Miokardo perfuzijos normalizavimosi po miokardo revaskulizacijos prognozavimas atliekant širdies radionuklidinius tyrimus su nitratais

Antanas Mačys1, Ilona Kulakienė2, Šarūnas Kinduris31 Kauno medicinos universiteto klinikų Širdies, krūtinės ir kraujagyslių chirurgijos klinika,Eivenių g. 2, LT-50009 Kaunas2 Kauno medicinos universiteto klinikų Radiologijos klinika, Kaunas3 Kauno medicinos universiteto Biomedicininių tyrimų institutas,Eivenių g. 4, LT-50009 KaunasEl paštas: [email protected] Įvadas / tikslas Miokardo gyvybingumo vertinimas atliekant širdies radionuklidinius tyrimus su nitratais išlieka nevienareikšmis. Šio darbo tikslas buvo įvertinti priešoperacinį gyvybingą miokardą ir prognozuoti miokardo perfuzijos normalizavimąsi po chirurginės revaskulizacijos radionuklidinės kompiuterinės tomografijos (RKT) su nitratais metodu ligoniams, sergantiems pažengusia išemine širdies liga (IŠL). Ligoniai ir metodai Dvidešimt dviem ligoniams (19 vyrų, 3 moterys; amžiaus vidurkis 63,5 ± 8,8 metai), sergantiems stabiliąja IŠL su sutrikusia kairiojo skilvelio funkcija (vidutinė kairiojo skilvelio išstūmimo frakcija (KS IF) 32,7 ± 11,6%, vidutinis sienelių judėjimo indeksas 1,80 ± 0,54), buvo atliktas širdies RKT tyrimas su 99mTc-MIBI ramybėje ir ramybėje su nitratais (0,5 mg nitroglicerino tabletė po liežuviu) prieš vainikinių jungčių suformavimo operaciją (VJSO) bei ramybėje praėjus 3 ir 6 mėnesiams po jos. Rezultatai VJSO metu 20 ligonių (90,9%) atlikta visiškoji miokardo revaskulizacija. Operacijuojant vienam ligoniui suformuotos vidutiniškai 2,8 ± 0,9 distalinės jungtys. Prieš operaciją suminis ramybės rodmuo (SRR) buvo 20,0 ± 11,3, o suminis ramybės su nitratais rodmuo (SRnR) – 16,81 ± 1,1, raumens sustorėjimas (RS) – 16,1 ± 8,6, sienelės judesys (SJ) – 16 ± 9,1 bei KS IF – 32,7 ± 11,6%. Prognozavome, kad po operacijos SRR bus toks pat, kaip ir prieš operaciją nustatytas SRnR, tačiau pooperacinis SRR po 3 mėnesių buvo 14,6 ± 10,8, o po 6 mėnesių – 13,9 ± 11,0. Taigi, ###Delta(gr)SRR po 3 mėnesių pagerėjo 1,69 karto (###Delta(gr)SRR 5,4 ± 7,8), o po 6 mėnesių – 1,91 karto (###Delta(gr)SRR 6,1 ± 6,9) labiau, negu prognozavome. Norėdami tiksliau prognozuoti pooperacinį miokardo perfuzijos normalizavimąsi, naudojome tiesinės regresijos metodą ir sudarėme tiesinės regresijos lygtį: priešop. SRR = 24,197 – 0,345 × amžius + 0,689 × SRnR (determinacijos koeficientas R2 = 0,707). Pooperaciniu laikotarpiu RS ir SJ statistiškai reikšmingai sumažėjo, t. y. kontrakcija pagerėjo, tiek po 3, tiek po 6 mėnesių (RS – 13,4 ± 8,3 ir 13,7 ± 9,1; SJ – 13,4 ± 8,1 ir 13 ± 8,7), tačiau KS IF padidėjimas nebuvo statistiškai reikšmingas (nuo 32,7 ± 11,6% iki 34,2 ± 14,1% ir 35,4 ± 15,4%). Išvados Miokardo radionuklidinė kompiuterinė tomografija su nitratais naudojant tiesinės regresijos metodą leidžia tiksliai prognozuoti miokardo perfuzijos normalizavimąsi po chirurginės revaskulizacijos. Pagrindiniai žodžiai: išeminė širdies liga, vainikinių jungčių suformavimo operacija, radionuklidinė kompiuterinė tomografija Evaluation of left ventricle ejection fraction impact on cardiac surgery risk stratification by EuroSCORE system Antanas Mačys1, Ilona Kulakienė2, Šarūnas Kinduris31 Kaunas University of Medicine Hospital, Department of Cardiothoracic and Vascular Surgery,Eivenių str. 2, LT-50009 Kaunas, Lithuania2 Kaunas Medical University Hospital, Clinic of Radiology, Kaunas, Lithuania3 Kaunas University of Medicine, Institute for Biomedical Research,Eivenių str. 4, LT-50009 Kaunas, LithuaniaE-mail: [email protected] Background / objective Nitrate-augmented imaging in the evaluation of myocardial viability still remains controversial. The aim of this study was to predict postoperative myocardial perfusion recovery after coronary artery bypass grafting (CABG) using nitrate-enhanced myocardial perfusion SPET in patients with coronary artery disease and severe left ventricular dysfunction. Patients and methods Twenty-two patients (19 male, 3 female; mean age 63.5 ± 8.8 years) with ischaemic cardiomyopathy (left ventricular ejection fraction (LVEF) 32.7 ± 11.6%; wall motion index 1.80 ± 0.54) were referred to baseline-nitrate Sestamibi gated-SPET both before CABG and at 3 and 6-month follow-up. Acquisitions were recorded at baseline after rest-injection of 450–550 MBq of Sestamibi and repeated under nitrates (0.5 mg of nitroglycerin sublingually). Results Twenty patients (90.9%) had complete myocardial revascularization. The mean number of distal anastomoses was 2.8 ± 0.9. Preoperative perfusion summed rest score (SRS) was 20.0 ± 11.3 and summed nitrate enhanced rest score (SRnS) was 16.8 ± 11.1, wall thickening (WT) 16.1 ± 8.6, wall motion (WM) 16 ± 9.1 and LVEF 32.7 ± 11.6%. Post surgery SRS was expected to be of the same value as SRnS and postoperative perfusion improvement score (###Delta(gr)SRS) to be 3.2 ± 3.7. But postoperative SRS proved to be 14.6 ± 10.8 at a 3-month follow-up and 13.9 ± 11.0 at 6-month follow-up. ###Delta(gr)SRS was 1.69 times (###Delta(gr)SRS 5.4 ± 7.8) at 3-month and 1.91 times (###Delta(gr)SRS 6.1 ± 6.9) at 6-month follow up higher than predicted. In order to predict postoperative myocardial perfusion recovery more precisely, the method of linear regression was used with the following regression equation: postop. SRS = 24.197 – 0.345 × age + 0.689 × SRnS (coefficient of determination R2 = 0.707). A significant improvement of regional wall thickening and wall motion were detected at 3 and 6-month follow up (WT = 13.4 ± 8.3 and 13.7 ± 9.1; WM = 13.4 ± 8.1 and 13 ± 8.7). But LVEF improvement was not statistically significant (from 32.7 ± 11.6% to 34.2 ± 14.1% and 35.4 ± 15.4%). Conclusions Nitrate-augmented gated-SPET data combined with a linear regression equation allow a precise prediction of myocardial perfusion recovery after myocardial revascularization. Key words: coronary artery disease, coronary artery bypass grafting, single-photon emission tomograph

