technetium-tc-99m-exametazime and Coronary-Disease

To estimate possibilities for studies of cerebral perfusion with brain scintigraphy for revealing and an estimation of features of change brain perfusion at patients with a cardio-cerebral vascular pathology before and after carotid stenting (CAS).. 11 patients with established (after carotid angiography) stenosis of internal carotid artery and coronary artery disease have been studied with SPECT with analogue HMPAO teoxim--Tc99M after intravenous introduction 700 MBk up to and in 5 days and in the remote period after stenting. For analysis of results the program "Neurogam" have been used. Standartized perfusion maps have been created.. Before performing CAS various variants of the image cerebral perfusion maps have been obtained: from diffuse insignificant reduction in both hemispheres of a brain up to the regions hypoperfusion, characteristic for ischemic changes. Regions of hypoperfusion on the side opposite to a stenosis or occasion were revealed. SPECT, performed after cas on 5th day or after 2-3 months found increase of general brain perfusion, disappearance of symmetric both asymmetric regions hypoperfusion and reduction of a degree local hypoperfusion on the side of stenting.. Maps of brain perfusion before and after CAS adequately reflect microcirculation of a brain with local changes of perfusion. Use of perfusion parameters gives possibility to estimate changes of brain perfusion before and after CAS in patients with combined carotid and coronary pathology.

Topics: Brain; Brain Mapping; Carotid Artery, Internal; Carotid Stenosis; Coronary Disease; Female; Follow-Up Studies; Humans; Male; Middle Aged; Oximes; Perfusion Imaging; Radionuclide Imaging; Radiopharmaceuticals; Stents; Technetium Tc 99m Exametazime; Time Factors; Tomography, Emission-Computed, Single-Photon; Treatment Outcome

Platelets (Plt) accumulate in reperfused myocardium but their effect on myocardial necrosis has not been established. We tested the hypothesis that the effect of Plt depends on their activation status. Pig Plt were obtained before 48 min of coronary occlusion (pre-CO-Plt), 10 min after reperfusion (R-Plt), or after a 60-min sham operation (sham-Plt). Plt were infused into isolated rat hearts (n = 124) and subsequently submitted to 60 min of ischemia and 60 min of reperfusion. P-selectin expression was higher (P = 0.02) in R-Plt than in pre-CO-Plt or sham-Plt. Lactate dehydrogenase (LDH) release during reperfusion was similar in hearts receiving pre-CO-Plt, sham-Plt, or no Plt, but R-Plt increased LDH release by 60% (P = 0.004). Activation of pre-CO-Plt with thrombin increased P-selectin expression and LDH release (P < 0.001), and these results were unaffected by tirofiban. There was a close correlation between P-selectin expression and LDH release (r = 0.84; P < 0.001), and myocardial Plt accumulation (r = 0.85; P < 0.001). We conclude that the deleterious effect of Plt on reperfused myocardium depends on their activation status as represented by P-selectin expression, which is enhanced by ischemia-reperfusion.

Topics: Animals; Blood Platelets; Coronary Disease; Disease Models, Animal; Hemostatics; In Vitro Techniques; Male; Myocardial Infarction; Myocardial Reperfusion Injury; Necrosis; P-Selectin; Platelet Activation; Radionuclide Imaging; Radiopharmaceuticals; Rats; Rats, Sprague-Dawley; Swine; Technetium Tc 99m Exametazime; Thrombin

Since the perioperative mortality of coronary artery bypass surgery is high in patients with cerebrovascular disease, it is crucial to assess a cerebrovascular risk before operation. Acetazolamide (ACZ) was applied to brain SPECT to evaluate the vascular reserve, and ACZ stress brain imaging was useful for predicting perioperative cerebrovascular events. We performed 201Tl myocardial and 99mTc-hexamethyl-propyleneamine oxime (HMPAO) brain SPECT with ACZ stress simultaneously to a patient with severe coronary artery disease and experienced the abnormality of 201Tl myocardial imaging with ACZ, as did that with dipyridamole. Technetium-99m-HMPAO brain SPECT showed no defect. Brain SPECT with ACZ demonstrated the region of poor coronary vascular reserve, which suggested myocardial ischemia induced by ACZ in a patient with severe coronary artery disease.

