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Yaghoobi N, Maghsudi M, Malek H, Bakhshandeh H, Bitarafan-Rajabi A, Baay M. Role of CT attenuation correction gated SPECT MPI in prediction of pulmonary hypertension. J Nucl Cardiol 2024; 31:101777. [PMID: 38237365 DOI: 10.1016/j.nuclcard.2023.101777] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/13/2024]
Abstract
OBJECTIVE To elucidate the value of gated SPECT-MPI using CT attenuation correction (AC) for prediction of pulmonary hypertension (PHT) in coronary patients by estimation of reliability of non-contrast CT in measurement of main pulmonary artery diameter (MPAd) as well as by assessment of potential predictive role of gated parameters as beneficial accessory findings. BACKGROUND Contrast-enhanced CT is known as an accurate tool for assessment of MPAd to predict PHT. [1] The low-dose non-contrast CT which is used for AC in MPI study, however, has an unclear value in precise vascular diameter measurement; it is also uncertain whether gated parameters could help to predict PHT. METHODS AND PATIENTS A total of 207 patients, who had a transthoracic echocardiography and MPI with an interval of maximum one month, underwent this retrospective study. PHT was defined as a RVSP ≥36 mmHg by echocardiography; peak tricuspid regurgitation velocity (PTRV) was also calculated to use as a criterion for PHT. Of all subjects, 120 had RVSP ≥ 36 and 87 showed RVSP < 36; there also were 191 and 16 patients with PTRV ≤ 3.4 m/s and >3.4 m/s, respectively. Comparison was made unconnectedly between each group regarding the echocardiography results with the MPI parameters, with and without CT-AC, including MPAd derived from CT as well as RV/LV uptake ratio, shape index and septal wall motion and thickening scores to define the best indicators of PHT. RESULTS There was a significant association between established benchmark of PHT in echocardiography (RVSP), with MPAd derived from non-contrast CT as well as with LV shape index from gated study and RV/LV uptake ratio acquired from non-AC SPECT-MPI. Also, stress and rest RV/LV uptake ratio, MPAd, LV end-systolic and LV end-diastolic shape indexes are significantly higher in patients with RVSP ≥ 36 mmHg compare to patients with RVSP < 36 mmHg. CONCLUSIONS Gated-SPECT-MPI using CT-AC can predict PHT by reliable estimation of MPAd as well as by defining RV/LV uptake ratio and shape index, providing an added clinical value for this invaluable modality in cardiac patients.
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Affiliation(s)
- Nahid Yaghoobi
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran.
| | - Mehdi Maghsudi
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran; Department of Nuclear Medicine, School of Medicine, Iran University of Medical Sciences, Tehran, Iran.
| | - Hadi Malek
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran.
| | - Hooman Bakhshandeh
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Ahmad Bitarafan-Rajabi
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammadreza Baay
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran.
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Hamzaraj K, Angjeliu S, Knopf P, Stadler M, Zbucki K, Kastrati L, Graf S, Gyöngyösi M, Hacker M, Calabretta R. Case report: Myocardial perfusion gated-SPECT in pulmonary artery hypertension-the Movahed's sign. Front Cardiovasc Med 2023; 10:1168360. [PMID: 37608818 PMCID: PMC10442157 DOI: 10.3389/fcvm.2023.1168360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 07/04/2023] [Indexed: 08/24/2023] Open
Abstract
Primary pulmonary artery hypertension (PAH) is a clinical diagnosis that requires the exclusion of other underlying causes of pulmonary hypertension (PH). Increased pulmonary artery (PA) pressure and subsequent right ventricular (RV) pressure overload often result in a flattening of the curved interventricular septum, leading to a D-shaped left ventricle (LV), as observed in echocardiographic short-axis views. A similar finding may be also observed on myocardial perfusion SPECT images, the so-called Movahed's sign. We present a clinical case of a female patient with PAH and progression of exertional dyspnea that underwent myocardial perfusion SPECT to investigate LV myocardial ischemia. The SPECT images revealed enhanced tracer uptake in the dilated right ventricle. Additionally, we observed a D-shaped LV or Movahed's sign, which may serve as a potential marker of RV pressure overload, along with a small stress-induced perfusion defect on the LV septal wall. Our findings highlight the importance of considering the presence of a D-shaped LV and signs of RV pressure overload, as they can alter the interpretation of LV perfusion deficits on SPECT images. This case report aims to emphasize the complex nature of right heart abnormalities in pathologies such as PAH and the consideration of the RV implications in myocardial SPECT images-which typically focus solely on the LV.
