Inter-institution preference-based variability of ejection fraction and volumes using quantitative gated SPECT with Tc-99m tetrofosmin : A multi-center study involving 106 hospitals

Purpose Inter-institution reproducibility of gated SPECT quantification based on institutional preferences was evaluated. This sort of variability is crucial for a multicentre study when many hospitals are involved. Methods A total of 106 institutes participated in this study and were grouped according to their use of five workstation types. Fifteen sets of 99mTc-tetrofosmin gated projection images with normal ejection fraction (EF) (70%, group A, n=5), borderline low EF (50%, group B, n=5) and low EF with large perfusion defects (30%, group C, n=5) were prepared. The projection images were processed by QGS software in each institute based on its own routine settings. Based on 318 QGS results, the reproducibility of EF and volumes was analysed for each group and workstation. Results The reproducibility of EF was good in 14 of 15 cases, showing a standard deviation (SD) of <3.6%, and the coefficient of variance of the end-diastolic volume (EDV) was <9.3% in all cases. When the deviation from the average value was analysed, the difference between EF at each institute and the average EF of the workstation (dEF) showed an SD of 2.2–3.7% for each group. The ratio of the EDV divided by the average EDV (rEDV) showed an SD of 0.061–0.069 for each group. One case in group C that had a large anterior defect with low EF showed bimodal EF distribution in one of the five workstations. The SD of EF was workstation dependent, owing to the SPECT reconstruction conditions. Conclusion The reproducibility in EF and volumes within a workstation was good, even though the gated SPECT preferences varied. This reproducibility study supports the use of gated SPECT as a standard of ventricular function in multicentre studies.© Springer-Verlag 1999

Prediction of Cardiac Mortality and Events by Myocardial Perfusion Imaging: Differences between Japanese and American Populations

金沢大學医薬保健研究域医学系Cardiac diseases are one of the major causes of death both in Western countries and in Japan. Based on various clinical information, identification of myocardial ischemia and contractile function plays a major role in predicting serious cardiac events of death and acute coronary syndromes. Currently, myocardial perfusion imaging provides both kinds of information, and clinical follow-up studies have been performed in the U.S., Europe and Japan. Due to our involvement in a Japanese multi-center prognostic study, we have found similarities and differences between Western and Japanese populations. The most important predictors of cardiac events are myocardial perfusion abnormality and ventricular function. The importance of diabetes and chronic kidney disease should be also emphasized. The trends of cardiovascular events should be carefully investigated because of westernized diets and lifestyles in addition to current progress of therapeutic strategy

Prognostic table for predicting major cardiac events based on J-ACCESS investigation

金沢大学医薬保健研究域医学

Cardiac 123I-MIBG Imaging for Clinical Decision Making: 22-Year Experience in Japan

Cardiac neuroimaging with (123)I-metaiodobenzylguanidine ((123)I-MIBG) has been officially used in clinical practice in Japan since 1992. The nuclear cardiology guidelines of the Japanese Circulation Society, revised in 2010, recommended cardiac (123)I-MIBG imaging for the management of heart failure (HF) patients, particularly for the assessment of HF severity and prognosis of HF patients. Consensus in North American and European countries regarding incorporation into clinical practice, however, has not been established yet. This article summarizes 22 y of clinical applications in Japan of (123)I-MIBG imaging in the field of cardiology; these applications are reflected in cardiology guidelines, including recent methodologic advances. A standardized cardiac (123)I-MIBG parameter, the heart-to-mediastinum ratio (HMR), is the basis for clinical decision making and enables common use of parameters beyond differences in institutions and studies. Several clinical studies unanimously demonstrated its potent independent roles in prognosis evaluation and risk stratification irrespective of HF etiologies. An HMR of less than 1.6-1.8 and an accelerated washout rate are recognized as high-risk indicators of pump failure death, sudden cardiac death, and fatal arrhythmias and have independent and incremental prognostic values together with known clinical variables, such as left ventricular ejection fraction and brain natriuretic peptide. Another possible use of this imaging technique is the selection of therapeutic strategy, such as pharmacologic treatment and nonpharmacologic treatment with an implantable cardioverter-defibrillator or cardiac resynchronization device; however, this possibility remains to be investigated. Recent multiple-cohort database analyses definitively demonstrated that patients who were at low risk for lethal events and who were defined by an HMR of greater than 2.0 on (123)I-MIBG studies had a good long-term prognosis. Future investigations of cardiac (123)I-MIBG imaging will contribute to better risk stratification of low-risk and high-risk populations, to the establishment of cost-effective use of this imaging technique for the management of HF patients, and to worldwide acceptance of this imaging technique in clinical cardiology practice. © 2015 by the Society of Nuclear Medicine and Molecular Imaging, Inc

Relationships between Spirituality, Health Self-efficacy and Health Locus of Control in the Elderly

The purpose of this study was to clarify the relationships between spirituality, health locus of control and health self-efficacy. A questionnaire survey was administered to elderly people living at home, and 696 valid responses were collected and analyzed. The subjects\u27 mean age was 74.0±5.2 years. Using a causal model to analyze the relationship between spirituality, health locus of control and health self-efficacy, data fitness to the model was evaluated by structural equation modeling. As a result, the validity of a model in which health locus of control affects health self-efficacy and spirituality while health self-efficacy enhances spirituality was confirmed. However, the nature of the relationship between health locus of control and spirituality and health self-efficacy differed according to the characteristics of health locus of control. In addition, there was a positive correlation between health self-efficacy and spirituality regarding "significance and objectives of life", "harmony with others", "belief", and "union with nature". In order to support for the spirituality of the elderly, the author suggests that strategies to improve the health self-efficacy for basic health control behavior are useful

Identification of Myocardial Damage in Systemic Sclerosis: A Nuclear Cardiology Approach

Myocardial involvement is an important prognostic factor in patients with systemic sclerosis, and early diagnosis and staging of the disease have been sought after. Since myocardial damage is characterized by connective tissue disease, including fibrosis and diffuse vascular lesions or microcirculation, nuclear myocardial perfusion imaging has been a promising option for evaluating myocardial damages in early stages. In addition to the conventional stress-rest perfusion imaging, the current use of quantitative electrocardiographic gated imaging has contributed to more precise evaluation of cardiac perfusion, ventricular wall motion, and diastolic function, all of which have enhanced diagnostic ability of evaluating myocardial dysfunction. Abnormal sympathetic imaging with Iodine-123 metaiodobenzylguanidine might be another option for identifying myocardial damage. This paper deals with approaches from nuclear cardiology to detect perfusion and functional abnormality as an early sign of myocardial involvement as well as possible prognostic values in patients with abnormal imaging results. The role of nuclear cardiology in the era of multiple imaging modalities is discussed

123I MIBG: Are There Any Additional Roles in Clinical Practice of Heart Failure?

Since the advent of 123I-meta-iodobenzylguanidine（MIBG）in 1990s, it has been widely used in clinical practice in Japan. Based on the wide range of clinical applications, 123I MIBG is now incorporated in Japanese Circulation Society)s guidelines of nuclear cardiology. The major role of 123I MIBG has been in determination of severity and prognostic evaluation of heart failure. In addition, assessment of the treatment by various types of medications has been the second major role of 123 I MIBG imaging. Compared with the conventional clinical parameters of heart failure, additive values of 123I MIBG depend on how it reflects the patient condition more accurately, and how it relates to improvement in the patient outcome. 123 I MIBG is also now available for cardiac imaging in the USA and Europe. Unified methodology and further studies focusing on clinical decision-making are the next required steps to document MIBG utility