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Göbel A, Pählig S, Motz A, Breining D, Traikov S, Hofbauer LC, Rachner TD. Overcoming statin resistance in prostate cancer cells by targeting the 3-hydroxy-3-methylglutaryl-CoA-reductase. Biochem Biophys Res Commun 2024; 710:149841. [PMID: 38588613 DOI: 10.1016/j.bbrc.2024.149841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Revised: 03/14/2024] [Accepted: 03/26/2024] [Indexed: 04/10/2024]
Abstract
Prostate cancer is the most prevalent malignancy in men. While diagnostic and therapeutic interventions have substantially improved in recent years, disease relapse, treatment resistance, and metastasis remain significant contributors to prostate cancer-related mortality. Therefore, novel therapeutic approaches are needed. Statins are inhibitors of the 3-hydroxy-3-methylglutaryl-CoA reductase (HMGCR), the rate-limiting enzyme of the mevalonate pathway which plays an essential role in cholesterol homeostasis. Numerous preclinical studies have provided evidence for the pleiotropic antitumor effects of statins. However, results from clinical studies remain controversial and have shown substantial benefits to even no effects on human malignancies including prostate cancer. Potential statin resistance mechanisms of tumor cells may account for such discrepancies. In our study, we treated human prostate cancer cell lines (PC3, C4-2B, DU-145, LNCaP) with simvastatin, atorvastatin, and rosuvastatin. PC3 cells demonstrated high statin sensitivity, resulting in a significant loss of vitality and clonogenic potential (up to - 70%; p < 0.001) along with an activation of caspases (up to 4-fold; p < 0.001). In contrast, C4-2B and DU-145 cells were statin-resistant. Statin treatment induced a restorative feedback in statin-resistant C4-2B and DU-145 cells through upregulation of the HMGCR gene and protein expression (up to 3-folds; p < 0.01) and its transcription factor sterol-regulatory element binding protein 2 (SREBP-2). This feedback was absent in PC3 cells. Blocking the feedback using HMGCR-specific small-interfering (si)RNA, the SREBP-2 activation inhibitor dipyridamole or the HMGCR degrader SR12813 abolished statin resistance in C4-2B and DU-145 and induced significant activation of caspases by statin treatment (up to 10-fold; p < 0.001). Consistently, long-term treatment with sublethal concentrations of simvastatin established a stable statin resistance of a PC3SIM subclone accompanied by a significant upregulation of both baseline as well as post-statin HMGCR protein (gene expression up to 70-fold; p < 0.001). Importantly, the statin-resistant phenotype of PC3SIM cells was reversible by HMGCR-specific siRNA and dipyridamole. Our investigations reveal a key role of a restorative feedback driven by the HMGCR/SREBP-2 axis in statin resistance mechanisms of prostate cancer cells.
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Affiliation(s)
- Andy Göbel
- Mildred Scheel Early Career Center, Division of Endocrinology and Metabolic Bone Diseases, Department of Medicine III, Technische Universität Dresden, Dresden, Germany; Center for Healthy Ageing, Department of Medicine III, Technische Universität Dresden, Dresden, Germany; German Cancer Consortium (DKTK), Dresden and German Cancer Research Center (DKFZ), Heidelberg, Germany.
| | - Sophie Pählig
- Mildred Scheel Early Career Center, Division of Endocrinology and Metabolic Bone Diseases, Department of Medicine III, Technische Universität Dresden, Dresden, Germany; Center for Healthy Ageing, Department of Medicine III, Technische Universität Dresden, Dresden, Germany; German Cancer Consortium (DKTK), Dresden and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Anja Motz
- Mildred Scheel Early Career Center, Division of Endocrinology and Metabolic Bone Diseases, Department of Medicine III, Technische Universität Dresden, Dresden, Germany
| | - Dorit Breining
- Mildred Scheel Early Career Center, Division of Endocrinology and Metabolic Bone Diseases, Department of Medicine III, Technische Universität Dresden, Dresden, Germany
| | - Sofia Traikov
- Max Planck Institute for Molecular Cell Biology and Genetics, Dresden, Germany
| | - Lorenz C Hofbauer
- Mildred Scheel Early Career Center, Division of Endocrinology and Metabolic Bone Diseases, Department of Medicine III, Technische Universität Dresden, Dresden, Germany; Center for Healthy Ageing, Department of Medicine III, Technische Universität Dresden, Dresden, Germany; German Cancer Consortium (DKTK), Dresden and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Tilman D Rachner
- Mildred Scheel Early Career Center, Division of Endocrinology and Metabolic Bone Diseases, Department of Medicine III, Technische Universität Dresden, Dresden, Germany; Center for Healthy Ageing, Department of Medicine III, Technische Universität Dresden, Dresden, Germany; German Cancer Consortium (DKTK), Dresden and German Cancer Research Center (DKFZ), Heidelberg, Germany
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2
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Cortigiani L, Gaibazzi N, Ciampi Q, Rigo F, Rodríguez‐Zanella H, Wierzbowska‐Drabik K, Kasprzak JD, Arbucci R, Lowenstein J, Zagatina A, Bartolacelli Y, Gregori D, Carerj S, Pepi M, Pellikka PA, Picano E. High Resting Coronary Flow Velocity by Echocardiography Is Associated With Worse Survival in Patients With Chronic Coronary Syndromes. J Am Heart Assoc 2024; 13:e031270. [PMID: 38362899 PMCID: PMC11010105 DOI: 10.1161/jaha.123.031270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Accepted: 11/14/2023] [Indexed: 02/17/2024]
Abstract
BACKGROUND Resting coronary flow velocity (CFV) in the mid-distal left anterior descending coronary artery can be easily assessed with transthoracic echocardiography. In this observational study, the authors sought to assess the relationship between resting CFV, CFV reserve (CFVR), and outcome in patients with chronic coronary syndromes. METHODS AND RESULTS In a prospective multicenter study design, the authors retrospectively analyzed 7576 patients (age, 66±11 years; 4312 men) with chronic coronary syndromes and left ventricular ejection fraction ≥50% referred for dipyridamole stress echocardiography. Recruitment (years 2003-2021) involved 7 accredited laboratories, with interobserver variability <10% for CFV measurement at study entry. Baseline peak diastolic CFV was obtained by pulsed-wave Doppler in the mid-distal left anterior descending coronary artery. CFVR (abnormal value ≤2.0) was assessed with dipyridamole. All-cause death was the only end point. The mean CFV of the left anterior descending coronary artery was 31±12 cm/s. The mean CFVR was 2.32±0.60. During a median follow-up of 5.9±4.3 years, 1121 (15%) patients died. At multivariable analysis, resting CFV ≥32 cm/s was identified by a receiver operating curve as the best cutoff and was independently associated with mortality (hazard ratio [HR], 1.24 [95% CI, 1.10-1.40]; P<0.0001) together with CFVR ≤2.0 (HR, 1.78 [95% CI, 1.57-2.02]; P<0.0001), age, diabetes, history of coronary surgery, and left ventricular ejection fraction. When both CFV and CFVR were considered, the mortality rate was highest in patients with resting CFV ≥32 cm/s and CFVR ≤2.0 and lowest in patients with resting CFV <32 cm/s and CFVR >2.0. CONCLUSIONS High resting CFV is associated with worse survival in patients with chronic coronary syndromes and left ventricular ejection fraction ≥50%. The value is independent and additive to CFVR. The combination of high resting CFV and low CFVR is associated with the worst survival.
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Affiliation(s)
| | | | - Quirino Ciampi
- Cardiology Division, Fatebenefratelli HospitalBeneventoItaly
| | - Fausto Rigo
- Cardiology Division, Villa Salus HospitalMestreItaly
| | | | | | | | - Rosina Arbucci
- Cardiodiagnosticos, Investigaciones Medicas CenterBuenos AiresArgentina
| | - Jorge Lowenstein
- Cardiodiagnosticos, Investigaciones Medicas CenterBuenos AiresArgentina
| | - Angela Zagatina
- Saint Petersburg State Pediatric Medical UniversitySaint PetersburgRussian Federation
| | - Ylenia Bartolacelli
- Paediatric Cardiology and Adult Congenital Heart Disease Program, Department of Cardio‐Thoracic and Vascular Medicine IRCCS Azienda Ospedaliero‐Universitaria di BolognaPoliclinico S. Orsola‐Malpighi HospitalBolognaItaly
| | - Dario Gregori
- Biostatistics, Epidemiology and Public Health UnitPadova UniversityPadovaItaly
| | - Scipione Carerj
- Divisione di Cardiologia, Policlinico UniversitarioUniversità di MessinaMessinaItaly
| | - Mauro Pepi
- Centro Cardiologico Monzino, IRCCSMilanItaly
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Hotani A, Kitabatake K, Tsukimoto M. Extracellular Guanosine and Guanine Nucleotides Decrease Viability of Human Breast Cancer SKBR-3 Cells. Biol Pharm Bull 2024; 47:14-22. [PMID: 37880111 DOI: 10.1248/bpb.b23-00402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2023]
Abstract
Though the physiological effects of adenosine and adenine nucleotides on purinergic receptors in cancer cells have been well studied, the influence of extracellular guanosine and guanine nucleotides on breast cancer cells remains unclear. Here, we show that extracellular guanosine and guanine nucleotides decrease the viability and proliferation of human breast cancer SKBR-3 cells. Treatment with guanosine or guanine nucleotides increased mitochondrial production of reactive oxygen species (ROS), and modified the cell cycle. Guanosine-induced cell death was suppressed by treatment with adenosine or the equilibrium nucleoside transporter (ENT) 1/2 inhibitor dipyridamole, but was not affected by adenosine receptor agonists or antagonists. These results suggest that guanosine inhibits adenosine uptake through ENT1/2, but does not antagonize adenosine receptors. In contrast, guanosine triphosphate (GTP)-induced cell death was suppressed not only by adenosine and dipyridamole, but also by the A1 receptor agonist 2-chloro-N6-cyclopentyladenosine (CCPA), suggesting that GTP-induced cell death is mediated in part by an antagonistic effect on adenosine A1 receptor. Thus, both guanosine and GTP induce apoptosis of breast cancer cells, but via at least partially different mechanisms.
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Affiliation(s)
- Ai Hotani
- Department of Radiation Biosciences, Faculty of Pharmaceutical Sciences, Tokyo University of Science
| | - Kazuki Kitabatake
- Department of Radiation Biosciences, Faculty of Pharmaceutical Sciences, Tokyo University of Science
| | - Mitsutoshi Tsukimoto
- Department of Radiation Biosciences, Faculty of Pharmaceutical Sciences, Tokyo University of Science
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Tavoosi A, Khetarpal R, Wells RG, Beanlands RSB, deKemp RA. Exponential dosing to standardize myocardial perfusion image quality with rubidium-82 PET. J Nucl Cardiol 2023; 30:2477-2489. [PMID: 37258955 PMCID: PMC10682245 DOI: 10.1007/s12350-023-03303-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 05/08/2023] [Indexed: 06/02/2023]
Abstract
BACKGROUND 82Rb PET is commonly performed using the same injected activity in all patients, resulting in lower image quality in larger patients. This study compared 82Rb dosing with exponential vs proportional functions of body weight on the standardization of myocardial perfusion image (MPI) quality. METHODS Two sequential cohorts of N = 60 patients were matched by patient weight. Rest and dipyridamole stress 82Rb PET was performed using 0.1 MBq·kg-2 exponential and 9 MBq·kg-1 proportional dosing. MPI scans were compared qualitatively with visual image quality scoring (IQS) and quantitatively using the myocardium-to-blood contrast-to-noise ratio (CNR) and blood background signal-to-noise ratio (SNR) as a function of body weight. RESULTS Average (min-max) patient body weight was 81 ± 18 kg (46-137 kg). Proportional dosing resulted in decreasing CNR, SNR, and visual IQS with increasing body weight (P < 0.05). Exponential dosing eliminated the weight-dependent decreases in these image quality metrics that were observed in the proportional dosing group. CONCLUSION 82Rb PET dosing as an exponential (squared) function of body weight produced consistent stress perfusion image quality over a wide range of patient weights. Dramatically lower doses can be used in lighter patients, with the equivalent population dose shifted toward the heavier patients to standardize diagnostic image quality.