Miokardo perfuzijos normalizavimosi po miokardo revaskulizacijos prognozavimas atliekant širdies radionuklidinius tyrimus su nitratais

Antanas Mačys1, Ilona Kulakienė2, Šarūnas Kinduris3 1 Kauno medicinos universiteto klinikų Širdies, krūtinės ir kraujagyslių chirurgijos klinika, Eivenių g. 2, LT-50009 Kaunas 2 Kauno medicinos universiteto klinikų Radiologijos klinika, Kaunas 3 Kauno medicinos universiteto Biomedicininių tyrimų institutas, Eivenių g. 4, LT-50009 Kaunas El paštas: [email protected] Įvadas / tikslas Miokardo gyvybingumo vertinimas atliekant širdies radionuklidinius tyrimus su nitratais išlieka nevienareikšmis. Šio darbo tikslas buvo įvertinti priešoperacinį gyvybingą miokardą ir prognozuoti miokardo perfuzijos normalizavimąsi po chirurginės revaskulizacijos radionuklidinės kompiuterinės tomografijos (RKT) su nitratais metodu ligoniams, sergantiems pažengusia išemine širdies liga (IŠL). Ligoniai ir metodai Dvidešimt dviem ligoniams (19 vyrų, 3 moterys; amžiaus vidurkis 63,5 ± 8,8 metai), sergantiems stabiliąja IŠL su sutrikusia kairiojo skilvelio funkcija (vidutinė kairiojo skilvelio išstūmimo frakcija (KS IF) 32,7 ± 11,6%, vidutinis sienelių judėjimo indeksas 1,80 ± 0,54), buvo atliktas širdies RKT tyrimas su 99mTc-MIBI ramybėje ir ramybėje su nitratais (0,5 mg nitroglicerino tabletė po liežuviu) prieš vainikinių jungčių suformavimo operaciją (VJSO) bei ramybėje praėjus 3 ir 6 mėnesiams po jos. Rezultatai VJSO metu 20 ligonių (90,9%) atlikta visiškoji miokardo revaskulizacija. Operacijuojant vienam ligoniui suformuotos vidutiniškai 2,8 ± 0,9 distalinės jungtys. Prieš operaciją suminis ramybės rodmuo (SRR) buvo 20,0 ± 11,3, o suminis ramybės su nitratais rodmuo (SRnR) – 16,81 ± 1,1, raumens sustorėjimas (RS) – 16,1 ± 8,6, sienelės judesys (SJ) – 16 ± 9,1 bei KS IF – 32,7 ± 11,6%. Prognozavome, kad po operacijos SRR bus toks pat, kaip ir prieš operaciją nustatytas SRnR, tačiau pooperacinis SRR po 3 mėnesių buvo 14,6 ± 10,8, o po 6 mėnesių – 13,9 ± 11,0. Taigi, ###Delta(gr)SRR po 3 mėnesių pagerėjo 1,69 karto (###Delta(gr)SRR 5,4 ± 7,8), o po 6 mėnesių – 1,91 karto (###Delta(gr)SRR 6,1 ± 6,9) labiau, negu prognozavome. Norėdami tiksliau prognozuoti pooperacinį miokardo perfuzijos normalizavimąsi, naudojome tiesinės regresijos metodą ir sudarėme tiesinės regresijos lygtį: priešop. SRR = 24,197 – 0,345 × amžius + 0,689 × SRnR (determinacijos koeficientas R2 = 0,707). Pooperaciniu laikotarpiu RS ir SJ statistiškai reikšmingai sumažėjo, t. y. kontrakcija pagerėjo, tiek po 3, tiek po 6 mėnesių (RS – 13,4 ± 8,3 ir 13,7 ± 9,1; SJ – 13,4 ± 8,1 ir 13 ± 8,7), tačiau KS IF padidėjimas nebuvo statistiškai reikšmingas (nuo 32,7 ± 11,6% iki 34,2 ± 14,1% ir 35,4 ± 15,4%). Išvados Miokardo radionuklidinė kompiuterinė tomografija su nitratais naudojant tiesinės regresijos metodą leidžia tiksliai prognozuoti miokardo perfuzijos normalizavimąsi po chirurginės revaskulizacijos. Pagrindiniai žodžiai: išeminė širdies liga, vainikinių jungčių