A
Abnormal glucose handling, 85 ACS. See Acute coronary syndromes Acute cardiac ischemia, 229 Acute coronary artery occlusion, 27 Acute coronary syndromes (ACS), 28,
57, 221
risk stratification for, 237–245 Acute coronary thrombosis, 28 Acute ischemia, 224f
Acute myocardial infarction, 28–30 Adenosine, 71–73, 164
Adenosine perfusion cardiac magnetic resonance, 167, 170–174
advantages of, 172–174 disadvantages of, 174 procedure of, 171–172 Adenosine triphosphate (ATP), 5 Adequate risk stratification, 191 Agaston score, 95–96
Akinesia, 9 Akinetic, 28 Anger camera, 58–59 Angina, 12, 244
atypical, 281
Angiographic coronary artery stenosis, 116, 159 Angiographic stenosis, 251 Angiographic variables, 241 Angiography, 48–50. See also
Coronary angiography of CMR, 168, 301
X-ray, 49
Anteroseptal infarct, 47f Antihypertensive therapy, 124 Aorta repair, 292
Aortic aneurysm, 278 Aortic diastolic pressure, 4 Aortic dissection, 278 Aortic regurgitation, 24 Aortic valve stenosis, 210–211 Apoptosis, 87
Arrhythmia, 49, 278 Arteries
acute coronary, occlusion, 27 ALCAPA, 290
Angiographic coronary, stenosis, 116
atheromatous coronary, disease, 155
CABG, 247, 252
Carotid, imaging, 123–125 circumflex coronary, 252 coronary, 93, 290–291 coronary, occlusion, 29 FRISC, 243
left anterior coronary, 103f obstructive coronary, disease,
115–116
revascularized coronary, 250–251 TGA, 288
Asymptomatic cardiac ischemia pilot study, 140
Asymptomatic individual(s) at risk of CHD, 137–149 screening for, 138
Asymptomatic low-risk individuals, 121
Atheromatous coronary artery disease, 155–284, 277 Atherosclerosis, 2
carotid artery imaging’s relationship to, 123 coronary, 57, 110 imaging, 2–3
Atherosclerotic plaques, 2 histopathologic stages of, 109f ATP. See Adenosine triphosphate Automated endocardial border
tracking, 26
Autonomic innervation, 86–87 Autonomic nervous control, 6 B
Bayes’ theorem, 31, 138 application of, 157–158 Biological processes, 81 Biomarkers, 230–231 Biphasic response, 179f Bisoprolol, 214 Black blood image(s), 38
short axis, 41f
Blood flow. See also Coronary blood flow
changes in, 6–8 myocardial, 57, 82–83 splanchnic, 67
Blood oxygenation level (BOLD), 283
Blood vessel growth, 87 Broad-band transducers, 25
C
CABG. See Coronary artery bypass grafting; Coronary bypass surgery
CAD. See Coronary artery disease Caffeine, 164
Calcification, 93. See also Coronary calcification
in noncoronary territories, 113 Calcium hydroxyapatite crystals,
110
Calcium mass measurement, 96, 112 Calcium scoring scan, 94
Cardiac catheterization, 203–204, 248 Cardiac event rate, 240f
Cardiac magnetic resonance (CMR), 37–52
absolute value of signal of, 39 adenosine perfusion, 167, 170–174 angiography of, 48–50, 168, 301 basic sequences of, 37–40 conclusion and future of, 51–52 delayed contract enhancement of,
46–48
dobutamine stress, 167–170 flow of, 48
with flow velocity, 253 function of, 42–44 morphology of, 40–42 perfusion images of, 173 perfusion of, 44–46 pericardium directly imaged
through, 42 post-processing of, 50–51 radiation exposure and, 172 real-time imaging of, 37 resolution of, 172 spectroscopy, 50 Cardiac output (CO), 23 Cardiac oxygen, 4
important requests of, 19
Cardiac physiology, PET imaging and, 82–83
Cardiac risk
clinical predictors of increased perioperative, 213t, 215 common indices of, 212t MPS and, 214
Cardiac transplant(s)
appropriate responses to, 147 clinical, 146
Index
307
Cardiac transplant(s) (cont.) echocardiography of, 146 screening for, 146–147 Cardiosympathy, 278
Cardiovascular magnetic resonance (CMR), 156
DSCMR, 167–170
Cardiovascular magnetic resonance (CMR) imaging, 127–128, 299–301
angiography and, 301 future prospects of, 301 myocardial scarring/viability,
299–300 safety issues of, 299 stress imaging, 300 ventricular function, 299 Cardiovascular risk factors, 123 Cardiovascular risk stratification,
126–127 Carotid artery imaging
atherosclerosis’ relationship to, 123
cardiovascular risk factors’
relationship to, 123 cIMT v., 124–125
clinical outcomes’ relationship to, 123
contrast-enhanced, 126 by high resolution ultrasound,
122–127
IMT measuring and, 126 therapeutic interventions on IMT
and, 123–124
Carotid intima-media thickness (cIMT), 123–125 Carotid plaque
area of, 124
character assessment of, 125 v. cIMT, 124–125
volume of, 124–125
