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Prediction of human transplantation arteriopathy and coronary events with lung heart count ratios during intravenous dipyridamole thallium-201 imaging

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AMERICAN HEART JOURNAL 1999年第5期137卷 942-948页

作者： Lenihan, DJ Rosenbaum, AF Burwinkel, P Tseng, CY Bhat, G Wagoner, L Walsh, RA Gerson, MC Univ Cincinnati Div Cardiol Dept Internal Med Cincinnati OH 45267 USA Univ Cincinnati Div Epidemiol & Biostat Dept Environm Hlth Cincinnati OH 45267 USA Univ Cincinnati Eugene L Saenger Radioisotope Lab Dept Radiol Cincinnati OH 45267 USA

Background Cardiac allograft arteriopathy often limits long-term survival in transplantation recipients but has been difficult to-detect by standard diagnostic methods. Because of the diffuse nature of transplantation coronary disease, we postulated that a lung/heart ratio during dipyridamole thallium imaging might better predict arteriopathy-related complications than diagnostic methods that detect discrete luminal stenoses. Methods and Results Sixty-six unselected heart transplantation recipients were evaluated with annual coronary arteriograms, endomyocardial biopsy, and intravenous dipyridamole thallium testing (initial study group). The mean lung/heart ratio on an anterior planar image was 0.40 for all patients;therefore <0.40 was arbitrarily defined as normal. After October 1992, 98 patients were tested (validation study group) and a lung/heart ratio cutoff of 0.40 was evaluated prospectively. Coronary end points were defined as (1) at least 1 coronary artery stenosis greater than or equal to 50% of the luminal diameter, (2) sudden cardiac death, and (3) acute myocardial infarction. Stepwise:logistic regression analysis was performed to identify independent predictors of future coronary end points. For the initial study group, the lung/heart ratio on the first annual thallium study was the only independent predictor of subsequent cardiac end points (0.47 +/- 0.13 [SD] with end points vs 0.38 +/- 0.11 without end points, P<.05). For the validation study group, independent predictors of subsequent coronary events included the lung/heart ratio and the radionuclide left ventricular election fraction. No patient with a lung/heart ratio <0.40 and a left ventricular ejection fraction greater than or equal to 0.50 developed a cardiac event during 21 +/- 11 months of follow-up. Conclusions A lung/heart ratio greater than or equal to 0.40 on dipyridamole thallium testing is a sensitive predictor of coronary events after heart transplantation. Patients with heart transpl

关键词：冠心病/病因学冠心病/病理生理学冠心病/放射性核素显像冠状血管/放射性核素显像双嘧达莫/投药和剂量双嘧达莫/诊断应用随访研究注射静脉内肺/放射性核素显像试验预期值前瞻性研究可重复性结果每搏输出量铊放射性同位素/投药和剂量铊放射性同位素/诊断应用女(雌)性人类男(雄)性中年人

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Selective dual nuclear scanning in low-risk patients with chest pain to reliably identify and exclude acute coronary syndromes

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ANNALS OF EMERGENCY MEDICINE 2001年第3期38卷 207-215页

作者： Fesmire, FM Hughes, AD Stout, PK Wojcik, JF Wharton, DR Univ Tennessee Coll Med Erlanger Med Ctr Dept Emergency Med Chattanooga TN 37405 USA Univ Tennessee Coll Med Erlanger Med Ctr Dept Radiol Chattanooga TN 37405 USA

