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Myocardial viability testing in patients with severe left ventricular dysfunction by SPECT and PET  [cached]
Mehmet Onur Demirkol
Anadolu Kardiyoloji Dergisi , 2008,
Abstract: In this article, the role of nuclear medicine modalities in assessing myocardial viability and risk stratification in patients with advanced left ventricular (LV) dysfunction are reviewed. Diagnosis of reversible LV dysfunction in patients with heart failure is an important clinical issue. Patients with severe LV dysfunction who have viable myocardium are the patients at highest risk because of the potential for ischemia but at the same time benefit most form revascularization. It is important to identify viable myocardium in these patients, and nuclear medicine techniques are an excellent tool for this. Single-photon emission computed tomography (SPECT) in combination with myocardial perfusion tracers plays an important role in the identification of tissue viability in myocardial segments. Imaging with positron emission tomography (PET) tracers allow the assessment of physiologic processes such as myocardial oxygen consumption, metabolic rate of glucose utilization, and myocardial blood flow. Metabolic imaging with PET offers regional tissue viability in patients with advanced coronary artery disease and severely impaired LV function.
Monitoring the Sequelae of Coronary Microembolization on Myocardium Using Noninvasive Imaging (Review)  [PDF]
M. Saeed, M. W. Wilson
World Journal of Cardiovascular Diseases (WJCD) , 2014, DOI: 10.4236/wjcd.2014.412073
Abstract: Acute myocardial infarction (AMI) is a leading cause of death worldwide. It has been clinically classified into 1) ischemic from a primary coronary event (e.g., plaque rupture or thrombotic occlusion), 2) ischemic from a supply-and-demand mismatch and c) ischemic from a percutaneous coronary interventions (PCI). Catheter-based PCI has been frequently used as an alternative to conventional bypass surgery for patients at high risk. However, this method of treatment is associated with microvascular obstruction (MVO) by dislodged microemboli that results in left ventricular (LV) dysfunction/remodeling, perfusion deficits, microinfarction and arrhythmia. The contributions of microemboli after revascularization of AMI have been acknowledged by major cardiac and interventional societies. Recent studies showed that Emboli Detection and Classification (EDAC) Quantifier offers increased sensitivity and capability for detecting dislodged coronary microemboli during PCI. Coronary microembolization can be detected directly by monitoring intra-myocardial contrast opacification on contrast echocardiography, increasing F-18 fluorodeoxyglucose (FDG) uptake on positron emission tomography, loss/diminution of signal on first pass perfusion and hypoenhanced zone on contrast enhanced magnetic resonance imaging (MRI) and multidetector computed tomography (MDCT) and indirectly by ST-segment elevation on electro-cardiography (ECG). The relations between volumes/sizes of microemboli, visibility of microinfarct, myocardial perfusion and LV function are still under intensive discussions. Non-invasive imaging can play important role in assessing these parameters. This review shed the light on the techniques used for detecting coronary microemboli, microvascular obstruction and microinfarct and the short- and long-term effects of microemboli on LV function, structure and perfusion.
Comparison of the myocardial perfusion and wall motion results by ECG-Gated 99mTc-MIBI SPECT, before and after CABG for evaluation of myocardial viability
Hekmat S,Rastgoo F,Omrani Gh.R,Yaghoobi N
Iranian Journal of Nuclear Medicine , 2003,
Abstract: It is of value to determine the amount of viable myocardial tissue in patients suffering from chronic coronary artery disease and ventricular dysfunction. Having the capability of evaluating both myocardial perfusion and function, simultaneously, myocardial scanning by ECG-Gated is an appropriate method for this purpose. The aim of this study was to compare the results of myocardial perfusion and wall motion before and after Coronary Artery Bypass Grafting (CABG), as well as assessment of the efficiency of these parameters for detection of myocardial viability. Forty patients with positive history of previous myocardial infarction and candidate for CABG underwent ECG-Gated SPECT scanning 1 month before and 2-3 months after surgery. Findings of myocardial perfusion and wall motion, obtained from the two phases of the study, were compared. The results showed that functional status of some preoperatively severely hypoperfused segments, recovered significantly after CABG, which proved existence of viable tissue in these regions. Also, septal wall motion presented no statistically significant changes after CABG. These results suggest that septal perfusion and motion are not reliable parameters for the assessment of surgical outcome in this region. Most of the myocardial walls demonstrated considerable wall motion improvement after operation. Concerning the results of this research, as a marker of viable against nonviable myocardial tissue, we recommend revision of applying the severity of perfusion defect, alone, as well as taking the wall motion parameter into consideration, to improve diagnostic accuracy of the SPECT method.