Carotid ultrasonography, 126–127 CFVR. See Coronary flow velocity
reserve
CHD. See Congenital heart disease;
Coronary heart disease Chest pain
acute, 223t, 226t
diagnostic v. prognostic construct for evaluating, 224–226 ED patients with, 227–228 ERASE, 226
resting scan during, 225 Chest pain patients
ideal triaging strategy of, 222 noninvasive imaging rationale for,
222 Chest x-ray, 157
cIMT. See Carotid intima-media thickness
Cine imaging, 38, 43 Circulating hormones, 6 Circumflex coronary artery, 252 Clinical cardiac transplants, 146 Clinical phenomena, 12–13 Clinically significant stenosis, 117
Clopidogrel in Unstable angina to prevent Recurrent ischemic Events (CURE), 244 CMR. See Cardiac magnetic
resonance; Cardiovascular magnetic resonance CMR angiography, 301 CO. See Cardiac output
Coarctation of the aorta (CoA), 292 Collimator, 59, 62
Color flow Doppler, 21–22 Compensatory hyperkinesis, 9 Computed tomography (CT), 88. See
also Electron beam computed tomography (EBCT);
Multislice computed tomography (MS-CT) basics of, 99–101
gated single photon emission, 190–191
hybrid, 88 scanner of, 99–100
black design of, 99–100 spiral, 101
techniques and principles of, 93–105
Concomitant mitral regurgitation, 272 Congenital anomalies, 290
Congenital anomalies, of coronary arteries, 290–291
Congenital heart disease (CHD) myocardial ischemia in, 287–302
CMR imaging and, 299–301 nuclear imaging techniques,
296–299
stress echocardiography, 293–296
noninvasive imaging for, 287–302 optimal imaging modality and, 288 problems with interpretation of
stress echo in, 295 size of problem of, 287–288 specific considerations for patients
with, 288–290 complex lesions, 289–290 simple lesions, 288–289 Congestive heart failure, 29 Continuity equation, 23–24 Continuous wave Doppler, 20–21 Contouring, 51
Contractile dysfunction, 8–10 Contractile reserve, 250 Contraindications, 40
Contrast echocardiography, 22, 23, 33, 263
Contrast-enhanced carotid imaging, 126
Contrast-enhanced MRI, 267 Convective acceleration, 25 Coronary angiography
with EBCT, 97–98 indications of, 213t of MS-CT, 102
clinical implementation of, 104–105
limitations of, 104
Coronary arteries calcification of, 93
congenital anomalies of, 290–291 Coronary artery bypass grafting
(CABG), 247 MPS for, 252
Coronary artery disease (CAD) atheromatous, 155, 277–284 chronic, 175
clinical decision-making in patients with, 189–205 clinical diagnosis of
assessment of likelihood of, 157 Bayes’ theorem applied to,
157–158 chest x-ray, 157 medical history/physical
examination of, 156 resting electrocardiography,
156–157
diagnosis of, 155–183, 225 DSE and, 242f
echocardiography and, 17–34 myocardial ischemia and, 277 obstructive, 115–116 progression of native, 250–251 risk-based approach to, 190 Coronary artery occlusion, 29 Coronary atherosclerosis, 57, 110 Coronary blood flow, 4–6
autonomic nervous control for, 6 autoregulation of, 6
circulating hormones of, 6 endothelial-dependent modulation
of, 5–6
extravascular compressive forces of, 6
metabolic regulation of, 5 at rest v. maximal vasodilatation, 6 Coronary bypass surgery (CABG), 143 Coronary calcification, 94–95
ethnic differences in, 118–119 histologic stages of, 108–109 mechanism of, 110–111 obstructive CAD and, 115–116 outcomes’ relationship to, 114–115
prospective studies of, 115 respective studies of, 114–115 pathologic consequences of, 111 pathophysiologic aspects of,
108–109 Coronary calcium, 114
Coronary calcium imaging, MS-CT and, 119–120
Coronary calcium score, 119–120 Coronary circulation, 3–4 Coronary endothelial lining, 5 Coronary flow reserve, 282 Coronary flow velocity reserve
(CFVR), 295–296
Coronary heart disease (CHD), 108 noninvasive assessment of
asymptomatic individuals at risk of, 137–149
subclinical, 117–118 Coronary hemodynamics, 48
Coronary revascularization, 115 Coronary risk, 118, 121–122 Coronary scan technique, 102 Coronary sinius oxygen saturation,
277 Coronary spasm, 3 Coronary stenosis, 194, 249 Cox regression analysis, 239 CT. See Computed tomography CT-based technologies, 120 CURE. See Clopidogrel in Unstable
angina to prevent Recurrent ischemic Events
D
Delayed contrast enhancement, 46–48
of anteroseptal infarct, 47f infarcted tissue shown by, 48 subsequent dynamics of, 46–48 Delayed perfusion, 46
Detection of Ischemia in
