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Pelletier-Galarneau M, Dilsizian V. Microvascular Angina Diagnosed by Absolute PET Myocardial Blood Flow Quantification. Curr Cardiol Rep 2020; 22:9. [DOI: 10.1007/s11886-020-1261-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Sciagrà R. Quantitative cardiac positron emission tomography: the time is coming! SCIENTIFICA 2012; 2012:948653. [PMID: 24278760 PMCID: PMC3820449 DOI: 10.6064/2012/948653] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2012] [Accepted: 08/14/2012] [Indexed: 06/02/2023]
Abstract
In the last 20 years, the use of positron emission tomography (PET) has grown dramatically because of its oncological applications, and PET facilities are now easily accessible. At the same time, various groups have explored the specific advantages of PET in heart disease and demonstrated the major diagnostic and prognostic role of quantitation in cardiac PET. Nowadays, different approaches for the measurement of myocardial blood flow (MBF) have been developed and implemented in user-friendly programs. There is large evidence that MBF at rest and under stress together with the calculation of coronary flow reserve are able to improve the detection and prognostication of coronary artery disease. Moreover, quantitative PET makes possible to assess the presence of microvascular dysfunction, which is involved in various cardiac diseases, including the early stages of coronary atherosclerosis, hypertrophic and dilated cardiomyopathy, and hypertensive heart disease. Therefore, it is probably time to consider the routine use of quantitative cardiac PET and to work for defining its place in the clinical scenario of modern cardiology.
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Affiliation(s)
- Roberto Sciagrà
- Department of Clinical Physiopathology, Nuclear Medicine Unit, University of Florence, Largo Brambilla 3, 50134 Florence, Italy
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Schwartz RG. Early insights of cardiac risk and treatment response with quantitative PET monitoring of coronary-specific endothelial dysfunction and myocardial perfusion reserve. J Nucl Cardiol 2010; 17:985-9. [PMID: 20963538 DOI: 10.1007/s12350-010-9295-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Schwaiger M, Ziegler SI, Nekolla SG. PET/CT challenge for the non-invasive diagnosis of coronary artery disease. Eur J Radiol 2010; 73:494-503. [PMID: 20206454 DOI: 10.1016/j.ejrad.2009.12.025] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2009] [Accepted: 12/15/2009] [Indexed: 10/19/2022]
Abstract
This review will focus on the clinical potential of PET/CT for the characterization of cardiovascular diseases. We describe the technical challenges of combining instrumentation with very different imaging performance and discuss the clinical applications in the field of cardiology.
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Affiliation(s)
- Markus Schwaiger
- Klinikum rechts der Isar, Technische Universität München, Nuklearmedizinische Klinik und Poliklinik, München, Germany
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Impaired myocardial blood flow reserve in subjects with metabolic syndrome analyzed using positron emission tomography and N-13 labeled ammonia. Eur J Nucl Med Mol Imaging 2009; 37:368-76. [PMID: 19915835 DOI: 10.1007/s00259-009-1307-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2009] [Accepted: 10/15/2009] [Indexed: 10/20/2022]
Abstract
PURPOSE Coronary vasomotor response might be impaired in metabolic syndrome (MS); however, the precise abnormality has not been elucidated. The aim of this study was to assess coronary-vasomotor response in MS subjects using N-13 labeled ammonia and positron emission tomography. METHODS AND RESULTS Myocardial blood flow (MBF) was measured at rest and during adenosine infusion in MS subjects (n = 13, MS group) with no definite evidence of heart disease and in subjects without MS (n = 14, non-MS group). Coronary vascular resistance (CVR) was calculated by dividing the mean aortic blood pressure by MBF. Myocardial blood flow reserve (MFR) was calculated as the ratio of the MBF during adenosine infusion to that during rest. Blood chemical parameters were measured to evaluate their relationship with MFR. During adenosine infusion, MBF was lower (p = 0.0085) and CVR higher (p = 0.0128) in the MS group than in the non-MS group and MFR was significantly lower in the MS group than in the non-MS group (2.13 +/- 0.99 vs. 3.38 +/- 0.95, p = 0.0027). Multivariate analysis demonstrated that the homeostasis model assessment-insulin resistance (p < 0.05) and the presence of hypertension (p < 0.05) were independent determinants of MFR. CONCLUSIONS The results indicate that MFR was impaired in MS subjects, suggesting that an abnormal coronary microvascular response occurred in these subjects. This abnormality may have been partially due to insulin resistance and hypertension.
