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Medicine Feb 2020The aim of this study was to compare tissue doppler imaging (TDI) and equilibrium radionuclide angiography (ERNA) for detection of right ventricular (RV) dyssynchrony...
Equilibrium radionuclide angiography compared with tissue doppler imaging for detection of right ventricular dyssynchrony and prediction of acute response to cardiac resynchronization therapy.
OBJECTIVE
The aim of this study was to compare tissue doppler imaging (TDI) and equilibrium radionuclide angiography (ERNA) for detection of right ventricular (RV) dyssynchrony and prediction of the acute response to cardiac resynchronization therapy (CRT).
METHODS
This study was approved by the local ethics committee of Huai'an First People's Hospital. Patient consent was not provided due to the use of completely anonymous images from which the individual could not be identified in this study. Thirty-three patients with nonischemic dilated cardiomyopathy underwent both TDI and ERNA before and within 48 hour after CRT implantation. RV dyssynchrony was measured with TDI using the difference in time to peak systolic velocity between the RV free wall and ventricular septum (RV-T). With ERNA, the standard of RV mean phase angle and RV phase standard deviation (RVmPA% and RVPSD%) were assessed.
RESULTS
Moderate positive correlations were observed among baseline RVmPA%, RVPSD% and RV-T (r = 0.689 and 0.716, P < .001). Twenty patients (61%) with a reduction of at least 15% in LV end-systolic volume were categorized as acute responders after CRT. Responders showed significant reduction in RVmPA% and RVPSD% after CRT (53.60 ± 4.15% to 43.95 ± 6.88% and 14.00 ± 2.41% to 10.40 ± 1.67%, P < .05), whereas RV-T remained unchanged (50.10 ± 10.28 ms to 49.25 ± 13.64ms, NS). Receiver operating characteristic curve showed that the cut-off value of RV-T was 48.5ms, yielding 65% sensitivity and 77% specificity to predict acute respond to CRT. The cut-off value of RVmPA% was 49.5%, yielding 85% sensitivity and 85% specificity and the cut-off value of RVPSD% was 11.5%, yielding 85% sensitivity and 92% specificity.
CONCLUSION
ERNA might be an appropriate alternative to TDI for assessment of RV dyssynchrony. Either RVmPA% or RVPSD% was highly predictive for acute response to CRT.
Topics: Aged; Cardiac Resynchronization Therapy; Female; Gated Blood-Pool Imaging; Heart Diseases; Humans; Male; Middle Aged; Predictive Value of Tests; ROC Curve; Ventricular Function, Right
PubMed: 32118744
DOI: 10.1097/MD.0000000000019296 -
Journal of Nuclear Medicine : Official... Apr 2011New antitumor agents have resulted in significant survival benefits for cancer patients. However, several agents may have serious cardiovascular side effects. Left... (Review)
Review
New antitumor agents have resulted in significant survival benefits for cancer patients. However, several agents may have serious cardiovascular side effects. Left ventricular ejection fraction measurement by (99m)Tc multigated radionuclide angiography is regarded as the gold standard to measure cardiotoxicity in adult patients. It identifies left ventricular dysfunction with high reproducibility and low interobserver variability. A decrease in left ventricular ejection fraction, however, is a relatively late manifestation of myocardial damage. Nuclear cardiologic techniques that visualize pathophysiologic processes at the tissue level could detect myocardial injury at an earlier stage. These techniques may give the opportunity for timely intervention to prevent further damage and could provide insights into the mechanisms and pathophysiology of cardiotoxicity caused by anticancer agents. This review provides an overview of past, current, and promising newly developed radiopharmaceuticals and describes the role and recent advances of scintigraphic techniques to measure cardiotoxicity. Both first-order functional imaging techniques (visualizing mechanical [pump] function), such as (99m)Tc multigated radionuclide angiography and (99m)Tc gated blood-pool SPECT, and third-order functional imaging techniques (visualizing pathophysiologic and neurophysiologic processes at the tissue level) are discussed. Third-order functional imaging techniques comprise (123)I-metaiodobenzylguanidine scintigraphy, which images the efferent sympathetic nervous innervations; sympathetic neuronal PET, with its wide range of tracers; (111)In-antimyosin, which is a specific marker for myocardial cell injury and necrosis; (99m)Tc-annexin V scintigraphy, which visualizes apoptosis and cell death; fatty-acid-use scintigraphy, which visualizes the storage of free fatty acids in the lipid pool of the cytosol (which can be impaired by cardiotoxic agents); and (111)In-trastuzumab imaging, to study trastuzumab targeting to the myocardium. To define the prognostic importance and clinical value of each of these functional imaging techniques, prospective clinical trials are warranted.
