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Objective To observe the evaluation function of gated equilibration ventriculography for the changes of left ventricular function in breast cancer with targeted therapy. Methods From February 2016 to December 2017, a total of 60 female breast cancer patients (age:28-65 (48.7±9.4) years) were included prospectively. Patients were divided into 2 groups: lapatinib combined with taxeme-based chemo-therapy group (group A;n=25, age:29-65 (47.8±11.3) years) and lapatinib monotherapy group (group B;n=35, age:31-62 (51.1±8.5) years). All patients underwent gated equilibration ventriculography be-fore treatment and 6/12 months after treatment. The parameters of left ventricular function including left ven-tricle ejection fraction (LVEF), peak ejection rate (PER), peak filling rate (PFR), 1/3 ejection fraction (EF), 1/3 filling fraction (FF), time to peak ejection rate (TPER) and time of peak filling rate (TPFR) were observed. Repeated measurement analysis of variance, independent-samples t test and Wilcoxon rank sum test were performed. Results In group A, the PER at 12 months after treatment ((3.11±0.48) end-di-astolic volume (EDV)/s) was lower than that before treatment ((3.60±0.62) EDV/s;F=3.447, t=0.60, P<0. 05), while there was no statistical difference between PER at 6 months after treatment ((3.34±0.57) EDV/s) and that before treatment (t=0.51, P>0. 05);the PFR at 6 months ((3.07±0.71) EDV/s) and 12 months after treatment ((2.84±0.54) EDV/s) declined significantly compared with that before treatment ((3. 57± 0. 81) EDV/s;F=5.345, t=0.82 and 0.75, both P<0. 05) . In group B, the PFR at 12 months after treat-ment ((2.86±0.55) EDV/s) declined significantly compared with that before treatment ((3.23±0. 87) EDV/s;F=3.214, t=0.84, P<0. 05) . The decrease of PFR at 6 months and 12 months after treatment in group A was greater than that in group B (-0.37(-0.78, 0. 15) vs -0.13(-0.44, 0.17) EDV/s; z=-1.569, P<0. 05) . Conclusions The gated equilibration ventriculography can effectively monitor the left ventricular function of breast cancer patients after targeted therapy. PER and PFR may be more sensitive than other pa-rameters to assess heart function changes. The lapatinib combined with taxeme-based chemotherapy can af-fect diastolic function more and earlier than lapatinib monotherapy.
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Purpose To evaluate the clinical guiding value of 99Tcm-methoxyisobutylisonitrile gated myocardial perfusion imaging (99Tcm-MIBI G-MPI) in diagnosing the coronary microangiopathy in patients with diabetic mellitus.Materials and Methods Sixty patients with clinical confirmed coronary microvascular angina were selected and assigned into two groups,with 26 patients (with diabetes mellitus) in group A and 34 patients in group B (without diabetes mellitus).The region,extent and range of coronary microangiopathy was detected by 99Tcm-MIBI G-MPI,and the difference of myocardial ischemia between the two groups was statistically analyzed.Results The ratio of abnormal myocardial perfusion in group A was significantly higher than that in group B (96.15％ vs.73.53％,x2=5.43,P＜0.05);the total number of abnormal coronary branches in group A was significantly larger than that in group B (82.67％ vs.62.67％,P＜0.05);the total number abnormal perfusion segments in group A was significantly larger than that in group B (P＜0.05),and the abnormal perfusion segments number of anterior wall,septum,apical region and inferior wall in group A was significantly larger than that ingroup B (P＜0.05);the rate of abnormal perfusion at single coronary supplying region in group A was significantly lower than that in group B (P＜0.05).Conclusion 99Tcm-MIBI G-MPI is of great clinical significance for diagnosing coronary microangiopathy and evaluating myocardial ischemia in patients with diabetes mellitus.
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Purpose To investigate the clinical value of gated myocardial perfusion imaging (GMPI) quantitative analysis technique in evaluating left ventricular remodeling and its effects on left ventricular function in patients with myocardial infarction (MI). Materials and Methods Seventy-six cases of MI patients were retrospectively analyzed, including pure left anterior descending artery (LAD) disease in 21 cases , left circumlfex artery (LCX) or right coronary branch (RCA) disease in 23 patients and multivessel disease in 32 cases. Seventy-four healthy people were additionally selected as control group. GMPI was performed on all subjects. Reconstruction images were automatically analyzed by using cardiac software QGS 2009 to obtain left ventricular remodeling index, including diastolic sphericity index (SIED) and end-systolic sphericity index (SIES). Cardiac function parameters were also obtained, including left ventricular end-diastolic volume (EDV), end-systolic volume (ESV), left ventricular ejection fraction (LVEF), and peak iflling rate (PFR). Differences of the left ventricular remodeling index and cardiac function parameters between the MI group and the control group were compared to analyze the relationship between left ventricular remodeling after myocardial infarction and coronary artery lesions. Results SIED, SIES and EDV, ESV in MI group were signiifcantly higher than those in the normal group (P0.05). Linear regression analysis showed that LVEF and PFR in group of left ventricular remodeling was signiifcantly lower with the increase of SIED (F=43.231 and 15.642, P<0.01). SIED and SIES analysis resulted in high correlation for both intra-observer and inter-observer (r=0.881-0.926, P<0.01). Conclusion Left ventricular remodeling after myocardial infarction can be accurately evaluated by GMPI. Patients with myocardial infarction due to LAD or multi-vessel coronary artery diseases may have left ventricular remodeling easier and more severe. Left ventricular remodeling will seriously affect the myocardial contraction and diastolic function, resulting in the entire left ventricular dysfunction.
