Sternal nonunion on bone scintigraphy: A case report

Sternal non-union is a severe complication of sternotomy closure following open heart surgeries. Healing problems typically occur in 0.3% to 5% of patients. Technetium-99m methylene diphosphonate (99mTc-MDP) bone scintigraphy has been used to assess bone nonunion to predict the healing response for proper management. In this report, we present the case of a marked sternal nonunion following coronary artery bypass graft (CABG), using radionuclide bone scintigraphy

The role of gated myocardial perfusion scintigraphy (GMPS) in myocarditis: A case report and review of the literature

Acute myocarditis is one of the most challenging diagnoses and treatments in cardiology. The acute viral myocarditis diagnosis is usually based on high suspicion, history taking, and physical examination. Likewise, the use of chest radiography, electrocardiography (ECG), and echocardiography is helpful in making a final diagnosis, but all are non-specific. In addition, in imaging query, magnetic resonance imaging (MRI) depicts some degree of cardiac inflammation in the course of myocarditis. Myocardial perfusion imaging (MPI) has also been shown to be useful in diagnosis, and this noninvasive technique diminishes the need for myocardial biopsy. The current study presents the diagnostic and prognostic role of MPI in a 25-year-old patient with suspected myocarditis. The patient underwent gated-technetium-99m-lablled, methoxyisobutyl isonitrile, single photon emission computed tomography (Gated 99mTc-MIBI SPECT) that showed nonheterogeneous absorption with remarkable decreased radiotracer uptake in the myocardium in both stress and rest phases. In addition, the gated mode demonstrated decreased wall motion and thickening of the myocardium with a sum motion score (SMS) of 28, a sum thickening score (STS) of 15, and a measured LVEF of 34%. The study concludes that 99mTC-MIBI SPECT imaging is a useful modality in the preparation of supplementary diagnostic and prognostic information in viral myocarditis. Copyright © 2011 Via Medica

The association of rate pressure product (RPP) and myocardial perfusion imaging (MPI) findings: A preliminary study

Introduction: The product of heart rate and systolic blood pressure, termed as rate-pressure product (RPP), is a very reliable indicator of myocardial oxygen demand and is widely used clinically. There have been previous attempts to describe the relationship between RPP and the onset of pain in angina pectoris. The current study aimed to evaluate the association between RPP results and scan findings.Materials and methods: In total, 497 patients with suspected coronary artery disease (CAD) underwent gated, single-photon emission computed tomography (SPECT) imaging with dipyridamole, exercise, or dobutamine stress, and were included in this study. Baseline and maximum heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), and electrocardiogram (ECG) results were recorded. The rate-pressure product (RPP) was calculated as the product of heart rate and systolic arterial pressure for both baseline and maximum measures. The difference between the RPP max and the basal RPP is known as the RPP reserve. Researchers also obtained semi-quantitative analyses of myocardial perfusion imaging (MPI), using gated software, demographic information, risk factors of CAD, and pretest likelihoods of CAD using nomograms.Result: Four hundred and ninety-seven cases, including 426 patients with dipyridamole stress, 59 with exercise stress, and 12 with dobutamine stress, underwent myocardial perfusion imaging. Scan results were positive in 194 (45.5) and negative in 232 (54.5) patients with dipyridamole stress. In patients with exercise stress, the scan was positive in 24 (40.7) cases and negative in 35 (59.3) cases. In dobutamine stressed patients, the scan was positive in 6 (50) cases and negative in the 6 remaining cases. Dipyridamole stress resulted in a significant difference between HR at rest and at maximum (28.95 ± 24.53, p-value<0.0001), between systolic BP at rest and maximum (6.75 ± 12.50, p-value<0.0001) and between diastolic BP at rest and maximum (1.45 ± 5.80; p-value<0.0001). There was a significant correlation between sum stress scores (SSS) and reserved RPP (r= -0.12, p-value<0.001) which, in dipyridamole patients, was r=-0.18, p-value=0.0001). In addition, there was a significant association between reserved RPP and risk of CAD (p-value<0.001). In the patients with dipyridamole stress, the ejection fraction (EF) change (odds ratio =0.92; 95 CI: 0.86-0.98; p=0.01), reserve RPP (odds ratio =1.00; 95 CI: 1.00-1.00; p=0.04), risk of CAD (odds ratio =5.80; 95 CI: 3.21-10.50; p<0.0001) and age (odds ratio =0.94; 95 CI: 0.89-0.98; p=0.01) were associated significantly with MPI results, using multiple logistic regressions.Conclusion. The study demonstrated that RPP is associated with MPI findings using gated SPECT imaging with dipyridamole stress. However, to confirm this preliminary result, further studies are mandatory. © The Author(s) 2012

