Impact of myocardial perfusion imaging on in-hospital coronary angiography and revascularization of patients with suspected coronary artery disease / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Noninvasive cardiac imaging is now central to the diagnosis and management of patients with moderate probability for coronary artery disease. The aim of this study was to assess the impact of stress myocardial perfusion single photon emission computerized tomography (SPECT) on in-hospital coronary angiography and revascularization for such patients.</p><p><b>METHODS</b>Between January 2005 and June 2007, 1053 consecutive in-hospital patients (423 women, the average age of (57.2 ± 11.2) years) with suspected coronary artery disease but without any prior interventional treatment were retrospectively analyzed. All patients underwent a 2-day stress/rest (99m)Tc-methoxyisobutylisonitrile (MIBI) myocardial perfusion SPECT, including 984 exercise test and 69 adenosine test.</p><p><b>RESULTS</b>Overall, stress/rest myocardial perfusion SPECT was normal in 973 patients (92.4%) and abnormal in 80 patients (7.6%). A total of 190 patients underwent coronary angiography, 46 underwent percutaneous coronary intervention and 10 coronary artery bypass grafting during hospitalization. From the whole perspective, only 14.7% of patients with normal SPECT underwent coronary angiography, so did 58.8% of patients with abnormal SPECT (χ(2) = 97.0, P < 0.001); furthermore, the rates of revascularization in patients with normal and abnormal SPECT were 2.8% and 36.3%, respectively (27 out of 973 vs. 29 out of 80, χ(2) = 157.9, P < 0.001). The extent and severity of ischemia did not add more predictive value for subsequent coronary angiography, but did have impact on revascularization. Multivariate analysis showed that reversible perfusion defect was the most predictive variable for referral rate to coronary angiography (odds ratio = 7.5, P < 0.001).</p><p><b>CONCLUSIONS</b>Abnormal myocardial perfusion SPECT is a powerful referral for in-hospital coronary angiography and revascularization during the same hospitalization. Thus, stress/rest SPECT is an effective gatekeeper for early coronary angiography and invasive treatment for patients with suspected coronary artery disease.</p>

Comparison of 99Tcm-MIBI myocardial perfusion imaging and delayed enhancement MRI for patients with idiopathic dilated cardiomyopathy / 中华核医学杂志

Objective To compare 99Tcm-MIBI MPI with delayed enhancement MRI (DE-MRI) in patients with idiopathic dilated cardiomyopathy (IDCM). Methods Forty patients with IDCM were included. They underwent both rest 99Tcm-MIBI myocardial perfusion imaging and DE-MRI within 7 days. 99Tcm-MIBI MPI was performed to identify diffuse or segmental abnormal perfusion patterns including reduced or defect perfusion segments. DE-MRI images were divided into 4 categories: no delayed enhancement, septal, subendocardial and transmural delayed enhancement, x2 test was used for data analysis. Results Diffuse and segmental perfusion abnormality on 99Tcm-MIBI MPI were found in 19 (47.5%) and 21 (52.5%)patients respectively, while DE-MRI enhancement was simultaneously found in 5 patients of the former (5/19, 26.3%) and 18 (18/21, 85.7%) of the latter (x2 =14.401, P＜0. 001). For those (n=18) with both segmental perfusion abnormality and DE-MRI enhancement, the number of segments of the 4 DE-MRI respectively. A significant difference was found in the DE-MRI enhancement categories between normal and defect perfusion segments (x2 = 29. 183, P ＜0.001 ) and between reduced and defect perfusion segments as well (x2 =25. 110, P＜0. 001). Conclusions Both diffuse and segmental perfusion abnormalities on 99Tcm-MIBI MPI can be found in patients with IDCM. DE-MRI enhancement is more frequently found in patients with segmental perfusion abnormality.

Clinical application of stress/rest myocardial perfusion imaging in the patients with 50 ％-75 ％ coronary stenosis / 中华核医学杂志

Objective To evaluate the clinical application of stress/rest MPI in the patients with 50％-75％ coronary artery stenosis.Methods The criteria for patient selection were that the patients should have at least one main coronary artery with stenosis more than 50％,and the maximal stenosis should be less than 75％ according to CAG.The stress/rest MPI was performed in 2 weeks before or after CAG.A total of 244 patients (178 males,66 females) with mean age (57 ± 10) years were included in this study.Symptom restriction stress test was used and stress MPI was performed 1 - 1.5 h after 99Tcm-MIBI (925 MBq)injection at the exercise peak.Rest MPI was performed within 48 - 72 h after stress MPI.Myocardial ischemia was diagnosed when there was a reduced uptake or even a defect in 2 different tomographic sections or in the same part of a myocardium in the continuous 2 slices.When there was an irreversible reduced uptake or defect,myocardial infarction was given as the final diagnosis.No reduced uptake or defect in all slices was shown as normal.The impact of MPI images on the selection for optimal clinical therapy plans was also discussed.X2 test was used for statistical analysis.Results A total of 340 coronary arteries with stenosis 50％ - 75％ were found by CAG.According to stress/rest MPI results,207 patients (84.8％)presented normal,33 had myocardial ischemia,3 had myocardial infarction,and 1 had both myocardial infarction and ischemia.In abnormal MPI images,there were 61 ischemic segments and 9 infarct segments,which were associated with 43 stenotic arteries (23 LAD,10 LCX,and 10 RCA).Patients were divided into 2 groups according to the results of MPI:Group 1 with normal MPI (207/244,84.8％ ) and Group 2 with abnormal MPI (37/244,15.2％ ).In Group 1,9 patients underwent coronary artery revascularization (PTCA or CABG),and the others had medical treatment.Eight patients had PTCA and 29 patients had medical treatment in Group 2.There was a statistically significant difference between the two groups ( X 2 =11.9,P =0.001 ).Conclusion Stress-rest MPI may be an effective method to evaluate ischemia degree for patients with 50％ -75％ coronary artery stenosis and a useful indicator for the individual treatment.

