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Background: There is variable cardiac uptake observed on oncological 18 F-fludeoxyglucose ([ 18 F]FDG) positron emission/computed tomography (PET/CT). The main purpose of this study is to evaluate patterns of overnight fasting myocardial [ 18 F]FDG uptake in oncological PET/CT and analyse the relationship between myocardial [ 18 F]FDG uptake and myocardial ischaemia on stress single-photon emission CT (SPECT) myocardial perfusion imaging (MPI). Material and methods: A total of 362 subjects underwent both oncological PET/CT and stress SPECT MPI within 3 months of each other. Subjects with focal-mass-like [ 18 F]FDG myocardial uptake raising the suspicion of cardiac metastasis and subjects with coronary artery disease (CAD) were excluded. The myocardial [18F]FDG uptake was classified into four patterns. Results: Abnormal SPECT MPI was noted in 91 (25%) patients; 220 (61%) patients had completely absent [18F]FDG uptake, 80 (22%) had diffuse [ 18 F]FDG uptake, 39 (11%) had focal on diffuse [ 18 F]FDG uptake, and 23 (6%) had focal or regional myocardial [ 18 F]FDG uptake, the regional [ 18 F]FDG myocardial uptake was the most predictive of myocardial ischaemia on SPECT MPI, and there were positive associations between age, sex, hypertension, tobacco smoking, hypercholesterolemia, and left ventricular ejection, a fair agreement was noted between the focal or regional FDG uptake and presence of ischaemia on SPECT, K = 0.394 (95% CI 0.164 to 0.189). Conclusions: Based on the presented findings, the physiological myocardial [ 18 F]FDG uptake in fasting oncology patients is variable. The regional myocardial [ 18 F]FDG uptake pattern is the most frequent pattern associated with myocardial ischaemia on stress SPECT MPI, however, the agreement between regional FDG uptake and presence of ischaemia on SPECT is fair.

Objectives A higher coronary artery calcium score (CACS) is associated with increased coronary artery plaque burden resulting in increased cardiovascular risk. Conversely, the absence of calcium indicates a low risk of cardiovascular events. However, coronary plaque calcification is a late manifestation of atherosclerosis; earlier stages of atherosclerosis present noncalcified plaques (NCPs) A recent study demonstrated that the absence of coronary artery calcification deposit does not preclude obstructive stenosis or the need for revascularization in patients with a high suspicion of coronary artery disease (CAD). Our study aimed to investigate the prevalence of NCP and the severity of coronary artery stenosis in symptomatic patients in our local population who were referred for coronary artery computed tomography angiogram (CCTA) with 0 CACS. Methods A total of 299 patients who had undergone CACS and CCTA, and had scored zero for coronary artery calcium. Patients included had clinically appropriate indications, mainly chest pain with variable severity with no history of CAD. The presence of CAD risk factors, such as diabetes, hypertension, and smoking, was obtained from reviewing patient charts. The CCTA analysis was performed to evaluate for coronary artery stenosis and the presence of NCP. The severity of stenosis was quantified by visual estimation and divided into 0% stenosis, 1-25% stenosis, 26-50% stenosis, and more than 50% stenosis. Results The prevalence of NCP was 6.4% (19 of the 299). Among the 19 patients with NCP, 52.6% had no identified coronary artery stenosis, 26.3% had less than 25%, and 21% had stenosis between 25 and 50%. None had stenosis greater than 50%. There was a strong association between male sex (P = 0.001), smoking (P = 0.0.004), hypertension, and NCP (P = 0.042), but no association was found between NCP and age or diabetes. Conclusions In patients with a high clinical suspicion of CAD, the absence of coronary artery calcification does not rule out CAD; up to 6.4% of these patients have early CAD as evidenced by NCP detected by CCTA, and none have more than 50% stenosis, However, future prognostic and long-term follow-up studies are needed to determine prognostic value of NCP in patients with 0 CACS.

