relationship between coronary artery calcification and myocardial perfusion in asymptomatic women

No data are available in Saudi Arabia on the relationship between coronary artery calcification [CAC] and myocardial perfusion scintigraphy [MPS] in asymptomatic women, for determining subclinical coronary artery disease [CAD]. The main objective of this study was to investigate the relationship between the presence of CAC and stress-induced myocardial ischemia by MPS in asymptomatic women. Single-center retrospective study over a 2-year period. One hundred and one women [mean [SD] age, 56 [11] years] without known CAD underwent both MPS and CAC scanning within 3 months. The frequency of ischemia by MPS was compared with the presence or absence of CAC and the number of CAD risk factors. The prevalence of ischemic MPS was 22% [22/101]. Among the 22 patients with ischemic MPS, the CAC score was 0 in 5 patients of 22 [23%], 1 to 200 in 4 patients of 22 [18%], and more than 200 in 13 patients of 22 [59%] [P=.0001]. In contrast, among the 79 patients with normal MPS, the CAC score was 0 in 44 of 79 [56%] patients, 1 to 200 in 25 of 79 [32%], and more than 200 in 10 of 79 [13%]. The presence or absence of CAC was the single most important predictor of the MPS result [P=.0001]. Moderate to severe CAC is associated with ischemic MPS in more than 50% of asymptomatic women with 2 or more CAD risk factors. Abnormal MPS is rarely associated with a 0 CAC score. Normal MPS does not exclude subclinical CAD. Therefore, CAC screening is an appropriate initial screening test for CAD in asymptomatic women

Coronary artery anomalies: a diagnostic challenge

Coronary artery anomalies [CAAs] are found in approximately 1% of all patients undergoing coronary angiography and in 0.3% of patients undergoing autopsy [Roberts, 1986]. CAAs may be classified into those of origin and course, intrinsic coronary arterial anatomy, and coronary termination [Angelini et al. 2002]. The most common malformation is abnormal origin and course, origin of a coronary artery from a wrong aortic sinus of Valsalva; either the right from the left coronary sinus or the left from the right coronary sinus; these anomalies must be excluded in young adults with typically ischemic- sounding chest pain or syncope. Anomalies coronary artery termination typically presented as coronary artery fistula, commonly the right coronary artery is affected, although, left sided coronary artery fistulae are well documented [Gandy et al. 2004]. The anomalies of intrinsic coronary arterial anatomy, such as ostial stenosis, Artesia, and single, absent, or hypoplastic coronary arteries are rare but may have clinical importance

Potential role of coronary computed tomography angiogram in cardiac preoperative evaluation

Preoperative assessment of the cardiac patients before noncardiac surgery is concern in the clinical practice of anesthesiologist, surgeon, and medical consultant. The preferred stress testing is exercise electrocardiogram [ECG] in patients who are able to exercise and have normal ECG; however, either stress myocardial perfusion scintigraphy [MPS] or stress echocardiography is necessary if further testing is appropriately indicated before surgery. Unfortunately, stress MPs or stress echocardiography is not widely available and has some limitations. Coronary computed tomography angiogram [CCTA] has demonstrated excellent diagnostic accuracy in detecting coronary artery disease and accurate left ventricle function measurement. CCTA seems to be feasible, reliable, and has strong potential of becoming sole screening test before surgery

Myocardial perfusion scintigraphy: techniques, interpretation, indications and reporting

Myocardial perfusion single photon emission-computed tomography [MRS] has been one of the most important and common non-invasive diagnostic cardiac test. Gated MRS provides simultaneous assessment of myocardial perfusion and function with only one study. With appropriate attention to the MRS techniques, appropriate clinical utilization and effective reporting, gated MRS will remain a useful diagnostic test for many years to come. The aim of this article is to review the basic techniques of MRS, a simplified systematic approach for study interpretation, current clinical indications and reporting. After reading this article the reader should develop an understanding of the techniques, interpretation, current clinical indications and reporting of MRS studies

Myocardial perfusion single photon computed tomography: an atlas

The purpose of this Teaching Atlas is to provide the reader with both image recognition and an understanding of the basis for myocardial perfusion single photon computed tomography [SPECT] images interpretation. The objective is to present a wide variety of myocardial perfusion cases, both relevant and to some extent in-depth, to be used by nuclear cardiologist/nuclear medicine physicians as well as trainees in cardiology, radiology and nuclear medicine. In recent years, the field of nuclear cardiology has made major advances in both radiopharmaceuticals and instrumentation. Attenuation correction techniques have and will continue to improve the diagnostic accuracy of myocardial perfusion SPECT. Several attenuation correction aspects are included in this Atlas

Comparison of cardiac magnetic resonance with gated SPECT for evaluation of left ventricular function and volumes in patients with severe and multiple myocardial perfusion defects

Gated SPECT is an accurate technique for assessment of myocardial perfusion [MP], left ventricular ejection fraction [LVEF], end-diastolic volume [EDV] and end-systolic volume [ESV]. However recent studies have concluded that there are large discrepancies in assessment of LVEF and volumes by gated SPECT in patients with multiple severe myocardial perfusion defects. We sought to investigate the correlation between LVEF and volumes calculated by gated SPECT and cardiac magnetic resonance [CMR] in patients with severe multiple perfusion defects who are referred for CMR. Twenty-nine patients [20 male and 9 female, mean age: 63 years +/- 11] with multiple severe fixed perfusion defects [mean 5 +/- 3 segments] were referred to undergo CMR. The average time between CMR and SPECT was 4 weeks. LVEF, EDV, and ESV were derived automatically from gated SPECT. In the CMR studies, the endocardial and epicardial borders were delineated manually in the short axis planes to calculate the LVEF and volumes. The different parameters were compared using linear regression, and correlation coefficients were calculated. Substantial correlation was found between CMR and gated SPECT for EDV: r = 0.7, p < 0.001. Moderate correlation between CMR and gated SPECT for LVEF: r = 0.5, p < 0.007 and ESV r =0.53, p < 0.003. Our data showed that the gated SPECT correlates substantially with MRI for measurement of EDV and moderately for ESV and LVEF in patients with multiple and severe perfusion defects. Thus, when accurate measurement is required, cardiac MRI is recommended

Quantitative lung perfusion scintigraphy in patients with congenital heart disease

The objectives of this article are to review different patterns and potential pitfalls of quantitative lung perfusion scintigraphy [IPS] in patients with congenital heart disease [CHD]. The patterns of quantitative IPS in patients with CHD include normal symmetrical bilateral perfusion to both lungs, unilateral absent perfusion in one lung, unilateral decreased perfusion, and multiple segmental perfusion abnormalities that suggest pulmonary embolism. Knowledge of several potential pitfalls is very important to avoid false interpretations; common pitfalls are related to type of site of injection [upper versus lower extremities], right or left upper extremity in case of persistence of left superior vena cava and previous surgery. An important incidental finding that may prompt immediate attenuation is multiple segmental defect that suggests asymptomatic pulmonary embolism, which is relatively common in this population