Study objective: We sought to determine the use in routine clinical practice of selective dual nuclear cardiac scanning (rest and stress) in low-risk patients with chest pain for identifying and excluding acute coronary syndromes (ACSs) during the initial emergency department evaluation. Methods: A prospective observational study was conducted over 13 months in 1,775 low-risk patients with chest pain who had intermediate- and high-risk ACSs ruled out by means of our 2-hour protocol, which consists of automated serial 12-lead ECG monitoring in conjunction with baseline and 2-hour creatine kinase (CK) MB and troponin I (cTnI) measurements. At the completion of the 2-hour evaluation period, low-risk patients were stratified by means of physician judgment into 1 of 2 categories: category III, possible ACS;and category IV, probable non-ACS chest pain. Level III patients underwent immediate dual nuclear scanning (rest thallium and stress sestamibi scanning), and level IV patients were discharged directly from the ED unless another serious non-ACS medical condition was thought to exist. Rest and stress scans were interpreted by a board-certified radiologist contemporaneous with patient evaluation. All patients were followed up for 30-day ACS, which was defined as acute myocardial infarction, percutaneous transluminal coronary angioplasty/coronary artery bypass grafting, coronary arteriography revealing stenosis of the major coronary artery of 70% or greater not amenable to percutaneous transluminal coronary angioplasty/coronary artery bypass grafting, life-threatening complication, or cardiac death within 30 days of ED presentation. Results: A total of 2,206 ED patients with chest pain were evaluated for ACS during the study period. Four hundred thirty-one patients were excluded for having 1 or more of the following findings: initial ECG diagnostic of injury;baseline CK-MB level, cTnI level, or both diagnostic of acute myocardial infarction;2-hour Delta CK-MB level of +1.5

关键词：血管成形术经腔经皮冠状动脉胸痛/放射性核素显像冠状动脉分流术冠心病/放射性核素显像冠心病/治疗急诊室医院运动试验心肌梗死/放射性核素显像心肌梗死/治疗试验预期值前瞻性研究危险性评估 99m锝甲氧基异丁基异腈/诊断应用铊放射性同位素/诊断应用体层摄影术发射型计算机单光子成年人老年人女(雌)性人类男(雄)性中年人

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Cost-effectiveness of measuring fractional flow reserve to guide coronary interventions

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AMERICAN HEART JOURNAL 2003年第5期145卷 882-887页

作者： Fearon, WF Yeung, AC Lee, DP Yock, PG Heidenreich, PA Stanford Univ Med Ctr Div Cardiovasc Med Falk Cardiovasc Res Ctr Stanford CA 94305 USA VA Palo Alto Hlth Care Syst Palo Alto CA USA

Background Most patients come to the catheterization laboratory without prior functional tests, which makes the cost-effective treatment of patients with intermediate coronary lesions a practical challenge. Methods We developed a decision model to compare the long-term costs and benefits of 3 strategies for treating patients with an intermediate coronary lesion and no prior functional study: 1) deferring the decision for percutaneous coronary intervention (PCI) to obtain a nuclear stress imaging study (NUC strategy);2) measuring fractional flow reserve (FFR) at the time of angiography to help guide the decision for PCI (FFR strategy);and 3) stenting all intermediate lesions (STENT strategy). On the basis of the literature, vac: estimated that 40%. of intermediate lesions would produce ischemia, 70% of patients treated with PCI and 30%. of patients treated medically would be free of angina after 4-years, and the quality-of-life adjustment far living with angina was 0.9 (1.0 = perfect health). We estimated the cost of FFR to be 76 1, the cost of nuclear stress imaging to be 1093, and the cast of medical treatment for angina to be $1775 per year. The extra cost of splitting the angiogram and PCI as dictated by the NUC strategy vas $3886 by use of hospital cost-accounting data. Sensitivity and threshold analyses were performed to determine which variables affected our results. Results The FFR strategy saved 1795 per patient compared with the NUC strategy and $3830 compared with the STENT strategy. Quality-adjusted life expectancy was similar among the 3 strategies (NUC-FFR = 0.8 quality-adjusted days, FFR-STENT = 6 quality-adjusted life days). Compared with the FFR strategy, the NUC strategy was expensive (>$800,000 per quality-adjusted life year gained). Both screening strategies were superior to (less cost, better outcomes) the STENT strategy. Sensitivity analysis indicated that the NUC strategy would only become attractive (<$50,000/quality-adjusted life years compar

关键词：心绞痛/经济学心绞痛/治疗血管成形术经腔经皮冠状动脉/经济学冠状血管造影术/经济学冠状动脉循环/生理学冠心病/经济学冠心病/放射性核素显像冠心病/治疗费用效益分析决策支持技术心脏功能试验/经济学心脏功能试验/方法医院费用质量校正寿命敏感性与特异性支架/经济学人类

