Myocardial Perfusion Scintigraphy Research Articles

O027 Less is more: extensive cardiac investigations add little value in waitlisting patients for kidney transplantation

Abstract Introduction The utility and reliability of extensive cardiac investigations to aid waitlisting for kidney transplantation has been debated. This study assessed the prognostic power of coronary artery calcium scoring (CACS) using computed tomography coronary angiogram (CTCA) and myocardial perfusion scintigraphy (MPS) in predicting major adverse cardiac events (MACE). Methods We conducted a retrospective study of all ESRD patients considered for kidney transplantation and referred for MPS and/or CTCA for CACS between October 2012 to March 2014 and assessed MACE occurrences (heart failure, cardiac arrest, myocardial infarction, angina, CVA, PVD and transient ischaemic attack) over a 9-year follow-up period. Results Among 131 patients in our study, 91.6% had a MPS (76.7% Negative MPS result, 23.3% Positive MPS) and 92.4% had a CTCA (75.2% CACS <400 (Low Score), 24.8% CACS>400 (High Score)). Sensitivity, specificity, positive and negative predictive values were poor for CTCA (38.8%, 84.7%, 63.3%, 67.0%) and MPS (34.8%, 82.4%, 55.2%, 67.0%). There was no statistical significance in MACE when stratified by CACS and MPS in transplanted patients (log-rank p=0.155); statistical significance observed when stratified by transplant status in all patients (p=<0.0001). No statistical difference in MACE observed when stratified by MPS (p=0.749) or CACS (p=0.706) in non-transplanted patients. Conclusion This challenges the value of extensive cardiac assessments (MPS, CTCA) in predicting MACE. Candidates conventionally considered low-risk by these methods had similar risk of MACE when transplanted against higher-risk groups. Transplantation confers an advantage in MACE-free years. Such tests are best used for risk stratification and counselling for shared decision-making. Take-home message Extensive cardiac investigations such as MPS and CTCA are poor predictors of MACE in end-stage renal disease patients. These tests should not be used as key determinants in waitlisting patients for kidney transplantation.

Comparison of the Diagnostic Performance of Myocardial Perfusion Scintigraphy with and Without Attenuation Correction.

Objectives:Myocardial perfusion scintigraphy (MPS) is an important diagnostic test for detecting of coronary artery stenosis (CAS); however, tissue attenuation can lead to a difference in accuracy. We evaluated the diagnostic accuracy of attenuation-corrected (AC) and non-attenuation-corrected (NC) MPS for the detection of CAS.Methods:We retrospectively recruited patients who underwent invasive coronary angiography within 10 months after Tc-99m sestamibi MPS. The AC and NC perfusion images were analyzed separately, and each myocardial segment was scored based on relative uptake from 0 to 4. The summed stress score (SSS), summed rest score (SRS), and summed difference score (SDS) were calculated. The diagnostic performances were analyzed using the area under the curve (AUC) of the receiver operating characteristic curve.Results:From 117 patients, significant coronary stenosis was present in 66 patients (56%). The SSS and SRS obtained from NC-images were higher than those from AC, supporting the presence of attenuation artifacts in NC images. The AUC of SSS and SDS were significantly higher than those of SRS in both AC- and NC-images, but no significant difference was found between the AUC of SSS, and those of SDS. The optimal cut-offs were >12 for AC-SSS, >15 for NC-SSS, >4 for AC-SDS and >3 for NC-SDS. There was no statistically significant difference in the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy among AC-SSS, NC-SSS, AC-SDS, and NC-SDS.Conclusion:NC-based Tc-99m-sestamibi MPS promised comparable accuracy to AC images by using different cut-off values for diagnosis.

The diagnostic value of SPECT CZT quantitative myocardial blood flow in high-risk patients

