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

Venous Thromboembolism After Removal of Retrievable Inferior Vena Cava Filters

The purpose of this study was to examine the incidence of new or recurrent venous thromboembolism (VTE) after retrieval of inferior vena cava (IVC) filters and risk factors associated with such recurrence. Between March 2001 and September 2008, at our institution, implanted retrievable vena cava filters were retrieved in 76 patients. The incidence of new or recurrent VTE after retrieval was reviewed and numerous variables were analyzed to assess risk factors for redevelopment of VTE after filter retrieval. In 5 (6.6%) of the 76 patients, redevelopment or worsening of VTE was seen after retrieval of the filter. Three patients (4.0%) had recurrent deep venous thrombosis (DVT) in the lower extremities and 2 (2.6%) had development of pulmonary embolism, resulting in death. Although there was no significant difference in the incidence of new or recurrent VTE related to any risk factor investigated, a tendency for development of VTE after filter retrieval was higher in patients in whom DVT in the lower extremities had been so severe during filter implantation that interventional radiological therapies in addition to traditional anticoagulation therapies were required (40% in patients with recurrent VTE vs. 23% in those without VTE; p = 0.5866 according to Fisher’s exact probability test) and in patients in whom DVT remained at the time of filter retrieval (60% in patients with recurrent VTE vs. 37% in those without VTE; p = 0.3637). In conclusion, new or recurrent VTE was rare after retrieval of IVC filters but was most likely to occur in patients who had severe DVT during filter implantation and/or in patients with a DVT that remained at the time of filter retrieval. We must point out that the fatality rate from PE after filter removal was high (2.6%)

Normal limits of ejection fraction and volumes determined by gated SPECT in clinically normal patients without cardiac events: A study based on the J-ACCESS database

金沢大学大学院医学系研究科がん制御学Purpose: Quantitative gated single-photon emission computed tomography (SPECT) is known to have high accuracy and precision for measurement of the principal cardiac functional parameters. We hypothesised that normal values for EF and LV volumes may differ among nationalities, and that optimal threshold values specific to the study population are required. Methods: Among 4,670 consecutively registered patients for a J-ACCESS (Japanese investigation regarding prognosis based on gated SPECT) study from 117 hospitals, a total of 268 (149 women, 119 men) were selected who had no baseline cardiac diseases and had experienced no cardiac events during the preceding 3-year period. A gated SPECT study was performed with 99mTc-tetrofosmin and analysed with Cedars Sinai Medical Center\u27s quantitative gated SPECT (QGS) software. The results in respect of ejection fraction (EF), end-diastolic volume (EDV), end-systolic volume (ESV) and stroke volume (SV), and EDV, ESV and SV normalised by body surface area (EDVI, ESVI and SVI), were calculated and summarised to obtain normal limits. Results: EF for women and men was 74 ± 9% and 63 ± 7%, respectively (p < 0.0001). EDV, ESV and SV were significantly smaller in women than in men. Based on multiple regressions for linear models, the primary and secondary predictors of EF, EDVI, ESVI were gender and age. By stepwise multiple regression analysis, a statistically significant third predictor for EDV, ESV, SV and SVI was body weight. No colinearity was found between age and body weight. Important factors for the studied Japanese population included a high incidence of small hearts in women and the relatively advanced age of the population (the mean age ±SD was 64.1 ± 10.0 years for women and 60.9 ± 11.7 years for men). Conclusion: EF and volumes determined by gated SPECT with QGS were significantly affected by gender and age, with body weight as a third predictor for volumes. Moreover, the normal limits were so specific for the population studied that standards appropriate for the study in question should be utilised. © 2007 Springer-Verlag

Prognostic value of myocardial perfusion and ventricular function in a Japanese multicenter cohort study (J-ACCESS): the first-year total events and hard events

金沢大学医薬保健研究域医学系Objective: To determine the prognostic value of myocardial ischemia, function and coronary risk factors on total and hard cardiac events using myocardial perfusion imaging in a Japanese population. Methods: A prospective cohort study was performed in 117 Japanese hospitals, each with a nuclear cardiology facility. A total of 4,031 patients with suspected or confirmed ischemic heart disease were registered. The patients were followed up for a year to investigate total and hard events, and those who had any events were followed up for 3 years to evaluate subsequent hard events. A stress-rest gated myocardial perfusion study was performed with 99mTc-tetrofosmin using gated single-photon emission computed tomography (SPECT) and analyzed by semi-quantitative scores. Results: During the 1-year follow-up period, 263 (6.5%) patients had total events comprising all-cause death, non-fatal myocardial infarction (MI), heart failure, unstable angina, angina pectoris and coronary revascularization. Cardiac death occurred in 23 patients (0.6%) and non-fatal MI in 11 (0.3%). Among patients with ejection fraction (EF) of <45% and a summed difference score (SDS) of ≥2, 18.7% (2.4% for cardiac death and 0.6% for non-fatal MI) experienced total events compared with 3.9% (0.3% for cardiac death and 0.2% for non-fatal MI; P < 0.0001) of those with EF ≥ 45% and SDS < 2. Multivariate analysis identified EF, SDS, age, history of revascularization and diabetes as significant predictors of all events, while the significant predictors were age and EF for hard events. When the patients who had heart failure in the first year were followed up, 9 of 41 (22.0%) experienced cardiac death in the subsequent 3-year follow-up period. Conclusions: Myocardial ischemia defined by SDS and ventricular function were the main predictors of total events despite the relatively low incidence of hard events in this Japanese population. In patients with cardiac events in a year, closer attention should be paid to subsequent hard events particularly in patients with heart failure. © 2009 The Japanese Society of Nuclear Medicine