Evaluation of poor left ventricle: multislice computer tomography in the assessment of myocardial viability  [cached]
Elif Eroglu,Muzaffer Degertekin
Anadolu Kardiyoloji Dergisi , 2008,
Abstract: The evaluation of left ventricular function and viability is critical in patients with suspected or documented ischemic heart disease. Recently, cardiac multislice computed tomography (MSCT) has emerged as a powerful modality for cardiac imaging. In addition to coronary artery assessment, contrast enhanced MSCT can provide reliable information about myocardial function, perfusion and viability. This review will focus on the pathophysiological mechanisms and clinical applications of contrast enhanced myocardial function and viability MSCT imaging.
Effect of Puerarin on the myocardial perfusion and ventricular wall motion in patients with acute coronary syndrome

Ling Niu,Dongye Li,Yong Xi,Defeng Pan,Xiaoping Wang,Yan Yan,Li Liang,Tongda Xu,

老年心脏病学杂志(英文版) , 2008,
Abstract: Objective The purpose of the present study was to investigate the effect of Puerarin (Pur) on the myocardial perfusion and ventricular wall motion in patients with acute coronary syndrome (ACS). Methods Thirty-seven patients with ACS were randomly divided into two groups: conventional group (n=17, 11 men and 6 women, with a range of age from 32 to 80 years, and with a mean age 60.9±4.9 years) and Pur group (n=20, 12 men, 8 women, with a range of age from 40 to 76 years, and with a mean age 62.7±3.5 years). Course of treatment for all patients was 10 days. Real-time myocardial contrast echocardiography (RT-MCE) was applied to two groups before and after the therapy to evaluate myocardial microcirculation and ventricular wall motion by observing the change of myocardial perfusion index (MPI) and ventricular wall motion index (VWMI). Results The level of MPI increased and VWMI decreased after 10 days of the therapy, which is significant difference between the Pur group and conventional group (P<0.05). Conclusions Puerarin can increase the level of MPI and decrease the level of VWMI in patients with ACS. Myocardial microcirculation perfusion and ventricular wall motion could be improved probably in patients with ACS treated by Puerarin.