18F-FDG SPECT myocardial imaging of right ventricle in patients with idiopathic pulmonary hypertension / 中华核医学杂志

ObjectiveTo investigate the value of 18F-FDG SPECT myocardial imaging in evaluating haemodynamic change,treatment outcome and prognosis for idiopathic pulmonary arterial hypertension (IPAH).MethodsAll 24 patients with IPAH underwent 18 F-FDG SPECT myocardial imaging.Right ventricle/left ventricle (RV/LV)-FDG uptake was calculated by ROI method drawing over the central areas of left and right ventricular free walls.All patients underwent right heart catheterization within 3 days after imaging studies.Mean pulmonary artery pressure (mPAP) and pulmonary vascular resistance (PVR) were recorded.After six month pharmaceutical treatment,15 IPAH patients were re-examined with 18F-FDG SPECT myocardial imaging followed by repeated right heart catheterization within 3 days.Plasma N-terminal pro-brain naturetic peptide (NT-proBNP) and endothelin-1 ( ET-1 ) were measured in 17 patients using electrochemiluminescent immunoassay and enzyme immunoassay respectively.All patients were followed up for 12 months at least.Correlations between RV/LV-FDG uptake and mPAP and PVR were determined by simple linear regression analysis.Change of RV/LV-FDG before and after treatment was calculated using Student's t-test.Survival in groups with RV/LV FDG uptake ≥ 1.15 and RV/LV-FDG uptake ＜ 1.15 were compared using Log-rank test.ResultsSignificant correlations were found between RV/LV-FDG uptake and mPAP (r =0.562,P ＜ 0.01 ),and between RV/LV-FDG uptake and PVR ( r =0.574,P ＜ 0.01 ).There were no significant correlation between RV/LV-FDG uptake and NT-proBNP( r =0.18 1,P ＞ 0.05 ),but a significant correlation between RV/LV-FDG and ET-1 was observed (r =0.669,P ＜ 0.01 ).The RV/LV-FDG uptake in patients with positive treatment outcome ( n =6) decreased from 1.38 ± 0.52 to 0.92 ±0.26 (t =4.018,P ＜ 0.05) after 6 months treatment.In contrast,no significant change of RV/LV-FDG uptake was seen in those patients (n =9) with negative treatment outcome ( t =1.861,P ＞ 0.05 ).The mean follow-up time was (21 ±8) months.Mean survival time for the patients with RV/LV- FDG uptake ≥ 1.15was 28 months (95％ confidence interval:24-32 months),which was significantly lower than 34 months survival (95％ confidence interval:33-35 months) for the patients with RV/LV-FDG ＜ 1.15 (x2 =3.956,P ＜0.05 ).Conclusions Detection of right ventricle myocardial glucose metabolism level with 18F-FDG SPECT may be a practical method for evaluating haemodynamic change,treatment outcome and prognosis of IPAH.

Alterations in electrocardiogram of adenosine test for 99Tcm-MIBI myocardial perfusion imaging / 中华核医学杂志

Objective To analyze alterations in electrocardiogram (ECG) of adenosine test in 99Tcm-MIBI myocardial perfusion imaging(MPI)SPECT study. Methods A total of 641 patients were in cluded in the study. The patients each underwent 99Tcm-MIBI MPI with adenosine test. The ECGs were taken before, during, and after adenosine infusion. Results In all, abnormal ECGs were found in 205(32.0%) patients. During adenosine infusion, 20.6%(132/641) of patients suffered from arrhythmia,29.5%(39/132) had atrial premature beats, 34. 1% (45/132) had premature ventricular beats, and 6. 1% (8/132) had sinoatrial block. In addition, 5.3% (7/132) had first-, 24.2% (32/132) had second-, and 0.8%(1/132) had third-degree atrioventricular block (AVB). After adenosine infusion, 4.4%( 28/641) of patients suffered from arrhythmia, 57.1% (16/28) had atrial premature beats, 39.3%(11/28) had premature ventricular beats, and 3.6% (1/28) had sinoatrial block. The perfusion images showed ischemia in 36 patients and infarction in 8 patients. Adenosine infusion was terminated in 39 patients (6. 1%) because of poorly tolerated side effects. However, no death or acute myocardial infarction occurred in the study. Conclusions Adenosine pharmacologic test for 99TcmMIBI MPI may result in relatively high incidence of arrhythmia in ECG monitoring.

