Detection of left ventricular hypertrophy by Tc-99 tetrofosmin gated-SPECT.

Introduction. Left ventricular hypertrophy (LVH) is a strong cardiovascular risk factor and an independent major cardiac risk factor for sudden cardiac death, myocardial infarction and stroke. The objective of this study was to determine the specificity, sensitivity, positive predictive value (PPV) Negative Predictive Value (NPV) and accuracy of a Tc-99 gated-SPECT method for detecting LVH. Methods: Patients referred for evaluation of known or suspected CAD, who underwent myocardial perfusion SPECT imaging with Tc-99 Tetrofosmin and who had also an echocardiogram performed within the previous 2 months were prospectively enrolled in the study. The group consisted of 52 patients, 25 men and 27 women, the mean age was 64.5 ± 12 yrs. Results: When the echocardiographic LVH was defined as a mean wall thickness VSTd + PWTd/2 ≥ 11mm, the SPECT method had aspecificity and sensitivity of 91% and 33% respectively, a PPV of 94%, a NPV of 48% and an accuracy of 58%. When the LVH was defined as a thickness to radius ratio (h/r) >0.45, the SPECT Method showed a specificity of 95%, sensitivity of 37% and a PPV of 97% and NPV of 54% with an accuracy of 62% . In Men, when the LVH criteria was a LV Mass >111 g/m2, the specificity and sensitivity for the SPECT method criteria was 100% and 20% respectively with a PPV, NPV and Accuracy of 100%, 45% and 48%. In Women, when LVH was defined as a LV Mass >106 g/m2, the SPECT method had a specificity of 91% and sensitivity of 44%, a PPV of 94%, and NPV and Accuracy of 42% and 63%. If the criteria was a LV Mass >125 g/m2, SPECT showed a specificity and sensitivity of 86% and 30% respectively and a PPV of 85% and a NPV of 64% with an Accuracy of 62 %

Myocardial perfusion in patients with ST depression during the recovery phase of treadmill stress tests

Objectives: To determine the incidence and characteristics of myocardial perfusion abnormalities in patients with ST depression in recovery only, using Tc-99m gated-SPECT. Background: The significance of ST depression in recovery only after exercise treadmill testing (ETT) remains controversial. Such finding has been classified as a false positive, false negative and inconclusive sign of CAD. Methods: Fifty patients who underwent ETT and Tc-99m gated-SPECT and demonstrated ST depression only in recovery were analyzed. The group consisted of 28 men and 22 females, mean age of 61 ± 9 years. Perfusion abnormalities, reverse redistribution, heart/lung ratio, changes in LV cavity size and global function were assessed. Results: The mean peak heart rate (PHR) was 139 ± 18 bpm (88% ± 14 of the predicted maximal heart rate). Sixty % of the patients had evidence of CAD in form of either fixed or reversible perfusion abnormalities. Fixed only perfusion abnormalities were found in 3 patients (6%), seven (14%) had fixed and reversible perfusion defects and 20 (40%) showed ischemia only. Ischemia was observed in the anterior wall in 10 patients, inferior wall in 12, lateral wall in 5, apex in 8 and septum in 1 patient. Mean extent of the perfusion abnormalities were 3.7 segments (out of 20) ± 2. Conclusions: Evidence of CAD was found in 60% of the patients with ST depression in recovery only. The most common finding was ischemia in 54% of the patients, and the anterior and inferior walls were most frequently involved. The mean extent of myocardial involvement was moderate, which implies prognostic significance

Impact of COVID-19 on cardiovascular testing in the United States versus the rest of the world

