The prognostic value of normal myocardial perfusion spect with positive coronary angiography

BACKGROUND: Normal exercise SPECT studies are associated with a low event rate. The association of the negative SPECT and positive coronary angiography with the results for the long time follow up was determined. MATERIAL AND METHODS: 45 patients were included into the study. All patients had normal SPECT study and positive angiography in the ≤ 6 months after SPECT. 20 of them were women.Six patients had diabetes mellitus, 8 was smokers. Two patients had had left main coronary artery and 12 had multivessel disease. Baseline clinical risk factors were recorded for each patients and compared to outcomes. RESULTS: There were no deaths in the study group in the follow up period. One myocardial infarct occurred in patient with multivessel disease and five more angioplasties with stents were performed in the long term follow up due to progression of coronary stenosis. CONCLUSIONS: We observed that the normal SPECT with positive ECG pattern is infrequent and has a very good prognostic value However, the long-term survival among a patient cohort with a normal exercise SPECT study is influenced by the number of concomitant CAD risk factors. We conclude that there is an importance of modifying CAD risk factors among patients with a normal SPEC

The prognostic value of normal myocardial perfusion spect with positive coronary angiography

BACKGROUND: Normal exercise SPECT studies are associatedwith a low event rate. The association of the negative SPECTand positive coronary angiography with the results for the longtime follow up was determined.MATERIAL AND METHODS: 45 patients were included intothe study. All patients had normal SPECT study and positiveangiography in the ≤ 6 months after SPECT. 20 of them werewomen.Six patients had diabetes mellitus, 8 was smokers. Twopatients had had left main coronary artery and 12 had multivesseldisease. Baseline clinical risk factors were recorded for eachpatients and compared to outcomes.RESULTS: There were no deaths in the study group in the followup period. One myocardial infarct occurred in patient withmultivessel disease and five more angioplasties with stentswere performed in the long term follow up due to progressionof coronary stenosis.CONCLUSIONS: We observed that the normal SPECT withpositive ECG pattern is infrequent and has a very good prognosticvalue However, the long-term survival among a patientcohort with a normal exercise SPECT study is influenced by thenumber of concomitant CAD risk factors. We conclude that there is an importance of modifying CAD risk factors among patientswith a normal SPECT

Left coronary arteriovenous malformation with fistulous connections to the left and right ventricles

A 20-year-old man with right bundle branch block in recorded ECG was referred to our department. His physical examination was unremarkable. Transthoracic echocardiography showed a severe hypertrophy of the interventricular septum (22 mm) which contained multiple echo-free spaces of the vascular nature. A flow pattern suggestive to a coronary artery fistula into the left ventricle was recorded. The patient was referred for a coronary angiography, which revealed an arteriovenous malformation starting from the septal branch of the enlarged left anterior descending artery. The malformation communicated with the lumen of the left (arterial phase) and right ventricle (venous phase) as well. The posterior descending artery was fed exclusively from the described arteriovenous malformation. 99mTc MIBI SPECT images showed a moderately reversible perfusion defect in the inferior wall, suggesting non-critical ischemia of this region

Left coronary arteriovenous malformation with fistulous connections to the left and right ventricles

A 20-year-old man with right bundle branch block in recordedECG was referred to our department. His physical examinationwas unremarkable. Transthoracic echocardiography showeda severe hypertrophy of the interventricular septum (22 mm)which contained multiple echo-free spaces of the vascularnature. A flow pattern suggestive to a coronary artery fistulainto the left ventricle was recorded. The patient was referredfor a coronary angiography, which revealed an arteriovenousmalformation starting from the septal branch of the enlarged leftanterior descending artery. The malformation communicatedwith the lumen of the left (arterial phase) and right ventricle(venous phase) as well. The posterior descending artery wasfed exclusively from the described arteriovenous malformation.99mTc MIBI SPECT images showed a moderately reversible perfusiondefect in the inferior wall, suggesting non-critical ischemiaof this region

Dom jako środowisko życia rodziny

"„Czy ten dom będzie dla mnie dobry? Czy wszystkie zastosowane materiały spełniają odpowiednie standardy? Czy dom jest „zdrowy”, wolny od substancji potencjalnie toksycznych?” Wszystkie te pytania zadaje sobie znaczna część tych ludzi, którzy kupują albo rozpoczynają budowę własnego domu. Z roku na rok w coraz większym stopniu ludzie zwracają uwagę na komfort - również zdrowotny - miejsca, w którym spędzają większą część swojego życia."(...

