ABSTRACTEndothelial dysfunction that can be detected as impaired flow-mediated dilation by ultrasonography is an early event in atherogenesis and has been demonstrated in healthy subjects with risk ...factors for atherosclerosis many years before the appearance of atheromatous plaques. We examined the influence of physical training on flow-mediated dilation in patients with the polymetabolic syndrome. Twenty-nine asymptomatic men aged 40 to 60 years with the polymetabolic syndrome were randomly divided between the control group and the training group, which trained 3 times a week for 12 weeks. On high-resolution ultrasound images, the diameter of the brachial artery was measured at rest, after reactive hyperemia (causing flow-mediated, endothelium-dependent dilation), and after sublingual glyceryltrinitrate (causing endothelium-independent vasodilation) in all subjects before and after the training period. The training program induced an increase of 18% in physical fitness. Flow-mediated dilation increased from 5.3±2.8% to 7.3±2.7% (P <0.05). There was no change in body mass index, blood pressure, insulin resistance, lipids, and big endothelin-1 in either group. Flow-mediated dilation measured before training was negatively correlated with resting heart rate, waist-to-hip ratio, and insulin resistance. Resting heart rate emerged as the only independent determinant, which explained 22% of the variation in flow-mediated dilation. In conclusion, our findings suggest that a 3-month physical training program, which improved maximal exercise capacity, enhances flow-mediated dilation in patients with the polymetabolic syndrome.
To investigate the impact of myocardial perfusion scintigraphy results on the decision for invasive coronary angiography in elderly patients (≥75 years) with suspected coronary artery disease ...hospitalized in a single tertiary medical center.
In the retrospective study, data of 276 (136 elderly) consecutive hospitalized patients referred to myocardial perfusion imaging were analyzed. The clinical characteristics, myocardial perfusion scintigraphy results, invasive coronary angiography and revascularization rates and in-hospital adverse events were identified by manually reviewing the patients' records.
Ischemia was found in 40.2% of patients. There was no significant difference in the proportion of ischemia between elderly and younger patients (38.2% vs. 42.1%, P=0.508). Invasive coronary angiography was performed in 64.0% of patients with ischemia and in 6.8% of patients with normal myocardial perfusion imaging (P<0.001). The referral rate for invasive coronary angiography was not different between elderly and younger patients with ischemia (63.5% vs. 64.4%, P=0.848). Ischemia on myocardial perfusion imaging was the most predictive variable for a referral to invasive coronary angiography (odds ratio 31.8, 95% confidence interval 14.6-69.5, P<0.001). There was no significant difference between the younger and elderly patients in revascularization rate and adverse events until discharge (39% vs. 40%, P=0.99 and 7.1% vs. 8.8%, P=0.6, respectively).
Ischemia on myocardial perfusion scintigraphy is a powerful predictor for in-hospital invasive coronary angiography independent of the patient's age. Elderly patients with ischemia received invasive coronary angiography equally as their younger counterparts and have similar rates of adverse events until discharge.
Summary
Sarcoidosis is an inflammatory disease. Epidemiological and treatment studies suggest that fungi play a part in the pathogenesis. The aim of this work was to study the effect of fungal cell ...wall agents (FCWA) on the in vitro secretion of cytokines from peripheral blood monocytes from subjects with sarcoidosis and relate the results to fungal exposure at home and clinical findings. Subjects with sarcoidosis (n = 22) and controls (n = 20) participated. Peripheral blood mononuclear cells were stimulated with soluble or particulate β‐glucan (S‐glucan, P‐glucan), chitin or lipopolysaccharide (LPS), whereafter tumour necrosis factor (TNF)‐α, interleukin (IL)‐6, IL‐10 and IL‐12 were measured. The severity of sarcoidosis was determined using a chest X‐ray‐based score. Serum cytokines (IL‐2R, IL‐6, IL‐10 and IL‐12) were determined. To measure domestic fungal exposure, air in the bedrooms was sampled on filters. N‐acetylhexosaminidase (NAHA) on the filters was measured as a marker of fungal cell biomass. The induced secretion of cytokines was higher from peripheral blood mononuclear cells (PBMC) from subjects with sarcoidosis. P‐glucan was more potent than S‐glucan inducing a secretion. Chitin had a small effect. Among subjects with sarcoidosis there was a significant relation between the spontaneous PBMC production of IL‐6, IL‐10 and IL‐12 and the NAHA levels at home. The P‐glucan induced secretion of IL‐12 was related to the duration of symptoms at the time of diagnosis. Their X‐ray scores were related to an increased secretion of cytokines after stimulation with LPS or P‐glucan. Subjects with sarcoidosis have a higher reactivity to FCWA in vitro and to home exposure. The influence of FCWA on inflammatory cells and their interference with the inflammatory defense mechanisms in terms of cytokine secretion could be important factors for the development of sarcoidosis.
