Equilibrium radionuclide angiocardiography:Its usefulness in current practice and potential future applications

The routine and potential future applications of equilibrium radionuclide angiocardiography/multigated acquisition (MUGA) in clinical decision making are explored in this review. The non-invasive nature of the test, less operator dependence, lower radiation dose and ease of performing, even in ill patients, are important considerations in clinical cardiology practice. Two important routine uses of this modality in day-to-day clinical practice include the following: serial assessment of left ventricular ejection fraction (LVEF) in patients receiving cardiotoxic chemotherapy, and determination of accurate LVEF in patients with intractable heart failure. Other potential utilities of MUGA that could be translated into clinical practice include determination of regional LVEF, obtaining information about both right and left ventricle in suitable patients as a part of first pass angiocardiography, identification of diastolic dysfunction in patients with heart failure with preserved LVEF, and demonstration of dyssynchrony prior to cardiac resynchronisation, specifically by MUGA single photon emission tomography.The last two indications are particularly important and evolving at this point.

Diagnosis of isolated dextrocardia using angiocardiography or surgery

Background Isolated dextrocardia is a rare phenomenon a nd usually associated with multiple cardiac anomalies. This study was to evaluat e the accuracy of diagnosis of isolated dextrocardia by using angiocardiography and to compare it with the results of surgery.Methods The clinical data of 27 cases of congenital isolated dextrocardia were collected to understand the diagnostic approaches to the major cardiac anomalies. All cases underwent angiocardiography followed by palliative or curative surgery. The diagnosis was compared by angiocardiography relying on segmental analysis with the pathological features observed in surgery.Results The results of angiocardiography of 22 patients were the same as the pathological features observed during surgery, including one case with congenital left ventricular diverticulum was inadvertently omitted in angiocardiograhy. There were significantly dissimilar diagnoses between angiocardiograhy and post-operation in 5 patients, including anatomical corrected transposition of great arteries misinterpreted as corrected transposition of the great arteries in 1, complete transposition of great arteries misinterpreted as corrected transposition of the great arteries in 1, single ventricle misinterpreted as double-outlet right ventricle in 1, and anatomical double-outlet left ventricle misinterpreted as corrected transposition of the great arteries in 2. Misdiagnostic rate of angiocardiograhy was almost 20%.Conclusions Angiocardiography is of great significance in the diagnosis and classification of isolated dextrocardia. However, because of the intricacy of cardiac anomalies of isolated dextrocardia, atrial angiography and double oblique projection are needed to improve the accuracy of diagnosis to support surgical treatments.

Morphological and functional study of ischemic left ventricle after laser transmural revascularization

Objective:The study aimed at looking into the effects of transmural revascularization with Nd:YAG laser for myocardial ischemia.Methods:Twelve healthy mongrel dogs were divided at random into 2 groups:experiment (EG) and control (CG).The dogs of EG were followed up for 8 months to observe the morphological and functional changes of ischemic left ventricle which had been treated with laser transmural revascularization.Results:Left ventriculography showed EG exceeded CG in the total and area ejection fractions,and in the short diameter shortening of left ventricle (P<0.05).Two dogs in EG showed weak pulsation of anterior wall of left ventricle.All dogs in CG revealed aneurysm in anterior wall of left ventricle.The left ventricular end diastolic pressures were -0.06?.84 kpa (1 kpa=7.5 mmHg) in EG,and 0.36?.75 kpa in CG (P>0.05).Single photon emission computed tomography (SPECT) showed total myocardial infarction in all the dogs in CG while in EG there was subendocardial infarction in only one animal (P<0.01).Conclusion:Left ventriculography and SPECT could be used to monitor the effects of transmural revascularization and Nd:YAG laser might be an efficient technique for direct transmural revascularization.