suformavimo operacija, radionuklidinė kompiuterinė tomografija Evaluation of left ventricle ejection fraction impact on cardiac surgery risk stratification by EuroSCORE system Antanas Mačys1, Ilona Kulakienė2, Šarūnas Kinduris3 1 Kaunas University of Medicine Hospital, Department of Cardiothoracic and Vascular Surgery, Eivenių str. 2, LT-50009 Kaunas, Lithuania 2 Kaunas Medical University Hospital, Clinic of Radiology, Kaunas, Lithuania 3 Kaunas University of Medicine, Institute for Biomedical Research, Eivenių str. 4, LT-50009 Kaunas, Lithuania E-mail: [email protected] Background / objective Nitrate-augmented imaging in the evaluation of myocardial viability still remains controversial. The aim of this study was to predict postoperative myocardial perfusion recovery after coronary artery bypass grafting (CABG) using nitrate-enhanced myocardial perfusion SPET in patients with coronary artery disease and severe left ventricular dysfunction. Patients and methods Twenty-two patients (19 male, 3 female; mean age 63.5 ± 8.8 years) with ischaemic cardiomyopathy (left ventricular ejection fraction (LVEF) 32.7 ± 11.6%; wall motion index 1.80 ± 0.54) were referred to baseline-nitrate Sestamibi gated-SPET both before CABG and at 3 and 6-month follow-up. Acquisitions were recorded at baseline after rest-injection of 450–550 MBq of Sestamibi and repeated under nitrates (0.5 mg of nitroglycerin sublingually). Results Twenty patients (90.9%) had complete myocardial revascularization. The mean number of distal anastomoses was 2.8 ± 0.9. Preoperative perfusion summed rest score (SRS) was 20.0 ± 11.3 and summed nitrate enhanced rest score (SRnS) was 16.8 ± 11.1, wall thickening (WT) 16.1 ± 8.6, wall motion (WM) 16 ± 9.1 and LVEF 32.7 ± 11.6%. Post surgery SRS was expected to be of the same value as SRnS and postoperative perfusion improvement score (###Delta(gr)SRS) to be 3.2 ± 3.7. But postoperative SRS proved to be 14.6 ± 10.8 at a 3-month follow-up and 13.9 ± 11.0 at 6-month follow-up. ###Delta(gr)SRS was 1.69 times (###Delta(gr)SRS 5.4 ± 7.8) at 3-month and 1.91 times (###Delta(gr)SRS 6.1 ± 6.9) at 6-month follow up higher than predicted. In order to predict postoperative myocardial perfusion recovery more precisely, the method of linear regression was used with the following regression equation: postop. SRS = 24.197 – 0.345 × age + 0.689 × SRnS (coefficient of determination R2 = 0.707). A significant improvement of regional wall thickening and wall motion were detected at 3 and 6-month follow up (WT = 13.4 ± 8.3 and 13.7 ± 9.1; WM = 13.4 ± 8.1 and 13 ± 8.7). But LVEF improvement was not statistically significant (from 32.7 ± 11.6% to 34.2 ± 14.1% and 35.4 ± 15.4%). Conclusions Nitrate-augmented gated-SPET data combined with a linear regression equation allow a precise prediction of myocardial perfusion recovery after myocardial revascularization. Key words: coronary artery disease, coronary artery bypass grafting, single-photon emission tomograph