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Affiliation(s)
- Anahita Tavoosi
- Department of Medicine (Cardiology), University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, ON, K1Y 4W7, Canada
| | - Ritika Khetarpal
- School of Interdisciplinary Science (Life Sciences), McMaster University, 1280 Main St W, Hamilton, ON, L8S 4L8, Canada
| | - R Glenn Wells
- Department of Medicine (Cardiology), University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, ON, K1Y 4W7, Canada
| | - Rob S B Beanlands
- Department of Medicine (Cardiology), University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, ON, K1Y 4W7, Canada
| | - Robert A deKemp
- Department of Medicine (Cardiology), University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, ON, K1Y 4W7, Canada.
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Wu H, Xiao Z. A knowledge graph-based analytical model for mining clinical value of drug stress echocardiography for diagnosis, risk stratification and prognostic evaluation of coronary artery disease. Int J Cardiol 2023; 387:131107. [PMID: 37271285 DOI: 10.1016/j.ijcard.2023.05.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 05/04/2023] [Accepted: 05/30/2023] [Indexed: 06/06/2023]
Abstract
The three major techniques for clinically diagnosing coronary heart disease, including angina associated with myocardial ischemia, are coronary angiography, myocardial perfusion imaging, and drug stress echocardiography. Compared to the first two methods, which are invasive or involve the use of radionuclides, drug stress echocardiography is increasingly used in clinical practice due to its non-invasive, low-risk, and controllable nature, and wide applicability. We developed a novel methodology to demonstrate knowledge graph-based efficacy analysis of drug stress echocardiography as a complement to traditional meta-analysis. By measuring coronary flow reserve (CFR), we discovered that regional ventricular wall abnormalities (RVWA) and drug-loaded cardiac ultrasound can be used to detect coronary artery disease. Additionally, drug-loaded cardiac ultrasound can be used to identify areas of cardiac ischemia, stratify risks, and determine prognosis. Furthermore, adenosine stress echocardiography(ASE) can determine atypical symptoms of coronary heart disease with associated cardiac events through CFR and related quantitative indices for risk stratification. Using a knowledge graph-based approach, we investigated the positive and negative effects of three drugs - Dipyridamole, Dobutamine, and Adenosine - for coronary artery disease analysis. Our findings show that Adenosine has the highest positive effect and the lowest negative effect among the three drugs. Due to its minimal and controlled side effects, and high sensitivity for diagnosing coronary microcirculation disorders and multiple lesions, adenosine is frequently used in clinical practice.
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Affiliation(s)
- Hongyi Wu
- Department of Cardiology, Zhongshan Hospital affiliated to Fudan University, Shanghai, China.
| | - Zhifeng Xiao
- School of Engineering, Penn State Erie, The Behrend College, Erie, 16563, PA, USA.
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Alexanderson-Rosas E, Garcia-Cardenas M, Gonzalez-Hernandez M, Keirns C, Carvajal-Juarez I, Espinola-Zavaleta N. Hypertensive response to dipyridamole: Report of a case and review of the literature. J Nucl Cardiol 2023; 30:851-853. [PMID: 34951002 DOI: 10.1007/s12350-021-02885-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 11/22/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Erick Alexanderson-Rosas
- Department of Nuclear Medicine, Instituto Nacional De Cardiología Ignacio Chávez, Juan Badiano No. 1 Colonia Sección XVI P.C., Tlalpan, 14080, Mexico City, Mexico
- Department of Physiology, National Autonomous University of Mexico, Mexico City, Mexico
| | - Mauricio Garcia-Cardenas
- Department of Nuclear Medicine, Instituto Nacional De Cardiología Ignacio Chávez, Juan Badiano No. 1 Colonia Sección XVI P.C., Tlalpan, 14080, Mexico City, Mexico
| | - Miguel Gonzalez-Hernandez
- Department of Nuclear Medicine, Instituto Nacional De Cardiología Ignacio Chávez, Juan Badiano No. 1 Colonia Sección XVI P.C., Tlalpan, 14080, Mexico City, Mexico
| | - Candace Keirns
- International Medical Interpreters Association, Boston, MA, USA
| | - Isabel Carvajal-Juarez
- Department of Nuclear Medicine, Instituto Nacional De Cardiología Ignacio Chávez, Juan Badiano No. 1 Colonia Sección XVI P.C., Tlalpan, 14080, Mexico City, Mexico
| | - Nilda Espinola-Zavaleta
- Department of Nuclear Medicine, Instituto Nacional De Cardiología Ignacio Chávez, Juan Badiano No. 1 Colonia Sección XVI P.C., Tlalpan, 14080, Mexico City, Mexico.
- Department of Echocardiography, ABC Medical Center I.A.P., Mexico City, Mexico.
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Cortigiani L, Vecchi A, Bovenzi F, Picano E. Reduced coronary flow velocity reserve and blunted heart rate reserve identify a higher risk group in patients with chest pain and negative emergency department evaluation. Intern Emerg Med 2022; 17:2103-2111. [PMID: 35864372 DOI: 10.1007/s11739-022-03018-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 05/25/2022] [Indexed: 11/30/2022]
Abstract
To estimate the prognostic value of stress echo (SE) with the assessment of coronary flow velocity reserve (CFVR) and heart rate reserve (HRR) in patients admitted for chest pain with non-diagnostic EKG, negative troponin, and without inducible regional wall motion abnormalities (RWMA). 658 patients (age 67 ± 12 years) admitted to our Emergency Department with chest pain, non-diagnostic EKG, and negative serial troponin underwent dipyridamole (0.84 mg/kg in 6') SE with simultaneous assessment of RWMA, CFVR in the left anterior descending artery, and HRR as peak/rest heart rate. The outcome measure was all-cause mortality. Of the 658 patients initially enrolled, 20 (3%) showed RWMA during SE and were referred to ischemia-driven revascularization. In the remaining 638, CFVR was abnormal (≤ 2.0) in 148 patients (23%). HRR was abnormal (≤ 1.22 in patients in sinus rhythm, or ≤ 1.17 in patients with permanent atrial fibrillation) in 196 patients (31%). During a follow-up of 7.3 ± 4.3 years, 151 (24%) patients died. Survival at 8 years was 93% in patients with normal CFVR and HRR, 76% in patients with abnormal CFVR only, 73% in patients with abnormal HRR only, and 38% in those with abnormal CFVR and HRR (p < 0.0001). At multivariable analysis, abnormal CFVR (HR 1.49, 95% CI 1.05-2.10, p = 0.02) and abnormal HRR (HR 2.01, 95% CI 1.43-2.84, p < 0.0001) were independent predictors of survival. In admitted patients with non-ischemic EKG, negative serial troponin, and without RWMA during dipyridamole SE, a reduced CFVR and blunted HRR independently identify a subset with worse survival in the long term. Upper panel: Color and pulsed-wave Doppler with the electrocardiographic lead tracing of Four different response patterns (from left to right): normal CFVR and HRR; normal CFVR, abnormal HRR; abnormal CFVR, normal HRR; abnormal CFVR and HRR. Lower panel: The annualized death rate for each of the four groups with negative SE for RWMA and stratified according to the presence of CFVR and HRR: none, one, or two abnormalities.
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Affiliation(s)
- Lauro Cortigiani
- Ospedale San Luca, Via Guglielmo Lippi Francesconi, 55100, Lucca, Italy.
| | - Andrea Vecchi
- Ospedale San Luca, Via Guglielmo Lippi Francesconi, 55100, Lucca, Italy
| | - Francesco Bovenzi
- Ospedale San Luca, Via Guglielmo Lippi Francesconi, 55100, Lucca, Italy
| | - Eugenio Picano
- Biomedicine Department, CNR, Institute of Clinical Physiology, Pisa, Italy
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Liu FS, Wang SY, Shiau YC, Wu YW. Integration of quantitative absolute myocardial blood flow estimates from dynamic CZT-SPECT improves the detection of coronary artery disease. J Nucl Cardiol 2022; 29:2311-2321. [PMID: 34240342 DOI: 10.1007/s12350-021-02713-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 06/17/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Balanced ischemia with multi-vessel coronary artery disease (CAD) is difficult to diagnose with semiquantitative single photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI). Dynamic cardiac SPECT provides quantitative estimations of stenosis severity and ischemic burden by assessing myocardial flow reserve (MFR) and myocardial blood flow (MBF). The aim of this study was to evaluate the incremental value of dynamic SPECT in multi-vessel coronary artery disease (CAD). METHODS Patients with suspected CAD who underwent dynamic ECG-gated dipyridamole MPI and coronary angiography within 6 months were retrospectively reviewed. The performance of summed stress, rest and difference scores (SSS, SRS, SDS), post-stress and resting MBF (MBFs, MBFr) and MFR were compared at both patient level and vessel level. RESULTS In 32 patients with 39 stenotic vessels, 12 had three-vessel disease (38%). Globally increased SSS and impaired MBF values were significantly associated with significant CAD at the patient level, but SDS and MFR were not. Regional increases in SSS and reductions in both MBFs and MBFr were significantly associated with stenotic vessels. The best cutoff value of global MBFs to predict CAD was 3.5 ml·g-1·min-1 (area under the curve, AUC = .84, P = .002). The best cutoff value of regional MBFs to detect significant stenosis was 3.6 ml·g-1·min-1 (AUC = .74, P < .001). However, the best possible cut-off values of MFR were not found. Sex-difference in both global and regional MBFr but MBFs was found, which might result in the non-significance in MFR. CONCLUSIONS This study validated a clinically available method to quantify MFR using dynamic CZT-SPECT. This method improved the detectability of multi-vessel CAD, and absolute MBFs was superior to MFR and other semiquantitative MPI parameters.
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Affiliation(s)
- Fang-Shin Liu
- Department of Nuclear Medicine, Far Eastern Memorial Hospital, No. 21, Sec. 2, Nanya S. Rd., Banciao Dist., New Taipei City, 220, Taiwan
- Department of Nuclear Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi County, Taiwan
| | - Shan-Ying Wang
- Department of Nuclear Medicine, Far Eastern Memorial Hospital, No. 21, Sec. 2, Nanya S. Rd., Banciao Dist., New Taipei City, 220, Taiwan
- Department of Nuclear Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei City, Taiwan
| | - Yu-Chien Shiau
- Department of Nuclear Medicine, Far Eastern Memorial Hospital, No. 21, Sec. 2, Nanya S. Rd., Banciao Dist., New Taipei City, 220, Taiwan
| | - Yen-Wen Wu
- Department of Nuclear Medicine, Far Eastern Memorial Hospital, No. 21, Sec. 2, Nanya S. Rd., Banciao Dist., New Taipei City, 220, Taiwan.
