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Can nuclear medicine technologists assess whether a myocardial perfusion rest study is required?

https://arctichealth.org/en/permalink/ahliterature91262
Source
J Nucl Med Technol. 2008 Dec;36(4):181-5
Publication Type
Article
Date
Dec-2008
Author
Johansson Lena
Lomsky Milan
Gjertsson Peter
Sallerup-Reid Maria
Johansson Johanna
Ahlin Nils-Göran
Edenbrandt Lars
Author Affiliation
Department of Clinical Physiology, Sahlgrenska University Hospital, Göteborg, Sweden. lena.bi.johansson@vgregion.se
Source
J Nucl Med Technol. 2008 Dec;36(4):181-5
Date
Dec-2008
Language
English
Publication Type
Article
Keywords
Exercise Test - statistics & numerical data
Humans
Middle Aged
Myocardial Infarction - complications - radionuclide imaging
Observer Variation
Prevalence
Professional Competence - statistics & numerical data
Radiopharmaceuticals - diagnostic use
Reproducibility of Results
Rest
Sensitivity and specificity
Sweden - epidemiology
Technetium Tc 99m Sestamibi - diagnostic use
Tomography, Emission-Computed, Single-Photon - statistics & numerical data
Ventricular Dysfunction, Left - complications - radionuclide imaging
Abstract
Both stress and rest imaging are usually performed to diagnose ischemia or infarction in the left ventricle. If the stress study is performed first and the images indicate normal findings, it might be unnecessary to perform the rest study. The current study determines whether nuclear medicine technologists can assess the necessity of a rest study. METHODS: The results of gated SPECT performed using a 2-d nongated stress and gated rest (99m)Tc-sestamibi protocol for 532 consecutive patients were studied. Myocardial perfusion imaging was performed for diagnosing coronary artery disease (CAD) in 421 patients and for managing known CAD in 107 patients; 4 patients were examined for other reasons. Seventy-nine patients had previous myocardial infarction. Visual interpretation by 1 experienced physician at the time of clinical reporting was used as the gold standard for determining the scintigraphic presence of myocardial infarction or ischemia; rest, stress, and gated rest images and clinical information were available to this physician. All cases categorized as infarction or ischemia present or probably present were categorized as the group requiring a rest study (i.e., the "rest-study-required group"), whereas all other cases were categorized as the group not requiring a rest study (i.e., the "no-rest-study-required group"). A total of 3 physicians and 3 technologists independently interpreted the nongated stress images (slice images and polar plots) and decided whether a rest study was required. RESULTS: In the rest-study-required group, the 3 technologists correctly classified on average 171 of the 172 cases, and the 3 physicians correctly classified 169 (a difference that was not statistically significant). In the no-rest-study-required group, the physicians correctly classified 32% and the technologists 21% of the cases (P = 0.001). The risk that a patient sent home without a rest study would have been diagnosed with infarction or ischemia using the combined stress-rest interpretation was 1.3% (1/75) for the technologists and 2.6% (3/115) for the physicians. CONCLUSION: The nuclear medicine technologists were able to assess whether a rest study was needed; the risk that this assessment would be incorrect was not higher for the technologists than it was for the physicians. This type of assessment by a nuclear medicine technologist could be of value in efforts to improve effectiveness at a nuclear medicine clinic.
PubMed ID
19008292 View in PubMed
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Can preoperative myocardial perfusion scintigraphy predict changes in left ventricular perfusion and function after coronary artery bypass graft surgery?

