Search

The objective of this study was to determine the accuracy of right ventricular function (RVF) assessed by Cadmium Zinc Telluride ECG-gated SPECT equilibrium radionuclide angiocardiography (CZT-ERNA). Twenty-one consecutive patients with cardiomyopathy (aged 54 ± 19 years; 62% male) were included. RV ejection fraction (EF) and volumes were analyzed by CZT-ERNA and compared with values obtained by cardiac magnetic resonance imaging (CMR). Mean values were not different between CZT-ERNA and MRI for RVEF (48.1 ± 10.4% vs 50.8 ± 10.0%; P = .23). Significant correlations (P

Introduction Myocardial perfusion reserve (MPR) is a validated diagnostic and prognostic value by Positron Emission Tomography (PET) scans. However, PET availability stays limited in certain countries as France. Gamma cameras with cadmium-zinc telluride detector (CZT-SPECT) are more available and allow the evaluation of this MPR. However, there is no comparison of its results with the interventional diagnostic procedure. Method Twenty-seven patients with suspected of epicardial or microcirculatory coronary involvement were prospectively included. All patients benefited from an evaluation of the MPR by CZT SPECT as well as an interventional diagnostic procedure with measure of the Fractionnal Flow Reserve (FFR), coronary flow reserve (CRF) and index of microcirculation resistance (IMR). Correlation between MPR and CFR was measured and sensitivity and specificity to detect severe coronary microcirculation disease (CMVD) defined by FFR > 0.8, CFR 25. Results Coronary angiography was performed in 27 patients, with a complete functional evaluation (FFR, CFR, IMR) on 33 vessels. Two patients had significant stenosis (50-90% stenosis and FFR Conclusion MPR was correlated with CRF and presented satisfactory diagnostic performance to discriminate, in the absence of significant stenosis, patients free from patients with severe CMVD.

Introduction Atherosclerosis is associated with a worse prognosis in many diseases, but its impact in non-ischemic dilated cardiomyopathy (NIDCM) is not known. Purpose This study investigated the prognostic value of coronary atherosclerotic burden, as measured by Gensini score, in a cohort of NIDCM patients. Methods In total, 139 patients with left ventricular (LV) dysfunction due to NIDCM were classified according to both invasive coronary angiography (ICA) and cardiovascular magnetic resonance (CMR) imaging data in 3 subtypes of NIDCM: true NIDCM, NIDCM with bystander coronary artery disease (CAD) and NIDCM with bystander myocardial infarction (MI). Percentage, extent, location of fibrosis was assessed with CMR and coronary atherosclerotic burden by calculating Gensini score. Primary endpoint was a composite of cardiovascular mortality, non-fatal MI and revascularisation by percutaneous coronary intervention (PCI). Results Out of 139 patients (mean age 59.4 ± 14.7 years old, 74% male), there were 101 patients (73%) with true NIDCM, 30 patients (22%) with NIDCM and bystander MI and 8 patients (5%) with NIDCM and bystander MI. 6 patients (4.3%) died and 6 (4.3%) underwent PCI during a median follow-up of 34.2 ± 18 months ( Table 1 ). Gensini score predicted primary composite endpoint, in univariate and multivariate analysis, hazard ratio = 1.08, confidence interval 95% (1.034–1.13) P = 0.001, as well as a history of CAD, LV ejection fraction (LVEF) and age (P Conclusion Coronary atherosclerotic burden, as measured by Gensini score, is a new prognostic factor in NIDCM. Assessing this parameter improves risk stratification and could be used to help personalise treatment in this population ( Fig. 1 ).

