Browsing by Author "Petrasinovic, Zorica (56057995200)"

Purpose of the Report: The aims of this study were to compare perfusion and functional parameters between early (ES) and standard (SS) post-stress gated SPECT MIBI, to validate ES against coronary angiography, and to determine whether ES parameters can predict future cardiac events. Patients and Methods: The sample included 63 patients with normal or mildly impaired left ventricular function and intermediate Duke Treadmill Score. They underwent a 2-day stress-rest gated SPECT MIBI with the poststress data acquired at 15 minutes (ES) and 60 minutes (SS) after i.v. injection of 740 MBq of 99mTc-MIBI. The ES findings were compared to SS and against coronary angiography to determine their sensitivity/specificity for detecting 970% stenosis. The information about new-onset cardiac events was collected 26 T 6 months later. Results: Perfusion parameters did not significantly differ between ES and SS. Ejection fraction was significantly lower and regional wall motion abnormalities were significantly higher on ES than SS. The corresponding perfusion and functional parameters were strongly related (linear regression slope 0.65-1.00, intercept j0.36Y8.5, R2 0.98Y0.75). ES parameters had high sensitivity (96%) and specificity (83%) for detecting 970% stenosis. Lower early stress than rest EF (95%), higher early stress than rest EDV, and early SSS 98 emerged as significant predictors of new-onset cardiac events. Conclusions: Early post-stress gated SPECT MIBI yields comparable perfusion and functional parameters as the standard post-stress protocol. ES parameters are useful for detecting the existing coronary disease and for predicting future cardiac events. ES protocol is recommended for improving patient compliance and efficiency of nuclear cardiology services.

Objective: Assessment of the first febrile urinary tract infection (UTI) in children has been the subject of debate for many years. Diagnosis of acute pyelonephritis (APN) is usually based on clinical and biological data. The clinical usefulness of early Tc-99m DMSA scintigraphy remains controversial, although it may influence the type and duration of treatment. The aim of this study was to assess the role of initial cortical scintigraphy in the detection of early renal parenchymal damage in children highly suspected of having APN and to compare the scintigraphic findings with selected clinical/laboratory parameters and ultrasonography. Methods: A prospective study was conducted in 34 infants and young children (18 boys, 16 girls), aged 1.5-36 months (mean 9.8 ± 8.7 months), hospitalized with a first episode of clinically suspected APN. Within the first 5 days after admission, Tc-99m DMSA renal scintigraphy, ultrasonography (US), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), white blood cell count (WBC) and urine analyses were performed. Results: DMSA scintigraphy showed changes consistent with APN in 27/34 (79%) patients, with a mean age of 10.9 months, including 12 males (44%) and 15 (56%) females. Out of 9 febrile children with negative urine culture and supportive evidence of UTI, scintigraphy showed parenchymal involvement in 8 children (24% in the whole group, 30% in scintigraphically documented APN). There were no statistically significant correlations between the frequency or size of the initial scintigraphic abnormalities and age, sex, body temperature, CRP levels or ESR. A CRP level of >54 mg/L and a WBC of >13,300/mm3 had sensitivities of 56 and 59% and specificities of 86 and 71%, respectively. US showed changes consistent with APN in 7/34 (21%) in the whole group and in 7/27 (26%) patients with positive cortical scan (p < 0.05). Conclusion: Initial DMSA renal scintigraphy is a sensitive method for the early diagnosis of APN in young children and is useful in the assessment of the severity of kidney injury even in patients with negative urine culture. Clinical, biological and ultrasound parameters do not identify children with renal damage. Normal DMSA study, excluding parenchymal involvement and late sequelae, could minimize the use of scintigraphy in the follow-up and reduce the redundancy of cystography. © 2010 The Japanese Society of Nuclear Medicine.

OBJECTIVE: The aims of this study were to investigate the incidence and parameters associated with myocardial ischemia during mental stress (MS) as measured by echocardiography and to evaluate the relation between MS-induced and exercise-induced myocardial ischemia. METHODS: Study participants were 79 patients (63 men; mean [M] [standard deviation {SD}] age = 52 [8] years) with angiographically confirmed coronary artery disease and previous positive exercise test result. The MS protocol consisted of mental arithmetic and anger recall task. The patients performed a treadmill exercise test 15 to 20 minutes after the MS task. Data of post-MS exercise were compared with previous exercise stress test results. RESULTS: The frequency of echocardiographic abnormalities was 35% in response to the mental arithmetic task, compared with 61% with anger recall and 96% with exercise (p <.001, exercise versus MS). Electrocardiogram abnormalities and chest pain were substantially less common during MS than were echocardiographic abnormalities. Independent predictors of MS-induced myocardial ischemia were: wall motion score index at rest (p =.02), peak systolic blood pressure (p =.005), and increase in rate-pressure product (p =.004) during MS. The duration of exercise stress test was significantly shorter (p <.001) when MS preceded the exercise and in the case of earlier exercise (M [SD] = 4.4 [1.9] versus 6.7 [2.2] minutes for patients positive on MS and 5.7 [1.9] versus 8.0 [2.3] minutes for patients negative on MS). CONCLUSIONS: Echocardiography can be successfully used to document myocardial ischemia induced by MS. MS-induced ischemia was associated with an increase in hemodynamic parameters during MS and worse function of the left ventricle. MS may shorten the duration of subsequent exercise stress testing and can potentiate exercise-induced ischemia in susceptible patients with coronary artery disease. Copyright © 2012 by the American Psychosomatic Society.