Asymptomatic Patients with Diabetes (DIAD), 122 Dextrocardia, 296
Diabetes, 280
appropriate responses to, 142–143 mellitus, 142–143
type II, 121–122
DIAD. See Detection of Ischemia in Asymptomatic Patients with Diabetes
Diagnostic accuracy, 201–202 Dipyridamole, 8, 73 Dobutamine, 9, 73
different responses to, 179f Dobutamine MPS, 165 Dobutamine MRI, 267 Dobutamine stress, 32
Dobutamine stress cardiac magnetic resonance (DSCMR), 167 advantages of, 170
analysis of, 169f disadvantages of, 170 procedure for, 168–170
Dobutamine stress echocardiography (DSE), 32, 168, 214
CAD indicated by, 242f
sensitivity and specificity of, 269f Dobutamine stress magnetic
resonance (DSMR), 43 risk of complications of, 44 Doppler
color flow, 21–22 continuous wave, 20–21 pulsed wave, 21 TDI, 9, 22, 263, 295 tissue imaging of, 22
Doppler echocardiography, 20–21 DSCMR. See Dobutamine stress
Cardiac magnetic resonance DSE. See Dobutamine stress
echocardiography Dual-isotope simultaneous
acquisition SPECT scan, 266f Dykinesia, 9
E
Eagles criteria, 138
EBCT. See Electron beam computed tomography
ECG. See Electrocardiogram ECG-gated MPS, 165
Echo planar imaging (EPI), 171 Echocardiogram(s)
positive stress, 139–140
transthoracic two-dimensional, 263 Echocardiographic techniques,
241–242
Echocardiography, 9, 174–182. See also Stress echocardiography in acute coronary syndromes, 28 basic anatomy of, 176–177 in CAD, 17–34
acute myocardial infarction, 28–30
assessing LV function, 26–27 mechanism for regional wall
motion abnormality, 27 regional wall function
assessment, 27–28
stress echocardiography, 30–34 of cardiac transplants, 146 contrast, 22, 23, 33, 263
in coronary artery disease, 17–34 of diabetes mellitus, 142–143 dobutamine stress, 32, 168, 214,
242f, 269f Doppler, 20–22 ED and, 231–232 of ESRF, 144–145 evolution of, 18 exercise, 31–32, 158–160 live-3D, 296
MPS and, 215–216
myocardial viability and, 262–263 of noncardiac (vascular) surgery,
147–148
regional wall motion abnormality and, 174–175
at rest, 262
role of, in myocardial ischemia in CHD, 292–293
RWMA, 231 as screening tool, 139 stress contrast, 181–182 stress, v. radionuclide MPS,
180–181
three-dimensional, 18–19 tissue doppler imaging and, 263 two-dimensional, 18
wall motion v. systolic wall thickening, 175–176
ED. See Emergency department; End- diastolic
Effectiveness, 226–227 Efficacy, 226–227 Ejection fraction (EF), 200 Electrocardiogram (ECG), 3, 26
myocardial viability and, 261 12-lead, 221–222
Electrocardiographic abnormalities, 10
Electrocardiographic changes, 10–11 Electrocardiography
resting, 156–157 surface, 262
Electromechanical mapping, 267–268 Electron beam computed tomography
(EBCT), 93–98 calcium imaging of, 108–121 coronary angiography with, 97–98 as derived from coronary calcium
scores, 119–120
protocol for calcium scoring scan and, 94
reproducibility of, 97 scanner of, 93–94
scoring of coronary calcification and, 94–95
Electron beam computed tomography coronary calcium imaging, 108–121
clinical application of, 116–117 CT soft plaque characterization,
120–121 data needed for, 118
economic evaluation of, 117–118 emerging issues related to, 118–120 incidental findings on, 118 obstructive CAD and, 115–116 outcomes and, 114–115 pathophysiologic aspects of,
108–109
quantification of, 111–11114 radiation exposure of, 111 for subclinical CHD, 117–118 summary of, 121
technology of, 111
Emergency department (ED), 221 echocardiography and, 231–232 patients of, with chest pain,
227–228
tracer injection and, 228–229 triaging of, 228–229
Emergency Room Assessment of Sestamibi for the Evaluation of Chest Pain (ERASE Chest Pain), 226
End-diastolic (ED), 40 Endothelial function, 282 Endothelium, 5 Endpoints, 270–271
End-stage renal failure (ESRF), 137 appropriate response to, 146 clinical, 143–144
echocardiography of, 144–145 screening for, 145–146 End-systolic (ES), 40 EPI. See Echo planar imaging Epicardial fat, 48
ERASE Chest Pain. See Emergency Room Assessment of Sestamibi for the Evaluation of Chest Pain
ES. See End-systolic
ESRF. See End-stage renal failure Euglycemic hyperinsulinemic
clamping, 85
Event risk, 193 Exercise ECG, 156, 238
Exercise echocardiography, 31–32, 158–160
accuracy for women with, 160 limitations of, 159–160 procedure of, 158–159 Exercise MPI, 238–240 Exercise MPS, 162–163 Exercise stress, 70–73 Extracellular lipid core, 109 Extravascular compressive forces, 6 F
