International Impact of COVID-19 on the Diagnosis of Heart Disease

BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic has adversely affected diagnosis and treatment of noncommunicable diseases. Its effects on delivery of diagnostic care for cardiovascular disease, which remains the leading cause of death worldwide, have not been quantified.OBJECTIVES The study sought to assess COVID-19`s impact on global cardiovascular diagnostic procedural volumes and safety practices.METHODS The International Atomic Energy Agency conducted a worldwide survey assessing alterations in cardiovascular procedure volumes and safety practices resulting from COVID-19. Noninvasive and invasive cardiac testing volumes were obtained from participating sites for March and April 2020 and compared with those from March 2019. Availability of personal protective equipment and pandemic-related testing practice changes were ascertained.RESULTS Surveys were submitted from 909 inpatient and outpatient centers performing cardiac diagnostic procedures, in 108 countries. Procedure volumes decreased 42% from March 2019 to March 2020, and 64% from March 2019 to April 2020. Transthoradc echocardiography decreased by 59%, transesophageat echocardiography 76%, and stress tests 78%, which varied between stress modalities. Coronary angiography (invasive or computed tomography) decreased 55% (p < 0.001 for each procedure). hi multivariable regression, significantly greater reduction in procedures occurred for centers in countries with lower gross domestic product. Location in a low-income and lower-middle-income country was associated with an additional 22% reduction in cardiac procedures and less availability of personal protective equipment and teteheatth.CONCLUSIONS COVID-19 was associated with a significant and abrupt reduction in cardiovascular diagnostic testing across the globe, especially affecting the world's economically challenged. Further study of cardiovascular outcomes and COVID-19-related changes in care delivery is warranted. (C) 2021 The Authors. Published by Elsevier on behalf of the American College of Cardiology Foundation

Impact of COVID-19 on cardiovascular testing in the United States versus the rest of the world

Objectives: This study sought to quantify and compare the decline in volumes of cardiovascular procedures between the United States and non-US institutions during the early phase of the coronavirus disease-2019 (COVID-19) pandemic. Background: The COVID-19 pandemic has disrupted the care of many non-COVID-19 illnesses. Reductions in diagnostic cardiovascular testing around the world have led to concerns over the implications of reduced testing for cardiovascular disease (CVD) morbidity and mortality. Methods: Data were submitted to the INCAPS-COVID (International Atomic Energy Agency Non-Invasive Cardiology Protocols Study of COVID-19), a multinational registry comprising 909 institutions in 108 countries (including 155 facilities in 40 U.S. states), assessing the impact of the COVID-19 pandemic on volumes of diagnostic cardiovascular procedures. Data were obtained for April 2020 and compared with volumes of baseline procedures from March 2019. We compared laboratory characteristics, practices, and procedure volumes between U.S. and non-U.S. facilities and between U.S. geographic regions and identified factors associated with volume reduction in the United States. Results: Reductions in the volumes of procedures in the United States were similar to those in non-U.S. facilities (68% vs. 63%, respectively; p = 0.237), although U.S. facilities reported greater reductions in invasive coronary angiography (69% vs. 53%, respectively; p < 0.001). Significantly more U.S. facilities reported increased use of telehealth and patient screening measures than non-U.S. facilities, such as temperature checks, symptom screenings, and COVID-19 testing. Reductions in volumes of procedures differed between U.S. regions, with larger declines observed in the Northeast (76%) and Midwest (74%) than in the South (62%) and West (44%). Prevalence of COVID-19, staff redeployments, outpatient centers, and urban centers were associated with greater reductions in volume in U.S. facilities in a multivariable analysis. Conclusions: We observed marked reductions in U.S. cardiovascular testing in the early phase of the pandemic and significant variability between U.S. regions. The association between reductions of volumes and COVID-19 prevalence in the United States highlighted the need for proactive efforts to maintain access to cardiovascular testing in areas most affected by outbreaks of COVID-19 infection