BackgroundThe objective of this study was to evaluate the accuracy of global MBF and MFR quantitation performed by myocardial perfusion scintigraphy (MPS) for the detection of multivessel coronary artery disease (CAD). Methods52 CAD patients underwent CZT MPS, with the evaluation of MBF and MFR, followed by invasive coronary angiography (ICA). According to MPS and ICA results, all patients were divided into three groups: (1) non-obstructive CAD and normal MPS scan (control group) (n = 7), (2) one vessel disease (1VD) (n = 16), (3) multivessel disease (MVD) (n = 29). ResultsGlobal absolute MBF and MFR were significantly reduced in MVD patients as compared to those with 1VD [0.93 (IQR 0.76; 1.39) vs 1.94 (1.37; 2.21) mL·min−1·g−1, P = .00012] and [1.4 (IQR 1.02; 1.85) vs 2.3 (1.8; 2.67), P = .0 004], respectively. The Syntax score correlated with global stress MBF (ρ = − 0.64; P < .0001) and MFR (ρ = − 0.53; P = .0003). ROC analysis showed higher sensitivity and specificity for stress MBF and MFR compared with semiquantitative MPS stress evaluation. Multivariate regression analysis showed that only stress MBF [OR (95% CI) 0.59 (0.42-0.82); P < .0003] was an independent predictor of MVD. ConclusionsQuantitative myocardial blood flow values assessed with the use of CZT camera may identify high-risk patients, such as those with multivessel disease.

Predictive value of lymphocyte to monocyte ratio for cardiac syndrome X.

Cardiac syndrome X (CSX) is typically described with ischemia in stress tests in addition to angina-like chest pain and without stenosis in coronary angiography. We aimed at determining the relationship between LMR and CSX. We retrospectively collected patients with CSX between January 2016 and December 2019. Patients with typical angina-like chest pain, normal 12-lead electrocardiography at rest, a positive response to the exercise test (> 0.1 mV ST-segment depression at 80 ms after the J point in two or more contiguous leads) or ischemia on myocardial perfusion scintigraphy and normal coronary angiography were included in the study as CSX patients. This study consisted of 116 patients with CSX and 153 control groups. The mean age of the patients with CSX was 52.7±9.7 years, and the mean age of the control group was 53.7±10.6 years (p= 0.416). The patients with CSX were more likely to have higher monocyte counts and LMR. According to the Pearson correlation test, the CRP value negatively correlated with the LMR. In multivariate logistic regression analysis, LMR remained a significant predictor of CSX. In ROC analysis, LMR < 4.1 had 64% sensitivity and 50% specificity (ROC area under curve: 0.587, 95% CI: 0.519-0.655, p=0.015) in accurately predicting a CSX diagnosis. We showed that lower LMR levels were associated with the presence of CSX.

Reproducibility of global LV function and dyssynchrony parameters derived from phase analysis of gated myocardial perfusion SPECT: A multicenter comparison with core laboratory setting

BackgroundGated myocardial perfusion scintigraphy (GMPS) phase analysis is an important tool to investigate the physiology of left ventricular (LV) dyssynchrony. We aimed to test the performance of GMPS LV function and phase analysis in different clinical settings and on a diverse population. MethodsThis is a post hoc analysis of a prospective, non-randomized, multinational, multicenter cohort study. Clinical evaluation and GMPS prior to cardiac resynchronization therapy (CRT)(baseline) and 6-month post CRT (follow-up) were done. LV end-systolic volume (LVESV), LV end-diastolic volume (LVEDV), LV ejection fraction (LVEF), LV phase standard deviation (LVPSD), and percentage of left ventricle non-viable (PLVNV) were obtained by 10 centers and compared to the core lab. Results276 GMPS studies had all data available from individual sites and from core lab. There were no statistically significant differences between all variables except for LVPSD. When subjects with no mechanical dyssynchrony were excluded, LVPSD difference became non-significant. LVESV, LVEF, LVPSD and PLVNV had strong correlation in site against core lab comparison. Bland–Altman plots demonstrated good agreement. ConclusionsThe presented correlation and agreement of LV function and dyssynchrony analysis over different sites with a diverse sample corroborate the strength of GMPS in the management of heart failure in clinical practice.

Effectiveness of Iodine-123 β-methyl-P-iodophenyl-pentadecanoic acid (BMIPP) Myocardial Scintigraphy for Cancer Therapeutics-Related Cardiac Dysfunction (CTRCD) in Breast Cancer Patients.