- Division of Cardiology, Cardiovascular Medical Center, Far Eastern Memorial Hospital, New Taipei City, Taiwan.
- National Yang-Ming University School of Medicine, Taipei City, Taiwan.
- Department of Nuclear Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei City, Taiwan.
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Zhelankin AV, Iulmetova LN, Sharova EI. The Impact of the Anticoagulant Type in Blood Collection Tubes on Circulating Extracellular Plasma MicroRNA Profiles Revealed by Small RNA Sequencing. Int J Mol Sci 2022; 23:ijms231810340. [PMID: 36142259 PMCID: PMC9499385 DOI: 10.3390/ijms231810340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 08/29/2022] [Accepted: 09/02/2022] [Indexed: 11/16/2022] Open
Abstract
Pre-analytical factors have a significant influence on circulating microRNA (miRNA) profiling. The aim of this study was a comprehensive assessment of the impact of the anticoagulant type in blood collection tubes on circulating plasma miRNA profiles using small RNA sequencing. Blood from ten healthy participants (five males and five females from 25 to 40 years old) was taken in collection tubes with four different anticoagulants: acid citrate dextrose (ACD-B), sodium citrate, citrate-theophylline-adenosine-dipyridamole (CTAD) and dipotassium-ethylenediaminetetraacetic acid (K2 EDTA). Platelet-free plasma samples were obtained by double centrifugation. EDTA plasma samples had elevated levels of hemolysis compared to samples obtained using other anticoagulants. Small RNA was extracted from plasma samples and small RNA sequencing was performed on the Illumina NextSeq 500 system. A total of 30 samples had been successfully sequenced starting from ~1 M reads mapped to miRNAs, allowing us to analyze their diversity and isoform content. The principal component analysis showed that the EDTA samples have distinct circulating plasma miRNA profiles compared to samples obtained using other anticoagulants. We selected 50 miRNA species that were differentially expressed between the sample groups based on the type of anticoagulant. We found that the EDTA samples had elevated levels of miRNAs which are abundant in red blood cells (RBC) and associated with hemolysis, while the levels of some platelet-specific miRNAs in these samples were lowered. The ratio between RBC-derived and platelet-derived miRNAs differed between the EDTA samples and other sample groups, which was validated by quantitative PCR. This study provides full plasma miRNA profiles of 10 healthy adults, compares them with previous studies and shows that the profile of circulating miRNAs in the EDTA plasma samples is altered primarily due to an increased level of hemolysis.
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10
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Yang H, Faust E, Gao E, Sethi S, Kitt TM, Kristy RM, Spalding JR, Xu Y. Evaluating the use of pharmacological stress agents during single-photon emission computed tomography myocardial perfusion imaging tests after inadequate exercise stress test. J Nucl Cardiol 2022; 29:1788-1795. [PMID: 33709333 PMCID: PMC9345818 DOI: 10.1007/s12350-021-02546-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 12/24/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Past clinical trial findings suggest that the availability of regadenoson in a nuclear imaging center may affect real-world center practices related to the transition of patients from an inadequate exercise stress test (EST) to a pharmacological stress agent (PSA). METHODS AND RESULTS This was a cross-sectional study using one-on-one telephone interviews with nuclear imaging center staff to facilitate survey development, followed by an online survey to evaluate patterns and processes around use of PSAs during single-photon emission computed tomography myocardial perfusion imaging (SPECT-MPI) in patients with inadequate ESTs. Of the 50 participants, 35 (70%) used only regadenoson, 3 (6%) only adenosine, 3 (6%) regadenoson and adenosine, 7 (14%) regadenoson and dipyridamole, and 2 (4%) all 3 agents for converting patients from an inadequate EST to a PSA. Nearly all centers (94%) used protocols to guide conversions. Of 12 centers using > 1 PSA, 11 reported regadenoson to be the most preferred PSA. Total staff time required from PSA transition to post-test monitoring was shortest for regadenoson. CONCLUSIONS Compared to adenosine and dipyridamole, regadenoson is preferred by nuclear imaging center staff and associated with operational efficiencies after inadequate EST in real-world practice SPECT-MPI.
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Affiliation(s)
| | | | | | | | | | | | | | - Yanqing Xu
- Astellas Pharma Global Development, Northbrook, IL USA
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11
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Wierzbowska-Drabik K, Picano E, Cortigiani L, Kasprzak JD. Comparison of coronary flow reserve feasibility in different stress echocardiography protocols: dobutamine, dipyridamole, exercise, and rapid pacing. Pol Arch Intern Med 2021; 131:830-839. [PMID: 34142788 DOI: 10.20452/pamw.16035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Coronary Flow Velocity Reserve (CFVR) assessment may improve diagnostic and prognostic value of stress echocardiography (SE). OBJECTIVES To compare the feasibility of CFVR assessment in the left anterior descending (LAD) artery in four types of SE: dobutamine (DOB), dipyridamole (DIP), rapid pacing (PAC) and bicycle exercise (EXE). PATIENTS AND METHODS We subjected 369 patients, mean (SD) age: 67 (11) to SE with DOB (n = 230), DIP (n = 73), PAC (n = 22) or EXE (n = 44). CFVR was measured as the ratio of peak diastolic coronary flow velocity (CFV) during exercise, pharmacological stress or pacing and peak diastolic CFV at rest in distal or mid LAD. RESULTS The feasibility was excellent during PAC (100%), DOB (95%) and DIP (95%) and lower during EXE (73%, P < 0.01 vs other groups). In multivariable analysis the EXE protocol was a predictor of LAD flow loss during SE, with OR = 7.89 (95% CI 2.17 - 31.33), P = 0.002. CFVR was lower with PAC 1.7 (1.4 - 2.0) as compared to DOB 2.1 (1.7 - 2.5), DIP 2.1 (1.8 - 2.5) and EXE 2.0 (1.7 - 2.3), P < 0.05 for all. CONCLUSIONS CFVR in LAD can be obtained during all forms of SE, but the feasibility is significantly higher with PAC and pharmacological tests as compared to EXE, which was identified in our study as the independent predictor of the loss of LAD flow recording at the peak of stress test.
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Affiliation(s)
| | | | | | - Jarosław D Kasprzak
- 1st Department of Cardiology, Medical University of Lodz, Biegański Hospital, Łódź, Poland
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12
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Cortigiani L, Carpeggiani C, Landi P, Raciti M, Bovenzi F, Picano E. Prognostic Value of Heart Rate Reserve during Dipyridamole Stress Echocardiography in Patients With Abnormal Chronotropic Response to Exercise. Am J Cardiol 2021; 154:106-110. [PMID: 34233833 DOI: 10.1016/j.amjcard.2021.05.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 05/26/2021] [Accepted: 05/26/2021] [Indexed: 11/29/2022]
Abstract
Heart rate reserve (HRR) during physical or pharmacological stress is a sign of cardiac autonomic function and sympathetic reserve, but it can be reduced during exercise for confounders such as poor motivation, drugs or physical fitness. In this study we sought to assess the prognostic meaning of HRR during dipyridamole stress echocardiography (DSE) in patients with abnormal chronotropic response to exercise. From 2004 to 2019, we prospectively acquired and retrospectively analyzed 379 patients (age 62 ± 11 years; ejection fraction 60 ± 5%) with suspected (n = 243) or known (n = 136) chronic coronary syndromes, referred to DSE for chronotropic incompetence during upright bicycle exercise-electrocardiography test defined as HRR used [(peak HR - rest HR) / (220 - age) - rest HR] ≤80% in patients off and ≤62% in patients on beta-blockers. All patients were in sinus rhythm and underwent DSE (0.84 mg/kg) within 3 months of exercise testing. During DSE, age-independent HRR (peak/rest HR) ≤1.22 was considered abnormal. All patients were followed-up. All-cause death was the only outcome measure. HRR during DSE was normal in 275 (73%) and abnormal in 104 patients (27%). During a follow-up of 9.0 ± 4.2 years, 67 patients (18%) died. The 15-year mortality rate was 23% in patients with normal and 61% in patients with abnormal HRR (p < 0.0001). At multivariable analysis a blunted HRR during DSE was an independent predictor of outcome (hazard ratio 2.01, 95% confidence intervals 1.23-3.29; p = 0.005) with age and diabetes, while neither inducible ischemia nor ongoing beta-blocker therapy were significant predictors. In conclusion, a blunted HRR during DSE predicts a worse survival in patients with chronotropic incompetence during exercise test. HRR during DSE is an appealingly simple biomarker of cardiac autonomic dysfunction independent of imaging, exercise and beta-blocker therapy.
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Affiliation(s)
| | | | | | - Mauro Raciti
- CNR Institute of Clinical Physiology, Pisa, Italy
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13
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Lehmann A, Krollik K, Beran K, Hirtreiter C, Kubas H, Wagner C. Increasing the Robustness of Biopharmaceutical Precipitation Assays - Part I: Derivative UV Spectrophotometric Method Development for in-line Measurements. J Pharm Sci 2021; 111:146-154. [PMID: 34464648 DOI: 10.1016/j.xphs.2021.08.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 08/25/2021] [Accepted: 08/25/2021] [Indexed: 12/17/2022]
Abstract
In vitro precipitation assays are often applied to support drug and formulation development. Current methods applied to quantify the amount of dissolved drug, in particular (U)HPLC, require time-consuming sample preparation. Furthermore, small precipitates formed during the nucleation phase may not be removed quantitatively by filtration or centrifugation of the sample. Given the drawbacks of standard (U)HPLC analyses during the application in transfer experiments, it was the aim of this work to develop a robust and simple to implement in-line UV spectrophotometric method which accurately reflects the precipitation profile obtained from in vitro transfer assays. Based on the three model compounds cinnarizine, dipyridamole, and ketoconazole, the manuscript describes the development of a design of experiments (DoE) based approach to develop derivative UV spectrophotometric methods accounting for the change in media composition over time due to the dilution of simulated intestinal with simulated gastric fluid. An R script was developed which automatically identifies suitable wavelengths for in-line measurements. As an outcome of this study, a fast, robust, accurate, and specific derivative UV spectrophotometric methodology for measuring the concentration of dissolved drugs in in vitro transfer experiments was successfully developed. This method can flexibly be applied to multi-compartmental precipitation assays.
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Affiliation(s)
| | - Katharina Krollik
- Merck KGaA, Frankfurter Strasse 250, Darmstadt, Germany; Institute of Pharmacy, Department of Biopharmaceutics and Pharmaceutical Technology, University of Greifswald, Felix-Hausdorff-Strasse 3, Greifswald, Germany
| | - Kristian Beran
- Merck KGaA, Frankfurter Strasse 250, Darmstadt, Germany; Institute of Pharmaceutical Chemistry, Goethe University, Frankfurt, Germany
| | | | - Holger Kubas
- Merck KGaA, Frankfurter Strasse 250, Darmstadt, Germany
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Aikawa T, Funayama N, Sunaga D, Kayanuma K, Oyama-Manabe N, Hotta D. Reverse redistribution-like change on dipyridamole-stress 99mTc-tetrofosmin imaging in a patient with angiographically mild coronary artery stenosis. J Nucl Cardiol 2021; 28:1182-1185. [PMID: 33751474 PMCID: PMC8249293 DOI: 10.1007/s12350-021-02553-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 12/08/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Tadao Aikawa
- Department of Cardiology, Hokkaido Cardiovascular Hospital, 1-30, Minami-27, Nishi-13, Chuo-ku, Sapporo, 064-8622, Japan.