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Mahmarian JJ. Myocardial perfusion imaging to evaluate the efficacy of medical therapy in patients with coronary artery disease. CURRENT CARDIOVASCULAR IMAGING REPORTS 2009. [DOI: 10.1007/s12410-009-0023-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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The Effects of Medications on Myocardial Perfusion. J Am Coll Cardiol 2008; 52:401-16. [PMID: 18672159 DOI: 10.1016/j.jacc.2008.04.035] [Citation(s) in RCA: 75] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2008] [Revised: 04/14/2008] [Accepted: 04/21/2008] [Indexed: 11/23/2022]
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A 6 month randomized, double blind, placebo controlled, multi-center trial of high dose atorvastatin on myocardial perfusion abnormalities by positron emission tomography in coronary artery disease. Am Heart J 2008; 155:245-53. [PMID: 18215593 DOI: 10.1016/j.ahj.2007.10.025] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2007] [Accepted: 10/01/2007] [Indexed: 11/21/2022]
Abstract
BACKGROUND In coronary artery disease (CAD), statins decrease morbidity and mortality but changes in myocardial perfusion abnormalities remain poorly defined. METHODS We completed a randomized, double blind, placebo controlled, multi-center trial of 145 patients, 43 to 86 years old, with CAD from seven community and academic centers for cardiac positron emission tomography (PET) randomized to 6 months of atorvastatin 80 mg daily (72 patients) or placebo (73 patients). PET scans were obtained at baseline, 6 weeks and 6 months using N-13 ammonia or Rb-82 at rest and after dipyridamole or adenosine stress, submitted to the core PET laboratory in Houston. Change in stress induced perfusion defects from baseline to follow-up PET scans was scored by two independent, double blinded readers and by automated quantitative software. RESULTS Total and LDL cholesterol decreased by 37% and 51%, respectively in atorvastatin but not placebo groups (P < .05). The primary endpoint, quantitative severity (lowest mean quadrant activity), showed no significant difference between treatment and placebo. The secondary endpoint, predefined blinded visual change scores, improved significantly after atorvastatin compared to placebo at six months (P = .02). Ad-hoc subgroup analysis showed interaction between quantitative defect size and treatment response with perfusion defects in the upper tertile of size by automated software improving more in atorvastatin than placebo groups (P = .016). CONCLUSION The primary endpoint, quantitative severity of myocardial perfusion abnormalities by PET, did not improve after 6 months of atorvastatin 80 mg daily compared to placebo. The secondary endpoint of predefined blinded visual change scores significantly improved, as did a subgroup in the upper tertile of defect size, compared to placebo.