Comparison of cardiac function parameters in gated myocardial SPECT determined by filtered backprojection and OSEM reconstruction methods / 中华核医学杂志

Objective To compare the cardiac function parameters in gated SPECT determined by filtered back projection (FBP) and OSEM reconstruction methods. Methods One hundred and forty-four patients underwent 99Tcm-MIBI gated-SPECT imaging studies. The parameters LVEF, EDV and ESV, were derived using quantitative gated SPECT (QGS), four-dimensional model SPECT (4D-MSPECT) and emory cardiac toolbox (ECToolbox) softwares. Each image was reconstructed by FBP or OSEM. Bland-Altman analysis and paired t-test were applied to evaluate those parameters. Results Correlation coefficients for LVEF, EDV and ESV between FBP and OSEM methods were all more than 0.93 (all P<0.001). EDV calculated by FBP was lower than that by OSEM using QGS software, but became the opposite when using 4D-MSPECT and ECToolbox softwares. (QGS: (82.2±39.1) ml vs (83.5±40.8) ml, t=-2.53, P<0.05; 4D-MSPECT: (93.5±46.9) ml vs (88.8±45.2) ml, t=5.95, P<0.01; ECToolbox: (106.4±51.1) ml vs (100.8±49.0) ml, t=3.99, P<0.01). ESV calculated by FBP was higher than that by OSEM using 4D-MSPECT software (4D-MSPECT:(37.5±41.4) ml vs (34.8±37.6) ml, t=3.92, P<0.01). LVEF calculated by FBP was lower than that by OSEM using QGS software ((62.1±16.9)% vs (63.1±16.1)%, t=-3.14, P<0.05), but higher than that by OSEM using ECToolbox software ((74.1±18.8)% vs (71.3±17.1)%, t=5.28, P<0.01). Conclusion Generally, cardiac functional parameters based on FBP and OSEM construction methods correlated well, although they might have singnificantly different results.

18F-FDG/99Tcm-MIBI SPECT myocardial imaging for the detection of myocardial viability in patients with acute myocardial infarction / 中华核医学杂志

Objective To investigate the value of 18F-FDG/99Tcm-MIBI SPECT myocardial imaging for the detection of myocardial viability and prognosis in patients with AMI. Methods 18F-FDG/99Tcm-MIBI SPECT myocardial imaging was performed in 98 consecutive patients [man 87, women 11; average age (58 ±11)y] with AMI. The myocardium was scored individually for nine segments: mildly decreased uptake = 1,significantly decreased uptake = 2, and no uptake = 3. Perfusion defect but preserved 18 F-FDG uptake was defined as perfusion-metabolism mismatch, indicating jeopardized but viable myocardium. Perfusion defect and decreased 18 F-FDG uptake were defined as match, indicating myocardial necrosis. Echocardiogram was performed before and after treatment for evaluating the LVEF. All patients were followed after treatment.The rate of cardiac events was calculated and compared between patients with medication and revascularization. Paired t test, Chi-square test and log-rank test were used for statistical analysis. Results In the group with viable myocardium, 27 patients received revascularization and 10 received medication. In the group with infarcted myocardium, 26 patients received medication and 35 received revascularization. Patients underwent revascularization and with medication had no significant difference in improvement of LVEF between both groups (viable myocardium group: χ2 = 0.509, P > 0. 05; infarcted myocardium group: χ2 =0.035, P > 0.05). In viable myocardium group, cardiac event rate was significantly higher in patients with medication than in those who had undergone revascularization (50.0% vs 14.8%, χ2 =4.91, P<0.05).In the infarcted myocardium group, cardiac event rate was also significantly higher in patients with medication (30.7% vs5.7% ,χ2 =6.83, P<0.05). Conclusions 18F-FDG/ -MIBI SPECT myocardial imaging may well be of value but limited for the detection of myocardial viability and prediction of improvement in cardiac function as well as prognosis. However, more prospective data are needed for final evaluation.

Pulmonary perfusion imaging combined with Wells score and D-dimer assay for the diagnosis of acute pulmonary embolism / 中华核医学杂志

Objective To investigate the value of the Wells score and D-dimer assay in assisting pulmonary perfusion imaging (PPI) for the diagnosis of acute pulmonary embolism (APE). Methods One hundred twenty-one patients with suspected APE were studied from January, 2006 to December, 2008. All patients underwent the Wells score, the quantitative D-dimer assay, chest X-ray photography, and PPI. The diagnostic sensitivity, specificity, positive predictive value and negative predictive value of PPI with the assistance of Wells score and D-dimer assay were calculated. Results Fifty (41.3%) patients were diagnosed with APE. PPI combined with chest X-ray photography (Q/X scan) showed positive results in 49 patients. The sensitivity, specificity, positive predictive value and negative predictive value of the Q/X scan were 86.0% (43/50), 91.5% (65/71), 87.8% (43/49) and 90.3% (65/72), respectively. With assistance of Wells score >4 and D-dimer≥0. 5 mg/L, Q/X scan had a positive predictive value of 100.0% (29/29), for patients with Wells score ≤4 and D-dimer<0.5 mg/L, the negative predictive value for Q/X scan was 100.0% (41/41). Conclusion Combined with Wells score and D-dimer assay, PPI can make accurate diagnosis of APE.