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Affiliation(s)
- Kevin Hamzaraj
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Silvia Angjeliu
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Paul Knopf
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Michael Stadler
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Kamil Zbucki
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Lisbona Kastrati
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Senta Graf
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Mariann Gyöngyösi
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Marcus Hacker
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Raffaella Calabretta
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
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Nuclear cardiology for a cardiothoracic surgeon. Indian J Thorac Cardiovasc Surg 2022; 38:268-282. [PMID: 35529010 PMCID: PMC9023643 DOI: 10.1007/s12055-021-01311-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 12/06/2021] [Accepted: 12/07/2021] [Indexed: 10/19/2022] Open
Abstract
Cardiac surgeons are commonly faced with issues regarding the balance between the potential risk and the potential benefit of a surgical procedure. Nuclear cardiology procedures such as single-photon emission computed tomography and positron emission tomography provide the surgeon with objective information that augments standard clinical and angiographic assessments related to the diagnosis, prognosis, and potential benefit from any intervention. Myocardial perfusion is imaged with the use of radiopharmaceuticals that accumulate rapidly in the myocardium in proportion to the myocardial blood flow. Radionuclide lung imaging most commonly involves the demonstration of pulmonary perfusion using technetium-99 m macro aggregate albumin (Tc-99 m MAA), as well as the assessment of ventilation using inspired inert gas, usually xenon, or Tc-99 m-labelled aerosols. Nuclear cardiology is extensively used as a part of the work-up of ischemic heart disease and cardiac failure in deciding the optimal therapeutic strategy with its ability to predict the severity of the disease. It has also proved extremely useful in the management of congenital heart disease and the diagnosis of pulmonary embolism, among many other applications. Myocardial perfusion imaging is a basic adjunct to the noninvasive assessment of patients with stable angina, baseline electrocardiogram (ECG) abnormalities, post-revascularisation assessment, and heart failure. This review article covers a summary of basic concepts of nuclear cardiology about what a cardiac surgeon should be aware of. To many, it is just a perfusion test, but the versatility, reliability, and future of the technology are without a doubt.
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4
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Nair A, Hansen CL. Perfusion artifacts caused by marked RV enlargement. J Nucl Cardiol 2020; 27:1834-1836. [PMID: 31148095 DOI: 10.1007/s12350-019-01757-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 05/03/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Abhinav Nair
- Thomas Jefferson University, 925 Chestnut St, Philadelphia, PA, 19107, USA
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5
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Van Tosh A, Nichols KJ. Pharmacologic stress myocardial perfusion imaging in patients with pulmonary hypertension: What do we know, and what remains to be learned? J Nucl Cardiol 2018; 25:828-832. [PMID: 28074408 DOI: 10.1007/s12350-016-0771-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Andrew Van Tosh
- Division of Cardiovascular Research, Research Department, St. Francis Hospital-The Heart Center, 100 Port Washington Boulevard, Roslyn, NY, 11576, USA
| | - Kenneth J Nichols
- Division of Nuclear Medicine and Molecular Imaging, Northwell Health, New Hyde Park, NY, USA.
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Wagner JL, Landeck BF, Hunter K. Quantification of Left Ventricular Shape Differentiates Pediatric Pulmonary Hypertension Subjects From Matched Controls. JOURNAL OF ENGINEERING AND SCIENCE IN MEDICAL DIAGNOSTICS AND THERAPY 2018; 1:0110071-110077. [PMID: 35832296 PMCID: PMC8597644 DOI: 10.1115/1.4038408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 11/05/2017] [Indexed: 06/15/2023]
Abstract
Changes in left ventricle (LV) shape are observed in patients with pulmonary hypertension (PH). Quantification of ventricular shape could serve as a tool to noninvasively monitor pediatric patients with PH. Decomposing the shape of a ventricle into a series of components and magnitudes will facilitate differentiation of healthy and PH subjects. Parasternal short-axis echo images acquired from 53 pediatric subjects with PH and 53 age and sex-matched normal control subjects underwent speckle tracking using Velocity Vector Imaging (Siemens) to produce a series of x,y coordinates tracing the LV endocardium in each frame. Coordinates were converted to polar format after which the Fourier transform was used to derive shape component magnitudes in each frame. Magnitudes of the first 11 components were normalized to heart size (magnitude/LV length as measured on apical view) and analyzed across a single cardiac cycle. Logistic regression was used to test predictive power of the method. Fourier decomposition produced a series of shape components from short-axis echo views of the LV. Mean values for all 11 components analyzed were significantly different between groups (p < 0.05). The accuracy index of the receiver operator curve was 0.85. Quantification of LV shape can differentiate normal pediatric subjects from those with PH. Shape analysis is a promising method to precisely describe shape changes observed in PH. Differences between groups speak to intraventricular coupling that occurs in right ventricular (RV) overload. Further analysis investigating the correlation of shape to clinical parameters is underway.