Significance of the determination of doppler sonography haemodynamic indices for the assessment of distal perfusion in patients with critical ischemia of lower limbs  [PDF]
?izmi? Milica,Kronja Goran,Ajdinovi? Boris,Pucar Dragan
Vojnosanitetski Pregled , 2006, DOI: 10.2298/vsp0607653c
Abstract: Background/Aim: The perfusion of tissue, especially the muscles of the lower limbs (LL), implies the blood flow that carries enough nutrition, energy materials and oxygen. The aim of this study was to determine whether the decreased Doppler sonography parameters, resistance index (RI), and pulsatility index (PI) were significant as indicators of irreversible ischemia of LL. Methods. In 40 patients (mean age 66±14.9 years, 21% women and 79% men) with the signs of critical ischemia of LL, Lariche-Fontaine class III and IV, we performed contrast angiography of the LL arteries, and perfusion scintigraphy of LL using, thallium-201, while we performed Doppler sonography to determine resistance index (RI), as well as pulsatility index (PI). After that, all the patients were treated with vasodilatation using Bergmann's solution within a 10-day period. Following that, all the patients underwent the determination of haemodynamic indices RI and PI applying the methods of Doppler sonography. The obtained values of RI and PI indices revealed no clinical recovery which suggested the irreversibility of critical ischemia (unsuccessful therapy in 100% of the patients), and clinical recovery which suggested the reversibility of the disease (unsuccessful therapy in 80% of the patients). Results. The obtained values of PI = 0-0.3 and RI = 0-0.25 for the examined LL arteries were the indicators of irreversible ischemia. A significant correlation between the values of RI in the distal parts of a. tibialis anterior and posterior was proved, as well as between the decreased perfusion of LL determined by tallium-201 (p < 0.05, r = 0.43), and a tibialis anterior (p = 0.05, r = 0.38). There was, however, no statistically significant correlation between the angiographic values and perfusion scintigraphy of LL. Conclusion. The obtained values of haemodynamic RI and PI indices should be a novel approach for introducing a new criteria for the assessment of reversible and irreversible critical ischemia of LL using the method of Doppler.
Dipyridamole Stress and Rest Gated 99mTc-Sestamibi Myocardial Perfusion SPECT: Left Ventricular Function Indices and Myocardial Perfusion Findings
Vahid Reza Dabbagh Kakhki Hadi Jabari
Iranian Journal of Nuclear Medicine , 2007,
Abstract: Introduction: We investigated the difference in left ventricular ejection fraction (LVEF) and end-systolic volume(ESV) measured by gated myocardial perfusion SPECT (GSPECT) in the post-dipyridamole stress and rest periods, and compared the results with the perfusion patterns found in the conventional non-gated tomograms. Methods: 297 consecutive patients were studied with post-stress and rest 99mTc-sestamibi GSPECT using a two-day protocol. Stress images were obtained 90 min after dipyridamole infusion and radiotracer injection. All acquisitions were analyzed visually, semi-quantitatively and quantitatively using QGS software. Results: Patients were divided into 4 groups according to the perfusion patterns: Group-1 = no perfusion defects (n= 129, 43.4%); Group-2 = reversible perfusion defects (n = 85, 28.6%); Group-3=Fixed defects (n =52, 17.5%); Group 4 = partially reversible perfusion defects (n =31, 10.4%). Differences between post-stress LVEF (SEF) and rest LVEF (REF) (DEF=SEF-REF) were +3.39, -6.45, -1.61, and -0.70 for groups 1, 2, 3 and 4 respectively. Post-stress stunning (>5% decrease in LVEF) was present in 49 patients (16.5%). SEF was significantly more than REF in patients with summed difference score (SDS) <5 while patients with SDS≥5 had lower SEF (54.84) than REF (60.44). No statistical significant difference was seen between post-stress end-systolic volume (SESV) and rest end-systolic volume (RESV) in patients with SDS<5. In patients with SDS≥5, SESV was significantly more than RESV. Conclusion: LVEF as measured by GSPECT decreased slightly in post-stress period when an ischemic insult was present, while it has a mild tendency to increase when the myocardial perfusion is normal. Not only exercise stress but also dipyridamole can cause a transient decrease in LVEF in stunned patients. It was concluded that gated study be performed in both stress and rest phases of the procedure.