The effect of 131I on apoptosis of thyrocytes in patients with Graves disease / 中华核医学杂志

Objective To investigate the effect of 131I on apoptosis of thyrocytes in patients with Graves disease. Methods Forty-seven patients with Graves disease were divided into two groups, two week group (G2w) and four week group (G4w). All patients underwent thyoid needle biopsy before 131I treatment and the repeated biopsy at two weeks (G2w) or four weeks (G4w) after 131I treatment. The positive units of pro-apoptotic proteins (Fas, FasL) and anti-apoptotic protein (Bcl-2) were studied with immunohistochemistry staining. The differences of the two groups were compared with t-test. Liner correlation analysis was applied to study the correlation between 131I dose and apoptosis-related proteins and that between serum sTSH after 131I treatment and apoptosis-related proteins. Results Fas, FasL and Bcl-2 expression (positive units) were significantly increased in both groups after 131I treatment, G2w :22.84 ± 9.31 vs 16.20 ± 6.75,21.13±6.29vs 14.56±4.06, 21.69±7.83 vs 15.22 ±5.94, t= -3.08, -3.73, -4.05 (allP<0.05); G4w:21.69 ±4.52 vs 15.83 ±5.03, 19. 11 ±3.75 vs 14.02 ±4.98, 19.06 ±3.44 vs 16.63 ±4. 73, t = - 5.26, - 5.00, - 2.41 (all P<0.05). However, no statistical differences were found between G2w and G4w (t = 0. 53, 0. 82, 1.46, all P > 0.05). Significant correlation was found between 131I 0. 727, rFasL = 0. 763 (both P<0.05)), but not between the dose and Bcl-2, rBcl-2 = - 0. 094, 0. 102(both P > 0.05). There were significant correlation between serum sTSH three months after 131I treatment and apoptosis-related proteins, rFas = 0.433, rFasL = 0. 601, rBcln2 = - 0. 397, (all P<0. 05). Conclusions 131I can induce thyrocytes to express the pro-apoptotic proteins in patients with Graves disease.

Myocardial perfusion evaluation post percutaneous transluminal septal myocardial ablation in patients with hypertrophic obstructive cardiomyopathy by ⁹⁹Tc(m) MIBI SPECT MPI / 中华心血管病杂志

<p><b>OBJECTIVE</b>To evaluate the myocardial perfusion and function in patients with hypertrophic obstructive cardiomyopathy (HOCM) before and after percutaneous transluminal septal myocardial ablation (PTSMA).</p><p><b>METHODS</b>Sixty-eight patients with hypertrophic obstructive cardiomyopathy were included and (99)Tc(m)-MIBI SPECT MPI was applied before and at 1 week after PTSMA, six-month follow-up was finished in 11 patients. Semi quantity and QGS quantity perfusion and function assessment was performed in 17 LV segments.</p><p><b>RESULTS</b>Myocardial perfusion post-PTSMA was significantly reduced in 98% patients, especially in basal anterosepta, basal interseptal, mid-anteroseptal, mid-interseptal and apical septal segments compared with pre-PTSMA (all P < 0.05). Perfusion was significantly increased at 6 months follow-up than at 1 week post-PTSMA but still lower than pre-PTSMA (all P < 0.05). LVEF (evaluated by gated SPECT) was similar before and after the procedure (P > 0.05). Regional wall motion after PTSMA was lower than pre-PTSMA in basal anterior, basal anteroseptal, basal interseptal and basal inferior (P < 0.05). Regional wall thinkening was lower than pre-PTSMA in basal interseptal, mid-anteroseptal, mid-interseptal (P < 0.05).</p><p><b>CONCLUSIONS</b>(99)Tc(m) MIBI SPECT can be used to monitor myocardial perfusion post PTSMA in patients with HOCM.</p>