Purpose: The optimal imaging modality for evaluating Cancer Therapeutics-Related Cardiac Dysfunction (CTRCD) other than echocardiography is currently not known. We conducted a retrospective study utilizing myocardial scintigraphy to detect early-stage CTRCD in asymptomatic breast cancer patients.Patients and Methods: Fifty-five asymptomatic breast cancer patients who had received chemotherapy within three years were involved in this study. Echocardiography was performed for all patients before and during chemotherapy. Thallium (201Tl) and 123I-β-methyl-P-iodophenyl-pentadecanoic acid (123I-BMIPP) myocardial perfusion and metabolism scintigraphy were performed for all patients. Scintigraphy images were reviewed by several doctors including cardiologists, radiologists, palliative care physicians, and breast surgeons. The visual image assessment was then compared with the automated analysis utilizing Heart Risk View-S software (Nihon Medi-Physics Co Ltd, Tokyo, Japan). The results of scintigraphy were then compared with previous echocardiography data.Results: Measuring global longitudinal strain (GLS) was impossible in 51% of patients. Measuring left ventricular ejection fraction (LVEF) was impossible in 15% of patients. A significant reduction of 123I-BMIPP uptake was observed in 15 patients out of 55 patients (27.3%). Among the 51 patients who were not previously diagnosed with CTRCD, 11 patients (21.6%) showed a significant reduction of 123I-BMIPP uptake.Conclusion: Myocardial scintigraphy with 123I-BMIPP detected myocardial damage in asymptomatic patients. If echocardiography is difficult to perform, myocardial scintigraphy could provide a second option for evaluating CTRCD.

Combined myocardial perfusion scintigraphy and computed tomography: diagnostic and prognostic value in coronary artery disease

Modern imaging techniques occupy an important place in the diagnosis, selection of treatment and prognosis of patients with coronary artery disease. Hybrid imaging is a combination of two sets of diagnostic data that complement and enhance each other by comparing anatomical and functional characteristics. As a rule, hybrid imaging is synergistic, that is, more powerful, since the addition of new information leads to an increase in the sensitivity and specificity of each of the modalities separately.The review provides brief information on the diagnostic efficacy of myocardial perfusion scintigraphy (MPS), computerized tomography (CT) coronary angiography in comparison with invasive coronary angiography with fractional flow reserve. The diagnostic and prognostic significance of assessing calcium index with MPS, as well as CT coronary angiography combined with MPS in the diagnosis, risk stratification and prognosis of patients with coronary artery disease, is characterized in detail. A separate section is devoted to the importance of hybrid imaging in making decisions about myocardial revascularization.

The effect of prior COVID-19 infection on coronary microvascular dysfunction

Background Thrombolysis in Myocardial Infarction Frame Count (TFC) is an index that provides a quantitative evaluation of coronary microvascular dysfunction. In this study, we aimed to examine the effect of COVID-19 infection on TFC in patients admitted with chest pain and dyspnoea after COVID-19 disease and had abnormal findings in myocardial perfusion scintigraphy. Methods For this single-center retrospective study, patients with and without a history of COVID-19 who were underwent coronary angiography for abnormal findings in myocardial perfusion scintigraphy between January 1, 2021 and June 30, 2021 were analysed. Patients were divided into two groups as patients with COVİD-19 history and those without. After exclusion criteria, patients with adequate angiographic monitoring and data were included in the study. Results A total of 210 patients, 48 with a history of COVID-19, were included in the study. The mean age was ±55 10 years, and 122 (58%) patients were women. In patients with a history of COVID-19, TFC was significantly higher in the LAD (p < 0.001) and LCx (p < 0.001) arteries and RCA TFC (p = 0.223) was similar in both groups. In the linear mix model, male gender (β = 2.38, 95% CI = 1.26–3.51, p < 0.001) and history of COVID-19 (β = 1.51, 95% CI = 0.49–2.53, p = 0.004) were significantly associated with TFC. Conclusıon TFC may be elevated due to coronary microvascular dysfunction in patients with a history of COVID-19.

Pentoxifylline Reduces Inflammation And Myocardial Perfusion Derangements In Experimental Chronic Chagas Cardiomyopathy In Hamsters.