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Power Doppler harmonic imaging: A feasibility study of a new technique for the assessment of myocardial perfusion

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AMERICAN HEART JOURNAL 2000年第2期139卷 245-251页

作者： Senior, R Kaul, S Soman, P Lahiri, A Northwick Pk Hosp Dept Cardiovasc Med Harrow HA1 3UJ Middx England Inst Med Res Harrow Middx England Univ Virginia Sch Med Charlottesville VA 22903 USA

Background The aim of the study was to assess the feasibility of a! new technique, power Doppler harmonic imaging (PDHI)I for assessing myocardial perfusion through a venous injection of microbubbles, with the use of a new ultrasound contrast agent. Methods and Results Fifteen patients with known coronary artery disease and a resting perfusion abnormality on Tc-99m sestamibi single-photon emission computed tomography (SPECT) underwent PDHI at rest during intravenous injections: of 2 to 3 mi of Sonovue (Bracco SpA, Milan, Italy), a new second-generation ultrasound contrast agent. Myocardial perfusion was determined to be present or absent by use of a 5-segment model by 2 blinded observers for both PDHI and SPECT Of a total of 75 possible myocardial segments, 7 (9%) were not analyzed because of obvious artifacts on PDHI. SPECT:showed perfusion defects in 40 of the remaining 68 segments, whereas PDHI showed 39 defects. There was high concordance between the 2 imaging modalities for the presence (93%) as well as the location (96% for the anteroseptal region, 93% for the inferoposterior region, and 87% for the apical region) of the defects. Conclusions These preliminary results suggest that PDHI is a feasible technique for the detection of resting myocardial perfusion defects in patients with coronary artery disease after a venous injection of a new second-generation ultrasound contrast agent.

关键词：造影剂冠状动脉循环/生理学冠心病/放射性核素显像冠心病/超声检查冠状血管/生理学冠状血管/超声检查可行性研究微球体体层摄影术发射型计算机单光子超声检查多普勒/方法成年人老年人人类男(雄)性中年人

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Transmyocardial laser revascularization with excimer laser: Clinical results at 1 year

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ANNALS OF THORACIC SURGERY 2000年第2期70卷 498-503页

作者： Lee, LY O'Hara, MF Finnin, EB Hachamovitch, R Szulc, M Kligfield, PD Okin, PM Isom, OW Rosengart, TK Cornell Univ Weill Med Coll New York Presbyterian Hosp Dept Cardiothorac Surg Cardiol & Nucl Cardiol New York NY USA

Background. Transmyocardial laser revascularization, a new strategy for the treatment of diffuse ischemic heart disease, uses laser technology for the theoretical purpose of forming transmyocardial channels in the heart to increase perfusion to ischemic zones. This report summarizes our initial clinical experience with the procedure. Methods. Excimer transmyocardial laser revascularization was performed in a reversibly ischemic region of the heart in 15 patients. Ischemia and myocardial viability were evaluated by assessment of symptoms and of results of radionuclide single photon emission computed tomography imaging, exercise tolerance testing, and 24-hour Holter monitoring. Results. No adverse events occurred as a result of the laser revascularization, although 1 patient with preoperative ventricular arrhythmias died 48 hours postoperatively as a result of refractory ventricular tachycardia. Angina class decreased significantly from base line values in patients who had undergone the procedure (mean Canadian Cardiovascular Association angina class, 3.5 +/- 0.5 at base line, 1.6 +/- 0.6 at 1 month, 1.5 +/- 0.8 at 3 months, 1.9 +/- 0.9 at 6 months, 1.8 +/- 0.8 at 12 months;p < 0.002), and nitroglycerin requirements were similarly decreased in patients who had undergone laser revascularization (mean g/wk of sublingual nitroglycerin, 19 +/- 4 at baseline, 5 +/- 3 at 1 month, 4 +/- 2 at 3 months, 4 +/- 2 at 6 months, 2 +/- 1 at 12 months;p <0.02). Exercise tolerance testing demonstrated increase in exercise duration compared with base line values (mean minutes, 7.4 +/- 3.1 at base line, 8.0 +/- 3.9 at 1 month, 8.5 +/- 4.4 at 3 months, and 9.0 +/- 3.9 at 12 months;p >0.05);those increases were not large enough to be statistically significant, however. Conclusions. Our data are consistent with the concept that excimer transmyocardial laser revascularization in individuals with significant ischemic heart disease appears to be well tolerated, can be performed safely, and ma