BACKGROUND: The relationship between breast arterial calcification (BAC) and angiographic coronary artery disease (CAD) is uncertain. Some studies have shown a positive association between BAC and angiographically proven CAD, while other studies have shown no association. OBJECTIVE: Examine the association between visually detected BAC on mammography and CAD found on invasive coronary angiography (ICA) in women and compare the frequency of risk factors for CAD between women with normal and abnormal ICA. DESIGN: Retrospective. SETTING: Single tertiary care center. PATIENTS AND METHODS: A review of the radiology databases was performed for female patients who underwent both ICA and mammography within six months of each other. Cases were excluded if there was a history of CAD, such as coronary artery bypass graft or prior percutaneous coronary intervention. MAIN OUTCOME MEASURES: BAC as a predictor of obstructive CAD on ICA. SAMPLE SIZE: 203 Saudi women RESULTS: The association between age at catheterization and ICA was statistically significant (P=.01). There was no association between BAC and abnormal ICA (P=.108). Women with abnormal ICA were older than women with a normal ICA (P=.01). There was a higher frequency of CAD risk factors among the patients with abnormal ICA, except for smoking. In the multiple logistic regression model, ICA was associated with age, a family history of CAD, diabetes mellitus, hypertension and hypercholesterolemia. BAC-positive women were older than BAC-negative women (P=.0001). BAC was associated with age, diabetes, hypertension, and chronic kidney disease in the multiple logistic regression model. CONCLUSIONS: BAC on mammography did not predict angiographically proven CAD. There was a strong association between BAC and age and many other conventional CAD risk factors. LIMITATIONS: Relatively small sample, single-center retrospective study. CONFLICT OF INTEREST: None.

Background: Coronary artery calcification score (CACS) is well validated prognostic tool in coronary artery disease (CAD). The data on the prevalence of myocardial ischemia on myocardial perfusion single photon emission computed tomography (MPS) in symptomatic patients with zero CACS and low to intermediate risk probability is lacking and controversial. The aim of our study was to evaluate the capability of zero CACS to exclude myocardial ischemia on MPS. Methods: A total of 157 patients ((mean age 53 ± 10 years), 88 (56%) female patients, 69 (44%) male patients) who were suspected to have CAD and having low to intermediate pretest likelihood for CAD underwent CACS on dedicated computed tomography (CT) scanners. CACS was reported as zero in all patients, subsequently all patients underwent MPS. Patients with abnormal MPS underwent additional imaging with coronary computed tomography angiography (CCTA). Results: All patients had zero CACS, of which 122 (78%) had normal MPS, and 35 (22%) had abnormal MPS. Abnormal MPS included fixed defect in 22 (13%), equivocal in 10 (6%), and reversible defect in four (3%) patients. All patients with abnormal MPS had further imaging with CTCA. CTCA was normal in 30 (85%) patients, one patient had coronary artery stenosis more than 50%, one patient had coronary artery stenosis less than 50%, one patient had anomalous origin coronary artery, and two patients had myocardial bridging. Patients with abnormal MPS and normal coronary artery had dilated cardiomyopathy in 14 (40%), asymmetrical septal hypotrophy in one (3%), and mitral valve disease in three (9%). Conclusions: Zero CACS in stable patients with low or intermediate risk indicated very low likelihood of obstructive CAD, less than 1%. Patients with zero CACS and normal MPS most likely will not benefit from further testing; however, patients with abnormal MPS will need further imaging with CCTA. CCTA is helpful in this group of patients for evaluation of coronary artery and cardiac morphology. Cardiol Res. 2018;9(1):28-34 doi: https://doi.org/10.14740/cr659w Â

Isolated right ventricle (RV) hypertrophy, anomalous muscle bundles, heavy trabeculations, a redundant hypertrophic papillary muscle, and variations in the shape and thickness of the moderator band (MB), with or without RV hypertrophy, may be confused with a cardiac mass on echocardiography. Therefore, multiple off-axis echocardiographic images and further cross-sectional imaging with cardiac magnetic resonance or computed tomography coronary angiography (CTCA) must be considered in order to avoid unnecessary surgery. We present a case of 65-year-old man with atypical chest pain was referred to our facility for CTCA to evaluate RV mass that was seen on echocardiography, and to evaluate his coronary arteries before attempting a surgical excision of the mass. The echocardiography showed an RV mass that was causing a minimal inflow obstruction. The CTCA showed nonobstructive coronary artery disease, RV hypertrophy, markedly focal thickening of the MB with multiple thickened trabeculations, and muscle bundles extending from the MB to the free wall of the RV. However, but there was no specific feature to suggest a cardiac tumor. Keywords: Right ventricular mass, Right ventricular hypotrophy, Multimodality cardiac imaging