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Affiliation(s)
- Jennifer L Wagner
- Department of Bioengineering, University of Colorado, 12705 E. Montview Boulevard, Suite 100, Aurora, CO 80045 e-mail:
| | - Bruce F Landeck
- School of Medicine, University of Colorado, Aurora, CO 80045
| | - Kendall Hunter
- Department of Bioengineering, University of Colorado, Aurora, CO 80045
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Van Tosh A, Nichols KJ. Ventricular asynchrony: A shift to the right? J Nucl Cardiol 2017; 24:79-82. [PMID: 26747435 DOI: 10.1007/s12350-015-0383-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Accepted: 12/11/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Andrew Van Tosh
- Research Department, St. Francis Hospital-The Heart Center, Roslyn, NY, USA.
- St. Francis Hospital, Roslyn, NY, USA.
| | - Kenneth J Nichols
- Division of Nuclear Medicine and Molecular Imaging, North Shore - Long Island Jewish Health System, Manhasset, NY, USA
- Division of Nuclear Medicine and Molecular Imaging, North Shore - Long Island Jewish Health System, New Hyde Park, NY, USA
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Ferrando-Castagnetto F, Ricca-Mallada R, Selios V, Ferrando R. Atrial Arrhythmias and Scintigraphic "D-shape" Sign in Pulmonary Artery Hypertension. World J Nucl Med 2017; 16:75-77. [PMID: 28217026 PMCID: PMC5314670 DOI: 10.4103/1450-1147.181152] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Pulmonary hypertension significantly changes biventricular anatomy and physiology, frequently evolving to clinical deterioration and right ventricular failure. The case of a woman developing atrial arrhythmias complicating dipyridamole stress in concomitance with scintigraphic “D-shaped” left ventricle is briefly reported. Although rare, our finding may suggest that nonselective vasodilators should be used with caution in this clinical setting.
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Affiliation(s)
- Federico Ferrando-Castagnetto
- Department of Cardiology, University Cardiovascular Center, School of Medicine, Republic University, Montevideo, Uruguay
| | - Roberto Ricca-Mallada
- Department of Cardiology, University Cardiovascular Center, School of Medicine, Republic University, Montevideo, Uruguay
| | - Valentina Selios
- Nuclear Medicine and Molecular Imaging Center, School of Medicine, Republic University, Montevideo, Uruguay
| | - Rodolfo Ferrando
- Nuclear Medicine and Molecular Imaging Center, School of Medicine, Republic University, Montevideo, Uruguay
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Ohira H, Beanlands RS, Davies RA, Mielniczuk L. The role of nuclear imaging in pulmonary hypertension. J Nucl Cardiol 2015; 22:141-57. [PMID: 25161042 DOI: 10.1007/s12350-014-9960-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Accepted: 07/17/2014] [Indexed: 12/14/2022]
Abstract
Pulmonary hypertension (PH) is a disease characterized by a chronic elevation of pulmonary artery pressure from various causes. Pulmonary artery hypertension (PAH) is one of subtype which results in premature death often as a result of right ventricular (RV) dysfunction. In spite of the recent progress in novel cardiac imaging techniques and new drugs for PAH, there remain significant unresolved issues including a need for earlier diagnosis, refinement of risk stratification, and monitoring the effects of treatment. Cardiac and pulmonary imaging with transthoracic echocardiography (TTE) with Doppler, magnetic resonance imaging (MRI), and computed tomography (CT) are done routinely in many clinical centers. However, routine and emerging nuclear techniques may have a pivotal role of assessment of the patient with PH, and is currently the subject of significant research. Potential Roles for Nuclear Imaging in the Evaluation of the PH Patient: (1) Evaluation of cardiac structure and function (RNA) (non-nuclear techniques would include TTE, CT, and MRI). (2) Functional imaging. This includes the use of ventilation-perfusion scintigraphy (V/Q scan) to diagnose chronic thromboembolic pulmonary hypertension (CTEPH), 123l-metaiodobenzylguanidine (MIBG) imaging to evaluate the cardiac sympathetic nervous system (non-nuclear techniques include invasive right heart catheterization and TTE). (3) Measurement of RV perfusion (with gated SPECT studies). (4) Evaluation of cardiac and pulmonary metabolism (PET scans). This review article will summarize the pathophysiology, classification, natural history, and diagnostic approach of PH. Current and emerging nuclear techniques will be discussed under the four themes of evaluation of structure, functional imaging, flow, and metabolism. These will be compared to current and emerging nuclear and non-nuclear diagnostic tests in the evaluation and management of patients with PH. We will also discuss research applications exploring new insights into flow and metabolism in the right heart and lung and the application of new radioligands.