https://arctichealth.org/en/permalink/ahliterature125498
Source
Interact Cardiovasc Thorac Surg. 2012 Jun;14(6):779-84
Publication Type
Article
Date
Jun-2012
Author
Rozy Eckardt
Bo Juel Kjeldsen
Allan Johansen
Peter Grupe
Torben Haghfelt
Per Thayssen
Lars Ib Andersen
Birger Hesse
Author Affiliation
Department of Cardiothoracic Surgery, Institute of Clinical Research, Odense University Hospital, Odense, Denmark. rozy@eckardtmail.dk
Source
Interact Cardiovasc Thorac Surg. 2012 Jun;14(6):779-84
Date
Jun-2012
Language
English
Publication Type
Article
Keywords
Aged
Angina Pectoris - physiopathology - radionuclide imaging - surgery
Coronary Angiography
Coronary Artery Bypass - adverse effects
Coronary Artery Disease - physiopathology - radionuclide imaging - surgery
Coronary Circulation
Denmark
Female
Humans
Male
Middle Aged
Myocardial Perfusion Imaging - methods
Predictive value of tests
Preoperative Care
Prospective Studies
Radiopharmaceuticals - diagnostic use
Recovery of Function
Stroke Volume
Technetium Tc 99m Sestamibi - diagnostic use
Time Factors
Treatment Outcome
Vascular Patency
Ventricular Function, Left
Abstract
OBJECTIVES We wanted to evaluate whether preoperative myocardial perfusion scintigraphy (MPS) could predict changes in cardiac symptoms and postoperative myocardial perfusion and left ventricular function after coronary artery bypass grafting (CABG). METHODS Ninety-two patients with stable angina pectoris (and at least one occluded coronary artery) underwent MPS before, and 6 months after, undergoing CABG. The result of the MPS was kept secret from the surgeons. RESULTS Before CABG, 90% of the patients had angina. After CABG, 97% of the patients were without symptoms. Overall graft patency was 84%. Before CABG, one patient had normal perfusion; in the rest of them the defects were classified as follows: reversible (60%), partly reversible (27%) and irreversible (12%). Following CABG, 33% had normal perfusion; in the rest the defects were reversible in 29%, partly reversible in 12% and irreversible in 26%. Left ventricular ejection fraction (LVEF), which was normal before operation in 45%, improved in 40% of all patients. The increase in LVEF was not related to the preoperative pattern of perfusion defects. Of 30 patients with normalized perfusion after CABG, 29 (97%) had reversible defects and one patient had partly reversible defects. Of 83 perfusion defects, which were normalized after CABG, 67 were reversible (81%) or partly reversible (12%). Seventy-five percent of all reversible coronary artery territories before CABG were normalized after operation. CONCLUSIONS Our results indicate that reversible or partly reversible perfusion defects at a preoperative MPS have a high chance of normalized myocardial perfusion assessed by MPS 6 months after operation. Normal perfusion is obtained almost exclusively in territories with reversible ischaemia. Symptoms improved in nearly all patients and LVEF in a significant fraction of the patients, not related to preoperative MPS.
Notes
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PubMed ID
22473665 View in PubMed
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Cardiac ??mTc sestamibi SPECT and ยน8F FDG PET as viability markers in Takotsubo cardiomyopathy.