N-terminal pro-B-type natriuretic peptide and diastolic function measurements by adenosine stress echocardiography in prediction of coronary stenosis in patients / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Stress echocardiography is mainly used in detection of coronary artery disease (CAD) and to assess risk. This study aimed to use adenosine stress echocardiography (ASE) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) to noninvasively assess coronary stenosis in patients with chest pain syndromes or anginal equivalent.</p><p><b>METHODS</b>NT-proBNP was measured after overnight fast in fifty patients, 42 males and 8 females, who were (57 ± 11) years old. They then underwent echocardiography before and during adenosine administration. Left ventricular (LV) diastolic function analyzed included mitral annular early (E') and late velocity (A') both at the mitral septal and lateral level and the mitral inflow to annulus ratio (E/E'). Coronary angiography was performed the following day after which patients were assigned to three groups: normal results (16 patients), stenosis 50% - 69% (17 patients) and stenosis ≥ 70% (17 patients).</p><p><b>RESULTS</b>NT-proBNP levels in the groups of stenosis 50% - 69% and ≥ 70% were significantly higher than that in the group with normal results (P = 0.014 and P = 0.040). During adenosine stress, the E/E' in the group of stenosis ≥ 70% was higher than in the group of normal results (P = 0.024). E'(lateral)/A'(lateral) in the group of stenosis 50% - 69% and E'(septal)/A'(septal) and E'(lateral)/A'(lateral) in the group of stenosis ≥ 70% were also decreased during stress compared with baseline (P = 0.003, P = 0.001, P = 0.022). The variation of E'(septal)/A'(septal) before and during adenosine stress (ΔE'(septal)/A'(septal)) between the groups of normal results and stenosis ≥ 70% were significantly different (P = 0.001). By receiver operating characteristic (ROC), the specificity of ΔE'(septal)/A'(septal) ≥ 0.037 predicting coronary stenosis < 70% was 94%. The sensitivity and specificity of NT-proBNP ≥ 544.6 fmol/ml in predicting coronary stenosis ≥ 70% were 93% and 75%, respectively. NT-proBNP inversely correlated with E'(lateral)/A'(lateral) (r = - 0.390, P = 0.014) and positively correlated with E/E'(lateral) (r = 0.550, P = 0.001).</p><p><b>CONCLUSIONS</b>Adenosine might induce diastolic dysfunction in patients with coronary stenosis more than 70% and NT-proBNP could reflect LV diastolic function to a certain extent. We support the prediction that most patients having chest pain syndromes or anginal equivalent with NT-proBNP < 544.6 fmol/ml and in ASE ΔE'(septal)/A'(septal) ≥ 0.037 might be spared coronary angiography.</p>

The 18F-FDG myocardial metabolic imaging in twenty seven pilots with regular aerobic training / 中华心血管病杂志

<p><b>OBJECTIVE</b>To evaluate the characteristics of myocardial (18)F-FDG imaging in pilots with regular aerobic exercise training.</p><p><b>METHODS</b>Twenty seven healthy male pilots with regular aerobic exercise training were included in this study. The subjects were divided into fasting (n = 17) or non-fasting group (n = 10). Fluorine-18-labeled deoxyglucose and Tc-99m-sestamibi dual-nuclide myocardial imaging were obtained at rest and at target heart rate during bicycle ergometer test. The exercise and rest myocardial perfusion imaging were analyzed for myocardial ischemia presence. The myocardial metabolism imaging was analyzed with the visual semi-quantitative analyses model of seventeen segments.</p><p><b>RESULTS</b>The secondary-extreme heart rate (195-age) was achieved in all subjects. There was no myocardial ischemia in all perfusion imaging. In the visual qualitative analyses, four myocardial metabolism imaging failed in the fasting group while one failed in the non-fasting group (P > 0.05). In the visual semi-quantitative analyses, myocardial metabolism imaging scores at rest or exercise in all segments were similar between two groups (P > 0.05). In the fasting group, the myocardial metabolism imaging scores during exercise were significantly higher than those at rest in 6 segments (P < 0.05). In the non-fasting group, the scores of 3 exercise myocardial metabolism imaging were significantly higher than those at rest (P < 0.05).</p><p><b>CONCLUSION</b>Satisfactory high-quality myocardial metabolism imaging could be obtained at fasting and exercise situations in subjects with regular aerobic exercise.</p>

Assessment of therapeutic effects of stem cell transplantation in heart failure patients with old myocardial infarction by magnetic resonance imaging / 中华心血管病杂志

<p><b>OBJECTIVE</b>To evaluate the therapeutic effects of stem cell transplantation in heart failure patients with old myocardial infarction (OMI) by MRI.</p><p><b>METHODS</b>Heart failure patients [NYHA 2.7 +/- 0.7, male = 18, mean age (59.5 +/- 10.1) y] with OMI were randomly divided into 2 groups (group A: CABG + stem cell transplantation, group B: CABG; n = 10 each). Left ventricular (LV) function was measured by MRI, viable myocardium was detected by (18)F-FDG myocardial metabolism imaging and late contrast-enhanced at baseline and 6 months post intervention.</p><p><b>RESULTS</b>LVEF and LVEDV at baseline for group A were (20.71 +/- 6.09)% and (172.73 +/- 32.74) ml, and for group B were (27.59 +/- 2.31)% and (155.13 +/- 28.36) ml, respectively (P > 0.05). The LVEF was equally improved in group A and B (mean 8.63% vs. 10.37%, P > 0.05) while DeltaLVEDV was significant higher in group A than that in group B [(9.91 +/- 39.50) ml vs. (-22.34 +/- 31.35) ml, P < 0.05]. Ventricular wall thickening ratio at 6 months post intervention was significantly higher in group A than that in group B [(11.40 +/- 11.53)% vs. (2.27 +/- 7.20)%, P < 0.05]. Late contrast-enhanced MRI results correlated with (18)F-FDG myocardial metabolism imaging SPECT well in assessment of myocardial viability (kappa value: 0.446, P < 0.001; sensitivity: 68.3% and specificity: 92.5%).</p><p><b>CONCLUSIONS</b>Stem cell therapy on top of CABG aggravated LV remodeling in heart failure patients with old myocardial infarction. The specificity of MRI is similar to (18)F-FDG SPECT while the sensitivity is inferior to (18)F-FDG SPECT on detecting viable myocardium.</p>

