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Alagiakrishnan K, Mah D, Aronow WS, Lam PH, Frishman WH, Ahmed A, Deedwania P. Considerations Regarding Management of Heart Failure in Older Adults. Cardiol Rev 2024:00045415-990000000-00223. [PMID: 38421170 DOI: 10.1097/crd.0000000000000677] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
Understanding noncardiovascular comorbidities and geriatric syndromes in elderly patients with heart failure (HF) is important as the average age of the population increases. Healthcare professionals need to consider these complex dynamics when managing older adults with HF, especially those older than 80. A number of small studies have described associations between HF and major geriatric domains. With information on patients' cognitive, functional decline, and ability to adhere to therapy, physicians can plan for individualized treatment goals and recommendations for these patients.
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Affiliation(s)
| | - Darren Mah
- Department of Radiology, University of Alberta, Edmonton, Alberta, Canada
| | - Wilbert S Aronow
- Departments of Cardiology and Medicine, Westchester Medical Center and New York Medical College, Valhalla, NY
| | - Phillip H Lam
- Department of Medicine, Georgetown University, MedStar Washington Hospital Center, Washington, DC
| | | | - Ali Ahmed
- Center for Data Science and Outcomes Research, Veterans Affairs Medical Center, George Washington University, Georgetown University, Washington, DC; and
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Bhattacharjee P, Khan Z. Sacubitril/Valsartan in the Treatment of Heart Failure With Reduced Ejection Fraction Focusing on the Impact on the Quality of Life: A Systematic Review and Meta-Analysis of Randomized Clinical Trials. Cureus 2023; 15:e48674. [PMID: 38090453 PMCID: PMC10714125 DOI: 10.7759/cureus.48674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/11/2023] [Indexed: 04/10/2024] Open
Abstract
There exists a paucity of research data reported by analyses performed on randomized clinical trials (RCTs) that encompass quality of life (QOL) and the aftermath for patients suffering from heart failure with reduced ejection fraction (HFrEF). This systematic review and meta-analysis of randomized clinical trials (RCTs) have been done to evaluate the drug sacubitril/valsartan in the treatment of heart failure (HF) with reduced ejection fraction (HFrEF) with a clear focus on the effect it bestows on measures of physical exercise tolerance and quality of life. A thorough systematic search was done in databases including Cochrane Central Register of Controlled Trials (CENTRAL), ClinicalTrials.gov, Embase, and PubMed from 1 January 2010 to 1 January 2023. The search only included published RCTs on adult patients aged 18 and above, with heart failure with reduced ejection fraction (HFrEF). Data analysis was performed by using the software RevMan 5.4 (Cochrane Collaboration, London, United Kingdom). The included studies' bias risk was assessed using the Cochrane Collaboration's Risk of Bias tool. The quality of evidence for the primary outcome was done using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) framework. This systematic review and meta-analysis of RCTs yielded 458 studies, of which eight randomized clinical trials were included and analyzed. The meta-analysis of the included trials shows that the I2 value is 61% (i.e., I2 > 50%), demonstrating a substantial heterogeneity within the studies. The left ventricular ejection fraction (LVEF) expressed in percentage was reported in the five studies, and thereby, a subgroup analysis that yielded a confidence interval (CI) of 95% had the standard mean difference of 0.02 (-0.02, 0.07). The trials had disparity between the reporting of effect on peak oxygen consumption (VO2), measured through cardiopulmonary exercise testing (CPET) methods, six-minute walking test (6MWT), overall physical activity, and exercise capacity. Sacubitril/valsartan did not exponentially improve peak VO2 or 6MWT in these trials; however, the patient-reported data suggested that the quality of life was modestly influenced by the drug. A subgroup analysis was performed using the pooled effect value by the random effects model. The findings showed that the sacubitril/valsartan group significantly was better than the control group in improving HFrEF-associated health-related quality of life (HRQoL). This study is a systematic review and meta-analysis of randomized clinical trials that evaluated the drug sacubitril/valsartan in treating heart failure with reduced ejection fraction (HFrEF) and focused on its tangible effect on the measures of physical exercise tolerance and quality of life. It depicts that the statistical scrutiny due to the lack of significant data and parity across studies did not impart significant improvement of either LVEF, peak VO2, or 6MWT with the use of sacubitril/valsartan; however, the reported exercise tolerance, including daytime physical activity, had a modest impact with the said drug. The pooled values demonstrated that the sacubitril/valsartan group significantly outperformed the control group in improving HFrEF HRQoL.
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Affiliation(s)
| | - Zahid Khan
- Acute Medicine, Mid and South Essex NHS Foundation Trust, Southend-on-Sea, GBR
- Cardiology, Barts Heart Centre, London, GBR
- Cardiology and General Medicine, Barking, Havering and Redbridge University Hospitals NHS Trust, London, GBR
- Cardiology, Royal Free Hospital, London, GBR
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Pieters H, van Staden JA, du Plessis FCP, du Raan H. Validation of a Monte Carlo simulated cardiac phantom for planar and SPECT studies. Phys Med 2023; 111:102617. [PMID: 37290226 DOI: 10.1016/j.ejmp.2023.102617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 04/19/2023] [Accepted: 05/30/2023] [Indexed: 06/10/2023] Open
Abstract
PURPOSE This work aimed to validate Monte Carlo (MC) simulated cardiac phantoms for the evaluation of planar- and SPECT-gated-blood-pool (GBP-P and GBP-S) studies. METHODS A comparison of gamma camera system performance criteria measurements (energy resolution, spatial resolution, sensitivity) with MC simulations was conducted. Furthermore, the accuracy of measured and simulated volumes of two stereolithography-printed cardiac phantoms (based on 4D-XCAT phantoms) was assessed. Finally, the simulated GBP-P and GBP-S XCAT studies were validated by comparing calculated left ventricular ejection fraction (LVEF) and ventricle volume values with known parameters. RESULTS The simulated performance criteria compared well with measured values (energy resolution difference: 0.1 ± 0.10%; spatial resolution (full width at half maximum) difference ≤ 0.5 ± 0.8 mm and system sensitivity difference ≤ 6.2 ± 0.62cps/MBq). The measured and simulated cardiac phantoms were in good agreement; the left anterior oblique views compared well. This is supported by line profiles through these phantoms and on average, simulated counts were 5.8% lower than measured counts. The LVEF values calculated from the GBP-P and GBP-S simulated data differ from known values (2.8 ± 0.64% and 0.8 ± 0.52%). The differences between the known XCAT LV volumes and simulated GBP-S calculated volumes were -1.2 ± 1.91 ml and -1.5 ± 0.96 ml for the end-diastolic and end-systolic volumes. CONCLUSION The MC-simulated cardiac phantom has been validated successfully. Stereolithography-printing allows researchers to create clinically realistic organ phantoms and is a valuable tool for validating MC simulations and clinical software. By conducting GBP simulation studies with various XCAT models, the user will be able to generate GBP-P and GBP-S databases for future software evaluation.
