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Nuclear cardiac stress test

Mads E Jørgensen, Charlotte Andersson, Bjarne L Nørgaard, Jawdat Abdulla, Jacqueline B Shreibati, Christian Torp-Pedersen, Gunnar H Gislason, Richard E Shaw, Mark A Hlatky
BACKGROUND: The choice of either anatomical or functional noninvasive testing to evaluate suspected coronary artery disease might affect subsequent clinical management and outcomes. OBJECTIVES: This study analyzed the association of initial noninvasive cardiac testing in outpatients with stable symptoms, with subsequent use of medications, invasive procedures, and clinical outcomes. METHODS: We studied patients enrolled in a Danish nationwide register who underwent initial noninvasive cardiac testing with either coronary computed tomography angiography (CTA) or functional testing (exercise electrocardiography or nuclear stress testing) from 2009 to 2015...
April 11, 2017: Journal of the American College of Cardiology
Max Wagener, Roger Abächerli, Ursina Honegger, Nicolas Schaerli, Gil Prêtre, Raphael Twerenbold, Christian Puelacher, Germaine Sunier, Philipp Reddiess, Maria Rubini Gimenez, Karin Wildi, Jasper Boeddinghaus, Thomas Nestelberger, Patrick Badertscher, Zaid Sabti, Ramun Schmid, Remo Leber, Dayana Flores Widmer, Samyut Shrestha, Ivo Strebel, Damian Wild, Stefan Osswald, Michael Zellweger, Christian Mueller, Tobias Reichlin
We aimed to assess the diagnostic and prognostic value of ST-segment deviation in aVR, a lead often ignored in clinical practice, during exercise testing and to compare it to the most widely used criterion of ST-segment depression in V5. We enrolled 1,596 patients with suspected myocardial ischemia referred for nuclear perfusion imaging undergoing bicycle stress testing. ST-segment amplitudes in leads aVR and V5 were automatically measured. The presence of inducible myocardial ischemia was the diagnostic end point and adjudicated based on nuclear perfusion imaging and coronary angiography...
April 1, 2017: American Journal of Cardiology
Hagir B Suliman, Jeffrey E Keenan, Claude A Piantadosi
The heme oxygenase-1 (Hmox1; HO-1) pathway was tested for defense of mitochondrial quality control in cardiomyocyte-specific Hmox1 KO mice (HO-1[CM](-/-)) exposed to oxidative stress (100% O2). After 48 hours of exposure, these mice showed persistent cardiac inflammation and oxidative tissue damage that caused sarcomeric disruption, cardiomyocyte death, left ventricular dysfunction, and cardiomyopathy, while control hearts showed minimal damage. After hyperoxia, HO-1(CM)(-/-) hearts showed suppression of the Pgc-1α/nuclear respiratory factor-1 (NRF-1) axis, swelling, low electron density mitochondria by electron microscopy (EM), increased cell death, and extensive collagen deposition...
February 9, 2017: JCI Insight
Qian Chen, Xiaosong Chen, Conghui Han, Ying Wang, Tao Huang, Yingdong Du, Zhen Dong
BACKGROUND/AIMS: Cardiovascular disease is a growing major global public health problem. Necrosis is one of the main forms of cardiomyocyte death in heart disease. Oxidative stress is regarded as one of the key regulators of cardiac necrosis, which eventually leads to cardiovascular disease. Many pharmacological and in vitro studies have suggested that FGF-2 can act directly on cardiomyocytes to maintain the integrity and function of the myocardium and prevent damage during oxidative stress...
2016: Cellular Physiology and Biochemistry
Vinay Kini, Fenton H McCarthy, Elias Dayoub, Steven M Bradley, Frederick A Masoudi, P Michael Ho, Peter W Groeneveld
Importance: After a period of rapid growth, use of cardiac stress testing has recently decreased among Medicare beneficiaries and in a large integrated health system. However, it is not known whether declines in cardiac stress testing are universal or are confined to certain populations. Objective: To determine trends in rates of cardiac stress testing among a large and diverse cohort of commercially insured patients. Design, Setting, and Participants: A serial cross-sectional study with time trends was conducted using administrative claims from all members aged 25 to 64 years belonging to a large, national managed care company from January 1, 2005, to December 31, 2012...
December 1, 2016: JAMA Cardiology
Sophie Mavrogeni, George Markousis-Mavrogenis, Genovefa Kolovou
Factors leading to Cardiovascular Disease (CVD) in Autoimmune Rheumatic Diseases (ARD) include: a) atherosclerosis and macro-microvascular coronary artery disease b) pericardial, myocardial and vascular inflammation c) heart valve disease d) heart failure and e) pulmonary hypertension.Cardiology utilizes various non-invasive imaging modalities, such as rest/stress Electrocardiogram (ECG), echocardiography, nuclear imaging and more recently Cardiovascular Magnetic Resonance (CMR) to detect ischemic or inflammatory disease in ARD...