Prosedur Kedokteran Nuklir pada Anak

Childrens are different from adults in terms of organ maturity and the prevalence of diseases that often occur. Because of that, there are need for special skills in diagnosing diseases in children. Nuclear medicine diagnostic imaging is one of the modalities for diagnosing diseases in children. It takes special skills and techniques to perform nuclear medicine procedures in children. The cooperation of the child, the dose of radiopharmaceutical, and the dose of CT given are several important factors to support the examination. The purpose of this literature review is to discuss the preparation needed to carry out nuclear medicine examinations on children and the things that need to be considered in performing imaging on children. The type of literature review used is the narrative review method. Based on the criteria of inclusion and exclusion we get 17 articles related to the procedure and preparation of nuclear medicine actions in childrenAnak memiliki perbedaan dengan dewasa dari sisi kematangan organ maupun prevalensi penyakit yang sering terjadi. Hal demikian mengakibatkan perlunya keterampilan khusus dalam mendiagnosa penyakit pada anak. Pencitraan diagnostik kedokteran nuklir merupakan salah satu modalitas untuk penegakan diagnosis penyakit pada anak. Perlu keterampilan dan teknik khusus untuk melakukan prosedur kedokteran nuklir pada anak.  Kerjasama anak, dosis radiofarmaka, dan dosis CT yang diberikan merupakan beberapa faktor penting untuk menunjang pemeriksaan. Tujuan dari tinjauan pustaka ini adalah untuk membahas persiapan yang dibutuhkan untuk melakukan pemeriksaan kedokteran nuklir pada anak dan hal-hal yang perlu diperhatikan dalam melakukan pencitraan pada anak. Jenis literature review yang digunakan adalah metode narrative review. Berdasarkan kriteria inklusi dan eksklusi tersebut kami mendapatkan 17 artikel yang berkaitan dengan prosedur dan persiapan tindakan kedokteran nuklir pada ana

Insidentaloma Tiroid

Kanker tiroid merupakan kanker endokrin yang paling sering ditemui. Kanker tiroid diawali dengan terbentuknya nodul pada kelenjar tiroid. Nodul tiroid sering ditemukan secara kebetulan pada pemeriksaan fisik dan pada saat pencitraan anatomi maupun fungsional (insidentaloma). Sidik tiroid merupakan modalitas untuk menentukan status fungsional nodul tiroid tersebut. Keganasan tiroid sangat jarang terjadi pada nodul fungsional. Wanita 65 tahun dengan diagnosis suspek kanker paru yang bermetastasis ke tiroid dan hati, mengeluh sesak napas, sulit menelan, dan terjadi perubahan suara. Ditemukan nodul di tiroid kiri dengan ukuran ≤ 4 cm dan teraba adanya limfadenopati bilateral area jugular dan supraclavicular. Citra ultrasonografi menunjukkan gambaran tiroiditis, dari sidik tiroid SPECT/CT dengan menggunakan radiofarmaka Tc-99m Pertechnetate memberikan gambaran nodul fungsional yang sudah mendesak trakea. Dari hasil pemeriksaan FNAB memberikan hasil karsinoma tiroid papiler. Meskipun keganasan pada nodul fungsional sangat kecil namun keganasan  tetap perlu dicurigai jika dari penilaian stratifikasi risiko menunjukkan risiko tinggi. Pencitraan sidik tiroid dengan SPECT/CT mempunyai nilai tambah dalam penegakkan diagnosis pada pasien yang memiliki risiko tinggi keganasan</jats:p

Pencitraan Penyakit Metabolik Tulang dengan Modalitas Kedokteran Nuklir

Metabolic bone disease is a group of disorders associated with disturbances in changes in calcium levels and phosphorus homeostasis, which occur frequently but are difficult to distinguish based on history, physical examination and imaging studies. Osteoporosis is one that often occurs, which often occurs in women who have a higher risk of osteoporosis (21.7%) than men (14.8%). Clinically, metabolic bone disease is often found in patients with fractures which are the main complications of this disease. The modalities used include plain radiography or even computed tomography (CT) and Magnetic Resonance Imaging (MRI), but currently Bone scan (bone fingerprint) is an examination that can be used to detect, is an imaging technique capable of high resolution in a long time. short (acquisition of whole body or specific parts of bone), relatively low dose, sensitivity and specificity for detecting lesions as a result of tomographic data and is an option in routine examinations in Nuclear Medicine. In this article, we will thoroughly explain the various manifestations in the form of peculiarities of the uptake picture of metabolic disease in bone using bone scan (bone fingerprint) examination using the literature study method or literature review as well as conducting article inclusion and article review. These articles can be in the form of research, systematic reviews or case reports. The places where the research was carried out from these articles all came from abroad, on the continents of Asia, Europe, and America.Penyakit metabolik tulang merupakan kelompok kelainan yang berkaitan dengan adanya gangguan pada perubahan kadar kalsium dan homeostasis fosfor, sering terjadi namun sulit dibedakan berdasarkan riwayat, pemeriksaan fisik dan studi pencitraan. Osteoporosis merupakan salah satu yang sering terjadi, dimana sering terjadi pada wanita memiliki resiko osteoporosis lebih tinggi (21,7%) dibandingkan laki-laki (14,8%). Secara klinis, penyakit tulang metabolik sering ditemukan pada pasien dengan fraktur yang merupakan komplikasi utama penyakit ini. Modalitas yang digunakan antara lain radiografi polos atau bahkan dengan Computed Tomography (CT) dan Magnetic Resonance Imaging (MRI), namun saat ini bone scan (sidik tulang) merupakan pemeriksaan yang dapat digunakan untuk mendeteksi, merupakan teknik pencitraan yang berkemampuan resolusi tinggi dalam waktu yang singkat (akuisisi seluruh tubuh atau bagian tertentu dari tulang), dosis relatif rendah, sensitivitas dan spesifisitas untuk mendeteksi lesi sebagai hasil data tomografi dan menjadi pilihan dalam pemeriksaan yang rutin pada Kedokteran Nuklir. Pada artikel ini, akan dijelaskan secara menyeluruh manifestasi beragam berupa kekhasan gambaran uptake penyakit metabolik pada tulang menggunakan pemeriksaan bone scan (sidik tulang) dengan menggunakan metode studi kepustakaan atau literature review serta melakukan inklusi artikel dan review artikel. Artikel tersebut dapat berupa penelitian, systematic review maupun case-report. Tempat dilakukan penelitian dari artikel tersebut semua berasal dari luar negeri, di benua Asia, Eropa, dan Amerika