https://arctichealth.org/en/permalink/ahliterature263237
Source
Int J Cardiovasc Imaging. 2014 Oct;30(7):1407-16
Publication Type
Article
Date
Oct-2014
Author
Thomas Emil Christensen
Lia Evi Bang
Lene Holmvang
Adam Ali Ghotbi
Martin Lyngby Lassen
Flemming Andersen
Nikolaj Ihlemann
Hedvig Andersson
Peer Grande
Andreas Kjaer
Philip Hasbak
Source
Int J Cardiovasc Imaging. 2014 Oct;30(7):1407-16
Date
Oct-2014
Language
English
Publication Type
Article
Keywords
Aged
Coronary Angiography
Denmark
Female
Fluorodeoxyglucose F18 - diagnostic use
Heart Ventricles - physiopathology - radionuclide imaging - ultrasonography
Humans
Male
Myocardial Contraction
Positron-Emission Tomography
Predictive value of tests
Prognosis
Radiopharmaceuticals - diagnostic use
Recovery of Function
Takotsubo Cardiomyopathy - physiopathology - radiography - radionuclide imaging - ultrasonography
Technetium Tc 99m Sestamibi - diagnostic use
Time Factors
Tissue Survival
Tomography, Emission-Computed, Single-Photon
Ventricular Function, Left
Abstract
In patients with heart failure (HF) due to coronary disease, a combined evaluation of perfusion and glucose metabolism by cardiac single photon emission computed tomography (SPECT)/positron emission tomography (PET) can be used to distinguish viable from non-viable myocardium, and current guidelines recommend cardiac SPECT and fluorodeoxyglucose (FDG) PET for viability assessment. Takotsubo cardiomyopathy (TTC) is a disease characterized by acute but reversible HF leaving no scarring. To explore how robust the semi-quantitative viability criteria used in cardiac SPECT and FDG PET stands their ground in a population with TTC. From 1 September 2009 to 1 October 2012, 24 patients suspected of TTC were enrolled in a multimodality cardiac imaging research project. Echocardiography, (99m)Tc SPECT, and (18)F FDG PET were performed during the acute admission and at follow-up 4 months later. Nineteen patients had a final diagnosis of TTC consistent with Mayo Clinic Diagnostic Criteria. Three of these patients were excluded from further analysis, since wall motion abnormalities were not persistent at the time of nuclear imaging. The remaining sixteen patients exhibited a distinct pattern with HF, "apical ballooning" and a perfusion-metabolism defect in the midventricular/apical region. When viability criteria were applied, they identified significant scarring/limited hibernation in the akinetic part of the left ventricle. However, full recovery was found in all TTC patients on follow-up. Using the current guideline-endorsed viability criteria for semiquantitative cardiac SPECT and FDG PET, these modalities failed to demonstrate the presence of viability in the acute state of TTC.
PubMed ID
24852336 View in PubMed
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Continuous vectorcardiographic changes in relation to scintigraphic signs of reperfusion in patients with acute myocardial infarction receiving thrombolytic therapy.

https://arctichealth.org/en/permalink/ahliterature54715
Source
J Intern Med. 1996 Jan;239(1):35-41
Publication Type
Article
Date
Jan-1996
Author
P. Juhlin
P A Boström
O. Hansen
H. Diemer
M. Freitag
B. Lilja
L. Erhardt
Author Affiliation
Department of Cardiology, Malmö University Hospital, Lund University, Sweden.
Source
J Intern Med. 1996 Jan;239(1):35-41
Date
Jan-1996
Language
English
Publication Type
Article
Keywords
Aged
Female
Humans
Male
Middle Aged
Myocardial Infarction - physiopathology - radionuclide imaging - therapy
Research Support, Non-U.S. Gov't
Technetium Tc 99m Sestamibi - diagnostic use
Thrombolytic Therapy
Time Factors
Tomography, Emission-Computed, Single-Photon - methods
Vectorcardiography
Abstract
OBJECTIVES. Changes in the electrical activity of the heart reflecting the infarct process can be recorded by continuous vector-ECG, a method which is now clinically available for cardiac supervision. Shifts of the ST-segment and QRS-vector reflect ischaemia and necrosis of the myocardium. Continuous vector-ECG changes were evaluated against myocardial scintigraphy in 18 patients with acute myocardial infarction treated with streptokinase in order to study the impact of improved myocardial perfusion. DESIGN. Myocardial perfusion was analysed with 99Tcm-Sestamibi (Cardiolite, DuPont Scandinavia AB, Kista, Sweden) single photon emission computerized tomography (SPECT). Registrations were performed before and after thrombolysis in order to estimate the amount of myocardium with impaired perfusion initially (threatened myocardium) and the degree of perfusion improvement in this myocardial area. X, Y, Z vectors were registered continuously by Frank leads (Ortivus Medical, Täby, Sweden). QRS-vector difference, and the time to plateau phase and the ST-vector magnitude were used as a measurement of ischaemia and size of the myocardial infarction. RESULTS. In seven out of 11 patients treated within 3 h of onset of symptoms, an improvement in myocardial perfusion in the initially hypoperfused areas was achieved in contrast to none of the seven patients treated > 3 h after onset of pain (P
PubMed ID
8551198 View in PubMed
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Delayed recovery of myocardial perfusion in acute myocardial infarction: a scintigraphic study after early thrombolytic treatment.