Topics: 3-Iodobenzylguanidine; Annexin A5; Anthracyclines; Antibodies, Monoclonal; Antibodies, Monoclonal, Humanized; Antineoplastic Agents; Fatty Acids; Gated Blood-Pool Imaging; Heart; Heart Diseases; Humans; Neoplasms; Organometallic Compounds; Radiopharmaceuticals; Sympathetic Nervous System; Tomography, Emission-Computed, Single-Photon; Trastuzumab
PubMed: 21421717
DOI: 10.2967/jnumed.110.082784 -
American Heart Journal Dec 2012The ability to make informed benefit-risk assessments for potentially cardiotoxic new compounds is of considerable interest and importance at the public health, drug... (Review)
Review
The ability to make informed benefit-risk assessments for potentially cardiotoxic new compounds is of considerable interest and importance at the public health, drug development, and individual patient levels. Cardiac imaging approaches in the evaluation of drug-induced myocardial dysfunction will likely play an increasing role. However, the optimal choice of myocardial imaging modality and the recommended frequency of monitoring are undefined. These decisions are complicated by the array of imaging techniques, which have varying sensitivities, specificities, availabilities, local expertise, safety, and costs, and by the variable time-course of tissue damage, functional myocardial depression, or recovery of function. This White Paper summarizes scientific discussions of members of the Cardiac Safety Research Consortium on the main factors to consider when selecting nonclinical and clinical cardiac function imaging techniques in drug development. We focus on 3 commonly used imaging modalities in the evaluation of cardiac function: echocardiography, magnetic resonance imaging, and radionuclide (nuclear) imaging and highlight areas for future research.
Topics: Cardiac Imaging Techniques; Cardiomyopathies; Cardiovascular Agents; Echocardiography; Humans; Magnetic Resonance Imaging; Radionuclide Angiography; Risk Assessment
PubMed: 23194484
DOI: 10.1016/j.ahj.2012.09.001 -
Magma (New York, N.Y.) Dec 2021Model-driven registration (MDR) is a general approach to remove patient motion in quantitative imaging. In this study, we investigate whether MDR can effectively correct...
INTRODUCTION
Model-driven registration (MDR) is a general approach to remove patient motion in quantitative imaging. In this study, we investigate whether MDR can effectively correct the motion in free-breathing MR renography (MRR).
MATERIALS AND METHODS
MDR was generalised to linear tracer-kinetic models and implemented using 2D or 3D free-form deformations (FFD) with multi-resolution and gradient descent optimization. MDR was evaluated using a kidney-mimicking digital reference object (DRO) and free-breathing patient data acquired at high temporal resolution in multi-slice 2D (5 patients) and 3D acquisitions (8 patients). Registration accuracy was assessed using comparison to ground truth DRO, calculating the Hausdorff distance (HD) between ground truth masks with segmentations and visual evaluation of dynamic images, signal-time courses and parametric maps (all data).
RESULTS
DRO data showed that the bias and precision of parameter maps after MDR are indistinguishable from motion-free data. MDR led to reduction in HD (HD = 9.98 ± 9.76, HD = 1.63 ± 0.49). Visual inspection showed that MDR effectively removed motion effects in the dynamic data, leading to a clear improvement in anatomical delineation on parametric maps and a reduction in motion-induced oscillations on signal-time courses.
DISCUSSION
MDR provides effective motion correction of MRR in synthetic and patient data. Future work is needed to compare the performance against other more established methods.
Topics: Algorithms; Humans; Magnetic Resonance Imaging; Magnetic Resonance Spectroscopy; Motion; Radioisotope Renography; Respiration
PubMed: 34160718
DOI: 10.1007/s10334-021-00936-x -
Clinical Cardiology Jun 2011The objective of this meta-analysis was to evaluate the efficacy of the metabolic agent trimetazidine (TMZ) as monotherapy in the treatment of stable angina pectoris,... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
The objective of this meta-analysis was to evaluate the efficacy of the metabolic agent trimetazidine (TMZ) as monotherapy in the treatment of stable angina pectoris, from echocardiography and radionuclide angiography data.
HYPOTHESIS
Treatment with TMZ proved to be as effective as other first-line antianginal agents for coronary patients, and it provided additional efficacy in combination with hemodynamic agents.