Introduction Microvascular perfusion disturbance (MPD) is common in chronic Chagas cardiomyopathy (CCC) and may cause myocardial damage. Hypothesis Pentoxifylline (PT) is a phosphodiesterase inhibitor with anti-inflammatory properties that may lead to reduction of inflammation and MPD and attenuate the progression of the myocardial dysfunction in CCC. Methods We investigated 3 groups of hamsters: controls and treated with saline (CO, n=9), infected with T. cruzi and treated with saline (CH+SL, n=12), infected and treated with PT (CH+PT, n=12). After 6 months of infection and 60 days of PT (20 mg/kg/day, ip) or saline, the animals were submitted to echocardiography and to rest Sestamibi-Tc99m SPECT myocardial perfusion scintigraphy (MPS). The area of myocardial perfusion defects (PD) was assessed through the calculation of polar maps. After euthanasia, we performed a histopathological study of cardiac inflammation and gene expression of TNF-α. Results At baseline all groups showed similar areas of PD (CO: 0.0±0.0%, CH+SL:0.8±1.6%, CH+PT:1.9±3.0%, p>0.05) and LVEF (CO:53.4±5.6%, CH+SL:47.0±10.1%, CH+PT:53.9±6.5%, p>0.05). After treatment, there was a significant increase of the PD only in the CH+SL group (0.8±1.6 to 9.4±9.7%, p>0.05), and CH+PT animals exhibited PD area similar to CO animals 2.7±2.7% and 0.0±0.0%, respectively (p>0.05). Similar decrease of LVEF was seen in both infected groups: (CH+SL:40.0±13.7% and CH+PT:42.7±9.0%). No change of the LVEF was observed in CO (53.4±5.6%). Quantitative histological analysis revealed a larger number of nuclei of mononuclear inflammatory cells in CH+SL, 615.1±133.0 cel/mm² and CH+PT groups, 395.7±88.3 cel/mm² when compared to CO, 193.0 ± 25.7 cel/mm², p<0.001. A higher number of inflammatory cells was found in the CH+SL group when compared to the CH+PT group, p<0.001. TNF-α expression was higher in the CH+SL group (2.5±1.7) when compared to the CO (0.9±0.4), but similar to the CH+PT (2.4±1.7), p>0.9. There was a moderate correlation between PD and inflammatory cells (R=0.6) and LVEF (R=-0.7), p<0.0001 for both; and between LVEF and inflammatory cells (R=-0.4, p=0.01). Conclusions The prolonged use of PT in CCC animals was effective in reducing inflammation and progression of MPD evaluated in vivo. However, PT did not prevent the progression of left ventricular systolic dysfunction in this model. These results suggest that PD may represent a surrogate marker for inflammation and its potential use to monitor disease progression. Microvascular perfusion disturbance (MPD) is common in chronic Chagas cardiomyopathy (CCC) and may cause myocardial damage. Pentoxifylline (PT) is a phosphodiesterase inhibitor with anti-inflammatory properties that may lead to reduction of inflammation and MPD and attenuate the progression of the myocardial dysfunction in CCC. We investigated 3 groups of hamsters: controls and treated with saline (CO, n=9), infected with T. cruzi and treated with saline (CH+SL, n=12), infected and treated with PT (CH+PT, n=12). After 6 months of infection and 60 days of PT (20 mg/kg/day, ip) or saline, the animals were submitted to echocardiography and to rest Sestamibi-Tc99m SPECT myocardial perfusion scintigraphy (MPS). The area of myocardial perfusion defects (PD) was assessed through the calculation of polar maps. After euthanasia, we performed a histopathological study of cardiac inflammation and gene expression of TNF-α. At baseline all groups showed similar areas of PD (CO: 0.0±0.0%, CH+SL:0.8±1.6%, CH+PT:1.9±3.0%, p>0.05) and LVEF (CO:53.4±5.6%, CH+SL:47.0±10.1%, CH+PT:53.9±6.5%, p>0.05). After treatment, there was a significant increase of the PD only in the CH+SL group (0.8±1.6 to 9.4±9.7%, p>0.05), and CH+PT animals exhibited PD area similar to CO animals 2.7±2.7% and 0.0±0.0%, respectively (p>0.05). Similar decrease of LVEF was seen in both infected groups: (CH+SL:40.0±13.7% and CH+PT:42.7±9.0%). No change of the LVEF was observed in CO (53.4±5.6%). Quantitative histological analysis revealed a larger number of nuclei of mononuclear inflammatory cells in CH+SL, 615.1±133.0 cel/mm² and CH+PT groups, 395.7±88.3 cel/mm² when compared to CO, 193.0 ± 25.7 cel/mm², p<0.001. A higher number of inflammatory cells was found in the CH+SL group when compared to the CH+PT group, p<0.001. TNF-α expression was higher in the CH+SL group (2.5±1.7) when compared to the CO (0.9±0.4), but similar to the CH+PT (2.4±1.7), p>0.9. There was a moderate correlation between PD and inflammatory cells (R=0.6) and LVEF (R=-0.7), p<0.0001 for both; and between LVEF and inflammatory cells (R=-0.4, p=0.01). The prolonged use of PT in CCC animals was effective in reducing inflammation and progression of MPD evaluated in vivo. However, PT did not prevent the progression of left ventricular systolic dysfunction in this model. These results suggest that PD may represent a surrogate marker for inflammation and its potential use to monitor disease progression.