- Department of Radiology, Jichi Medical University Saitama Medical Center, 1-847 Amanuma-cho, Omiya-ku, Saitama, 330-8503, Japan.
| | - Naohiro Funayama
- Department of Cardiology, Hokkaido Cardiovascular Hospital, 1-30, Minami-27, Nishi-13, Chuo-ku, Sapporo, 064-8622, Japan
| | - Daisuke Sunaga
- Department of Cardiology, Hokkaido Cardiovascular Hospital, 1-30, Minami-27, Nishi-13, Chuo-ku, Sapporo, 064-8622, Japan
| | - Keigo Kayanuma
- Department of Cardiology, Hokkaido Cardiovascular Hospital, 1-30, Minami-27, Nishi-13, Chuo-ku, Sapporo, 064-8622, Japan
| | - Noriko Oyama-Manabe
- Department of Radiology, Jichi Medical University Saitama Medical Center, 1-847 Amanuma-cho, Omiya-ku, Saitama, 330-8503, Japan
| | - Daisuke Hotta
- Department of Cardiology, Hokkaido Cardiovascular Hospital, 1-30, Minami-27, Nishi-13, Chuo-ku, Sapporo, 064-8622, Japan
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15
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Schelbert HR. On the Relativity of Dipyridamole and Dobutamine Flows. J Nucl Cardiol 2021; 28:46-49. [PMID: 32968970 DOI: 10.1007/s12350-020-02309-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 04/13/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Heinrich R Schelbert
- Department of Molecular and Medical Pharmacology, David Geffen School of Medicine at UCLA, Box 95648, B2-085J, 650 Charles E Young Drive South, Los Angeles, CA, 90095-6948, USA.
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Pelletier-Galarneau M, Ferro P, Patterson S, Ruddy TD, Beanlands RS, deKemp RA. Comparison of myocardial blood flow and flow reserve with dobutamine and dipyridamole stress using rubidium-82 positron emission tomography. J Nucl Cardiol 2021; 28:34-45. [PMID: 32449001 DOI: 10.1007/s12350-020-02186-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 02/01/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND The objective of this study was to compare the hyperemic myocardial blood flow (MBF) and myocardial flow reserve (MFR) obtained with dobutamine to those of dipyridamole in patients referred for myocardial perfusion imaging (MPI) using 82Rb positron emission tomography. METHODS One hundred and fifty-six patients who underwent a 82Rb PET MPI study with dobutamine stress were included. A matching cohort of patients who underwent a 82Rb PET MPI study with dipyridamole stress was created, accounting for sex, age, history of coronary artery disease (CAD), prior revascularization, CAD risk factors, body mass index, and MPI interpretation. RESULTS Global rest MBF (median [interquartile range] 0.84 [0.64-1.00] vs 0.69 [0.59-0.85]), stress MBF (2.36 [1.73-3.08] vs 1.66 [1.25-2.06]), MFR (2.75 [2.19-3.64] vs 2.29 [1.78-2.84]), and corrected MFR (2.85 [2.14-3.64] vs 2.20 [1.65-2.75]) were all significantly higher (P < 0.0001) in the dobutamine cohort compared to the dipyridamole cohort. CONCLUSION The results of this study suggest that dobutamine produces higher MBF compared to dipyridamole in a representative population referred to nuclear cardiology laboratories.
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Affiliation(s)
- Matthieu Pelletier-Galarneau
- Department of Medical Imaging, Institut de cardiologie de Montréal, Université de Montréal, Montreal, QC, Canada
- Gordon Center for Medical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Paola Ferro
- San Raffaele Hospital, Milan, Italy
- University of Ottawa Heart Institute, University of Ottawa, 40 Ruskin Street, Ottawa, ON, K1Y 4W7, Canada
| | - Samuel Patterson
- University of Ottawa Heart Institute, University of Ottawa, 40 Ruskin Street, Ottawa, ON, K1Y 4W7, Canada
| | - Terrence D Ruddy
- University of Ottawa Heart Institute, University of Ottawa, 40 Ruskin Street, Ottawa, ON, K1Y 4W7, Canada
| | - Rob S Beanlands
- University of Ottawa Heart Institute, University of Ottawa, 40 Ruskin Street, Ottawa, ON, K1Y 4W7, Canada
| | - Robert A deKemp
- University of Ottawa Heart Institute, University of Ottawa, 40 Ruskin Street, Ottawa, ON, K1Y 4W7, Canada.
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Sheikh KU, Sarfaraz A, Sarfaraz S, Farooq A, Munawwar R, Aamir M. To assess the co-relation between corrected qt interval prolongation and abnormal scan during vasodilator nuclear stress test. Pak J Pharm Sci 2021; 34:417-421. [PMID: 34275788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
In the detection of coronary heart diseases amongst the non-invasive techniques the role of myocardial perfusion imaging is indexed. The rationale of this study was to compare the different parameters and the association between the exercise MPI and vasodilator MPI in the detection of coronary artery disease (that is prolonged Qt interval with the size of perfusion defects). It was a cross-sectional prospective study with purposive non-probability sampling technique which was conducted in a tertiary care hospital from January 2020 to June 2020 for a period of 6 months. All patients regardless of gender were included in this study and age ranging from 30 to 80 years with comorbidities ranging from diabetes, hypertension and smokers were also included. A total of 100 patients were included in this study out of which 81% were male, 50% were diabetics, 69% were hypertensive, 39% had a history of coronary artery disease, 25% were smokers and 63% had hyperlipidemia. For statistical analysis SPSS 21 was applied and significant association was observed between DTS treadmill score and the perfusion defect in vasodilator MPI, corrected Qt interval and DTS tread mill score and between corrected Qt and size of the perfusion defect (P value < 0.001). It was thus seen that the different components of the noninvasive nuclear stress test tend to co-relate and thus aid in the detection of coronary artery disease increasing the accuracy of results.
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Affiliation(s)
| | - Abeer Sarfaraz
- Liaquat National Hospital and Medical College, Karachi, Pakistan
| | - Sana Sarfaraz
- Department of Pharmacology, Faculty of Pharmacy & Pharmaceutical Sciences, University of Karachi, Karachi, Pakistan
| | - Amna Farooq
- Liaquat National Hospital and Medical College, Karachi, Pakistan
| | - Rabia Munawwar
- Department of Pharmacology, Jinnah Sindh Medical University, Karachi, Pakistan
| | - Mohad Aamir
- Dow International Medical College, Karachi, Pakistan
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Abstract
BACKGROUND COVID-19 pandemic is caused by coronavirus also known as severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). The viral infection continues to impact the globe with no vaccine to prevent the infection or highly effective therapeutics to treat the millions of infected people around the world. The disease starts as a respiratory infection, yet it may also be associated with a hypercoagulable state, severe inflammation owing to excessive cytokines production, and a potentially significant oxidative stress. The disease may progress to multiorgan failure and eventually death. OBJECTIVE In this article, we summarize the potential of dipyridamole as an adjunct therapy for COVID-19. METHODS We reviewed the literature describing the biological activities of dipyridamole in various settings of testing. Data were retrieved from PubMed, SciFinder-CAS, and Web of Science. The review concisely covered relevant studies starting from 1977. RESULTS Dipyridamole is an approved antiplatelet drug, that has been used to prevent stroke, among other indications. Besides its antithrombotic activity, the literature indicates that dipyridamole also promotes a host of other biological activities including antiviral, anti-inflammatory, and antioxidant ones. CONCLUSION Dipyridamole may substantially help improve the clinical outcomes of COVID-19 treatment. The pharmacokinetics profile of the drug is well established which makes it easier to design an appropriate therapeutic course. The drug is also generally safe, affordable, and available worldwide. Initial clinical trials have shown a substantial promise for dipyridamole in treating critically ill COVID-19 patients, yet larger randomized and controlled trials are needed to confirm this promise.
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Affiliation(s)
- Kholoud F. Aliter
- Department of Chemistry, School of STEM, Dillard University, New Orleans LA70122, USA
| | - Rami A. Al-Horani
- Division of Basic Pharmaceutical Sciences, College of Pharmacy, Xavier University of Louisiana, New Orleans LA70125, USA
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19
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Abele JT, Raubenheimer M, Bain VG, Wandzilak G, AlHulaimi N, Coulden R, deKemp RA, Klein R, Williams RG, Warshawski RS, Lalonde LD. Quantitative blood flow evaluation of vasodilation-stress compared with dobutamine-stress in patients with end-stage liver disease using 82Rb PET/CT. J Nucl Cardiol 2020; 27:2048-2059. [PMID: 30456495 DOI: 10.1007/s12350-018-01516-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Accepted: 10/19/2018] [Indexed: 12/26/2022]
Abstract
BACKGROUND Our aim was to determine if end-stage liver disease (ESLD) is associated with an attenuated response to vasodilator-stress or dobutamine-stress using 82Rb-PET MPI with blood flow quantification. METHODS AND RESULTS Pre-liver transplant patients who had a normal dipyridamole-stress (n = 27) or dobutamine-stress (n = 26) 82Rb PET/CT MPI study with no identifiable coronary artery calcium were identified retrospectively and compared to a prospectively identified low-risk of liver disease dipyridamole-stress control group (n = 20). The dipyridamole-stress liver disease group had a lower myocardial flow reserve (MFR) (1.89 ± 0.79) than the control group (2.79 ± 0.96, P < .05). The dobutamine-stress group had a higher MFR than both other groups (3.69 ± 1.49, P < .05). A moderate negative correlation between MELD score and MFR was demonstrated for the dipyridamole-stress liver disease group (r = - 0.473, P < .05). This correlation was not observed for the dobutamine-stress liver disease group (r = - 0.253, P = .21). The liver failure group as a whole (n = 53) had a higher resting myocardial blood flow (0.97 ± 0.33 mL/min/g) than the control group (0.82 ± 0.26, P < .05). CONCLUSION Dipyridamole demonstrates an attenuated vasodilatory response in ESLD patients compared to a non-ESLD control group related to higher resting blood flow and comparatively reduced stress blood flow. Dobutamine does not demonstrate this effect implying it may be the preferred pharmacologic MPI stress agent for ESLD patients.
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Affiliation(s)
- Jonathan T Abele
- Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, Alberta, Canada.
- Department of Radiology and Diagnostic Imaging, 2A2.42 Walter C MacKenzie Health Sciences Centre, University of Alberta, 8440 - 112 Street NW, Edmonton, Alberta, T6G 2B7, Canada.
| | - Monique Raubenheimer
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Vincent G Bain
- Liver Unit, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Greg Wandzilak
- Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, Alberta, Canada
| | - Naji AlHulaimi
- Division of Cardiology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Richard Coulden
- Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, Alberta, Canada
| | - Robert A deKemp
- Division of Cardiology, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Ran Klein
- Division of Nuclear Medicine, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Randall G Williams
- Division of Cardiology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Robert S Warshawski
- Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, Alberta, Canada
| | - Lucille D Lalonde
- Division of Cardiology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
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20
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Packard RRS. Dipyridamole infusion protocols for absolute myocardial blood flow quantitation by PET. J Nucl Cardiol 2020; 27:1829-1831. [PMID: 30515747 DOI: 10.1007/s12350-018-01554-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 11/28/2018] [Indexed: 12/24/2022]
Affiliation(s)
- René R Sevag Packard
- Division of Cardiology, Department of Medicine, David Geffen School of Medicine, University of California, 10833 Le Conte Ave., CHS Building Room 17-054A, Los Angeles, CA, USA.
