scholarly journals Fixed myocardial perfusion defects on SPECT are not associated with focal myocardial fibrosis on CMR in adult patients with systemic right ventricle

2021 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
N Pavsic ◽  
P Koritnik ◽  
M Dolenc Novak ◽  
M Stalc ◽  
B Guzic Salobir ◽  
...  
Keyword(s):  
Myocardial Perfusion ◽  
Right Ventricle ◽  
Myocardial Fibrosis ◽  
Diffuse Myocardial Fibrosis ◽  
Adult Patients ◽  
Common Finding ◽  
Systemic Right Ventricle ◽  
Perfusion Defects ◽  
The Right ◽  
Myocardial Perfusion Defects

Abstract Funding Acknowledgements Type of funding sources: None. Background Myocardial fibrosis is a known prognostic factor in patients with systemic right ventricle (SRV). In these patients fixed myocardial perfusion defects are a common finding and are thought to represent areas of myocardial infarction and fibrosis. However, no study has yet correlated myocardial perfusion imaging findings with cardiac magnetic resonance (CMR) imaging, which is the imaging gold standard for detecting myocardial fibrosis. Purpose Our aim was to evaluate whether fixed myocardial perfusion defects in adult patients with SRV represent myocardial fibrosis. Methods Patients with SRV followed at our outpatient clinic for congenital heart disease were prospectively included. Myocardial perfusion was evaluated with a two-day stress/rest single-photon emission computed tomography (SPECT) protocol, focal myocardial fibrosis with late gadolinium enhancement (LGE) and diffuse myocardial fibrosis with T1 mapping by CMR. The 12-segment model of the right ventricle was used to report segments with myocardial perfusion defects and fibrosis (Figure 1). Results Fifteen patients with SRV (12 patients with transposition of the great arteries following atrial switch procedure and 3 patients with congenitally corrected transposition of the great arteries; 4 (26.7%) females; mean age 34.6 ± 10.0 years) were included. Myocardial perfusion defects were present in 14 patients (93%), with predominate fixed perfusion defects (73%) and less common reversible perfusion defects (27%). Fixed myocardial perfusion defects were most frequent in anterior RV segments (figure 1), with multiple segments affected in 11 patients (median number of affected segments – 2 segments). CMR was possible in 11 (73%) patients, others had a permanent pacemaker. LGE indicating focal myocardial fibrosis was detected in only 1 (9%) patient, while increased T1 values indicating diffuse myocardial fibrosis were present in 7 (64%) patients. There was no matching between areas of fixed myocardial perfusion defects and focal myocardial fibrosis in individual patients. Conclusions In our study, fixed myocardial perfusion defects detected on SPECT in patients with SRV did not represent areas of focal myocardial fibrosis on CMR. Other causes than scar may explain the frequently reported fixed perfusion defects, such as SRV anatomy with anterior position of the outflow tract and aorta, SRV morphology with variable degree of wall thickness and hypertrophy that influences tracer accumulation and image quality, or difficulties due to complex image acquisition and interpretation. To improve the diagnostic accuracy, the use of fused imaging modalities (SPECT-CT or PET-CT) is recommended in patients with SRV. Figure 1. Bull`s eye 12-segment plots of the right ventricle (RV) representing the number of segments with fixed myocardial perfusion defects detected by SPECT (1A) and LGE by CMR (1B) in patients with SRV. ANT – anterior, FW – free wall, INF – inferior, SEP – septal wall of RV. Abstract Figure.

scholarly journals Prognostic Significance of Myocardial Ischemia Detected by Single-Photon Emission Computed Tomography in Children with Hypertrophic Cardiomyopathy

2021 ◽  
Author(s):  
Lidia Ziolkowska ◽  
Agnieszka Boruc ◽  
Dorota Sobielarska-Lysiak ◽  
Agnieszka Grzyb ◽  
Joanna Petryka-Mazurkiewicz ◽  
...  
Keyword(s):  
Myocardial Perfusion ◽  
Myocardial Ischemia ◽  
Myocardial Fibrosis ◽  
Single Photon ◽  
Photon Emission ◽  
Emission Computed Tomography ◽  
Perfusion Defects ◽  
Single Photon Emission Computed ◽  
Myocardial Perfusion Defects ◽  
Photon Emission Computed Tomography

