Search

Treatment of osteochondrosis is one of the actual problems in the therapy of degenerative-dystrophic diseases of the musculoskeletal system [1]. The clinical studies have shown that osteochondrosis — a disease of the whole body, and therefore, interdisciplinary problem, relevant both for neurologists, as well as for orthopedists and general practitioners [2]. A brief review of clinical studies is presented demonstrating the relevance of using bioregulatory approach, Discus compositum and other combined bioregulatory drugs (CBD) [3–6]. The feature of CBD — the content of ultra-low doses (low dose, very-low dose antigen) of active substances that contribute to the recovery of the processes of self-regulation and detoxification in the body, activation of metabolism and regeneration/reparation processes. Bioregulatory action of CBD complements the effect of other medicines, combining well with them. Since the ultra-small doses are not metabolized in the body, CBD have no pharmacokinetics: they do not require additional energy and do not have a pharmacological stress on the body [3–6]. In this regard, they are well-tolerated by patients during chronic administration. Also, their application is helpful, if there are contraindications, side effects and the risk of complications when using other groups of drugs.

Left ventricular mechanical dyssynchrony (LVMD) induced by exercise stress was reported to be clinically useful in detecting multivessel coronary artery diseases. The aim of this study was to compare the prognostic value of LVMD induced by pharmacological stress with that induced by exercise stress. We retrospectively examined 918 consecutive patients who underwent exercise (N = 310) or pharmacological stress (N = 608) 99mTc-tetrofosmin single-photon emission computed tomography (SPECT) with normal myocardial perfusion. LVMD was evaluated by phase analysis as the indices of phase bandwidth and phase standard deviation (PSD). During the follow-up period (2.2 ± 1.9 years), 74 major cardiac events (MCEs) occurred (7 cases of cardiac death, 17 cases of heart failure, and 50 cases of coronary intervention). In global patients, the indices of LVMD on rest images were significantly greater in patients with MCEs (bandwidth (°): 51 ± 31 vs 37 ± 21, P = .001, PSD: 14 ± 9 vs 10 ± 6, P = .001). The exercise stress bandwidth was significantly higher in patients with MCEs (62 ± 37° vs 42 ± 21°, P = .026), as was the pharmacological stress bandwidth (57 ± 35° vs 43 ± 24°, P = .006). Multivariate analysis demonstrated the exercise stress bandwidth to be an independent predictor of MCEs (HR 1.017, CI 1.003 to 1.032, P = .019), but the pharmacological stress bandwidth had no influence on MCEs. LVMD induced by exercise stress was an independent predictor of MCEs in patients with normal perfusion SPECT, whereas that induced by pharmacological stress had no association with further events.

INTRODUCTION Three-dimensional (3D) data acquisition is now standard on PET/computed tomography scanners. The aim of this study was to evaluate the repeatability of myocardial blood flow (MBF) estimation with rubidium-82 (Rb) 3D PET and to validate regional MBF measurements by comparison with two-dimensional (2D) PET. PATIENTS AND METHODS Fifteen healthy individuals (31.6 ± 11.4 years old) were enrolled for the evaluation of the short-term repeatability of rest 3D MBF quantification. Another 19 healthy individuals (35.3 ± 12.6 years old) underwent rest and pharmacological stress PET using 2D and 3D data acquisition within a 1-month interval. The injected dose was 1500 MBq for 2D and 555 MBq for 3D PET acquisition. RESULTS MBF at rest showed good repeatability [whole left ventricular MBF; 0.54 ± 0.13 vs. 0.52 ± 0.13 mL/min/g, P = 0.98]. Rest MBF, stress MBF, and myocardial flow reserve (MFR) were not significantly different between 3D and 2D data acquisition. 3D MBF correlated well with 2D MBF over a wide flow range for both whole left ventricular (r = 0.97, P