Fallot accounting, 289 Fallot’s tetralogy, 300 First-pass perfusion, 45–46 Flow acceleration, 25, 48 Flow assessment, 23 Flow velocity, 39
FRagmin during InStability in Coronary artery disease (FRISC), 243
Framingham score, 140 Functional capacity, 250
Functional gated planar imaging, 68 Further molecular probes, 87–88 G
Gadolium (Gd), 37
Gamma scintillation camera, 58–59 Gated single photon emission
computed tomography, 190–191
Glagovian vascular remodeling, 109 Global perfusion, 281
Graft disease
alternative noninvasive diagnostic techniques for assessment of, 253
diagnosis of, 252–253 MPS and, 252
stress echocardiography and, 252–253
Graft stenosis, 253 H
Harmonic imaging, 25–26 Harmonic phase thickening, 42 Heart. See also Arteries; Congenital
heart disease (CHD);
Coronary heart disease (CHD) hemodynamic assessment of,
23–25
noncoronary disorders of, 278 Heart disease. See also Coronary
heart disease (CHD) congenital, 287–302 ischemic, 42
noncoronary ischemic, 279–283 Heart rate, 102
maximum predicted, 158 Hemodynamic assessment, of heart,
23–25
continuity equation and, 23–24 principle of flow assessment, 23
regurgitant volumes of, 24 right ventricular pressure, 25 SV and cardiac output, 23 transvalvular pressure gradient,
24–25 Hemoglobin, 4 Hibernation, 11, 259–272
methods to assess, 261–268 Horizontal long axis (HLA), 169 Hormone replacement therapy
(HRT), 124 Hormones, 6
Hounsfield unit (HU), 111 Hounsfield values, 96
HRT. See Hormone replacement therapy
Hybrid computed tomography imaging, 88–89 Hybrid PET imaging, 88–89 Hypokinesia, 9
Hypokinetic, 27 Hypoxia, 1 I
Ideal triaging strategy, 222 Image acquisition, 61–64
continuous, 63 dual head system for, 64 duration of, 74 MS-CT and, 101 time of, 63–64
Image interpretation, 65–69 Image processing, 64–65 Imaging. See also Myocardial
perfusion imaging (MPI);
Noninvasive imaging;
Radionuclide imaging artifacts of, 229–230 atherosclerosis, 2–3 carotid artery, 122–127 in chest pain unit, 221–232 cine, 38
CMR, 299–301
contrast-enhanced carotid, 126 coronary calcium, 119–120 echo planar, 171
in ED, 221–232 electron beam computed
tomography coronary calcium, 108–121 findings of, 8–11 functional gated planar, 68 harmonic, 25–26, 42 integrated biological/
morphological, 89 methodology of, 80 modalities of, 302t native coronary, 50
noninvasive cardiac, 1–13, 182–183 optimal modality for, 288 perfusion, 44–46 PET, 80–89 planar, 61–62
positron emission, 82–83
radionuclide myocardial perfusion, 279–280
SPECT, 62–64 SPET, 64
stress, 189, 249, 300
stress-redistribution-reinjection, 264
tissue doppler, 9, 22, 263, 295 transesophageal, 19–20 vessel wall, 42 wall motion, 283 Imaging technique(s), 18–23
for assessment of viability and hibernation, 259–272 contrast echocardiography, 22 doppler echocardiography, 20–21 TDI, 22
three-dimensional
echocardiography, 18–19 transesophageal imaging and, 19–20 two-dimensional
echocardiography, 18 IMT. See Intra-media thickness Increased lung uptake, 195–196 Increased perioperative cardiac risk,
213t
Incremental perfusion, 225–226 Incremental prognostic power, 241f Individual velocities (TVI), 25 Infarcted tissue, 48
Infarction, 238–239 acute myocardial, 28–30 myocardial, 57, 190, 242 nonfatal, 243f right ventricular, 29 Inflammation, 230–231 Intensive insulin therapy, 124 Interventional therapy, 242–245 Interventricular septum (IVS), 288 Intra-media thickness (IMT), 123
measuring, 126
therapeutic interventions of, 123–124
IR. See Single-slice inversion recovery Ischemia. See also Myocardial
ischemia acute, 224f acute cardiac, 229 consequences of, 11–12
Ischemic preconditioning, 11–12 Ischemic-perfusion/no-reflow
phenomenon, 12 myocardial hibernation and
stunning, 11 detecting, 241–242
diagnosis of, after interventions, 251 diseases and mechanisms for, 278 events during, 6–11
contractile dysfunction/imaging finding, 8–10
metabolic and blood flow changes/imaging findings, 6–8 myocardial, 277–284
optimal imaging modality and, 288 radionuclide techniques for
detecting, 238–241 reversible, 240 in right ventricle, 295
Ischemia-reperfusion injury, 12 Ischemic cardiomyopathy, 260f Ischemic dilatation, 68 Ischemic heart disease, 42 Ischemic preconditioning, 11–12 Ischemic threshold, 147 IVS. See Interventricular septum K
