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

Successful pharmaco-invasive approach using a lower alteplase dose and VA-ECMO support in high-risk pulmonary embolism: case report

Despite the elevated mortality rates associated with high-risk pulmonary embolism (PE), this condition remains understudied. Data regarding the effectiveness and safety of invasive therapies such as venoarterial extracorporeal membrane oxygenation (VA-ECMO) in this patient population remains controversial. Here, we present the case of a 61-year-old male with high-risk PE associated with refractory cardiac arrest and cardiogenic shock who underwent a combination of extracorporeal cardiopulmonary resuscitation with VA-ECMO and pharmaco-invasive therapy (mechanical thrombi fragmentation plus lower alteplase dose), resulting in successful pulmonary reperfusion. After a prolonged in-hospital stay, the patient was discharged in stable condition

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