- Ronald Reagan UCLA Medical Center, Los Angeles, CA, USA.
- Veterans Affairs West Los Angeles Medical Center, Los Angeles, CA, USA.
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21
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Cortigiani L, Carpeggiani C, Landi P, Raciti M, Bovenzi F, Picano E. Prognostic Value of Heart Rate Reserve in Patients with Permanent Atrial Fibrillation during Dipyridamole Stress Echocardiography. Am J Cardiol 2020; 125:1661-1665. [PMID: 32273056 DOI: 10.1016/j.amjcard.2020.02.046] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Revised: 02/11/2020] [Accepted: 02/14/2020] [Indexed: 11/30/2022]
Abstract
In patients in sinus rhythm, a blunted heart rate reserve (HRR) during dipyridamole stress echocardiography (SE) is a prognostically unfavorable sign of cardiac autonomic dysfunction. In this study we sought to assess the prognostic meaning of HRR in patients with permanent atrial fibrillation (AF). The study population was made by 301 patients (176 men, age 73 ± 8 years) with suspected (n = 200) or known (n = 101) coronary artery disease and permanent AF who underwent high-dose dipyridamole SE. HRR was calculated on an average of 5 consecutive beats as the peak/rest ratio of HR from 12-lead EKG. During a median follow-up time of 77 months (first quartile 44, third quartile 115 months), 111 (37%) patients died. Receiver operating characteristics analysis identified HRR ≤1.17 as the best predictor of mortality. At multivariable analysis, HRR ≤1.17 (HR 1.75, 95% CI 1.17 to 2.62; p = 0.006) independently predicted mortality together with age (HR 1.09, 95% CI 1.06 to 1.13; p <0.0001), rest wall motion score index (HR 1.69, 95% CI 1.01 to 2.83; p = 0.04), and systemic hypertension (HR 1.76, 95% CI 1.06 to 3.00; p = 0.04). The annual mortality was 5.1% in the overall population, 7.0% in the 140 (46%) patients with abnormal HRR and 3.5% in the 161 (54%) patients with normal HRR. The 8-year mortality was 48% in patients with abnormal HRR and 18% in those with normal HRR (p <0.0001). In conclusion, patients with suspected or known coronary artery disease with permanent AF with a blunted HRR have an increased mortality. HRR outweighs inducible ischemia for prediction of survival. The assessment of HRR should become an integral part of dipyridamole SE reading also in AF.
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Affiliation(s)
| | | | | | - Mauro Raciti
- CNR Institute of Clinical Physiology, Pisa, Italy
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22
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Jiang Z, Zhou W. Left ventricular mechanical dyssynchrony for CAD diagnosis: Does it have incremental clinical values? J Nucl Cardiol 2020; 27:251-253. [PMID: 30218216 DOI: 10.1007/s12350-018-1440-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 08/31/2018] [Indexed: 12/01/2022]
Affiliation(s)
- Zhixin Jiang
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, Jiangsu, China.
| | - Weihua Zhou
- School of Computing, University of Southern Mississippi, Long Beach, MS, 39560, USA.
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23
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Lin WL, Wang SY, Shiau YC, Wu YW. The clinical usefulness of phase analysis in detecting coronary artery disease using dipyridamole thallium-201-gated myocardial perfusion imaging with a cadmium-zinc-telluride camera. J Nucl Cardiol 2020; 27:241-250. [PMID: 30171522 DOI: 10.1007/s12350-018-1417-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Accepted: 08/02/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Previous studies have demonstrated left ventricular mechanical dyssynchrony (LVMD) in patients with severe coronary artery disease (CAD) with ≥ 70% stenosis. The aim of this study was to evaluate the clinical usefulness of stress/rest LVMD in the diagnosis of CAD with ≥ 50% stenosis using dipyridamole thallium-201 (Tl-201) myocardial perfusion imaging (MPI) with a cadmium-zinc-telluride camera. METHODS AND RESULTS A total of 476 patients without known CAD who underwent dipyridamole Tl-201 MPI and coronary angiography within 6 months were retrospectively reviewed. LVMD parameters including phase standard deviation and phase histogram bandwidth, phase skewness and phase kurtosis, as well as myocardial perfusion and myocardial stunning were assessed in post-stress and rest MPI. Relationships between the presence of CAD on coronary angiography and single photon emission computerized tomography (SPECT) parameters were evaluated. The presence of perfusion abnormalities was the best diagnostic tool in detecting CAD. Although less left ventricular synchrony was observed post-stress in the CAD group compared to the non-CAD group, no significant dyssynchrony was noted. CONCLUSIONS The addition of phase analysis to help diagnose CAD in Tl-201-gated SPECT with dipyridamole stress may have limited value in patients with CAD with ≥ 50% stenosis.
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Affiliation(s)
- Wan-Ling Lin
- Department of Nuclear Medicine, Far Eastern Memorial Hospital, No. 21, Sec. 2, Nanya S. Rd., Banciao Dist., New Taipei City, 220, Taiwan
- Department of Nuclear Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu City, Taiwan
| | - Shan-Ying Wang
- Department of Nuclear Medicine, Far Eastern Memorial Hospital, No. 21, Sec. 2, Nanya S. Rd., Banciao Dist., New Taipei City, 220, Taiwan
| | - Yu-Chien Shiau
- Department of Nuclear Medicine, Far Eastern Memorial Hospital, No. 21, Sec. 2, Nanya S. Rd., Banciao Dist., New Taipei City, 220, Taiwan
| | - Yen-Wen Wu
- Department of Nuclear Medicine, Far Eastern Memorial Hospital, No. 21, Sec. 2, Nanya S. Rd., Banciao Dist., New Taipei City, 220, Taiwan.
- National Yang-Ming University School of Medicine, Taipei City, Taiwan.
- Department of Nuclear Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei City, Taiwan.
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Bestetti A, Cuko B, Gasparini M, De Servi S. Better characterization of dipyridamole-induced myocardial stunning by systolic wall thickening. A gated perfusion SPECT study. J Nucl Cardiol 2020; 27:137-146. [PMID: 29951894 DOI: 10.1007/s12350-018-1340-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 06/04/2018] [Indexed: 11/30/2022]
Abstract
AIM AND PATIENTS The aim of the present study was to assess the additional value of systolic wall thickening to myocardial perfusion in diagnosing myocardial stunning induced by dipyridamole infusion. We selected 52 ischemic patients (43 males; mean age 65.5 ± 7.64), with CAD documented by angiography. Ischemia was defined as a summed difference score ≥ 5. All patients underwent a 2-day gated perfusion SPECT protocol. The patients received a dose of 740 MBq of 99mTc-tetrofosmin after stress and at rest. RESULTS The post-stress LVEF was significantly lower than rest LVEF (48.3% ± 14.5% vs. 50.7% ± 15%; P = 0.0001). The wall thickening summed difference score was 3.97 ± 3.84 (P = 0.0001). At a multivariate regression analysis, only WT-SDS as independent variable was significantly correlated with myocardial ischemia (SDS) (P = 0.001). We divided patients according to SDS in those with mild (SDS < 8) and severe (SDS ≥ 8) ischemia. WT-SDS, but not ∆LVEF, was significantly different between groups. CONCLUSIONS WT-SDS showed a better correlation with the degree of ischemia than the depression in the global function of the left ventricle. It allowed to better identify the stunning phenomenon in patients submitted to pharmacological stress.
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Affiliation(s)
- Alberto Bestetti
- Department of Clinical and Biomedical Sciences, University of Milan, Milan, Italy.
- Department of Nuclear Medicine, IRCCS MultiMedica Sesto San Giovanni, Milan, Italy.
| | - Besart Cuko
- School of Specialty in Cardiac Surgery, University of Brescia, Brescia, Italy
| | - Massimo Gasparini
- Department of Nuclear Medicine, IRCCS MultiMedica Sesto San Giovanni, Milan, Italy
| | - Stefano De Servi
- Cardiovascular Department, IRCCS MultiMedica Sesto San Giovanni, Milan, Italy
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Kimpton J, Khong T. Intensive antiplatelet therapy with three agents does not reduce risk of another stroke. Drug Ther Bull 2020; 58:6-7. [PMID: 31712390 DOI: 10.1136/dtb.2019.000058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- James Kimpton
- Clinical Pharmacology, St George's University of London, London, UK
| | - Teck Khong
- Clinical Pharmacology, St George's University of London, London, UK
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Affiliation(s)
- C Rischpler
- Department of Nuclear Medicine, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.
| | - M Totzeck
- Department of Cardiology and Vascular Medicine, University Hospital Essen, West German Heart and Vascular Center, University of Duisburg, Essen, Germany
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Affiliation(s)
- Mario Petretta
- Department of Translational Medical Sciences, University Federico II, Via Pansini 5, 80131, Naples, Italy
| | - Alberto Cuocolo
- Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy.
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Klein R, Ocneanu A, Renaud JM, Ziadi MC, Beanlands RSB, deKemp RA. Consistent tracer administration profile improves test-retest repeatability of myocardial blood flow quantification with 82Rb dynamic PET imaging. J Nucl Cardiol 2018; 25:929-941. [PMID: 27804067 PMCID: PMC5966478 DOI: 10.1007/s12350-016-0698-6] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Quantification of myocardial blood flow (MBF) and stress/rest flow reserve is used increasingly to diagnose multi-vessel coronary artery disease and micro-vascular disease with PET imaging. However, variability in the measurements may limit physician confidence to direct revascularization therapies based on specific threshold values. This study evaluated the effects of rubidium-82 (82Rb) tracer injection profile using a constant-activity-rate (CA) vs a constant-flow-rate (CF) infusion to improve test-retest repeatability of MBF measurements. METHOD 22 participants underwent single-session 82Rb dynamic PET imaging during rest and dipyridamole stress using one of 2 test-retest infusion protocols: CA-CA (n = 12) or CA-CF (n = 10). MBF was quantified using a single-tissue-compartment model (1TCM) and a simplified retention model (SRM). Non-parametric test-retest repeatability coefficients (RPCnp) were compared between groups. Myocardium-to-blood contrast and signal-to-noise ratios of the late uptake images (2 to 6 minutes) were also compared to evaluate standard myocardial perfusion image (MPI) quality. RESULTS MBF values in the CA-CA group were more repeatable (smaller RPCnp) than the CA-CF group using the 1TCM at rest alone, rest and stress combined, and stress/rest reserve (21% vs 36%, 16% vs 19%, and 20% vs 27%, P < 0.05, respectively), and using the SRM at Rest and Stress alone, Rest and Stress combined, and stress/rest reserve (21% vs 38%, 15% vs 25%, 22% vs 38%, and 23% vs 49%, P < 0.05, respectively). In terms of image quality, myocardium-to-blood contrast and signal-to-noise ratios were not significantly different between groups. CONCLUSIONS Constant-activity-rate 'square-wave' infusion of 82Rb produces more repeatable tracer injection profiles and decreases the test-retest variability of MBF measurements, when compared to a constant-flow-rate 'bolus' administration of 82Rb, especially with SRM, and without compromising standard MPI quality.
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Affiliation(s)
- Ran Klein
- National Cardiac PET Centre, Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, Canada.