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Purpose To evaluate the correlation and consistency of left ventricular ejection fraction (LVEF) obtained by ECG-gated myocardial perfusion SPECT (GMPS) using four formulae (R0-R3) of ECToolbox software and findings on equilibrium radionuclide angiography (ERNA), and to determine the optimal diagnostic thresholds by using the four formulae. Materials and Methods A total of 38 patients with myocardial infarction and 65 patients with suspected coronary heart disease underwent both 99Tcm-MIBI rest GMPS and 99Tcm-RBC ERNA within a week. The LVEF values calculated by ECToolbox R0, R1, R2 and R3 were compared with those obtained by ERNA, and compared with ERNA results, the optimal diagnostic thresholds of the four formulae (R0-R3) were assessed by receiver operating characteristic (ROC) curves. Results The results calculated by the formulae (R0-R3) presented a significant positive correlation with that obtained by ERNA [mean LVEF value by ERNA (54.6±17.5)%, mean LVEF value by formulae R0-R3 (64.1±15.7)%, (56.3±15.1)%, (69.9±17.9)% and (56.7±13.6)%, respectively, r=0.899, 0.898, 0.890, 0.895; P<0.01]. All mean LVEF values calculated by the four formulae were higher than that by ERNA, and the difference was significant (P<0.05). LVEF≥50%obtained by ERNA was considered as normal diagnostic value, the optimal diagnostic thresholds of R0-R3 were 56.5%, 51.5%, 64.5% and 52.5%, respectively. Conclusion The results calculated by R0, R1, R2 and R3 in the ECToolbox software and that by ERNA show significant correlation and difference for the assessment of LVEF. Thus it is advisable to stick to one formula in the follow-up of each patient and select correspondent threshold in the clinical diagnosis.
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Objective To evaluate the applicability of formula R0, R1, R2 of ECToolbox software in measurement of left ventricular ejection fraction (LVEF) with gated myocardial imaging. Methods Rest gated myocardial SPECT with ~(99m)Tc-MIBI and rest gated blood-pool SPECT with ~(99m)Tc-RBC were performed on 64 patients (44 with CHD, 20 with hypertension). LVEFs were separately calculated with formula R0, R1, R2 of ECToolbox software, and the results were recorded as R0 LVEF, R1 LVEF and R2 LVEF, respectively, and compared with LVEFs from gated blood-pool imaging (GBPI LVEF). Results The LVEFs from formula R0, R1 and R2 were all significantly correlated with GBPI LVEF (r=0.905, 0.905 and 0.903, P0.05). Conclusion The formula R1 of ECToolbox software is most applicable in measuring LVEF with gated myocardial imaging.
