scholarly journals Demonstration of ischemia in myocardial perfusion scintigraphy before coronary revascularization decreases acute coronary syndrome-related hospitalizations

2017 ◽  
Vol 16 (3) ◽  
pp. 212
Author(s):  
Hakki Kaya ◽  
Ozan Kandemir ◽  
Osman Beton ◽  
Tarik Kivrak ◽  
Recep Kurt ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Myocardial Perfusion ◽  
Myocardial Perfusion Scintigraphy ◽  
Coronary Revascularization ◽  
Perfusion Scintigraphy ◽  
Coronary Syndrome

scholarly journals Clozapine-Induced Myocarditis or Acute Coronary Syndrome? Optical Coherence Tomography to the Rescue

2018 ◽  
Vol 2018 ◽  
pp. 1-3
Author(s):  
Ayodeji Dina ◽  
Peter Barlis ◽  
William van Gaal
Keyword(s):  
Acute Coronary Syndrome ◽  
Patient Outcomes ◽  
Myocardial Perfusion Scintigraphy ◽  
Underlying Mechanism ◽  
Perfusion Scintigraphy ◽  
Troponin Elevation ◽  
X Ray ◽  
Coronary Syndrome ◽  
Coronary Syndromes ◽  
Chest X Ray

Chest pain and troponin elevation may be due to an acute coronary syndrome, myocarditis, acute cardiomyopathy, or other less common conditions. Management differs depending on the aetiology, and the pathophysiologic diagnosis has direct implications on treatment and patient outcomes. History and clinical examination is supplemented by selected investigations including the electrocardiogram, chest X-ray, echocardiography, coronary angiography, and even myocardial perfusion scintigraphy or cardiac magnetic resonance imaging. Intravascular imaging can provide important insights into the underlying mechanism of acute coronary syndromes, especially when angiography is ambiguous.

Myocardial perfusion scintigraphy: clinical value

2017 ◽  
Author(s):  
Nikant Sabharwal ◽  
Parthiban Arumugam ◽  
Andrew Kelion
Keyword(s):  
Coronary Artery Disease ◽  
Chest Pain ◽  
Coronary Artery ◽  
Myocardial Perfusion ◽  
Myocardial Perfusion Scintigraphy ◽  
Coronary Revascularization ◽  
Stable Coronary Artery Disease ◽  
Hibernating Myocardium ◽  
Perfusion Scintigraphy ◽  
Artery Disease

Myocardial perfusion scintigraphy (MPS) is most commonly used to diagnose or exclude obstructive coronary disease in patients presenting with chest pain. This chapter covers the value of MPS in this context, as well as providing detail on the guidelines which help the clinician choose what investigations are appropriate for the patient presenting with chest pain. It also details a number of considerations related to the use of MPS, such as its cost-effectiveness and the prognosis value in the diagnosis of coronary artery disease compared to exercise ECG, X-ray computed tomographic coronary angiography, and other imaging investigations. Risk assessment prior to elective non-cardiac surgery is covered, with detailed attention paid to the challenges of assessing coronary artery disease special groups including women and patients with diabetes or renal disease. This chapter also covers assessment in known stable coronary artery disease, predicting the value of coronary revascularization and hibernating myocardium.

scholarly journals Assessment of the warranty period of a normal myocardial perfusion scintigraphy in patients with diabetes mellitus: 5 year follow-up of the prospective multicenter BARDOT trial

2021 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
P Haaf ◽  
F Caobelli ◽  
G Haenny ◽  
M Pfisterer ◽  
MJ Zellweger
Keyword(s):  
Myocardial Perfusion ◽  
Myocardial Perfusion Scintigraphy ◽  
Coronary Revascularization ◽  
Major Adverse Cardiovascular Events ◽  
Diabetic Patients ◽  
Cardiac Events ◽  
Perfusion Scintigraphy ◽  
Warranty Period ◽  
Increased Risk