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Affiliation(s)
- Hané Pieters
- Department of Medical Physics, University of the Free State, PO Box 339, Bloemfontein 9301, South Africa.
| | - Johannes A van Staden
- Department of Medical Physics, University of the Free State, PO Box 339, Bloemfontein 9301, South Africa.
| | - Frederik C P du Plessis
- Department of Medical Physics, University of the Free State, PO Box 339, Bloemfontein 9301, South Africa.
| | - Hanlie du Raan
- Department of Medical Physics, University of the Free State, PO Box 339, Bloemfontein 9301, South Africa.
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Ansheles AA, Sergienko IV, Prus YA, Sergienko VB. Nuclear imaging of chemotherapy-induced cardiotoxicity. КАРДИОВАСКУЛЯРНАЯ ТЕРАПИЯ И ПРОФИЛАКТИКА 2021. [DOI: 10.15829/1728-8800-2021-2537] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
The high efficiency of modern chemotherapy has made it possible to achieve great success in the treatment of cancer. Cardiovascular adverse effects are a major disadvantage of anticancer therapy, often requiring low and less effective doses or even drug withdrawal. Nuclear imaging techniques are the most sensitive in early detection of left ventricular damage and dysfunction during chemotherapy. This review presents modern data on the potential of nuclear imaging of cardiotoxicity.
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Affiliation(s)
| | | | - Yu. A. Prus
- National Medical Research Center of Cardiology
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Ebrahimi A, Raichlen JS, Pointon A, Gottfridsson C, Munley J, Hockings P, Cartwright J, Buss N, Wikström J, Gan LM, Whittaker A, Khalil A, George RT, Garkaviy P, Brott D. Drug-induced myocardial dysfunction - recommendations for assessment in clinical and pre-clinical studies. Expert Opin Drug Saf 2020; 19:281-294. [PMID: 32064957 DOI: 10.1080/14740338.2020.1731471] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Introduction: Drug-induced myocardial dysfunction is an important safety concern during drug development. Oncology compounds can cause myocardial dysfunction, leading to decreased left ventricular ejection fraction and heart failure via several mechanisms. Cardiovascular imaging has a major role in the early detection and monitoring of cardiotoxicity. Echocardiography is the method of choice because of its widespread availability, low cost, and absence of radiation exposure. Cardiac magnetic resonance imaging can provide better reliability, reproducibility, and accuracy in the detection of drug-induced myocardial dysfunction. In addition, it enables assessment of myocardial edema, fibrosis, and necrosis. Cardiac serologic biomarkers such as troponins and B-type natriuretic peptides are used in combination with imaging during drug development. This article provides a general overview of each imaging modality and practical guidance for early detection and monitoring of cardiotoxicity.Areas covered: Cardiovascular imaging modalities and cardiac biomarkers for monitoring of cardiac function and early detection of drug-induced myocardial dysfunction in drug development.Expert opinion: Some new drugs especially in the oncology field, can cause myocardial dysfunction. Depending on the strength of pre-clinical or clinical data, CV imaging modalities and cardiac biomarkers play an important role in the early detection and mitigation plans for such drugs during their development.
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Wang S, Choi JW. Imaging the Vasculature of Immunodeficient Mice Using Positron Emission Tomography/computed Tomography (PET/CT) and 18F-fluorodeoxyglucose Labeled Human Erythrocytes. Bio Protoc 2019; 9:e3391. [PMID: 33654883 DOI: 10.21769/bioprotoc.3391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 09/08/2019] [Accepted: 09/16/2019] [Indexed: 11/02/2022] Open
Abstract
Nuclear blood pool imaging using radiolabeled red blood cells has been used in the clinical setting for the evaluation of a number of medical conditions including gastrointestinal hemorrhage, impaired cardiac contractility, and altered cerebrovascular blood flow. Nuclear blood pool imaging is typically performed using Technetium-99m-labeled (99mTc) human erythrocytes (i.e., the "tagged RBC" scan) and gamma camera-based planar scintigraphic imaging. When compared to typical clinical planar scintigraphy and single-photon emission computed tomographic (SPECT) imaging platforms, positron emission tomography (PET) provides superior image quality and sensitivity. A number of PET-based radionuclide agents have been proposed for blood pool imaging, but none have yet to be used widely in the clinical setting. In this protocol, we described a simple and fast procedure for imaging the vasculature of immunodeficient mice through a combination of a small animal positron emission tomography/computed tomography (PET/CT) scanner and human erythrocytes labeled with the PET tracer 2-deoxy-2-(18F)fluoro-D-glucose (18F-FDG). This technique is expected to have significant advantages over traditional 99mTc -labeled erythrocyte scintigraphic nuclear imaging for these reasons.