Metabolic syndrome is not a predictor for cardiovascular events in Japanese patients with diabetes mellitus asymptomatic for coronary artery disease: A retrospective analysis of the J-ACCESS-2 study

Purpose: Patients with metabolic syndrome (MetS) have potentially higher risk for cardiovascular events. The aim of this study was to evaluate the effect of MetS on cardiac events in type-2 diabetic patients asymptomatic for coronary artery disease (CAD) in a Japanese population. Methods: A total of 485 patients from a J-ACCESS-2 investigation with stress-gated myocardial perfusion imaging (MPI) and quantitative-gated MPI analysis were examined. Cardiovascular hard events (cardiac death and acute coronary syndrome) and total events during a 3-year follow-up were analyzed. Results: The MetS group (n = 229) had higher incidence of hypertension, dyslipidemia, and ventricular dilatation than the non-MetS group (n = 256). The hard events were 8 and 12 for the MetS and non-MetS groups (P = n.s.), and total events were 31 and 31 for each of these groups, respectively (P = n.s.). Significant variables related to total cardiovascular events included age, current smoking, insulin use, total cholesterol, ejection fraction, summed stress score ≥ 9, and summed difference score ≥ 2. Cox proportional hazard analysis and Kaplan-Meier survival analysis showed that only the summed stress score was related to total events (P = .01), and the presence and the number of items for MetS criteria were not. Conclusion: In patients with type 2 diabetes asymptomatic for CAD, cardiovascular events and ischemia are as common in diabetic patients without MetS as in those with MetS. A high MPI defect score is related to total events including cardiac and cerebrovascular events. © 2012 American Society of Nuclear Cardiology

Cardiovascular events in Japanese asymptomatic patients with type 2 diabetes: a 1-year interim report of a J-ACCESS 2 investigation using myocardial perfusion imaging

金沢大学医薬保健研究域医学系Purpose Diabetic patients have a high risk for cardiovascular events. The role of myocardial perfusion imaging was investigated in asymptomatic diabetic patients to evaluate short-term prognosis in a Japanese population. Methods A total of 506 asymptomatic patients ≥50 years of age who had carotid artery maximum intima-media thickness ≥1.1 mm, urinary albumin excretion of ≥30 mg/g creatinine, with additional criteria of abdominal obesity, low HDL cholesterol, high triglyceride level, and hypertension were enrolled and followed up over a 3-year period. Gated SPECT with stress-rest protocol was performed and analyzed by summed defect scores and QGS software. One-year cardiovascular events were analyzed. Results Myocardial ischemia was observed in 17% of patients, and abnormal perfusion findings of ischemia and/or scar were observed in 32% of patients. By the end of the 1-year follow-up, 33 (6.5%) cardiovascular events occurred including 6 all-cause deaths. Patients with summed stress score (SSS) >8 had a higher incidence of either death or cardiovascular events. Event-free survival rates for SSS 0–3, 4–8, 9–13, and ≥14 were 0.96, 0.95, 0.82, and 0.76, respectively. Multivariate Cox regression analysis showed that significant variables were SSS, history of cerebrovascular accident, and electrocardiographic abnormality at rest. Conclusion The 1-year interim summary showed that cardiovascular events were significantly higher in patients with SPECT abnormality, although hard cardiac event rate was relatively low. Targeted treatment strategy is required for asymptomatic but potentially high-risk diabetic patients

Age is not a limiting factor for brachytherapy for carcinoma of the node negative oral tongue in patients aged eighty or older

<p>Abstract</p> <p>Background</p> <p>To examine the role of brachytherapy for aged patients 80 or more in the trend of rapidly increasing number.</p> <p>Methods</p> <p>We examined the outcomes for elderly patients with node negative oral tongue cancer (T1-3N0M0) treated with brachytherapy. The 21 patients (2 T1, 14 T2, and 5 T3 cases) ranged in age from 80 to 89 years (median 81), and their cancer was pathologically confirmed. All patients underwent definitive radiation therapy, with low dose rate (LDR) Ra-226 brachytherapy (n = 4; median 70Gy), with Ir-192 (n = 12; 70Gy), with Au-198 (n = 1) or with high dose rate (HDR) Ir-192 brachytherapy (n = 4; 60 Gy). Eight patients also underwent external radiotherapy (median 30 Gy). The period of observation ranged from 13 months to 14 years (median 2.5 years). We selected 226 population matched younger counterpart from our medical chart.</p> <p>Results</p> <p>Definitive radiation therapy was completed for all 21 patients (100%), and acute grade 2-3 mucositis related to the therapy was tolerable. Local control (initial complete response) was attained in 19 of 21 patients (90%). The 2-year and 5-year local control rates were 91%, (100% for T1, 83% for T2 and 80% for T3 tumors after 2 years). These figures was not inferior to that of younger counterpart (82% at 5-year, n.s.). The cause-specific survival rate was 83% and the regional control rate 84% at the 2-years follow-up. However, 12 patients died because of intercurrent diseases or senility, resulting in overall survival rates of 55% at 2 years and 34% at 5 years.</p> <p>Conclusion</p> <p>Age is not a limiting factor for brachytherapy for appropriately selected elderly patients, and brachytherapy achieved good local control with acceptable morbidity.</p