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Murakami M, Fujioka S, Hirata Y, Kuratsu JI. Low-dose of Statin Treatment Improves Cerebrovascular Reactivity in Patients With Ischemic Stroke: Single Photon Emission Computed Tomography Analysis. J Stroke Cerebrovasc Dis 2008; 17:16-22. [DOI: 10.1016/j.jstrokecerebrovasdis.2007.09.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2006] [Revised: 08/03/2007] [Accepted: 09/03/2007] [Indexed: 11/27/2022] Open
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Nemes A, Forster T, Csanády M. Impaired coronary flow velocity reserve and aortic distensibility in patients with untreated hypercholesterolemia--an echocardiographic study. Int J Cardiovasc Imaging 2006; 23:15-23. [PMID: 16779615 DOI: 10.1007/s10554-006-9103-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2005] [Accepted: 05/08/2006] [Indexed: 01/20/2023]
Abstract
INTRODUCTION Hypercholesterolemia is a primary risk factor for the development of atherosclerosis and leading to severe stages of coronary artery disease (CAD) and aortic atherosclerosis (AA). The objective of this investigation was to measure elastic modulus [(E(p), in 10(3) mmHg] and Young's circumferential static elastic modulus [(E(s), in 10(3) mmHg] as aortic distensibility indices and coronary flow velocity reserve (CFR) in untreated hypercholesterolemic (HC) patients in the course of the same stress transesophageal echocardiography (TEE) and to compare their results to normochole- sterolemic (NC) subjects. PATIENTS AND METHODS The following patient populations were compared: 17 NC subjects with negative coronary angiograms, 18 patients with untreated hypercholesterolemia with a negative coronary angiogram and 23 HC patients with significant left anterior descending coronary artery (LAD) disease. All patients underwent coronary angiography, transthoracic and stress TEE examinations. RESULTS CFR was significantly reduced in patients of both groups with hypercholesterolemia as compared to NC subjects (1.99+/-0.76 and 1.79+/-0.32 vs. 2.58+/-0.63, P<0.05, respectively). E(p) was significantly increased in HC patients with negative coronary angiograms as compared to NC subjects (0.39+/-0.18 vs. 0.67+/-0.19, P<0.05), while further increase was found in HC patients with LAD disease (0.67+/-0.19 vs. 1.09+/-0.52, P<0.05). E(s) behaved similarly (4.06+/-2.73 vs. 7.60+/-3.70 vs. 11.38+/-6.91, P<0.05, respectively). CONCLUSION In conclusion it may be stated that CFR and aortic distensibility indices can be evaluated simultaneously by stress TEE in HC patients. CFR and aortic distensibility were impaired in HC patients as compared to NC subjects.
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Affiliation(s)
- Attila Nemes
- Medical Faculty, 2nd Department of Medicine and Cardiology Center, Albert Szent-Györgyi Medical and Pharmaceutical Center, University of Szeged, Korányi fasor 6, P.O. Box 427, H-6720, Szeged, Hungary.
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Dimitrow PP, Galderisi M, Rigo F. The non-invasive documentation of coronary microcirculation impairment: role of transthoracic echocardiography. Cardiovasc Ultrasound 2005; 3:18. [PMID: 16080792 PMCID: PMC1201155 DOI: 10.1186/1476-7120-3-18] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2005] [Accepted: 08/04/2005] [Indexed: 02/06/2023] Open
Abstract
Transthoracic Doppler echocardiographic-derived coronary flow reserve is an useful hemodynamic index to assess dysfunction of coronary microcirculation. Isolated coronary microvascular abnormalities are overt by reduced coronary flow reserve despite normal epicardial coronary arteries. These abnormalities may occur in several diseases (arterial hypertension, diabetes mellitus, hypercholesterolemia, syndrome X, aortic valve disease, hypertrophic cardiomyopathy and idiopathic dilated cardiomyopathy). The prognostic role of impaired microvascular coronary flow reserve has been shown unfavourable especially in hypertrophic or idiopathic dilated cardiomyopathies. Coronary flow reserve reduction may be reversible, for instance after regression of left ventricular hypertrophy subsequent to valve replacement in patients with aortic stenosis, after anti-hypertensive treatment or using cholesterol lowering drugs. Coronary flow reserve may increase by 30% or more after pharmacological therapy and achieve normal level >3.0. In contrast to other non invasive tools as positron emission tomography, very expensive and associated with radiation exposure, transthoracic Doppler-derived coronary flow reserve is equally non invasive but cheaper, very accessible and prone to a reliable exploration of coronary microvascular territories, otherwise not detectable by invasive coronary angiography, able to visualize only large epicardial arteries.