AbstractMyocardial ischemia caused by microvascular dysfunction is an important pathophysiologic component of hypertrophic cardiomyopathy (HCM), promoting myocardial fibrosis, adverse left ventricular remodeling, and impacting on clinical course and outcome in HCM patients. The aim of study was to assess the prevalence and clinical significance of myocardial ischemia in children with HCM using 99mTc-MIBI single-photon emission computed tomography (SPECT). Ninety-one children with HCM, median age 13.6 years, underwent SPECT evaluation from 2006 to 2017. Imaging was performed at rest and after maximal exercise. Myocardial perfusion defects were identified in 70 children (76.9%; group I), median age 13.8 years. Fixed perfusion defects were evident in 22 of them, while reversible at rest in 48. In 21 children (23.1%; group II), median age 11 years, myocardial perfusion defects were not detected. Patient demographics, echocardiography, resting electrocardiogram (ECG), 24-h Holter ECG, myocardial fibrosis in cardiovascular magnetic resonance imaging, and cardiovascular events were analyzed and compared between the groups. During follow-up at a median of 8.3 years in children with myocardial ischemia, clinical endpoints occurred more often (47 vs. 5; p = 0.02) and more patients reached a clinical endpoint (28 [40%] vs. 3 [14.3%]; p = 0.036). In children with myocardial ischemia, myocardial fibrosis was observed with greater frequency. Myocardial perfusion defects may reflect an ischemic process which (1) affects the clinical manifestations and (2) is an important predictor of adverse clinical events and risk of death in children with HCM. Myocardial ischemia in HCM patients frequently correlates with myocardial fibrosis.

scholarly journals The right ventricle in congenital heart disease - Cardiac T1 mapping for measurements of diffuse myocardial fibrosis

2016 ◽  
Vol 18 (Suppl 1) ◽  
pp. O25 ◽  
Author(s):  
Nadya Al-Wakeel ◽  
Sarah Nordmeyer ◽  
Sevim Yilmaz ◽  
Sanaz Rastin ◽  
Frédéric H Münch ◽  
...  
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Right Ventricle ◽  
Myocardial Fibrosis ◽  
Congenital Heart ◽  
T1 Mapping ◽  
Diffuse Myocardial Fibrosis ◽  
The Right

scholarly journals Сравнительный анализ данных перфузионной сцинтиграфии миокарда у пациентов с поражением коронарных артерий различной степени выраженности

2019 ◽  
Author(s):  
E DENISENKO-KANKIYA ◽  
F.N. CHANAKHCHIAN ◽  
E.I. VASILENKO ◽  
M.N. VAKHROMEEVA
Keyword(s):  
Myocardial Perfusion ◽  
Single Photon ◽  
Photon Emission ◽  
Emission Computed Tomography ◽  
Vulnerable Atherosclerotic Plaque ◽  
Gated Perfusion Spect ◽  
Perfusion Spect ◽  
Perfusion Defects ◽  
Reversible Ischemia ◽  
Myocardial Perfusion Defects