Kawasaki disease, 290, 292, 298 Kondos database, 97
L
LAD. See Left anterior descending Late enhancement, 51
Left anterior coronary artery, 103f Left anterior descending (LAD), 28,
250 Left ventricle, 295
Left ventricular (LV), 18, 195 dysfunction with, 268–271 function of, 25–26
Left ventricular ejection fraction (LVEF), 190
changes in, 260f
incremental prognostic value of, 239f
revascularization’s improvement of, 270t
Lesion(s)
complex, 289–290 simple, 288–289 Leukocytes, 2
Lipid-lowering trials, 124 Live-3D echocardiography, 296 Long-term prognosis, 271
Low-energy parallel hole collimators, 62
LV. See Left ventricular LV dysfunction, 84 LV function, 27
assessing, 26
new methods in improving assessment of, 25–26 automated endocardial border
tracking, 26 harmonic imaging, 25 LV Opacification, 22
LVEF. See Left ventricular ejection fraction
M
Magnetic resonance imaging (MRI), 3. See also Cardiovascular magnetic resonance (CMR) imaging
contrast-enhanced, 267 dobutamine, 267
myocardial viability and, 266–267 resting, 267
techniques of, 266–267 Magnetic resonance techniques, 10 Mass measurement, 95
of calcium, 96, 112 Maximal vasodilatation, 6
Maximum predicted heart rate (MPHR), 158
MBF. See Myocardial blood flow Medical therapy, 197–200, 242–245 Metabolic changes, 6–8
Metabolic hyperemia, 5 Metabolic regulation, 5, 282–283 Metabolic standardization, 85–86 Metabolic syndrome, 140–141 Metabolism
myocardial, 282 substrate, 86
MI. See Myocardial infarction Microvascular injury, 12 Microvascular-obstructed
myocardium, 46
Mildly abnormal perfusion scans, 193–194
MIRACL. See Myocardial Ischemia Reduction with Aggressive Cholesterol Lowering Mitral annular ring, 113f Mitral regurgitation, 24 Moderately abnormal perfusion
scans, 194–195
Molecular nuclear techniques, 128 Monocytes, 2
Morphology, 40–42
MPHR. See Maximum predicted heart rate
MPI. See Myocardial perfusion imaging (MPI) MPS. See Myocardial perfusion
scintigraphy
MPS pharmaceutical(s), 59–61 Tc-labeled agents, 61 thallium-201, 59–61 MRI. See Magnetic resonance
imaging
Multiple risk factors, 140–141 Multislice computed tomography
(MS-CT), 99–105 accuracy of, 103 acquisition and image
reconstruction with, 101 coronary angiography of, 102
clinical implementation, 104–105
limitations of, 104
coronary calcium imaging and, 119–120
coronary scan technique of, 102 derived from coronary calcium
scores, 119–120 image acquisition and, 101 limitations of, 104 radiation dosimetry of, 120 scanner of, 102
speed of performance of, 102 technical aspects of, 119 to track disease progress, 120 Myocardial blood flow (MBF), 57
PET imaging and, 82–83 Myocardial bridging, 290, 291 Myocardial function, 250 Myocardial hibernation, 11
Myocardial infarction (MI), 57, 190, 242
acute, 28–30
complications of, 29–30 Myocardial ischemia, 1
assessing, 32–33
basic pathophysiology of, 277–279 CAD and, 277
cardiac events caused by, 210 causes of, 2–3, 277–279 in conditions other than
atheromatous coronary artery disease, 277–284
in congenital heart disease, 287–302
multiple complex events at, 7 Myocardial Ischemia Reduction with
Aggressive Cholesterol Lowering (MIRACL), 244 Myocardial metabolism, 282 Myocardial motion, 283 Myocardial oxygen demand, 3 Myocardial oxygen supply, 3 Myocardial performance, 42–43 Myocardial perfusion, 23, 83f
agents, 60f
Myocardial perfusion imaging (MPI), 160
abnormalities of, 116 for acute chest pain, 223t, 226t economics of, 167f
for ED patients with chest pain, 227–228, 230–231 exercise, 238–240 incremental value of, 225 after PCI, 251–252
pharmacologic stress, 240–241 prognostic indicators for, 215t radionuclide, 222–231, 279–280 randomized trials of, 226–227 utility comparison of, 230–231 Myocardial perfusion scintigraphy
(MPS), 57–75, 156 advantages of, 165–167 for CABG, 252 cardiac risk and, 214
currently used protocols for, 73–75 disadvantages of, 165–167167 dobutamine, 165
ECG-gated, 165
echocardiography and, 215–216 exercise, 162–163
exercise stress of, 70–73 graft disease and, 252 image acquisition and, 61–64 image interpretation of, 65–69 image processing of, 64–65 indications of, 70t IVs in, 57
nonperfusion, 195–200 for perioperative assessment of
cardiac risk, 215t pharmaceuticals of, 59–61, 201 pharmacologic, 163–165 pharmacologic modalities used in
stress, 69–70
Myocardial perfusion scintigraphy (MPS) (cont.)
