Abstract: The aim of the study was to assess the potential of nuclear imaging for long-term results assessment in myocardial infarction (MI) surgical treatment. 35 patients were included in the study: the main group (n = 15) of patients underwent bypass surgery in 3-4 weeks after MI, and the control group (n = 20) with conventional conservative MI treatment. Radionuclide angiopulmonography and radionuclide ECG-synchronized ventriculography was performed in all the patients in 1 month, 6 months, and 12 months after MI. Scintigraphic markers of post-operative complications were the following: (1) prolongation of minimal pulmonary circulation time 1 month after operation followed by (2) right chamber passage prolongation and (3) ejection fraction decrease. Stability of the mentioned parameters can serve as a predictor of smooth postoperative course. Feebleness of pulmonary circulation occurs earlier that the ejection fraction decrease, so it can be mentioned among the earliest symptoms of heart failure in patients with MI. Reference
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Abstract: Background: according to the international registry ICOPER, right ventricular (RV) dysfunction is the most significant predictor of mortality in patients with pulmonary embolism (PE). Diagnosis of PE should include not only verification of thrombus in branches of pulmonary arteries, but also estimation of RV contractile function. Aim: was to identify the most informative indicators of Gated Blood Pool SPECT (GBPS) for estimation of RV function in patients with PE. Methods: 52 patients were included in the study Main group (n=37) included patients with PE; comparison group (n=15) included patients suffering from coronary heart disease (NYHA I-II). All patients received ventilation-perfusion lung scintigraphy, gated blood pool single photon emission computer tomography (GBPS), and estimation of plasma levels of endothelin-1, stable nitric oxide (NO) metabolites, and 6-keto-PG F1a. Results: in patients with PE, RV end-systolic volume, stroke volume, ejection fraction, peak ejection rate, peak filling rate, and mean filling rate were significantly lower in comparison with patients without PE. In patients with PE volume from 3 to 7 bronchopulmonary segments, we have not found any correlations between PE volume and functional status of the right ventricle. In patients with PE, levels of endothelin-1, 6-keto-PG F1a, and stable NO metabolites were increased in comparison with patients without PE. Conclusion: GBPS allows to verify RV dysfunction in patients without massive PE and severe pulmonary hypertension. Dissociation between volume of PE and the degree of RV dysfunction may be caused by humoral vasoactive factors disbalance. Reference 1. Torbicki A., Perrier A., Konstantinides S., et al. ESC Committee for Practice Guidelines (CPG). Guidelines on the diagnosis and management of acute pulmonary embolism: the Task Force for the Diagnosis and Management of Acute Pulmonary Embolism of the European Society of Cardiology (ESC). Eur. Heart J. 2008; 29 (18): 2276-2315. 2. Anderson F.A. Jr., Spencer F.A. Risk factors for venous thromboembolism. Circulation. 2003; 107: 9-16. 3. Heit J.A. The epidemiology of venous thromboembolism in the community: implications for prevention and management. J. Thromb Thrombolysis. 2006; 21: 23-29. 4. White R.H. The Epidemiology of Venous Thromboembolism. Circulation. 2003; 107: 1-4. 5. Golghaber S.Z. Echocardiography in the Management of Pulmonary Embolysm. Ann. Intern. Med. 2002; 136 (99): 691-700. 6. Haddad F., Hunt 7. MacNee W. Pathophysiology of cor pulmonale in chronic obstructive pulmonary disease: part one. Am. J. Respi. Crit. Care Med. 1994; 150: 833-852. 8. Zavadovskij K.V., Pan'kova A.N., Krivonogov N.G. i dr. Radionuklidnaja diagnostika trombojembolii legochnoj arterii: vizualizacii perfuzii i ventiljacii legkih, ocenka sokratimosti pravogo zheludochka [Radionuclide diagnosis of pulmonary embolism: perfusion and ventilation, assessment of right ventricular contractility]. Sibirskij medicinskij zhurnal. 2011; 26(2), vypusk 1:14-21 [In Russ]. 9. Petri A., Sjebin K. Nagljadnaja statistika v medicine. Per. s angl. V.P. Leonova. M.: GJeOTAR-MED. 2003; 144 s.: il. (Serija «Jekzamen na otlichno») [In Russ]. 10. Mansencal N., Joseph T., Vieillard-Baron A., et al. Diagnosis of right ventricular dysfunction in acute pulmonary embolism using helical computed tomography. Am. J. Cardiol. 2005; 95 (10): 1260-1263. 11. Contractor S., Maldjian P.D., Sharma V.K. Role of helical CT in detecting right ventricular dysfunction secondary to acute pulmonary embolism. J. Comput. Assist. Tomogr. 2002;
