scholarly journals Psychological factors of suspect coronary microvascular dysfunction in patients undergoing SPECT imaging

2020 ◽  
Author(s):  
Maria T. Bekendam ◽  
Ilse A. C. Vermeltfoort ◽  
Willem J. Kop ◽  
Jos W. Widdershoven ◽  
Paula M. C. Mommersteeg
Keyword(s):  
Psychological Factors ◽  
Single Photon ◽  
Reference Group ◽  
Obstructive Coronary Artery Disease ◽  
Photon Emission ◽  
Microvascular Dysfunction ◽  
Coronary Microvascular Dysfunction ◽  
Emission Computed Tomography ◽  
Cardiac Events ◽  
Inducible Ischemia

Abstract Background Patients with myocardial ischemia in the absence of obstructive coronary artery disease (CAD) often experience anginal complaints and are at risk of cardiac events. Stress-related psychological factors and acute negative emotions might play a role in these patients with suspect coronary microvascular dysfunction (CMD). Methods and Results 295 Patients (66.9 ± 8.7 years, 46% women) undergoing myocardial perfusion single-photon-emission computed tomography (MPI-SPECT), were divided as follows: (1) a non-ischemic reference group (n = 136); (2) patients without inducible ischemia, but with a history of CAD (n = 62); (3) ischemia and documented CAD (n = 52); and (4) ischemia and suspect CMD (n = 45). These four groups were compared with regard to psychological factors and acute emotions. Results revealed no differences between the groups in psychological factors (all P > .646, all effect sizes d < .015). State sadness was higher for patients with suspect CMD (16%) versus the other groups (P = .029). The groups did not differ in the association of psychological factors or emotions with anginal complaints (all P values > .448). Conclusion Suspect CMD was not associated with more negative psychological factors compared to other groups. State sadness was significantly higher for patients with suspect CMD, whereas no differences in state anxiety and other psychological factors were found.

scholarly journals Radionuclide imaging methods in the diagnosis of microvascular dysfunction in non-obstructive coronary artery disease

2021 ◽  
Vol 26 (12) ◽  
pp. 4746
Author(s):  
A. N. Maltseva ◽  
A. V. Mochula ◽  
K. V. Kopyeva ◽  
E. V. Grakova ◽  
K. V. Zavadovsky
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Single Photon ◽  
Obstructive Coronary Artery Disease ◽  
Photon Emission ◽  
Small Diameter ◽  
Microvascular Dysfunction ◽  
Emission Computed Tomography ◽  
Flow Reserve ◽  
Artery Disease

Non-obstructive coronary artery disease is generally considered as a favorable type of pathology, however, a number of studies indicate that in non-obstructive atherosclerosis, the risk of such cardiovascular events as myocardial infarction, ischemic stroke, sudden cardiac death and decompensated heart failure cannot be completely ruled out. This may be due to microvascular dysfunction. However, due to the small diameter of vessels, none of the imaging techniques used in clinical practice makes it possible to assess microvascular morphology. To date, the most well-established methods for assessing myocardial perfusion are single-photon emission computed tomography (SPECT) and positron emission tomography (PET). The ability to quantify myocardial blood flow and coronary flow reserve allows SPECT and PET to be the methods of choice for non-invasive diagnosis of microvascular dysfunction. This review is devoted to current data on the clinical significance of radionuclide diagnosis of microvascular dysfunction in patients with non-obstructive coronary artery disease.

Impact of pretransplant mitral annular calcification on the incidence of cardiac events after renal transplantation

2019 ◽  
Vol 35 (3) ◽  
pp. 526-533 ◽  
Author(s):  
Nadia El Hangouche ◽  
Javier Gomez ◽  
Addis Asfaw ◽  
Jayakumar Sreenivasan ◽  
Tauseef Akhtar ◽  
...  
Keyword(s):  
Risk Factors ◽  
Renal Transplantation ◽  
Single Photon ◽  
Photon Emission ◽  
Emission Computed Tomography ◽  
Cardiac Events ◽  
Mitral Annular Calcification ◽  
Post Transplant ◽  
Increased Risk ◽  
Annular Calcification

Abstract Background Mitral annular calcification (MAC) is associated with increased risk of major adverse cardiac events. We hypothesized that MAC, identified on a pretransplant transthoracic echocardiography (TTE), is predictive of cardiac events following renal transplantation (RT). Methods In a retrospective cohort of consecutive RT recipients, pretransplant MAC presence and severity were determined on TTE performed within 1 year prior to transplant. MAC severity was quantified based on the circumferential MAC extension relative to the mitral valve annulus. Post-transplant cardiac risk was assessed using the sum of risk factors (range: 0–8) set forth by the American Heart Association/American College of Cardiology Foundation consensus statement on the assessment of RT candidates. Subjects underwent pretransplant stress single-photon emission computed tomography myocardial perfusion imaging and followed for post-transplant composite outcome of cardiac death or myocardial infarction (CD/MI). Results Among 336 subjects (60.5% men; mean age 52 ± 12 years), MAC was present in 78 (23%) patients. During a mean follow-up of 3.1 ± 1.9 years, a total of 70 events were observed. Patients with MAC had a higher event rate compared with those without MAC (34.6% versus 17.8%, log-rank P = 0.001). There was a stepwise increase in CD/MI risk with increasing MAC severity (P for trend = 0.002). MAC-associated risk remained significant after adjusting for sex, duration of dialysis, sum of risk factors, ejection fraction and perfusion abnormality burden, providing an incremental prognostic value to these parameters (Δχ2 =4.63; P = 0.031). Conclusion Among RT recipients, the burden of pretransplant MAC is an independent predictor of post-transplant risk of CD/MI. MAC should be considered in the preoperative assessment of RT candidates.