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Affiliation(s)
- H Ohira
- Advanced Heart Disease and Pulmonary Hypertension Programs, National Cardiac PET Centre, Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, 40 Ruskin Street, Room 3409, Ottawa, ON, K1Y 4W7, Canada
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Movahed MR. D-shaped left ventricle seen on gated single-photon emission computed tomography is suggestive of right ventricular overload: the so-called Movahed's sign. Am J Med 2014; 127:e37. [PMID: 25481210 DOI: 10.1016/j.amjmed.2014.08.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Revised: 08/11/2014] [Accepted: 08/11/2014] [Indexed: 12/13/2022]
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De Lorenzo A, Lima RSL. The reply. Am J Med 2014; 127:e39. [PMID: 25481211 DOI: 10.1016/j.amjmed.2014.08.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2014] [Accepted: 08/25/2014] [Indexed: 11/24/2022]
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Obesity cardiomyopathy and systolic function: Obesity is not independently associated with dilated cardiomyopathy. Heart Fail Rev 2012; 18:207-17. [DOI: 10.1007/s10741-012-9320-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Movahed MR. Correspondence: gated SPECT can detect abnormal RV structure or function. Nat Rev Cardiol 2011; 8:290; author reply 290. [PMID: 21656937 DOI: 10.1038/nrcardio.2010.118-c1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Burger IA, Husmann L, Herzog BA, Buechel RR, Pazhenkottil AP, Ghadri JR, Nkoulou RN, Jenni R, Russi EW, Kaufmann PA. Main pulmonary artery diameter from attenuation correction CT scans in cardiac SPECT accurately predicts pulmonary hypertension. J Nucl Cardiol 2011; 18:634-41. [PMID: 21688066 DOI: 10.1007/s12350-011-9413-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2010] [Accepted: 09/22/2010] [Indexed: 10/18/2022]
Abstract
OBJECTIVES To establish the value of the main pulmonary artery (MPA) diameter assessed from unenhanced computer tomography (CT) scans used for attenuation correction (AC) of single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) to predict pulmonary hypertension (PHT). BACKGROUND In contrast-enhanced chest CT scans an MPA diameter of 29 mm or greater is an established predictor of PHT. However, it is unknown, whether measurements from an unenhanced CT scan for AC may be used as predictor of PHT. METHODS 100 patients underwent SPECT MPI for assessment of coronary artery disease. PHT was defined as a right ventriculo-atrial gradient of 30 mm Hg or greater by Doppler echocardiography. We compared MPA diameter from CT to SPECT findings (right ventricular hypertrophy/enlargement, septal wall motion abnormality/perfusion defect, and D-shape) to determine the best predictor of PHT. RESULTS PHT was found in 37 patients. An MPA diameter of 30 mm or greater yielded a sensitivity, specificity, accuracy, positive, and negative predictive value of 78%, 91%, 86%, 83%, and 88%, respectively. This yielded an area under the ROC curve of 0.85. CONCLUSIONS MPA diameter from low-dose unenhanced multi-slice CT reliably predicts PHT, providing an important added clinical value from AC for SPECT MPI.
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Affiliation(s)
- Irene A Burger
- Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland.
