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Survivorship: Pediatric cancer survivors
Published in Susan F. Dent, Practical Cardio-Oncology, 2019
Shahnawaz Amdani, Neha Bansal, Emma Rachel Lipshultz, Michael Jacob Adams, Steven E. Lipshultz
Exercise or pharmacologic stress testing augments the diagnosis of ischemic heart disease and cardiac dysfunction compared to rest-only studies. Radionuclide myocardial perfusion imaging during exercise is 90% sensitive and specific for ischemic heart disease in the general population; however, its sensitivity and specificity in irradiated patients has not been well studied. Myocardial perfusion imaging appears to detect radiation-induced microvascular damage in the myocardium, but the ability of perfusion scanning to distinguish microvascular abnormalities from coronary heart disease in this population is unclear (133). Detecting microvascular damage, however, may identify survivors at highest risk for HF and death from cardiac causes, although this relationship requires further study (134,135).
Perioperative cardiovascular evaluation and treatment of elderly patients undergoing noncardiac surgery
Published in Wilbert S. Aronow, Jerome L. Fleg, Michael W. Rich, Tresch and Aronow’s Cardiovascular Disease in the Elderly, 2019
Dipika Gopal, Monika Sanghavi, Lee A. Fleisher
In patients with baseline ECG abnormalities that render the exercise ECG uninterpretable (e.g., left bundle branch block, LVH with repolarization abnormality, digitalis effect) or in those who are unable to ambulate, an imaging study needs to be added. The choice between nuclear myocardial perfusion imaging and echocardiographic imaging should be based on availability and local expertise. Pharmacological stress tests with echocardiographic or nuclear scintigraphic imaging have been studied extensively in preoperative cardiac risk assessment for noncardiac, and especially vascular, surgery and will be briefly reviewed here.
Coronary arterial and venous disease
Published in Paul Schoenhagen, Carl J. Schultz, Sandra S. Halliburton, Cardiac CT Made Easy, 2014
Paul Schoenhagen, Carl J. Schultz, Sandra S. Halliburton
An optimized diagnostic approach to coronary artery disease combines anatomical information with functional data about ischemia and infarction.294 While the diagnostic value of CT to delineate coronary plaques and stenosis is well documented, the role of CTA in assessing functional information is incompletely understood. Initial experience of myocardial perfusion imaging was described with electron beam and multi-detector scanners.295 Based on technical advances, including wide-detector and dual-source scanners, there is now growing clinical experience.
Widespread ST depression and ST elevation in avR in severe hypokalaemia
Published in Acta Cardiologica, 2022
Leili Pourafkari, Nader D. Nader
A 35-year-old man with past medical history of sarcoidosis and chronic kidney disease stage III presented with cough, diarrhoea, weakness and pleuritic chest pain. SARS-CoV-2 RNA test was positive. Serum creatinine level was 2.6 mg/dl (normal: 0.6–1.2), glomerular filtration rate (GFR) was 29.3 ml/min, serum potassium level was 2.4 mmol/L (normal: 3.6–5.2) and serum calcium was 9.4 mg/dl (normal: 8.6–10.30). Medication history included prednisone 5 mg every other day and potassium 20meq daily. Electrocardiogram (ECG) showed widespread ST-segment depression and ST-segment elevation in lead avR (Figure 1(A)). Serial troponin measurements were normal. Echocardiography was normal with no regional wall motion abnormalities. Patient received hydration and potassium supplement and his kidney function improved to baseline. ECG following treatment of hypokalaemia showed resolution of ECG changes (Figure 1(B)). Review of medical records showed that three months earlier patient had presented with hypokalaemia and acute on chronic kidney injury. ECG interestingly had shown similar ST-T changes that had resolved after correction of hypokalaemia. Myocardial perfusion imaging study was normal.
Non-invasive imaging techniques to assess myocardial perfusion
Published in Expert Review of Medical Devices, 2020
Olivier Villemain, Jérôme Baranger, Zakaria Jalal, Christopher Lam, Jérémie Calais, Mathieu Pernot, Barbara Cifra, Mark K. Friedberg, Luc Mertens
Interpretation in clinical practice is qualitative [30], with hypoenhancement greater than 25% myocardial extent typically considered pathological. However, numerous automated quantitative CMR myocardial perfusion methods are under investigation and beginning to make headway into clinical practice. Quantitative myocardial perfusion is based on mathematical models of myocardial structure and thus contrast perfusion. Measured parameters include myocardial blood flow (MBF; ml/g/min) at stress and rest, and myocardial perfusion reserve (MPR), which is the ratio of MBF at stress to MBF at rest. Relative flow reserve can also be determined at each myocardial segment. A requirement of quantitative methods is precise measurement of the arterial input function (AIF), which represents the varying signal intensity of blood in the left ventricle due to contrast transit. This has traditionally been labor-intensive and prone to errors, though has now been improved with automated methods, including for obtaining whole-heart slice coverage using simultaneous multi-slice techniques [31–34]. In the largest quantitative perfusion CMR study to date (1049 patients), Knott KD and colleagues use stress CMR myocardial perfusion mapping via an automated artificial-intelligence-based approach to show, quantitative measures of MBF and perfusion reserve to be independent predictors for death and major adverse cardiovascular events [35]. Future trials will be needed to validate the utility of quantitative CMR myocardial perfusion imaging for clinical practice.
Molecular imaging of myocardial necrosis: an updated mini-review
Published in Journal of Drug Targeting, 2020
Dongjian Zhang, Cuihua Jiang, Yuanbo Feng, Yicheng Ni, Jian Zhang
SPECT is a widely available and recommended imaging tool for diagnostic and prognostic purposes in patients with intermediate probability of coronary artery disease [20,21]. It has been extensively used to assess myocardial viability by myocardial perfusion imaging, in which radiotracers such as 201TI, 99mTc-sestamibi and 99mTc-tetrofosmin are taken up by healthy cardiomyocytes, reflecting myocardial perfusion [22–24]. However, myocardial perfusion imaging is not a direct imaging method to visualise myocardial necrosis. Generally, direct imaging of necrotic myocardium using necrosis-specific probes appears to be more accurate than indirect imaging as the biochemical processes of cardiomyocyte damage are studied directly. Early studies on SPECT imaging of myocardial necrosis were mainly focussed on the use of 99mTc-pyrophosphate, 111In-antimyosin and 99mTc-glucarate, which have been reviewed in detail in previous literatures [11,16,25].