: An Observational Study

Objective: To evaluate prospectively the early cardiac changes from doxorubicin based chemotherapy and radiotherapy in breast cancer patients. Methods and Materials: 56 patients with early or locally advanced breast cancer were included in the study. ECG, ECHO and Equilibrium Radionuclide Ventriculography (ERV) was done at baseline, after chemotherapy, after radiotherapy and at 6 months of follow up. Results: In Group 1 patients who completed six cycles of chemotherapy before starting radiation, the mean LVEF decreased after chemotherapy and after RT(from 66.79 ± 3.73 to 63.45 ± 3.54 and 61.64 ± 4.26, p<0.05). In Group 2 patients who received six cycles of chemotherapy after completion of radiotherapy, mean LVEF decreased post RT and post chemotherapy (from 66.67 ± 4.33 to 66 ± 4.975 and 62.7 ± 2.92, p<0.05).In Group 3 patients also who received neoadjuvant chemotherapy, radiation and adjuvant chemotherapy there was a decline in mean LVEF.In Group 4 patients who received only adjuvant chemotherapy mean LVEF decreased after chemotherapy (from 67.25 ± 4.33 to 64.75 ± 2.062, p<0.05). LVEF was also measured by MUGA/ERV. In Group 1, mean LVEF decreased after chemotherapy and RT (from 58.14 ± 2.997 to 56.15 ± 3.144 and 56.21 ± 3.81, p<0.050. In Group 2 mean LVEF decreased after RT and chemotherapy (from 59.11 ± 1.41 to 58.67 ± 2.872 and 54.44 ± 1.81, p<0.05).In Group 3 patients, there was a decline in mean LVEF post neoadjuvant chemotherapy, after radiation and after adjuvant chemotherapy. In Group 4 mean LVEF decreased after chemotherapy (from 60 ± 1.63, to 58.75 ± 1.89, p<0.05). Conclusion: Our prospective study shows that a significant number of patients can develop a significant transient depression in ventricular function acutely after chemotherapy and radiotherapy as demonstrated by a decrease in LVEF by conventional ECHO and ERV scan.

Is TOMPOOL (gated blood-pool SPECT processing software) accurate to diagnose right and left ventricular dysfunction in a clinical setting?

BackgroundThe assessment of right ventricular function is crucial for management of heart disease. TOMPOOL is a software that processes data acquired with Tomographic Equilibrium Radionuclide Ventriculography. In this report, TOMPOOL’s diagnostic accuracy and inter-observer reproducibility were assessed in a cohort of patients with various etiologies of ventricular dysfunction. Methods and ResultsEnd-diastolic volume (EDV), ejection fraction (EF), and cardiac output (CO) were calculated for the right ventricle (RV) and the left ventricle (LV) using TOMPOOL in 99 consecutive patients. Thirty-five patients underwent cardiac magnetic resonance imaging (CMR) considered as the reference-standard to measure EDV and EF; the Spearman’s rho correlation coefficients were r = 0.73/0.80 and 0.67/0.73 for right/left EF and EDV, respectively. Twenty-one patients had thermodilution measurements of right CO (reference-standard), the correlation was r = 0.57. The best cut-off points (sensitivity/specificity) in order to diagnose a ventricular dysfunction or enlargement were 46% for RVEF (67%/89%), 62% for LVEF (100%/90%), 94 mL for RVEDV (77%/73%), and 84 mL for LVEDV (100%/91%). The areas under the ROC curve were, respectively, 0.79, 0.91, 0.83, and 0.99. Inter-observer reproducibility was r = 0.81/0.94, 0.77/0.90, and 0.78/0.75 for Right/Left EF, EDV, and CO, respectively. ConclusionTOMPOOL is accurate: measurements of EDV, EF, and CO are reproducible and correlate with CMR and thermodilution. However, thresholds must be adjusted.