AIM Evaluation of major adverse cardiovascular events (MACE) in women referred for NH3-PET/CT in relation to scan outcome and pharmacological stress ECG (PxECG) results. PATIENTS AND METHODS Six hundred twenty-four women, referred for NH3-PET/CT between 2012 and 2016, were included. Demographic data and MACE during follow-up (407 ± 207 days) were retrieved from electronic patient charts. NH3-PET/CT was scored as either normal or abnormal. PxECG was scored as negative, non-diagnostic or positive. PxECG was compared with NH3-PET/CT and related to MACE. RESULTS The NH3-PET/CT was normal in 482/624 (77%) and abnormal in 142/624 (23%). PxECG was negative in 234/624 (38%), non-diagnostic in 365/624 (58%) and positive in 25/624 (4%). NH3-PET/CT was normal in 87, 71 and 72% with normal, nondiagnostic and positive PxECG, respectively. 41/624(7%) experienced a MACE, 38 with abnormal NH3-PET/CT versus three with normal NH3-PET/CT (P < 0.001). MACE occurred in 5/234 (0.9%), 31/365 (8%) and 5/25 (20%) with normal, non-diagnostic and positive PxECG, respectively (P < 0.001). No MACEs were seen in 204 with both normal PxECG and NH3-PET/CT versus 5/30(17%) with normal PxECG but abnormal NH3-PET/. No MACE occurred in 3/260(1%) with non-diagnostic PxECG and normal NH3-PET/CT versus 28/105(27%) with non-diagnostic PxECG and abnormal NH3-PET/CT. 0/18 with positive PxECG and normal NH3-PET/CT showed MACE versus 5/7(71%) with a positive PxECG and abnormal NH3-PET/CT. CONCLUSION Normal NH3-PET/CT is most prevalent in women with normal PxECG. The occurrence of MACE during follow-up is more frequently related to an abnormal NH3-PET/CT than to PxECG. Furthermore, in women with positive PxECG but normal NH3-PET/CT no MACE are to be expected.

We present a case of reverse redistribution in a patient imaged with Rb-82 positron-emitting tomography. The patient was imaged twice in rapid succession using pharmacological stress – once with dipyridamole and once with dobutamine. The patient demonstrated reverse redistribution after dipyridamole but not after dobutamine administration. We speculate on the relationship between the pharmacological stressing agent and the presence of reverse redistribution.

Resumo Fundamento Em 2007, a Food and Drug Administration (FDA) determinou revisões sobre segurança dos agentes de contraste ecocardiográfico (ACE) disponíveis no mercado após relatos de mortes. Ao longo desses anos, diversos estudos comprovaram a segurança dos ACE, porém com poucos estudos relacionados ao SonoVue®. Objetivos Avaliar a segurança do SonoVue® durante o ecocardiograma sob estresse farmacológico (EEF) por meio da análise da incidência de reações alérgicas e da comparação entre os grupos quanto ao surgimento de arritmia, efeitos colaterais menores e eventos adversos. Métodos Estudo observacional, prospectivo, no qual 2.346 pacientes foram submetidos ao EEF e divididos em dois grupos: grupo 1 com ACE (n=1.099) e grupo 2 sem ACE (n=1.247). Os pacientes foram avaliados durante o EEF – 24 horas e 30 dias. Foi definido p significativo quando