https://arctichealth.org/en/permalink/ahliterature54318
Source
Coron Artery Dis. 1998;9(7):443-9
Publication Type
Article
Date
1998
Author
F. Bouvier
J. Höjer
B A Samad
K. Jensen-Urstad
H. Ruiz
J. Hulting
M. Jensen-Urstad
Author Affiliation
Department of Clinical Physiology, Söder Hospital, Stockholm, Sweden. bouvier.info@swipnet.se
Source
Coron Artery Dis. 1998;9(7):443-9
Date
1998
Language
English
Publication Type
Article
Keywords
Adenosine - diagnostic use
Comparative Study
Coronary Circulation - physiology
Female
Fibrinolytic Agents - therapeutic use
Heart - radionuclide imaging
Humans
Male
Middle Aged
Myocardial Infarction - drug therapy - physiopathology - radionuclide imaging
Myocardial Stunning - radionuclide imaging
Prospective Studies
Radiopharmaceuticals - diagnostic use
Streptokinase - therapeutic use
Technetium Tc 99m Sestamibi - diagnostic use
Thrombolytic Therapy
Time Factors
Tissue Plasminogen Activator - therapeutic use
Tomography, Emission-Computed, Single-Photon
Vasodilator Agents - diagnostic use
Abstract
BACKGROUND: Assessments of compromised myocardium and infarct size early after thrombolytic treatment in acute myocardial infarction (AMI) are important for risk stratification and for treatment management. We have therefore evaluated the clinical usefulness of myocardial perfusion scintigraphy (MIBI-SPECT) for the assessment of myocardial viability early after AMI. METHODS: Seventy-one patients [53 men and 18 women, aged 64 +/- 9 years (range 45-75 years)] with AMI treated by thrombolysis took part in this prospective study at University Hospital, Stockholm, Sweden. Sixty of them underwent adenosine-stress and resting MIBI-SPECT 2-4 days after AMI, and 11 were examined only at rest. Six months after the AMI, a repeat MIBI-SPECT at rest was obtained for comparison. RESULTS: All patients had significant perfusion defects compared with an age- and sex-matched healthy reference population. Seventy-six percent of the patients able to undergo a complete adenosine-stress and rest SPECT showed signs of reversible perfusion defects. Defect size (extent) and severity at rest decreased between the tests at 2-5 days and 6 months after AMI (P
PubMed ID
9822863 View in PubMed
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Identifying which treated hypertensive patients without known coronary artery disease should be tested for the presence of myocardial ischemia by perfusion imaging.

https://arctichealth.org/en/permalink/ahliterature160091
Source
J Clin Hypertens (Greenwich). 2007 Dec;9(12):921-8
Publication Type
Article
Date
Dec-2007
Author
Yves Lacourcière
Christian Côté
Jean Lefebvre
Luc Poirier
Marcel Dumont
Author Affiliation
Hypertension Unit, Centre Hospitalier de l'Université Laval, Québec, Canada. yves.lacourciere@crchul.ulaval.ca
Source
J Clin Hypertens (Greenwich). 2007 Dec;9(12):921-8
Date
Dec-2007
Language
English
Publication Type
Article
Keywords
Aged
Coronary Artery Disease - epidemiology - etiology - radionuclide imaging
Cross-Sectional Studies
Female
Humans
Hypertension - complications - epidemiology
Male
Mass Screening
Middle Aged
Perfusion
Prevalence
Quebec - epidemiology
Risk factors
Technetium Tc 99m Sestamibi - diagnostic use
Tomography, Emission-Computed
Abstract
Stress dipyridamole technetium-99(m) sestamibi single photon emission computed tomographic imaging was used to study myocardial perfusion in 1116 hypertensive patients without known coronary artery disease (CAD). The test confirmed the presence of CAD in 28.9% of patients. As expected, patients with diabetes mellitus (DM) had a significantly higher prevalence of myocardial perfusion abnormalities (35.9% vs 23.9%; odds ratio, 1.79; 95% confidence interval [CI], 1.38-2.33; P
PubMed ID
18046097 View in PubMed
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Myocardial reperfusion in thrombolysis A 99Tcm-Sestamibi SPECT study in patients with acute myocardial infarction.