planar, 62
radionuclide, 180–181 radionuclide imaging of, 58–59 risk of adverse events after normal
study of, 191–192 role of, 253–255
stress, 69–70, 190, 197–200 stress radionuclide, 160–167 technetium-99m, 161–162 thallium, 60–61, 161 vasodilator, 163–164
Myocardial reporter gene expression, 88
Myocardial revascularization comparison of different
management strategies for, 248–249
evaluation of patients before, 248–250
identification of patients who will benefit from, 248
myocardial viability and, 249–250 risk stratification after, 253–255 stress imaging and, 247–255, 249 Myocardial scarring, 299–300 Myocardial tagging, 283 Myocardial uptake, 60f
Myocardial viability, 33, 249–250, 299–300
clinical importance of, 83–84 echocardiography and, 262–263 electromechanical mapping and,
267–268
methods to assess, 261–268 MRI and, 266–267 PET imaging and, 83–86 radionuclide imaging with
positron emitting tracers and, 265–266
radionuclide imaging with single photon emitting tracers and, 264–265
surface electrocardiography and, 262
thallium-201 chloride and, 265 Myocarditis, 278
Myocardium
dysfunctional/viable, 262t hibernating, 261
microvascular-obstructed, 46 percent, 192–195
stunned, 174
viable, 84, 260–261, 268–271 N
Nanoparticles, 127 Native CAD, 250–251
Noncardiac atherosclerotic disease, 191
Noncardiac (vascular) surgery appropriate responses to, 148–149 clinical, 147–149
echocardiography of, 147–148 screening of, 148
Noncoronary ischemic heart disease, 279–283
diagnostic testing in, 278–282 metabolic regulation assessment,
282–283
myocardial motion and wall thickening, 283
reduced coronary flow reserve and, 282
vascular dysfunction and, 278–282
Nonfatal infarction, 243f
Noninvasive cardiac imaging, 1–13 recommendations for, 182–183 Noninvasive imaging
for CHD, 287–302 chest pain patients and, 222 future directions for, 283–284 prognostic assessment by, 189–205,
209–217
Nonperfusion MPS, 195–200 increased lung uptake of perfusion
tracers, 195–196
scan results/physician action for, 197–200
Nonradionuclide techniques, 280–282
No-reflow phenomenon, 12 Normal thickening, 27
Nuclear imaging techniques, 296–299 O
Obesity, 140–141
Obstructive coronary artery disease, 115–116
Occlusion
acute coronary artery, 27 coronary artery, 29 One-day dual tracer imaging
protocol, 75 Opacification, 22
Optimal imaging modality, 288 Oral glucose loading, 85 P
Patency of grafts, 250–251 Pathophysiology, 210–211, 260–261
for myocardial ischemia, 277–279 principles of, 1–13
PCI. See Percutaneous coronary intervention
PDS. See Perfusion defect size Percent myocardium, 192–195 Percutaneous coronary intervention
(PCI), 237 MPI after, 251–252 Percutaneous intervention, 143 Percutaneous transluminal coronary
angiography (PTCA), 251 Perfusion, 300–301. See also
Myocardial perfusion imaging (MPI); Myocardial perfusion scintigraphy (MPS) abnormalities, 8 analysis of, 51 characteristics of, 46
of CMR, 44–46 delayed, 46
extent and severity of results of, 192–195
first-pass, 45–46 global, 281
imaging of, 44–46, 173 incremental, 225–226
mildly abnormal, scans, 193–194 moderately/severely abnormal,
scans, 194–195 reversible, 254 semiquantitative, 51
Perfusion defect size (PDS), 192–195, 244
Perfusion tracers, 195–196 Pericardial disease, 278 Pericardium plaque, 113 Perioperative cardiac death, 210f Perioperative cardiac events, 210–211 Perioperative cardiac risk, 213t Perioperative care, 211–214
additional testing of, 211–2114 patients at risk selection of, 211 Peripheral lipolysis, 85
Peripheral vascular disease (PVD), 209
PET. See Positron emission tomographic PET imaging, 80–89
basic principle of, 80f of cardiac physiology, 82–83
metabolic standardization of, 85–86
myocardial blood flow and, 82–83
myocardial viability and, 83–86 other imaging and, 86–88 hybrid, 88–89
of myocardial reporter gene expression, 88f radioscopes for, 81t
summary and future perspectives of, 89
technical aspects of, 80–82 methodology, 80
noninvasive quantification of biological processes, 81–82 radioistopes/radiopharmaceutica
ls, 80–81 viability of, 84 Pharmaceutical(s)
MPS, 59–61, 201 radio, 58, 80–81
Pharmacologic modalities, 69–70 Pharmacologic MPS, 163–165 Pharmacologic stress, 71–73, 195
adenosine, 71–73 dipyridamole, 73 dobutamine, 73