Efficacy of myocardial washout of 99mTc-MIBI/Tetrofosmin for the evaluation of inflammation in patients with cardiac sarcoidosis: comparison with 18F-fluorodeoxyglucose positron emission tomography findings.

Both myocardial perfusion scintigraphy and 18F-fluorodeoxyglucose positron emission tomography (FDG PET) are useful for the diagnosis of cardiac sarcoidosis (CS). However, the association between the washout of 99mTc-labeled tracer and FDG PET has not been established. This study aimed to evaluate the association between the washout of 99mTc-labeled tracer and FDG PET findings in patients with CS. We retrospectively analyzed 64 patients (65.0 ± 11.2years, 53% male) with suspected CS who underwent myocardial single-photon emission computed tomography (SPECT) with 99mTc-labeled tracer and FDG PET. The SPECT images were acquired at 15min (early images) and 3h (delayed images) after injection and scored visually using a 17-segment model with a 5-point scoring system. The washout score was defined as the difference between the early and delayed total defect scores. FDG positivity was considered as focal or focal on diffuse patterns on visual assessment, and FDG uptake was quantified by measuring the standardized uptake value (SUV) of each of the 17 segments. The washout score was significantly higher for the CS group than for the non-CS group (3.0 [-1.0-5.0] vs. 0.0 [-0.5-1.0], p = 0.010). Receiver operating characteristic analysis showed that a washout score of ≥ 2 had the best accuracy for detecting CS (88% sensitivity and 56% specificity) and FDG positivity (71% sensitivity and 89% specificity). In the segment-based analysis of 833 segments from 49 patients, excluding 15 patients with diffuse FDG uptake, the median SUVs for FDG uptake for the washout scores of ≤ 0, 1, and 2 were 2.3 (1.8-3.6), 4.2 (2.9-7.8), and 8.3 (6.5-9.4), respectively (p < 0.001). The washout of 99mTc-labeled tracer can be a useful marker for the evaluation of FDG PET findings in patients with CS.

The role of cardiac biomarkers and epicardial fat in the diagnosis of heart failure in patients with various types of atrial fibrillation

Aim. To assess the level of various cardiac biomarkers and the volume of epicardial adipose tissue (EAT) in patients with heart failure (HF) depending on the type of atrial fibrillation (AF).Material and methods. This prospective observational study included 69 patients with symptomatic AF, as well as with manifestations of New York Heart Association (NYHA) class II-III HF. All patients were examined before catheter ablation for AF. The following investigations were performed: echocardiography, computed tomography, myocardial perfusion scintigraphy, immunochemical analysis of cardiac biomarkers (brain natriuretic peptide (BNP), high-sensitivity troponin I (hs-TnI)), as well as biochemical analysis of high-sensitivity C reactive protein (hsCRP). Patients were divided into 2 groups, depending on the AF type, into paroxysmal and non-paroxysmal (persistent and long-standing persistent).Results. The analysis included 69 patients with various AF types and symptomatic HF. There were significantly more patients with HF confirmed by an elevated BNP level in the group with non-paroxysmal type (27 (71%) vs 5 (16%), p&lt;0,00001). Comparison analysis showed that in group 2 the mean BNP level was significantly higher than in group 1 (135,5 pg/ml [75,2;303,2] vs 40 pg/ml [20,7;56,9], respectively, p&lt;0,00001). The hs-TnI level was higher in group 2 (2,5 [1,7;5,1] vs 1,9 [0,8;3,9], respectively, p=0,19), but there was no significant difference between the groups. The level of hsCRP did not differ in both groups. In group 1, the EAT volume was 139 [117,5;171] vs 169 [130;209,5] in group 2 (p=0,03).Conclusion. The type of AF plays a role in the interpretation of cardiac specific enzymes, and BNP levels and EAT volume are higher in patients with the non-paroxysmal form.