METHODS
A search of the literature published between 1965 and 2008 was performed on the MEDLINE and EMBASE databases. Only randomized, controlled trials were included in this meta-analysis. Patients had to be treated for at least 2 weeks with data on the following 4 parameters at baseline and at the end of the treatment period: left ventricular ejection fraction (LVEF), LV end-diastolic volume (LVEDV), LV end-systolic volume (LVESV), and wall motion score index (WMSI). The quality of the trials was assessed by the Jadad score.
RESULTS
Eleven clinical studies meeting our criteria were analyzed. Results showed that TMZ significantly improved LVEF, with a mean increase of 6.88% (95% confidence interval [CI]: 5.50-8.25), and significantly reduced LVESV by 11.58 mL (95% CI: 5.79-17.37) and WMSI by 0.23 (95% CI: 0.07-0.38). Changes in LVEDV were variable. In both the long term and the short term, TMZ can improve LV function. The efficacy was unchanged in patients with diabetes mellitus.
CONCLUSIONS
This meta-analysis confirmed the efficacy of TMZ monotherapy in improving LV function compared with placebo.
Topics: Aged; Angina Pectoris; Drug Therapy, Combination; Echocardiography; Evidence-Based Medicine; Female; Humans; Male; Middle Aged; Predictive Value of Tests; Radionuclide Angiography; Randomized Controlled Trials as Topic; Stroke Volume; Time Factors; Treatment Outcome; Trimetazidine; Vasodilator Agents; Ventricular Function, Left
PubMed: 21538382
DOI: 10.1002/clc.20888 -
Clinical Cardiology Jul 2000Right ventricular infarction (RVI) as assessed by various diagnostic methods accompanies inferior-posterior wall myocardial infarction (MI) in 30 to 50% of patients.... (Review)
Review
Right ventricular infarction (RVI) as assessed by various diagnostic methods accompanies inferior-posterior wall myocardial infarction (MI) in 30 to 50% of patients. Recognition of the syndrome of RVI is important as it defines a significant clinical entity, which is associated with considerable immediate morbidity and mortality and has a well-delineated set of priorities for its management. Patients may clinically present with hypotension, elevated jugular venous pulse (JVP), and occasionally shock, all in the presence of clear lung fields. The ST-segment elevation of > or = 0.1 mV in the right precordial leads V4R is a readily available electrocardiographic sign used for diagnosis of RVI. Other diagnostic approaches for assessing RVI include echocardiography, radionuclide ventriculography, technetium pyrophosphate scanning, and hemodynamic measurements. The proper management of RVI includes volume loading to maintain adequate right ventricular preload, ionotropic support, and maintenance of atrioventricular synchrony. Reperfusion therapy should be initiated at the earliest signs of right ventricular dysfunction. Finally, complete recovery over a period of weeks to months is a rule in a majority of patients, suggesting right ventricular "stunning" rather than irreversible necrosis has occurred.
Topics: Animals; Cardiotonic Agents; Coronary Angiography; Echocardiography; Electrocardiography; Fibrinolytic Agents; Heart Ventricles; Hemodynamics; Humans; Myocardial Infarction; Myocardial Revascularization; Prognosis; Radionuclide Angiography; Thrombolytic Therapy
PubMed: 10894433
DOI: 10.1002/clc.4960230721 -
Clinical Medicine (London, England) 2006
Review
Topics: Coronary Artery Disease; Gated Blood-Pool Imaging; Heart; Heart Diseases; Humans; Myocardium; Organophosphorus Compounds; Organotechnetium Compounds; Perfusion; Prognosis; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Sestamibi; Thallium Radioisotopes
PubMed: 16826859
DOI: 10.7861/clinmedicine.6-3-263 -
The American Journal of Cardiology Apr 1996Left ventricular (LV) ejection fraction (EF) is commonly assessed by equilibrium radionuclide angiography and echocardiography. These methods are presumed to be... (Comparative Study)
Comparative Study
Left ventricular (LV) ejection fraction (EF) is commonly assessed by equilibrium radionuclide angiography and echocardiography. These methods are presumed to be interchangeable for this purpose. This study (1) compares quantification of LVEF by equilibrium radionuclide angiography with visual estimation of LVEF by echocardiography, (2) determines the reproducibility of both methods, and (3) evaluates whether differences in determinations of LVEF are of clinical relevance. Seventy-three clinically stable patients had both equilibrium radionuclide angiography and echocardiography performed within a 4-day period. LVEF by both techniques was compared after blinded analysis by 3 echocardiographers and 3 nuclear technologists. Reproducibility was assessed by blinded repeat analysis after a 1-week interval. The frequency of differences in repeat assessments of EF that the authors considered to be of potential clinical relevance (i.e., difference > or = 10% EF units) was assessed for both techniques. Correlation of LVEF determined by both methods was good (r = 0.81, SEE = 3.5) but with substantial differences in individual patients (limits of agreement, 23.6%). Intra- and inter-observer reproducibility was good for both methods, but better for radionuclide LVEF than for echocardiographic LVEF. Limits of agreement were substantially better for radionuclide LVEF than for echocardiographic LVEF (1.8% to 3.6% versus 13.4% to 17.4%, respectively). Clinically relevant differences did not occur on repeat processing of equilibrium radionuclide angiography. In contrast, potentially clinically relevant differences occurred in 8% to 26% of studies on repeat analysis of echocardiography. Thus, LVEF determined by equilibrium radionuclide angiography and echocardiography show good agreement. Both methods provide clinically valuable measurements for LV function. However, when a precisely reproducible measurement is required for patient management decisions, equilibrium radionuclide angiography is the method of choice.