Impact of viable myocardium assessed by 99Tcm-MIBI SPECT and 18F-FDG PET imaging on clinical outcome of patients with left ventricular aneurysm underwent revascularization / 中华心血管病杂志

<p><b>OBJECTIVE</b>To evaluate the impact of viable myocardium assessed by (99)Tc()m-MIBI SPECT and (18)F-fluorodeoxyglucose (FDG) PET imaging in patients with left ventricular aneurysm (LVA) underwent revascularization (RVS).</p><p><b>METHODS</b>Forty-six consecutive patients with LVA (mean LVEF 36% +/- 7%), underwent (99)Tc(m)-sestamibi SPECT and (18)F-FDG PET examinations and received RVS therapy, were followed-up for a mean period of 80 +/- 27 months. Viable myocardium in aneurysm was defined as perfusion-metabolism mismatch score (MMS) >/= 2.0. Patients were divided into four groups by aneurysm viability and aneurysmectomy. Group A1 (n = 8): viability-; Group A2 (n = 15): viability-, aneurysmectomy; Group B1 (n = 10): viability +; and Group B2 (n = 13): viability +, aneurysmectomy.</p><p><b>RESULTS</b>The cardiac event rates during follow up were similar among groups [A1 (25%, 2/8), B1 (40%, 6/15), A2 (20%, 2/10) and B2 (31%, 4/13; P > 0.05)]. After revascularization, LVEF was improved (> 10%) in groups A2, B1 and B2 (P < 0.05). Multivariate logistic regression analysis showed that LV-MMS (OR = 2.34, 95% CI 1.08 - 5.06, P < 0.05), distal vessel disease (OR = 0.008, 95% CI 0.001 - 0.560, P < 0.05) and nonaneurysm perfusion score (OR = 0.24, 95% CI 0.07 - 0.85, P < 0.05) were significantly associated with the improvement of LVEF after revascularization.</p><p><b>CONCLUSIONS</b>Long term cardiac events rate post revascularization was not affected by viable myocardium or aneurysmectomy in LVA patients. Viable myocardium in LVA patients was associated with better LVEF improvement after revascularization.</p>

Value of radionuclide lung scintigraphy in the diagnosis and quantitative analysis of chronic thromboembolic pulmonary hypertension / 中华心血管病杂志

<p><b>OBJECTIVE</b>This study was to assess the reliability of perfusion/ventilation (Q/V) lung scintigraphy in the diagnosis and quantitative analysis of chronic thromboembolic pulmonary hypertension (CTEPH).</p><p><b>METHODS</b>A total of 78 in-patients with pulmonary hypertension who had no history of congenital heart disease, valvular disease and acute pulmonary embolism were included in this study. All patients underwent Q/V scintigraphy for detecting CTEPH. The sensitivity, specificity and accuracy of Q/V scintigraphy were defined by comparing with the results of pulmonary angiography. Percentage of Perfusion Defect score (PPDs%) was calculated in patients with CTEPH confirmed by pulmonary angiography. The correlations between PPDs% and mPAP, PPDs% and SPAP were analyzed.</p><p><b>RESULTS</b>The sensitivity, specificity and accuracy of a high-probability Q/V scintigraphy interpretation were 96.0%, 81.1% and 86.9%, respectively, compared with 100%, 69.8% and 79.5% for the combination of high- and intermediate- probability Q/V scintigraphy interpretation. PPDs% was significantly correlated with mPAP and SPAP (r = 0.538 for mPAP, P < 0.01 and r = 0.456 for SPAP, P < 0.05).</p><p><b>CONCLUSION</b>Perfusion/ventilation lung scintigraphy is a valuable technique for diagnosis and quantitative analysis of CTEPH.</p>

Myocardial perfusion imaging with (99m)Tc (N) (PNP5) (DBODC)(+) in canine model of acute myocardial ischemia / 中华心血管病杂志

