Screening for acute myocarditis — is scintigraphy with 99mTc-Anti-Granulocyte BW 250/183 an answer?

BACKGROUND: Myocarditis is most often caused by Coxackie B virus, influenza viruses, and echoviruses. It is usually self-restricting and ending in full recovery, but in some patients the infection leads to congestive cardiomyopathy. It is difficult to identify patients with myocarditis using clinical criteria, laboratory tests, ECG and ultrasonography, and currently a myocardial biopsy is required to establish the diagnosis. The risk of complications, sampling error and costs of this procedure underline the need of non-invasive but sensitive methods of imaging. Several radiopharmaceuticals have been used so far to confirm inflammation: 67Ga, 99mTc-nanocolloids and 111In-leucocytes. Scintigraphy with radiolabeled autologous white blood cells (WBCs) is considered a very useful method in identifying sources of inflammation but is difficult to perform and time-consuming. AIMS: The aim of our study was to investigate whether scintigraphy with 99mTc-Anti-Granulocyte BW 250/183 antibody is a valuable diagnostic method in evaluating focal and diffuse inflammation of the heart and could therefore be suggested for use in screening for acute myocarditis. MATERIAL AND METHODS: A two dimensional scintigraphy and SPECT mode of heart imaging with the use of 99mTc-Anti-Granulocyte antibody (740 MBq) was performed on 14 subjects (11 males and 3 females) aged 25–60 years with a positive myocardial biopsy confirming an inflammatory process in the myocardium. After i.v. administration of the tracer a 1 minute series of planar scans was performed within the first 60 minutes. Delayed static scans were performed at 1, 2, 4 and 24 hours. RESULTS: The scintigraphic scans revealed the uptake of the tracer in the heart area in 13 patients, confirming active inflammatory process. Follow-up scintigraphy was performed 3–5 months after the first study, when the control myocardial biopsy was negative. The results of the study showed the concordance between myocardial biopsy and scintigraphy results in patients with an inflammatory process in the heart. CONCLUSIONS: Scintigraphy with the use of 99mTc-Anti-Granulocyte seems to be a useful diagnostic method in evaluating patients with suspected myocarditis, but further studies are needed to establish its sensitivity and specificity

Screening for acute myocarditis : is scintigraphy with ^{99m}Tc-Anti-Granulocyte BW 250/183 an answer?

BACKGROUND: Myocarditis is most often caused by Coxackie B virus, influenza viruses, and echoviruses. It is usually self-restricting and ending in full recovery, but in some patients the infection leads to congestive cardiomyopathy. It is difficult to identify patients with myocarditis using clinical criteria, laboratory tests, ECG and ultrasonography, and currently a myocardial biopsy is required to establish the diagnosis. The risk of complications, sampling error and costs of this procedure underline the need of non-invasive but sensitive methods of imaging. Several radiopharmaceuticals have been used so far to confirm inflammation: 67Ga, 99mTc-nanocolloids and 111In-leucocytes. Scintigraphy with radiolabeled autologous white blood cells (WBCs) is considered a very useful method in identifying sources of inflammation but is difficult to perform and time-consuming. AIMS: The aim of our study was to investigate whether scintigraphy with 99mTc-Anti-Granulocyte BW 250/183 antibody is a valuable diagnostic method in evaluating focal and diffuse inflammation of the heart and could therefore be suggested for use in screening for acute myocarditis. MATERIAL AND METHODS: A two dimensional scintigraphy and SPECT mode of heart imaging with the use of 99mTc-Anti-Granulocyte antibody (740 MBq) was performed on 14 subjects (11 males and 3 females) aged 25–60 years with a positive myocardial biopsy confirming an inflammatory process in the myocardium. After i.v. administration of the tracer a 1 minute series of planar scans was performed within the first 60 minutes. Delayed static scans were performed at 1, 2, 4 and 24 hours. RESULTS: The scintigraphic scans revealed the uptake of the tracer in the heart area in 13 patients, confirming active inflammatory process. Follow-up scintigraphy was performed 3–5 months after the first study, when the control myocardial biopsy was negative. The results of the study showed the concordance between myocardial biopsy and scintigraphy results in patients with an inflammatory process in the heart. CONCLUSIONS: Scintigraphy with the use of 99mTc-Anti-Granulocyte seems to be a useful diagnostic method in evaluating patients with suspected myocarditis, but further studies are needed to establish its sensitivity and specificity

Cardiovascular risk management in type 2 diabetes of more than 10-year duration: Results of Polish ARETAEUS2-Grupa Study