Effect of puerarin on myocardial perfusion and ventricular wall motion in patients with acute coronary syndrome

Ling Niu,Dongye Li,Yong Xia,Defeng Pan,Xiaoping Wang,Yan Yan,Li Liang,Tongda Xu,

老年心脏病学杂志(英文版) , 2008,
Abstract: Objective To investigate the effects of puerarin(Pur)on myocardial perfusion and ventricular wall motion in patients withacute coronary syndrome(ACS).Methods Thirty-seven patients with ACS were randomly divided into two groups:conventionaltreatment group(n=17,11 males,range of age:32-80 years,average age:60.9±4.9 years)and Purtreatment group(n=20,12 males,rangeof age:40-76 years.average age:62.7±3.5 years).Patients in the conventional treatment group received standard treatment according tothe current guidelines,while patients in the Pur treatment group received intravenous administration of Pur(500 mg/day)for 10 daysplus conventional treatment.Real-time myocardial contrast echocardiography (RT-MCE) was performed to evaluate the change inmyocardial perfusion index (MPI)and veiltricular wall motion index(VWMI)at admission and 10 days after treatment.Results At10 days after treatment,MPI was significantly higher(P<0.01)and VWMI significantly lower(P<0.01)in the Pur group comparingwith those in the conventional group.Conclusions Puerarin might improve myocardial microcirculation perfusion and ventricularwall motion in patients with ACS.
Viability of Split Thickness Autogenous Skin Transplantation in Canine Distal Limb Reconstruction – An Experimental Evaluation  [PDF]
M. S. Ijaz, A. K. Mahmood, N. Ahmad1, M. A. Khan, and U. Farooq
Pakistan Veterinary Journal , 2012,
Abstract: Distal limb reconstruction is complicated by the paucity of local tissues and the frequent association of orthopedic injury with cutaneous loss. Though, second-intention healing or skin stretching techniques are used for wounds involving less than a 30% circumference of the limb, however, skin grafts are recommended for reconstruction of larger superficial wounds. The present study was designed to clinically evaluate the viability of split thickness autogenous skin transplantation (STAST) in dogs. Standardized surgical defects of variable size i.e. 3×3, 4×4 and 5×5 sq cm were made on the left middle radial area (forearm) of 15 mongrel dogs assigned to Group A, B and C, respectively having 5 dogs each. Split thickness autogenous skin grafts were harvested from mid thorax and placed in these defects through several simple interrupted sutures. Results indicated a success rate of 80% with no clinical difference in the survival rate of three different sizes of grafts used. Hence, STAST can successfully be used for canine distal limb reconstruction.
Assessment of tissue viability for improvement of the left ventricular function after revascularization  [PDF]
Matunovi? Radomir,Stojanovi? Aleksandar,Mijailovi? Zdravko,Gligi? Branko
Medicinski Pregled , 2006, DOI: 10.2298/mpns0604169m
Abstract: Introduction. Treatment of patients with heart failure following myocardial infarction is still a clinical challenge. Drug therapy in these patients is limited, and invasive revascularization is not always successful and does not guarantee desired results. The aim of this study was to compare the effectiveness of invasive revascularization procedures (coronary artery bypass grafting - CABG or percutaneous transluminal coronary angioplasty - PICA) with conventional drug therapy in patients with heart failure after acute myocardial infarction in whom significant portion of viable myocardial tissue was detected during low dose dobutamine stress echocardiography. Material and methods. Using a prospective analysis, we investigated 66 patients with heart failure following myocardial infarction and reduced left ventricular ejection fraction (LVEF<35%). 34 patients underwen revascularization procedures including CABG or PTCA. The other 32 patients received only conventional drug therapy. The patients were followed during 12 months examing LVEF, left ventricular wall motion score index (WMSI), NYHA functional class, and cardiac death. Results. After 12 months, patients undergoing revascularization procedures presented with significantly better functional improvement of LVEF (37.84% vs. 33.14%, p<0.05), better clinical status and significantly less cardiac deaths (8.82% vs. 21.87%, p<0.01) in comparison to patients who stayed on drug therapy. After 12 months WMSI was significantly better in patients who underwent interventional therapy (l.69±Q7 vs. 1.82 ±04, p<0.01). Conclusion. After a 12-month follow up period, patients with presence of viable myocardial tissue after myocardial infarction and under-going revascularization procedures presented with better functional recovery and less cardiac events, including cardiac death, in comparison with patients who received only drug therapy.
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