Abstract 4211: Depth of Myocardial Bridges on Computed Tomographic Angiography is Associated with Myocardial Perfusion Defects on Single Photon Emission Computed Tomography

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
James J Jang ◽  
Ashok Krishnaswami ◽  
Mateo Go ◽  
Kenneth S Battaglia
Keyword(s):  
Myocardial Perfusion ◽  
Single Photon ◽  
Photon Emission ◽  
Computed Tomographic Angiography ◽  
Emission Computed Tomography ◽  
Myocardial Bridges ◽  
Spect Mpi ◽  
Computed Tomographic ◽  
Cardiac Cta ◽  
Perfusion Defects

Although considered a relatively benign congenital coronary anomaly, myocardial bridges have been associated with myocardial ischemia, infarctions, and sudden cardiac death. The aim of this study was to identify characteristics of myocardial bridges on computed tomographic angiography (CTA) associated with abnormal defects on myocardial perfusion imaging (MPI). A retrospective study was performed to identify patients who had myocardial bridges detected by 64-slice multidetector cardiac CTA and prior stress single photon emission computed tomography (SPECT) MPI. Using axial, oblique, and curved multi-planar reformatted images, myocardial bridge characteristics, including length and maximum depth of the tunneled segments, were compared in patients with and without corresponding coronary perfusion defects on SPECT MPI. From a total of 272 patients who had both SPECT MPI and cardiac CTA performed, 23 patients (8%, males= 9, mean age= 57 years) were identified with myocardial bridges. The left anterior descending artery was the predominant affected coronary artery (20/23, 87%). Eight patients (35%) with myocardial bridges had corresponding perfusion defects on SPECT MPI. Increased depth of the tunneled segment was significantly associated with abnormal SPECT MPI compared to normal SPECT MPI (4.1 ± 2.0mm vs. 1.9 ± 0.9mm, respectively, p< 0.002). The length of the tunneled segment did not differ in patients with or without abnormal SPECT MPI (27.8 ± 15.6mm vs. 20.9 ± 12.6mm, respectively, p=0.26). This is the first study to correlate SPECT MPI and 64-slice multidetector cardiac CTA in the evaluation of myocardial bridges. Increased maximum depth of the tunneled segment on cardiac CTA is significantly associated with myocardial perfusion defects.

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.

scholarly journals Impact of age, sex, and cardiac size on the diagnostic performance of myocardial perfusion single-photon emission computed tomography: insights from the REFINE SPECT registry

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
M J Randazzo ◽  
P Elias ◽  
T J Poterucha ◽  
T Sharir ◽  
M B Fish ◽  
...  
Keyword(s):  
Myocardial Perfusion ◽  
Elderly Patients ◽  
Diagnostic Performance ◽  
Single Photon ◽  
Photon Emission ◽  
Emission Computed Tomography ◽  
Spect Mpi ◽  
Significant Difference ◽  
Cardiac Volumes ◽  
Photon Emission Computed Tomography

Abstract Background Single-photon emission computed tomography myocardial perfusion imaging (SPECT MPI) is a well-validated non-invasive method for detecting coronary artery disease (CAD). Variations in diagnostic performance due to age and sex have been thoroughly investigated in the literature yet have demonstrated conflicting results. Several studies have associated female sex with reduced accuracy, although others have discovered no significant difference (1). Similarly, while SPECT MPI in the elderly has shown prognostic utility, cardiac event rates are elevated compared to younger patients despite a normal study (2). Additional analyses have suggested that cardiac chamber size may contribute to these observed differences due to its relationship with spatial resolution; however, the interaction of age, sex, and cardiac size remains unknown. Purpose We aimed to leverage a large, multicenter, international registry to assess the impact of age, sex, and left ventricular size on the diagnostic accuracy of contemporary SPECT MPI. Methods In 9 centers, 2067 patients (67% male, 64.7±11.2 years) in the REFINE SPECT database (REgistry of Fast Myocardial Perfusion Imaging with NExt Generation SPECT) underwent MPI with new generation solid-state scanners followed by invasive coronary angiography within 6 months (3). Stress total perfusion deficit was quantified automatically, and obstructive CAD was defined as &gt;70% stenosis or &gt;50% for left main. Receiver-operating characteristic curves and corresponding areas under the curve (AUC) were computed to compare diagnostic performance between cohorts created based on age (&lt;75 vs. ≥75 years), sex, and end-diastolic volume (EDV; ≥20th vs. &lt;20th sex-specific percentile). Results Female and elderly patients had a significantly lower EDV than male and younger patients respectively (p&lt;0.001, Figure 1). Diagnostic accuracy of SPECT was similar by sex (p=0.63). Elderly patients (AUC 0.72 vs. 0.78, p=0.025) and patients with reduced volumes (AUC 0.72 vs. 0.79, p=0.009) exhibited significantly worse performance. When isolating male patients with reduced volumes, a significant difference in accuracy was observed (AUC 0.69 vs. 0.79, p=0.001; Figure 2A), while female patients trended towards significance (p=0.32). Likewise, SPECT performed poorly for elderly patients with reduced volumes (AUC 0.64 vs. 0.78, p=0.01; Figure 2B). If patients possessed any two characteristics of male sex, age ≥75, or low EDV, prediction of CAD with SPECT was significantly decreased (p=0.002; Figure 2C). Conclusions Our findings suggest that men with reduced cardiac volumes display worse diagnostic SPECT performance, although it is uncertain whether a pathophysiologic reason exists or further investigation is required for female patients. Patients age ≥75 tended to have lower cardiac volumes as well as lower diagnostic performance. Given these results, alternative diagnostic modalities may better diagnose CAD in patients with these characteristics. FUNDunding Acknowledgement Type of funding sources: None. Figure 1 Figure 2