关键词：心绞痛不稳定型/外科学冠心病/放射性核素显像冠心病/外科学运动试验心肌缺血/外科学心肌血管重建术体层摄影术发射型计算机单光子成年人老年人女(雌)性人类男(雄)性中年人

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Predictive value of PAI-1 plasma activity and thallium perfusion imaging for restenosis after percutaneous transluminal angioplasty in clinically asymptomatic patients

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THROMBOSIS AND HAEMOSTASIS 1999年第4期81卷 522-526页

作者： Gottsauner-Wolf, M Sochor, H Hornykewycz, S Beckmann, R Long, I Probst, P Binder, BR Huber, K Univ Vienna Dept Cardiol A-1090 Vienna Austria Univ Vienna Dept Vasc Biol & Thrombosis Res A-1090 Vienna Austria

Background. The main long-term complication of percutaneous transluminal coronary angioplasty (PTCA) is restenosis that occurs in 30-50 percent of all primary successful cases. The purpose of this study was to evaluate the predictive value of changes in plasminogen activator inhibitor-1 (PAI-1) activity and of thallium dipyridamole perfusion imaging performed 3 months after successful angioplasty. All patients were asymptomatic at evaluation. The results of these two noninvasive tests were compared with the angiographic outcome after 6 months. Methods and Patients. Twenty-five patients were included in this prospective study. All patients had single vessel disease, successful angioplasty and were free of clinical symptoms 3 months after angioplasty that would suggest late restenosis. In 12/25 patients (48%) angiographic restenosis (percent diameter stenosis >50%) was determined by follow-up angiography 6 months after angioplasty. PAI-1 plasma activity was determined by a functional titration assay and increase or decrease of PAI-1 plasma activity was evaluated between values obtained before and 3 months after angioplasty. In 7/25 (28%) patients PAI-1 plasma activity increased to more than 90% of pre-angioplasty values. This increase correlated with angiographic restenosis evaluated 6 months after angioplasty (sensitivity 42%, specificity 85%, positive predictive value 71%, and negative predictive value 61%). Tl-201-perfusion imaging was performed 3 months after angioplasty. This test was indicative for subsequent restenosis in 5/25 patients (sensitivity 33%, specificity 100%, positive predictive value 62%, and negative predictive value 100%). In 10/25 (40%) patients at least one of the two non-invasive tests performed 3 months after angioplasty predicted angiographic restenosis at 6 months;the combined use of PAI-1 and Tl-201-perfusion imaging resulted in increased sensitivity (67%) and high specificity (85%). Conclusion. The results of this study indicate that an i

关键词：血管成形术经腔经皮冠状动脉冠心病/血液冠心病/放射性核素显像冠心病/治疗心脏/放射性核素显像纤溶酶原激活物抑制物1/血液试验预期值复发危险因素铊放射性同位素/诊断应用女(雌)性人类男(雄)性中年人

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Predictors of outcome of medically treated patients with left main/three-vessel coronary artery disease by coronary angiography

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AMERICAN JOURNAL OF CARDIOLOGY 1999年第3期83卷 445-+页

作者： Amanullah, AM Heo, J Acio, E Narula, J Iskandrian, AE MCP Hahnemann Sch Med Dept Med Div Cardiol Sch Med Philadelphia PA 19102 USA

This study examined the prognostic value of single-photon emission computed tomography in angiographically high-risk patients with left main and/or 3-vessel coronary artery disease who were treated medically. Multivariable Cox survival analysis revealed the single-photon emission computed tomography score (based on size of perfusion abnormality, multivessel abnormality, left ventricular dilation, and lung uptake) as the only independent predictor of outcome.

