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Regional Therapy of Liver Metastases: A Surgeon’s View
Published in Neville Willmott, John Daly, Microspheres and Regional Cancer Therapy, 2020
In another study designed to identify those patients with hepatic metastases who would respond to intra-arterial chemotherapy, Kaplan et al.43 used radionuclide angiography to predict response. Nineteen patients underwent hepatic artery catheterization; then patterns of perfusion were assessed using 99mTc-MAA infused at high and low flow rates. Responses to chemotherapy could be predicted: 10 of 11 patients with good flow to tumor areas responded to therapy; none of 8 patients with absent or poor flow responded. The study also examined the relationship between infusion rate of 99mTc-MAA and tumor perfusion. Two patients showed improved perfusion of tumor lesions when the infusion rate of 99mTc-MAA was increased.
Approach to risk stratification in cardio-oncology
Published in Susan F. Dent, Practical Cardio-Oncology, 2019
Christopher B. Johnson, Gary Small, Angeline Law, Habibat Garuba
Imaging detection of cardiac dysfunction has a critical role to play in identifying cardiotoxicity, and recent technology may permit very early identification of altered cardiac function following cancer therapy. The first cardiac imaging technology applied to cardiotoxicity monitoring was radionuclide angiography (7). By detecting reductions in EF after anthracyclines using radionuclide angiography, anthracycline therapy could be stopped prior to onset of clinical congestive heart failure (7,8). Definitions of cardiotoxicity based on serial EF changes and absolute EF thresholds were proposed in the context of EF monitoring during anthracycline chemotherapy (26–28). While radionuclide angiography remains a reproducible technique for serial EF monitoring, this technology has largely been replaced by echocardiography, which has the advantage of eliminating exposure to ionizing radiation while obtaining reproducible EF measurements during cancer therapy (29,30). The recognition of clinical congestive heart failure during treatment with the targeted agent trastuzumab prompted implementation of a schedule of regular EF monitoring in clinical trials, and this monitoring schedule has been adopted into clinical practice today (31).
Angiographie Anatomy of the Peripheral Vasculature and the Non-invasive Assessment of Peripheral Vascular Disease
Published in Richard R Heuser, Giancarlo Biamino, Peripheral Vascular Stenting, 1999
Philip A. Morales, Richard R. Heuser
Another and perhaps simpler method for evaluating renal artery stenosis is radionuclide angiography with technetium-99m-diethylenetriamine pentaacetic acid (DTPA). The concept is similar in that an oral dose of captopril is administered. Radionuclide angiography is performed prior to (pre-captopril imaging) and after (post-captopril imaging) the administration of oral captopril. The criteria for a positive test are based on asymmetry of renal function and the presence of captopril changes. Specifically, it is: a percentage uptake of DTPA by the affected kidney of less than 40% of the combined bilateral uptake;a delayed time to peak uptake of DTPA; and/ora delayed excretion of DTPA.
Association between mitral regurgitation and clinical outcome after endovascular thrombectomy in stroke patients
Published in Neurological Research, 2020
Junya Aoki, Kentaro Suzuki, Takuya Kanamaru, Takehiro Katano, Yuki Sakamoto, Akihito Kutsuna, Satoshi Suda, Yasuhiro Nishiyama, Kazumi Kimura
Clinical outcome at 3 months was significantly related to the damage to the stroke itself. Two mechanisms, including lack of CBF reserve and insufficient CBF restoration, may explain the severe neurological outcome in AF patients with severe MR. First, AF patients with severe MR seemed to have a limited CBF at baseline before stroke onset. Previously, in AF patients without HF or neurological deficits, CBF was calculated to be 5.5–17.5% lower than in those with sinus rhythm [16]. Transcranial Doppler examinations to measure transient CBF in patients during and after paroxysmal AF found that MCA flow velocity was significantly lower during AF [17]. Regarding MR, a previous study measured CBF by radionuclide angiography and reported that CBF decrement was clearly associated with the MR grade in patients with HF [18]. Thus, stroke patients with both significant MR and AF were presumed to be more vulnerable to CBF reduction and complete ischemic damage, compared to those without significant MR.
Cardiotoxicity in pediatric lymphoma survivors
Published in Expert Review of Cardiovascular Therapy, 2021
Neha Bansal, Chaitya Joshi, Michael Jacob Adams, Kelley Hutchins, Andrew Ray, Steven E. Lipshultz
Cardiac MRI has been utilized to evaluate early and late cardiotoxicity in children, as well as adults [110]. Cardiac MRI has improved reproducibility compared to echocardiography and radionuclide angiography and can evaluate subendocardial damage and perfusion abnormalities [7]. Patients are also not exposed to cardiac assessment-related radiation [7]. Limitations of cMRI include that it is time-consuming, may require sedation, especially in younger patients, and is not widely available. These measures, along with others such as myocardial performance index, two-dimensional strain and strain rate continue to be investigated, but their predictive value has not yet been established [110].
Association between fragmented QRS and left ventricular dysfunction in acromegaly patients
Published in Acta Cardiologica, 2020
Seçkin Dereli, Hatice Özer, Nurtaç Özer, Adil Bayramoğlu, Ahmet Kaya
Myocardial fibrosis and LV hypertrophy have been considered common findings of the acromegalic CMP according to a previous autopsy study by Lie and Grossman [27]. Few studies used the gold standard CMRI for the evaluation of patients with acromegaly [4,28,29]. Bogazzi et al. and Santos Silva et al. demonstrated myocardial fibrosis using CMRI [4,30]. Also Ratheendran et al. showed that fQRS can be used as an indirect marker to predict the presence of fibrosis in hypertrophic cardiomyopathy [31]. Canga et al. speculated that the fQRS might represent increased myocardial fibrosis and LV systolic and diastolic dysfunction [32]. Conversely, most echocardiographic studies show normal LV systolic function but impaired diastolic function as an early sign of acromegalic CMP [1,33]. In another study, the prevalence of diastolic dysfunction was found to be approximately 30% in untreated acromegaly with conventional methods [34]. Using more sensitive equilibrium radionuclide angiography, impairment of ejection frac after exercise was observed in 73% of patients [35]. Therefore, it is clear that novel echocardiographic methods are needed to evaluate global cardiac performance in acromegaly. Previous studies have shown the impaired MPI in acromegaly patients and its correlation with GH and IGF-1. Akgul et al. and Bruch et al. found that MPI was significantly elevated in acromegaly patients [36,37]. Cho et al. found an association with the increased MPI evaluated by echocardiography and fQRS in Duchenne Muscular Dystrophy [38]. In patients with acromegaly, previous studies suggest that the miyorcardial fibrosis, which begins before the development of diabetes or hypertension, may be associated with the MPI that show left ventricular dysfunction in subclinical patients. In our study, we found that both fQRS predicted MPI and that MPI predicted fQRS.