Funding Acknowledgements Type of funding sources: None. Introduction Department for nuclear medicine in the University medical centre Ljubljana provides nuclear medicine diagnostic procedures for approximately 1.000.000 inhabitants of Slovenia. As many countries in Europe, Slovenia was faced with the first wave of the COVID-19 pandemic in early spring of 2020. Since our country is situated next to the northern part of Italy, where the situation was critical, our Ministry of health issued specific recommendations in March 2020. The aim was to increase hospital capacities for COVID-19 patients through limiting non-urgent diagnostic tests including myocardial perfusion scintigraphy (MPS) and to minimize the spread of the virus into hospital departments. The epidemiologic situation of the first wave resolved within 3 months. In the second wave of the pandemic in autumn 2020, the recommendations on patient care in non COVID-19 cases were less limiting to avoid worsening of non COVID-19 related diseases and patient prognosis. Purpose The aim of our study was to evaluate the influence of the COVID-19 pandemic on MPS in our medical institution. Methods Data on numbers of MPS, clinical characteristics of the patients and findings of MPS were prospectively collected for the first wave (in spring from March 15th to June 15th 2020) and second wave (in autumn from September 15th to December 15th 2020) of the pandemic and were compared with the same periods in 2019. Results During the first wave we performed 40% less MPS, significantly more patients had pharmacological stress and were outpatients than in spring 2019. There were no significant differences in other clinical characteristics and MPS findings (Table 1 and Figure 1). In autumn 2020 we reorganized our schedule to increase the number of patients, which was once again comparable to previous year’s autumn. Although the number of patients was comparable, patients were now significantly older and had more often pharmacological stress, but there were no significant differences in other clinical data or MPS findings (Table 1 and Figure 1). Conclusions In our hospital, during the first wave of COVID-19 pandemic, we performed significantly less MPS than in the same period of the previous year. To minimize the possibility of virus transmission from asymptomatic patients, we followed international recommendations and avoided exercise stress tests but increased the percentage of pharmacological stress tests. A similar approach regarding the type of stress tests was chosen for the second wave in autumn of 2020. However, we decided to increase the number of MPS performed, in order to lessen the negative impact of the pandemic on non COVID-19 related diseases, focusing on coronary artery disease.

The assessment of coronary flow velocity reserve (CFVR) may improve the diagnostic and prognostic value of stress echocardiography (SE).The aim of the study was to compare the feasibility of CFVR assessment in the left anterior descending artery (LAD) in 4 modalities of SE: dobutamine, dipyridamole, rapid cardiac pacing, and exercise using cycle ergometer.We performed SE in 369 patients (mean [SD] age, 67 [11] years) with dobutamine (n = 230), dipyridamole (n = 73), rapid cardiac pacing (n = 22), or exercise (n = 44) between June 2017 and June 2020. We measured CFVR as the ratio of peak diastolic coronary flow velocity during exercise, pharmacological stress, or pacing to peak diastolic coronary flow velocity at rest in the distal or mid LAD.The feasibility of CFVR was excellent during rapid cardiac pacing (100%), dobutamine (95%), and dipyridamole (95%) and was lower during exercise (73%; P⁠0.01 vs other groups). In multivariable analysis, the exercise protocol was a predictor of the loss of blood flow in the LAD during SE (odds ratio, 7.89; 95% CI, 2.17–31.33; P = 0.002). The median (interquartile range) CFVR was lower with rapid cardiac pacing (1.7 [1.4–2.0]) as compared with dobutamine (2.1 [1.7–2.5]), dipyridamole (2.1 [1.8–2.5]), and exercise (2.0 [1.7–2.3]) (P⁠0.05 for all).CFVR in the LAD can be obtained during all forms of SE, but the feasibility is significantly higher with rapid cardiac pacing and pharmacological tests as compared with exercise, which was identified in our study as an independent predictor of the loss of blood flow during a blood flow recording in the LAD at the peak of stress test.

Vasodilator stress cardiac magnetic resonance (CMR) offers superior accuracy over single-photon emission computed tomography (SPECT) ([1][1]); however, pharmacological stress cannot reproduce exertional symptoms or signs. We have shown that MR-compatible treadmill stress with CMR offers excellent

