ABSTRACT
OBJECTIVES: The aim of the present study was to determine the long-term prognostic value provided by the exercise electrocardiographic (ECG) response to nuclear myocardial perfusion imaging (MPI) in the evaluation of patients with chest pain, focusing on patients with a discrepancy between the two tests. METHODS: A total of 1460 consecutive patients (777 female; 62.6 ± 11.4 years) undergoing exercise myocardial single-photon emission computed tomography (SPECT) were included. The endpoint was the occurrence of acute coronary syndrome, heart failure or cardiac death during follow-up. RESULTS: Ischemic ECG changes were observed during stress testing in 271 patients (18.5%) and 362 patients (24.7%) had positive (abnormal) exercise MPI results. There was a discrepancy between ECG and SPECT findings in 471 patients (32.2%). During the follow-up period (14.0-39.6 months), 224 patients (15.3%) presented cardiac events. The hazard ratios (HR) of ECG and MPI results to predict events were 1.506 (95% CI: 1.113-2.039) and 10.481 (95% CI: 7.799-14.080), respectively. In patients with negative MPI, the ECG response did not predict events (HR 1.214 [95% CI: 0.646-2.282]), the same as in patients with positive MPI (HR 1.203 [95% CI: 0.848-1.705]). Only in hypertensive patients with positive SPECT did the ECG show significant prognostic value (HR 1.937 [95% CI: 1.030-3.642]). In multivariate analysis, positive MPI proved an independent long-term prognostic factor (HR 10.536 [95% CI: 7.759-14.308]), but not ECG (HR 1.356 [95% CI: 0.994-1.850]). CONCLUSION: MPI results (normal vs. abnormal) had strong predictive value and discrepant ECG results had no significant additive prognostic value.
Subject(s)
Chest Pain/diagnostic imaging , Chest Pain/etiology , Electrocardiography , Exercise Test , Myocardial Perfusion Imaging , Tomography, Emission-Computed, Single-Photon , Female , Humans , Male , Middle Aged , Prognosis , Time FactorsABSTRACT
Poorly differentiated follicular thyroid carcinoma (PDFC) is a tumor of follicular cell origin with intermediate attributes between well-differentiated carcinomas and anaplastic carcinomas. The majority of patients presenting with distant metastases have locally advanced tumors, being lungs and bones the most common sites affected. We present a case of a patient with a painful bulky mass at the left thorax-abdominal wall as an uncommon distant metastasis of a PDFC. After thyroidectomy, a pre-ablative 131I whole-body scan showed distant metastases on the neck, both lungs, and lateral chest-abdominal wall, so the administration of I for thyroid remnant ablation stimulated with RH-TSH was decided.
Subject(s)
Adenocarcinoma, Follicular/pathology , Cell Differentiation , Adenocarcinoma, Follicular/surgery , Aged, 80 and over , Biopsy, Fine-Needle , Female , Humans , Neoplasm Metastasis , Thyroid Gland/pathology , Thyroidectomy , Whole Body ImagingSubject(s)
Liver Neoplasms/diagnostic imaging , Lung Neoplasms/diagnostic imaging , Neuroendocrine Tumors/diagnostic imaging , Radiography, Abdominal , Radiography, Thoracic , Tomography, X-Ray Computed , Aged , Aged, 80 and over , Biopsy, Needle , Hepatomegaly/diagnosis , Humans , Immunohistochemistry , Liver/pathology , Liver Neoplasms/pathology , Liver Neoplasms/secondary , Lung Neoplasms/diagnosis , Male , Malignant Carcinoid Syndrome/diagnosis , Neuroendocrine Tumors/diagnosis , Neuroendocrine Tumors/pathology , Neuroendocrine Tumors/secondary , Palpation , Radionuclide Imaging , Somatostatin/analogs & derivativesSubject(s)
Pulmonary Embolism/diagnostic imaging , Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Radiography , Radionuclide Imaging , Retrospective StudiesABSTRACT
No disponible
Subject(s)
Adult , Aged , Middle Aged , Humans , Pulmonary Embolism/diagnosis , Ventilation-Perfusion Ratio/physiology , Tomography, X-Ray Computed , Spectrometry, GammaABSTRACT
Tumours that produce metastases in the paranasal sinuses or sphenoidal sinus are rare; the carcinomas of kidney and lung being the most frequent with this type of metastasis. Distant metastases from differentiated thyroid carcinoma are rare and, moreover, when they metastasize, they do so into lung and bone. We report a patient who had a papillary thyroid carcinoma with metastases into the sphenoidal sinus.
Subject(s)
Carcinoma, Papillary/secondary , Paranasal Sinus Neoplasms/secondary , Sphenoid Sinus/pathology , Thyroid Neoplasms/pathology , Carcinoma, Papillary/diagnostic imaging , Carcinoma, Papillary/radiotherapy , Carcinoma, Papillary/surgery , Combined Modality Therapy , Cranial Irradiation , Diplopia/etiology , Female , Headache/etiology , Humans , Hysterectomy , Iodine Radioisotopes/therapeutic use , Leiomyoma/surgery , Magnetic Resonance Imaging , Middle Aged , Neoplasms, Second Primary , Paranasal Sinus Neoplasms/diagnostic imaging , Paranasal Sinus Neoplasms/radiotherapy , Paranasal Sinus Neoplasms/surgery , Radionuclide Imaging , Radiopharmaceuticals/therapeutic use , Radiotherapy, Adjuvant , Thyroid Neoplasms/surgery , Thyroidectomy , Uterine Neoplasms/surgeryABSTRACT
Tumours that produce metastases in the paranasal sinuses or sphenoidal sinus are rare; the carcinomas of kidney and lung being the most frequent with this type of metastasis. Distant metastases from differentiated thyroid carcinoma are rare and, moreover, when they metastasize, they do so into lung and bone. We report a patient who had a papillary thyroid carcinoma with metastases into the sphenoidal sinus