BACKGROUND: The prevalence and predictors of myocardial ischemia before noncardiac surgery are unknown. In addition the predictive value of myocardial perfusion single-photon emission computed tomography (SPECT) before noncardiac in individual patients is uncertain. OBJECTIVE: Evaluate the prevalence and predictors of myocardial ischemia before noncardiac surgery, and determine the postoperative cardiac outcome based on results of myocardial perfusion SPECT. DESIGN: Retrospective. SETTING: Single tertiary care center. PATIENTS AND METHODS: We reviewed the records of adult patients diagnosed with myocardial ischemia by myocardial perfusion SPECT who were undergoing noncardiac surgery. Myocardial perfusion SPECT had been performed within 4 weeks prior to noncardiac surgery requiring general anesthesia. MAIN OUTCOME MEASURES: Prevalence of abnormal myocardial perfusion SPECT results on preoperative evaluation; abnormal myocardial perfusion SPECT results as a predictor for postoperative cardiac events such as cardiac death, nonfatal myocardial infarction, and unstable angina. RESULTS: Of 131 patients who underwent noncardiac surgery from February 2015 to April 2016, 84 (64%) patients were female and the mean (SD) age was 64.1 (13.6) years. The prevalence of abnormal myocardial perfusion SPECT was 18% (24 of 131). Normal myocardial perfusion SPECT was highly predictive (up to 100%), but a positive myocardial perfusion SPECT had low positive predictive value (4%). Variables associated with an abnormal myocardial perfusion SPECT included ischemic heart disease, congestive heart failure, ASA score of 3 or more, limited exercise capacity (less than 4 METs), male sex, hypercholesterolemia, hypertension, smoking, and abnormal ECG. In a multivariable analysis, history of ischemic heart disease and history of smoking were significant predictors of abnormal myocardial perfusion SPECT (P=.001, and .029, respectively). CONCLUSIONS: Because of the low positive predictive value of myocardial perfusion SPECT, utilization of the technique in the workup of cardiac patients undergoing noncardiac surgery has been inappropriate. Myocardial perfusion SPECT should be restricted to only clearly defined appropriate use criteria. LIMITATIONS: Relatively small number of patients and retrospective design.

BACKGROUND: Normal single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) has a high negative predictive value for ischemic heart disease. Thus, the presence of subclinical coronary atherosclerosis detected by coronary artery calcification (CAC) score in patients who have undergone SPECT MPI is unknown. OBJECTIVES: Determine the prevalence of coronary artery calcification (CAC) in patients with normal SPECT MPI and examine the association of CAC with conventional coronary artery disease (CAD) risk factors. DESIGN: Cross-sectional analytical study using medical records from February 2010 to April 2016. SETTINGS: Single tertiary-care center. PATIENTS AND METHODS: We studied patients referred from the outpatient clinical services for clinically indicated noninvasive CAD diagnosis with MPI SPECT. CAC scoring was subsequently performed within 3 months after a normal MPI. We excluded patients with chest pain or decompensated heart failure or patients with a history of CAD. The study population was divided into three groups: patients with a CAC score of 0, a CAC score from 1 to 300, and a CAC score more than 300. The groups were analyzed by age and other demographic and clinical characteristics. MAIN OUTCOME MEASURE(S): Prevalence of CAC in patients with normal MPI. RESULTS: The prevalence of CAC was 55% (n=114) in 207 patients with a mean (SD) age of 57.1 (10.4) years. Twelve percent had severe coronary atherosclerosis (CAC score >300). All patients had a normal MPI SPECT. CAC scores were 0 for 93 patients (45%), 1 to 300 for 89 (43%), and more than 300 for 24 (12%). There was a strong association between CAC score and age (P

