刘秀杰
中国医学科学院阜外医院 核医学科
BACKGROUND:Coronary revascularization in patients with coronary artery disease may be guided by coronary angiography (CA) or alternatively by ischemia on stress myocardial perfusion imaging (MPI). Which strategy leads to optimal cardiac outcomes is uncertain.METHODS:We performed a retrospective analysis of 170 patients with MPI ischemia and percutaneous coronary intervention. The primary endpoint was all-cause mortality at a mean follow-up of 47 ± 21 months; the secondary end point was the composite of deaths, nonfatal myocardial infarction, and repeat coronary revascularization (MACE). The coronary revascularization was defined as complete (CCR) or incomplete (ICR) as judged by CA criteria and by MPI ischemia matched with CA criteria.RESULTS:Nighty-two patients (54%) had ICR by CA criteria (ICR-CA) and 84 (49%) had ICR by MPI criteria (ICR-MPI). Mortality and MACE were lower in patients with CCR-MPI than with ICR-MPI (P = .048, and P = .025). Survival of patients with CCR-CA and ICR-CA was not different (P = .081). Patients with both ICR-MPI and ICR-CA had the worst survival, whereas patients with CCR-MPI and CCR-CA had the best survival (P = .047). By multivariate analysis, ICR-MPI + ICR-CA was an independent predictor of death (P = .025).CONCLUSION:Patients with ICR by MPI were at higher risk than those with CCR. Patients with both ICR by MPI and CA were at the highest risk, while patients with CCR by both MPI and CA had the best long-term event-free survival.
Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology 2016
OBJECTIVE:To observe in vivo stem cell distribution and viability after transplantation by noninvasive imaging of 18F-fluorodeoxyglucose (18F-FDG) labeled autologous mononuclear bone marrow cells.METHODS:Myocardial infarction was established in 8 swine by ligating left anterior descending coronary artery after anesthesia. Bone marrow (20 ml) was drawn through ileum. After isolation, mononuclear bone marrow cells were labeled by radionuclide 18F-FDG and intramyocardially injected into infarction region. Whole body planar scan and myocardial tomography scan were performed immediately, 1 h, 2 h, and 3 h post stem cell injection. Viability and stability of radionuclide labeled stem cells were determined at 3 h post labeling in vitro.RESULTS:The labeling efficiency was (67 +/- 14)%. Mean dose of radioactive in marrow cells was (32 +/- 7) MBq. Trypan blue staining showed in vitro viability was (95 +/- 3)% at 3 h post labeling. After intramyocardial injection, labeled mononuclear bone marrow cell retention rate in infarction region was (83 +/- 6)%, (49 +/- 8)%, (32 +/- 6)% and (24 +/- 5)% immediately, 1 h, 2 h, and 3 h post injection, respectively.CONCLUSIONS:Distribution and viability of stem cell after cardiac transplantation could be effective monitored by 18F-FDG labeled autologous mononuclear bone marrow cell technique in acute stage in this model.
Zhonghua xin xue guan bing za zhi 2010
Seventy-eight patients with prior myocardial infarction and left ventricular dysfunction who underwent nitrate-augmented myocardial tomography were followed for 23 +/- 14 months. Event-free survival was 100% in 34 patients with myocardial viability who underwent coronary artery bypass grafting (CABG) and 53% in those who received medical therapy (p = 0.0008). Of the 44 patients without myocardial viability, event-free survival was not significantly different between patients who underwent CABG and those who received medical therapy (96% vs 90%, p = NS).
The American journal of cardiology 2003
OBJECTIVE:To assess the change of pulmonary perfusion after thrombolytic therapy in patients with acute pulmonary embolism.METHODS:Eighty patients with acute pulmonary embolism received pulmonary radionuclide perfusion imaging before and after thrombolytic therapy. Percentage of perfusion defect scores (PPDs) was calculated by semiquantitative analysis of pulmonary perfusion imaging before thrombolytic therapy (PPDsD(0)), 1 - 5 days (PPDsD(5)), 6 - 30 days (PPDsD(30)) and 3 months after thrombolytic therapy (PPDsM(3)).RESULTS:The mean PPDsD(0) of the 80 patients was (57.3 +/- 16.4)%. In 64 of the 80 patients, mean PPDsD(0) and PPDsD(5) were (55.5 +/- 16.8)% and (40.0 +/- 18.6)% respectively (P < 0.001). In 30 of these 64 patients, mean PPDsD(0), PPDsD(5) and PPDsD(30) were (57.5 +/- 16.1)%, (39.3 +/- 16.8)% and (29.5 +/- 17.3)% respectively. Differences between these 3 mean PPDs values were highly significant (all P < 0.001). In 11 of the 80 patients, mean PPDsD(30) and PPDsM(3) were (40.9 +/- 18.1)% and (29.1 +/- 27.1)% respectively (P < 0.05). In two groups of patients with the courses of disease in 7 days and in 8 - 14 days respectively, significant differences were found between PPDsD(0) and PPDsD(5) (P < 0.001, P < 0.001 respectively), and between PPDsD(0) and PPDsD(30) (P < 0.001, P < 0.005 respectively). The difference was also significant, although to a lesser degree (P < 0.05) between these values in a group of patients with the course of disease beyond 14 days.CONCLUSION:This study suggests that radionuclide pulmonary perfusion imaging is a reliable method for evaluating the changes of pulmonary perfusion before and after thrombolytic therapy in patients with acute pulmonary embolism.