<p><b>OBJECTIVE</b>(99m)Tc-[bis (dimethoxypropylphosphinoethyl)-ethoxyethylamine (PNP5)]-[bis (N-ethoxyethyl)-dithiocarbamate (DBODC)] nitride ([(99m)Tc (N) (PNP5) (DBODC)](+)) is a new myocardial perfusion tracer with high heart uptake and rapid liver clearance. The objectives of this study were to compare the myocardial imaging of [(99m)Tc (N) (PNP5) (DBODC)](+) with (99m)Tc-MIBI in a canine model of acute myocardial ischemia.</p><p><b>METHODS</b>The left anterior descending artery (LAD) was occluded in 12 adult beagle dogs, adenosine was then infused intravenously at a rate of 0.14 mg.kg(-1).min(-1) for 6 min. At the end of 3 min of adenosine infusion, 185 MBq of [(99m)Tc (N) (PNP5) (DBODC)](+) or (99m)Tc-MIBI was injected intravenously. The occluder was released after 6 min adenosine infusion. Serial myocardial SPECT imaging acquisitions were obtained at 0.5, 1, 1.5 and 2 h after tracer injection, respectively. Rest myocardial SPECT imaging was acquired in the next day.</p><p><b>RESULTS</b>Similar as (99m)Tc-MIBI, [(99m)Tc (N) (PNP5) (DBODC)](+) exhibited high heart uptake, minimal lung uptake and minimal redistribution. No significant myocardial washout was observed with both tracers over a period of 2 hours. [(99m)Tc (N) (PNP5) (DBODC)](+) clearance from the liver was more rapid than that with (99m)Tc-MIBI (heart-liver radio at 60 min, 1.36 +/- 0.43 vs. 0.58 +/- 0.21, P = 0.005). [(99m)Tc (N) (PNP5) (DBODC)](+) the ability to detect myocardial ischemia was also comparable between the two tracers ([(99m)Tc (N) (PNP5) (DBODC)](+) detected 3.60 +/- 1.52 defect segments, (99m)Tc-MIBI detected 4.25 +/- 0.96 defect segments, P = 0.48). The image quality of [(99m)Tc (N) (PNP5) (DBODC)](+) was better than (99m)Tc-MIBI.</p><p><b>CONCLUSION</b>[(99m)Tc (N) (PNP5) (DBODC)](+) is comparable to (99m)Tc-MIBI on detecting myocardial ischemia in this model and liver clearance is more rapid and the image quality is better than (99m)Tc-MIBI.</p>

Effects of Tongxinluo-facilitated cellular cardiomyoplasty with autologous bone marrow-mesenchymal stem cells on postinfarct swine hearts / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Treatment of ischemic heart disease remains an important challenge, though there have been enormous progresses in cardiovascular therapeutics. This study was conducted to evaluate whether Tongxinluo (TXL) treatment around the transplantation of mesenchymal stem cells (MSCs) can improve survival and subsequent activities of implanted cells in swine hearts with acute myocardial infarction (AMI) and reperfusion.</p><p><b>METHODS</b>Twenty-eight Chinese mini-pigs were divided into four groups including a control group (n = 7); group 2, administration of low-dose TXL alone from the 3rd day prior to AMI to the 4th day post transplantation (n = 7); group 3, MSCs alone (n = 7) and group 4, TXL + MSCs (n = 7). AMI models were made by occlusion of the left anterior descending coronary artery for 90 minutes. Autologous bone marrow-MSCs (3 x 10(7) cells/animal) were then injected into the post-infarct myocardium immediately after AMI and reperfusion. The survival and differentiation of implanted cells in vivo were detected by immunofluorescent analysis. The data of cardiac function were obtained at baseline (1 week after transplantation) and endpoint (6 weeks after transplantation) by single photon emission computed tomography (SPECT) and magnetic resonance imaging (MRI). Apoptosis was detected by TUNEL assay and the oxidative stress level was investigated in the post-infarct myocardium at endpoint.</p><p><b>RESULTS</b>At endpoint, there was less fibrosis and inflammatory cell infiltration with more surviving myocardium in group 4 than in the control group. In group 4 the survival and differentiation of implanted MSCs were significantly improved more than that seen in group 3 alone (P < 0.0001); the capillary density was also significantly greater than in the control group, group 2 or 3 both in the infarcted zone (P < 0.0001) and the peri-infarct zone (P < 0.0001). MRI showed that parameters at baseline were not significantly different between the 4 groups. At endpoint, regional wall thickening and the left ventricular ejection fraction were increased while the left ventricular mass index, dyskinetic segments and infarcted size were decreased only in group 4 compared with control group (P < 0.0001). SPECT showed that the area of perfusion defect was significantly decreased at endpoint only in group 4 compared with control group (P < 0.0001). TUNEL assay indicated that TXL administration significantly decreased cell apoptosis in peri-infarct myocardium in groups 2 and 4. Furthermore, superoxide dismutase (SOD) significantly increased and malondialdehyde (MDA) decreased in groups 2 and 4 by the administration of TXL.</p><p><b>CONCLUSIONS</b>Our study demonstrates the following: (1) immediate intramyocardial injection of MSCs after AMI and reperfusion resulted in limited survival and differentiation potential of implanted cells in vivo, thus being incapable of beneficially affecting post-hearts; (2) TXL-facilitation resulted in a significant survival and differentiation potential of implanted cells in vivo via inhibition of apoptosis and oxidative stress, accompanied by significant benefits in cardiac function.</p>

Noninvasive detection of experimental vulnerable atherosclerotic plaques with 99Tc m labeled C2A domain of synaptotagmin I / 中华心血管病杂志