Background: The aim of this study was to determine if breast arterial calcification (BAC) on mammography predicts myocardial ischemia (MI) on stress myocardial perfusion single-photon emission computed tomography (MPS). BAC is a type of medial artery calcification that can be seen incidentally on mammography, but the relationship between coronary artery calcification and MI on MPS is yet unknown. Methods: A total of 435 consecutive women underwent mammography and stress MPS within 1 year of each other. BAC was quantitatively evaluated (0 - 13). Patients with known coronary artery diseases (CADs) such as coronary artery bypass grafting (CABG), percutaneous coronary intervention (PCI), MI, positive coronary angiogram or positive MPS were excluded from the study. Risk factors for CAD were obtained from a chart review. Results: The mean age was 58 ± 8 years. BAC was found in 258 (59%) of the study population. BAC-positive patients were significantly older than BAC-negative patients (P < 0.0001), there were strong associations between BAC and hypertension (P = 0.0309), chronic kidney disease (CKD) (P = 0.0001), and diabetes (P = 0.0309), but there were significant associations between BACV and hyperlipidemia, family history of CAD, and smoking (P = 0.6856, P = 0.9642, and P = 0.087, respectively). The mean score of BAC was 5 ± 5 in patients with normal MPS and was 6 ± 6 in patients with abnormal MPS. There were no associations between total BAC and MPS results (P = 0.2095), and between BAC categories and MPS result (P = 0.3069). Conclusions: Based on our study, the presence and severity of BAC on screening or diagnostic mammography do not predict MI on stress MPS, and further cardiac workup based on the presence of BAC is not warranted. BAC is very common in mammography up to 59% and associated with age, diabetes, CKD, and hypertension. In contrast, the prevalence of MI is only 13% in women with BAC and associated with age, diabetes, CKD, hyperlipidemia, and impaired left ventricular function. Cardiol Res. 2017;8(5):220-227 doi: https://doi.org/10.14740/cr604w

Objectives: The purpose of this study is to assess the diagnostic performance of coronary artery calcium score (CACS), computed tomography coronary angiography (CTCA), and the prevalence of coronary artery disease (CAD) as etiology of heart failure (HF) in the Middle Eastern population. Background: CTCA has several advantages compared to invasive coronary angiography (ICA). However, studies on the diagnostic accuracy of CTCA and CACS in detecting the prevalence of CAD in patients with newly diagnosed HF are lacking in the Middle East. Methods: This study included 204 patients with symptoms of HF and ejection fraction (EF) of

There have been little and conflicting data regarding the relationship between coronary artery calcification score (CACS) and myocardial ischemia on positron emission tomography myocardial perfusion imaging (PET MPI). The aims of this study were to investigate the relationship between myocardial ischemia on PET MPI and CACS, the frequency and severity of CACS in patients with normal PET MPI, and to determine the optimal CACS cutoff point for abnormal PET. This retrospective study included 363 patients who underwent same-setting stress PET perfusion imaging and CACS scan because of clinically suspected coronary artery disease (CAD). Fifty-five (55%) of the 363 patients had abnormal PET perfusion. There was an association between sex, diabetes mellitus (DM), smoking, and CACS and PET perfusion abnormities with P = 0.003, 0.05, 0.005, and 0.001, respectively. However, there was no association between PET perfusion abnormalities with age, body mass index, hypertension, and hypercholesterolemia. There was association between CACS and age, sex, and DM with P = 0.000, 0.014, and 0.052, respectively, and stepwise increase in the frequency of myocardial ischemia and CACS groups. Receiver-operating characteristic analysis showed that a CACS ≥304 is the optimal cutoff for predicting perfusion abnormalities with sensitivity of 64% and specificity of 69%. In conclusion, the frequency of CAC in patients with normal PET MPI is 49%, it is highly recommended to combine CACS with PET MPI in patients without a history of CAD. PET MPI identifies myocardial ischemia and defines the need for coronary revascularization, but CAC reflects the anatomic burden of coronary atherosclerosis. Combining CACS to PET MPI allows better risk stratification and identifies high-risk patients with PET, and it may change future follow-up recommendations. CACS scan is readily available and easily acquired with modern PET-computed tomography (CT) and single-photon emission CT (SPECT)-CT with modest radiation exposure.