Insidentaloma Tiroid

Thyroid cancer is the most common type of endocrine cancer. Thyroid cancer begins with the formation of nodule in the thyroid gland. Thyroid nodule is frequently discovered incidentally during physical examination and by anatomic or functional imaging (incidentaloma). The aim of thyroid scintigraphy in the evaluation of thyroid nodule is to determine the functional status of the thyroid nodule which will impact its management options. The risk of malignancy is low in a functional thyroid nodule. A 65-year-old woman was admitted with complaints of shortness of breath, difficulty in swallowing, and low voice. On physical examination, a nodule was found in the inferior part of the left thyroid gland with a size of approximately 4 cm. Multiple lymphadenopathies was also palpable in the bilateral jugular and supraclavicular areas. Ultrasound imaging showed an image of thyroiditis, then the thyroid scintigraphy and SPECT/CT was done using radiopharmaceutical Tc-99m Pertechnetate which showed an image of a functional nodule that was pressing against the trachea. Histopathological examination using fine needle aspiration biopsy with ultrasound guidance yielded papillary thyroid carcinoma. The risk of malignancy in functional nodule is very low but we should aware of malignancy if the assessment of risk stratification is high. Integrated planar and SPECT/CT of thyroid scintigraphy has an incremental value to predict thyroid cancer in patient who have a high risk of malignancy.Kanker tiroid merupakan kanker endokrin yang paling sering ditemui. Kanker tiroid diawali dengan terbentuknya nodul pada kelenjar tiroid. Nodul tiroid sering ditemukan secara kebetulan pada pemeriksaan fisik dan pada saat pencitraan anatomi maupun fungsional (insidentaloma). Sidik tiroid merupakan modalitas untuk menentukan status fungsional nodul tiroid tersebut. Keganasan tiroid sangat jarang terjadi pada nodul fungsional. Wanita 65 tahun dengan diagnosis suspek kanker paru yang bermetastasis ke tiroid dan hati, mengeluh sesak napas, sulit menelan, dan terjadi perubahan suara. Ditemukan nodul di tiroid kiri dengan ukuran ≤ 4 cm dan teraba adanya limfadenopati bilateral area jugular dan supraclavicular. Citra ultrasonografi menunjukkan gambaran tiroiditis, dari sidik tiroid SPECT/CT dengan menggunakan radiofarmaka Tc-99m Pertechnetate memberikan gambaran nodul fungsional yang sudah mendesak trakea. Dari hasil pemeriksaan FNAB memberikan hasil karsinoma tiroid papiler. Meskipun keganasan pada nodul fungsional sangat kecil namun keganasan  tetap perlu dicurigai jika dari penilaian stratifikasi risiko menunjukkan risiko tinggi. Pencitraan sidik tiroid dengan SPECT/CT mempunyai nilai tambah dalam penegakkan diagnosis pada pasien yang memiliki risiko tinggi keganasa

Hyperthyroidism-Induced Myocardial Ischemia: Quantification and Correlation with fT4 via 99mTc-Sestamibi Scintigraphy