This paper presents the results of the 8 291 questionnaires (184 practices (PR), 77 hospitals (HO), 30 university hospitals (UH)) were evaluated. Results of the last survey from 2015 are set in squared brackets. MPS of 145 930 [121 939] patients were reported (+ 19.6 %). 76 % [78 %] of all patients were studied in PR, 16 % [14 %] in HO, and 8 % [8 %] in UH, mostly with a 2-day-protocol 48 % [50 %]. 99.96 % [98 %] of all MPS were performed with Tc-99 m radiopharmaceuticals and in 0.04 % with Tl-201.A pharmacological stress test was applied in 49 % [43 %] (23 % [22 %] adenosine, 26 % [20 %] regadenoson, dipyridamole or dobutamine together 1 % [1 %]). Attenuation correction was performed in 26 % [25 %] of all MPS, gated SPECT in 86 % [80 %] of stress MPS, in 87 % [78 %] of rest and in 83 % [76 %] of all stress and rest MPS. 67 % [53 %] of the departments performed MPS scoring by default, whereas 16 % [24 %] did not apply this feature at all.69 % [60 %] reported an increase or no changes in their MPS patient numbers. One hundred twenty-six departments which participated in the surveys from 2009 to 2018 reported an increase in MPS by 44 %. 69 % [70 %] of the MPS were requested by ambulatory care cardiologists. The 2018 MPS survey reveals a high-grade adherence of routine MPS practice to current guidelines. The positive development in MPS performance and MPS numbers observed since 2012 remains ongoing. Dieser Artikel stellt die Ergebnisse der 8. Erhebung zur Myokard-Perfusions-SPECT (MPS) in Deutschland für das Jahr 2018 zusammen. Es wurden 291 Fragebögen (184 Praxen (PR), 77 Krankenhäuser (KH), 30 Universitätskliniken (UK)) ausgewertet. Die Daten der letzten Umfrage stehen in eckigen Klammern. In der Umfrage wurden MPS von 145 930 [121 939] Patienten erfasst. 76 % [78 %] der Patienten wurden in PR, 16 % [14 %] in KH und 8 % [8 %] in UK untersucht. Am häufigsten erfolgte die MPS als 2-Tages-Protokoll (48 % [50 %]). 99,96 % [98 %] der MPS wurden mit Tc-99m-Perfusionsradiopharmaka durchgeführt, mit Tl-201 nur 0,04 %.Die Belastung erfolgte zu 49 % [43 %] pharmakologisch (23 % [22 %] mit Adenosin, 26 % [20 %] mit Regadenoson, Dipyridamol oder Dobutamin 1 % [1 %]). Eine Schwächungskorrektur wurde bei 26 % [25 %] der MPS durchgeführt. 86 % [80 %] der Stress-, 87 % [78 %] der Ruhe- sowie 83 % [76 %] der Ruhe- und der Stressaufnahmen wurden als gated SPECT aufgenommen. 67 % [53 %] der Abteilungen verwendeten standardmäßig Perfusions-Scores bei der Befundung, 16 % [24 %] befundeten ohne Scores.69 % [60 %] der Teilnehmer verzeichneten eine Zunahme ihrer Untersuchungszahlen oder keine Änderungen. 126 Abteilungen/Einrichtungen nahmen an allen Erhebungen von 2009 bis 2018 teil. Bei ihnen ergab sich eine Zunahme der Untersuchungszahlen um 44 %. Die größte Zuweisergruppe stellten Kardiologen (69 % [70 %] der MPS) dar. Anhand der aktuellen Erhebung zur MPS in Deutschland zeigt sich eine gute Leitlinienkonformität. Die sich seit 2012 abzeichnende positive Entwicklung bei den MPS-Qualitätsparametern und den Untersuchungszahlen hält an.

Objectives: Transient ischemic dilation (TID) refers to an apparent increase in the size of the left ventricular cavity on stress myocardial perfusion imaging compared to rest imaging. This study was performed to correlate the value of TID ratio in gated SPECT MPI in Coronary Artery Disease (CAD). Patients & Methods: Seventy-four suspected or known CAD patients underwent MPI performed with Tc-99m sestamibi. Single day stress - rest protocol with pharmacological stress was followed, according to established practicing protocol of NINMAS. A statistical analysis was carried out by using the Statistical Package for Social Sciences version 20.0 for Windows (SPSS Inc., Chicago, Illinois, USA). Student t-test was used for continuous variables. Chi-square test used to compare categorical data. P values 1.19, 24(64.9%) patients were in MVD group and 13(92.9%) were in SVD group. Whereas among the patients with TID ratio