Spectral Doppler interrogation of the descending thoracic and abdominal aorta provides valuable information regarding cardiac and vascular hemodynamics. An abnormal aortic Doppler profile is encountered in pathological conditions that affect the aorta and its branches, the aortic valve, the left ventricle, and the pericardium. Characteristic findings on Doppler interrogation of the aorta are often noted in individuals with obstructive atherosclerotic disease of the aorto-iliac system including severe stenosis or occlusion of the distal aorta and/or iliac arteries. In this manuscript, we highlight the findings on spectral Doppler that led to the identification of occlusive disease in the distal aorta.

BACKGROUND AND OBJECTIVE: Coronary artery calcification (CAC) is indicated by calcium deposits in the coronary artery wall. Calcification is a component of atherosclerosis and coronary artery disease. Currently, there are no data on calcification in Saudi women at high risk of coronary artery disease. The aim of this study was to investigate the prevalence and percentiles of CAC score in high-risk asymptotic women in Saudi Arabia with comparison of age-specific CAC percentiles derived from la arge population-based published study in the United States. DESIGN AND SETTING: Retrospective analysis of CAC scores (CACS) at a single tertiary care center. METHODS. Between January 2011 and April 2015, women referred for CAC screening because of the presence of one or more CAD risk factors were enrolled in the study. CT scans were interpreted by an experienced radiographic technologist, and confirmed by a radiologist. RESULTS: The study sample consisted of 918 women, mean (SD) age of 55 (11) years. All patients were asymptomatic and referred by their primary care physician or cardiologist for CAC screening because presence of one or more CAD risks factors. CAD risk factors included diabetes, hypertension, hypercholesterolemia, family history of CAD, and obesity. Baseline CAD risk factors were remarkably higher than in the US comparator group. CACS for 25th, 50th, 75th, and 90th percentiles were calculated. The 75th and 90th CACS percentiles in Saudi women were significantly higher than the US percentiles. Age and diabetes are the most independent predictor of severity of CAC. LIMITATIONS: A potential bias due to sample collection because data was from a single tertiary care center, the study was retrospective and the sample size was small. CONCLUSION: There are significantly higher CACS percentiles in Saudi women compared with international data. Application of available published percentiles to a local population is not applicable and underestimates the severity of subclinical atherosclerosis. A large local population-based study is warranted to establish local CACS percentiles for a better understanding CAD screening, diagnosis, and treatment.

Left ventricular noncompaction cardiomyopathy is a very rare condition, yet believed to be often overlooked. It is thought to be caused by the developmental arrest in embryogenesis and characterized by an increase in the noncompacted, trabeculated myocardium adjacent to compacted myocardium in the left ventricular. The clinical presentations of this type of cardiomyopathy are of variable severity. Echocardiography used to be the diagnostic modality, but recent reports suggest that cardiac magnetic resonance imaging has higher sensitivity and specificity by showing a ratio of the noncompacted myocardium to compacted myocardium of >2.3.

The objectives of this article are to review different patterns and potential pitfalls of quantitative lung perfusion scintigraphy (LPS) in patients with congenital heart disease (CHD). The patterns of quantitative LPS in patients with CHD include normal symmetrical bilateral perfusion to both lungs, unilateral absent perfusion in one lung, unilateral decreased perfusion, and multiple segmental perfusion abnormalities that suggest pulmonary embolism. Knowledge of several potential pitfalls is very important to avoid false interpretations; common pitfalls are related to type of site of injection (upper versus lower extremities), right or left upper extremity in case of persistence of left superior vena cava and previous surgery. An important incidental finding that may prompt immediate attenuation is multiple segmental defect that suggests asymptomatic pulmonary embolism, which is relatively common in this population.

Study Objectives.There are few data on the effects of continuous positive airway pressure (CPAP) therapy on the structural and functional characteristics of the right heart in patients with obstruc...