Objectives: This study sought to quantify and compare the decline in volumes of cardiovascular procedures between the United States and non-US institutions during the early phase of the coronavirus disease-2019 (COVID-19) pandemic. Background: The COVID-19 pandemic has disrupted the care of many non-COVID-19 illnesses. Reductions in diagnostic cardiovascular testing around the world have led to concerns over the implications of reduced testing for cardiovascular disease (CVD) morbidity and mortality. Methods: Data were submitted to the INCAPS-COVID (International Atomic Energy Agency Non-Invasive Cardiology Protocols Study of COVID-19), a multinational registry comprising 909 institutions in 108 countries (including 155 facilities in 40 U.S. states), assessing the impact of the COVID-19 pandemic on volumes of diagnostic cardiovascular procedures. Data were obtained for April 2020 and compared with volumes of baseline procedures from March 2019. We compared laboratory characteristics, practices, and procedure volumes between U.S. and non-U.S. facilities and between U.S. geographic regions and identified factors associated with volume reduction in the United States. Results: Reductions in the volumes of procedures in the United States were similar to those in non-U.S. facilities (68% vs. 63%, respectively; p = 0.237), although U.S. facilities reported greater reductions in invasive coronary angiography (69% vs. 53%, respectively; p < 0.001). Significantly more U.S. facilities reported increased use of telehealth and patient screening measures than non-U.S. facilities, such as temperature checks, symptom screenings, and COVID-19 testing. Reductions in volumes of procedures differed between U.S. regions, with larger declines observed in the Northeast (76%) and Midwest (74%) than in the South (62%) and West (44%). Prevalence of COVID-19, staff redeployments, outpatient centers, and urban centers were associated with greater reductions in volume in U.S. facilities in a multivariable analysis. Conclusions: We observed marked reductions in U.S. cardiovascular testing in the early phase of the pandemic and significant variability between U.S. regions. The association between reductions of volumes and COVID-19 prevalence in the United States highlighted the need for proactive efforts to maintain access to cardiovascular testing in areas most affected by outbreaks of COVID-19 infection

Valoración de la función ventricular con tomografía computarizada de 16 detectores (TCMD-16): Correlación con resonancia magnética cardiovascular

La evaluación de parámetros funcionales del VI tienen implicaciones tanto pronosticas como terapéuticas en pacientes con cardiopatías. La angiotomografía coronaria con TCMD-16 permite obtener imágenes de la anatomía coronaria y por su alta resolución temporal y espacial, obtener datos de la función ventricular izquierda. El objetivo de este estudio fue correlacionar el uso de la TCMD-16 para la valoración de parámetros de función ventricular izquierda, utilizando la RM como estándar de referencia. Métodos: Resonancia: Se utilizó un resonador GE Cvl, de 1.5 Teslas optimizado para aplicaciones cardiovasculares. Mediante una secuencia de precesión rápida de estado fijo de manera sincronizada al ECG, (SSFP, Grosor de corte de 10 mm, Flip Angle 45, FOV 36 cm., NEX 1, Frecuencia 256, Fase 128, FOV parcial 0.75, 16 VPS), se obtuvieron de 6 a 8 imágenes en eje corto desde la base hasta el ápex del VI. Tomografía: Con un TCMD-16 GE Lightspeed sincronizado al ECG, se obtuvieron imágenes del corazón tras la administración de 80 mis. de contraste no-iónico. Las imágenes fueron reconstruidas para obtener de 6 a 8 cortes de manera similar a la RM. Ambos estudios fueron independientemente analizados por 2 operadores quienes obtuvieron los parámetros ventriculares. Las comparaciones fueron analizadas mediante la prueba de t de Student pareada y las correlaciones mediante regresión linear, considerando significativo cuando p<0.05. Resultados: Se evaluaron 20 pacientes consecutivos con TAC y RM cardiaca, 18 del sexo masculino, con una edad promedio de 52 ± 15 años. No hubo diferencia significativa entre las mediciones por TAC y por RM cardiaca del volumen telediastólico (VTD) y telesistólico (VTS) del VI, ni en el volumen latido (VL), la masa ventricular izquierda o la fracción de expulsión del VI (FEVI). Conclusión: Los resultados demuestran una alta correlación entre los parámetros de función ventricular sistólica clínicamente relevantes evaluados por TAC y por RM cardiaca. Esto sugiere que puede evaluarse la función ventricular en forma satisfactoria al mismo tiempo que se estudian estructuralmente las coronarias mediante el TCMD-16

Proinflammatory Cytokines Are Soluble Mediators Linked with Ventricular Arrhythmias and Contractile Dysfunction in a Rat Model of Metabolic Syndrome

