Can Stress Echocardiography Compete with Perfusion Scintigraphy in the Detection of Coronary Artery Disease and Cardiac Risk Assessment?

Aims: The aim of this review was to define the place of stress echocardiography in the context of perfusion scintigraphy for the detection of coronary artery disease (CAD) and the assessment of cardiac risk. Stress echocardiography has the benefits of widespread availability, relatively low cost, portability, absence of radiation, and the determination of the ischaemic threshold. However, the echocardiographic windows are variable, sometimes with poor echogenicity, and interpretation is subjective and requires an adequate learning period. Methods and Results:Diagnostic and prognostic comparisons were focused on studies compari

Dobutamine Stress Test: its role in the diagnosis and functional evaluation of coronary artery disease

Dobutamine stress testing is increasingly used for the diagnosis and functional evaluation of coronary artery disease. High dose dobutamine in conjunction with echocardiography or myocardial perfusion scintigraphy was shown to have a good accuracy for the diagnosis and localization of coronary artery disease. Low-dose dobutamine echocardiography is of potential value in the identification of myocardial viability and the prediction of functional improvement of dyssynergic myocardium spontaneously or after revascularization. However, the clinical utility and limitations of dobutamine stress testing in the diagnosis of myocardial viability and ischemia in some clinical settings have not been investigated. The role of dobutamine stress echocardiography and myocardial perfusion scintigraphy in the diagnosis of peri-infarction ischemia has not been established. The influence of fixed wall motion and perfusion abnormalities on the occurrence of ischemic response in peri-infarction area in patients with infarct-related artery stenosis was not studied. Additionally, it is not known if observation of various changes in contractility from low to high-dose dobutamine may be provide data regarding myocardial viability and ischemia additional to those obtained only at low or high dose

Prognostic stratification of obese patients by stress ^99mTc- tetrofosmin myocardial perfusion imaging

Obesity is a major heath problem associated with increased cardiovascular mortality. There are currently no data to support a role for stress imaging techniques in the risk stratification of obese patients. The aim of this study was to assess the independent value of stress 99mTc-tetrofosmin SPECT in predicting mortality and hard cardiac events in obese patients. Methods: We studied 265 patients with a body mass index greater than 30 kg/m2 by exercise or dobutamine stress 99mTc-tetrofosmin myocardial perfusion tomography. Endpoints during follow-up were cardiac death and death of any cause. Results: The mean patient age (±SD) was 59 ± 10 y, and 110 of the patients were men (42%). The mean body mass index was 37 ± 7 kg/m2. Scan findings were normal in 113 patients (43%). Myocardial perfusion abnormalities were fixed in 62 patients (23%) and reversible in 90 patients (34%). During a mean follow-up period of 5.5 ± 2 y, 41 patients (15%) died. Death was considered cardiac in 22 patients (8%). Nonfatal myocardial infarction occurred in 20 patients (7.5%). The annual cardiac death rate was 0.6% in patients with normal perfusion and 3.3% in patients with abnormal perfusion. Patients with a multiple-vessel distribution of abnormalities had a higher cardiac death rate than did patients with a single-vessel distribution (4.1%vs. 2.5%, P &lt; 0.05). The annual mortality rate was 1.3% in patients with normal perfusion and 4.2% in patients with abnormal perfusion. In a multivariate analysis, perfusion abnormalities were independently predictive of cardiac mortality (risk ratio, 3.2; 95% confidence interval, 1.5-6.7) and overall mortality (risk ratio, 2.7; 95% confidence interval, 1.4-4.3). Conclusion: Stress 99mTc-tetrofosmin myocardial perfusion imaging is a useful tool for predicting cardiac and overall mortality in obese patients.</p

Prognostic stratification of obese patients by stress ^99mTc- tetrofosmin myocardial perfusion imaging

Obesity is a major heath problem associated with increased cardiovascular mortality. There are currently no data to support a role for stress imaging techniques in the risk stratification of obese patients. The aim of this study was to assess the independent value of stress 99mTc-tetrofosmin SPECT in predicting mortality and hard cardiac events in obese patients. Methods: We studied 265 patients with a body mass index greater than 30 kg/m2 by exercise or dobutamine stress 99mTc-tetrofosmin myocardial perfusion tomography. Endpoints during follow-up were cardiac death and death of any cause. Results: The mean patient age (±SD) was 59 ± 10 y, and 110 of the patients were men (42%). The mean body mass index was 37 ± 7 kg/m2. Scan findings were normal in 113 patients (43%). Myocardial perfusion abnormalities were fixed in 62 patients (23%) and reversible in 90 patients (34%). During a mean follow-up period of 5.5 ± 2 y, 41 patients (15%) died. Death was considered cardiac in 22 patients (8%). Nonfatal myocardial infarction occurred in 20 patients (7.5%). The annual cardiac death rate was 0.6% in patients with normal perfusion and 3.3% in patients with abnormal perfusion. Patients with a multiple-vessel distribution of abnormalities had a higher cardiac death rate than did patients with a single-vessel distribution (4.1%vs. 2.5%, P &lt; 0.05). The annual mortality rate was 1.3% in patients with normal perfusion and 4.2% in patients with abnormal perfusion. In a multivariate analysis, perfusion abnormalities were independently predictive of cardiac mortality (risk ratio, 3.2; 95% confidence interval, 1.5-6.7) and overall mortality (risk ratio, 2.7; 95% confidence interval, 1.4-4.3). Conclusion: Stress 99mTc-tetrofosmin myocardial perfusion imaging is a useful tool for predicting cardiac and overall mortality in obese patients.</p

The relationship between serum osteopontin level and parameters of Chronic Kidney Disease – mineral bone disease in patients on regular hemodialysis

Background: Chronic Kidney Disease (CKD) is becoming a major health concern worldwide. For many patients, CKD is associated with substantial morbidity and mortality. Osteopontin (OPN) is an extracellular matrix protein first identified in bone tissue and has pleiotropic functions due to its common expression in the main organs and apparatuses. It is a phosphorylated glycophosphoprotein composed of 314 amino acids, involved in biomineralization and remodeling.Objective: This research aimed to assess the serum level of osteopontin in patients with end-stage renal disease (ESRD) on regular haemodialysis and to correlate osteopontin level in patients with ESRD on hemodialysis with other biomarkers CKD-MBD.Patients &amp; Methods: This Study was conducted on 160 participants that were divided into two groups. Control group included 80 healthy subjects of both sexes, and patients group that included 80 ESRD patients on regular hemodialysis of both sexes. All studied groups were subjected to osteopontin level by enzyme-linked immunosorbent assay (ELISA).Results: Serum osteopontin levels were higher in ESRD patients on regular dialysis than in healthy individuals, where it might have a higher predictive value for CKD development. Also, they were positively correlated with serum phosphorus, serum alkaline phosphatase and serum parathyroid hormone, which are parameters of chronic kidney disease-mineral and bone disorder.Conclusion: Osteopontin may be considered an early marker of chronic kidney disease