Background: The presence of septal perfusion defect on myocardial perfusion single-photon emission computed tomography (SPECT) in patients with known left bundle branch block (LBBB) can present a major diagnostic dilemma. Methods: Thirty-nine patients with known LBBB underwent both SPECT and coronary computed tomography angiography (CCTA), a median of 65 days after SPECT. Patients underwent SPECT; CCTA was performed on the basis of abnormal SPECT and presence of clinical symptoms. Exclusion criteria included a history of myocardial infarction, previous coronary artery bypass surgery or percutaneous coronary intervention. Results : Of the study population (n=39), 22 (56%) patients were female and the mean (± SD) age was 63±13 years; all patients were known to have LBBB diagnosed by electrocardiogram. SPECT results showed 24 (61%) patients had a reversible septal defect and 15 (39%) had a fixed septal defect. CCTA revealed that 27 (69%) patients had normal coronary artery or nonobstructive coronary artery disease (CAD); only 12 (31%) had abnormal coronary artery (>50% luminal stenosis). There was no relationship between patterns of SPECT perfusion abnormalities and CCTA results. Conclusion: The presence of abnormal SPECT in patients with LBBB did not necessarily indicate the presence of CAD. Approximately 70% of patients with LBBB and abnormal SPECT had normal CCTA. The authors strongly believe CCTA must be considered the first noninvasive test in patients without history of CAD and LBBB. Normal CCTA excludes CAD, but patients with obstructive CAD >50% on CCTA will benefit from conventional coronary angiography.

Coronary artery anomalies (CAAs) are found in approximately 1% of all patients undergoing coronary angiography and in 0.3% of patients undergoing autopsy (Roberts, 1986). CAAs may be classified into those of origin and course, intrinsic coronary arterial anatomy, and coronary termination (Angelini et al. 2002). The most common malformation is abnormal origin and course, origin of a coronary artery from a wrong aortic sinus of Valsalva; either the right from the left coronary sinus or the left from the right coronary sinus; these anomalies must be excluded in young adults with typically ischemic- sounding chest pain or syncope. Anomalies coronary artery termination typically presented as coronary artery fistula, commonly the right coronary artery is affected, although, left sided coronary artery fistulae are well documented (Gandy et al. 2004). The anomalies of intrinsic coronary arterial anatomy, such as ostial stenosis, Artesia, and single, absent, or hypoplastic coronary arteries are rare but may have clinical importance.

Preoperative assessment of the cardiac patients before noncardiac surgery is concern in the clinical practice of anesthesiologist, surgeon, and medical consultant. The preferred stress testing is exercise electrocardiogram (ECG) in patients who are able to exercise and have normal ECG; however, either stress myocardial perfusion scintigraphy (MPS) or stress echocardiography is necessary if further testing is appropriately indicated before surgery. Unfortunately, stress MPs or stress echocardiography is not widely available and has some limitations. Coronary computed tomography angiogram (CCTA) has demonstrated excellent diagnostic accuracy in detecting coronary artery disease and accurate left ventricle function measurement. CCTA seems to be feasible, reliable, and has strong potential of becoming sole screening test before surgery.

Although the immediate and intermediate-term results of balloon angioplasty (BA) for patients with aortic coarctation (AC) have been encouraging, there is paucity of data on long-term follow-up results. This study evaluated the long-term (up to 22 years) follow-up results of BA in adolescent and adult patients with discrete (shelf-like) coarctation of the aorta.Follow-up data of 58 patients (mean age 24+/-9 years) undergoing BA for discrete AC at median interval of 13.4 years including cardiac catheterization, magnetic resonance imaging, and Doppler echocardiography form the basis of this study.No early deaths occurred. Balloon angioplasty produced immediate reduction in peak AC gradient from 60+/-22 mm Hg to 8.5+/-8 mm Hg (P.0001). Follow-up catheterization 12 months later revealed a residual gradient of 5+/-6.4 mm Hg (P=.01). Five patients (8%) with suboptimal initial outcome (peak gradient20 mm Hg) developed restenosis, and 4 of these had successful repeat angioplasty. Aneurysm developed at the site of dilatation in 4 patients (7%). Magnetic resonance imaging follow-up results revealed no new aneurysm. In one patient, the aneurysm increased in size, but no recoarctation or appreciable changes in the Doppler gradient across the AC site was noted. The blood pressure had normalized without medical treatment in 29 (50%) of the 58 patients.Long-term results of BA for discrete AC are excellent and should be considered as first option for treatment of this disease.