This study aimed to evaluate the incremental diagnostic value of dynamic myocardial computed tomography (CT) perfusion (CTP) imaging for detecting obstructive coronary artery disease (CAD) in comparison with coronary CT angiography (CTA).Thirty-eight patients who had undergone coronary CTA and pharmacological stress dynamic CTP before invasive coronary angiography (ICA) were selected retrospectively. Using ICA, obstructive CAD was defined as the presence of severe (≥70%) or moderate (50-69%) stenosis with fractional flow reserve (FFR)0.75. For CT evaluations, coronary vessels with any stenosis ≥50%, ≥70% or unassessable lesions were considered significantly stenotic. Dynamic CTP was assessed quantitatively using CT-derived myocardial blood flow (CT-MBF). Receiver operating characteristic (ROC) curve analysis determined the cut-off value of CT-MBF for identifying obstructive CAD. The diagnostic performances of CTA alone and integrated CTA and CTP assessments for detecting obstructive CAD were compared.Using ICA and FFR, 24 of 114 vessels had obstructive CAD. The cut-off value of CT-MBF for detecting obstructive CAD was 1.26mL/g/min. The sensitivity, specificity, and positive and negative predictive values (PPV and NPV) at the vessel level were 96%, 57%, 37%, and 98% for CTA, and 83%, 93%, 77%, and 95% for integrated CTA and CTP assessment using cut-off 50% stenosis on CTA, respectively. The sensitivity, specificity, and PPV and NPV at the vessel level were 79%, 69%, 40%, and 93% for CTA, and 71%, 97%, 85%, and 93% for integrated CTA and CTP assessment using cut-off 70% stenosis on CTA, respectively. The area under the ROC curve for CTA and CTP was significantly higher than that for CTA alone (0.96 vs. 0.84, p0.05).Stress dynamic myocardial CTP is feasible to detect hemodynamically obstructive CAD in patients with high pre-test likelihood and helps for improving diagnostic performance in comparison with coronary CTA alone.

BACKGROUND: Coronary artery disease (CAD) is the leading cause of mortality and morbidity in patients with diabetes (DM). AIM: Тhe aim of our study was to analyse the ability of pharmacological SE to risk stratify patients with DM using qualitative and quantitative assessment of LV function. METHODS: We prospectively assessed 105 consecutive patients (58.7 ± 9.5 y, 39 male) with known or suspected CAD who underwent dipyridamole or dobutamine SE. RESULTS: Change of systolic LV function at maximal SE was less pronounced in patients with DM, while parameters of the diastolic function and its change with stress were almost insignificant. WMSI in comparison to GLS% didn’t make a difference in SE outcome regarding DM presence. WMSI was almost unchanged at maximal stress in diabetic patients. Conversely, GLS% showed significant worsening at maximal stress in diabetic patients. However, only WMSI at maximal stress along with DM presence appeared as independent predictors of the presence of new and worsening CAD during SE. Longitudinal strain assessed using speckle tracking during pharmacological stress echocardiography was superior to conventional echocardiography expressed by wall motion analysis in making a difference regarding DM presence. CONCLUSION: We confirmed the usefulness of stress echocardiography using qualitative and/or quantitative parameters in the detection of CAD in patients with DM.

Background: Pharmacological stress testing can help to uncover pathological hemodynamic conditions and is, therefore, used in the clinical routine to assess patients with structural heart diseases such as aortic coarctation with borderline indication for treatment. The aim of this study was to develop and test a reduced-order model predicting dobutamine stress induced pressure gradients across the coarctation. Methods: The reduced-order model was developed based on n=21 imaging data sets of patients with aortic coarctation and a meta-analysis of subjects undergoing dobutamine stress testing. Within an independent test cohort of n=21 patients with aortic coarctation, the results of the model were compared with dobutamine stress testing during catheterization. Results: In n=19 patients responding to dobutamine stress testing, pressure gradients across the coarctation during dobutamine stress increased from 15.7±5.1 to 33.6±10.3 mm Hg (paired t test, P P =0.021). Conclusions: The developed reduced-order model can instantly predict dobutamine-induced hemodynamic changes with accuracy equivalent to heart catheterization in patients with aortic coarctation. The method is easy to use, available as a web-based calculator, and provides a promising alternative to conventional stress testing in the clinical routine. Registration: URL: https://www.clinicaltrials.gov . Unique identifier: NCT02591940.