Background: ARETAEUS 1 study showed that a great majority of patients with type 2 dia­betes mellitus (T2DM) of short duration did not meet all of the treatment goals. Since then the treatment goals in T2DM have been changed. The aim of the ARETAEUS 2-Grupa Study was to assess cardiovascular (CV) risk management and meeting treatment goals in the population of T2DM of more than 10-year duration. Methods: ARETAEUS2-Grupa was a cross-sectional questionnaire-based study conducted in Poland in 2012. Randomly selected physicians recruited 1,740 patients with T2DM diag­nosed more than 10 years before the study. Results: Lipid treatment goals were met respectively: for total cholesterol in 34.5% of all patients, triglycerides in 53.8%, low density lipoprotein cholesterol (LDL-C) in 26.5% and high density lipoprotein cholesterol (HDL-C) in 38.2%. Most of patients with and without coronary artery disease were receiving aspirin (90.3% and 60%, respectively) and statins (84.4% and 67.7%, respectively). The current blood pressure (BP) goal (140/90 mm Hg) was met in 43.5% of pa­tients and the previous goal (< 130/80 mm Hg) in 12.4%. The patients were mainly treated with ≥ 3 antihypertensive drugs. All treatment goals (for HbA1c, BP and LDL-C) were reached only by 8.2% of patients, any two goals by 26.3% of patients, one goal by 39.8% of patients, none by 25.6% of patients. Conclusions: The new less restrictive treatment goals are reached more frequently but still much is to be done in the field of clinical practice guidelines implementation and CV prevention in T2DM population

Management and treatment goals in Polish patients with type 2 diabetes of more than ten years’ duration — results of ARETAEUS2-Grupa Study

Wstęp: W poprzednich badaniach wykazano niewystarczającą kontrolę choroby u chorych na cukrzycę. Polskie Towarzystwo Diabetologiczne zmieniło wartości docelowe HbA1c i ciśnienia tętniczego u chorych na cukrzycę w wytycznych z 2011 roku, które zostały utrzymane w kolejnych edycjach wytycznych. Badanie przeprowadzono w celu oceny leczenia cukrzycy i wyboru metod leczenia u chorych na cukrzycę typu 2 o czasie trwania > 10 lat oraz określenia stopnia spełniania kryteriów kontroli cukrzycy zalecanych w wytycznych Polskiego Towarzystwa Diabetologicznego z 2012 roku.Materiał i metody: Badanie ARETAEUS2-Grupa było przekrojowym badaniem kwestionariuszowym przeprowadzonym w Polsce w 2012 roku (kwiecień–czerwiec). Badaniem objęto 1740 chorych na cukrzycę typu 2 w każdym wieku i obu płci rozpoznaną ponad 10 lat przed rozpoczęciem badania, włączonych do badania przez losowo wybranych lekarzy.Wyniki: Wszyscy chorzy otrzymywali leczenie farmakologiczne, większość — leczenie skojarzone lub insulinę w monoterapii. 40% chorych spełniło kryterium kontroli HbA1c (≤ 7%), a mediana odsetka HbA1c była powyżej zalecanej wartości (7,2%). W całej populacji jedynie 8% chorych spełniło wszystkie kryteria kontroli choroby (HbA1c, ciśnienie tętnicze i profil lipidowy), 26% — dwa z tych kryteriów, 40%— jedno z tych kryteriów. Ponad 25% chorych nie spełniło żadnego z tych kryteriów.Wnioski: Zaobserwowano duże odstępstwa od celów leczenia zalecanych w aktualnych wytycznych postępowania u chorych na cukrzycę typu 2 o czasie trwania > 10 lat. Częstość występowania sercowo-naczyniowych czynników ryzyka i późnych powikłań cukrzycy była duża, a stosunkowo duży odsetek chorych nie był badany w kierunku późnych powikłań cukrzycy.Introduction: Previous studies have shown insufficient diabetes control in patients with type 2 diabetes (T2DM). Diabetes Poland changed the target HbA1c and blood pressure (BP) values in diabetic patients in their practice guidelines in 2011, that were further sustained. To assess the management and treatment choices in T2DM of more than ten years’ duration and the degree to which diabetic control criteria recommended by the Diabetes Poland clinical practice guidelines 2012 are being met.Material and methods: ARETAEUS2-Grupa was a cross-sectional questionnaire-based study conducted in Poland in 2012 (April–June). It involved 1,740 patients of any age and both genders, with T2DM diagnosed more than ten years before the study, and recruited by randomly selected physicians.Results: All patients received pharmacological treatment, most of them combination therapy or insulin in monotherapy. 40% of patients met the goal for HbA1c control (≤ 7%) and the median value of HbA1c was above the recommended threshold (7.2%). Only 8% of thetotal population met all three goals (HbA1c, BP and lipid levels), 26% — two goals, and 40% — only one goal. Over 25% of patients did not meet any of the treatment goals.Conclusions: We observed considerable deviations from treatment targets recommended by current clinical practice guidelines for patients with T2DM of more than ten years’ duration. The frequency of cardiovascular risk factors and late diabetes complications was high, while a relatively high percentage of patients was not examined for late diabetes complications