Pharmacologic stress MPI, 240–241 Photomultiplier tube (PMT), 58 Physician action, 197–200 Planar imaging, 61–62 Plaque
atherosclerotic, 2, 109f
carotid, 124–125 pericardium, 113 soft, 120–121 Plaque echodensity, 125 Plaque instability, 109 Plaque morphology, 125 Plaque surface characteristics, 125 PMT. See Photomultiplier tube Positive stress echocardiograms,
139–140
Positron emission imaging, 82–83 Positron emission tomographic
imaging (PET), 3, 50, 79–89, 261
introduction of, 79 limitations of, 79
technical aspects of imaging of, 80–82
techniques of, 265–266 tracers of, 266
Postarterial switch operation, 291–292
Postcoarctation, 292 Post-Kawasaki disease, 290 Post-processing, 50–51 Poststress defect, 241 Potential benefit, 200–201 Potential risk, 200–201 Pretest probability, 138f Prognostic construct, 224–226 Prospective studies, 115
PTCA. See Percutaneous transluminal coronary angiography PTF. See Water-perfusable tissue
fraction Pulsed wave doppler, 21
PVD. See Peripheral vascular disease R
Radiation dosimetry, 120 Radiation exposure, 111, 172 Radioistopes, 80–81 Radionuclide imaging, 166
anger camera for, 58–59 data analysis and display of, 59 digital image creation by, 59 gamma scintillation for, 58–59 with positron emitting tracers,
265–266 principles of, 58–59 with single photon emitting
tracers, 264–265
Radionuclide MPI, 222–231, 279–280 Radionuclide MPS, 180–181 Radionuclide techniques, 238–241 Radiopharmaceuticals, 58, 80–81 Rate-pressure product (RPP), 4 Receiver operating characteristics
(ROC), 190 Receptors, 87
Reduced coronary flow reserve, 282 Regional wall function, 27–28 Regional wall motion abnormality
(RWMA), 27, 231 occurrence of, 174–175 Regurgitant volumes, 24
Regurgitation aortic, 24
concomitant mitral, 272 mitral, 24
valvular, 21
Resting electrocardiography, 156–157 Resting MRI, 267
Rest-redistribution, 264 Retenosis, 251
Revascularization, 197–200. See also Myocardial revascularization long hazard ratio for, 198f LVEF improvement after, 270t patient’s LV dysfunction and,
268–271
prediction of improvement after, 269–270
risk stratification after, with stress echocardiography, 254 stress imaging techniques after,
250–252
Revascularized coronary arteries, 250–251
Reversible ischemia, 240 Right ventricle, 289, 295 Right ventricular infarction, 29 Right ventricular pressure, 25 Right ventricular systolic pressure
(RSVP), 25 Risk
cardiac, 212–214 coronary, 118, 121–122 event, 193
perioperative cardiac, 213t potential, 200–201
treatment algorithms based on, 200
Risk assessment, 209–27 Risk stratification, 202–204
after acute coronary acute syndromes, 237–245 adequate, 191
candidates for, 203–204 cardiovascular, 126–127 clinical history and, 211 of ED patients with chest pain
using MPI, 227–228
after myocardial revascularization, 253–255
ROC. See Receiver operating characteristics RPP. See Rate-pressure product RSVP. See Right ventricular systolic
pressure
RWMA. See Regional wall motion abnormality
S
Saturation pulse, 172f Scan(s)
abnormal, 193 calcium scoring, 94 coronary, technique, 102 dual-isotope simultaneous
acquisition SPECT, 266f for EBCT, 93–94
mildly abnormal perfusion, 193–194
moderately abnormal perfusion, 194–195
resting, 225 results of, 197–200
severely abnormal perfusion, 194–195
Scintigaphic variables, 241 Scintigraphy. See Myocardial
perfusion scintigraphy Scintillation camera, 58–59 Score
Agaston, 95–96
coronary calcium, 119–120 Framingham, 140 volume, 95, 96, 112 wall motion, 28, 177 Screening
alternate strategies for, 141, 142 for asymptomatic individuals, 138 for cardiac transplants, 146–147 echocardiography as tool for, 139 for ESRF, 145–146
of noncardiac (vascular) surgery, 148
value of, 138 Serum Markers, 230–231
Severely abnormal perfusion scans, 194–195
Signal-intensity-time curves, 173f Single photon emission computed
tomographic (SPECT), 7, 23, 223, 261, 265
Single photon emission tomography (SPET), 64
Single photon emitting tracer(s), 264–265
technetium-99m sestamibi, 265 thallium-201 chloride, 264–265 Single ventricle physiology, 290 Single-slice inversion recovery (IR),
170 Soft plaque, 120–121 Spatial resolution, 49
SPECT. See Single photon emission computed tomographic SPECT imaging, 62–64 SPECT semiquantification, 65 SPECT tomograms, 66 Spectroscopy, 50