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Affiliation(s)
- Shaowei Wang
- University of South Florida, Department of Medical Engineering, Tampa, Florida, United States of America
| | - Jung W Choi
- H. Lee Moffitt Cancer Center and Research Institute, Department of Cancer Physiology, Tampa, Florida, United States of America.,H. Lee Moffitt Cancer Center and Research Institute, Diagnostic Imaging, Tampa, Florida, United States of America
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Seraphim A, Westwood M, Bhuva AN, Crake T, Moon JC, Menezes LJ, Lloyd G, Ghosh AK, Slater S, Oakervee H, Manisty CH. Advanced Imaging Modalities to Monitor for Cardiotoxicity. Curr Treat Options Oncol 2019; 20:73. [PMID: 31396720 PMCID: PMC6687672 DOI: 10.1007/s11864-019-0672-z] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Early detection and treatment of cardiotoxicity from cancer therapies is key to preventing a rise in adverse cardiovascular outcomes in cancer patients. Over-diagnosis of cardiotoxicity in this context is however equally hazardous, leading to patients receiving suboptimal cancer treatment, thereby impacting cancer outcomes. Accurate screening therefore depends on the widespread availability of sensitive and reproducible biomarkers of cardiotoxicity, which can clearly discriminate early disease. Blood biomarkers are limited in cardiovascular disease and clinicians generally still use generic screening with ejection fraction, based on historical local expertise and resources. Recently, however, there has been growing recognition that simple measurement of left ventricular ejection fraction using 2D echocardiography may not be optimal for screening: diagnostic accuracy, reproducibility and feasibility are limited. Modern cancer therapies affect many myocardial pathways: inflammatory, fibrotic, metabolic, vascular and myocyte function, meaning that multiple biomarkers may be needed to track myocardial cardiotoxicity. Advanced imaging modalities including cardiovascular magnetic resonance (CMR), computed tomography (CT) and positron emission tomography (PET) add improved sensitivity and insights into the underlying pathophysiology, as well as the ability to screen for other cardiotoxicities including coronary artery, valve and pericardial diseases resulting from cancer treatment. Delivering screening for cardiotoxicity using advanced imaging modalities will however require a significant change in current clinical pathways, with incorporation of machine learning algorithms into imaging analysis fundamental to improving efficiency and precision. In the future, we should aspire to personalized rather than generic screening, based on a patient’s individual risk factors and the pathophysiological mechanisms of the cancer treatment they are receiving. We should aspire that progress in cardiooncology is able to track progress in oncology, and to ensure that the current ‘one size fits all’ approach to screening be obsolete in the very near future.
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Affiliation(s)
- Andreas Seraphim
- Department of Cardiovascular Imaging, Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London, EC1A 7BE, UK.,Institute of Cardiovascular Sciences, University College London, Chenies Mews, London, UK
| | - Mark Westwood
- Department of Cardiovascular Imaging, Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London, EC1A 7BE, UK.,Department of Cardio-oncology, Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London, EC1A 7BE, UK
| | - Anish N Bhuva
- Department of Cardiovascular Imaging, Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London, EC1A 7BE, UK.,Institute of Cardiovascular Sciences, University College London, Chenies Mews, London, UK
| | - Tom Crake
- Department of Cardio-oncology, Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London, EC1A 7BE, UK
| | - James C Moon
- Department of Cardiovascular Imaging, Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London, EC1A 7BE, UK.,Institute of Cardiovascular Sciences, University College London, Chenies Mews, London, UK
| | - Leon J Menezes
- Department of Cardiovascular Imaging, Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London, EC1A 7BE, UK
| | - Guy Lloyd
- Department of Cardiovascular Imaging, Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London, EC1A 7BE, UK
| | - Arjun K Ghosh
- Department of Cardiovascular Imaging, Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London, EC1A 7BE, UK.,Department of Cardio-oncology, Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London, EC1A 7BE, UK
| | - Sarah Slater
- Department of Haematology, Barts Health NHS Trust, West Smithfield, London, EC1A 7BE, UK
| | - Heather Oakervee
- Department of Oncology, Barts Health NHS Trust, West Smithfield, London, EC1A 7BE, UK
| | - Charlotte H Manisty
- Department of Cardiovascular Imaging, Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London, EC1A 7BE, UK. .,Institute of Cardiovascular Sciences, University College London, Chenies Mews, London, UK. .,Department of Cardio-oncology, Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London, EC1A 7BE, UK.
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Chen-Scarabelli C, McRee C, Leesar MA, Hage FG, Scarabelli TM. Comprehensive review on cardio-oncology: Role of multimodality imaging. J Nucl Cardiol 2017; 24:906-935. [PMID: 27225513 DOI: 10.1007/s12350-016-0535-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Accepted: 04/19/2016] [Indexed: 10/21/2022]
Abstract
Cancer and cardiovascular disease are the two leading causes of mortality worldwide. Evolving oncologic therapy, including the use of newer targeted agents, has led to an improvement in survival from childhood- and adult-onset cancers. Consequently, there has been a growing realization of cardiotoxic complications related to cancer therapy, with some complications manifesting over months to decades after completion of cancer treatment. This paper reviews cancer therapeutics-related cardiovascular toxicity and its manifestations, multimodality imaging techniques for surveillance and detection of this complication, and the current state of knowledge in this emerging field.
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Affiliation(s)
- Carol Chen-Scarabelli
- Birmingham Veterans Affairs Medical Center, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Chad McRee
- Division of Cardiovascular Disease, University of Alabama at Birmingham, 1530 3rd Avenue, South Tinsley Harrison Tower, Birmingham, Alabama, 35294-0006, USA
| | - Massoud A Leesar
- Birmingham Veterans Affairs Medical Center, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Division of Cardiovascular Disease, University of Alabama at Birmingham, 1530 3rd Avenue, South Tinsley Harrison Tower, Birmingham, Alabama, 35294-0006, USA
| | - Fadi G Hage
- Birmingham Veterans Affairs Medical Center, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Division of Cardiovascular Disease, University of Alabama at Birmingham, 1530 3rd Avenue, South Tinsley Harrison Tower, Birmingham, Alabama, 35294-0006, USA
| | - Tiziano M Scarabelli
- Birmingham Veterans Affairs Medical Center, University of Alabama at Birmingham, Birmingham, Alabama, USA.