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Swiss National Foundation for Research Background Asymptomatic diabetic patients with an abnormal myocardial perfusion scintigraphy (MPS) are known to be at an increased risk of major cardiac events (MACE) at 2-years follow-up. It remains unclear whether this finding holds true even for a follow-up of 5 years. Methods four hundred patients with type-2 diabetes without coronary artery disease were evaluated clinically and with MPS and followed up for 5 years. Major adverse cardiovascular events (MACE) were defined as cardiac death, myocardial infarction or late coronary revascularization.  Results  An abnormal MPS (SSS≥4 or SSS≥2) was found in 87 patients (21.8%). MACE within 5 years occurred in 14 patients with abnormal MPS (16.1%) and in 22 with normal scan (1.7%, p = 0.009); 15 deaths were recorded (3.8%). Patients with normal MPS had lower rates of MACEs than patients with abnormal scans (p = 0.016) (Figure 1A + B). Patients with abnormal MPS who had undergone revascularization had a lower mortality rate and a better event free survival from MI and revascularization than patients with abnormal MPS who had either undergone medical therapy only or could not be revascularized (Figure 1C + D).  Conclusions Patients with  normal MPS have a low event rate and may not need retesting within 5 years (warranty period). Patients with an abnormal MPS have higher event rates and may benefit from a combined medical and revascularization approach. Abstract Figure 1 A-D

scholarly journals Diagnostic accuracy of functional, imaging and biochemical tests for patients presenting with chest pain to the emergency department: A systematic review and meta-analysis

2018 ◽  
Vol 8 (5) ◽  
pp. 412-420 ◽  
Author(s):  
Mario Iannaccone ◽  
Sebastiano Gili ◽  
Ovidio De Filippo ◽  
Salvatore D’Amico ◽  
Marco Gagliardi ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Emergency Department ◽  
Myocardial Perfusion ◽  
Diagnostic Accuracy ◽  
Myocardial Perfusion Scintigraphy ◽  
Troponin T ◽  
Perfusion Scintigraphy ◽  
Coronary Computed Tomography ◽  
Coronary Syndrome ◽  
Non Invasive

Background: Non-invasive ischaemia tests and biomarkers are widely adopted to rule out acute coronary syndrome in the emergency department. Their diagnostic accuracy has yet to be precisely defined. Methods: Medline, Cochrane Library CENTRAL, EMBASE and Biomed Central were systematically screened (start date 1 September 2016, end date 1 December 2016). Prospective studies (observational or randomised controlled trial) comparing functional/imaging or biochemical tests for patients presenting with chest pain to the emergency department were included. Results: Overall, 77 studies were included, for a total of 49,541 patients (mean age 59.9 years). Fast and six-hour highly sensitive troponin T protocols did not show significant differences in their ability to detect acute coronary syndromes, as they reported a sensitivity and specificity of 0.89 (95% confidence interval 0.79–0.94) and 0.84 (0.74–0.9) vs 0.89 (0.78–0.94) and 0.83 (0.70–0.92), respectively. The addition of copeptin to troponin increased sensitivity and reduced specificity, without improving diagnostic accuracy. The diagnostic value of non-invasive tests for patients without troponin increase was tested. Coronary computed tomography showed the highest level of diagnostic accuracy (sensitivity 0.93 (0.81–0.98) and specificity 0.90 (0.93–0.94)), along with myocardial perfusion scintigraphy (sensitivity 0.85 (0.77–0.91) and specificity 0.92 (0.83–0.96)). Stress echography was inferior to coronary computed tomography but non-inferior to myocardial perfusion scintigraphy, while exercise testing showed the lower level of diagnostic accuracy. Conclusions: Fast and six-hour highly sensitive troponin T protocols provide an overall similar level of diagnostic accuracy to detect acute coronary syndrome. Among the non-invasive ischaemia tests for patients without troponin increase, coronary computed tomography and myocardial perfusion scintigraphy showed the highest sensitivity and specificity.