Zhonghua jie he he hu xi za zhi = Zhonghua jiehe he huxi zazhi = Chinese journal of tuberculosis and respiratory diseases 2003
BACKGROUND:Scintigraphic myocardial perfusion imaging is the most widely used noninvasive modality for the detection of coronary artery disease (CAD). A technique for direct imaging of exercise-induced myocardial ischemia is highly desirable and preferable over perfusion imaging but is presently unavailable. We evaluated the feasibility and diagnostic accuracy of direct imaging of exercise-induced myocardial ischemia with fluorine-18-2-deoxyglucose (18FDG).METHODS AND RESULTS:Twenty-six patients with known or suspected CAD and no prior myocardial infarction underwent simultaneous myocardial perfusion and ischemia imaging after the intravenous injection of Tc-99m-sestamibi (99mTc-sestamibi) and 18FDG at peak exercise. Rest perfusion imaging was carried out separately. All patients underwent coronary angiography. Exercise 18FDG myocardial images were compared with exercise-rest 99mTc-sestamibi images and coronary angiography. Of 22 patients with > or =50% narrowing of > or =1 coronary arteries, 18 had perfusion abnormalities (sensitivity 82%) whereas 20 had abnormal myocardial 18FDG uptake (sensitivity 91%, P=NS). Perfusion abnormalities were seen in myocardial segments corresponding to 25 vascular territories of a total of 51 vessels with > or =50% luminal narrowing in 22 patients (sensitivity 49%), whereas increased 18FDG uptake was seen in 34 vascular territories (sensitivity 67%, P=0.008). 18FDG images were of high quality and easy to interpret but required simultaneous perfusion images for localizing abnormal myocardial 18FDG uptake.CONCLUSIONS:Exercise-induced myocardial ischemia can be imaged directly with 18FDG. Combined exercise 18FDG-99mTc-sestamibi imaging provides a better assessment of exercise-induced myocardial ischemia compared with exercise-rest perfusion imaging. Direct ischemia imaging eliminates some of the limitations of presently used myocardial perfusion imaging. Large-scale clinical studies are warranted.
Circulation 2003
OBJECTIVE:The purpose of this study was to evaluate the relation between deep venous thrombosis (DVT) and pulmonary thromboembolism (PTE) by radionuclide imaging.METHODS:One hundred forty patients with PTE from September 1997 to March 2001 at this institution was confirmed by clinical manifestation, pulmonary perfusion (PPI)/ventilation scan (PPV) and deep venous radionuclide venography (RNV), which were performed in all patients. There were 79 males and 61 females, with an average age of 39 +/- 18 years. Twenty-six cases underwent pulmonary angiography; 11 underwent X Ray venography of lower extremities (XRV); 18 underwent impedence plethymography (IPG); and 36 underwent lower limb echocardiography (UCG).RESULTS:Of the 140 patients with PTE, 120 (85.7%) had lower limb venous pathological changes. Among them, 94 patients had risk factors for DVT. The agreement rates of RNV with XRV, UCG and IPG were 90.9%, 72.2% and 80.0%, respectively.CONCLUSIONS:The results indicated that DVT was highly prevalent in patients with acute pulmonary embolism. Thrombosis was a primary pathogenic factor for PTE, and thrombi were mostly from proximal veins. (99m)TC-MAA radionuclide imaging was a useful method for noninvasive detection of DVT and PTE.
Zhonghua jie he he hu xi za zhi = Zhonghua jiehe he huxi zazhi = Chinese journal of tuberculosis and respiratory diseases 2002
OBJECTIVE:To investigate the effects of higeramine (HG) on hemodynamics and its tolerability and safety so as to see if it can be used in cardiac loading test, and to compare the hemodynamic effects of HG and dobutamine (DB).METHODS:Six dogs were infused intrevenously with HG in escalating doses from l microgram/kg/min through 2 microgram/kg/min and to 4 microgram/kg/min, each dose being given for 5 minutes. Then the dogs were infused intravenously with DB at the escalating doses from 5 microgram/kg/min through 10 microgram/kg/min to 20 microgram/kg/min, each dose being given for 5 minutes. Heart rate (HR), blood pressure (BP), cardiac output (CO), myocardial oxygen consumption (MOC), and coronary blood flow (CBF) were measured at the beginning of test and by the end of each dose-infusion. Electrocardiography was conducted in the meantime. Left ventricular ejection fraction (LVEF) was measured with radionuclide equilibrium ventriculography. Another 8 dogs were given HG at the escalating doses from 1 microgram/kg/min up to 500 microgram/kg/min, each dose being infused for 3 minutes, to observe the tolerability and safety of HG, HR, BP, and ECG were monitored during the test.RESULTS:Intravenous administration of HG results in significant inotropic and chronotropic effects on the heart. HR, MOC, CO and CBF all increased in a dose-dependent manner in both HG and DB tests. HG did not cause significant change in systolic blood pressure (SBP), but a slight decrease in diastolic blood pressure (DBP) was found. HR increased steeply to the peak, and then remained at a plateau level. No significant ECG abnormality was seen except a few occasional premature ventricular beats. No dog died during the study.CONCLUSION:HG can be used in pharmacological stress test with remarkable tolerability and safety even at the dosage of 500 microgram/kg/min without serious adverse effect. It can be used as an alternative agent to DB under appropriate circumstances.
Zhonghua yi xue za zhi 2002