Unilateral Breast Uptake on Radionuclide Ventriculography

Gated equilibrium radionuclide ventriculography is frequently used to measure the left ventricular ejection fraction. We report a case of unilateral breast activity resulting in significant underestimation of the left ventricular ejection fraction, which mimicked a left ventricular aneurysm, pseudoaneurysm, or an intrathoracic vascular mass. Unilateral breast uptake, in the absence of gastric activity, was presumed because of increased blood pool in the lactating breast, a finding not previously reported in the literature. This case is also presented to emphasize the importance of localizing abnormalities based on a review of tomographic images or images taken in at least 2 orthogonal projections.

BNP predicts chemotherapy-related cardiotoxicity and death: comparison with gated equilibrium radionuclide ventriculography.

Cardiotoxicity is a dose-limiting side-effect of cancer chemotherapeutics such as anthracyclines. The drug-induced cardiac toxicity is currently monitored with repeated assessments of the left ventricular ejection fraction (LVEF) using multigated equilibrium radionuclide ventriculography (MUGA) or echocardiography. However, the plasma cardiac biomarker B-type natriuretic peptide (BNP) has been suggested for early identification of cardiac dysfunction. The aim of the study was to compare LVEF obtained by MUGA and plasma BNP as predictors of developing congestive heart failure (CHF) or death in a population of anthracycline-treated cancer patients.MethodsWe prospectively followed 333 cancer patients referred to our department for routine monitoring of LVEF with MUGA and measurement of BNP, January-December 2004. Study end points were hospitalization for CHF and death during follow-up 2004-2010. Data were obtained from the Danish National Patient Registry.ResultsDuring follow-up (mean 1,360 days), 21 of the patients were admitted to hospital with a diagnosis of CHF and 194 of the patients died. BNP levels were significantly higher and LVEF lower in the group of patients that developed CHF. Using cut-off points of BNP>100 pg/ml (HR 5.5; CI 1.8–17.2; p = 0.003) and LVEF <50% (HR 7.9; CI 3.0–21.4; p<0.001) both significantly predicted CHF. Using the same cut-off points only BNP (HR 1.9; CI 1.3-2.9; p = 0.002) and not LVEF (HR 1.1; CI 0.7–1.8; p = 0.58) was predictive of overall death. In multivariate Cox analysis both BNP and LVEF were independent predictors of CHF while age remained the only independent predictor of overall death.ConclusionIn cancer patients treated with cardiotoxic chemotherapy both BNP and LVEF can significantly predict subsequent hospitalization with CHF. In addition, BNP and not LVEF has a prognostic value in detecting overall death. This prospective study based on the hitherto largest study population supports BNP as a clinical relevant method for monitoring chemotherapy-related cardiac failure and death.

Left ventricular diastolic parameters in dilated cardiomypoathy: are we missing out on something?

Equilibrium radionuclide ventriculography is an established modality to assess the left ventricular (LV) systolic function in several clinical situations. Diastolic parameters can also be extracted from this investigation. The aim of our study is to assess the diastolic function of the left ventricle in cases of idiopathic dilated cardiomyopathy (IDCM) and ischemic cardiomyopathy, where systolic dysfunction has been considered of prime pathologic significance. We conducted a retrospective analysis of 89 patients who had undergone radionuclide ventriculography at our department with established diagnosis of IDCM in 59 patients and ischemic cardiomyopathy in remaining 30 patients. Peak filling rate (PFR) was assessed. The PFR was significantly lower in both patients with IDCM (median = 1.61 end diastolic volumes [EDV]/s) and ischemic cardiomyopathy (median = 2.005 EDV/s). 33% of the patients with ischemic cardiomyopathy and ejection fraction (EF) >45% had diastolic dysfunction while 25% of patients with IDCM and EF >45% had low PFR. Diastolic dysfunction can coexist in patients with dilated cardiomyopathy and even in patients with preserved LV EF. Routine evaluation of diastolic function in patients with heart failure can help in elucidation of pathogenesis and management of patients.