The Role of 18-fluoro-2-deoxy-glucose positron emission tomography/computed tomography as response and prognosis predictive factor of concurrent chemoradiotherapy after induction chemotherapy in head and neck squamous cell carcinoma: A prospective study

Background and objectives: The importance of induction chemotherapy (ICT) followed by concurrent chemoradiotherapy (CCRT) has been re-established in recent years aiming at fewer metastatic sites and better control of the disease. We prospectively studied the possibility of early prediction of overall survival (OS) and progression-free survival (PFS) after 3 cycles of chemotherapy with doxetacel, cisplatin and 5-fluorouracil using 18-fluoro-2-deoxy-glucose positron emission tomography computed tomography (18F-FDG PET/CT) in patients with head and neck squamous cell cancer. To our knowledge, this is the first such study. Materials and Methods: Thirty-five patients were studied. They underwent an 18F-FDG PET/CT examination twice: a day before ICT and 10–14 days after the last cycle of ICT. Tumor-standardized uptake value (SUVmax) and hypermetabolic tumor volume were measured on both scans. The mean age of patients was 56.5 years. Complete responses to CCRT PFS and OS were calculated. Results: Our results showed that a decrease of 30% in the SUVmax value after ICT was a prognostic factor of tumor response to PFS and OS (p = 0.026 and p = 0.021). The groups of patients with a SUVmax between 10 and 14.5 in the primary tumor on a pre-ICT 18F-FDG PET/CT scan had statistically shorter PFS and OS (p = 0.001, p = 0.006) when compared with other groups of patients with SUVmax less than 10 or SUVmax more than 14.5. A decrease of less than 55% of hypermetabolic tumor volume of the primary tumor was significantly related to poor prognosis in PFS and OS (p = 0.033, p = 0.017). Conclusions: SUVmax and hypermetabolic tumor volume measured on 18F-FDG PET/CT after ICT might be valuable prognostic tools for predicting OS and PFS and, thus, for the selection of patients with head and neck cancer who will benefit from CCRT

Static 99mTc-tetrofosmin scintigraphy predicts chemotherapy response in small cell lung cancer

Abstracts annual congress of the EANM, September 30-October 4, 2006, Athens, Greece. ISSN: 1619-7089 (electronic version)Kauno medicinos universiteto klinikosTaikomosios informatikos katedraVytauto Didžiojo universiteta

Prediction and evaluation of surgical treatment results of severe ischemic heart disease