https://arctichealth.org/en/permalink/ahliterature55078
Source
Clin Physiol. 1992 Nov;12(6):679-84
Publication Type
Article
Date
Nov-1992
Author
P A Boström
H. Diemer
M. Freitag
P. Juhlin
B. Lilja
L. Erhardt
Author Affiliation
Department of Medicine, Lund University, Malmö General Hosital, Sweden.
Source
Clin Physiol. 1992 Nov;12(6):679-84
Date
Nov-1992
Language
English
Publication Type
Article
Keywords
Aged
Female
Heart - radionuclide imaging
Humans
Male
Middle Aged
Myocardial Infarction - drug therapy - radionuclide imaging
Myocardial Reperfusion
Research Support, Non-U.S. Gov't
Technetium Tc 99m Sestamibi - diagnostic use
Thrombolytic Therapy
Tomography, Emission-Computed, Single-Photon
Abstract
This study presents the outcome of myocardial scintigraphy performed before and after thrombolytic treatment in 16 patients with acute myocardial infarction using 99Tcm-Sestamibi (Cardiolite, Du Pont Scandinavia AB, Kista, Sweden). The patients were given 99Tcm-Sestamibi intravenously as soon as possible after the decision to give thrombolytic treatment. When the patients were in a clinically stable state after the thrombolytic treatment, myocardial perfusion was analysed with the gamma camera using single photon emission computerized tomography (SPECT). A second 99Tcm-Sestamibi tomography was carried out on the second to fourth day after the myocardial infarction. Data reconstruction was done with the 'Bull's eye technique'. Nine patients received thrombolysis 10% after treatment, while all seven patients who received treatment > or = 3 h after the onset of pain improved their myocardial perfusion by
PubMed ID
1424485 View in PubMed
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[Myocardial scintigraphy in Denmark 1997-2001. Activity and status]

https://arctichealth.org/en/permalink/ahliterature53525
Source
Ugeskr Laeger. 2003 May 19;165(21):2202-4
Publication Type
Article
Date
May-19-2003

Observer reproducibility and validity of systems for clinical classification of angina pectoris: comparison with radionuclide imaging and coronary angiography.

