Ferreira, MJ

Ferrer-Antunes, A

Pedroso de Lima, J

Providência, LA

Rodrigues, V

Santos, F

English

Repositório Institucional dos Hospitais da Universidade de Coimbra

1.33Application of dipirydamole stress TC-99MIBI spect in patients with significantaortic stenosis.M. Magdalena Kostkiewicz1, W. Szot2, A. Mura3, A. Lesniak-Sobelga3, M. Ol-szowska3, W. Tracz.3 1Institute of Cardiology, Dept. of Nuclear Medicine, Krakow,Poland, 2Of Heart and Lung Institute, Centre for Diagnosis, Krakow, Poland, 3Instituteof Cardiology, Dept of Cardiovascular Diseases, Krakow, PolandBackground: Exercise cardiac stress testing in patients with significant aortic stenosisis generally avoided for safety reasons. Furthermore, the studies that actually addressedthe value of exercise testing both with and without myocardial Tc99MIBI scintigraphyfor the diagnosis of coronary artery disease (CAD) proved to yield low specificity.Nowadays there are no safe and accurate means for noninvasive assessment of thepresence, extent and severity of CAD in patients with significant aortic stenosis. Ourstudy aimed to assess overall safety and usefulness of dipirydamole stress myocardialperfusion scintigraphy for detection of CAD using single-photon emission computedtomography (SPECT) in patients with aortic stenosis.Methods: The study comprised 20 patients with significant aortic stenosis who werecompared with 20 patients with CAD designated as CCS II and III. All patientsunderwent a 5-minute dipirydamole infusion (1.5 mg/kg body weight) protocol stresstechnetium-99m sestamibi SPECT. Visual 17-segment SPECT analysis used a standardfive-point scoring system ranging from 0 (normal tracer uptake) to 4 (absent uptake).The SPECT results were considered abnormal if more than two segments had a stressscore 3 2. These results were compared to the same number of patients diagnosed withCAD. All patients also underwent coronary angiography procedure. The respectiveresults in the groups were subsequently compared using the U-Mann-Whitney test andPearson’s correlation nonparametric test.Results: Sensitivity of gated SPECT study was calculated at the level of 83% in thestudied group vs. 100% in the controls, with positive predictive value at 88% vs. 90%,respectively.Hemodynamic responses during dipirydamole stress testing demonstrated no significantdifferences in the net change in systolic blood pressure (30% vs. 25%, patients withaortic stenosis vs. control subjects), heart rate (20% vs. 20%), dyspnea (25% vs. 30%)or incidence of chest pain (30% vs. 30%).Conclusions: Dipirydamole Tc99m MIBI SPECT study was established to be welltolerated, safe and diagnostically accurate in patients with significant aortic stenosis andsuspected CAD.1.34Rest myocardial perfusion imaging and troponin I in the evaluation of chest painpatients.MJ. Maria Joao Ferreira1, AI. Ferrer-Antunes2, V. Rodrigues3, F. Santos4, J. Lima2,MD. Cerqueira5, LA. Providência.6 1University Hospital, Cardiology, Coimbra, Portu-gal, 2University Hospital, Nuclear Medicine Depart., Coimbra, Portugal, 3CoimbraUniversity Medical School, Coimbra, Portugal, 4University Hospital, EmergencyDepart., Coimbra, Portugal, 5Cleveland Clinic Foundation, Cleveland, United States ofAmerica, 6University Hospital, Cardiology Depart., Coimbra, PortugalBackground: In patients with acute coronary syndromes there is a quantitative relationbetween cardiac troponins (TnI and T) and the risk of death. Also there is evidence thateven a mild elevation of troponins may be related to reversible ischemic injury. Restmyocardial perfusion imaging (RMPI) in the evaluation of patients with chest pain hasdiagnostic but most important prognostic information.The purpose of this study was to evaluate the relationship between the severity ofperfusion defects on RMPI and the maximal level of cTnI, in a group of patients (pts)admitted in the Emergency Department (ED) due to chest pain.Methods: We enrolled hemodynamically stable pts, without prior myocardial infarc-tion, presenting in the ED with ongoing chest pain or an episode of pain within the lastsix hours.CTnI was determined by the central laboratory, and values above 0.2 ng/ml wereconsidered indicative of myocardial injury. The first blood sample was drawn afterclinical evaluation and in higher risk patients the test was repeated at 6 and 12 hours.Three groups of patients were defined considering cTnI values: I  0.10; 0.10  II 0.20; III  0.20 ng/ml.Perfusion images were acquired after an injection of 15 mCi of 99mTc-tetrofosmin andvisual scoring analysis was performed using a 17 segment system. A summed restperfusion score was obtained (SRPS).ANOVA was used in order to evaluate the SRPS in the defined troponin groups.Results: Ninety-nine pts were included in this study. Thirty-three (33.3%) had a finaldiagnosis of myocardial infarction. There were 54 pts in group I, 13 in group II and 32in group III. The mean SRPS values  1 standard deviation for each group were:I-4.6  5.9; II-7.9  8.7; III-13.2  8.2 (p  0.0001)Conclusion: There is a strong relationship between rest myocardial perfusion imagingand troponins in the evaluation of chest pain patients and similar to troponins, restmyocardial perfusion imaging may be used for prognostic assessment.1.35Rest myocardial perfusion imaging in the evaluation of patients with chest pain:rest myocardial perfusion imaging and cardiac ischemic events within 90-days