Metabolic syndrome (MS) increases cardiovascular risk and is associated with cardiac dysfunction and arrhythmias, although the precise mechanisms are still under study. Chronic inflammation in MS has emerged as a possible cause of adverse cardiac events. Male Wistar rats fed with 30% sucrose in drinking water and standard chow for 25–27 weeks were compared to a control group. The MS group showed increased weight, visceral fat, blood pressure, and serum triglycerides. The most important increases in serum cytokines included IL-1β (7-fold), TNF-α (84%), IL-6 (41%), and leptin (2-fold), the latter also showing increased gene expression in heart tissue (35-fold). Heart function ex vivo in MS group showed a decreased mechanical performance response to isoproterenol challenge (ISO). Importantly, MS hearts under ISO showed nearly twofold the incidence of ventricular fibrillation. Healthy rat cardiomyocytes exposed to MS group serum displayed impaired contractile function and Ca2+ handling during ISO treatment, showing slightly decreased cell shortening and Ca2+ transient amplitude (23%), slower cytosolic calcium removal (17%), and more frequent spontaneous Ca2+ release events (7.5-fold). As spontaneous Ca2+ releases provide a substrate for ventricular arrhythmias, our study highlights the possible role of serum proinflammatory mediators in the development of arrhythmic events during MS

Cirugía intrauterina para la corrección de espina bífida: a propósito del primer caso exitoso reportado en el Perú

We report the first successful case of fetal surgery for spina bifida repair in Peru. A pregnant woman was referred to our center at 23 weeks’ gestation because of prenatal diagnosis of spina bifida. We formed a multidisciplinary international team with the goal of performing the first open intrauterine surgery in Peru. We performed a successful intrauterine surgery at 25 weeks of gestation and a healthy infant was born by cesarean section at 37 weeks of gestation. We demonstrated the feasibility of this complex intrauterine surgery in our local setting.Se presenta el caso de una primigesta de 22 semanas de edad gestacional referida a nuestro servicio con el diagnóstico prenatal de espina bífida abierta. Se coordinó un equipo multidisciplinario nacional e internacional en el lapso de tres semanas para llevar a cabo la primera cirugía intrauterina de corrección de espina bífida. La operación se realizó a las 25 semanas y el parto por cesárea se produjo a las 37 semanas, obteniéndose buenos resultados a corto plazo. Demostramos que esta cirugía, altamente especializada y que involucra un gran equipo multidisciplinario, se puede realizar exitosamente en nuestro país

Reduction of cardiac imaging tests during the COVID-19 pandemic: The case of Italy. Findings from the IAEA Non-invasive Cardiology Protocol Survey on COVID-19 (INCAPS COVID)

Background: In early 2020, COVID-19 massively hit Italy, earlier and harder than any other European country. This caused a series of strict containment measures, aimed at blocking the spread of the pandemic. Healthcare delivery was also affected when resources were diverted towards care of COVID-19 patients, including intensive care wards. Aim of the study: The aim is assessing the impact of COVID-19 on cardiac imaging in Italy, compare to the Rest of Europe (RoE) and the World (RoW). Methods: A global survey was conducted in May–June 2020 worldwide, through a questionnaire distributed online. The survey covered three periods: March and April 2020, and March 2019. Data from 52 Italian centres, a subset of the 909 participating centres from 108 countries, were analyzed. Results: In Italy, volumes decreased by 67% in March 2020, compared to March 2019, as opposed to a significantly lower decrease (p &lt; 0.001) in RoE and RoW (41% and 40%, respectively). A further decrease from March 2020 to April 2020 summed up to 76% for the North, 77% for the Centre and 86% for the South. When compared to the RoE and RoW, this further decrease from March 2020 to April 2020 in Italy was significantly less (p = 0.005), most likely reflecting the earlier effects of the containment measures in Italy, taken earlier than anywhere else in the West. Conclusions: The COVID-19 pandemic massively hit Italy and caused a disruption of healthcare services, including cardiac imaging studies. This raises concern about the medium- and long-term consequences for the high number of patients who were denied timely diagnoses and the subsequent lifesaving therapies and procedures