Topics: Adult; Aged; Aged, 80 and over; Echocardiography; Female; Gated Blood-Pool Imaging; Humans; Male; Middle Aged; Reproducibility of Results; Retrospective Studies; Stroke Volume; Ventricular Function, Left
PubMed: 8623737
DOI: 10.1016/s0002-9149(97)89179-5 -
HPB Surgery : a World Journal of... Sep 1991The study of hepatic haemodynamics is of importance in understanding both hepatic physiology and disease processes as well as assessing the effects of portosystemic... (Review)
Review
The study of hepatic haemodynamics is of importance in understanding both hepatic physiology and disease processes as well as assessing the effects of portosystemic shunting and liver transplantation. The liver has the most complicated circulation of any organ and many physiological and pathological processes can affect it. This review surveys the methods available for assessing liver blood flow, examines the different parameters being measured and outlines problems of applicability and interpretation for each technique. The classification of these techniques is to some extent arbitrary and several so called "different" methods may share certain common principles. The methods reviewed have been classified into two groups (Table 1): those primarily reflecting flow through discrete vessels or to the whole organ and those used to assess local microcirculatory blood flow. All techniques have their advantages and disadvantages and in some situations a combination may provide the most information. In addition, because of the many factors affecting liver blood flow and sinusoidal perfusion, readings in a single subject may vary depending on positioning, recent food intake, anxiety, anaesthesia and drug therapy. This must be borne in mind if different studies are to be meaningfully compared.
Topics: Angiography; Dye Dilution Technique; Humans; Lasers; Liver Circulation; Magnetic Resonance Imaging; Microspheres; Radionuclide Angiography; Radionuclide Imaging; Ultrasonics; Ultrasonography
PubMed: 1931785
DOI: 10.1155/1991/68915 -
In Vivo (Athens, Greece) 2022This study performed Tc-MAG renal scintigraphy on rabbit kidneys and evaluated its ability to identify obstructive or non-obstructive kidneys.
BACKGROUND/AIM
This study performed Tc-MAG renal scintigraphy on rabbit kidneys and evaluated its ability to identify obstructive or non-obstructive kidneys.
MATERIALS AND METHODS
Renal function was assessed during a four-week post-obstruction period by obtaining planar images of Tc-MAG activity following an ear vein injection. The individual renal function was evaluated by renal scintigraphy in conjunction with histopathological and morphological examinations.
RESULTS
The renal perfusion of Tc-MAG in the right kidney with a ureteral obstruction decreased with time. The width, height, and cortical thickness of the obstructed right kidney were significantly larger than those of the left kidney. A histopathological examination four weeks after the ureteral obstruction revealed a typical pattern of urinary tract obstruction, including multiple tubules, enlargement of the interstitial area, and cytoplasmic vacuoles.
CONCLUSION
Tc-MAG renal scintigraphy provides the kidney shape and size and can identify potential obstructive and non-obstructive kidneys in rabbits.
Topics: Animals; Kidney; Rabbits; Radioisotope Renography; Radiopharmaceuticals; Technetium Tc 99m Mertiatide; Ureteral Obstruction
PubMed: 34972716
DOI: 10.21873/invivo.12692