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 * diagnostic imaging MeSH
- Ventricular Function, Left MeSH
- Tomography, Emission-Computed, Single-Photon methods MeSH
- Coronary Vessels MeSH
- Humans MeSH
- Coronary Artery Disease * diagnostic imaging MeSH
- Heart Ventricles MeSH
- Stroke Volume MeSH
- Calcium MeSH
- Myocardial Perfusion Imaging * methods MeSH
- Check Tag
- Humans MeSH
- Publication type
- Journal Article MeSH
Konvenční SPECT na dvoudetektorové gamakameře umožňuje hodnotit relativní regionální distribuci perfuzního radiofarmaka, může však podhodnotit rozsah postižení u nemoci více koronárních tepen. Dynamická pozitronová emisní tomografie (PET) je standardem pro kvantifikaci koronární průtokové rezervy (coronary flow reserve, CFR) a může pomoci při identifikaci nemoci více koronárních tepen. CFR se stanovuje jako poměr myokardiálního průtoku po vazodilatační zátěži a v klidu. Za normální rezervu se obvykle považuje CRF ≥ 2. Radiofarmaka pro perfuzní PET myokardu jsou však drahá a obtížně dostupná. Nově byla kvantifikace CFR validována i pro dynamický SPECT na kadmium zinek telluridových (Cadmium Zinc Telluride, CZT) kamerách. Klinika nukleární medicíny FN Olomouc je prvním pracovištěm s licencí pro CFR SPECT software v ČR. Cílem práce je podělit se o první zkušenosti s novou technologií dynamického SPECT myokardu na CZT kameře.
Conventional SPECT on dual-head camera allows relative estimation of myocardial perfusion. However, it can underestimate the extent of disease in patients with multivessel coronary artery disease. Dynamic positron emission tomography (PET) is the standard for quantification of coronary flow reserve (CFR) and it can assist in the identification of multivessel disease. CFR is calculated as a ratio between myocardial blood flow during stress vasodilator hyperaemia and flow at rest. The normal value of CFR is usually ≥ 2. However, perfusion PET tracers are costly, and not widely available. Recently, quantification of CFR has been validated for dynamic SPECT on Cadmium Zinc Telluride (CZT) cameras. Department of nuclear medicine of University Hospital Olomouc is the first laboratory with the licence for CFR SPECT software in the Czech Republic. The aim is to present our first experience with the new technology of dynamic SPECT on CZT camera.
- MeSH
- Fractional Flow Reserve, Myocardial MeSH
- Tomography, Emission-Computed, Single-Photon MeSH
- Coronary Angiography * methods instrumentation MeSH
- Humans MeSH
- Coronary Artery Disease * diagnostic imaging MeSH
- Positron Emission Tomography Computed Tomography methods instrumentation MeSH
- Radiopharmaceuticals MeSH
- Sensitivity and Specificity MeSH
- Check Tag
- Humans MeSH
- Publication type
- Research Support, Non-U.S. Gov't MeSH
- Review MeSH
Sklerotizace adenomu příštítného tělíska absolutním alkoholem – Percutaneous Ethanol Injection Therapy (PEIT) – pod ultrasonografickou kontrolou se individuálně používá jako alternativní postup při řešení primární hyperparatyreózy u polymorbidních pacientů vyššího věku, kteří mají zvýšené operační riziko. Popisujeme případ 92letého muže, který před 3 lety podstoupil tyreoidektomii pro papilární karcinom štítné žlázy. Součástí pravidelných kontrol bylo i roční ultrasonografické vyšetření, při kterém byl v lůžku po odstraněné štítné žláze verifikován solitární adenom příštítného tělíska. S ohledem na předchorobí, polymorbiditu i věk nemocného byla k léčbě úspěšně použita metoda PEIT. Zajímavá je rovněž koincidence adenomu a papilárního karcinomu štítné žlázy v čase.
Percutaneous Ethanol Injection Therapy of parathyroid adenoma under ultrasound guidance is individually used as an alternative procedure in management of primary hyperparathyroidism in polymorbid elderly patients with increased surgical risk. We present a case of a 92-year-old male patient, who underwent thyroidectomy for papillary thyroid carcinoma three years ago. Part of the regular annual follow-up visits was also ultrasonography, which showed a solitary parathyroid adenoma at the site of the removed thyroid gland. Given the underlying condition, polymorbidity and age of the patient, the PEIT method was successfully used in the therapy. The coincidence of adenoma and papillary thyroid carcinoma is also interesting.
- Keywords
- Percutaneous Ethanol Injection Therapy (PEIT),
- MeSH
- Ethanol administration & dosage history therapeutic use MeSH
- Humans MeSH
- Parathyroid Neoplasms * therapy MeSH
- Thyroid Neoplasms epidemiology surgery MeSH
- Hyperparathyroidism, Primary etiology MeSH
- Aged, 80 and over MeSH
- Sclerotherapy * methods statistics & numerical data MeSH
- Treatment Outcome MeSH
- Check Tag
- Humans MeSH
- Male MeSH
- Aged, 80 and over MeSH
- Publication type
- Case Reports MeSH
OBJECTIVE: Coronary artery disease (CAD) is highly prevalent in patients with end-stage renal disease (ESRD), owing to clustering of traditional and uremic-specific risk factors. However, in this population asymptomatic course of CAD is common and it has been reported that myocardial perfusion imaging (MPI) with single-photon emission tomography (SPET) has lower sensitivity. In the current study, we assessed the value of MPI gated-SPET and its combination with coronary artery calcium (CAC) score measurements in risk stratification of ESRD patients. MATERIALS AND METHODS: MPI gated-SPET was performed with dual-headed SPET camera and CAC score measured by multi-detector computed tomography (MDCT) system.There were tested 77 ESRD individuals. During the follow-up study, cardiac events (CE) defined as cardiac death or nonfatal myocardial infarction (MI) or the necessity for coronary revascularization were recorded. Univariate and stepwise multivariable Cox proportional hazards-models were used to identify the predictors of CE. RESULTS: Eighteen CE were recorded during the follow-up. They were significantly associated with higher summed stress scores on MPI, higher percentage of ischaemic myocardium, higher occurrence of defects in multiple territories and higher CAC score (all with P<0.05). Univariate Cox proportional hazard-models showed that severe perfusion abnormalities as well as CAC score ≥1000 were significantly associated with cardiac events (P<0.0001, P=0.0056). In stepwise Cox proportional hazards-models considering age, gender, history of diabetes mellitus, post-stress left ventricular stunning, the degree of perfusion abnormality and CAC score, only severe perfusion abnormalities and CAC score ≥1000 were independent predictors of CE. There was no CE in patients with normal perfusion, normal function and zero CAC score. CONCLUSION: This study suggests that combined evaluation of MPI and CAC can predict the outcome in ESRD individuals, while severe perfusion abnormality on gated-SPET and high CAC score ≥1000 are predictors of future cardiac events.
- MeSH
- Kidney Failure, Chronic etiology mortality MeSH
- Calcinosis mortality MeSH
- Comorbidity MeSH
- Middle Aged MeSH
- Humans MeSH
- Survival Rate MeSH
- Coronary Artery Disease mortality MeSH
- Prevalence MeSH
- Prognosis MeSH
- Reproducibility of Results MeSH
- Risk Factors MeSH
- Sensitivity and Specificity MeSH
- Cardiac-Gated Single-Photon Emission Computer-Assisted Tomography statistics & numerical data MeSH
- Myocardial Perfusion Imaging statistics & numerical data MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Research Support, Non-U.S. Gov't MeSH
- Geographicals
- Czech Republic MeSH