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Objective To compare the effect of right ventricular outflow tract (RVOT) and right ventricular apex (RVA) pacing on ventricular systolic synchrony using gated blood pool SPECT (GBPS).Methods A total of 50 patients implanted with pacemaker due to high degree or complete atria-ventricular block were enrolled in the study. Twenty-three patients were RVOT paced ( Group A, n = 23) and 27 were RVA paced (Group B, n=27). Twenty-four patients with malignancy, normal echocardiographic findings and no history of cardiac diseases were scheduled for pre-chemotherapy evaluation of cardiac structure and function and were enrolled as control group ( Group C, n = 24). All patients underwent GBPS imaging and the values of phase angle (PS), mean phase of each wall, standard deviation (SD) of mean phase of each wall, lateral-septal motion delay of left ventricle ( LV Sep-Lat Delay), septal-right ventricular (RV) delay of LV ( LV Sep-RV Delay) and LV-RV Delay were acquired. The parameters of ventricular systolic synchrony among the three groups were compared using one-way ANOVA. Results The mean phase of LV lateral wall in Groups A and B were significantly higher than that in Group C: Group A (120.50 ±40.58) ms; Group B (103.23±28.34) ms; Group C (84.63 ±22.38) ms (F=7.72, P ＜0.05). There was no significant difference between Groups A and B ( t = 1.30, P ＞ 0.05 ). The mean phase of RV in Group A was significantly larger than those in Groups B and C: Group A ( 137.05 ± 39.27) ms, Group B ( 100.85 ± 23.79) ms,Group C (59. 13 ±30.52) ms (F=35.55, P＜0.05). PS, SD and LV Sep-Lat Delay in Groups A and B were significantly higher than those in Group C: (85.73 ± 12.00)°vs (89.85 ± 15.61 )°vs (58.95 ±9.87)°, (27.68±10.66) ms vs (26.15 ±13.02) ms vs (15.63 ±8.35) ms, (25.06±34.23) ms vs (2. 62 ± 60. 31 ) ms vs ( - 23.66 ± 31.39) ms, F = 41.54,8.55,6.81, all P ＜ 0.01 ), however, there was no significant difference between Groups A and B ( t = 0. 68, 0.68, 1.30, all P ＞ 0.05 ). LV Sep-RV Delay and LV-RV Delay were significantly different among the three groups ( LV Sep-RV Delay: Group A (57.60 ±56.77) ms, Group B (6.36 ±61.88) ms, Group C ( -41.89 ±35.78) ms; LV-RV Delay:Group A (47.36 ±42.59) ms, Group B ( 3.08 ± 38.81 ) ms Group C ( - 26.50 ± 20.99 ) ms, F = 20. 32,25.38, both P ＜ 0.01 ). Conclusion Both RVA and RVOT pacing increase the segmental phases detected by GBPS, causing inter- and intra- ventricular asynchrony compared with patients without pacemakers.
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Objective To investigate the clinical value of the gated blood pool imaging phase analysis method in the evaluation of left ventricular mechanical synchronization in patients with chronic heart failure. Methods A total of 169 patients with chronic heart failure were enrolled in our study , using gated blood pool imaging phase analysis method to obtain left ventricular phase angle width ( PHB) and left ventricular phase angle standard deviation ( PSD) as evaluating left ventricular mechanical synchrony index; using tissue Doppler imaging (TDI) measurement of the standard deviation of systolic peak time(Ts-SD) of each segment by using the current prevailing 12 non-apical segments analysis method as evaluating left ventricular mechanical synchrony index, and parameters derived from both methods were compared. Results LVPHB was highly correlated with Ts-SD (r = 0. 83 ,P = 0. 000 ) . LVPSD was modestly correlated with Ts-SD ( r - 0. 69, P = 0. 000) . The ejection fraction measured by echocardiography was (42.93 ± 14. 89) % ,which was significantly higher than that measured by ERNA (39. 76 ± 17. 89)% (P <0. 01). Conclusions The evaluation of left ventricular mechanical synchrony in patients with chronic heart failure by the gated blood pool imaging can provide similar information with TDI, which can simultaneously measure two ventricular functions and get more accurate measurement of ejection fraction. Cardiac resynchronization therapy patients can be identified by combining two kinds of approaches, and cardiac resynchronization therapy responders could be improved as well. More patients with heart failure can benefit from cardiac resynchronization therapy therapy.
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Objective To compare the diagnostic performance of prospective electrocardiogram (ECG)-gating 320-detectorcomputed tomography coronary angiography (CTCA) versus retrospective ECG-gating CTCA. Methods 500consecutive patients suspected coronary artery disease with heart rate of less than 65 bpm were performed coronary computed tomography angiography (CCTA) with prospective (group P)and retrospective (group R) ECG gating in turn. The image quality was divided into four levels. Success rates, effective radiation dose,image quality and diagnosis were evaluated. Results Success rates of examination in group P and R are100%.Mean patient radiation dose was significantly different in group P (3.28±1mSv) and R(14.36 ±2.3 mSv).131 and 142 of 3750 segments (250 patients x 15 segments per patient) were too small(1.5mm)tobe characterized in group P and R. 96. 51% (3619/3750) and 96.12% (3608/3750) characterized segments were not significantly different in group P and R. 95.09% segments received a score of 4 and 1.09% segments received a score of 3 in group P, while 95.23% and 0.74% in group R.The cause of 2 and 3 points in the two groups was motion artifact. Stair-step artifacts and images scored as 1were not found.Compared with CAG,the sensitivity,specificity,false positive andfalse negative value in group P(86. 49% ,98. 70% ,88. 89% ,98.38%) and R(83. 87% ,98.74% ,89. 65%,97.93%) were not significantly different. Conclusion Although the patient radiation exposure was significantly lower, the diagnostic performance of prospective ECG-gating 320-detector CTCA was comparable with that of retrospective ECG-gating 320-detector CTCA on patients with stable heart rates less than 65 bpm.