Objectives. To estimate myocardial perfusion in patients with severe coronary artery disease performing before and early after single-photon emission computed tomography coronary artery bypass grafting; to predict results of complete myocardial revascularisation by preoperative perfusion data. Material and methods. Ten patients with stable coronary artery disease and resting left ventricular wall motion abnormalities (mean ejection fraction 31.8±6.4%, mean wall motion index 2.09±0.25) underwent 99mTc-MIBI single-photon emission computed tomography at rest and after nitrate administration before coronary artery bypass grafting and stress-rest single-photon emission computed tomography early (3 and 6 months) after surgery. We estimated myocardial perfusion, postoperative recovery and calculated scintigraphic indices. Results. The mean number of distal anastomoses was 3.0±0.7 and all of the patients had complete myocardial revascularisation. Out of 84 revascularized segments with different degree of myocardial perfusion disorders, 49 (58.3%) segments improved after 3 months and 53 (63.1%) improved after 6 months postoperatively. Amount of segments with fixed perfusion defects increased from 60 preoperatively to 72 after 3 months and 67 after 6 months.[...]

Introduction of Novel Semiquantitative Evaluation of 99mTc-MIBI SPECT Before and After Treatment of Glioma

Background and Objective. There is a need for objective semiquantitative indexes for the evaluation of results of single-photon emission tomography (SPECT) in patients with brain glioma. The aim of this study was to validate the total size index (TSI) and total intensity index (TII) based on technetium-99m-methoxyisobutylisonitrile (99mTc-MIBI) SPECT scans to discriminate the patients with high-grade glioma versus low-grade glioma and to evaluate the changes of viable glioma tissue by the means of TSI and TII after surgery and after radiation treatment. Material and Methods. Thirty-two patients (mean age, 55 years [SD, 18]; 20 men) underwent a 99mTc-MIBI-SPECT scan before surgery. Of these patients, 27 underwent a postoperative 99mTc- MIBI-SPECT scan and 7 patients with grade IV glioma underwent a third 99mTc-MIBI-SPECT scan after radiation treatment. TII that corresponds to the area and intensity of tracer uptake and TSI that corresponds to the area of tracer uptake were calculated before surgery, after surgery, and after radiation treatment. Results. The TII and TSI were found to be valid in discriminating the patients with high-grade versus low-grade glioma with optimal cutoff values of 3.0 and 2.5, respectively. Glioma grade correlated with the preoperative TSI score (r=0.76, P<0.001) and preoperative TII score (r=0.64, P<0.001). There was a significant decrease in the TII and TSI after surgery in patients with grade IV glioma. After radiation treatment, there was a significant increase in the TII in patients with grade IV glioma. Conclusions. TSI and TII were found to be reliable in discriminating the patients with high-grade versus low-grade glioma and allowed for the semiquantitative evaluation of change in viable glioma tissue after surgery and after radiation treatment in patients with grade IV glioma

Positron Emission Tomography in the Diagnosis and Management of Coronary Artery Disease

Cardiac positron emission tomography (PET) and positron emission tomography/computed tomography (PET/CT) are encouraging precise non-invasive imaging modalities that allow imaging of the cellular function of the heart, while other non-invasive cardiovascular imaging modalities are considered to be techniques for imaging the anatomy, morphology, structure, function and tissue characteristics. The role of cardiac PET has been growing rapidly and providing high diagnostic accuracy of coronary artery disease (CAD). Clinical cardiology has established PET as a criterion for the assessment of myocardial viability and is recommended for the proper management of reduced left ventricle (LV) function and ischemic cardiomyopathy. Hybrid PET/CT imaging has enabled simultaneous integration of the coronary anatomy with myocardial perfusion and metabolism and has improved characterization of dysfunctional areas in chronic CAD. Also, the availability of quantitative myocardial blood flow (MBF) evaluation with various PET perfusion tracers provides additional prognostic information and enhances the diagnostic performance of nuclear imaging

Data of coronary angiography and normal stress myocardial perfusion scintigraphy

Objective. To determine informativity of clinical variables in predicting signifi cant coronary artery disease in patients with chest pain and normal stress myocardial perfusion scintigraphy. Material and methods. This study was a retrospective analysis of data of coronary angiography performed in 84 patients with chest pain and normal stress myocardial perfusion scintigraphy during 2000–2007. Single-photon emission computed tomography was performed following a one-day protocol (stress-rest). A 5-point (0–4) scoring system in a 20-segment model was used for interpretation of results. Myocardial perfusion was considered normal if the sum of stress scores was 0 to 3. Results. High pretest probability and informative exercise-terminating criteria were documented in 25% and 45.2% of patients, respectively. Signifi cant coronary artery disease (stenosis ≥75%) was determined in 26 (31%) patients with normal myocardial perfusion scintigraphy: 15 (17.9%) patients had coronary artery disease of a single vessel, 5 (6%) of two vessels, and 6 (7.1%) of three vessels. Univariate logistic regression analysis showed that patients with typical angina and high pretest probability were more likely to have signifi cant stenosis of one to three arteries (odds ratios, 3.8; P=0.008 and 3.43; P=0.023, respectively). Three-vessel disease was more often documented in patients with typical angina (odds ratio, 11.2; P=0.009), high pretest probability (odds ratio, 7.93; P=0.018), and signs of ischemia during exercise test (odds ratio, 6.4; P=0.037). Conclusion. Patients with typical angina, high pretest probability, and signs of ischemia during exercise test have an increased probability of having signifi cant coronary artery disease despite normal stress myocardial perfusion scintigraphy; therefore, this group of patients should undergo coronary angiography