- Division of Cardiovascular Disease, University of Alabama at Birmingham, 1530 3rd Avenue, South Tinsley Harrison Tower, Birmingham, Alabama, 35294-0006, USA.
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Chen YC, Ko CL, Yen RF, Lo MF, Huang YH, Hsu PY, Wu YW, Cheng MF. Comparison of biventricular ejection fractions using cadmium-zinc-telluride SPECT and planar equilibrium radionuclide angiography. J Nucl Cardiol 2016; 23:348-61. [PMID: 26956876 DOI: 10.1007/s12350-015-0367-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Accepted: 11/29/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND We compared biventricular ejection fractions (EFs) from gated blood-pool single-photon emission computed tomography (SPECT) using a cadmium-zinc-telluride camera (CZT-SPECT) with planar equilibrium radionuclide angiography (ERNA) using a NaI gamma camera (NaI-planar). We also evaluated whether imaging time can be reduced without compromising image quality using the CZT camera. METHODS Forty-eight patients underwent NaI-planar and CZT-SPECT on the same day. CZT-SPECT datasets were re-projected at an LAO orientation similar to ERNA acquisition, forming CZT-repro planar datasets. The resulting biventricular volumetric measurements and EFs were compared. RESULTS LVEF calculated from CZT-SPECT and CZT-repro correlated better with NaI-planar (r = 0.93 and 0.99, respectively) than RVEF (r = 0.76 and 0.82, respectively). Excellent intra-class correlation and low bias in intra-observer comparisons were observed for the biventricular EFs derived from three datasets. A wider limit of agreement in CZT-SPECT-derived LVEFs, lower correlation and significant bias for NaI-planar, and CZT-repro-derived RVEFs was found in the inter-observer analyses. Nonetheless, the imaging time can be reduced to 4 minutes without increasing variability in EFs using the CZT camera (P = NS). CONCLUSIONS LVEFs calculated from CZT-SPECT and CZT-repro correlated well with NaI-planar. CZT camera may reduce imaging time while preserving image quality in the assessment of biventricular EFs.
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Affiliation(s)
- Yi-Chieh Chen
- Department of Nuclear Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, No. 7, Chung-Shan South Road, Taipei, Taiwan
| | - Chi-Lun Ko
- Department of Nuclear Medicine, National Taiwan University Hospital Yun-Lin Branch, Douliou City, Yunlin County, Taiwan
| | - Rouh-Fang Yen
- Department of Nuclear Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, No. 7, Chung-Shan South Road, Taipei, Taiwan
| | - Mei-Fang Lo
- Department of Nuclear Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, No. 7, Chung-Shan South Road, Taipei, Taiwan
| | - Yih-Hwen Huang
- Department of Nuclear Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, No. 7, Chung-Shan South Road, Taipei, Taiwan
- Department of Electrical Engineering, National Taiwan University, Taipei, Taiwan
| | - Pei-Ying Hsu
- Department of Nuclear Medicine, National Taiwan University Hospital Yun-Lin Branch, Douliou City, Yunlin County, Taiwan
| | - Yen-Wen Wu
- Department of Nuclear Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, No. 7, Chung-Shan South Road, Taipei, Taiwan.
- Department of Nuclear Medicine, Far Eastern Memorial Hospital, No. 21, Sec. 2, Nanya S. Rd., Banciao Dist., New Taipei City, Taiwan.
- Cardiology Division of Cardiovascular Medical Center, Far Eastern Memorial Hospital, No. 21, Sec. 2, Nanya S. Rd., Banciao Dist., New Taipei City, Taiwan.
- School of Medicine, National Yang-Ming University, Taipei, Taiwan.
| | - Mei-Fang Cheng
- Department of Nuclear Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, No. 7, Chung-Shan South Road, Taipei, Taiwan.
- Institute of Occupational Medicine and Industrial Hygiene, National Taiwan University, Taipei, Taiwan.
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Joergensen T, Hansson SH. Evaluation of the Left Ventricular Ejection Fraction with Gated IQ-SPECT Myocardial Perfusion Imaging. J Nucl Med Technol 2015; 43:193-200. [DOI: 10.2967/jnmt.115.155382] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Accepted: 05/05/2015] [Indexed: 11/16/2022] Open
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D’Amore C, Gargiulo P, Paolillo S, Pellegrino AM, Formisano T, Mariniello A, Della Ratta G, Iardino E, D’Amato M, La Mura L, Fabiani I, Fusco F, Perrone Filardi P. Nuclear imaging in detection and monitoring of cardiotoxicity. World J Radiol 2014; 6:486-492. [PMID: 25071889 PMCID: PMC4109100 DOI: 10.4329/wjr.v6.i7.486] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2014] [Revised: 04/21/2014] [Accepted: 05/29/2014] [Indexed: 02/06/2023] Open
Abstract
Cardiotoxicity as a result of cancer treatment is a novel and serious public health issue that has a significant impact on a cancer patient’s management and outcome. The coexistence of cancer and cardiac disease in the same patient is more common because of aging population and improvements in the efficacy of antitumor agents. Left ventricular dysfunction is the most typical manifestation and can lead to heart failure. Left ventricular ejection fraction measurement by echocardiography and multigated radionuclide angiography is the most common diagnostic approach to detect cardiac damage, but it identifies a late manifestation of myocardial injury. Early non-invasive imaging techniques are needed for the diagnosis and monitoring of cardiotoxic effects. Although echocardiography and cardiac magnetic resonance are the most commonly used imaging techniques for cardiotoxicity assessment, greater attention is focused on new nuclear cardiologic techniques, which can identify high-risk patients in the early stage and visualize the pathophysiologic process at the tissue level before clinical manifestation. The aim of this review is to summarize the role of nuclear imaging techniques in the non-invasive detection of myocardial damage related to antineoplastic therapy at the reversible stage, focusing on the current role and future perspectives of nuclear imaging techniques and molecular radiotracers in detection and monitoring of cardiotoxicity.