Acute myocardial infarction (AMI) is more frequent in winter months than in summer months. The aetiologic mechanisms underlying this seasonal pattern are poorly understood. We investigate whether ...seasonal variation of metabolic and haemostatic coronary risk factors exists, and whether this variation is more pronounced in subjects with coronary artery disease (CAD). In 82 subjects (47 free of clinical signs of CAD and in 35 survivors of AMI), measurements of body mass index (BMI), lipoproteins, glucose, insulin, plasminogen activator inhibitor-1, tissue-type plasminogen activator (t-PA), euglobulin clot lysis time, fibrinogen, and platelet count were performed twice in the cold months (December and March) and twice in the warm months (June and September). Significantly higher BMI (26.8 versus 26.2 kg/m, P < 0.01), glucose (5.5 versus 5.1 mmol/l, P < 0.01), total cholesterol (5.61 versus 5.32 mmol/l, P < 0.05), low-density lipoprotein cholesterol (3.63 versus 3.34 mmol/l, P < 0.05), triglycerides (1.79 versus 1.61 mmol/l, P < 0.01), Lp(a) (270.7 versus 237.5 mg/l, P < 0.01), fibrinogen level (3.50 versus 2.95 g/l, P < 0.00001), platelet count (212 × 10 versus 173 × 10/l, P < 0.01) and significantly lower high-density lipoprotein cholesterol level (1.22 versus 1.28 mmol/l, P < 0.05) were observed in the cold months compared with the warm months. Significant seasonal variation of t-PA activity (1.19 versus 0.87 IU/ml, P = 0.015) and t-PA antigen (8.5 versus 7.3 ng/ml, P = 0.05) was demonstrated only in subjects with CAD. Clustering of peak values of several metabolic and haemostatic coronary risk factors was observed in winter months. This variation might be of aetiopathogenetic importance for the seasonal pattern of acute myocardial infarction.
Abstract Introduction Patients with moderate to severe ischemia on stress myocardial perfusion scintigraphy are at highest risk for cardiovascular adverse events and death. The presence, extent and ...severity of ischemia detected on myocardial perfusion scintigraphy have all decreased over the past few years. Therefore, there is an increasing need to identify patient cohorts where the results of myocardial perfusion scintigraphy will have the greatest impact on clinical management. The data on predictors of moderate to severe ischemia within contemporary population of patients are scarce. Purpose of our study was to evaluate the predictors of moderate to severe ischemia across all potentially relevant clinical parameters in a cohort of patients referred to stress myocardial perfusion scintigraphy. Methods The clinical data and myocardial perfusion scintigraphy results of 4620 consecutive patients admitted to our department from January 2020 to December 2023 were prospectively collected. All patients underwent a 2-day stress/rest 99mTc tetrofosmin (Myoview, GE Healthcare) myocardial perfusion scintigraphy. Patients were imaged in the sitting position using a Cardius® X-ACT camera (Digirad, California, USA). The magnitude of myocardial ischemia was determined semi quantitatively in a 17-segment model according to the European Association of Nuclear Medicine guidelines. Patients were categorized in moderate to severe ischemia (>10% ischemia) and <10% of ischemia groups. Results The baseline clinical characteristics of the study population according to the degree of ischemia are shown in Table 1. Of the 4620 patients, 1695 (36.7%) had ischemia, 191 (4.1% of all patients, 11% of patients with ischemia) had moderate to severe ischemia. The proportion of male gender and the frequency of diabetes, dyslipidemia and prior coronary artery disease were higher in patients with moderate to severe ischemia (all p <0.001, Table 1). Patients with moderate to severe ischemia had more often typical chest pain, were inpatients and had a higher frequency of myocardial scar (all p <0.001, Table 1). In multivariable analysis male gender, diabetes, typical chest pain, known coronary artery disease and inpatient status turned out as predictors of moderate to severe ischemia (Table 2). Dyslipidemia and myocardial scar were not significant predictors (Table 2). Conclusion The prevalence of moderate to severe ischemia is particularly high among diabetic male patients with typical chest pain and known coronary artery disease. These observations may be used in clinical practice to identify patients who are most likely to benefit from referral to stress myocardial perfusion scintigraphy.