Cardiac rehabilitation : a good measure to improve quality of life in peri- and postmenopausal women with microvascular angina

Cardiac Syndrome X (CSX) was considered a stable coronary syndrome, yet due to its nature, CSX symptoms often have a great impact on patients’ Quality of Life (QoL). According to ESC 2013 stable coronary artery disease criteria, CSX was replaced by Microvascular Angina (MA).Unfortunately, most CSX or MA patients, after classical angina (involving main coronary vessels) has been ruled out, often do not receive proper treatment. Indications for pharmacological treatment of MA patients were introduced only recently. Another problematic issue is that scientists describing the pathophysiology of both CSX and MA stress a lack of a deeper insight into the multifactorial etiology of the source of pain associated with this disease. In the presented article we have attempted to study the influence of cardiac rehabilitation (3 months programme) on the QoL of patients recognized as suffering from MA, as well as to check if changes in myocardial perfusion in these patients at baseline and after completion of cardiac rehabilitation match changes in their QoL. Therefore, after screening 436 women for MA, we studied 55 of them who were confirmed as having MA and who agreed to participate in the study. Exercise tests, Myocardial Perfusion Imaging, and QoL questionnaires were studied at baseline and after completing 3 months period of cardiac rehabilitation. Results were subsequently compared, which showed a link between improved perfusion score in SPECT study and improved overall physical capacity, on one hand, and improved QoL score on the other. These results confirm that cardiac rehabilitation is a very useful treatment option for MA patients. It seems that training during cardiac rehabilitation is a very important factor (improved physical efficiency –> increase in self-belief), and that taking into consideration the multifactor pathophysiology of pain, it is connected with a better quality of life for MA patients

Prostate cancer in patients from rural and suburban areas : PSA value, Gleason score and presence of metastases in bone scan

Introduction. Prostate cancer is the second most common neoplasm among men both worldwide and in Poland. In prostate cancer, bone metastasis is related to a poorer prognosis. A diagnosis of metastatic bone disease is important in prostate cancer patients prior to therapy. Prostate specific antigen (PSA) serum value is used both as a screening tool and for staging of prostate cancer. Aim. To evaluate whether there is a link between symptoms presented by patients, pain in particular, and the presence, number and location of bone metastases as assessed by bone scan scintigraphy in concordance with PSA values and Gleason scores. Material. A group of 186 patients (aged: 68.38±6.16) diagnosed with prostate cancer, from rural and suburban areas of Małopolska province, that was directed for bone scan scintigraphy to the Nuclear Medicine Dept, John Paul II Hospital in Kraków. Methods. Analysis of all laboratory findings (including PSA value) and a biopsy were performed. Then, bone scan scintigraphy was done with the use of methylene disphosphonate (MDP) labeled with Tc-99m. Results. In patients with a Gleason value ≤7 and a PSA value ≤20 ng/ml, the cutoff value for a negative bone scan with a confidence interval of 0.95 was established at a PSA value below 10 ng/ml (p<0.01). Correlations were established between PSA value and presence of metastases in bone scan (r=0.45, p=0.05), the number of metastases (r=0.66, p<0.01), and their presence in particular body regions. Conclusions. The correlation between PSA value and both presence and number of metastases confirms the usefulness of bone scan scintigraphy in prostate cancer staging. The cutoff value for negative bone scan with a 95% confidence interval was established at PSA = 10 ng/ml