Clinical significance of mild inferolateral wall ischemia of the left ventricle on 99mTc-MIBI myocardial perfusion single photon emission computed tomography (SPECT)

INTRODUCTION: Mild ischemia in the inferolateral wall on myocardial perfusion imaging is seen frequently in practice. The aim of this study is to assess the importance of the above issue on myocardial perfusion SPECT with coronary angiography. PATIENTS AND METHODS: All patients enrolled in this study exhibited mild ischemia of the inferolateral wall on myocardial single photon emission computed tomography (SPECT) with 99mTc-MIBI, using the 20 left ventricular segments model. Each patient completed a questionnaire, including type of chest pain, risk factors, and previous examinations, and all cases were followed up for one year. Luminal stenosis of >50% was classified as significant stenosis on coronary angiography. A p value < 0.05 was considered statistically significant. RESULTS: During investigation, 105 cases had mild ischemia on myocardial perfusion imaging (MPI) of which 36 subjects (22 male and 14 female) underwent coronary angiography. The mean age was 56.62±10.23 years old (age range: 36-73 years). The inferolateral wall was compared to the left circumflex (LCX) territory. Nineteen out of 36 (52.7%) cases had stenosis in the LCX. Twenty-three of 105 (21.90%) underwent revascularization during the one year follow up. In multiple logistic regressions, with LCX stenosis on angiography as the dependent variable, only abnormal MPI was independently associated significantly. CONCLUSIONS: The findings of the study may indicate that even a mild perfusion defect in the inferolateral wall should be carefully managed, especially in high-risk subjects for coronary artery disease. European Review for Medical and Pharmacological Sciences Clinical significance of mild inferolateral wall ischemia of the left ventricle on 99mTc-MIBI myocardial perfusion single photon emission computed tomography (SPECT) M. ASSADI, A. ABDI-ARDEKANI1, M. POURBEHI2, A. AMINI2, H. JAVADI3, I. NABIPOUR, M. ABBASZADEH3, M. ASSADI3 The Persian Gulf Tropical Medicine Research Center, Bushehr University of Medical Sciences, Bushehr, Iran 1Department of Cardiology, Bushehr Heart Center, Faculty of Medicine, Bushehr University of Medical Sciences, Bushehr, Iran 2Golestan Research Center of Gastroenterology and Hepatology (GRCGH), Golestan University of Medical Sciences (GUOMS), Gorgan, Iran 3The Persian Gulf Nuclear Medicine Research Center, Bushehr University of Medical Sciences

Assessing the cardiology community position on transradial intervention and the use of bivalirudin in patients with acute coronary syndrome undergoing invasive management: results of an EAPCI survey.

AIMS: Our aim was to report on a survey initiated by the European Association of Percutaneous Cardiovascular Interventions (EAPCI) collecting the opinion of the cardiology community on the invasive management of acute coronary syndrome (ACS), before and after the MATRIX trial presentation at the American College of Cardiology (ACC) 2015 Scientific Sessions. METHODS AND RESULTS: A web-based survey was distributed to all individuals registered on the EuroIntervention mailing list (n=15,200). A total of 572 and 763 physicians responded to the pre- and post-ACC survey, respectively. The radial approach emerged as the preferable access site for ACS patients undergoing invasive management with roughly every other responder interpreting the evidence for mortality benefit as definitive and calling for a guidelines upgrade to class I. The most frequently preferred anticoagulant in ACS patients remains unfractionated heparin (UFH), due to higher costs and greater perceived thrombotic risks associated with bivalirudin. However, more than a quarter of participants declared the use of bivalirudin would increase after MATRIX. CONCLUSIONS: The MATRIX trial reinforced the evidence for a causal association between bleeding and mortality and triggered consensus on the superiority of the radial versus femoral approach. The belief that bivalirudin mitigates bleeding risk is common, but UFH still remains the preferred anticoagulant based on lower costs and thrombotic risks