Myocardial perfusion scintigraphy in myocardial infarction - impact of ST-segment elevation and of Diabetes mellitus.

Myocardial perfusion scintigraphy (MPS) is frequently used in the evaluation of patients with coronary artery disease, either stable or with the prior remote acute coronary syndrome. The goal of the present work was to evaluate changes in MPS according to the nature of the infarction (ST-elevation vs non-ST elevation status) as well as according to the presence or absence of Diabetes mellitus. A prospective study of 124 consecutive patients with myocardial infarction (MI) was carried out using MPS. Patients with ST-segment elevation MI (STEMI) had significantly larger values both for percentage and absolute areas of perfusion defects, both at rest and in a stress situation, when compared to patients without ST-segment elevation (NSTEMI). These patients had significantly lower values for left ventricular ejection fractions (EF), in a similar comparison. The values for perfusion defects at rest for STEMI patients were more than double the values for NSTEMI patients (17.1 ± 14.6% vs 6.5 ± 7.8%, P < .001). Concerning resting left ventricular EF, STEMI patients had a mean value of 47.6 ± 13.6% and NSTEMI patients had a mean value of 53.2 ± 12.4% (P.026). Regarding the comparison between patients with and without Diabetes mellitus, none of the parameters under study showed significant differences. Linear regression analysis, taking the percentage of perfusion defect, as the dependent variable, yielded an overall significant result, however, only ST-segment elevation was shown to have an individually significant result. We conclude that the presence of ST-segment elevation but not the presence of Diabetes mellitus is associated with different patterns of MPS in patients with MI.

Color kinesis-dobutamine stress echocardiography pinpoints coronary artery disease

Background/Aim: Dobutamine stress echocardiography (DSE) can identify significant coronary artery disease (CAD) and where it is localized. However, determining endocardial borders with poor echocardiographic views may create unsatisfactory results. Color kinesis (CK) shows endocardial movement with color, and allows easier and more objective evaluation of ventricular wall motion. In this study, our aim was to evaluate the role of CK in determining CAD localization during DSE. Methods: The study group consists of patients whose CAD diagnosis was confirmed with coronary angiography (CA). Patients with atrial fibrillation (A-Fib), left bundle branch block, poor echocardiography image quality, left ventricular (LV) ejection fraction < 40%, and non-ischemic LV wall motion abnormality were excluded. CK-DSE and dobutamine stress-induced myocardial perfusion scintigraphy (MPS) was done in all patients and compared to CA. Results: A total of twenty patients [16 males (80%) and 4 females (20%)] were included in the study. CK-DSE results were consistent with CA in determining CAD localization (kappa 0.66). Vessel-based kappa values for LAD, RCA, and Cx were 0.81, 0.70 and 0.61, respectively. Consistency between MPS and CK-DSE was evaluated by the area under curves (AUC) within a ROC curve analysis (p > 0.05, 95% CI). Conclusion: Our study showed that CK allows for rapid, objective, and automatic evaluation of segmental wall motion. In addition, CK-DSE is consistent with CA results.

Prevalence of myocardial perfusion scintigraphy derived ischemia in coronary lesions with discordant fractional flow reserve and non-hyperemic pressure ratios

BackgroundWhether a coronary lesion with discordant fractional flow reserve (FFR) and non-hyperemic pressure ratios (NHPRs) causes myocardial ischemia remains unclear. This study investigates the prevalence of myocardial ischemia as assessed by myocardial perfusion scintigraphy (MPS) in coronary lesions with discordant FFR and instantaneous wave-free ratio (iFR), and, additionally, other NHPRs: resting full-cycle ratio (RFR), diastolic pressure ratio (dPR), and resting Pd/Pa. MethodsA total of 484 coronary arteries in 295 patients with stable coronary artery disease that underwent MPS and invasive physiological pressure measurements were categorized into four groups (FFR+/NHPR+, FFR+/NHPR-, FFR-/NHPR+, and FFR-/NHPR-) using the respective cut-off values of FFR ≤ 0.80, iFR ≤ 0.89, RFR ≤ 0.89, dPR < 0.89, and Pd/Pa ≤ 0.92. The proportions of MPS-derived myocardial ischemia in a relevant myocardial territory were compared between the four groups. ResultsIn total, 175 (36%), 61(13%), 35(7%) and 213(44%) vessels were classified into FFR+/iFR+, FFR+/iFR-, FFR-/iFR+ and FFR-/iFR- groups, respectively. The FFR+/iFR+ group had the highest proportion of MPS-derived ischemia (70%), followed by the FFR+/iFR- group (38%), the FFR-/iFR+ group (23%), and the FFR-/iFR- group (10%) (P < 0.001). Similar proportions of MPS-derived ischemia were found when RFR.(70%, 34%, 24%, and 10%, P < 0.001), dPR (70%, 38%, 26%, and 10%, P < 0.001), and Pd/Pa (70%, 31%, 22%, and 10%, P < 0.001) were used in place of iFR. ConclusionsThe prevalence of MPS-derived myocardial ischemia in coronary lesions with discordance between FFR and NHPRs is lower than those with concordantly positive FFR and NHPRs, but higher than those with concordantly negative FFR and NHPRs.