Regadenoson is a pharmacological stress agent that has been widely used since its approval by the Food and Drug Administration (FDA) in 2008. For many years, dipyridamole and adenosine, which are non-selective adenosine receptor agonists, were more popular. However, these agents are less preferred now due to their undesirable adverse effects as compared to regadenoson. In the ADVANCE (ADenoscan Versus regAdenosoN Comparative Evaluation) phase 3 clinical trial, regadenoson demonstrated non-inferiority to adenosine for detecting reversible myocardial ischemia. This review summarizes the clinical utilities of regadenoson as the most widely used pharmacological stress agent. Moreover, the use of regadenoson has been documented in specific patient populations. Although regadenoson has established safety and efficacy in most patients with chronic diseases, there are equivocal results in the literature for other chronic diseases. It is warranted to highlight that the use of regadenoson has not been studied in patients of low socioeconomic class; it is a condition that carries a significant burden on the cardiovascular system.

Physical stress and pharmacological stress (vasodilator drugs and dobutamine) are complementary tests in the diagnosis of coronary artery disease (CAD). Exercise testing is mainly used to estimate prognosis and determine functional capacity. The association of myocardial perfusion scintigraphy (CPM) with physical or pharmacological stress has always been synergistically evaluated in the diagnosis and evaluation of CAD, offering high sensitivity and specificity. Exercise testing has a lower diagnostic performance than diagnostic imaging tests and has limited power to discard obstructive CAD. The systematic review of stress parameters is a key part of nuclear cardiology exam. Although stress myocardial imaging provides valuable diagnostic and prognostic information, added information derived from stress testing can yield substantial data for diagnosis and risk stratification.

BACKGROUND: With the 2019 update of European Society of Cardiology (ESC) guidelines for chronic coronary syndromes, the pre-test probabilities (PTPs) based on age, sex, and symptoms have undergone major revisions. We aimed to determine implications of these alterations on diagnostic accuracy of dobutamine stress echocardiography (DSE). METHODS: We retrospectively included consecutive patients undergoing pharmacological stress-echocardiography for evaluation of suspected obstructive coronary artery disease. DSE was performed as non-invasive imaging test and was indicated by individual treating physician's decision. Sensitivity, specificity, positive and negative predictive value as well as accuracy were assessed for detection of obstructive coronary artery disease, defined as revascularization therapy following DSE. RESULTS: We included 206 patients (mean age 63.2 ± 12.4 years, 59.7% male). 51% of the cohort had a PTP of < 15% according to both scores. 9.2% of patients with PTP < 15% according to the original Diamond and Forrester score had a PTP > 15% according to 2019 ESC guidelines, predominantly due to the accountancy of dyspnea. In contrast, 13.6% of patient had a PTP ≥ 15% according to the original Diamond and Forrester score, while PTP was assessed below this threshold by updated guidelines. The differences in patient selection according to updated guidelines did not alter the diagnostic accuracy of DSE (68% for both). CONCLUSIONS: Changes in assessment of PTP according to updated ESC guidelines from 2019 led to a relevant reclassification of patients with suspected coronary artery disease, ultimately changing the group of patients appropriate for DSE for evaluation of myocardial ischemia. Comparing the diagnostic performance in appropriate PTP groups, however, led to similar results. OA platinum