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Jensen MM, Haase C, Zerahn B. Interstudy repeatability of left and right ventricular volume estimations by serial-gated tomographic radionuclide angiographies using a cadmium-zinc-telluride detector gamma camera. Clin Physiol Funct Imaging 2014; 35:418-24. [DOI: 10.1111/cpf.12178] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2014] [Accepted: 05/30/2014] [Indexed: 11/30/2022]
Affiliation(s)
- Maria M. Jensen
- Department of Clinical Physiology and Nuclear Medicine; Herlev Hospital; Herlev Denmark
| | - Christine Haase
- Department of Clinical Physiology and Nuclear Medicine; Herlev Hospital; Herlev Denmark
| | - Bo Zerahn
- Department of Clinical Physiology and Nuclear Medicine; Herlev Hospital; Herlev Denmark
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Zavadovsky KV, Krivonogov NG, Lishmanov YB. The usefulness of gated blood pool scintigraphy for right ventricular function evaluation in pulmonary embolism patients. Ann Nucl Med 2014; 28:632-7. [PMID: 24903244 DOI: 10.1007/s12149-014-0861-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Accepted: 05/02/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE According to the international registry ICOPER, right ventricular (RV) dysfunction is the most significant predictor of mortality in patients with pulmonary embolism (PE). AIM To identify the most informative indicators of gated blood pool single photon emission computer tomography (GBP-SPECT) for evaluation of RV function in patients with PE. METHODS A total of 52 patients were included in the study. The main group (n = 37) comprised patients with PE, and the comparison group (n = 15) patients suffering from coronary heart disease (NYHA class I-II). All patients received GBP-SPECT, and assessment of plasma levels of endothelin-1, stable nitric oxide (NO) metabolites, and 6-keto-PG F1α. RESULTS In patients with PE, RV end-systolic volume, stroke volume, ejection fraction, peak ejection rate, peak filling rate, and mean filling rate were significantly lower in comparison with patients without PE. In patients with PE, the levels of endothelin-1, 6-keto-PG F1α, and stable NO metabolites were increased in comparison with patients without PE. CONCLUSIONS GBP-SPECT facilitates verification of RV dysfunction in patients without massive PE or severe pulmonary hypertension. Dissociation between the volume of PE and degree of RV dysfunction may be caused by an unbalance between humoral vasoactive factors.
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Affiliation(s)
- Konstantin V Zavadovsky
- Nuclear Medicine Department, Federal State Budgetary Institution "Research Institute for Cardiology" of Siberian Branch under the Russian Academy of Medical Science, 111a Kievskaya Str., Tomsk, 634012, Russia,
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Jensen MM, Schmidt U, Huang C, Zerahn B. Gated tomographic radionuclide angiography using cadmium-zinc-telluride detector gamma camera; comparison to traditional gamma cameras. J Nucl Cardiol 2014; 21:384-96. [PMID: 24366823 DOI: 10.1007/s12350-013-9844-6] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2013] [Accepted: 12/02/2013] [Indexed: 10/25/2022]
Abstract
PURPOSE Estimation of left ventricular ejection fraction (LVEF) with equilibrium 99MTc-HSA equilibrium radionuclide angiography (MUGA) is frequently used for assessing cardiac function. The purpose of this study was to compare intra- and interobserver variation between three different gamma cameras. MATERIALS AND METHODS Eighty-two patients, scanned in the same sequential order on the three cameras. Each acquisition was analyzed twice by two technologists. Inter- and intraobserver variations were calculated as the coefficient of variation and the 95% confidence interval for limits of agreement between each sequence of analyses for each of the three cameras. RESULTS The lowest intraobserver variations in LVEF for the two NaI-detector cameras were 3.1% (-4.0% to 3.5%) for the planar and 3.4% (-4.2% to 4.5%) for SPECT (P ≤ 0.001-0.019), the highest result for the CZT SPECT camera was 2.6% (-2.9% to 3.1%). Similarly, interobserver variation was 4.8% (-4.8% to 6.4%) and 4.9% (-5.4% to 7.5%), respectively, for each of the NaI-detector cameras and 3.3% (-3.4% to 4.3%) for the CZT SPECT camera (P ≤ 0.001-0.008). DISCUSSION The CZT detector camera was superior to both NaI detector cameras regarding intra- and interobserver variation. The CZT SPECT camera may identify changes in LVEF with greater certainty than its NaI detector-equipped counterparts.
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Affiliation(s)
- Maria Maj Jensen
- Department of Clinical Physiology and Nuclear Medicine, Copenhagen University Hospital Herlev, Herstedvesterstræde 54, 2620, Albertslund, Denmark,
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Todica A, Brunner S, Böning G, Lehner S, Nekolla SG, Wildgruber M, Übleis C, Wängler C, Sauter M, Klingel K, Cumming P, Bartenstein P, Schirrmacher R, Franz WM, Hacker M. [68Ga]-albumin-PET in the monitoring of left ventricular function in murine models of ischemic and dilated cardiomyopathy: comparison with cardiac MRI. Mol Imaging Biol 2014; 15:441-9. [PMID: 23408338 DOI: 10.1007/s11307-013-0618-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE The purpose of this study is to evaluate left ventricular functional parameters in healthy mice and in different murine models of cardiomyopathy with the novel blood pool (BP) positron emission tomography (PET) tracer [68Ga]-albumin. PROCEDURES ECG-gated microPET examinations were obtained in healthy mice, and mice with dilative (DCM) and ischemic cardiomyopathy (ICM) using the novel BP tracer [68Ga]-albumin (AlbBP), as well as [18F]-FDG microPET. Cine-magnetic resonance imaging (MRI) examination performed on a clinical 1.5-T MRI provided the reference standard measurements. RESULTS When considering the combined group of healthy controls, DCM and ICM AlbBP-PET significantly overestimated the magnitudes of EDV (AlbBP, 181±86 μl; cine-MRI, 125±80 μl; P<0.001) and ESV (AlbBP, 136±92 μl; cine-MRI, 96±77 μl; P<0.001), whereas the EF (AlbBP, 31±16%; cine-MRI, 33±21%; P=0.910) matched closely to cine-MRI results, as did findings with [18F]-FDG. High correlations were found between the measured cardiac parameters (EDV: R=0.978, ESV: R=0.989, and LVEF: R=0.992). CONCLUSIONS Measuring left ventricular function in mice with [68Ga]-albumin BP PET is feasible and showed a high correlation compared to cine-MRI, which was used as a reference standard.