Large sliding hiatus hernia: incidental finding in myocardial perfusion scintigraphy performed with SPECT/CT technique

Large sliding hiatus hernia: incidental finding in myocardial perfusion scintigraphy performed with SPECT/CT technique

Comparative Analysis of the Diagnostic Effectiveness of SATRO ECG in the Diagnosis of Ischemia Diagnosed in Myocardial Perfusion Scintigraphy Performed Using the SPECT Method.

There is a great need for early diagnosis of ischemic heart disease (IHD), the most common cause of which is haemodynamic disorders caused mainly by obstructive atherosclerosis of the coronary arteries. The diagnosis of IHD is usually made with the use of functional tests, which include resting ECG (R) or examination of significant perfusion disorders during exercise using the SPECT method. Despite the fact that the ECG (R) test is commonly used in cardiological diagnostics, it has a limited diagnostic value, especially in people with a low probability of coronary artery disease (CAD). In order to increase the effectiveness of the ECG (R) examination, SATRO ECG software, based on the single fibres heart activity model (SFHAM), was used to evaluate the electrocardiograms. The introduction of new classifiers from the available medical data to the analysis made it possible to evaluate the diagnostic efficacy of SATRO ECG (TOT) in predicting significant perfusion disorders in the exercise SPECT (TOT 2). These disorders are most often caused by obstructive atherosclerosis of the coronary arteries, which is the main cause of CAD. The database of 316 patients (219 men and 97 women, aged 57 ± 10 years) was analyzed using resting and stress ECG, perfusion scintigraphy performed using the SPECT method, and SATRO ECG analysis. The diagnostic efficacy parameters of SATRO ECG (TOT) in predicting significant perfusion abnormalities in the exercise-induced SPECT (TOT 2) study were: sensitivity, 99%; specificity, 91%; concordance, 96%; and positive, 96%, and negative, 97%, predictive values. The Kappa–Cohen coefficient was 0.92, and the statistical significance coefficient was p < 0.001. These results indicate a statistically significant agreement in the diagnosis of IHD in both diagnostic methods used.

Imaging myocardial perfusion with [99mTc] Tc-HMPAO: Fiction or reality? – Preliminary results

Introduction and objectives: [ 99mTc] Tc-HMPAO, developed for brain imaging, is taken up by the heart, but never used to study it. We aimed to compare cardiac images with [99mTc] Tc-HMPAO and [ 99mTc] Tc-Tetrofosmin, using imaging techniques. Materials and methods: Cardiac gated SPECTs with [99mTc] Tc-HMPAO were compared with myocardial perfusion scintigraphies (MPS) with [99mTc] Tc-Tetrofosmin in three inpatients, from the vascular surgery ward. We developed algorithms in MATLAB R2016 to compare the [99mTc] Tc-Tetrofosmin/ [99mTc] Tc-HMPAO images. Pixel-wise correlations for slices, reversibility, and polar maps were obtained. Results: Correlations of both radiotracers’ myocardial images were as high as 0.93. Polar maps correlations were 0.93-0.95 (for both stress and rest) and 0.62-0.90 (reversibility). One of the patients (smoker) had significant lung [99mTc] Tc-HMPAO uptake. Conclusions: Cardiac SPECT with [99mTc] Tc-HMPAO might be a screening method for myocardial ischemia in non-smoking patients with epilepsy suspected of having heart changes, and who need to perform a brain perfusion SPECT. Keywords: myocardial perfusion scintigraphy; epilepsy; HMPAO; myocardial SPECT.