October 28, 2016: BMC Cardiovascular Disorders
Gianluca Pontone, Giuseppe Muscogiuri, Daniele Andreini, Andrea I Guaricci, Marco Guglielmo, Saima Mushtaq, Andrea Baggiano, Edoardo Conte, Virginia Beltrama, Andrea Annoni, Alberto Formenti, Elisabetta Mancini, Mark G Rabbat, Mauro Pepi
The increased number of patients with coronary artery disease (CAD) in developed countries is of great clinical relevance and involves a large burden of the healthcare system. The management of these patients is focused on relieving symptoms and improving clinical outcomes. Therefore the ideal test would provide the correct diagnosis and actionable information. To this aim, several non-invasive functional imaging modalities are usually used as gatekeeper to invasive coronary angiography (ICA), but their diagnostic yield remains low with limited accuracy when compared to obstructive CAD at the time of ICA or invasive fractional flow reserve (FFR)...
December 2016: Current Treatment Options in Cardiovascular Medicine
Subha V Raman, Jennifer A Dickerson, Wojciech Mazur, Timothy C Wong, Erik B Schelbert, James K Min, Debbie Scandling, Cheryl Bartone, Jason T Craft, Paaladinesh Thavendiranathan, Ernest L Mazzaferri, John W Arnold, Robert Gilkeson, Orlando P Simonetti
BACKGROUND: Stress cardiac magnetic resonance (CMR) has typically involved pharmacologic agents. Treadmill CMR has shown utility in single-center studies but has not undergone multicenter evaluation. METHODS AND RESULTS: Patients referred for treadmill stress nuclear imaging (SPECT) were prospectively enrolled across 4 centers. After rest (99m)Tc SPECT, patients underwent resting cine CMR. In-room stress was then performed using an MR-compatible treadmill with continuous 12-lead electrocardiogram monitoring...
August 19, 2016: Journal of the American Heart Association
Dileep Unnikrishnan, Aasems Jacob, Mark Anthony Diaz, Jeffrey Lederman
An 83-year-old female patient with rheumatoid arthritis and hypertension presented to the emergency department with fever and chills of 1 day duration. On examination, temperature was 100.9 F, heart rate 111/min and she had orthostatic hypotension. Laboratory tests showed elevated blood urea nitrogen and white cell count. The patient underwent treatment for symptomatic urinary tract infection and while her fever and leucocytosis resolved, tachycardia persisted. An EKG done showed T inversions in leads II, III, arteriovenous fistula, V2 and V3...
August 3, 2016: BMJ Case Reports
Christian Hamilton-Craig, Jonathan Chan
Cardiac imaging is a rapidly evolving field, with improvements in the diagnostic capabilities of non-invasive cardiac assessment. We review the two main emerging technologies in cardiac imaging: computed tomography coronary angiography (CTCA) to evaluate chest symptoms and to exclude coronary artery disease; and cardiovascular magnetic resonance (CMR) for evaluating cardiac morphology, function and presence of scar. CTCA is an excellent "rule out" test, with a negative predictive value approaching 100%. Radiation exposure is no longer a concern for CTCA, with doses routinely < 5 mSv, and as low as < 1 mSv in selected patients...
August 1, 2016: Medical Journal of Australia
Venkatesh L Murthy, Jessica Lehrich, Brahmajee K Nallamothu
No abstract text is available yet for this article.
August 1, 2016: JAMA Cardiology
Daniel A Franco, Seth Truran, Volkmar Weissig, Diana Guzman-Villanueva, Nina Karamanova, Subhadip Senapati, Camelia Burciu, Marina Ramirez-Alvarado, Luis M Blancas-Mejia, Stuart Lindsay, Parameswaran Hari, Raymond Q Migrino
BACKGROUND: Light chain amyloidosis (AL) is associated with high mortality, especially in patients with advanced cardiovascular involvement. It is caused by toxicity of misfolded light chain proteins (LC) in vascular, cardiac, and other tissues. There is no treatment to reverse LC tissue toxicity. We tested the hypothesis that nanoliposomes composed of monosialoganglioside, phosphatidylcholine, and cholesterol (GM1 ganglioside-containing nanoliposomes [NLGM1]) can protect against LC-induced human microvascular dysfunction and assess mechanisms behind the protective effect...
June 2016: Journal of the American Heart Association
Fenling Fan, Lu Fang, Xiao-Lei Moore, Xuegang Xie, Xiao-Jun Du, David A White, Jessica O'Brien, Helen Thomson, Jun Wang, Hans G Schneider, Andris Ellims, Thomas W Barber, Anthony M Dart
BACKGROUND: Macrophage migration inhibitory factor (MIF) is a key regulator of inflammatory responses, including in the heart. Plasma MIF is elevated early in the course of acute myocardial infarction. In this study, we hypothesized that plasma MIF may also be increased in acute myocardial ischemia. METHODS AND RESULTS: Patients undergoing cardiac stress test (stress nuclear myocardial perfusion scan or stress echocardiography) were recruited. Twenty-two patients had a stress test indicative of myocardial ischemia and were compared with 62 patients who had a negative stress test...