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Affiliation(s)
- Andrei Todica
- Department of Nuclear Medicine, Ludwig-Maximilians-University, Klinikum Grosshadern, Munich, Germany
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Todica A, Böning G, Lehner S, Weidl E, Cumming P, Wängler C, Nekolla SG, Schwaiger M, Bartenstein P, Schirrmacher R, Hacker M. Positron emission tomography in the assessment of left ventricular function in healthy rats: a comparison of four imaging methods. J Nucl Cardiol 2013; 20:262-74. [PMID: 23255241 DOI: 10.1007/s12350-012-9663-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2012] [Accepted: 11/30/2012] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To measure left ventricular (LV) function parameters in heart of healthy rats by three different positron emission tomography (PET) imaging techniques and by magnetic resonance imaging (MRI). METHODS ECG-gated microPET examinations were obtained in seven healthy rats with 2-deoxy-2-[(18)F]fluoro-D-glucose (FDG) for calculation of LV-function from the blood-pool phase of the dynamic recording (FDGBP), and also from the later myocardial uptake (FDGMyo). On subsequent days, we re-measured LV-function using the novel blood-pool tracer (68)Ga-albumin (AlbBP) and again by FDG (FDGMyo2) in one setting. Cine-MRI examination provided the reference standard measurement. RESULTS The mean LV ejection fractions (LVEF) were 56 ± 3 (FDGBP), 55 ± 3 (FDGMyo), 56 ± 3 (FDGMyo2), 57 ± 3 (AlbBP), and 57 ± 2 (MRI). There were good to excellent correlations found between the LVEF-values as compared to MRI reference standard for FDGBP (r = 0.71), FDGMyo (r = 0.86) and AlbBP (r = 0.88). Both of the blood-pool methods significantly overestimated the magnitudes of end-diastolic-volume and end-systolic-volume, whereas FDGMyo matched closely to the MRI reference standard. There was no significant bias for both blood-pool methods and a minor negative bias for FDGMyo regarding the LV ejection fraction (LVEF) when compared to cine-MRI results. There was no significant difference between the means of FDGMyo and FDGMyo2 (P = .50). CONCLUSIONS Relative to reference standard MRI measurements of LVEF, there was excellent agreement between PET-based measurements, notably for the novel blood-pool tracer (68)Ga-albumin.
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Affiliation(s)
- Andrei Todica
- Department of Nuclear Medicine, University of Munich, Marchioninistr. 15, 81377, Munich, Germany
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17
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Brunner S, Todica A, Böning G, Nekolla SG, Wildgruber M, Lehner S, Sauter M, Ubleis C, Klingel K, Cumming P, Franz WM, Hacker M. Left ventricular functional assessment in murine models of ischemic and dilated cardiomyopathy using [18 F]FDG-PET: comparison with cardiac MRI and monitoring erythropoietin therapy. EJNMMI Res 2012; 2:43. [PMID: 22863174 PMCID: PMC3441325 DOI: 10.1186/2191-219x-2-43] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2012] [Accepted: 07/20/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND We performed an initial evaluation of non-invasive ECG-gated [18 F]FDG-positron emission tomography (FDG-PET) for serial measurements of left ventricular volumes and function in murine models of dilated (DCM) and ischemic cardiomyopathy (ICM), and then tested the effect of erythropoietin (EPO) treatment on DCM mice in a preliminary FDG-PET therapy monitoring study. METHODS Mice developed DCM 8 weeks after injection with Coxsackievirus B3 (CVB3), whereas ICM was induced by ligation of the left anterior descending artery. LV volumes (EDV and ESV) and the ejection fraction (LVEF) of DCM, ICM and healthy control mice were measured by FDG-PET and compared with reference standard results obtained with 1.5 T magnetic resonance imaging (MRI). In the subsequent monitoring study, LVEF of DCM mice was evaluated by FDG-PET at baseline, and after 4 weeks of treatment, with EPO or saline. RESULTS LV volumes and the LVEF as measured by FDG-PET correlated significantly with the MRI results. These correlations were higher in healthy and DCM mice than in ICM mice, in which LVEF measurements were somewhat compromised by absence of FDG uptake in the area of infarction. LV volumes (EDV and ESV) were systematically underestimated by FDG-PET, with net bias such that LVEF measurements in both models of heart disease exceeded by 15% to 20% results obtained by MRI. In our subsequent monitoring study of DCM mice, we found a significant decrease of LVEF in the EPO group, but not in the saline-treated mice. Moreover, LVEF in the EPO and saline mice significantly correlated with histological scores of fibrosis. CONCLUSIONS LVEF estimated by ECG-gated FDG-PET significantly correlated with the reference standard MRI, most notably in healthy mice and mice with DCM. FDG-PET served for longitudinal monitoring of effects of EPO treatment in DCM mice.
