Prognóstico em médio prazo da cintilografia de perfusão miocárdica de estresse na unidade de dor torácica

Azevedo, Jader Cunha de; Felix, R; Corrêa, Patrícia Lavatori; Barbirato, Gustavo Borges; Dohmann, Hans F.; Silva, Paulo Roberto Dutra da; Mesquita, Evandro Tinoco; Mesquita, Cláudio Tinoco

doi:10.1590/s0066-782x2007000500017

Cited by 9 publications

(8 citation statements)

References 46 publications

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“…The final result is a resting scintigraphic image with areas of reduced uptake where perfusion is impaired. This evaluation allows us to dismiss and prognose adverse events and future hospitalizations 2 . The admission of patients to undergo an investigative route generates costs to both the hospital and health insurance companies, which can have negative impacts on the health system.…”

Section: Discussionmentioning

confidence: 99%

“…Patients with negative investigative routes who have undergone non-invasive scintigraphy for risk stratification remain at the hospital at least 12 hours before they can be safely discharged 2,4 . The length of stay represents a significant cost burden, and new strategies are being developed aiming at improving this cost-benefit relationship.…”

Section: Introductionmentioning

confidence: 99%

“…The systematic approach towards the chest pain patient significantly reduces, from 5 to 0.5% 3 , the risk of the patient with AMI and unstable angina being inadvertently discharged from the emergency unit. By using electrocardiograms and serial cardiac enzymes, the investigative route system allows to significantly reduce the risk of AMI, whereas stress examinations such as myocardial scintigraphy help to define stress-induced myocardial ischemia 2 . At the emergency unit, the use of provocative testing for myocardial ischemia can reduce by 45% the number of admissions.…”

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confidence: 99%

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Uso da cintilografia miocárdica em repouso durante dor torácica para descartar infarto agudo do miocárdio

Barbirato¹,

Azevedo²,

Felix³

et al. 2009

Arq. Bras. Cardiol.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

mentioning

confidence: 99%

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Uso da cintilografia miocárdica em repouso durante dor torácica para descartar infarto agudo do miocárdio

Barbirato¹,

Azevedo²,

Felix³

et al. 2009

Arq. Bras. Cardiol.

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“…Is value on such diagnosis has been widely studied, which allows its utilization in patients admitted in emergency units and ambulatories 1 . However, a group of patients may relate thoracic pain in special situations without the utilization of the most commonly studied distress methods, like physical (through rolling mat) or pharmacological distress (adenosine, dipiridamol or dobutamine) 2 .…”

Section: Introductionmentioning

confidence: 99%

Prevalência de isquemia induzida por estresse mental

Barbirato¹,

Felix²,

Azevedo³

et al. 2010

Arq. Bras. Cardiol.

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Background: The myocardial radionuclide imaging with mental distress seems to induce ischemia through a particular physiopathology when compared to radionuclide imaging with physical or pharmacological distress.Objective: To assess the prevalence of induced myocardial ischemia by mental distress in patients with thoracic pain and radionuclide imaging with normal conventional distress, with 99mTc-Sestamibi.Methods: Twenty-two patients were admitted with thoracic pain at emergency or were referred to the nuclear medicine service of our institution, where myocardial radionuclide imaging of distress or rest without ischemic alterations was carried out. The patients were, then, invited to go through an additional phase with mental distress induced by color conflict (Strop Color Test) with the objective of detecting myocardial ischemia. Two cardiologists and nuclear physicians performed the blind analysis of perfusional data and consequent quantification through Summed Difference Score (SDS), punctuating the segments that were altered after mental distress and comparing it to the rest period image. The presence of myocardial ischemia was considered if SDS ≥ 3.Results: The prevalence of mental distress-induced myocardial ischemia was 40% (9 positive patients). Among the 22 studied patients, there were no statistical differences with regard to the number of risk factors, mental distress-induced hemodynamic alterations, usage of medications, presented symptoms, presence or absence of coronary disease and variations of ejection fraction and final systolic volume of Gated SPECT. Researches that used echocardiogram and radioisotope ventriculography associated with mental distress showed that this is the responsible for alterations in ventricular function 5,6 . Studies that applied radionuclide imaging of myocardial perfusion during mental distress confirmed that the contraction alterations were induced by alterations in perfusion. Conclusion Prevalence of Induced Ischemia by Mental DistressThe necessity for myocardial ischemia diagnosis in patients with thoracic pain is extremely important for a better clinical handling, risk factor control and improvement of their life quality. In this decade, an acute syndrome, unleashed by mental distress and represented by thoracic pain, supraunevenness of ST segment at electrocardiogram, elevation of myocardial necrosis markers and peculiar alterations of myocardial contractility demonstrated in echocardiograph and ventriculograph findings, was described. The so called Takotsubo syndrome is characterized by a reduction in contractility of apical myocardial segments and hyper-contractility of basal segments of left ventricle 7 . Other IntroductionThe myocardial perfusion radionuclide imaging has been applied in medical practice as an important tool for the diagnosis of myocardial ischemia. Is value on such diagnosis has been widely studied, which allows its utilization in patients admitted in emergency units and ambulatories 1 . However, a group of patients may relate thoracic ...

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“…Imaging exams have been playing an important role in the stratification of risk in patients that are suspected to be carriers of myocardial ischemia. Among the most widely used exams, radionuclide imaging is the one that bespeaks the most its value in diagnostic and prognostic evaluation of patients with thoracic pain 1 . Despite the fact that a radionuclide myocardial perfusion imaging is frequently associated with a risk for adverse events lower than 1% per year 2 , some patients with coronary arterial disease only have manifestation of ischemia when submitted to non-conventional ischemia induction techniques, such as psychological stress 3 .…”

Section: Introductionmentioning

confidence: 99%