关键词：腺苷/投药和剂量腺苷/诊断应用心血管药物/治疗应用冠状血管造影术/方法冠心病/药物疗法冠心病/放射摄影术冠心病/放射性核素显像心电描记术运动试验随访研究注射静脉内观察者偏差回顾性研究铊放射性同位素/投药和剂量铊放射性同位素/诊断应用体层摄影术发射型计算机单光子治疗结果血管舒张药/投药和剂量血管舒张药/诊断应用女(雌)性人类男(雄)性中年人

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Comparison of baseline and low-dose dobutamine technetium-99m sestamibi scintigraphy with low-dose dobutamine echocardiography for predicting functional recovery after revascularization

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AMERICAN JOURNAL OF CARDIOLOGY 2000年第2期86卷 153-157页

作者： Leoncini, M Marcucci, G Sciagrà, R Mondanelli, D Traini, AM Magni, M Frascarelli, F Mennuti, A Dabizzi, RP Misericordia & Dolce Hosp Div Cardiol Prato Italy Misericordia & Dolce Hosp Nucl Med Unit Prato Italy Univ Florence Dept Clin Physiopathol Nucl Med Unit Florence Italy

Injection of sestamibi during low-dose dobutamine (LDD) infusion might improve tracer ability to detect viable myocardium. This study investigated the potential value of LDD technetium-99m sestamibi (sestamibi) single-photon emission computed tomography (SPECT) in predicting functional recovery after revascularization by comparing its results with those of sestamibi SPECT at rest and of LDD echocardiography. Before revascularization, 23 patients with chronic coronary artery disease and regional left ventricular dysfunction underwent sestamibi SPECT at rest and, on a separate day, LDD echocardiography and sestamibi SPECT with tracer injection during LDD infusion. Echocardiography at rest was repeated after revascularization. Semiquantitative sestamibi uptake results (grading from 0 = normal to 4 = absent) and wall motion (grading from 1 = normal to 4 = dyskinesia) were evaluated with a 16-segment model. The ventricular wall was divided into 3 vascular territories. At follow-up, 20 of 32 asynergic vascular territories showed functional recovery, whereas 12 showed no changes. For prediction of functional recovery, LDD SPECT achieved better accuracy than SPECT at rest (87% vs 65%, p <0.05);positive and negative predictive values of LDD SPECT were 90% and 83%, respectively, which was not significantly different from the related LDD echocardiographic values (84% and 69%). Thus, LDD sestamibi SPECT appears to be a promising method for detecting myocardial viability, which provides better accuracy than sestamibi SPECT at rest, and achieves predictive values comparable to those of LDD echocardiography. (C)2000 by Excerpta Medica, Inc.

关键词：强心药/投药和剂量冠心病/放射性核素显像冠心病/外科学冠心病/超声检查多巴酚丁胺/投药和剂量心肌血管重建术试验预期值前瞻性研究放射性药物/诊断应用 99m锝甲氧基异丁基异腈/诊断应用体层摄影术发射型计算机单光子老年人人类男(雄)性中年人

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Radionuclide viability testing: Should it affect treatment strategy in patients with cardiomyopathy and significant coronary artery disease?

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AMERICAN HEART JOURNAL 2003年第5期145卷 758-767页

作者： Bourque, JM Velazquez, EJ Borges-Neto, S Shaw, LK Whellan, DJ O'Connor, CM Duke Univ Med Ctr Div Cardiol Durham NC 27710 USA Duke Univ Med Ctr Dept Internal Med Div Nucl Med Durham NC 27710 USA Duke Univ Med Ctr Dept Radiol Durham NC 27710 USA