Background Single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) provides valuable prognostic value. However, the risk stratification of patients with type 2 diabetes mellitus (T2D) remains suboptimal. Objectives We hypothesised that myocardial perfusion entropy (MPE) quantified from SPECT myocardial perfusion images may provide an incremental prognostic value in T2D patients independently from the routinely performed assessment of myocardial ischemia. Methods T2D patients with very high and high cardiovascular risk were studied (n = 166, 65 ± 12 years). Ischemia (> 10% of left ventricular area) was assessed by SPECT MPI. In addition, SPECT MPI was used for the quantification of rest and stress MPE. The primary endpoint was major adverse cardiac events (MACEs) defined as cardiac death, Q-wave myocardial infarction (MI) and myocardial revascularisation > 3 months after SPECT. Results Forty-six patients underwent MACEs over a median follow-up of 4.6 years. Significant differences in stress MPE were observed between patients with and without MACEs (4.19 ± 0.46 vs. 3.93 ± 0.39; P ≤ .01). By Kaplan–Meier analysis, the risk of MACEs was significantly higher in patients with higher stress MPE (log-rank P ≤ .01). Stress MPE and ischemia were significantly associated with the risk of MACEs (hazard ratio: 2.30 and 1.12, respectively, P ≤ .01 for both) after adjustment for clinical and imaging risk factors as identified from preliminary, univariate analysis and including age, hypertension, stress test and ischemia. The incremental prognostic value of MPE over clinical risk factors was quantified using nested models showing improved AIC, reclassification (global continuous Net Reclassification Improvement [NRI]: 54, global Integrated Discrimination Improvement [IDI]: 4.6%), discrimination (change in c-statistic: 0.69 vs. 0.74). Conclusions Stress MPE provided independent and incremental prognostic information for the prediction of MACEs in diabetic patients.

Background The risk assessment for ventricular arrhythmia in patients with ischemic cardiomyopathy is, at the present time, unspecific. Left ventricular (LV) entropy is a measure of myocardial heterogeneity derived from single photon emission computed tomography (SPECT). Purpose This study assesses the utility of LV entropy for predicting cardiovascular events in patients with ischemic cardiomyopathy. Methods Patients with ischemic cardiomyopathy referred for implantable cardioverter-defibrillator (ICD) implantation were included retrospectively. Their LV entropy was measured on SPECT. Patients were followed from implantable cardioverter-defibrillator placement to detect arrhythmic events (appropriate implantable cardioverter-defibrillator therapy and sustained ventricular arrhythmia), end-stage heart failure events (congestive heart failure, transplantation, or ventricular assist device placement), and cardiac death. Results Forty patients (mean age 68.1 ± 9.4 years, 75% men, LV ejection fraction 29.7 ± 4.6%) were followed for 22.8 ± 12.9 months. Of the forty patients, three (7.5%) experienced arrhythmic events, one died of advanced heart failure after receiving the appropriate shock, and three others (7.5%) experienced end-stage heart failure events. On univariate analysis, age (HR: 1.02 [0.99; 1.04]; P = 0.176); diabetes (HR: 0.30 [0.05; 1.68]; P = 0.17), CRT-D (HR: 0.06 [0.007; 0.53]; P = 0.01), NYHA class (HR: 7.6 [2.00; 29.5]; P = 0.003) and ischemia (HR: 1.07 [0.96; 1.18]; P = 0.19) were significant predictors of cardiac events. On multivariate analysis, CRT-D (HR: 0.06 [0.04; 0.89]; P = 0.04) remained a significant predictor of cardiac events. LV entropy was not a predictor of cardiac events. Conclusion In patients with ischemic cardiomyopathy, LV entropy measurement is not a predictor of life-threatening ventricular arrhythmia. However, CRT-D is a strong protector of ventricular arrhythmia in ischemic cardiomyopathy.

