Equilibrium radionuclide angiography compared with tissue doppler imaging for detection of right ventricular dyssynchrony and prediction of acute response to cardiac resynchronization therapy.

Authors: Yu Chen, Xue Xue, Yang Gu...

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

Review

Authors: Elizabeth Prvulovich

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

Authors: Charles-Edouard Decorads, Aurélien Lambert, Véronique Roch...

BACKGROUND

This study assesses a first-line left ventricular ejection fraction (LVEF) monitoring provided by an ultra-low-dose equilibrium radionuclide angiography (ERNA) in breast cancer women treated with potentially cardiotoxic drugs and analyzes patient outcome based on the ERNA results.

METHODS

Breast cancer women treated with anthracyclines, followed or not by trastuzumab, were monitored using ERNA with a high-sensitivity CZT-camera. Calibrated LVEF measurements were obtained with an almost threefold reduction of radiation doses and 10-min recording times.

RESULTS

During a mean 24 ± 6 months follow-up, 552 ERNAs with a mean effective dose of 2.3 ± 0.6 mSv were performed in 195 women, among whom 22 (11%) presented both ERNA criteria of cardiotoxicity (LVEF < 50% and > 10% drop from baseline; Tox + group), 35 (18%) only one criterion (Tox ± group), and 138 (71%) neither (Tox - group). This ERNA-based classification correlated with trastuzumab-anthracycline treatment (p = 0.001), prior cardiovascular disease (p = 0.018), and cardiac outcome, with a 30-month survival with no cardiotoxicity-driven drug regimen changes of 97 ± 2% in Tox -, 60 ± 13% in Tox ± and 36 ± 13% in Tox + (p < 0.001) groups.

CONCLUSION

First-line detection of breast cancer therapy-related cardiotoxicity by ultra-low-dose ERNA provides consistent results, confirming the excellent cardiac outcome for the greatest majority of women with no ERNA cardiotoxicity criteria.

Topics: Female; Humans; Breast Neoplasms; Stroke Volume; Gated Blood-Pool Imaging; Ventricular Function, Left; Trastuzumab; Cardiotoxicity; Antibiotics, Antineoplastic; Anthracyclines

PubMed: 36289164
DOI: 10.1007/s12350-022-03124-z

Comparative Study

Authors: I Iftikhar, M Koutelou, J J Mahmarian...

UNLABELLED

The purpose of this investigation was to evaluate the changes in left ventricular function and volumes concurrently with tomographic myocardial perfusion during dobutamine infusion.

METHODS

Ninety-two patients underwent first-pass radionuclide angiography using a multicrystal gamma camera and myocardial tomography after high-dose (40 micrograms/kg/min) dobutamine infusion and 99mTc-sestamibi administration.

RESULTS

Dobutamine increased systolic blood pressure (p < 0.0001), heart rate (p < 0.00017), left ventricular ejection fraction (p = 0.0001), cardiac output (p = 0.0001) and stroke volume (p = 0.042). The end-diastolic (p = 0.009) and end-systolic volumes (p = 0.0007) significantly decreased. Of 38 patients with cardiac catheterization, 28 had significant coronary artery disease and 10 had normal coronaries. The sensitivity and specificity for coronary artery disease detection by myocardial perfusion tomography were 78% and 90%, respectively. By radionuclide angiography, only 9 of 27 coronary artery disease patients experienced deterioration of wall motion during dobutamine (sensitivity 33%).

CONCLUSION

Changes in myocardial perfusion are more sensitive than changes in left ventricular function for detecting coronary artery disease during dobutamine stress.

Topics: Cardiac Catheterization; Coronary Disease; Dobutamine; Evaluation Studies as Topic; Female; Hemodynamics; Humans; Male; Middle Aged; Sensitivity and Specificity; Technetium Tc 99m Sestamibi; Tomography, Emission-Computed, Single-Photon; Ventricular Function, Left; Ventriculography, First-Pass

PubMed: 8708761
DOI: No ID Found

Review

Authors: Lioe-Fee de Geus-Oei, Annelies M C Mavinkurve-Groothuis, Louise Bellersen...

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

Meta-Analysis Review

Authors: Bo Hu, Wei Li, Tao Xu...

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

Authors: J F Baron, O Mundler, M Bertrand...

BACKGROUND

Because many patients with atherosclerotic disease of the abdominal aorta also have coronary artery disease, assessment of cardiac risk before abdominal aortic surgery has received much attention. Our prospective study was designed to identify predictors of cardiac risk in consecutive patients evaluated preoperatively with dipyridamole-thallium single-photon-emission computed tomography (SPECT) to assess myocardial perfusion and radionuclide angiography to measure left ventricular ejection fraction.

METHODS

Clinical and scintigraphic data were collected prospectively during hospitalization in 457 consecutive patients undergoing elective abdominal aortic surgery. Adverse cardiac outcomes were predicted with multivariate analyses.

RESULTS

Eighty-six patients (19 percent) had one or more of the following postoperative complications: prolonged myocardial ischemia (61 patients), myocardial infarction (22), congestive heart failure (20), and severe ventricular tachyarrhythmia (2). Twenty patients died postoperatively (4.4 percent), half of them from cardiac causes. Information about myocardial perfusion obtained from dipyridamole-thallium SPECT did not accurately predict adverse cardiac outcomes. The best correlates of cardiac complications were definite clinical evidence of coronary artery disease (odds ratio, 2.6; 95 percent confidence interval, 1.6 to 4.3) and age greater than 65 years (odds ratio, 2.3; 95 percent confidence interval, 1.4 to 3.6). Measurement of the ejection fraction was useful only in the prediction of left ventricular failure. Age greater than 65 years was the only predictor of death (odds ratio, 26.4; 95 percent confidence interval, 3.5 to 200.0).

CONCLUSIONS

The presence of definite clinical evidence of coronary artery disease and older age were the most important preoperative predictors of an adverse cardiac outcome after abdominal aortic surgery. These results suggest that the routine use of dipyridamole-thallium SPECT and radionuclide angiography for screening before abdominal aortic surgery may not be justified.

Topics: Aged; Aorta, Abdominal; Aortic Diseases; Coronary Circulation; Dipyridamole; Elective Surgical Procedures; Gated Blood-Pool Imaging; Heart Diseases; Humans; Middle Aged; Multivariate Analysis; Odds Ratio; Postoperative Complications; Risk Factors; Stroke Volume; Thallium Radioisotopes; Tomography, Emission-Computed, Single-Photon

PubMed: 8107716
DOI: 10.1056/NEJM199403103301002

Review

Authors: Bijoy K Khandheria

Topics: Cardiology; Diagnostic Imaging; Echocardiography; Heart Diseases; Humans; Magnetic Resonance Imaging; Positron-Emission Tomography; Radionuclide Ventriculography; Tomography, X-Ray Computed

PubMed: 15936636
DOI: 10.1016/j.jacc.2005.04.035

Authors: H W Strauss, K Ohtsuki

Topics: Adult; Equipment Design; Exercise Test; Gated Blood-Pool Imaging; Heart; Humans; Monitoring, Ambulatory; Posture; Radionuclide Ventriculography; Reproducibility of Results; Supine Position; Ventricular Function, Left

PubMed: 9374330
DOI: No ID Found

Authors: A D Seftel, I Goldstein

Topics: Erectile Dysfunction; Humans; Male; Penile Erection; Penis; Radionuclide Angiography; Regional Blood Flow; Vascular Diseases

PubMed: 1730994
DOI: No ID Found