Topics: Acetazolamide; Aged; Brain; Cerebrovascular Circulation; Cerebrovascular Disorders; Coronary Artery Bypass; Coronary Circulation; Coronary Disease; Female; Heart; Humans; Myocardial Ischemia; Preoperative Care; Radiopharmaceuticals; Technetium Tc 99m Exametazime; Thallium Radioisotopes; Tomography, Emission-Computed, Single-Photon; Vasodilator Agents

Acetazolamide (ACZ)-augmented brain SPECT is commonly used for evaluating cerebral vascular reserve in patients with cerebrovascular disease. ACZ may cause myocardial ischemia in patients with coronary artery disease. To evaluate the risk of induction of myocardial ischemia with ACZ-augmented myocardial SPECT, we performed combined ACZ-augmented Tl-201 myocardial SPECT (ACZ-myo SPECT) with Tc-99m HMPAO brain SPECT in patients with severe coronary artery disease.. Nine patients underwent combined ACZ-myo SPECT with Tc-99m HMPAO brain SPECT. (1) For qualitative analysis, SPECT images were divided into 13 segments to calculate the total defect scores. (2) Six ROIs were placed on the slices in the myocardial SPECT short-axis images and the regional uptake ratio was obtained as the ratio of the mean counts in the myocardium to the maximal count in the slice. The total defect score and regional uptake ratio of ACZ-myo SPECT were compared with those of early and delayed dipyridamole Tl-201 myocardial SPECT (DP-Tl SPECT) images.. (1) In the 21 coronary artery territories with coronary stenosis > or = 75%, the total defect score in ACZ-myo SPECT, early and delayed DP-Tl SPECT images were 3.52 +/- 4.14*, 4.19 +/- 4.65* and 2.25 +/- 3.34, respectively (*: p < 0.05 vs. delayed DP-Tl SPECT images). (2) In 44 of 54 ROIs with coronary stenosis > or = 75%, the regional uptake ratio of ACZ-myo SPECT, early and delayed DP-Tl SPECT images were 0.670 +/- 0.166**, 0.677 +/- 0.194**, 0.721 +/- 0.178, respectively (**: p < 0.01 vs. delayed DP-Tl SPECT images). Systolic blood pressure fell at 11 min after ACZ infusion without electrocardiographic ST-T changes or chest pain.. As ACZ has the potential to cause myocardial ischemia, ACZ-augmented brain SPECT should be performed with caution in patients with severe coronary artery disease associated with cerebrovascular disease.

Topics: Acetazolamide; Aged; Carbonic Anhydrase Inhibitors; Coronary Disease; Dipyridamole; Female; Humans; Male; Middle Aged; Myocardial Ischemia; Risk Factors; Technetium Tc 99m Exametazime; Thallium Radioisotopes; Tomography, Emission-Computed, Single-Photon; Vasodilator Agents

Twenty-eight children (5 girls, 23 boys; age, 20.3 +/- 16.2 months) with Kawasaki disease (KD) were included in this study. The children were treated with aspirin plus intravenous injection of gamma globulin (IVGG). Both Tc-99m HMPAO labeled WBC heart imaging (Tc-WBC) and two-dimensional echocardiograms (2D-Echo) were used to evaluate the effects of IVGG on the most common cardiac presentations--carditis and dilated coronary arteries--in KD. After IVGG therapy, the results showed that 32.1% (9/28) carditis patients had improved; 39.3% (11/28) of patients had no significant change; 28.6% (8/28) of patients had severe changes, and there was no significant difference among the three groups by the evidences of Tc-WBC. Dilated coronary arteries (CA) became smaller in 32.1% (9/28) of patients; 53.6% (15/28) of patients had no definite change; 14.3% (4/28) of patients had dilated LCA that became larger; and borderline difference existed among the three groups, proved by 2D-Echo. Between the Tc-WBC and 2D-Echo, 35.7% (10/28) of patients had similar changes, and 64% (18/28) of patients showed incongruous changes; and there was little difference. In conclusion, Tc-WBC and 2D-Echo provide strong evidence of the existence of carditis and dilated coronary arteries in certain patients, even after IVGG treatment. The improvements of carditis and dilated coronary arteries were not correlated with each other after IVGG therapy.

Topics: Aspirin; Coronary Disease; Echocardiography; Female; Heart; Humans; Immunoglobulins, Intravenous; Infant; Leukocytes; Male; Mucocutaneous Lymph Node Syndrome; Myocarditis; Organotechnetium Compounds; Oximes; Radionuclide Imaging; Technetium Tc 99m Exametazime