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Affiliation(s)
- Stefan Brunner
- Department of Nuclear Medicine, Ludwig-Maximilians-University, Klinikum Grosshadern, Marchioninistr 15, Munich, 81377, Germany.
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Xie BQ, Tian YQ, Zhang J, Zhao SH, Yang MF, Guo F, Wang DY, Wei HX, Chu KW, He ZX. Evaluation of left and right ventricular ejection fraction and volumes from gated blood-pool SPECT in patients with dilated cardiomyopathy: comparison with cardiac MRI. J Nucl Med 2012; 53:584-91. [PMID: 22393224 DOI: 10.2967/jnumed.111.096057] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
UNLABELLED This prospective study evaluated the accuracy of electrocardiogram-gated blood-pool SPECT (GBPS) for the assessment of left ventricular (LV) and right ventricular (RV) ejection fraction (EF), end-diastolic volume (EDV), and end-systolic volume (ESV) in patients with dilated cardiomyopathy (DCM), using cardiac magnetic resonance (CMR) imaging as the reference standard. METHODS Thirty-two patients (24 men and 8 women; mean age, 51 y) with a diagnosis of idiopathic DCM underwent GBPS and CMR. LV and RV parameters including EDV, ESV, and EF from GBPS were calculated using fully automated gradient software and compared with those obtained by CMR. RESULTS Biventricular volumes were underestimated by GBPS, compared with CMR (P < 0.001). We found no statistical difference between these 2 methods in the assessment of LV EF (P = 0.23), whereas RV EF was overestimated by GBPS (P < 0.001 vs. CMR). Regression analysis yielded significant correlations between GBPS and CMR in the assessments of biventricular parameters (r = 0.83 for LV EDV, 0.88 for LV ESV, 0.89 for LV EF, 0.86 for RV EDV, 0.86 for RV ESV, and 0.62 for RV EF; all P < 0.001). Comparison of the deviations of RV indices between GBPS and CMR with the ratio of RV EDV to LV EDV showed that there was a statistically significant trend for RV volumes to be underestimated and for RV EF to be overestimated as the biventricular volumetric ratio decreased (r = 0.61 for RV EDV, 0.68 for RV ESV, and -0.55 for RV EF; all P < 0.001). CONCLUSION For patients with DCM, GBPS correlated well with CMR for the assessment of biventricular parameters, but RV indices should be cautiously interpreted.
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Affiliation(s)
- Bo-Qia Xie
- Department of Nuclear Medicine, Cardiovascular Institute and Fu Wai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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de Geus-Oei LF, Mavinkurve-Groothuis AMC, Bellersen L, Gotthardt M, Oyen WJG, Kapusta L, van Laarhoven HWM. Scintigraphic techniques for early detection of cancer treatment-induced cardiotoxicity. J Nucl Med 2011; 41:170-81. [PMID: 21421717 DOI: 10.2967/jnumed.110.082784] [Citation(s) in RCA: 79] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
New antitumor agents have resulted in significant survival benefits for cancer patients. However, several agents may have serious cardiovascular side effects. Left ventricular ejection fraction measurement by (99m)Tc multigated radionuclide angiography is regarded as the gold standard to measure cardiotoxicity in adult patients. It identifies left ventricular dysfunction with high reproducibility and low interobserver variability. A decrease in left ventricular ejection fraction, however, is a relatively late manifestation of myocardial damage. Nuclear cardiologic techniques that visualize pathophysiologic processes at the tissue level could detect myocardial injury at an earlier stage. These techniques may give the opportunity for timely intervention to prevent further damage and could provide insights into the mechanisms and pathophysiology of cardiotoxicity caused by anticancer agents. This review provides an overview of past, current, and promising newly developed radiopharmaceuticals and describes the role and recent advances of scintigraphic techniques to measure cardiotoxicity. Both first-order functional imaging techniques (visualizing mechanical [pump] function), such as (99m)Tc multigated radionuclide angiography and (99m)Tc gated blood-pool SPECT, and third-order functional imaging techniques (visualizing pathophysiologic and neurophysiologic processes at the tissue level) are discussed. Third-order functional imaging techniques comprise (123)I-metaiodobenzylguanidine scintigraphy, which images the efferent sympathetic nervous innervations; sympathetic neuronal PET, with its wide range of tracers; (111)In-antimyosin, which is a specific marker for myocardial cell injury and necrosis; (99m)Tc-annexin V scintigraphy, which visualizes apoptosis and cell death; fatty-acid-use scintigraphy, which visualizes the storage of free fatty acids in the lipid pool of the cytosol (which can be impaired by cardiotoxic agents); and (111)In-trastuzumab imaging, to study trastuzumab targeting to the myocardium. To define the prognostic importance and clinical value of each of these functional imaging techniques, prospective clinical trials are warranted.
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Affiliation(s)
- Lioe-Fee de Geus-Oei
- Department of Nuclear Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
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Karanth NV, Roy A, Joseph M, de Pasquale C, Karapetis C, Koczwara B. Utility of prechemotherapy echocardiographical assessment of cardiac abnormalities. Support Care Cancer 2010; 19:2021-6. [DOI: 10.1007/s00520-010-1054-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2010] [Accepted: 11/14/2010] [Indexed: 12/22/2022]
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Sanz J, Fernández-Friera L, Moral S. Imaging techniques and the evaluation of the right heart and the pulmonary circulation. Rev Esp Cardiol 2010; 63:209-223. [PMID: 20109418 DOI: 10.1016/s1885-5857(10)70039-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Since the right side of the heart and the pulmonary circulation are regarded as secondary components of the circulatory system, their role in disease has traditionally not received the same attention as their counterparts in the systemic circulation. This was partly because precise noninvasive study of these structures was difficult. For many years, chest radiography and invasive angiography were the only techniques available for imaging the minor circulation. The development of transthoracic echocardiography and nuclear techniques has produced a significant leap forward for noninvasive imaging, particularly of the right ventricle. More recently, novel echocardiographic techniques, and advances in computed tomography and magnetic resonance imaging, in particular, have expanded our diagnostic armamentarium and provided new insights into the anatomy and function of the pulmonary circulation in both health and disease. This article contains a review of the current status of techniques for imaging the right side of the heart and the pulmonary circulation.