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Shababi M, Habibi J, Yang HT, Vale SM, Sewell WA, Lorson CL. Cardiac defects contribute to the pathology of spinal muscular atrophy models. Hum Mol Genet 2010; 19:4059-71. [DOI: 10.1093/hmg/ddq329] [Citation(s) in RCA: 152] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
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Murarka S, Movahed MR. Review of Movahed's sign (D shaped left ventricle seen on gated SPECT) suggestive of right ventricular overload. Int J Cardiovasc Imaging 2010; 26:553-7. [PMID: 20213472 DOI: 10.1007/s10554-010-9600-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2009] [Accepted: 02/08/2010] [Indexed: 12/11/2022]
Abstract
Recently, D shaped ventricle seen on gated SPECT imaging (Movahed's sign) has shown to correlate with right ventricular overload similar to the D shape ventricle seen on echocardiography. Right ventricle (RV) imaging during gated SPECT studies is challenging because of the low tracer uptake due to relatively smaller right ventricular myocardial mass and lower coronary flow to the RV. Increased mass or workload causes higher tracer uptake in the RV wall secondary to increase in RV wall thickness and higher coronary flow. Furthermore, increased RV volume or pressure load can cause displacement of the septum towards the left ventricle causing septal flattening and a D shaped configuration of the left ventricular septum. This is an important finding that should be a part of nuclear gated SPECT interpretation.
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Abraham A, Kass M, Ruddy TD, deKemp RA, Lee AKY, Ling MC, Ha A, Beanlands RS, Chow BJW. Right and left ventricular uptake with Rb-82 PET myocardial perfusion imaging: markers of left main or 3 vessel disease. J Nucl Cardiol 2010; 17:52-60. [PMID: 19826892 DOI: 10.1007/s12350-009-9153-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2009] [Accepted: 09/25/2009] [Indexed: 10/20/2022]
Abstract
BACKGROUND Relative myocardial perfusion imaging may underestimate severity of coronary disease (CAD), particularly in cases of balanced ischemia. Can quantification of peak left (LV) and right (RV) ventricular Rb-82 uptake measurements identify patients with left main or 3 vessel disease? METHODS Patients (N = 169) who underwent Rb-82 PET MPI and coronary angiography were categorized as having no significant coronary stenosis (n = 60), 1 or 2 vessel disease (n = 81), or left main disease/3 vessel disease (n = 28), based on angiography. Maximal LV and RV ventricular myocardial Rb-82 uptake was measured during stress and rest. RESULTS Failure to augment LV uptake by >or= 8500 Bq/cc at stress, predicted left main or 3 vessel disease with a sensitivity of 93% and specificity of 61% (area under curve = 0.83). A >or=10% increase in RV: LV uptake ratios with stress over rest was 93% specific (area under curve = 0.74) for left main or 3 vessel disease. These indices incrementally predicted left main or 3 vessel disease compared to models including age, gender, cardiac risk factors, and summed stress and difference scores. CONCLUSION Quantifying maximal rest and stress LV and RV uptake with PET myocardial perfusion imaging may independently and incrementally identify patients with left main or 3 vessel disease.
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Affiliation(s)
- Arun Abraham
- Department of Medicine (Cardiology), University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, ON, K1Y 4W7, Canada
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Sundaram PS, Padma S. Role of myocardial perfusion single photon emission computed tomography in pediatric cardiology practice. Ann Pediatr Cardiol 2009; 2:127-39. [PMID: 20808625 PMCID: PMC2922660 DOI: 10.4103/0974-2069.58314] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Diagnostic and prognostic power of myocardial perfusion imaging in patients with coronary artery disease has been demonstrated with planar imaging which was further improvised with addition of gated SPECT and newer Technetium labeled myocardial perfusion tracers like SestaMIBI, Tetrofosmin. Myocardial perfusion abnormalities at rest and after stress are considered to be the best predictors of cardiac event-free survival in adults with ischemic heart disease. This article highlights various myocardial perfusion imaging (MPI) radiopharmaceuticals, exercise procedures, pharmacological stress protocols, indications for MPI and myocardial perfusion patterns in children with some of the common congenital and acquired heart diseases.
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Affiliation(s)
- P Shanmuga Sundaram
- Department of Nuclear Medicine & PET CT, Amrita Institute of Medical Sciences and Research Center, Kochi, Kerala, India
| | - S Padma
- Department of Nuclear Medicine & PET CT, Amrita Institute of Medical Sciences and Research Center, Kochi, Kerala, India
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Shih WJ, Kousa K, Mitchell B, Huang WS. Permanently increased brightness of right ventricle (D-shaped left ventricle) on myocardial perfusion imaging in a patient with chronic cor pulmonale: an autopsy correlation. J Nucl Cardiol 2006; 13:294-6. [PMID: 16580965 DOI: 10.1007/bf02971253] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Wei-Jen Shih
- Department of Diagnostic Radiology, College of Medicine, University of Kentucky, Lexington, KY, USA.
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