scholarly journals Detecting Myocardial Ischemia With 99mTechnetium-Tetrofosmin Myocardial Perfusion Imaging in Ischemic Stroke

2017 ◽  
Vol 7 (4) ◽  
pp. 164-168 ◽  
Author(s):  
Sotirios Giannopoulos ◽  
Sofia Markoula ◽  
Chrissa Sioka ◽  
Sofia Zouroudi ◽  
Maria Spiliotopoulou ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Myocardial Perfusion Imaging ◽  
Myocardial Perfusion ◽  
Myocardial Ischemia ◽  
Perfusion Imaging ◽  
Single Photon ◽  
Photon Emission ◽  
Emission Computed Tomography ◽  
Spect Mpi ◽  
Artery Disease

Background: To assess the myocardial status in patients with stroke, employing myocardial perfusion imaging (MPI) with 99mTechnetium-tetrofosmin (99mTc-TF)-single-photon emission computed tomography (SPECT). Methods: Fifty-two patients with ischemic stroke were subjected to 99mTc-TF-SPECT MPI within 1 month after stroke occurrence. None of the patients had any history or symptoms of coronary artery disease or other heart disease. Myocardial perfusion imaging was evaluated visually using a 17-segment polar map. Myocardial ischemia (MIS) was defined as present when the summed stress score (SSS) was >4; MIS was defined as mild when SSS was 4 to 8, and moderate/severe with SSS ≥9. Patients with SSS >4 were compared to patients with SSS <4. Parameters such as age, body mass index, waist perimeter, smoking habits, and medical history (diabetes mellitus, dyslipidemia, etc) were evaluated according to MPI results. Results: Myocardial ischemia was present in 32 (62%) of 52 patients with stroke. Among them, 20 (62%) of 32 patients had mild abnormalities and 12 (38%) of 32 had moderate/severe. The age and waist perimeter showed a tendency to relate to severe MIS when patients with SSS >9 were compared to patients with SSS <4. In MPI-positive patients, an age was to be association with SSS, with the oldest age exhibiting the highest SSS ( P = .01). The association of age with SSS remained statistically significant in the multivariate analysis ( P = .04). Conclusion: The study suggested that more than half of patients with stroke without a history of cardiac disease have MIS. Although most of them have mild MIS, we suggest a thorough cardiological evaluation in this group of patients for future prevention of severe myocardial outcome.

Nuclear imaging

2019 ◽  
pp. 159-162
Author(s):  
Stefan Möhlenkamp
Keyword(s):  
Myocardial Perfusion ◽  
Single Photon ◽  
Photon Emission ◽  
Nuclear Imaging ◽  
Emission Computed Tomography ◽  
Invasive Method ◽  
Perfusion Defects ◽  
Artery Disease ◽  
Exercise Induced ◽  
And Function

Myocardial perfusion imaging using single photon emission computed tomography (SPECT) by means of scintigraphy is an established non-invasive method for detecting coronary artery disease (CAD) and improving risk stratification in symptomatic individuals. Data on its diagnostic and prognostic role and value in athletes are sparse. Possibly in part due to exercise-induced improved myocardial microvascular morphology and function, a mismatch between advanced coronary atherosclerosis burden and comparatively small myocardial perfusion defects has been reported in athletes. Because of radiation exposure and the costs of the test a careful risk–benefit assessment is necessary, particularly in asymptomatic athletes with risk factors and young athletes.

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.

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