OBJECTIVE: The aims of this study were to investigate the incidence and parameters associated with myocardial ischemia during mental stress (MS) as measured by echocardiography and to evaluate the relation between MS-induced and exercise-induced myocardial ischemia. METHODS: Study participants were 79 patients (63 men; mean [M] [standard deviation {SD}] age = 52 [8] years) with angiographically confirmed coronary artery disease and previous positive exercise test result. The MS protocol consisted of mental arithmetic and anger recall task. The patients performed a treadmill exercise test 15 to 20 minutes after the MS task. Data of post-MS exercise were compared with previous exercise stress test results. RESULTS: The frequency of echocardiographic abnormalities was 35% in response to the mental arithmetic task, compared with 61% with anger recall and 96% with exercise (p <.001, exercise versus MS). Electrocardiogram abnormalities and chest pain were substantially less common during MS than were echocardiographic abnormalities. Independent predictors of MS-induced myocardial ischemia were: wall motion score index at rest (p =.02), peak systolic blood pressure (p =.005), and increase in rate-pressure product (p =.004) during MS. The duration of exercise stress test was significantly shorter (p <.001) when MS preceded the exercise and in the case of earlier exercise (M [SD] = 4.4 [1.9] versus 6.7 [2.2] minutes for patients positive on MS and 5.7 [1.9] versus 8.0 [2.3] minutes for patients negative on MS). CONCLUSIONS: Echocardiography can be successfully used to document myocardial ischemia induced by MS. MS-induced ischemia was associated with an increase in hemodynamic parameters during MS and worse function of the left ventricle. MS may shorten the duration of subsequent exercise stress testing and can potentiate exercise-induced ischemia in susceptible patients with coronary artery disease. Copyright © 2012 by the American Psychosomatic Society.

Objective: Gated single photon emission computed tomography (gated SPECT) myocardial imaging gives useful information about the extent and severity of perfusion abnormalities (PA) and global left ventricular (LV) function in patients with coronary artery disease. The aim of this study was to evaluate by gated SPECT myocardial imaging differences in perfusion scores and LV function between stress and rest in patients with mild left ventricular dysfunction and/or normal function and previous inferior myocardial infarction (IMI) and to detect myocardial stunning. Materials and methods: The study included 77 patients (age 53 ± 8.21) with mild left ventricular dysfunction and previous IMI divided into two groups. Group 1 consisted of 34 patients with IMI and additional ischemia on perfusion scan and group 2 with 43 patients with previous IMI without ischemia on perfusion scan. All patients underwent a 2-day stress-rest gated SPECT myocardial imaging protocol with 99m technetium-methoxyisobutylisonitrile ( 99mTc-MIBI). Results: There was a more significant post-stress to rest decrease in ejection fraction (EFps) in patients with IMI and additional ischemia (group 1) than in patients with IMI (group 2) (-1.5 ± 2.5 vs. 1.5 ± 2.3, p < 0.001). In group 1, there was a significant increase in post-stress end-systolic volume (ESVps) in comparison to ESVr (70.4 ± 29.8 vs. 66.2 ± 26.2 ml, p = 0.044). However, the decrease in EF post-stress to rest did not reach the level of significance (51.7 ± 10.8 vs. 53.2 ± 10.2%, p = 0.147). The extent and severity of perfusion abnormalities were higher on stress (SSS) than on rest images (SRS) (13.9 ± 8.6 vs. 8.3 ± 7.8, p < 0.001). There was no difference in global LV parameters or perfusion abnormalities in patients in group 2 between stress and rest except for a significant increase in the post-stress EF to rest value (57.9 ± 11.9 vs. 56.2 ± 10.5%, p = 0.018). Severe decrease of post-stress EF to rest was found in 12 (16%) patients indicating stunning. Conclusion: In patients with mild left ventricular dysfunction and IMI with additional ischemia there is evidence of a decrease in the post-stress EF with an increase in the post-stress ESV. In addition, a significant association between the decrease of post-stress EF with the extent and severity of perfusion abnormalities was detected. Gated SPECT myocardial imaging has an important role in the evaluation of perfusion and LV function in patients with IMI especially in patients with additional ischemia. © 2011 The Japanese Society of Nuclear Medicine.