Identification of viable myocardium by dipyridamole-induced improvement in regional left ventricular function assessed by echocardiography in myocardial infarction and comparison with thallium scintigraphy at rest

Picaño, Eugenio; Marzullo, Paolo; Gigli, G.; Reisenhofer, Barbara; Parodi, Oberdan; Distante, Alessandro; LʼAbbate, Antonio

doi:10.1016/0002-9149(92)90545-a

Cited by 88 publications

(21 citation statements)

References 30 publications

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“…Myocardial territories were defined using a 13-territory model as previously described ( Figure 2). 20,21 The 13 myocardial territories were aligned to each coronary vessel based on anatomical variance data [8][9][10][11][12][22][23][24][25] and further classified as: primary vascular territories, when blood flow is usually supplied by the coronary vessel in the most common right dominant anatomical coronary pattern; secondary vascular territories, when blood flow may be supplied by the coronary vessel in some normal anatomic variations; and tertiary vascular territories, when blood flow is usually not supplied by the coronary vessel. Because each coronary vessel-myocardial vascular territory association is unique, 6-vessel-territory maps were generated and are displayed in Figure 3.…”

Section: Vascular Territory Distribution Modelmentioning

confidence: 99%

“…Coronary arterial segments were defined using a 19-coronary segment model (Figure 1), 18,19 and myocardial territories were defined using a 13-territory model ( Figure 2). 20,21 All coronary arterial segments that were at least 1.5 mm in diameter were analyzed by CCA and CTA for significant coronary artery stenoses defined as ≥50% obstructive lesions. Myocardial territories were analyzed by SPECT and CTP for rest and stress myocardial perfusion abnormalities with severity and reversibility scored.…”

Section: Image Acquisition and Data Analysismentioning

confidence: 99%

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Aligning Coronary Anatomy and Myocardial Perfusion Territories

Cerci

Arbab‐Zadeh

George

et al. 2012

Circ: Cardiovascular Imaging

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A ppropriate clinical decisions concerning diagnosis and treatment of coronary artery disease rely on the correct integration of data on coronary anatomy and myocardial perfusion.1 Revascularization of coronary stenosis is only justified if it relieves angina complaints and improves patient outcome, which depends on the extent and severity of inducible myocardial ischemia related to the lesion. 2-5 Clinical Perspective on p 595In clinical practice, conventional coronary angiography (CCA) and single-photon emission tomography myocardial perfusion imaging (single-photon emission computed tomography [SPECT]) are the standard imaging methods for detection and quantification of coronary artery stenosis and myocardial perfusion defects. To define a treatment strategy, physicians must mentally create a correlation map, merging the anatomical data from CCA, a projection-imaging method, with the functional data from SPECT, a mix of projection and tomographic imaging methods, overcoming image foreshortening, differences on image-acquisition times, and differences in spatial and temporal resolution between the methods.Myocardial perfusion defects have also been assigned to vascular territories using left ventricular segmentation models. [6][7][8] This approach is usually applied in research settings, where standardization between different imaging methods is attempted. However, standard assumptions about the vascular territory distribution in myocardial perfusion analysis are frequently inaccurate because of morphologic variability in the Background-Appropriate clinical decisions concerning diagnosis and treatment of coronary artery disease rely on correct integration of data on coronary anatomy and myocardial perfusion. The purpose of this article is to introduce a new left ventricular segmentation model for improved alignment of coronary arterial segments and myocardial perfusion territories, designed for the CORE320 study. Methods and Results-CORE320 is a prospective, multicenter study with a primary objective to evaluate the diagnostic accuracy of 320-row detector computed tomography (CT) to detect coronary artery luminal stenosis and corresponding myocardial perfusion deficits in patients with suspected coronary artery disease compared with the gold standard of conventional coronary angiography and single-photon emission CT myocardial perfusion imaging. We describe a 19-coronary segment and 13-myocardial territory alignment model, its application in both standard and CT image data sets, and the adjudication process of the initial cohort of patients recruited for the CORE320 study. Adjudication committees reviewed the images of the first 101 gold standard and 107 CT data sets. On the basis of the presented model and rules, all cases for adjudication were correctly identified. During image review, 6 (5.9%) gold standard and 9 (8.4%) CT data sets needed further realignment not triggered by the algorithm. Conclusions-We present a vascular territory distribution model developed for the CORE320 multicenter study, which acco...