ofpresentation.MJ. Maria Joao Ferreira1, AI. Ferrer-Antunes2, V. Rodrigues3, F. Santos4, J. Lima2,MD. Cerqueira5, LA. Providência.6 1University Hospital, Cardiology, Coimbra, Portu-gal, 2University Hospital, Nuclear Medicine Depart., Coimbra, Portugal, 3CoimbraUniversity Medical School, Coimbra, Portugal, 4University Hospital, EmergencyDepart., Coimbra, Portugal, 5Cleveland Clinic Foundation, Cleveland, United States ofAmerica, 6University Hospital, Cardiology Depart., Coimbra, PortugalBackground: Rest myocardial perfusion imaging (RMPI) in the evaluation of patientswith chest pain could be a valuable tool, not only because of its diagnostic but alsobecause of its prognostic value. This study used RMPI for the evaluation of patientswith chest pain to define the relationship between test results and the occurrence ofischemic events over a ninety-day period.Methods: Eighty-seven patients (pts) admitted in the emergency department forongoing chest pain or an episode of pain in the last six hours, were studied by RMPI.None of them had a history of myocardial infarction.Tomographic perfusion images were acquired after the injection of 15mCi of 99mTc-tetrofosmin and analyzed using a 17 segment scoring system. The summed rest scorewas expressed as a percentage of the maximal possible obtainable score (% summed restperfusion score SRPS). Regarding the result of the exam, 3 groups were established(based on the mean M value of %SRPS in patients with negative troponins, and the M 1SD): I-%SRPS  9.0%; II-9.0%  %SRPS  20.3%; III-%SRPS  20.3%. Ischemicevents were: death, myocardial infarction (chest pain and elevated troponin I) andmyocardial revascularization over a 90-day period. Statistical analysis was performedusing Kaplan-Meier survival analysis and the Logrank test.Results: Thirty-nine pts were included in group I (44.8%), 27 in group II (31,1%) and21 in group III (24.1%). The ischemic events were: 29 myocardial infarctions (33.3%),8 revascularizations (9.2%) and 1 death (1.1%). Four pts from group I (10.3%), 15 ptsfrom group II (55.6%) and 19 from group III (90.5%) had an ischemic event. Using theLogrank test with a Mantel-Cox analysis there was a strong relationship between%SRPS and events (p  0.0001).Conclusion: In this study a very strong relationship was found between the occurrenceof ischemic events and the extent of rest perfusion defects. This exam could be used inthe evaluation of patients with chest pain for risk stratification of events related withischemic heart disease.1.36Clinical relevance of gated spect imaging in ischemic dilated cardiomyopathy.E. Martins1, M. Mariana Vasconcelos2, T. Faria3, A. Oliveira3, M. Garcia2, J. Pereira3,F. Rocha-Gonçalves.1 1São João Hospital, Cardiology, Porto, Portugal, 2São JoãoHospital, Cardiology, Porto, Portugal, 3São João Hospital, Nuclear Medicine, Porto,PortugalBackground: Perfusion defects are common in gated single-photon emission computedtomography (GSPECT) of dilated cardiomyopathy patients (DCM pts), even in theabsence of major coronary artery disease. Left ventricle dilatation or remodeling couldaffect the sensibility and specificity of GSPECT.The aim of this work was to correlate perfusion, motility and thickness scores withcoronary anatomy in DCM pts.Methods: We retrospectively evaluated 87 pts with ischemic DCM (ejection fraction45%, end systolic volume  75 ml) who performed Tc-99 tetrofosmin QGS-QPS TMGSPECT and coronary angiography (CA) for etiologic diagnosis or risk stratification,with a 4 months lag. Those who underwent surgical or percutaneous revascularization,or had myocardial infarct (MI) between both exams were excluded (n17).Results: We analysed data from 70 pts, 55 (78. 6%) males, age 63  12 years, withejection fraction 33.3  8.6 %. Treadmill exercise was used in 19 (27.1%) pts andpharmacologic stress in 45 (64.3%) pts. Left bundle branch blockage was observed in11 (15.7%) pts, 55 (78.6%) pts had previous MI and 55 (78.6%) pts were underanti-ischemic therapy. CA was performed within 1.2  2.5 months from GSPECT andrevealed multivessel disease in 42 (60%) pts.We found that left anterior descending artery (LAD) stenosis was correlated withmotility (p0.006, r 0.34) and thickness (p0.001, r0.42) scores, perfusion defectextension in stress (p0.01, r0.55) and in rest (p0.01, r0.48), severity in rest(p0.01, r0.46) and reversibility (p0.002, r0.38) in LAD territory. Right coronary(RC) stenosis was only correlated with reversibility in RC territory (p0.012, r0.35).We found no correlation between perfusion, motility and thickness scores and thepresence of multivessel or circumflex artery disease.Conclusion: Significant LAD stenosis (60%) can be anticipated by GSPECT analysisbut, contrary to the expected results, we could not predict mutivessel coronary diseasein our patients. These results could be a particular feature of ischemic DCM.MONDAYMAY9MONDAYMAY9Journal of Nuclear Cardiology Abstracts S9Volume 12, Number 2 Monday, May 9, 2005

Rest myocardial perfusion imaging in the evaluation of patients with chest pain: Rest myocardial perfusion imaging and cardiac ischemic events within 90-days of presentation

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Rest myocardial perfusion imaging in the evaluation of patients with chest pain: Rest myocardial perfusion imaging and cardiac ischemic events within 90-days of presentation

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