https://arctichealth.org/en/permalink/ahliterature76241
Source
Clin Physiol Funct Imaging. 2006 Jan;26(1):26-31
Publication Type
Article
Date
Jan-2006
Author
Henrik Wulff Christensen
Torben Haghfelt
Werner Vach
Allan Johansen
Poul Flemming Høilund-Carlsen
Author Affiliation
Nordic Institute of Chiropractic and Clinical Biomechanics, Odense, Denmark. h.wulff@nikkb.dk
Source
Clin Physiol Funct Imaging. 2006 Jan;26(1):26-31
Date
Jan-2006
Language
English
Publication Type
Article
Keywords
Adult
Aged
Angina Pectoris - classification - diagnosis - epidemiology
Comparative Study
Coronary Angiography
Female
Humans
Male
Middle Aged
Observer Variation
Physical Examination
Prospective Studies
Radiopharmaceuticals - diagnostic use
Reproducibility of Results
Research Support, Non-U.S. Gov't
Severity of Illness Index
Technetium Tc 99m Sestamibi - diagnostic use
Thallium Radioisotopes - diagnostic use
Tomography, Emission-Computed, Single-Photon
Abstract
OBJECTIVE: To assess reproducibility and validity of clinical classification of angina pectoris (AP) patients. DESIGN: Fifty-six patients scheduled for coronary angiography because of stable AP were classified by two independent observers with regard to (i) type and (ii) severity of chest pain (Canadian Cardiovascular Society, CCS) and (iii) cardiac functional status (New York Heart Association, NYHA). Myocardial perfusion imaging (MPI) was performed in 55 including measurement of ejection fraction in 46, angiography was undertaken in 51. RESULTS: Observers agreed 100% on the presence (n = 45) or absence (n = 11) of angina. They agreed in 52 (93%), 48 (86%), and 42 (75%) patients with regard to type of pain, CCS grade, and NYHA class, respectively. In the remaining patients, they disagreed by one class only. The positive and negative predictive values of typical/atypical angina for perfusion abnormalities and coronary disease were 55%/82% and 53%/ 82%, respectively. CONCLUSIONS: Observer agreement was excellent for presence, type, and severity of chest pain but moderate with regard NYHA class. Clinical judgment could not predict with reasonable accuracy abnormal perfusion or coronary artery disease.
PubMed ID
16398667 View in PubMed
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Observer variability in the evaluation of dual-isotope Tl-201/Tc-99m sestamibi rest/stress myocardial perfusion SPECT in men and women with known or suspected stable angina pectoris.

https://arctichealth.org/en/permalink/ahliterature49641
Source
J Nucl Cardiol. 2004 Nov-Dec;11(6):710-8
Publication Type
Article
Author
Allan Johansen
Poul Flemming Høilund-Carlsen
Henrik Wulff Christensen
Peter Grupe
Annegrete Veje
Werner Vach
Torben Haghfelt
Author Affiliation
Department of Nuclear Medicine, Odense University Hospital, Sdr Boulevard 29, DK-5000 Odense C, Denmark. allan.johansen@dadlnet.dk
Source
J Nucl Cardiol. 2004 Nov-Dec;11(6):710-8
Language
English
Publication Type
Article
Keywords
Angina Pectoris - epidemiology - radionuclide imaging
Denmark - epidemiology
Exercise Test - statistics & numerical data
Female
Humans
Male
Middle Aged
Observer Variation
Radiopharmaceuticals - diagnostic use
Reproducibility of Results
Research Support, Non-U.S. Gov't
Rest
Sensitivity and specificity
Sex Distribution
Single-Blind Method
Subtraction Technique
Technetium Tc 99m Sestamibi - diagnostic use
Thallium - diagnostic use
Tomography, Emission-Computed, Single-Photon - methods - statistics & numerical data
Abstract
BACKGROUND: Observer variability of dual-isotope myocardial perfusion imaging (MPI) with single photon emission computed tomography has rarely been investigated. The aim of our study was to evaluate the interpretive reproducibility with this technique. METHODS AND RESULTS: We report on 507 patients with known or suspected stable angina who were studied before coronary angiography. A 1-day thallium 201/technetium 99m sestamibi rest/stress MPI protocol was used. MPI was interpreted by 2 independent observers without knowledge of clinical data, using a 20-segment scoring model. By consensus, the overall rate of abnormal MPI was 49% (59% in men and 34% in women). The interobserver agreement for the whole group (kappa = 0.85) and for men and women separately (kappa = 0.86 and 0.82, respectively) was excellent with regard to the overall diagnosis (normal, reversible, or fixed defects) as well as left anterior descending and left circumflex artery vascular territories (kappa = 0.85 and 0.82, respectively). However, in the right coronary artery territory, agreement was excellent in men (kappa = 0.83) but moderate in women (kappa = 0.57). CONCLUSIONS: In a relatively large group of men and women with stable angina pectoris, interpretive reproducibility (overall and individual vessel diagnosis) was excellent, except in the right coronary artery territory of women, in which it was moderate.
PubMed ID
15592195 View in PubMed
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