Regardless of the importance of acid-base disturbances in cardiac disease, there are currently no methods for clinical detection of pH in the heart. Several magnetic resonance imaging techniques hold translational promise and may enable in-vivo mapping of pH. We provide a brief overview of these emerging techniques. A particular focus is on the promising advance of magnetic resonance spectroscopy and imaging with hyperpolarized 13C-subtrates as biomarkers of myocardial pH. Hyperpolarization allows quantification of key metabolic substrates and their metabolites. Hereby, pH-sensitive reactions can be probed to provide a measure of acid-base alterations. To date, the most used substrates are [1-13C]pyruvate and 13C-labelled bicarbonate; however, others have been suggested. In cardiovascular medicine, hyperpolarized magnetic resonance spectroscopy has been used to probe acid-base disturbances following pharmacological stress, ischemia and heart failure in animals. In addition to pH-estimation, the technique can quantify fluxes such as the pivotal conversion of pyruvate to lactate via lactate dehydrogenase. This capability, a good safety profile and the fact that the technique is employable in clinical scanners have led to recent translation in early clinical trials. Thus, magnetic resonance spectroscopy and imaging may provide clinical pH-imaging in the near future.

Background Past clinical trial findings suggest that the availability of regadenoson in a nuclear imaging center may affect real-world center practices related to the transition of patients from an inadequate exercise stress test (EST) to a pharmacological stress agent (PSA). Methods and Results This was a cross-sectional study using one-on-one telephone interviews with nuclear imaging center staff to facilitate survey development, followed by an online survey to evaluate patterns and processes around use of PSAs during single-photon emission computed tomography myocardial perfusion imaging (SPECT-MPI) in patients with inadequate ESTs. Of the 50 participants, 35 (70%) used only regadenoson, 3 (6%) only adenosine, 3 (6%) regadenoson and adenosine, 7 (14%) regadenoson and dipyridamole, and 2 (4%) all 3 agents for converting patients from an inadequate EST to a PSA. Nearly all centers (94%) used protocols to guide conversions. Of 12 centers using > 1 PSA, 11 reported regadenoson to be the most preferred PSA. Total staff time required from PSA transition to post-test monitoring was shortest for regadenoson. Conclusions Compared to adenosine and dipyridamole, regadenoson is preferred by nuclear imaging center staff and associated with operational efficiencies after inadequate EST in real-world practice SPECT-MPI.

Objective: To evaluate how pharmacological stress agents (PSAs) are used during single-photon emission computed tomography myocardial perfusion imaging (SPECT-MPI) for patients (pts) with an inadequate exercise stress test (EST). Methods: This was a cross-sectional study. One-on-one telephone interviews with nuclear imaging center staff were used to develop an online survey, which was administered to evaluate patterns/processes around PSA use during SPECT-MPI in pts with inadequate EST. Eligible survey participants included nuclear technicians, nurses, physicians, and imaging center managers/directors with sufficient familiarity with SPECT-MPI/use of PSAs. Primary endpoint measures included gaining insights on how imaging centers convert to PSAs after inadequate EST and associated resource use. Results: Of 50 participating centers, 35 (70%) used only regadenoson (REG), 3 (6%) only adenosine (ADN), 3 (6%) REG and ADN, 7 (14%) REG and dipyridamole (DP), and 2 (4%) all 3 agents for converting pts after inadequate EST. Most centers (94%) used protocols to guide conversions. Post-test monitoring, including monitoring of pt performance and managing adverse reactions after completion of SPECT-MPI following PSA, was not conducted by 66%, 38%, and 56% of centers using REG, ADN, and DP, respectively. Same-day conversion occurred for 92%, 89%, and 98% of pts for REG, ADN, DP, respectively; the mean (standard deviation) number of pts converted in the past 30 days were 29.6 (44.1), 9.3 (9.9), and 1.9 (1.8), respectively. After an inadequate EST, average pt wait times to receiving REG, ADN, or DP were 4.9, 12.4 or 17.4 min, respectively; among centers using REG, 60% administered the PSA within a mean of 3 min, compared to 11% (1 center) using DP and no centers using ADN. Nearly 100%, 38%, and 11% of REG, ADN, and DP centers, respectively, reported that PSA administration was “not at all complex.” Of the centers using >1 PSA, 92% found REG to be the most preferred PSA (overall) among staff. Total staff time (aggregating time for multiple staff members who may have worked concurrently at each step) required from PSA transition to post-test monitoring was shortest for REG ( Table ). Conclusions: Imaging center staff prefer REG and its use is associated with operational efficiencies during SPECT-MPI after inadequate EST.