July 2016: Journal of the American Heart Association
Benoy N Shah, Roxy Senior
The incidence of significant obesity is rising across the globe. These patients often have a clustering of cardiovascular risk factors and are frequently referred for noninvasive cardiac imaging tests. Stress echocardiography (SE) is widely used for assessment of patients with known or suspected coronary artery disease (CAD), but its clinical utility in morbidly obese patients (in whom image quality may suffer due to body habitus) has been largely unknown. The recently published Stress Ultrasonography in Morbid Obesity (SUMO) study has shown that SE, when performed appropriately with ultrasound contrast agents (whether performed with physiological or pharmacological stress), has excellent feasibility and appropriately risk stratifies morbidly obese patients, including identification of patients who require revascularization...
June 2016: Echo Research and Practice
Brian Grunau, Jonathon Leipsic, Elizabeth Purssell, Naomi Kasteel, Kimchi Nguyen, Mikameh Kazem, Christopher Naoum, Rekha Raju, Philipp Blanke, Brett Heilbron, Carolyn Taylor, Frank X Scheuermeyer
Coronary computed tomography angiography (CCTA) appears comparable to standard care, including exercise stress testing (EST), in diagnosing acute coronary syndrome in emergency department (ED) patients with chest pain but may increase downstream testing. The objective of this study was to investigate rates of post-CCTA versus post-EST testing for (1) invasive angiography and (2) all combined cardiac testing. This was a retrospective cohort study performed at 2 urban Canadian EDs involving patients aged up to 65 years with chest pain but no objective ACS findings that were evaluated with CCTA or EST at the physician's discretion...
July 15, 2016: American Journal of Cardiology
Jorge G Farías, Catalina Carrasco-Pozo, Rodrigo Carrasco Loza, Néstor Sepúlveda, Pedro Álvarez, Mauricio Quezada, John Quiñones, Víctor Molina, Rodrigo L Castillo
The mechanistic evidence to support the cardioprotective effects of polyunsaturated fatty acids (PUFA) are controversial. The aim was to test cardioprotective mechanisms induced by PUFA supplementation against cardiac ischemia-reperfusion (IR) injury. Ten-week-old male Wistar rats (225 ± 14 g, n = 14) were divided in two groups: rats without supplementation (n = 7) and a PUFA group, supplemented by PUFA (0.6 g/kg/day; DHA:EPA = 3:1) for eight weeks (n = 7). Hearts were perfused with Krebs-Henseleit buffer for 20 min (control conditions); others were subjected to control conditions, 30 min of global ischemia and 120 min of reperfusion (IR group)...
May 10, 2016: Experimental Biology and Medicine
Katherine A Araque, Michael J Smith, Brooks M Walsh
A middle-aged Hispanic woman presented to the emergency department (ED) reporting of acute new onset pressure-like chest pain developed at rest. It was radiated to the right arm and associated with malaise. Initial ECG demonstrated T-wave inversions (TWIs) in all anterior and lateral leads. Electrolytes, serial cardiac troponin and D-dimer were all normal. Comprehensive transthoracic echocardiogram and nuclear stress test did not reveal a cardiac cause of her symptoms.Serum thyroid-stimulating hormone was markedly elevated (207 mIU/L) and free thyroxine was low (FT4 0...
April 7, 2016: BMJ Case Reports
Margarita E Pena, Michael R Jakob, Gerald I Cohen, Charlene B Irvin, Nastaran Solano, Ashley R Bowerman, Susan M Szpunar, Mason K Dixon
INTRODUCTION: Clinicians are urged to decrease radiation exposure from unnecessary medical procedures. Many emergency department (ED) patients placed in an observation unit (EDOU) do not require chest pain evaluation with a nuclear stress test (NucST). We sought to implement a simple ST algorithm that favors non-nuclear stress test (Non-NucST) options to evaluate the effect of the algorithm on the proportion of patients exposed to radiation by comparing use of NucST versus Non-NucST pre- and post-algorithm...
March 2016: Western Journal of Emergency Medicine
Alessia Gimelli, Ilaria Rovai, Riccardo Liga, Emilio Maria Pasanisi, Paolo Marzullo
The efforts for a broad application of the appropriate use criteria to reduce inappropriate nuclear stress testing have frequently been unsuccessful and the reported rates of inappropriateness have varied widely between studies. We sought to analyze the criteria of clinical appropriateness of a cohort of consecutive patients referred to our nuclear cardiology laboratory to perform stress myocardial perfusion imaging (MPI) and to assess the relationships between test appropriateness and the evaluation of ischaemia...
June 2016: International Journal of Cardiovascular Imaging
Anju Paudyal, Sukriti Dewan, Cindy Ikie, Benjamin J Whalley, Pieter P de Tombe, Samuel Y Boateng
KEY POINTS: The present study investigated the mechanism associated with impaired cardiac mechanosensing that leads to heart failure by examining the factors regulating muscle LIM protein subcellular distribution in myocytes. In myocytes, muscle LIM protein subcellular distribution is regulated by cell contractility rather than passive stretch via heme oxygenase-1 and histone deacetylase signalling. The result of the present study provide new insights into mechanotransduction in cardiac myocytes...
June 15, 2016: Journal of Physiology
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