Introduction Coronary microvascular dysfunction (CMD) is associated with a higher rate of major adverse cardiovascular events (MACEs) in diabetic patients. Liraglutide, a glucagon-like peptide-1 analog, decreases MACEs and all-cause mortality in this population. Purpose The present paper aims to study the effects of liraglutide on heart function and myocardial perfusion entropy (MPE) as a surrogate marker of coronary microvascular dysfunction (CMVD) in a rat model of type-2 diabetes. Methods Thirty-nine rats were divided into three groups, control (CTL), diabetic (T2D) and liraglutide (DT2-LIR). T2D and T2D-LIR rats were fed a high-fat diet and injected with 35 mg/kg streptozotocin intra-peritoneally (IP) to induce diabetes. T2D-LIR rats were injected with a subcutaneous liraglutide solution for four weeks. Heart structure and function were assessed with trans-thoracic-doppler echocardiography and CMVD was assessed with a novel 201 Thallium SPECT-technique, measuring MPE, under stress conditions. Histological analysis was later performed. Results T2D rats had a significantly lower left ventricular (LV) ejection fraction (LVEF) versus CTL (64.5 ± 4.3% vs. 74.4 ± 9.2% P Conclusion Liraglutide is associated with an improvement in heart systolic function and reduced LV hypertrophy in type 2 diabetic rats but only has a small specific effect on CMVD.

Objectives The aim of this study was to determine the diagnostic accuracy of stress thallium-201/rest technetium-99m sequential dual-isotope high-speed myocardial perfusion imaging (DI-HS-MPI) against invasively determined fractional flow reserve (FFR) and to establish the correlation between myocardium at risk defined by using the invasive BARI-score and DI-HS-MPI. Background Relatively few studies have compared the diagnostic performance of new Cadmium Zinc Telluride - cameras versus FFR. Methods Fifty-four patients referred for angiography underwent DI-HSMPI. Perfusion was scored visually by summed stress score (SSS) on a patient and coronary territory basis, and ischemic burden was calculated by quantitative segmentation of the extent of ischemia. Significant coronary artery disease (CAD) was defined by the presence of ≥90% stenosis/occlusion or fractional flow reserve ≤0.80 in vessels >2mm. The relation between FFR and perfusion was determined for each vascular zone. The BARI-score was calculated from the coronary angiograms to quantify the myocardium at risk. Results FFR was measured in 70 of 162 coronary vessels; Vessels FFR measured per patient was 1.3±0.57. Sensitivity, specificity, and diagnostic accuracy of MPI for the detection of significant CAD were 92%, 88%, and 90% by coronary territory and 87%, 93%, and 92%, on a patient basis. The area under the summary receiver-operating characteristic at the patient level was 0.94 (95% CI: 0.88 to 1) and 0.90 (95% CI: 0.83 to 0.97) at the artery and territory levels, respectively. The mean ischemic burden for MPI and BARI-score showed a strong correlation between techniques (r=0.71, P Conclusions Stress thallium-201/rest technetium-99m sequential DI-HSMPI accurately detects functionally significant CAD as defined by using FFR and provides an assessment of ischemic burden in agreement with the invasive BARI-score.

IntroductionRecent advances in nuclear myocardial perfusion imaging (MPI) have provided opportunity for improved image information with an important reduction of exam time and radiation. This technology can be used to explore novel protocols (dual isotope high-speed MPI). Today, two devices exist: D-SPECT and Discovery NM 530c (DNM) camera. With D-SPECT, it was showed that rapid stress Tl-201/rest Tc-99m protocol for use with high-speed MPI has offered the superior qualities of Tl-201 for stress imaging and of the Tc-99m agents for rest imaging can be preserved. However, no study has evaluated the same dual-isotope protocol with the other system.MethodsA total of 38 consecutive patients underwent simultaneous dual-radionuclide (stress thallium-201/rest technetium-99m) perfusion imaging with a DNM camera and standard dual dectector camera (S-SPECT) during the month of May 2011.ResultsAll patients successfully underwent stress/rest MPI with both cameras. In 38 patients (50%) pharmacological stress was induced with dipyridamole. DNM SPECT SSS and SRS correlated linearly with conventional S-SPECT respective scores (r=0.84, p