- Department of Systems and Computer Engineering, Carleton University, Ottawa, Canada.
- Division of Nuclear Medicine, Department of Medicine, The Ottawa Hospital and University of Ottawa, Box 232, 1053 Carling Ave, Ottawa, ON, K1Y 4E9, Canada.
| | - Adrian Ocneanu
- Department of Systems and Computer Engineering, Carleton University, Ottawa, Canada
| | - Jennifer M Renaud
- National Cardiac PET Centre, Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, Canada
| | - Maria C Ziadi
- National Cardiac PET Centre, Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, Canada
- Non Invasive Cardiovascular Imaging Department, Diagnostico Medico Oroño, Rosario, Argentina
| | - Rob S B Beanlands
- National Cardiac PET Centre, Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, Canada
- Division of Nuclear Medicine, Department of Medicine, The Ottawa Hospital and University of Ottawa, Box 232, 1053 Carling Ave, Ottawa, ON, K1Y 4E9, Canada
| | - Robert A deKemp
- National Cardiac PET Centre, Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, Canada
- Department of Systems and Computer Engineering, Carleton University, Ottawa, Canada
- Division of Nuclear Medicine, Department of Medicine, The Ottawa Hospital and University of Ottawa, Box 232, 1053 Carling Ave, Ottawa, ON, K1Y 4E9, Canada
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Nemes A, Szántó G, Domsik P, Kormányos Á, Kalapos A, Ambrus N, Forster T. Change of left ventricular "rigid body rotation" during dipyridamole-induced vasodilation: A case from the three-dimensional speckle tracking echocardiographic MAGYAR-Stress Study. J Clin Ultrasound 2018; 46:152-156. [PMID: 28493475 DOI: 10.1002/jcu.22498] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 03/28/2017] [Accepted: 04/07/2017] [Indexed: 06/07/2023]
Abstract
A patient with previous coronary stenting presented with stable angina and positive exercise treadmill test. Echocardiography with three-dimensional speckle-tracking demonstrated left ventricular rigid body rotation (near absence of left ventricular twist), whose characteristics changed dramatically during dipyridamole-induced vasodilatation. © 2017 Wiley Periodicals, Inc. J Clin Ultrasound 46:152-156, 2018.
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Affiliation(s)
- Attila Nemes
- 2nd Department of Medicine and Cardiology Centre, Medical Faculty, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
| | - Gyula Szántó
- 2nd Department of Medicine and Cardiology Centre, Medical Faculty, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
| | - Péter Domsik
- 2nd Department of Medicine and Cardiology Centre, Medical Faculty, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
| | - Árpád Kormányos
- 2nd Department of Medicine and Cardiology Centre, Medical Faculty, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
| | - Anita Kalapos
- 2nd Department of Medicine and Cardiology Centre, Medical Faculty, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
| | - Nóra Ambrus
- 2nd Department of Medicine and Cardiology Centre, Medical Faculty, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
| | - Tamás Forster
- 2nd Department of Medicine and Cardiology Centre, Medical Faculty, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
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Abstract
PURPOSE OF REVIEW Stress echocardiography (SE) is a well-established technique for the diagnosis and risk stratification of patients with known or suspected coronary artery disease (CAD). This review article summarizes the status of SE in CAD, including testing protocols, clinical efficacy and current use of newer technologies: myocardial perfusion, strain imaging, three-dimensional echocardiography and adjunctive carotid ultrasonography. RECENT FINDINGS Recent major findings in SE include the clinical value of myocardial perfusion imaging in multicentre studies, as well as when added to left ventricular (LV) wall motion assessment in clinical service. Additionally, SE has been shown to be more cost-effective than exercise ECG in patients with low-intermediate pre-test probability of CAD. Adjunctive atherosclerosis imaging by carotid ultrasonography (CU) to ischaemia testing by SE provides synergistic prognostic value, equivalent to hybrid imaging by PET-CT. Despite the development of newer and more expensive imaging modalities, SE remains the cornerstone for the assessment of CAD and has excellent clinical efficacy, is safe and is cost-effective.
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Affiliation(s)
- Sothinathan Gurunathan
- Department of Cardiology, Northwick Park Hospital, Harrow, UK
- Department of Cardiology, Royal Brompton Hospital, Sydney Street, London, SW3 6NP, UK
- Biomedical Research Unit National Heart and Lung Institute, Imperial College, London, UK
| | - Roxy Senior
- Department of Cardiology, Northwick Park Hospital, Harrow, UK.
- Department of Cardiology, Royal Brompton Hospital, Sydney Street, London, SW3 6NP, UK.
- Biomedical Research Unit National Heart and Lung Institute, Imperial College, London, UK.
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Marini C, Seitun S, Zawaideh C, Bauckneht M, Morelli MC, Ameri P, Ferrarazzo G, Budaj I, Balbi M, Fiz F, Boccalini S, Pregliasco AG, Buschiazzo A, Saracco A, Bagnara MC, Bruzzi P, Brunelli C, Ferro C, Bezante GP, Sambuceti G. Comparison of coronary flow reserve estimated by dynamic radionuclide SPECT and multi-detector x-ray CT. J Nucl Cardiol 2017; 24:1712-1721. [PMID: 27151303 DOI: 10.1007/s12350-016-0492-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2016] [Revised: 03/28/2016] [Indexed: 11/24/2022]
Abstract
BACKGROUND Recent technical advances in multi-detector computed tomography (MDCT) allow for assessment of coronary flow reserve (CFR). We compared regional CFR by dynamic SPECT and by dynamic MDCT in patients with suspected or known coronary artery disease (CAD). METHODS Thirty-five patients, (29 males, mean age 69 years) with greater than average Framingham risk of CAD, underwent dipyridamole vasodilator stress imaging. CFR was estimated using dynamic SPECT and dynamic MDCT imaging in the same patients. Myocardial perfusion findings were correlated with obstructive CAD (≥50% luminal narrowing) on CT coronary angiography (CA). RESULTS Mean CFR estimated by SPECT and MDCT in 595 myocardial segments was not different (1.51 ± 0.46 vs. 1.50 ± 0.37, p = NS). Correlation of segmental CFR by SPECT and MDCT was fair (r 2 = 0.39, p < 0.001). Bland-Altman analysis revealed that MDCT in comparison to SPECT systematically underestimated CFR in higher CFR ranges. By CTCA, 12 patients had normal CA, 11 had non-obstructive, and 12 had obstructive CAD. CFR by both techniques was significantly higher in territories of normal CA than in territories subtended by non-obstructive or obstructive CAD. SPECT CFR was also significantly different in territories subtended by non-obstructive and obstructive CAD, whereas MDCT CFR was not. CONCLUSION Despite relative underestimation of high CFR values, MDCT CFR shows promise for assessing the pathophysiological significance of anatomic CAD.
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Affiliation(s)
- Cecilia Marini
- CNR Institute of Bioimaging and Molecular Physiology, Milan, Section of Genoa, Italy
| | - Sara Seitun
- Interventional Radiology, IRCCS-AOU San Martino-IST, Genoa, Italy
| | - Camilla Zawaideh
- Clinic of Cardiovascular Diseases, IRCCS-AOU San Martino-IST, Genoa, Italy
| | | | | | - Pietro Ameri
- Clinic of Cardiovascular Diseases, IRCCS-AOU San Martino-IST, Genoa, Italy
| | | | - Irilda Budaj
- Interventional Radiology, IRCCS-AOU San Martino-IST, Genoa, Italy
| | - Manrico Balbi
- Clinic of Cardiovascular Diseases, IRCCS-AOU San Martino-IST, Genoa, Italy
| | - Francesco Fiz
- Nuclear Medicine, IRCCS-AOU San Martino-IST, Genoa, Italy
| | - Sara Boccalini
- Interventional Radiology, IRCCS-AOU San Martino-IST, Genoa, Italy
| | | | | | | | | | - Paolo Bruzzi
- Epidemiology Unit, IRCCS-AOU San Martino-IST, Genoa, Italy
| | - Claudio Brunelli
- Clinic of Cardiovascular Diseases, IRCCS-AOU San Martino-IST, Genoa, Italy
| | - Carlo Ferro
- Interventional Radiology, IRCCS-AOU San Martino-IST, Genoa, Italy
| | - Gian Paolo Bezante
- Clinic of Cardiovascular Diseases, IRCCS-AOU San Martino-IST, Genoa, Italy
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Massalha S, Reizberg I, Israel O, Kapeliovich M, Sholy H, Koskosi A, Keidar Z, Marai I. Conduction abnormalities during dipyridamole stress testing. J Nucl Cardiol 2017; 24:405-409. [PMID: 26494645 DOI: 10.1007/s12350-015-0294-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Revised: 09/15/2015] [Indexed: 10/22/2022]
Abstract
Pharmacological stress tests using dipyridamole are considered to be safe. However, cases of atrioventricular (AV) block have been reported. We retrospectively analyzed ECG at baseline and during dipyridamole stress tests of 2010 consecutive patients (patients with second or third degree AV block were excluded). At baseline, 350 (17.4%) patients had conduction abnormalities. Following dipyridamole infusion 16 patients (0.8%) developed a transient change in AV conduction (15 patients) and or sinus arrest (1 patient). Compared to patients without baseline conduction abnormalities, patients with any conduction abnormalities at baseline were at a higher risk for the development of AV block after dipyridamole infusion [0.3% vs 3.14%, respectively; P < .0001].
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Affiliation(s)
- Samia Massalha
- Department of Cardiology, Rambam Health Care Campus and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, 31096, Haifa, Israel
- Department of Nuclear medicine, Rambam Health Care Campus and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | - Ilya Reizberg
- Department of Nuclear medicine, Rambam Health Care Campus and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | - Ora Israel
- Department of Nuclear medicine, Rambam Health Care Campus and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | - Michael Kapeliovich
- Department of Cardiology, Rambam Health Care Campus and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, 31096, Haifa, Israel
| | - Haitham Sholy
- Department of Cardiology, Rambam Health Care Campus and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, 31096, Haifa, Israel
| | - Amjad Koskosi
- Department of Nuclear medicine, Rambam Health Care Campus and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | - Zohar Keidar
- Department of Nuclear medicine, Rambam Health Care Campus and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | - Ibrahim Marai
- Department of Cardiology, Rambam Health Care Campus and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, 31096, Haifa, Israel.
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Knollmann FD, Muschick P, Krause W, Hausmann H, Hetzer R, Felix R. Detection of myocardial ischemia by electron beam CT: Experimental studies. Acta Radiol 2016; 42:386-92. [PMID: 11442463 DOI: 10.1080/028418501127347034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Purpose: To determine if contrast-enhanced electron beam CT (EBCT) can detect areas of acute myocardial ischemia, and if pharmacological stress testing improves the diagnostic accuracy of EBCT. Material and Methods: We injected 0.5 ml/kg and 1.0 ml/kg b.w. of iopromide at a rate of 4 ml/s into the right atrium of 5 ventilated female minipigs at rest and after occlusion of the left anterior descending (LAD) coronary artery. Both ventricles were examined at six short axis levels with an EBCT unit. Myocardial perfusion was calculated from the time-density curves of four left ventricular myocardial segments and the aorta. We also tested the effect of the contrast agent on myocardial density after i.v. administration of 0.6 mg/kg dipyridamole before and after LAD occlusion. Results: At rest, the contrast agent increased myocardial density by 28±2 HU, corresponding to a myocardial perfusion estimate of 67±7 ml/min/100 g. After dipyridamole, myocardial density increased by 29±4 HU. Following occlusion of the LAD, anteroseptal myocardium displayed 10±4 HU density increase. The area of non-enhancement corresponded to ischemic myocardium in stained pathologic sections. Conclusion: Contrast-enhanced stress EBCT can be used to detect areas of myocardial ischemia, and EBCT stress perfusion imaging may be necessary to consistently differentiate ischemic from non-ischemic myocardial tissue.