Comparative Study on 16-slice CT Coronary Angiography vs Con-ventional Coronary Angiography―A Report of 38 Cases

The clinical application of 16-slice CT coronary angiography （CTCA） and the impact of plaques differently characterized on assessing coronary artery stenosis were evaluated. Thirty-eight patients with coronary artery disease diagnosed by conventional coronary angiography （CAG） underwent 16-slice CTCA （collimation： 16×0.75 mm; rotation time： 420 msec; kernel： 35f; effective current： 500 mAs; tube voltage： 120 kV）. The interval between CTCA and CAG was within one month. CTCA was evaluated by consensus of two independent experienced radiologists unknowing CAG findings. Original images, maximum intensity projections and multiplanar reconstructions were used to assess coronary artery stenosis. For a determined plaque an attenuation value ≥ 130 HU was considered as calcified, and 〈130 HU noncalcified. The plaques were then classified into significant calcification （extensive calcification）, medium calcification （small isolated calcification） and noncalcification. The diagnostic accuracy of 16-slice CTCA findings as well as to detect ≥50% stenoses caused by plaques was evaluated respectively regarding CAG as the standard of reference. In comparison with CAG findings, the sensitivity, specificity, positive and negative predictive value derived from CTCA for mild stenosis （〈50%） were 72.7%, 38.5%, 50%, 62.5%, respectively; for moderate stenosis （50%-75%） 82.4%, 72.7%, 70%, 84.2%, resepctively; and for severe coronary stenosis （〉75%） 85%, 90.5%, 81%, 92.7% respectively. With the increase of stenoses degree, the value of CTCA was greater. For the classification of the plaque calcification with ≥50% stenosis CTCA attained the sensitivity, specificity, positive and negative predictive value for severe calcificatoin 73.3% 22.2%, 61.1% and 33.3%, respectively; for moderate calcification 70%, 55.6%, 63.6% and 62,5%, respectively; for noncalcification 93.8%, 85.7%, 93.8% and 85.7% respectively. CTCA was restricted in assessing coronary artery stenosis in the presence of calcification, but CTCA value was much improved in assessing non-calcified stenosis. It was concluded that 16-slice CTCA could provide useful information about coronary artery stenosis, especially for severe stenosis （≥ 50%） and non-calcified plaque. Since CTCA is a noninvasive technique, it may be useful in screening coronary artery disease.

Influence of granulocyte colony-stimulating factor on cardiac function in patients with acute myocardial infarction and leukopenia after revascularization

Background Granulocyte colony-stimulating factor （G-CSF） seems to improve cardiac function and perfusion when used systemically through mobilization of stem cells into peripheral blood, but results of previous clinical trials remain controversial. This study was designed to investigate safety and efficacy of subcutaneous injection of G-CSF on left ventricular function in patients with impaired left ventricular function after ST-segment elevation myocardial infarction （STEMI）. Methods Thirty-three patients （22 men; age, （68.5±6.1） years） with STEMI and with comorbidity of leukopenia were included after successful primary percutaneous coronary intervention within 12 hours after symptom onset. Patients were randomized into G-CSF group who received G-CSF （10 μg/kg of body weight, daily） for continuous 7 days and control group. Results of blood analyses, echocardiography and angiography were documented as well as possibly occurred adverse events. Results No severe adverse events occurred in both groups. Mean segmental wall thickening in infract segments increased significantly at 6-month follow up compared with baseline in both groups, but the longitudinal variation between two groups had no significant difference （P〉0.05）. The same change could also be found in longitudinal variation of wall motion score index of infarct segments （P 〉0.05）. At 6-month follow-up, left ventricular end-diastolic volume of both groups increased to a greater extent, but there were no significant differences between the two groups when comparing the longitudinal variations （P 〉0.05）. In both groups, left ventricular ejection fraction measured by echocardiography ameliorated significantly at 6-month follow-up （P 〈0.05）, but difference of the longitudinal variation between two groups was not significant （P 〉0.05）. When pay attention to left ventricular ejection fraction measured by angiocardiography, difference of the longitudinal variation between groups was significant （P=0.046）. Early diastolic mitral flow velocity deceleration time changed significantly at 6- month follow-up in both groups （P=-0.05）. Conclusions Mobilization of stem cells by G-CSF after reperfusion of infarct myocardium is safe and seems to offer a pragmatic strategy for recovery of myocardial global function.

Congenital aortic arch anomalies: diagnosis using contrast enhanced magnetic resonance angiography

Congenital aortic arch anomalies occur most commonly in children. The disease can be classified into three types： ① obstructive congenital abnormalities, including coarctation of aorta （CoA） and interruption of aortic arch （IAA）; ② nonobstructive congenital abnormalities, including double aortic arch and others; ③ congenital shunt abnormalities, including different types of patent ductus arteriosus （PDA）. Management of patients with congenital aortic arch anomalies relies on imaging. Routine imaging modalities, such as conventional X-ray plain film and transthoracic echocardiography （TTE）, have been recently complemented by magnetic resonance imaging （MRI）.