A 23-year-old man presented with recent intermittent shortness of breath. He was healthy, with no significant medical history. Transthoracic echocardiographic examination revealed a left ventricular cyst attached to the interventricular septum (Figure, A); the rest of the echocardiographic examination was unremarkable. Cardiac magnetic resonance imaging was requested for tissue characterization. The lesion demonstrated high signal intensity on both T1- and T2-weighted fast spin echocardiography (Figure, B and C). In addition, the lesion demonstrated a homogeneous rapid enhancement pattern during first-pass infusion of gadolinium-containing contrast, indicating high vascularity (Movie I in the online-only Data Supplement and Figure, D and E). On delayed myocardial enhancement imaging, the mass showed marked enhancement because of its …

Background: The prevalence of coronary artery disease (CAD) in end stage liver disease (ESLD) being evaluated for orthotopic liver transplantation (OLT) is unclear based on variable definition used for CAD. Aim: The objective of this study to investigate the prevalence of abnormal stress myocardial perfusion SPECT (MPS) imaging, as a marker for CAD, among patients with ESLD who were referred for stress MPS imaging as a routine work up before OLT. Methods and materials: We reviewed data on 167 patients who were referred for MPS as a routine work up before OLT over last 2 years. All patients underwent evaluation for CAD risk factors (age, hypercholesterolemia, diabetes mellitus, hypertension, and smoking), and stress MPS per standard protocol. Results: The total number patients referred for stress MPS was 167 patients. 7 patients (4%) were excluded for being have nondiagnostic studies. 147 patients (92%) have normal but only 13 patients (8%) have abnormal MPS scans. Diabetes mellitus and male gender were the most independent risk factors for abnormal MPS with p-value of .046, and 0.26 respectively. There was no significant association between the abnormal result with hypertension, hypercholesterolemia, smoking, age or etiology of the liver disease. Conclusions: Based on our data the prevalence of abnormal MPS and LVEF in patients with ESLD is 8%. DM and male gender were the most independent predictor factors for abnormal MPS. True prevalence of CAD and usefulness of MPS in patients with ESLD can only be studied using a very large and randomized prospective study.

The preoperative cardiac assessment of patients undergoing noncardiac surgery is common in the daily practice of medical consultants, anesthesiologists, and surgeons. The number of patients undergoing noncardiac surgery worldwide is increasing. Currently, there are several noninvasive diagnostic tests available for preoperative evaluation. Both nuclear cardiology with myocardial perfusion single photon emission computed tomography (SPECT) and stress echocardiography are well-established techniques for preoperative cardiac evaluation. Recently, some studies demonstrated that both coronary angiography by gated multidetector computed tomography and stress cardiac magnetic resonance might potentially play a role in preoperative evaluation as well, but more studies are needed to assess the role of these new modalities in preoperative risk stratification. A common question that arises in preoperative evaluation is if further preoperative testing is needed, which preoperative test should be used. The preferred stress test is the exercise electrocardiogram (ECG). Stress imaging with exercise or pharmacologic stress agents is to be considered in patients with abnormal rest ECG or patients who are unable to exercise. After reviewing this article, the reader should develop an understanding of the following: (1) the magnitude of the cardiac preoperative morbidity and mortality, (2) how to select a patient for further preoperative testing, (3) currently available noninvasive cardiac testing for the detection of coronary artery disease and assessment of left ventricular function, and (4) an approach to select the most appropriate noninvasive cardiac test, if needed.

ObjectivesGated SPECT is an accurate technique for assessment of myocardial perfusion (MP), left ventricular ejection fraction (LVEF), end-diastolic volume (EDV) and end-systolic volume (ESV). However recent studies have concluded that there are large discrepancies in assessment of LVEF and volumes by gated SPECT in patients with multiple severe myocardial perfusion defects. We sought to investigate the correlation between LVEF and volumes calculated by gated SPECT and cardiac magnetic resonance (CMR) in patients with severe multiple perfusion defects who are referred for CMR.MethodsTwenty-nine patients (20 male and 9 female, mean age: 63years±11) with multiple severe fixed perfusion defects (mean 5±3 segments) were referred to undergo CMR. The average time between CMR and SPECT was 4weeks. LVEF, EDV, and ESV were derived automatically from gated SPECT. In the CMR studies, the endocardial and epicardial borders were delineated manually in the short axis planes to calculate the LVEF and volumes.ResultsThe different parameters were compared using linear regression, and correlation coefficients were calculated. Substantial correlation was found between CMR and gated SPECT for EDV: r=0.7, p