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Affiliation(s)
- F D Knollmann
- Department of Radiology, Charité, Virchow Hospital Campus, Medical Faculty of the Humboldt-University of Berlin, Germany
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Hombach V, Clausen M, Osterhues HH, Göller V, Grossmann G, Peper A, Eggeling T, Höher M, Ost W, Kochs M. Methodological aspects of detecting patients with symptomatic and silent myocardial ischemia. Adv Cardiol 2015; 37:76-95. [PMID: 2220468 DOI: 10.1159/000418819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- V Hombach
- Department of Cardiology/Angiology/Pneumonology, University Hospital of Ulm, FRG
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Modolo R, de Faria AP, Paganelli MO, Sabbatini AR, Barbaro NR, Nascimento BB, Ramos CD, Fontana V, Calhoun DA, Moreno H. Predictors of silent myocardial ischemia in resistant hypertensive patients. Am J Hypertens 2015; 28:200-7. [PMID: 25063735 DOI: 10.1093/ajh/hpu140] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Hypertension is the most prevalent and significant modifiable risk factor for coronary heart disease. A portion of patients with uncontrolled hypertension are considered to have resistant hypertension (RHTN). Myocardial ischemia incidence increases along with blood pressure (BP) levels. However, the prevalence of myocardial ischemia in patients with RHTN, as well as the factors associated with it, is unknown. METHODS We enrolled 129 patients with true RHTN regularly followed in our specialty hypertension clinic and evaluated then by resting and dipyridamole pharmacological stress myocardial perfusion scintigraphy. Patients were then divided into 2 groups: those with (I-RHTN; n = 36) and those without (NI-RHTN; n = 93) myocardial ischemia. Echocardiography, 24-hour ambulatory BP monitoring (ABPM), and flow mediated dilation (FMD) were also evaluated. RESULTS Thirty six (28%) patients had myocardial ischemia. There was no difference between groups regarding age, sex, biochemical parameters, office, and 24-hour ABPM levels. Patients in the I-RHTN group were more likely diabetic (31% vs. 11%; P < 0.05) and obese (75% vs. 40%; P < 0.001). Adjusting for age and body mass index, multiple logistic regression showed that diabetes (odds ratio (OR) = 6.5; 95% confidence interval (CI) = 1.06-40.14; P = 0.04), FMD (OR = 0.18; 95% CI = 0.07-0.41; P < 0.001), heart rate (OR = 1.23; 95% CI = 1.11-1.36; P < 0.001), left ventricular mass index (OR = 1.02; 95% CI = 1.01-1.04; P = 0.04), and microalbuminuria (OR = 1.02; 95% CI = 1.01-1.04; P = 0.002) were independent predictors of ischemia. CONCLUSIONS In conclusion, there is a high prevalence of myocardial ischemia in patients with RHTN. Increased microalbuminuria, heart rate, endothelial dysfunction, and left ventricular mass can be useful to guide the investigation for myocardial ischemia in these high risk patients.
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Affiliation(s)
- Rodrigo Modolo
- Department of Pharmacology, Faculty of Medical Sciences University of Campinas-UNICAMP, Campinas, SP, Brazil;
| | - Ana Paula de Faria
- Department of Pharmacology, Faculty of Medical Sciences University of Campinas-UNICAMP, Campinas, SP, Brazil
| | - Maria O Paganelli
- Department of Pharmacology, Faculty of Medical Sciences University of Campinas-UNICAMP, Campinas, SP, Brazil
| | - Andréa R Sabbatini
- Department of Pharmacology, Faculty of Medical Sciences University of Campinas-UNICAMP, Campinas, SP, Brazil
| | - Natália R Barbaro
- Department of Pharmacology, Faculty of Medical Sciences University of Campinas-UNICAMP, Campinas, SP, Brazil
| | - Beatriz B Nascimento
- Department of Radiology, Faculty of Medical Sciences, University of Campinas-UNICAMP, Campinas, SP, Brazil
| | - Celso D Ramos
- Department of Radiology, Faculty of Medical Sciences, University of Campinas-UNICAMP, Campinas, SP, Brazil
| | - Vanessa Fontana
- Department of Pharmacology, Faculty of Medical Sciences University of Campinas-UNICAMP, Campinas, SP, Brazil
| | - David A Calhoun
- Vascular Biology and Hypertension Program, University of Alabama at Birmingham, Birmingham, Alabama
| | - Heitor Moreno
- Department of Pharmacology, Faculty of Medical Sciences University of Campinas-UNICAMP, Campinas, SP, Brazil
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Russel S, Darmon S, Vermillet A, Haziza F. [Stress cardiac MRI in management of ischemic heart disease]. Ann Cardiol Angeiol (Paris) 2014; 63:345-352. [PMID: 25281219 DOI: 10.1016/j.ancard.2014.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2014] [Accepted: 08/24/2014] [Indexed: 06/03/2023]
Abstract
Stress magnetic cardiac resonance imaging (MRI) development is in progress. Many cardiac imaging technics already known are completed by this safe radiation free exam with a short time acquisition (30minutes) and a good diagnostic performance in particular for patients with three vessels coronary artery diseases. Best indication concerns symptomatic patients unable to exercise with intermediate or high pretest probability. Pharmacological heart stress can be induced with vasodilatators or dobutamine to identify the presence and extent of myocardial ischemia, with high precision to guide coronary vessels revascularization. MRI gives many other interesting informations like heart anatomy, left ventricular function. Myocardial viability can be assessed with study of late gadolinium enhancement or analysis of contractile reserve with low dose of dobutamine.
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Affiliation(s)
- S Russel
- Service de cardiologie, hôpital Foch, 40, rue Worth, 92150 Suresnes, France.
| | - S Darmon
- Service de radiologie, hôpital Foch, 92150 Suresnes, France
| | - A Vermillet
- Service de cardiologie, hôpital Foch, 40, rue Worth, 92150 Suresnes, France
| | - F Haziza
- Service de cardiologie, hôpital Foch, 40, rue Worth, 92150 Suresnes, France
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Abstract
Stress echocardiography is the combination of 2D echocardiography with a physical, pharmacological or electrical stress. The diagnostic end point for the detection of myocardial ischemia is the induction of a transient worsening in regional function during stress. Stress echocardiography provides similar diagnostic and prognostic accuracy as radionuclide stress perfusion imaging but at a substantially lower cost, without environmental impact and with no biohazards for the patient and the physician. In spite of its dependence upon operator's training, it is the best possible choice to achieve the still elusive target of sustainable cardiac imaging in the field of noninvasive diagnosis of coronary artery disease.
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Cullom SJ, Case JA, Courter SA, McGhie AI, Bateman TM. Regadenoson pharmacologic rubidium-82 PET: a comparison of quantitative perfusion and function to dipyridamole. J Nucl Cardiol 2013; 20:76-83. [PMID: 23188625 DOI: 10.1007/s12350-012-9636-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2012] [Accepted: 10/09/2012] [Indexed: 12/22/2022]
Abstract
BACKGROUND Dipyridamole is used for stress (82)rubidium chloride ((82)RbCl) PET because of its long hyperemic duration. Regadenoson has advantages of a fixed dose and favorable symptom profile, but its mean maximal hyperemia is only 2.3 minutes. To determine its suitability for (82)RbCl PET, we imaged subjects using a regadenoson protocol based on its hyperemic response and compared the images in the same subjects having dipyridamole PET. METHODS In 32 subjects (23 M), we assessed visually by blinded interpretation and quantitatively compared summed stress and difference scores, total perfusion deficit (TPD), LVEF, LV volumes, and change in stress-rest function. Linear correlation and Bland-Altman analysis of the paired measurements were applied for evaluation of differences. Paired t test and Pearson's correlation were applied for testing of significance. RESULTS The images were interpreted the same by visual assessment. Twenty-six (26) subjects had reversible defects; by quantitation the SSS was 12.9 ± 7.0 and 14.1 ± 6.4 (P = .23) and SDS was 7.0 ± 6.8 versus 7.6 ± 6.2 (P = .40) for dipyridamole and regadenoson, respectively. Six (6) subjects had <5% likelihood of CAD and were normal by both. All paired measurements showed a high positive correlation between regadenoson and dipyridamole; stress segmental perfusion Reg = 0.93Dip + 4.4, r = 0.88; TPD Reg = 0.94Dip + 0.41, r = 0.93; LVEF Reg = 0.92Dip + 4.7, r = 0.95; stress minus rest LVEF Reg = 0.87Dip - 0.99, r = 0.82. CONCLUSION Regadenoson stress (82)RbCl PET perfusion defect and cardiac function measurements are visually and quantitatively equivalent to dipyridamole studies and can be obtained with the clinical advantages of regadenoson.
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Affiliation(s)
- S James Cullom
- Cardiovascular Imaging Technologies, LLC, 4320 Wornall Road, Suite 55, Kansas City, MO 64111, USA.
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Neglia D, Sampietro T, Vecoli C, Liga R, Rossi G, Filidei E, Bigazzi F, Iozzo P, Giannessi D, L'Abbate A, Rovai D. Abnormal glucose and lipid control in non-ischemic left ventricular dysfunction. J Nucl Cardiol 2012; 19:1182-9. [PMID: 22879076 DOI: 10.1007/s12350-012-9609-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2012] [Accepted: 07/21/2012] [Indexed: 01/06/2023]
Abstract
BACKGROUND Cardiovascular risk factors are classically associated with coronary atherosclerosis. We sought to investigate whether risk factors are also associated with left ventricular (LV) dilatation, contractile impairment and reduced myocardial blood flow (MBF) in patients with non-ischemic LV dysfunction. METHODS We studied 81 patients (59 males, age 60 ± 9 years) with mild-to-severe LV dysfunction (mean ejection fraction 37%, range 19%-50%), no history of diabetes and normal coronary arteries. Absolute MBF was measured by positron emission tomography and (13)N-ammonia at rest and after dipyridamole (0.56 mg/kg I.V. over 4 min). RESULTS Overt LV dysfunction (LV end-diastolic diameter >60 mm associated with LV ejection fraction <45%) was present in 42 patients (52%); severely depressed hyperemic MBF (<1.09 mL · min(-1) · g(-1)) was present in 41 patients (51%). Using multivariate logistic regression analysis, low high-density lipoprotein cholesterol (HDL-C, P < .036), newly diagnosed non-insulin-dependent diabetes or insulin-resistance (NIDD/IR, P < .019) and the use of diuretics (P = .001) were independently associated with overt LV dysfunction. Low HDL-C (P = .015) and NIDD/IR (P = .048) were also independently associated with severely depressed hyperemic MBF. CONCLUSIONS Low HDL-C and NIDD/IR are associated with more severe LV impairment and reduced hyperemic MBF in non-ischemic LV dysfunction.