Stress echocardiography is an established technique for assessing coronary artery disease. It has primarily been used for the diagnosis and assessment of patients presenting with chest pain in whom there is an intermediate probability of coronary artery disease. In addition, it is used for risk stratification and to guide revascularisation in patients with known ischaemic heart disease. Although cardiac computed tomography has recently been recommended in the United Kingdom as the first-line investigation in patients presenting for the first time with atypical or typical angina, stress echocardiography continues to have an important role in the assessment of patients with lesions of uncertain functional significance and patients with known ischaemic heart disease who represent with chest pain. In this guideline from the British Society of Echocardiography, the indications and recommended protocols are outlined for the assessment of ischaemic heart disease by stress echocardiography.

This study evaluated the added predictive value of combining clinical information and myocardial perfusion single-photon emission computed tomography (SPECT) imaging (MPI) data using machine learning (ML) to predict major adverse cardiac events (MACE).Traditionally, prognostication by MPI has relied on visual or quantitative analysis of images without objective consideration of the clinical data. ML permits a large number of variables to be considered in combination and at a level of complexity beyond the human clinical reader.A total of 2,619 consecutive patients (48% men; 62 ± 13 years of age) who underwent exercise (38%) or pharmacological stress (62%) with high-speed SPECT MPI were monitored for MACE. Twenty-eight clinical variables, 17 stress test variables, and 25 imaging variables (including total perfusion deficit [TPD]) were recorded. Areas under the receiver-operating characteristic curve (AUC) for MACE prediction were compared among: 1) ML with all available data (ML-combined); 2) ML with only imaging data (ML-imaging); 3) 5-point scale visual diagnosis (physician [MD] diagnosis); and 4) automated quantitative imaging analysis (stress TPD and ischemic TPD). ML involved automated variable selection by information gain ranking, model building with a boosted ensemble algorithm, and 10-fold stratified cross validation.During follow-up (3.2 ± 0.6 years), 239 patients (9.1%) had MACE. MACE prediction was significantly higher for ML-combined than ML-imaging (AUC: 0.81 vs. 0.78; p 0.01). ML-combined also had higher predictive accuracy compared with MD diagnosis, automated stress TPD, and automated ischemic TPD (AUC: 0.81 vs. 0.65 vs. 0.73 vs. 0.71, respectively; p0.01 for all). Risk reclassification for ML-combined compared with visual MD diagnosis was 26% (p 0.001).ML combined with both clinical and imaging data variables was found to have high predictive accuracy for 3-year risk of MACE and was superior to existing visual or automated perfusion assessments. ML could allow integration of clinical and imaging data for personalized MACE risk computations in patients undergoing SPECT MPI.

O ecodopplercardiograma transtorácico é um exame de imagem de ampla aplicabilidade clínica que, apesar do requerimento de grande experiência do operador e de possibilidade de janelas acústicas ruins, permite a obtenção de muitas informações de maneira não invasiva, sem riscos de ionização para o paciente, com baixo custo. Quando realizado sob estresse físico ou farmacológico, torna-se uma opção com apropriada acurácia diagnóstica para investigação de isquemia miocárdica. Dentre os recursos disponíveis, o strain rate tem se mostrado útil na detecção de alterações incipientes da função sistólica segmentar, inclusive em pacientes portadores de hipertensão arterial sistêmica e doença arterial coronária. O presente trabalho demonstra o caso de uma paciente do gênero feminino assintomática que, após a submissão ao ecodopplercardiograma sob estresse farmacológico, apresentou hipertrofia do ventrículo esquerdo e strain rate alterado, mesmo sem alterações segmentares de motilidade miocárdica.