2., přepracované vydání 191 stran : ilustrace (některé barevné) ; 30 cm
Vysokoškolská učebnice, která se zaměřuje na nukleární lékařství.
- MeSH
- nukleární lékařství MeSH
- Publikační typ
- vysokoškolské kvalifikační práce MeSH
Regadenoson je selektivního A2A adenosin umožňující farmakologicky zatížit pacienty, u nichž by fyzická zátěž byla nemožná nebo jen velmi obtížná. Jsou prezentovány dvě kazuistiky demonstrující výhody tohoto preparátu. V prvním případě jsme se u 77letého muže po aortokoronárním bypassu nejprve pokoušeli o fyzickou zátěž, která byla pro nedostatečný vzestup tepové frekvence ihned změněna na zátěž farmakologickou. Během pokračující nižší úrovně fyzické zátěže byl aplikován regadenoson. Jednofotonová emisní tomografie (SPECT) zobrazila rozsáhlou ischemii laterální stěny a koronarografie následně prokázala uzávěr žilního štěpu na ramus circumflexus. Druhá kazuistika demonstruje současný pokrok technologie SPECT. Na moderních multidetektorových kadmium zinek telluridových (Cadmium Zinc Telluride, CZT) kamerách lze nahrávat dynamicky a kvantifikovat koronární průtokovou rezervu (coronary flow reserve, CFR), což může pomoci při identifikaci nemoci více koronárních tepen nebo mikrovaskulární ischemie. CFR se stanovuje jako poměr myokardiálního průtoku po vazodilataci navozené farmakologickou zátěži a v klidu. 50letý diabetik má na konvenčním SPECT myokardu normální pozátěžovou perfuzi i funkci levé komory. Dynamický SPECT prokázal normální hodnoty myokardiálního krevního průtoku (myocardial blood flow, MBF) i normální CFR ≥ 2. Během 18 měsíců sledování jsme u něj nezaznamenali kardiální příhodu.
Regadenoson as a selective A2A adenosine enables pharmacological stress when exercise stress techniques would be impossible or very difficult. We present two case reports demonstrating its advantages. In case 1, we initially attempted to induce stress using physical exercise in a 77-year-old male patient after coronary artery bypass graft. Due to inadequate heart rate increase, the stress was promptly converted to pharmacological stress using regadenoson in combination with a low level of exercise. Single-photon emission computed tomography (SPECT) showed extensive ischaemia of the lateral wall. Coronary angiography subsequently revealed vein graft occlusion at the left circumflex artery. Case 2 demonstrates recent advances in SPECT technology. Modern multidetector Cadmium Zinc Telluride (CZT) cameras enable dynamic acquisition and quantification of coronary flow reserve (CFR). It can be helpful in identifying multivessel disease or microvascular ischaemia. CFR is calculated as the ratio between myocardial blood flow during stress vasodilator hyperaemia and flow at rest. In a 50-year-old diabetic patient, a conventional cardiac SPECT showed normal post-stress left ventricular perfusion and function. Dynamic SPECT showed normal myocardial blood flow (MBF) and normal CFR ≥ 2. During 18 months of follow-up, no cardiac event was observed in this patient.
- Klíčová slova
- regadenoson,
- MeSH
- agonisté adenosinového receptoru A2 MeSH
- jednofotonová emisní výpočetní tomografie * metody MeSH
- lidé středního věku MeSH
- lidé MeSH
- senioři MeSH
- vazodilatancia MeSH
- zátěžový test metody MeSH
- zobrazování myokardiální perfuze metody MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- Publikační typ
- kazuistiky MeSH
INTRODUCTION: Up to 50% of patients with ST elevation myocardial infarction (STEMI) have ≥ 50% stenosis in a major non-infarct-related artery. Several studies have evaluated the prognostic value of the completion of revascularization with overall inconclusive results. Selection of the stenoses was based on the angiographic evaluation, invasive hemodynamic measurement or the combined approach. It is unknown whether such a selection provides correlation of comparable patient groups. MATERIAL AND METHODS: We enrolled 51 patients (62.7 ±10.2 years) with acute STEMI and at least one residual (50-90%) stenosis in a non-infarct-related major coronary artery (excluding left main coronary artery). Overall 65 stenoses (67.9 ±10.7%) were evaluated angiographically following primary percutaneous coronary intervention and the hemodynamic significance was estimated with respect to the stenosis severity, caliber of the arterial segment, localization of the stenosis (proximity) as well as the estimated size of the supplied vascular territory. During subsequent hospitalization, invasive measurement of the hemodynamic significance using fractional flow reserve (FFR) was performed to guide the final revascularization strategy (FFR value of ≤ 0.80 considered significant). RESULTS: Based on angiographic evaluation, a total of 44 stenoses would be recommended for treatment, whereas only 31 stenoses were revascularized based on FFR measurement. Moreover, visual evaluation and hemodynamic measurement were discrepant in 27 of 65 (41.5%) stenoses. CONCLUSIONS: We observed a weak correlation between visual angiographic evaluation and invasive hemodynamic measurement. More stents would be implanted based on angiographic evaluation compared to FFR measurement.