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Parga Filho JR, Lima CSLM, Lima FG, Jaques TDS, Avila LFRD, Kalil Filho R. Dynamic myocardial perfusion imaging by dual-source computed tomography. Arq Bras Cardiol 2012; 98:e54-e58. [PMID: 22527021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2011] [Accepted: 04/06/2011] [Indexed: 05/31/2023] Open
Abstract
We report a dual-source computed tomography study of dynamic and quantitative myocardial perfusion in a 44-year-old patient with previous documented coronary artery disease. Quantitatively, the tomography showed myocardial perfusion deficit in the territories with significant coronary stenosis, confirmed by computed tomography angiography and conventional angiography. Dual-source computed tomography allowed dynamic perfusion and anatomic evaluation in a single study during the follow-up of this patient.
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Azemi T, Rai M, Parwani P, Baghdasarian S, Kazi F, Ahlberg AW, Cyr G, Katten D, O'Sullivan D, Fram D, Heller GV. Electrocardiographic changes during vasodilator SPECT myocardial perfusion imaging: does it affect diagnosis or prognosis? J Nucl Cardiol 2012; 19:84-91. [PMID: 21947978 DOI: 10.1007/s12350-011-9457-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2011] [Accepted: 08/31/2011] [Indexed: 10/17/2022]
Abstract
BACKGROUND Significance of electrocardiographic (ECG) changes during vasodilator stress myocardial perfusion imaging (MPI) is controversial. We examined the diagnostic and prognostic significance of ECG changes during vasodilator single photon emission computerized tomography (SPECT) MPI. METHODS We studied consecutive patients who underwent vasodilator SPECT MPI from 1995 to 2009. Patients with baseline ECG abnormalities, previous history of coronary artery bypass graft surgery or myocardial infarction (MI) were excluded. Significant coronary artery disease (CAD) was defined as >70% stenosis of any vessel or ≥50% stenosis of left main. Mean follow-up was 2.4 ± 1.5 years for cardiac events (cardiac death and non-fatal MI). RESULTS Of patients in the diagnostic cohort, ST depression was associated with increased incidence of CAD with abnormal (P = .020 and P <.001) but not in those with normal perfusion (P = .342). Of 3,566 patients with follow-up in the prognostic cohort, including 130 (5.0%) with ST depression and normal perfusion, the presence of ST depression ≥1 mm did not affect the outcomes in any summed stress score category. CONCLUSIONS ST depression ≥1 mm during vasodilator SPECT MPI is associated with CAD in patients with abnormal perfusion, but provides no additional risk stratification beyond concomitant perfusion imaging, including those with normal studies.
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Affiliation(s)
- Talhat Azemi
- Nuclear Cardiology Laboratory, Henry Low Heart Center, Division of Cardiology, Hartford Hospital, 80 Seymour Street, Hartford, CT 06102, USA.
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Boshchenko AA, Vrublevskiĭ AV, Karpov RS. [Transthoracic dopllerographic assessment of the relative coronary reserve in the norm and in the presence of isolated hemodynamically significant stenoses of the left anterior descending coronary artery]. Kardiologiia 2012; 52:10-19. [PMID: 22839511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Comparison of velocity parameters of blood flow and absolute coronary reserve (absCR) in the left anterior descending and posterior interventricular coronary arteries (ADCA and PICA) with calculation of relative coronary reserve (relCR) and determination of its normative values was carried out with the help of transthoracic echocardiography in 29 healthy volunteers (mean age 40+/-13 years). Assessment of the role of absCR and relCR in ADCA in diagnostics of hemodynamically significant stenoses of this vessel was performed in 88 patients with syndrome of cardiac pain (mean age 40+/-12 years). Coronary angiography was used as a reference method. Coronary blood flow in distal segments of ADCA and PICA was measured at baseline and during infusion of a vasodilator (dipyridamole up to 0.84 mg/kg as intravenous infusion). AbsCR for each of these arteries was determined as ratio of hyperemic peak diastolic blood flow velocity and its baseline value. Lowering of absCR was diagnosed at its level <2.0). RelCR was calculated only for ADCA as ratio of absCR of ADCA and PICA. It was established that parameters of coronary blood flow and absCR level in healthy volunteers in ADA and PICA had no significant differences. Therefore these vessels were considered referent for each other. In the norm relCR in ADA was 1.09+/-0.36 (95% confidence interval from 0.95 to 1.23). We proved that ADA abs CR in <2.0 served as predictor of ADA stenosis >50% with sensitivity 89% and specificity 85%. However 22% of subjects with lowering of absCR had ADA stenoses <50%, microvascular involvement, or belonged to the group of healthy volunteers. It was established that ADA relCR <0.80 in patients with ADA absCR <2.0 was a sensitive and specific sign of isolated ADA stenosis >50%.
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Mikheev NN, Kukhtenkova VP. [Tissue Doppler imaging during dipyridamole and dobutamine stress echocardiography in the diagnosis of coronary heart disease]. Vestn Rentgenol Radiol 2011:17-20. [PMID: 22420205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The aim of the study was to determine the sensitivity and specificity of combined high-dose dipyridamole and dobutamine stress echocardiography (stress EchoCG) in the diagnosis of coronary artery stenotic lesions in coronary heart disease in a group of patients who were unable to perform physical exercise, by using different assessment criteria (local contractile impairments and systolic velocity changes during tissue Doppler imaging). The study enrolled 68 men who had undergone dipyridamole and dobutamine stress EchoCG, longitudinal tissue Doppler imaging, and coronary angiography. Stress EchoCG could bring up to diagnostic criteria in all the patients. Coronary angiography revealed no coronary artery lesion in 18 patients, but showed single and multiple vascular lesions in 31 and 19 patients, respectively. The sensitivity and specificity of combined stress EchoCG were significantly higher than those of stress EchoCG examination. The results of combined stress EchoCG allow one to judge to a greater validity (96% sensitivity and 100% specificity) local contractile impairments corresponding to the blood supply area in the atherosclerosis-afflicted coronary artery. Analysis of systolic velocity parameters during tissue Doppler imaging permits the diagnostic value of the technique to be insignificantly improved particularly when the test results are controversial.
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Cury RC, Magalhães TA, Paladino AT, Shiozaki AA, Perini M, Senra T, Lemos PA, Cury RC, Rochitte CE. Dipyridamole stress and rest transmural myocardial perfusion ratio evaluation by 64 detector-row computed tomography. J Cardiovasc Comput Tomogr 2011; 5:443-8. [PMID: 22146503 DOI: 10.1016/j.jcct.2011.10.012] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2011] [Revised: 10/27/2011] [Accepted: 10/30/2011] [Indexed: 11/29/2022]
Affiliation(s)
- Roberto C Cury
- Cardiovascular MR and CT Section, Heart Institute (InCor), University of São Paulo Medical School and Heart Hospital (HCOR), São Paulo, Brazil.
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Dori G, Gershinsky M, Ben-Haim S, Lewis BS, Bitterman H. "ECG variability contour" method reveals amplitude changes in both ischemic patients and normal subjects during Dipyridamole stress: a preliminary report. Med Biol Eng Comput 2011; 49:1311-20. [PMID: 21969223 DOI: 10.1007/s11517-011-0835-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2011] [Accepted: 09/12/2011] [Indexed: 11/26/2022]
Abstract
To detect and quantify consistent ECG amplitude changes, the "ECG variability contour" (EVC) method was proposed. Using this method we investigated amplitude changes in subjects undergoing myocardial perfusion imaging (MPI) with Dipyridamole (Dp). Fifty-three patients having reversible perfusion defects and 19 normal subjects (NS) who were free of: perfusion defects on their MPI, standard ST-T changes during Dp stress, and a negative clinical follow up. Mean ∏¹(<∏¹>) was similar for the NS and patient group (6.2 ± 6.1 vs. 6.3 ± 6.2, P = 0.95). <∏¹> was 4.6 ± 3.0 in patients not having ST-T changes during Dp stress (n = 42), whereas in patients having ST-T changes (n = 11) it was 13.1 ± 10.2 (P < 0.001). For both groups <∏(QRS)> was smaller than <∏(ST)>, which in turn was smaller than <∏(T)>. The values of <∏(QRS)>, <∏(ST)>, and <∏(T)> for the NS, patients without and with ST-T changes were: 26.8 ± 28.6, 42.6 ± 41.8, 44.9 ± 36.5; 19.6 ± 20.8, 26.4 ± 31.4, 38.7 ± 27.3; 51.0 ± 30.0, 71.0 ± 36.8, 75.1 ± 20.9, respectively (P < 0.05 for all comparisons of patients with versus without ST-T changes). This study showed that Dp stress, with or without hypoperfusion, had a clear effect on myocyte electrophysiology, expressed by consistent ECG amplitude changes, detected by the EVC method. The EVC method did not distinguish between NS and patients in this clinical setting.
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Affiliation(s)
- Guy Dori
- Department of Internal Medicine C, The Lady Davis Carmel Medical Center, Haifa, Israel.
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Ruano Pérez R, Gómez-Caminero López F, Diego Domínguez M, Martín De Arriba A, Martín Luengo C, García-Talavera Fernández JR. [Incidence and prognostic value of ischemic heart disease in high risk cardiovascular asymptomatic diabetic patients detected by gated myocardial perfusion SPECT study]. Rev Esp Med Nucl Imagen Mol 2011; 31:83-8. [PMID: 21944188 DOI: 10.1016/j.remn.2011.04.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2011] [Revised: 04/12/2011] [Accepted: 04/29/2011] [Indexed: 12/16/2022]
Abstract
AIM To determine the clinical utility of the gated myocardial perfusion SPECT to detect silent ischemia in asymptomatic diabetic patients without previous coronary events and to evaluate the prognosis of this population. MATERIAL AND METHODS A retrospective study of 56 asymptomatic diabetics referred for a gated myocardial perfusion SPECT for diagnosis of ischemic disease was performed. The criteria for ischemia were: mild SDS<4, moderate SDS 4-8, severe SDS>8. A multivariable statistical analysis was carried out to identify possible predictive variables of an abnormal SPECT. The cardiovascular events were recorded up to December-2010. RESULTS A high proportion of the 56 patients had an abnormal perfusion study (46.4%), there being moderate-severe ischemia in 10.7%, necrosis with ischemia in 5.4% and necrosis in 7.1%. We found no statistical differences in the type of stress used (treadmill or dipyridamole). The patients had a high combination of cardiovascular risk factors. In the multivariate analysis, diabetic nephropathy was the only factor related to an abnormal SPECT (p=0.043). The events recorded in the follow-up were: 2 early revascularizations, 5 cardiology admissions, 10 non-cardiac related deaths. The existence of ischemia in the SPECT was significantly related to the appearance of cardiovascular events (p<0.05). CONCLUSION A gated myocardial perfusion SPECT in asymptomatic diabetics with high combination of cardiovascular risk factors detects silent ischemia in a significant proportion and this seems to be related to future coronary events. Diabetic nephropathy implies a greater likelihood of abnormal studies. However, the screening criteria in this population still need to be established for better performance and lower cost.
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Affiliation(s)
- R Ruano Pérez
- Servicio de Medicina Nuclear, Hospital Universitario de Salamanca, España.
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Rai M, Pullatt R, Borer S, Heller GV. Cardiac tamponade on ECG-gated dipyridamole PET perfusion imaging. J Nucl Cardiol 2011; 18:744-7. [PMID: 21553159 DOI: 10.1007/s12350-011-9383-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Mridula Rai
- Division of Cardiology, Nuclear Cardiology Laboratory, Henry Low Heart Center, Hartford Hospital, Hartford, CT, 06106, USA.
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