SPET. See Single photon emission tomography
SPET imaging, 64
Spiral computed tomography, 101 Splanchnic blood flow, 67 Stenosis
angiographic, 251
angiographic coronary artery, 116, 159
aortic valve, 210–211 clinically significant, 117 coronary, 194, 249 graft, 253 Stress
dobutamine, 32
Stress (cont.) exercise, 70–73
for Kawasaki disease, 298
pharmacologic, 71–73, 195, 240–241 positive, 139–140
vasodilator, 163, 164, 196 Stress contrast echocardiography,
181–182
Stress echocardiography, 30–34, 138, 262–263
accuracy of, 177–180
assessing myocardial ischemia and, 32–33
assessing myocardial viability and, 33
Bayes’ theorem and, 31 clinical settings of, 33 current evidence on, 201–202 diagnostic accuracy of, 33 feasibility of, 32
graft disease and, 252–253 in high risk patient groups,
140–149 laboratory of, 33–34 limitations of, 181 methods of, 31–32
in patients with CHD, 293–296 procedure and interpretation of,
177
prognostic value of, 202f rationale of, 31 risk stratification after
revascularization with, 254 Stress imaging, 189, 300
for patients with known angiographic data, 249 Stress imaging techniques
importance of, 247
myocardial revascularization and, 247–255
after revascularization, 250–252 Stress MPS, 69–70
prognostic utilization of, 190 revascularization of, 197–200 survival with medical therapy after,
197–200
Stress radionuclide MPS, 160–167 Stress-redistribution-reinjection
imaging, 264 Stroke volume (SV), 40 ST-segment change, 195 Stunned myocardium, 174 Subclinical CHD, 117–118 Substrate metabolism, 86 Summed scores, 192
Surface electrocardiography, 262 SV. See Stroke volume
Symptom assessment, 221–222 Systemic right ventricular, 289 Systolic wall thickening, 175–176 T
Tc-agent one-day imaging protocol, 75
Tc-agent two-day imaging protocol, 75
Tc-labeled agents, 61
TDI. See Tissue Doppler imaging Technetium-99m MPS, 161–162 Tetrofosmin SPECT, 265
TGA. See Transposition of the great arteries
Thallium, 59–61 Thallium MPS, 161 Therapy
antihypertensive, 124 hormone replacement, 124 intensive insulin, 124 interventional, 242–245 medical, 197–200, 242–245 Three-dimensional echocardiography,
18–19
Thrombolysis in myocardial infarction (TIMI), 242 Thrombosis, 2, 28
TID. See Transient ischemic dilation Tissue characterization, 41 Tissue contrast, 102
Tissue doppler imaging (TDI), 9, 22, 263, 295
Tl rest distribution imaging protocol, 74
Tl stress-redistribution imaging protocol, 74
Tl stress-redistribution-reinjection protocol, 75
Tomographic reconstruction, 65 Tracer injection, 228
Tracer kinetic analysis, 82 Transesophageal imaging, 19–20 Transient ischemic dilation (TID),
195
Transmission images, 64 Transposition of the great arteries
(TGA), 288, 297
postarterial switch operation for, 291–292
Transthoracic two-dimensional echocardiogram, 263 Transvalvular pressure gradient,
24–25
Treatment algorithms, 200
based on potential benefit, 200–201 based on risk, 200
TVI. See Individual velocities 12-lead electrocardiogram, 221–222 Two-dimensional echocardiography,
18 U
Uranium, 61 V
Valvular regurgitation, 21 VANQWISH. See Veterans Affairs
Non-Q-Wave Infarction Strategies in Hospital Vascular dysfunction, 278–282 Vasodilatation, 4, 6
Vasodilator MPS, 163–164 Vasodilator stress, 163
clinical/hemodynamic responses to, 196
preparation for, 164 Ventricular function, 299 Ventricular hypertrophy, 279 Ventricular septal rupture, 29 Vertical long axis (VLA), 169 Vessel wall imaging, 42 Veterans Affairs Non-Q-Wave
Infarction Strategies in Hospital (VANQWISH), 238–239
Viability, 259–272. See also Myocardial viability Viability assessment
clinical importance of, 268–271 on management of patients with
ischemic LV dysfunction, 269 Viable myocardium
amount of, needed for improvement, 270 definition of, 260–261 incidence of, 268
revascularization in patients’ LV dysfunction and, 268–271 Viscous friction, 25
VLA. See Vertical long axis W
Wall motion, 175–177
Wall motion abnormalities, 29, 139f Wall motion imaging, 283 Wall motion score (WMS), 28, 177 Wall motion thickening, 27 Wall thickening, 42
Water-perfusable tissue fraction (PTF), 266
X
X-ray angiography, 49
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