- Publikační typ
- časopisecké články MeSH
- Publikační typ
- abstrakt z konference MeSH
- Publikační typ
- abstrakt z konference MeSH
OBJECTIVE: Myocardial perfusion imaging (MPI) can be challenging in some cases of multi vessel involvement. Our aim was to examine specific group of patients with diabetes mellitus (DM), who did not have significant reversible ischaemia diagnosed on perfusion study itself, and asses additional value of functional parameters obtained from gated acquisition and added information from coronary artery calcium score (CACS). SUBJECTS AND METHODS: One hundred and seventy eight patients with a history of DM, with summed difference score (SDS)≤1, were included in the study. All patients underwent gated acquisition with recording of functional parameters and CACS evaluation. During the follow-up, cardiac events (CE) were recorded. RESULTS: During the median follow-up of 20.3 months there were 23 CE encountered. Optimal cut-off value for CACS to predict CE was found at 1427, higher values were significantly related to CE (P<0.001). Low stress left ventricular ejection fraction (LVEF) <45% and induced stress LVEF drop for 5% were also more frequent in CE group (P=0.001, P=0.008). Multivariable Cox analysis revealed low stress LVEF (P=0.001, HR=4.48, 95%CI 1.79-11.22), stress induced LVEF drop (P=0.017, HR 3.13, 95%CI 1.22-8.01) and high CACS (P<0.001, HR 10.52, 95%CI 4.32-25.63) as significant predictors of CE. CONCLUSION: Low stress LVEF under 45%, post-stress LVEF drop for more than 5% and CACS more than or equal to 1427 are significant predictors of CE in patients with DM, who did not have reversible ischemia detected on MPI single photon emission computed tomography (SPECT).
- MeSH
- diabetes mellitus * diagnostické zobrazování MeSH
- funkce levé komory srdeční MeSH
- jednofotonová emisní výpočetní tomografie metody MeSH
- koronární cévy MeSH
- lidé MeSH
- nemoci koronárních tepen * diagnostické zobrazování MeSH
- srdeční komory MeSH
- tepový objem MeSH
- vápník MeSH
- zobrazování myokardiální perfuze * metody MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
BACKGROUND: Cadmium-Zinc-Telluride (CZT) technology allows use of low activities of radiopharmaceuticals. The aim was to verify the values of left ventricular volume parameters, obtained via ultra-low-dose thallium Single Photon Emission Computed Tomography (SPECT) using a CZT camera. METHODS AND RESULTS: Forty-five patients referred for an assessment of myocardial perfusion or viability imaging were examined using CZT-SPECT and 1.5 T magnetic resonance (MRI) scanner. The ultra-low-dose protocol with 0.5 Mbq 201-Tl per kg of body weight was used. The values of end-systolic (ESV) and end-diastolic volumes (EDV), left ventricular ejection fraction (EF) and myocardial mass (MM) were assessed using both techniques. A very good correlation was found between the EF, ESV, and EDV values assessed with CZT-SPECT and cardiac magnetic resonance MRI; the Pearson coefficients were 0.86, 0.95, and 0.91, respectively. A moderate correlation was found for myocardial mass, r = 0.57. Compared to MRI, SPECT systematically overestimated ESV and MM, while it underestimates the EF, with P ≤ .001 in all cases. There was no difference in EDV estimation. CONCLUSIONS: Left ventricular volumes and ejection fraction assessed via ultra-low-dose CZT-SPECT showed very good correlation with the values obtained by MRI. A moderate correlation was found for myocardial mass.
- MeSH
- funkce levé komory srdeční * MeSH
- jednofotonová emisní výpočetní tomografie * metody MeSH
- kadmium MeSH
- lidé MeSH
- magnetická rezonanční tomografie metody MeSH
- radioizotopy thallia MeSH
- telur MeSH
- tepový objem MeSH
- zinek MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
Aim: The aim was to measure changes in the profile of hard and soft tissues in patients with Class III anomalies treated either orthodontically or using orthodontic-surgical approach. Material and method: The retrospective study involved patients with Angle Class III and Skeletal Class III after the maximum growth spurt who had anterior crossbite all or at least three upper incisors. The sample included 57 patients (28 females, 29 males) after orthodontic or orthodontic-surgical treatment. Cephalograms taken prior to and after the therapy were analyzed; in case of the orthodontic-surgical therapy including orthodontic pretreatment and after-treatment. Results: In the surgery group (CHIR) there were found significant changes of hard tissues in all the parameters monitored. In the orthodontic group (ORTO) there were found minor changes of hard tissues in only three parameters. In the profile of soft tissues there were found more significant changes in CHIR group. The changes were small in the ORTO group (2 parameters). Conclusion: In patients with orthodontic-surgical treatment there were recorded more profound changes in both hard and soft tissues. In patients undergoing orthodontic treatment the change in the profile of soft tissues was observed only in the lips profile, the lower one in particular.
- MeSH
- lidé MeSH
- malokluze * chirurgie MeSH
- obličej MeSH
- ortodoncie korekční metody MeSH
- retrospektivní studie MeSH
- Check Tag
- lidé MeSH