99m-TC-MIBI miokardo perfuzijos tyrimo vertė diferencijuojant kairiojo skilvelio sistolinės visų segmentų disfunkcijos sąlygoto širdies nepakankamumo priežastis

Įvadas. Kairiojo skilvelio sistolinė visų segmentų disfunkcija gali būti sąlygota idiopatinės dilatacinės kardiomiopatijos ir išeminės kilmės kairiojo skilvelio pažeidimo bei pasireikšti panašia širdies nepakankamumo simptomatika. Šio tyrimo tikslas – nustatyti pradinių 99mTc-MIBI ramybės būsenos miokardo perfuzijos defektų diagnostinę vertę diferencijuojant šias dvi širdies nepakankamumo priežastis.Tyrimo medžiaga ir metodai. Išanalizuoti 43 ligonių, kuriems nustatyta kairiojo skilvelio sistolinė visų segmentų disfunkcija (kai kairiojo skilvelio galinis diastolinis diametras buvo ³65 mm, išstūmio frakcija (IF) £40 proc.), echokardiografijos, koronarografijos bei miokardo pozitronų emisinės tomografijos, atliktos su 99mTc-MIBI, duomenys. Idiopatinė dilatacinė kardiomiopatija buvo nustatyta 26 ligoniams (1 grupė), išeminės kilmės širdies nepakankamumas – 17 ligonių (2 grupė). Visiems ligoniams nustatyta miokardo perfuzijos defektų plotas bei laipsnis trijuose vainikinės kraujotakos baseinuose. Rezultatai. Kairės vainikinės arterijos priekinės tarpskilvelinės šakos ir dešinės vainikinės arterijos zonų perfuzijos defektų plotas sergančiųjų idiopatine dilatacine kardiomiopatija buvo mažesnis nei sergančiųjų išeminės kilmės širdies nepakankamumu: 1,43±0,9 ir 2,53±0,53, p=0,001 bei 2,19±0,6 ir 2,82±0,56, p=0,02. Miokardo perfuzijos defektų laipsnis tose pačiose vainikinės kraujotakos zonose buvo taip pat mažesnis: 1,39±0,93 ir 2,59±0,6, p=0,001 bei 1,6±0,46 ir 2,71±0,15, p=0,001. Miokardo perfuzijos defektų plotas ir laipsnis juosiančiosios šakos zonoje buvo panašūs. Naudodamiesi logistinės regresijos analize, išvedėme formulę širdies nepakankamumo priežasčiai prognozuoti: x=2,52MPDPrca+2,47MPDPlad+2,21MPDLrca. Idiopatinę dilatacinę kardiomiopatiją galima prognozuoti kai x£16, o IŠN, kai x>16. [...]Objective. The global left ventricular systolic impairment with left ventricular dilatation can manifest due to idiopathic dilated cardiomyopathy or ischemic heart disease and can present a similar clinical picture of severe heart failure. The aim of our investigation was to assess a differential diagnostic value of resting (99m)Tc-MIBI myocardial perfusion defects in evaluation of the etiology of heart failure. Material and methods. The data of 2D echocardiography, coronary angiography, and myocardial gated single photon emission computed tomography with (99m)Tc-MIBI investigation were evaluated in 43 patients with global left ventricular systolic impairment, characterized by left ventricular end-diastolic diameter of > or =65 mm and ejection fraction of 16. The sensitivity in predicting idiopathic dilative cardiomyopathy was 94.44%, and the specificity was 88.24%. Conclusion. The difference in the area and degree of (99m)Tc-MIBI myocardial perfusion [...]Lietuvos sveikatos mokslų universitetasLietuvos sveikatos mokslų universiteto Medicinos akademijos Kardiologijos instituta