<p><b>OBJECTIVE</b>(99)Tc(m) labeled C2A domain of synaptotagmin I ((99)Tc(m)-Syt I-C2A) is used for noninvasive detection of vulnerable atherosclerotic plaque.</p><p><b>METHODS</b>Recombinant C2A domain of synaptotagmin I, overexpressed in E. Coli, was thiolated with 2-iminothiolane (2-IT) and labeled with (99)Tc(m). Atherosclerotic plaques were produced in 5 rabbits by deendothelialization of the abdominal aorta and the rabbits were fed with cholesterol diet for 3 months. Three rabbits not manipulated served as normal controls. All animals were injected with (99)Tc(m)-Syt I-C2A and underwent in vivo imaging thereafter. Aortas were then explanted for ex vivo imaging and histological characterization.</p><p><b>RESULTS</b>In deendothelialized animals, intense radio-uptake in abdominal aorta, showed by gamma camera at 2 h after injection, was visualized and T/B was 3.25 +/- 0.51 by ROI measurement, quantitative uptake ratio of abdominal aortas with atherosclerotic lesions to thoracic aortas was 8.39 +/- 1.74 in ex vivo imaging. The mean uptake in specimens of abdominal aortas with lesions was 12.6-fold higher than in control abdominal aortas, and 10.2-fold higher than in thoracic aortas of deendothelialized animals by gamma-counter.</p><p><b>CONCLUSION</b>(99)Tc(m)-Syt I-C2A has a high affinity for vulnerable atherosclerotic plaque and is a suitable a gent for the noninvasive detection of vulnerable atherosclerotic plaque.</p>

Diagnostic value of 99mTc-N-NOET myocardial perfusion imaging during exercise for coronary artery disease / 中华心血管病杂志

<p><b>OBJECTIVE</b>To assess the value of (99m)Tc-N-NOET ((99m)Tc-N-ethoxy-N-ethyl dithiocarbamato-nitrito) myocardial perfusion SPECT for the diagnosis of coronary artery disease.</p><p><b>METHODS</b>A total of 42 patients [mean age (54 +/- 9) years, 35 men] with suspected chest pain were included in this study. 740 MBq of (99m)Tc-N-NOET was injected intravenously during bicycle exercise when the heart rate attained reached more than 85% of the expected maximum, or in cases of angina pectoris, severe arrhythmias and ischemic ST segment changes. (99m)Tc-N-NOET 740 MBq, SPECT myocardial imaging acquisitions were obtained at 15 minutes and 2 hours after (99m)Tc-N-NOET injection. Coronary angiography was performed in all patients.</p><p><b>RESULTS</b>Coronary artery stenosis was detected in 26 patients and normal coronary angiography was shown in 16 patients. (99m)Tc-N-NOET myocardial perfusion imaging was abnormal in twenty-one patients out of the 26 patients with significant coronary artery stenosis (sensitivity, 81%); 14 out of 16 patients with normal angiography had a normal myocardial perfusion imaging (specificity, 88%). The positive predictive value, negative predictive value and predictive accuracy of (99m)Tc-N-NOET myocardial perfusion imaging for detection of CAD was 91%, 74% and 83%, respectively. The sensitivity of the imaging for detecting single vessel, double vessels and triple vessels disease were 60% (6/10), 86% (6/7) and 100% (9/9), respectively. There was mild (99m)Tc-N-NOET lung uptake in patients with coronary artery stenosis 15 minutes post (99m)Tc-N-NOET injection.</p><p><b>CONCLUSION</b>SPECT myocardial perfusion imaging with (99m)Tc-N-NOET supplied an important diagnostic tool for detecting coronary artery disease. Lung uptake with stress (99m)Tc-N-NOET might be related to coronary artery disease.</p>

Inferior-septal myocardial infarction misdiagnosed as anterior-septal myocardial infarction: electrocardiographic, scintigraphic, and angiographic correlations / 中国医学科学杂志(英文版)

<p><b>OBJECTIVE</b>To explore the infarct sites in patients with inferior wall acute myocardial infarction (AMI) concomitant with ST segment elevation in leads V1-V3 and leads V3R-V5R.</p><p><b>METHODS</b>Five patients diagnosed as inferior, right ventricular, and anteroseptal walls AMI at admission were enrolled. Electrocardiographic data and results of isotope 99mTc-methoxyisobutylisonitrile (MIBI) myocardial perfusion imaging and coronary angiography (CAG) were analyzed.</p><p><b>RESULTS</b>Electrocardiogram showed that ST segment significantly elevated in standard leads II, III, aVF, and leads V1-V3, V3R-V5R in all five patients. The magnitude of ST segment elevation was maximal in lead V1 and decreased gradually from lead V1 to V3 and from lead V1 to V3R-V5R. There was isotope 99mTc-MIBI myocardial perfusion imaging defect in inferior and basal inferior-septal walls. CAG showed that right coronary artery was infarct-related artery.</p><p><b>CONCLUSIONS</b>The diagnostic criteria for basal inferior-septal wall AMI can be formulated as follows: (1) ST segment elevates > or = 2 mm in lead V1 in the clinical setting of inferior wall AMI; (2) the magnitude of ST segment elevation is the tallest in lead V1 and decreases gradually from lead V1 to V3 and from lead V1 to V3R-V5R. With two conditions above, the basal inferior-septal wall AMI should be diagnosed.</p>