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Affiliation(s)
- Pawel Petkow Dimitrow
- 2Department of Cardiology, Collegium Medicum, Jagiellonian University, Cracow, Poland
| | - Maurizio Galderisi
- Division of Cardioangiology with CCU, Department of Clinical and Experimental Medicine, Federico II University of Naples, Italy
| | - Fausto Rigo
- Department of Cardiology Umberto I° Hospital Mestre-Venice, Italy
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Alonso R, Mata N, Mata P. Benefits and risks assessment of simvastatin in familial hypercholesterolaemia. Expert Opin Drug Saf 2005; 4:171-81. [PMID: 15794711 DOI: 10.1517/14740338.4.2.171] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Familial hypercholesterolaemia (FH) is a frequent inherited monogenic disorder, associated with premature coronary artery disease. Life expectancy of FH patients is reduced by 15 - 30 years unless they are adequately treated with lipid-lowering therapy. Patients with this disorder need long-term drug therapy and the selection of treatment should be strongly based on its long-term safety and tolerability. The introduction of 3-hydroxy-3-methylglutaryl-coenzyme A reductase inhibitors has changed the treatment of FH. Simvastatin 40 - 80 mg/day effectively reduces serum low-density lipoprotein cholesterol levels, and also reduces triglycerides with a modest rise in high-density lipoprotein cholesterol levels. Other potentially important effects, such as improvement of endothelial function, reduction of LDL oxidation and vascular inflammation, have been associated with simvastatin therapy in FH. In addition, simvastatin has been shown to abolish the progression, and even facilitate the regression of existing human atherosclerotic lesions. The safety and tolerability of simvastatin is clearly highlighted by the low rate of therapy discontinuation observed in several population-based clinical trials. Asymptomatic elevations in liver transaminase levels and myopathy are uncommon. The efficacy and tolerability of simvastatin at doses up to 80 mg/day are well-established, as well as its cost-effectiveness in the management of FH patients.
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Affiliation(s)
- Rodrigo Alonso
- Fundación Jiménez Díaz, Lipid Clinic, Internal Medicine Department, Madrid 28040, Spain
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Affiliation(s)
- Marcelo F Di Carli
- Department of Nuclear Medicine, Department of Radiology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, USA.
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Sonoda M, Yonekura K, Yokoyama I, Takenaka K, Nagai R, Aoyagi T. Common carotid intima–media thickness is correlated with myocardial flow reserve in patients with coronary artery disease: a useful non-invasive indicator of coronary atherosclerosis. Int J Cardiol 2004; 93:131-6. [PMID: 14975538 DOI: 10.1016/s0167-5273(03)00125-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2002] [Revised: 01/20/2003] [Accepted: 01/21/2003] [Indexed: 11/16/2022]
Abstract
BACKGROUND The common carotid intima-media thickness (IMT) is correlated with the angiographically determined coronary artery stenosis. However, their correlation is weak, which limits the clinical application of the IMT as a predictor of coronary artery stenosis. The IMT reflects diffuse early-phase atherosclerosis, whereas the angiographically determined coronary artery stenosis is a late-phase phenomenon. The latter is localized and rapidly progressive with plaque rupture and acute thrombosis. Instead of the angiographically determined coronary artery stenosis, we employed myocardial flow reserve (MFR) that reflects diffuse early-phase coronary atherosclerosis and impaired coronary vasodilatation function. We evaluated the relationship between the IMT and the MFR. METHODS Twenty-three patients with angiographically diagnosed coronary artery disease (CAD) underwent B-mode ultrasound examination to measure their common carotid IMT and positron emission tomography (PET) with dipyridamole intervention to obtain their MFR. We also performed B-mode ultrasound examination in 21 patients with hypertension without CAD and in 15 control subjects. RESULTS The common carotid IMT in patients with CAD was thickened (0.92+/-0.15 vs. 0.81+/-0.14 mm in patients with hypertension (P<0.05) and 0.69+/-0.13 mm in control subjects (P<0.01)). The IMT was inversely correlated with the MFR (r=0.51, P<0.01). The correlations between the MFR and most of the coronary risk factors (age, blood pressure, serum cholesterol level and triglyceride level, HbA1c level, smoking index) did not reach statistical significance. CONCLUSIONS Thickened common carotid IMT is also an indicator of reduced MFR or early-phase coronary atherosclerosis.