Myocardial perfusion scintigraphy in Germany

2007 ◽  
Vol 46 (02) ◽  
pp. 49-55 ◽  
Author(s):  
W. Burchert ◽  
F. M. Bengel ◽  
R. Zimmermann ◽  
J. vom Dahl ◽  
W. Schäfer ◽  
...  
Keyword(s):  
Nuclear Medicine ◽  
Myocardial Perfusion ◽  
Attenuation Correction ◽  
Working Group ◽  
Primary Care Physicians ◽  
Gated Spect ◽  
Myocardial Perfusion Scintigraphy ◽  
German Society ◽  
University Hospitals ◽  
Perfusion Scintigraphy

SummaryThe working group Cardiovascular Nuclear Medicine of the German Society of Nuclear Medicine (DGN), in cooperation with the working group Nuclear Cardiology of the German Cardiac Society (DGK), decided to conduct a national survey on myocardial perfusion scintigraphy (MPS). Method: A questionnaire to evaluate MPS for the year 2005 was sent. Results: 346 completed questionnaires had been returned (213 private practices, 99 hospitals and 33 university hospitals). MPS of 112 707 patients were reported with 110 747 stress and 95 878 rest studies. The majority (>75%) was performed with 99mTc-MIBI or tetrofosmin. 201Tl stress-redistribution was used in 22 637 patients (20%). The types of stress were exercise in 78%, vasodilation with adenosine or dipyridamol in 21% and dobutamine in 1%. 99.97% of all MPS were SPECT studies. Gated SPECT was performed in 36% of the stress and in 32% of the rest studies. An attenuation correction was used in 21%. 29 institutions (8%) performed gated SPECT (stress and rest) and attenuation correction. 47% of all MPS were requested by ambulatory care cardiologists, 17% by internists, 12% by primary care physicians, 21% by hospital departments and 2% by others. Conclusion: In Germany, MPS is predominantly performed with 99mTc-perfusion agents. The common type of stress is ergometry. Gated SPECT and attenuation correction do not yet represent standards of MPS practice in Germany, which indicates some potential of optimization.

Paradoxical Hypotension during Dobutamine Infusion for Myocardial Perfusion Scintigraphy

1998 ◽  
Vol 37 (08) ◽  
pp. 268-271
Author(s):  
B. Caner ◽  
E. Atalar ◽  
A. Karanfil ◽  
L. Tokgözoğlu ◽  
E. L. Ergün
Keyword(s):  
Blood Pressure ◽  
Myocardial Perfusion ◽  
Systolic Blood Pressure ◽  
Myocardial Perfusion Scintigraphy ◽  
Stress Test ◽  
Dobutamine Infusion ◽  
Perfusion Scintigraphy ◽  
Tilt Table ◽  
Study Results ◽  
Group A

Summary Aim: Dobutamine as a predominant beta-1 agonist increases heart rate and myocardial contractility and at sufficient high doses, it also increases systolic blood pressure. This study was undertaken to describe instances of paradoxical hypotension during dobutamine infusion for TI-201 myocardial perfusion SPECT study and the relationship between scintigraphic findings and hypotension occurred during dobutamine infusion. Methods: In 201 consecutive patients unable to perform adequate exercise, dobutamine TI-201 myocardial SPECT was performed. Dobutamine was infused starting from 10 μg/kg/min increasing to 40 μg/kg/min. Paradoxical hypotension was defined as a decrease in systolic blood pressure ≥ 20 mmHg compared with baseline study. Results: Paradoxical hypotension was observed in 40 patients (Group A) out of 201 (19.9%) while no significant change in systolic blood pressure was detected in the remaining 161 patients (Group B). Mean maximum fall in systolic blood pressure was 39 ± 18 mmHg (range: 20-90). In 33 of 40 patients (83%) with paradoxical hypotension, scintigraphy was normal compared to 131 (81%) of the remaining 161 patients. In patients of Group A, angiography, echocardiography and tilt table tests were performed in 13, 11 and 6 patients respectively. Nine of 13 angiographic evaluations (69%), 10 of 11 echocardiographic evaluations (91%), all of the tilt table tests were normal. Additionally, all of the patients of Group A were clinically followed up at least 6 months after the myocardial perfusion scintigraphy. None of the patients had a cardiac event except one patient during the follow-up period. Conclusion: Paradoxical hypotension during dobutamine infusion for myocardial scintigraphy is not an uncommon finding and up to 19.9% patients may develop such hypotension. To maximize test safety, precautions should be taken during dobutamine myocardial stress test, since remarkable decrease in systolic blood pressure may occur. Unlike hypotension occurring with exercise test, hypotension response to dobutamine is not always a marker for coronary artery disease.

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