Application of the R0-R3 formulas using the ECToolbox software to calculate left ventricular ejection fraction in myocardial perfusion SPET and comparison with equilibrium radionuclide ventriculography. Normal cutoff values for a Chinese population.

The aim of this study was to compare the correlation and consistency of left ventricular ejection fraction (LVEF) obtained by ECG-gated myocardial perfusion SPET (GMPS) using the four formulas (R0-R3) in ECToolbox software and by equilibrium radionuclide ventriculography (ERNV), and determine the optimal diagnostic thresholds of the four formulas in a Chinese population. A hundred and three candidate donors (59 male and 44 female), including 38 patients with a history of myocardial infarction and 65 patients with suspected coronary heart disease, underwent both (99m)Tc-MIBI rest GMPS and technetium-99m red blood cells ((99m)Tc-RBC) ERNV within a week. The LVEF values calculated by ECToolbox R0, R1, R2 and R3 were compared with those obtained by ERNV. Using LVEF≥50% obtained by ERNV as the gold standard, the optimal diagnostic thresholds of the four formulas (R0-R3) were assessed by receiver operating characteristic (ROC) curves. Results showed that the mean LVEF value of ERNV was 54.6±17.5%, and the mean LVEF value of the four formulas was 64.1±15.7%, 56.3±15.1%, 69.9±17.9% and 56.3±13.6%, respectively, showing a significantly strong correlation between the results obtained by the two methods (r>0.85, P<0.001). All mean LVEF values obtained by the four formulas were higher than the mean LVEF value obtained by ERNV, and there was very significant difference between R0 and R2 results and the ERNV result (t=12.511 and 18.652, P<0.001). Furthermore, there was significant difference between R1 and R3 results and the ERNV result (t=2.169 and 2.570, P<0.05). Using ERNV LVEF≥50% as the normal diagnostic value, the optimal diagnostic threshold of R0∼R3 was 56.5%, 51.5%, 64.5% and 52.5%, respectively. There was a strong correlation between the LVEF values obtained by the four formulas in ECToolbox software and ERNV, but the numerical values of LVEF differed between the four formulas. In conclusion, A strong correlation was observed among R0, R1, R2 and R3 in the ECToolbox software when compared with ERNV and also between them for the assessment of LVEF. However, there were some differences in the numerical values of LVEF generated by the individual formulas, which must be taken into account in comparing clinical studies.

Right ventricular ejection fraction measured by multigated planar equilibrium radionuclide ventriculography is an independent prognostic factor in patients with ischemic heart disease

BackgroundThe number of studies on the prognostic value of the right ventricular ejection fraction (RVEF) in patients with ischemic heart disease (IHD) is limited, whereas it is widely accepted that the left ventricular ejection fraction (LVEF) is a strong prognostic factor. We assessed whether RVEF measured by multigated planar equilibrium radionuclide ventriculography (RNV) is an independent prognostic factor in patients with IHD. Methods and ResultsWe retrospectively identified 347 consecutive patients with IHD (mean age 71 ± 11 years; 18% women) who underwent multigated planar equilibrium RNV between 2004 and 2008 to determine the LVEF, which also provided the RVEF (mean 44.7% ± 11.0%). We categorized patients according to RVEF in ≥40% (n = 240) and <40% (n = 107). Patients were followed for a median of 826 days (range 3-2,400) for the occurrence of events [all-cause mortality (n = 60), cardiac mortality (n = 33), and cardiac hospitalization (n = 78)]. Cox regression analysis with significant univariate predictors [coronary artery revascularization (P = .003), diuretics (P = .03), and statins (P < .001)] showed that an RVEF <40% was associated with a 2.90 (1.68-5.00)-fold higher risk of all-cause death. Accordingly, a decreased RVEF was associated with a 2.15 (1.34-3.43)-fold increase in the risk of cardiac hospitalization and a 5.11(2.32-11.23)-fold risk of cardiac death. ConclusionRVEF measured by multigated planar equilibrium RNV is an independent prognostic factor in patients with chronic IHD.