Non-invasive cardiovascular imaging plays an important role in examination of patients with chronic coronary syndrome. Positron emission tomography (PET) has the highest diagnostic accuracy and prognostic significance due to the ability to assess myocardial blood flow (MBF) and coronary flow reserve (CFR). These physiological processes provide myocardial oxygen demand, both at rest and stress, as well as maintaining sufficient myocardial circulation during coronary artery constriction. At the same time, the high cost and low availability of assessing MBF and CFR by PET do not allow widespread use of this approach in clinical practice. The use of modern gamma cameras with cadmium zinc telluride detectors can be an alternative to PET. The aim of the review is to present fundamental information about MBF and CFR, as well as about the possibilities of using scintigraphy for determination of these parameters and their clinical significance.
Sudden cardiac death is a cause of fatal outcomes in large proportion of cardiovascular patients. Left ventricle ejection fraction at the moment is the main criteria for sudden cardiac death risk stratification, however the parameter is not enough reliable. Nuclear imaging methods make it to visualize finer pathophysiological processes representing the probability of the life threatening ventricular arrhythmias development. The review is focused on recent data on nuclear imaging for cellular perfusion assessment, transient ischemia, vitality of myocardium and myocardial blood flow, metabolic disorders and sympathetic innervation.
Цель. Изучить состояние перфузии и метаболизма миокарда ЛЖ у пациентов с дилатационной кардиомиопатией (ДКМП) и разработать на этой основе гамма-сцинтиграфические предикторы эффективности кардиоресинхронизи-рующей терапии (КРТ). Материал и методы. В исследование включены 63 пациента с ДКМП (41 мужчина, 22 женщины) средний возраст -55,4±8,3 лет, с хронической сердеч-ной недостаточностью (ХСН) III-IV функционального класса по NYHA. До КРТ всем пациентам была выполнена сцинтиграфия миокарда с 99m Тс-МИБИ (для оценки миокардиальной перфузии) и с 123 I-ФМПДК (для оценки метаболизма жирных кислот в миокарде). До и через 6 месяцев после КРТ всем пациентам была выполнена ЭхоКГ для оценки внутрисердечной гемодинамики. Результаты. Через 6 месяцев после КРТ все пациенты были подразде-лены на две группы: 1) КСО ЛЖ уменьшился ≥15% (n= 39) -"респондеры" и 2) КСО ЛЖ уменьшился <15% (n=24) -"нереспондеры". До КРТ по пока-зателям насосной функции ЛЖ группы достоверно не различались. Досто-верная разница между группами была выявлена по следующим доопера-ционным сцинтиграфическим параметрам: дефект перфузии (ДП) (9,22±5,06% и 12,5±4,22%, p<0,01), дефект метаболизма на ранних изо-бражениях (ДМр) (9,21±5,42% и 11,27±5,39%, p<0,01). Получено уравне-ние множественной регрессии, позволяющее прогнозировать динамику конечно-систолического объема после КРТ. По данным ROC анализа наи-лучшую значимость в прогнозе эффективности КРТ имеет размер дефекта метаболизма миокарда и расчётное значение динамики конечно-систоли-ческого объема. Наилучшее пороговое значение ДМр=7,35% позволяет говорить об эффективности КРТ с чувствительностью и специфичностью 77,8% и 66,7%, соответственно. Наилучшее пороговое значение расчет-ной динамики конечно-систолического объема -34,02 позволяет гово-рить об эффективности КРТ с чувствительность и специфичностью 87,5% и 100%, соответственно.Заключение. Данные, полученные при выполнении метаболической гамма-сцинтиграфии миокарда могут быть использованы в комплексе методов, позво-ляющих прогнозировать эффективность кардиоресинхронизирующей терапии. Aim. To study perfusion and metabolism of LV myocardium in patients with dilated cardiomyopathy (DCMP) and to invent on this basement a gamma-specific predictors for cardio-resynchronizing therapy (RT) efficacy. Material and methods. Totally 63 patients with DCMP included (41 male, 22 female) with mean age 55,4±8,3 y. o., having congestive heart failure (CHF) of III-IV NYHA. Before RT all patients underwent scintigraphy of myocardium with 99m Тс (for perfusion assessment) and 123 I (for fatty acids metabolism). Before and in 6 months after RT all patients underwent echocardiography to assess intracardiac hemodynamics. Results. In 6 months after RT all patients were divided into two groups: 1) EDV LV decreased by ≥15% (n= 39) -"responders", and 2) ESV LV decreased <15% (n=24) -"non-responders". Before RT groups did not significantly differ by pumping function of the ventricle. Significant difference was found by following pre-operational scintigraphic parameters: perfusion ...
Purpose: to assess the coronary flow reserve in patients with one, two and multi-vessel coronary artery diseases by dynamic SPECT using semiconductor (cadmium-zinctelluride)- based gamma camera.Material and methods.This work included 42 patients with stable coronary artery diseases. The first group consisted of 12 (28.6%) patients with single and two-vessel coronary artery disease (STCAD) (8 males and 4 females; mean age 61.5 ± 3.8 years) with intermediate (50–70%) and significant (>70%) coronary artery stenosis. Second group included 30 (71.4%) patients with multi- vessel coronary artery diseases (MVCAD) (22 males and 8 females; mean age 60.1 ± 4.3 years) with a lesion >70% in at least 2 major epicardial vessels according to invasive coronary angiography. All patients underwent rest-stress dynamic SPECT as well as conventional myocardial perfusion imaging with 99mTc-MIBI as a radiopharmaceutical. All scintigraphic images were acquired on the hybrid SPECT/CT unit (GE Discovery NM/CT 570C). Patient with STCAD underwent invasive FFR detection.Results.When comparing the results of MPI between the study groups, there were no significant differences. ROC analysis showed that the global MFR ≤ 1,42 allows to identify MVCAD with a sensitivity and specificity 68% and 86,4%, for PSM, these values are: 39.1% and 86.4% (AUC = 0.655, p < 0.05), respectively (“gold” standard CAG). The sensitivity and specificity of the regional MFR to identify the hemodynamic significance of coronary artery stenoses at a value of <1.33 was 100% (the “gold” standard of FFR). Most likely, high sensitivity and specificity in this case are associated with a small number of patients with true stenoses of FFR.Conclusion.The performance of standard MPI in combination with dynamic single-photon emission computed tomography allows to increase the diagnostic significance of the scintigraphic approach in the evaluation of myocardial microcirculation disorders in multivessel coronary artery disease. Dynamic SPECT is a promising method of noninvasive assessment of hemodynamic significance of coronary artery stenoses.
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