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Affiliation(s)
- Makoto Sonoda
- Department of Cardiovascular Medicine, University of Tokyo, Graduate School of Medicine, Tokyo, Japan
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Mata P, Alonso R, Badimón J. Benefits and risks of simvastatin in patients with familial hypercholesterolaemia. Drug Saf 2004; 26:769-86. [PMID: 12908847 DOI: 10.2165/00002018-200326110-00003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Familial hypercholesterolaemia is a frequent, inherited, monogenic disorder, associated with accelerated development of atherosclerotic disease leading to coronary artery disease. Life expectancy of patients with familial hypercholesterolaemia is reduced by 15-30 years unless they are adequately treated with lipid-lowering therapy. Given the chronic nature of this disease, the selection of a therapeutic approach should be strongly based on its long-term safety and tolerability. The introduction of HMG-CoA reductase inhibitors has revolutionised the treatment of familial hypercholesterolaemia. Simvastatin 40-80 mg/day effectively reduces serum low density lipoprotein (LDL)-cholesterol levels. Furthermore, simvastatin reduces triglycerides and mildly raises high density lipoprotein-cholesterol levels. In addition to the hypolipidaemic effect, other potentially important effects, such as improvement of endothelial function and reduction of LDL oxidation and vascular inflammation, have been associated with HMG-CoA reductase inhibitor therapy. Simvastatin has also been shown to abolish the progression, and even facilitate the regression, of existing human atherosclerotic lesions. The good safety and tolerability profile of simvastatin is clearly highlighted by the low rate of therapy discontinuation observed in several population-based clinical trials. The most common adverse events leading to the discontinuation of therapy are gastrointestinal upset and headache. Asymptomatic elevations in liver transaminase levels and myopathy are uncommon. The overwhelming clinical evidence regarding the long-term use of HMG-CoA reductase inhibitor therapy in patients with familial hypercholesterolaemia together with the long-term safety data (particularly relating to simvastatin) provide support for the use of this drug as a first-line agent when pharmacological treatment is indicated. Early intervention with simvastatin treatment can be successfully implemented with favourable economic benefits.
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Affiliation(s)
- Pedro Mata
- Lipid Clinic, Internal Medicine Department, Fundación Jiménez Díaz, Madrid, Spain.
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Schwartz RG, Pearson TA, Kalaria VG, Mackin ML, Williford DJ, Awasthi A, Shah A, Rains A, Guido JJ. Prospective serial evaluation of myocardial perfusion and lipids during the first six months of pravastatin therapy: coronary artery disease regression single photon emission computed tomography monitoring trial. J Am Coll Cardiol 2003; 42:600-10. [PMID: 12932588 DOI: 10.1016/s0735-1097(03)00767-8] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES This study was designed to assess prospectively changes in serum lipid profile and myocardial perfusion with serial radionuclide single photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) during the first six months of pravastatin therapy. BACKGROUND Morbid coronary events occur despite statin therapy and lipid-lowering in patients with coronary artery disease (CAD). A reliable strategy to identify responders with effective treatment from nonresponders on statin therapy before clinical events is needed. METHODS Rest and stress SPECT MPI and lipids were assessed serially in 25 patients (36% women) with CAD and dyslipidemia during the first six months of pravastatin therapy. RESULTS Total cholesterol, low-density lipoprotein cholesterol, and triglycerides declined (26%, 32%, and 30%, respectively) by six weeks and remained reduced at six months. Mean stress perfusion defect (summed stress score [SSS]) was severe (13.3 +/- 6.0) at baseline, showed no change at six weeks, and improved significantly at six months (10.3 +/- 7.3, p < 0.01). The six-month study SSS improved in 11 (48%) patients, was unchanged in 10 (43%) patients, and worsened in 2 (9%) patients. Changes in lipid levels did not reliably predict changes in myocardial perfusion at six weeks or six months in this small pilot study. CONCLUSIONS Serial SPECT MPI demonstrated improved stress myocardial perfusion in 48% of patients treated for six months with pravastatin. Time course of improved myocardial perfusion during pravastatin therapy is delayed compared to lipids. Direction and magnitude of changes in the myocardial perfusion vary and do not correlate closely with improvements in lipids.
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Affiliation(s)
- Ronald G Schwartz
- Cardiology Unit, Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA.
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Patel AD, Iskandrian AE. Role of single photon emission computed tomography imaging in the evaluation of therapy for angina pectoris. Am Heart J 2003; 145:952-61. [PMID: 12796749 DOI: 10.1016/s0002-8703(03)00088-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Amar D Patel
- Division of Cardiovascular Diseases, Department of Medicine, University of Alabama at Birmingham, USA
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