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Section: Vascular Territory Distribution Modelmentioning

confidence: 99%

Section: Image Acquisition and Data Analysismentioning

confidence: 99%

Aligning Coronary Anatomy and Myocardial Perfusion Territories

Cerci

Arbab‐Zadeh

George

et al. 2012

Circ: Cardiovascular Imaging

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“…In the setting of single vessel disease, ambiguous findings have been reported during vasodilators SE in patients with epicardial CAD [6,7,[9][10][11][12][13][14]. Some have reported an improvement while others have shown worsening in contractility in segments as measured by the global wall motion score index (WMSI).…”

Section: Introductionmentioning

confidence: 99%

The quantification of dipyridamole induced changes in regional deformation in normal, stunned or infarcted myocardium as measured by strain and strain rate: an experimental study

Marciniak

Claus

Streb

et al. 2007

Int J Cardiovasc Imaging

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“…Baixas doses de dobutamina ou de dipiridamol podem induzir melhora da motilidade nas regiões com disfunção em repouso que tenham viabilidade miocárdica. A acurácia de ambos os métodos é similar na previsão de recuperação funcional espontânea após o infarto agudo do miocárdio, embora a dobutamina tenha maior sensibilidade e o dipiridamol, maior especificidade 127,128 .…”

Section: -Diagnóstico De Viabilidade (Atordoamento E Hibernação)unclassified

Diretrizes

2009

Arq. Bras. Cardiol.

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-Atendimento pré-hospitalarO interesse no atendimento pré-hospitalar do infarto agudo do miocárdio (IAM) teve início na década de 1960, devido ao grande número de óbitos que ocorriam antes que os paciente chegassem ao hospital.A maioria das mortes por IAM ocorre nas primeiras horas de manifestação da doença, sendo 40%-65% dos casos na primeira hora e, aproximadamente, 80% nas primeiras 24 horas [1][2][3] . Assim, a maior parte das mortes por IAM acontece fora do ambiente hospitalar, geralmente desassistidas pelos médicos 4 . A modalidade mais frequente de parada cardiorrespiratória nas primeiras horas do IAM é a fibrilação ventricular 3 . -Período pré-hospitalar.O período pré-hospitalar compreende dois momentos: a) do início dos sintomas (geralmente dor torácica aguda) até a decisão de procurar atendimento; b) da decisão de procurar atendimento até a chegada ao hospital.No infarto agudo do miocárdio com elevação do segmento ST (IAMCST), o tempo desde o início dos sintomas (oclusão da artéria coronária) até a instituição do tratamento (reperfusão química ou mecânica) é diretamente proporcional à ocorrência de eventos clinicamente relevantes. Esse tempo é fator fundamental para o benefício do tratamento, tanto imediato quanto tardio 5 .No entanto, sabe-se que a fase pré-hospitalar (em ambos os momentos descritos) é caracterizada por ser demorada, especialmente em pacientes idosos, do sexo feminino e com baixa condição socioeconômica 4 . Alguns fatores estão relacionados ao aumento desse tempo tão precioso (Quadro 1.1.1.1) 6 . O componente pré-hospitalar no atraso do atendimento ao paciente com dor torácica é de tal magnitude que, na prática clínica, apenas cerca de 20% destes pacientes chegam ao setor de emergência com até duas horas após o início dos sintomas 7 . -Medidas na fase pré-hospitalarApesar da significativa redução da mortalidade hospitalar do IAM nas últimas décadas 8,9 , houve pouco avanço no conhecimento sobre a epidemiologia e o tratamento na fase pré-hospitalar. É notória a necessidade de mudanças nesse cenário, embora poucas sejam as evidências geradas para este fim.A abordagem do paciente com suspeita de síndrome coronária aguda em ambiente extra-hospitalar deve, idealmente, ser feita por profissional de saúde, com realização de uma história clínica direcionada, investigando as características dos sintomas atuais (momento do início, tempo de duração, qualidade, intensidade, relação com o esforço e repouso) e a presença de doença coronária estabelecida (angina prévia). Algumas características são reconhecidamente determinantes para a manifestação atípica de um evento coronariano e devem ser lembradas quando um indivíduo for abordado na fase pré-hospitalar, por mascararem o quadro de IAM (Tabela 1.1.2.1) [10][11][12] .O eletrocardiograma executado no local de atendimento e interpretado por um médico habilitado (na ambulância ou em local remoto) mostrou ser um método que reduz em 34% o tempo porta-agulha e em 18% o tempo porta-balão, além de proporcionar maiores taxas de tempo porta-balão ideal (men...

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Identification of viable myocardium by dipyridamole-induced improvement in regional left ventricular function assessed by echocardiography in myocardial infarction and comparison with thallium scintigraphy at rest

Cited by 88 publications

References 30 publications

Aligning Coronary Anatomy and Myocardial Perfusion Territories

Aligning Coronary Anatomy and Myocardial Perfusion Territories

The quantification of dipyridamole induced changes in regional deformation in normal, stunned or infarcted myocardium as measured by strain and strain rate: an experimental study

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