Abstract Introduction The presence of left bundle branch block (LBBB), although extensively studied, is still associated with many gaps in the knowledge of the underlying associated diseases. ...Although LBBB can sometimes be found in asymptomatic individuals with structurally normal heart, majority of patients with LBBB have some form of underlying heart disease, including coronary artery disease (CAD). Myocardial perfusion scintigraphy with pharmacological stress testing is one of the recommended non-invasive tests in patients with LBBB and suspected CAD. Heart failure, progressive conductive system disease and other cardiomyopathies can be also associated with LBBB. Purpose of our study was to assess the clinical characteristics and results of myocardial perfusion scintigraphy on patients with LBBB. Methods The clinical data and myocardial perfusion scintigraphy results of 5168 consecutive patients admitted to our department from January 2020 to December 2023 were prospectively collected. All patients underwent a 2-day stress/rest 99mTc tetrofosmin (Myoview, GE Healthcare) MPI. Patients were imaged in the sitting position using a Cardius® X-ACT camera (Digirad, California, USA). Patients were categorized into LBBB and without LBBB groups. Results 284 patients (5.5%) had LBBB. Clinical characteristics of the patients with and without LBBB are shown in Table 1. Patients in LBBB group were older and predominantly female. There were no differences in the prevalence of cardiovascular risk factors between the groups. The proportion of patients with reversible ischaemia was lower in patients with LBBB (Table 1). The extent of ischaemia was similar in both groups (Table 2). The summed stress score (on scintigrams with and without attenuation correction) was higher in patients with LBBB, due to expected perfusion artefacts (Table 2). Conclusions The findings of our study indicated that the presence of LBBB is associated with a lower incidence of reversible ischaemia on myocardial perfusion scintigraphy than in the non-LBBB population. This suggests that the impact of CAD as the leading underlying cause of LBBB could be less significant, possibly due to modern diagnostic and treatment options. Consequently, other factors might have more influence. Supporting this notion, the data reveals that patients with LBBB were typically older and exhibited a higher prevalence of heart failure.
Abstract
Funding Acknowledgements
Type of funding sources: None.
Introduction
Department for nuclear medicine in the University medical centre Ljubljana provides nuclear medicine diagnostic ...procedures for approximately 1.000.000 inhabitants of Slovenia. As many countries in Europe, Slovenia was faced with the first wave of the COVID-19 pandemic in early spring of 2020. Since our country is situated next to the northern part of Italy, where the situation was critical, our Ministry of health issued specific recommendations in March 2020. The aim was to increase hospital capacities for COVID-19 patients through limiting non-urgent diagnostic tests including myocardial perfusion scintigraphy (MPS) and to minimize the spread of the virus into hospital departments. The epidemiologic situation of the first wave resolved within 3 months. In the second wave of the pandemic in autumn 2020, the recommendations on patient care in non COVID-19 cases were less limiting to avoid worsening of non COVID-19 related diseases and patient prognosis.
Purpose
The aim of our study was to evaluate the influence of the COVID-19 pandemic on MPS in our medical institution.
Methods
Data on numbers of MPS, clinical characteristics of the patients and findings of MPS were prospectively collected for the first wave (in spring from March 15th to June 15th 2020) and second wave (in autumn from September 15th to December 15th 2020) of the pandemic and were compared with the same periods in 2019.
Results
During the first wave we performed 40% less MPS, significantly more patients had pharmacological stress and were outpatients than in spring 2019. There were no significant differences in other clinical characteristics and MPS findings (Table 1 and Figure 1). In autumn 2020 we reorganized our schedule to increase the number of patients, which was once again comparable to previous year’s autumn. Although the number of patients was comparable, patients were now significantly older and had more often pharmacological stress, but there were no significant differences in other clinical data or MPS findings (Table 1 and Figure 1).
Conclusions
In our hospital, during the first wave of COVID-19 pandemic, we performed significantly less MPS than in the same period of the previous year. To minimize the possibility of virus transmission from asymptomatic patients, we followed international recommendations and avoided exercise stress tests but increased the percentage of pharmacological stress tests. A similar approach regarding the type of stress tests was chosen for the second wave in autumn of 2020. However, we decided to increase the number of MPS performed, in order to lessen the negative impact of the pandemic on non COVID-19 related diseases, focusing on coronary artery disease.
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