Background: Hyperthyroidism exerts significant detrimental effects on the cardiovascular system, increasing the risk of major adverse cardiac events (MACE). While associations with atrial fibrillation and cardiomyopathy are well-documented, the incidence and characteristics of myocardial ischemia, particularly assessed by functional imaging, remain less explored. This study aimed to investigate the incidence of myocardial ischemia in hyperthyroid patients using Technetium-99m Sestamibi (⁹⁹ᵐTc-Sestamibi) myocardial perfusion scintigraphy (MPS) and correlate findings with thyroid hormone levels. Methods: This prospective preliminary study enrolled fifteen consecutive patients with confirmed hyperthyroidism and no prior history of ischemic heart disease between January and April 2024. All subjects underwent thyroid function tests (TSH, fT4, T3) and a one-day rest/adenosine-stress ⁹⁹ᵐTc-Sestamibi MPS protocol. Myocardial ischemia presence, reversibility, severity (Summed Stress Score, SSS), and extent (total ischemic segments) were assessed using the AHA 17-segment model. Spearman correlation was used to analyze the relationship between hormone levels and MPS parameters. Results: Fifteen subjects (93.3% female, mean age 34 ± 11 years) were included. Myocardial ischemia was detected in 14/15 subjects (93.3%). Among those with ischemia, 12 (80% of total subjects, 85.7% of ischemic subjects) exhibited reversible defects. Free thyroxine (fT4) levels showed a strong positive correlation with SSS (rs = 0.64, p = 0.01) and the total number of ischemic segments (rs = 0.65, p = 0.01). Conclusion: This preliminary study revealed a high incidence of myocardial ischemia, predominantly reversible, in patients with hyperthyroidism detected by ⁹⁹ᵐTc-Sestamibi MPS. The severity and extent of ischemia demonstrated a significant positive correlation with fT4 levels. These findings underscore the potential utility of MPS in cardiovascular risk assessment and suggest the need for comprehensive cardiac evaluation in hyperthyroid patients, particularly those with higher fT4 levels

The prognostic properties of thyroid disorders, hypothyroidism, and hyperthyroidism in predicting COVID-19 poor outcomes: A systematic review and diagnostic meta-analysis

Purpose: The relationship between thyroid metabolism and coronavirus disease 2019 (COVID-19) inflammation has been extensively investigated. This meta-analysis aimed to evaluate the prognostic properties of unspecified thyroid disorders, hypothyroidism and hyperthyroidism for predicting poor COVID-19 outcomes. Methods: We conducted systematic literature searching through multiple databases–PubMed, EBSCO and CENTRAL up until 27 September 2021. The main exposure was unspecified thyroid disorders, hypothyroidism or hypothyroidism on-admission status. The outcome of interest was the COVID-19 composite poor outcome that comprises severity, mortality, ICU admission and hospitalisation. Results: There were 24517 patients from 20 studies. Meta-analysis showed that thyroid disorder, regardless of its type, was associated with COVID-19 poor outcome (OR 2.92 (95% CI 2.09 – 4.08), P < 0.001; I2 = 71%, P < 0.001). Unspecified thyroid disorder has a sensitivity of 0.17 (0.08–0.33), specificity of 0.94 (0.88–0.97) and Area Under Curve (AUC) of 0.66. Hypothyroidism has a sensitivity of 0.24 (0.12–0.42), specificity of 0.92 (0.87–0.96) and AUC of 0.77. Hyperthyroidism has a sensitivity of 0.05 (0.02–0.11), specificity of 0.98 (0.88–1.00) and AUC of 0.36. In this pooled analysis, the posttest probability of unspecified thyroid disease, hypothyroidism and hyperthyroidism were 42%, 27% and 8% for poor outcomes, respectively. Conclusion: Thyroid disorders are associated with poor COVID-19 prognosis

The Appropriate Acquisition Time Interval Following Injection of 99mTc-Sestamibi with Water Protocol in Single Photon Emission Computed Tomography Myocardial Perfusion Imaging: First Experience in Indonesia

Abstract BackgroundAccording to EANM/ESC guideline, image acquisitions in stress test should be begun at 30-60 minutes after tracer administration. Our center is a referral hospital for nuclear medicine imaging with many patients but limited number of gamma camera. The shorter time between injection of radiopharmaceutical and imaging acquisition will lead to more examination can be done.The aim of this study was to evaluate the appropriate acquisition time interval with water protocol in 99mTc-Sestamibi SPECT myocardial perfusion imaging.MethodsPatients who were referred to undergo stress MPI between October 2020 to December 2020 were included in this study. Cardiac stress procedure was performed using treadmill with modified Bruce Protocol. Subjects should drink a total of 330 mL water following 99mTc-Sestamibi injection. Image acquisitions were performed 10 and 30 minutes afterwards. Quantitative assessment was done by calculated target background ratio (TBR). Statistical analysis was performed using student t-test with Microsoft Excel version 2019. P-value &lt; 0.05 was considered to be statistically significance.ResultsThirty out of 35 subjects were included in this study. Sixteen of them are male and 14 are female with mean of age was 48.7 years old (28 – 80). Mean target background uptake ratio (TBR) in 10- and 30-minutes images were 0.67 (0.44 – 1.11) and 0.76 (0.43 – 1.18) respectively (p-value = 0.15).ConclusionThere was no significant difference of target to background ratio between acquisition time 10- and 30-minutes following injection of 99mTc-Sestamibi with water protocol in myocardial perfusion imaging.Trial registrationNot applicable.</jats:p