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Affiliation(s)
- Javier Sanz
- The Zena and Michael A. Wiener Cardiovascular Institute and Marie-Josee and Henry R. Kravis Center for Cardiovascular Health, Mount Sinai School of Medicine, New York, NY, USA.
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Sanz J, Fernández-Friera L, Moral S. Técnicas de imagen en la evaluación del corazón derecho y la circulación pulmonar. Rev Esp Cardiol 2010. [DOI: 10.1016/s0300-8932(10)70039-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Fair JR, Heintz PH, Telepak RJ. Evaluation of new data processing algorithms for planar gated ventriculography (MUGA). J Appl Clin Med Phys 2009; 10:173-179. [PMID: 19692979 PMCID: PMC5720542 DOI: 10.1120/jacmp.v10i3.2977] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2008] [Accepted: 04/01/2009] [Indexed: 12/02/2022] Open
Abstract
Before implementing one of two new LVEF radionuclide gated ventriculogram (MUGA) systems, the results from 312 consecutive parallel patient studies were evaluated. Each gamma‐camera acquisition was simultaneously processed by semi‐automatic Medasys Pinnacle and by fully automatic and semiautomatic Philips nuclear medicine computer systems. The Philips systems yielded LVEF results within ±5LVEF percentage points of the Medasys system in fewer than half of the studies. The remaining values were higher or lower than those from the long‐used Medasys system. These differences might have changed cancer patient chemotherapy clinical decisions. As a result, our institution elected not to implement either new system. PACS: 87.57.U‐ Nuclear medicine imaging
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Affiliation(s)
- Joanna R Fair
- Department of Radiology, University of New Mexico School of Medicine, Albuquerque, New Mexico
| | - Philip H Heintz
- Department of Radiology, University of New Mexico School of Medicine, Albuquerque, New Mexico
| | - Robert J Telepak
- Department of Radiology, University of New Mexico School of Medicine, Albuquerque, New Mexico
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Abstract
Radionuclide imaging of cardiac function represents a number of well-validated techniques for accurate determination of right (RV) and left ventricular (LV) ejection fraction (EF) and LV volumes. These first European guidelines give recommendations for how and when to use first-pass and equilibrium radionuclide ventriculography, gated myocardial perfusion scintigraphy, gated PET, and studies with non-imaging devices for the evaluation of cardiac function. The items covered are presented in 11 sections: clinical indications, radiopharmaceuticals and dosimetry, study acquisition, RV EF, LV EF, LV volumes, LV regional function, LV diastolic function, reports and image display and reference values from the literature of RVEF, LVEF and LV volumes. If specific recommendations given cannot be based on evidence from original, scientific studies, referral is given to "prevailing or general consensus". The guidelines are designed to assist in the practice of referral to, performance, interpretation and reporting of nuclear cardiology studies for the evaluation of cardiac performance.
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Massardo T, Jaimovich R, Lavados H, Gutiérrez D, Rodríguez JC, Saavedra JM, Alay R, Gatica H. Comparison of radionuclide ventriculography using SPECT and planar techniques in different cardiac conditions. Eur J Nucl Med Mol Imaging 2007; 34:1735-46. [PMID: 17579852 DOI: 10.1007/s00259-007-0472-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2006] [Accepted: 04/02/2007] [Indexed: 10/23/2022]
Abstract
PURPOSE Accurate assessment of ventricular function is required to optimize therapeutic management of cardiac diseases. The aim of this study was to correlate planar equilibrium multigated acquisition (MUGA) with tomographic ventriculography (SPECT) in patients with diverse volumes and wall motion abnormalities. METHODS Eighty-three studies in 80 patients (56+/-14 years; 56% women) were classified according to ventricular dilation, wall motion abnormalities and systolic dysfunction. Left and right ventricular ejection fraction (LVEF and RVEF) and end-diastolic and end-systolic left ventricular volumes (EDV and ESV) were obtained using a commercial QBS program for SPECT. On planar acquisition, LVEF and RVEF were obtained using standard techniques and volumes were determined using the count-based method, without blood sampling. RESULTS A. Total group: With the planar method, LVEF was 44+/-17%, RVEF 42+/-13%, left EDV 147+/-97 ml (range 31-487 ml) and left ESV 93+/-85 ml (range 15-423 ml); with SPECT the corresponding values were 40+/-20%, 49+/-16%,131+/-95 ml and 91+/-89 ml, respectively (p=NS for all but RVEF). Linear correlation was 0.845 for LVEF, 0.688 for RVEF, 0.927 for left EDV and 0.94 for left ESV, with good intra-class correlation. B. Subgroups: Global and intra-class correlations between planar imaging and SPECT were high for volumes, RVEF and LVEF in all subgroups, except in patients with normal wall motion and function, who showed smaller volumes with SPECT. The group with diffuse wall motion abnormalities had a lower EDV on SPECT. In the abnormal left ventricle, RVEF was higher with SPECT. CONCLUSION Good correlation and agreement exist between SPECT and planar MUGA with respect to LVEF and left ventricular volumes. SPECT is useful in patients with functional abnormalities, but less reliable in those with normal small cavities. A combined technique is still necessary, and RVEF should be interpreted cautiously.
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Affiliation(s)
- Teresa Massardo
- Medicine Department, Nuclear Medicine Section, University of Chile - Clinical Hospital, Santos Dumont 999-1E, Independencia, Santiago, Chile.
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Daou D. SPECT radionuclide angiography: it is time for a consensus statement. Eur J Nucl Med Mol Imaging 2007; 34:1729-34. [PMID: 17579855 DOI: 10.1007/s00259-007-0496-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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