Background Ischemic heart failure is a significant source of morbidity and mortality, yet it has an unclear treatment strategy. The assessment of viable myocardium by nuclear imaging studies has shown promise in predicting improvements in ejection fraction and symptoms. However, the relationship of viability to long-term mortality has not been fully established. Methods A number of studies have addressed long-term mortality with nuclear viability imaging in patients with impaired left ventricular function and significant coronary artery disease. These studies were analyzed to determine differences in design, results, trends, and limitations. They were then evaluated by use of qualitative criteria established for prognostic studies. Results Fourteen studies met our criteria. Although the conclusions differed, it appears that patients with viability who undergo revascularization have the highest survival rate, whereas patients with viability who are treated medically love a much lower survival rate. Patients without viability have an intermediate survival rate, regardless of treatment;Several limitations were identified, including a lack of randomization, small sample size, inadequate follow-up, and extensive study protocol and design differences. Conclusions The use of viability testing in patients with heart failure and significant coronary artery disease has shown promise in predicting the long-term mortality rote with treatment allocation. However, there is a need for further study involving larger cohorts with a randomized design, longer periods of follow-up, improved study designs, and identification of referral bias and viability prevalence.

关键词：冠心病/死亡率冠心病/放射性核素显像冠心病/治疗氟脱氧葡萄糖F18/诊断应用心肌血管重建术前瞻性研究放射性药物/诊断应用回顾性研究存活率铊放射性同位素/诊断应用体层摄影术发射型计算机/方法体层摄影术发射型计算机单光子/方法心室功能障碍左/死亡率心室功能障碍左/放射性核素显像心室功能障碍左/治疗女(雌)性人类男(雄)性

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Prognostic value of thallium-201 single-photon emission computed tomography for patients with multivessel coronary artery disease after revascularization (the emory angioplasty versus surgery trial [EAST])

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AMERICAN JOURNAL OF CARDIOLOGY 1999年第12期84卷 1369-1374页

作者： Alazraki, NP Krawczynska, EG Kosinski, AS DePuey, EG Ziffer, JA Taylor, AT Pettigrew, RI Vansant, JP Shaw, LJ Weintraub, WS King, SB Emory Univ Sch Med Dept Radiol Div Nucl Med Atlanta GA 30322 USA Emory Univ Sch Med Dept Biostat Rollins Sch Publ Hlth Atlanta GA 30322 USA Emory Univ Sch Med Dept Med Div Cardiol Atlanta GA 30322 USA

The aim of this study was to investigate the relation between reversible thallium single-photon emission computed tomegraphy (SPECT) myocardial perfusion defects at 1-year after revascularization and quantitative indexes in Emery Angioplasty versus Surgery Trial (EAST) and outcomes 3 years after revascularization in 336 patients. EAST was a randomized controlled trial assessing cardiac outcomes for angioplasty versus bypass surgery for patients with multivessel coronary artery disease. During this prospective trial, a substudy included the evaluation of the prognostic value of reversible defects on quantitative thallium SPECT. At 1-year after revascularization, 336 patients underwent SPECT thallium-201 stress myocardial perfusion and 3-hour delayed imaging. Subsequent events, percutaneous transluminal coronary angioplasty, coronary artery bypass graft surgery, myocardial infarction, and death, were recorded at 3 years. A stress-induced reversible thallium-201 defect was defined using a quantitative index of a reversibility score >30% and severity score >500. Reversible defects were observed more frequently in the percutaneous transluminal coronary angioplasty than in the coronary artery bypass graft surgery treatment groups (46% vs 27%, p <0.001). A fetal of 123 patients had stress-induced, reversible thallium defects and more events than patients with other perfusion results (freedem from ail events was 81.3% vs 94% [p <0.001], and freedom from myocardial infarction and death 88.3% vs 95.5% [p = 0.031]). Quantitative thallium SPECT at 1 year after revascularization risk stratifies patients as to their likelihood of major cardiac outcomes. (C) 1999 by Excerpta Medico, Inc.

关键词：血管成形术经腔经皮冠状动脉死亡原因冠状动脉分流术冠状动脉循环/生理学冠心病/死亡率冠心病/放射性核素显像冠心病/外科学运动试验随访研究移植物闭塞血管/死亡率移植物闭塞血管/放射性核素显像心肌梗死/死亡率心肌梗死/放射性核素显像手术后并发症/死亡率手术后并发症/放射性核素显像预后存活率铊放射性同位素/诊断应用体层摄影术发射型计算机单光子老年人人类中年人

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