Abstract 2481: Myocardial Viability Determined by Myocardial Contrast Echocardiography is Superior to 99m Technetium Sestamibi Single Photon Emission Computed Tomography in Predicting Hard Cardiac Events Following Acute Myocardial Infarction

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Girish Dwivedi ◽  
Rajesh Janardhanan ◽  
Sajad A Hayat ◽  
Jonathan A Swinburn ◽  
Roxy Senior
Keyword(s):  
Myocardial Infarction ◽  
Cardiac Death ◽  
Single Photon ◽  
Contrast Echocardiography ◽  
Photon Emission ◽  
Emission Computed Tomography ◽  
Single Photon Emission ◽  
Cardiac Events ◽  
Single Photon Emission Computed ◽  
Photon Emission Computed Tomography

Introduction: The extent of residual myocardial viability (MV) following acute myocardial infarction (AMI) is an important determinant of outcome. 99m technetium sestamibi single photon emission computed tomography (SPECT) is widely used to assess MV following AMI. Hypothesis: We hypothesised that myocardial contrast echocardiography (MCE) which has a better spatial and temporal resolution compared to SPECT will be superior for predicting outcome following AMI. Methods: Accordingly, 99 patients who underwent simultaneous resting low-power MCE & nitrate enhanced SPECT 7 days after AMI were followed up for cardiac death (CD) and AMI. Both SPECT (0=normal;1=mild reduction ;2=moderate reduction;3=severe reduction;4=absent tracer uptake) & MCE perfusion (1=normal;2=reduced;3=absent) were scored on a 16 segment left ventricular (LV) model. Contrast perfusion index (CPI) on MCE and SPECT perfusion index (SPI), both measures of MV, were calculated by adding the respective scores in the 16 LV segments divided by 16. Results: Ninety five patients were available for the follow up (mean 46 months). There were 15 (16%) events (8 CDs & 7 AMIs). Area under the receiver operator characteristic curves for predicting CD and CD or AMI with MCE (0.82 and 0.80 respectively) were higher compared to SPECT (0.76 and 0.74 respectively). Amongst the clinical, biochemical, echocardiographic and SPECT markers of prognosis, only independent predictors of cardiac death and cardiac death or AMI were age and MV determined by MCE (p=0.01 & p=0.002 respectively). Conclusion: MV determined by resting MCE is superior to nitrate enhanced SPECT for the prediction of hard cardiac events following AMI.

scholarly journals Prevalence of Coronary Endothelial and Microvascular Dysfunction in Women with Symptoms of Ischemia and No Obstructive Coronary Artery Disease Is Confirmed by a New Cohort: The NHLBI-Sponsored Women’s Ischemia Syndrome Evaluation–Coronary Vascular Dysfunction (WISE-CVD)

2019 ◽  
Vol 2019 ◽  
pp. 1-8 ◽  
Author(s):  
R. David Anderson ◽  
John W. Petersen ◽  
Puja K. Mehta ◽  
Janet Wei ◽  
B. Delia Johnson ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Vascular Dysfunction ◽  
Hormone Replacement ◽  
Obstructive Coronary Artery Disease ◽  
Signs And Symptoms ◽  
Microvascular Dysfunction ◽  
Coronary Microvascular Dysfunction ◽  
Cardiac Events ◽  
Flow Reserve ◽  
Artery Disease

Objective. In a separate, contemporary cohort, we sought to confirm findings of the original Women’s Ischemia Syndrome Evaluation (WISE). Background. The original WISE observed a high prevalence of both invasively determined coronary endothelial and coronary microvascular dysfunction (CMD) that predicted adverse events in follow-up. Methods. We comparatively studied the WISE-Coronary Vascular Dysfunction (CVD) cohort (2009-2011), with signs and symptoms of ischemia but without significant CAD, to the original WISE (1997-2001) cohort. CMD was defined as coronary flow reserve (CFR) ≤2.5, or endothelial dysfunction as epicardial coronary artery constriction to acetylcholine (ACH), or <20% epicardial coronary dilation to nitroglycerin (NTG). Results. In WISE (n=181) and WISE-CVD (n=235) women, mean age in both was 54 years, and 83% were white (WISE) vs 74% (WISE-CVD, p=0.04). Use of hormone replacement therapy was less frequent in WISE-CVD vs WISE (46% vs 57%, p=0.026) as was presence of hypertension (40% vs 52%, p=0.013), hyperlipidemia (20% vs 46%, p<0.0001), and smoking (46% vs 56%, p=0.036). Similar rates were observed in WISE-CVD and WISE cohorts for CMD (mean CFR 2.7±0.6 vs 2.6±0.8, p=0.35), mean change in diameter with intracoronary ACH (0.2±10.0 vs 1.6±12.8 mm, p=0.34), and mean change in diameter with intracoronary NTG (9.7±13.0 vs 9.8±13.5 mm, p=0.94), respectively. Conclusions. This study confirms prevalence of CMD in the contemporary WISE-CVD cohort similar to that of the original WISE cohort, despite a lower risk factor burden in WISE-CVD. Because these coronary functional abnormalities predict major adverse cardiac events, clinical trials of therapies targeting these abnormalities are indicated.

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