Известно, что дестабилизация атеросклеротической бляшки коронарных артерий (КА) играет ключевую роль в развитии осложнений хронической ишемической болезни сердца (ИБС). Ранняя диагностика ишемии миокарда и определение субклинического стеноза КА с помощью неинвазивного метода визуализации сердца может стать важным методом в предотвращении развития сердечно-сосудистых осложнений у данной популяции больных. Цель исследования. Определить выраженность преходящих нарушений перфузии миокарда, выявленных при однофотонной эмиссионной компьютерной томографии (ОЭКТ) миокарда у пациентов со стенозами КА различной степени тяжести. Материал и методы. В исследование включен 231 пациент (средний возраст 6210лет). Проанализированы факторы кардиального риска. Всем пациентам проводили ОЭКТ миокарда по стандартному протоколу. Региональную перфузию миокарда оценивали с использованием стандартизированной 20-сегментной модели, на которой оценивали: SSS общий счет снижения перфузии миокарда при нагрузке SDS общую разницу счета, соответствующую степени выраженности преходящей ишемии левого желудочка (ЛЖ). На основании полученных данных обследуемых пациентов классифицировали на группы: с нормальной перфузией (SSS4), незначительной (SSS4-6), умеренной и выраженной степенью снижения (SSS712 и SSS13 соответственно) перфузии миокарда ЛЖ. Результаты SDS классифицировали как: отсутствие ишемии (SDS2), умеренная преходящая ишемия (SDS2-6) и выраженная преходящая ишемия (SDS7). Количественные показатели перфузии миокарда сравнивали с результатами инвазивной коронароангиографии (КАГ). Результаты. Из 231 пациента у 69 (29,9) по данным КАГ были выявлены стенозы до 20, у 126 (54,5) стенозы 2049, у 36 (15,6) стенозы 50 и более. Сравнительный анализ количественных показателей перфузии миокарда (SSS и SDS) и результатов КАГ показал, что достоверные дефекты перфузии после нагрузки и преходящая ишемия ЛЖ определены в основном у пациентов со стенозами КА50 (47,2 и 63,9 соответственно, р0,01). В группе пациентов с стенозами КА 2049 у 42,1 показатели SSS соответствовали незначительной (25,4) и умеренной (16,7) степени снижения перфузии после нагрузки (р0,01). При сопоставлении данных перфузионной сцинтиграфии миокарда выявлена связь между показателем SSS, наличием факторов риска и наличием сопутствующих заболеваний у пациентов с ИБС (р0,05). Заключение. Перфузионная ОЭКТ миокарда может использоваться в качестве метода выявления преходящей ишемии миокарда у пациентов со стенозами КА различной тяжести. Ключевые слова: ишемическая болезнь сердца, однофотонная эмиссионная компьютерная томография, перфузия миокарда, сцинтиграфия миокарда, необструктивное поражение, обструктивное поражение, коронароангиография.Vulnerable atherosclerotic plaque in coronary arteries (CA) is the primary mechanism responsible for complications of CAD even in the terms of non-obstructive CAD. Early determination of myocardial ischemia and CA stenosis with non-invasive imaging technique could predict the development of major cardiac events in patients with CAD. Aim: evaluation the severity of myocardial perfusion defects with single photon emission computed tomography (SPECT) in patients with obstructive or non-obstructive CAD. Material and methods: Overall 231patients (average age of 6210) were analyzed. All patients underwent 1-day gated perfusion SPECT protocol before coronary angiography (CAG). SPECT images were quantified by SSS and SDS using Cedars-Sinai QPS. Normal myocardial perfusion was considered if SSS4 mildly abnormal: SSS4-7 moderate and significantly abnormal: SSS8-12 and SSS13, respectively. Reversible ischemia was defined as SDS2. Degree of ischemia was assessed to moderate (SDS2-7) and severe (SDS7). Obstructive CAD was defined as 50 stenosis in 1 vessel on CAG. Results: From 231 patients 69 (29,9) have non-significant CA stenosis (20), 126 (54,5) have non-obstructive CAD (20-49) and 36 (15,6) - obstructive CAD (50). There were significant differences between CA stenosis severity via CAG and SSS via SPECT. In obstructive CAD significant myocardial perfusion defect at stress (SSS) and reversible ischemia (SDS) were observed in 47,2 and 63,9 patients, respectively (p0,01). In patients with non-obstructive CAD although the majority has normal myocardial perfusion in stress (SSS4 55,6), 42,1 has both mild (25,4) and moderate (16,7) myocardial perfusion defects in stress (p0,001). In this subgroup 45,2 of patients have moderate and 18,3 - severe reversible ischemia according to SDS (p0,001). Abnormal perfusion in stress was associated with hazards of cardiac risk factors or associated diseases (p0,05). Conclusion: Perfusion SPECT has a prognostic value over invasive CAG. The addition SPECT quantitative analysis to CAG allows improved risk stratification of patients with non-obstructive CAD.

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