Fatores Associados a Anormalidades na Cintilografia de Perfusão Miocárdica de Pacientes Diabéticos

Diabetes mellitus (DM) is the greatest risk factor for coronary artery disease. In addition to a long duration of diabetes, the presence of peripheral arterial disease and smoking are strong predictors of abnormalities on myocardial perfusion scintigraphy (MPS). This study aimed to assess the impact of risk factors in diabetic patients on MPS results and compare them with those of non-diabetic patients in a nuclear medicine clinic. A retrospective cross-sectional study was performed through the analysis of the medical records of patients who underwent MPS in 2010–2019. A total of 34,736 medical records were evaluated. Analyzing the stress phase of MPS, DM patients required two-fold more pharmacological stimulation than nondiabetic patients for MPS. Factors that negatively impact the MPS results were also evaluated, and DM (33.6%), insulin therapy (18.1%), systemic arterial hypertension (69.9%), dyslipidemia (53%), sedentary lifestyle (83.1%), use of pharmacological stress (50.6%), typical chest pain (8.5%), and limiting angina during the test (1.7%) were significantly associated (p &lt; 0.001) with test abnormalities

Deep learning applications in myocardial perfusion imaging, a systematic review and meta-analysis

BackgroundCoronary artery disease (CAD) is a leading cause of death worldwide, and the diagnostic process comprises of invasive testing with coronary angiography and non-invasive imaging, in addition to history, clinical examination, and electrocardiography (ECG). A highly accurate assessment of CAD lies in perfusion imaging which is performed by myocardial perfusion scintigraphy (MPS) and magnetic resonance imaging (stress CMR). Recently deep learning has been increasingly applied on perfusion imaging for better understanding of the diagnosis, safety, and outcome of CAD.The aim of this review is to summarise the evidence behind deep learning applications in myocardial perfusion imaging. MethodsA systematic search was performed on MEDLINE and EMBASE databases, from database inception until September 29, 2020. This included all clinical studies focusing on deep learning applications and myocardial perfusion imaging, and excluded competition conference papers, simulation and animal studies, and studies which used perfusion imaging as a variable with different focus. This was followed by review of abstracts and full texts. A meta-analysis was performed on a subgroup of studies which looked at perfusion images classification. A summary receiver-operating curve (SROC) was used to compare the performance of different models, and area under the curve (AUC) was reported. Effect size, risk of bias and heterogeneity were tested. Results46 studies in total were identified, the majority were MPS studies (76%). The most common neural network was convolutional neural network (CNN) (41%). 13 studies (28%) looked at perfusion imaging classification using MPS, the pooled diagnostic accuracy showed AUC = 0.859. The summary receiver operating curve (SROC) comparison showed superior performance of CNN (AUC = 0.894) compared to MLP (AUC = 0.848). The funnel plot was asymmetrical, and the effect size was significantly different with p value < 0.001, indicating small studies effect and possible publication bias. There was no significant heterogeneity amongst studies according to Q test (p = 0.2184). ConclusionDeep learning has shown promise to improve myocardial perfusion imaging diagnostic accuracy, prediction of patients’ events and safety. More research is required in clinical applications, to achieve better care for patients with known or suspected CAD.

Importance of myocardial perfusion scintigraphy for early detection of coronary artery disease in patients with positive family history of premature CAD -case study

Background: Acute coronary syndrome refers to a spectrum of clinical presentations ranging from those for ST-segment elevation myocardial infarction (STEMI) to presentations found in non-STEMI or unstable angina. Case presentation: We present a case of a 36-year-old female who visited cardiac outdoor patient department with continuous left arm pain. She was then referred to nuclear cardiology for screening of coronary artery disease (CAD). A pharmacological stress study was planned but the rest study was done instead due to the patient having persistent pain in the left arm. The rest study showed a large perfusion defect in left anterior descending artery (LAD) territory. As the patient was not having any previous history of CAD except for positive family history of premature CAD, she was immediately referred to an interventional cardiologist where her primary percutaneous coronary revascularization to LAD (3 × drug eluting stent) got done and she was saved from impending MI. Conclusion: Regular follow-up and monitoring should be fine in young adults with a positive family history of premature CAD. This may help in early detection leading to time management and acute coronary events in young adults may be avoided. This will eventually reduce mortality and morbidity.