Miocárdio viável pela tomografia computadorizada com Tc-99m (MIBI) sensibilizada por nitroglicerina endovenosa

Filho, José Ramos; Nascimento, Marcos Welber; Silva, Rafael Mariano Gislon da; Camargo, Thiago Negrini de; Almeida, Roberto Simões de; Lima, Eloá Jacinto

doi:10.1590/s0066-782x2008001500003

Cited by 4 publications

(3 citation statements)

References 24 publications

(28 reference statements)

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“…[12324] Nitroglycerine is known to increase blood flow in the hypoperfused myocardium and reduce regional ischemia of the heart muscle in coronary artery disease. [24589] Our study confirms these findings; we found statistically significant improvement of myocardial perfusion after nitroglycerine administration in hypoperfused areas seen at rest myocardial perfusion study.…”

Section: Discussionmentioning

confidence: 99%

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Observed influence of nitroglycerine on myocardial perfusion scintigraphy in patients with multiple vessel coronary artery disease and well-developed collaterals

et al. 2012

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The objective of this scientific work was to evaluate the extent and severity of perfusion abnormalities on myocardial perfusion scintigraphy (MPS) at rest and with sublingual nitroglycerine, in relation to the presence and anatomical location of collaterals demonstrated by selective coronary angiography (SCA). Twenty-eight patients with unstable angina underwent selective coronary angiography. Eighteen of them were diagnosed with myocardial infarction (MI) 2–15 days prior to examination. Presence or absence of collaterals was noted, with anatomical depiction of donor and recipient arteries as well as evaluation of degree of collateral flow. As an inclusion criterion, collateral flow had to be grade 2 (partial epicardial filling of the occluded artery) or 3 (complete epicardial filling of the occluded artery) in accordance with the Rentrop collateral flow classification. Flow was noted as follows: Complete antegrade (CA), complete retrograde (CR), partial antegrade (PA), and partial retrograde (PR). Myocardial perfusion scintigraphy using Tc-99m Sestamibi at rest and after sublingual administration of nitroglycerine was performed according to a 2-day protocol. Perfusion abnormalities, which were quantified using the 20-segments model and visual 5-point system (0, normal perfusion; 4, absent perfusion), were analyzed according to donor's and recipient's territories, as well as territories with limited or without collateral flow (PA/PR, grade 0–1 flow). A total of 84 arteries were analyzed, with stenosis in 79 of them. Arteries were divided into three groups: Donors (group I), recipients (group II), and arteries with limited or without collaterals (group III). In group I, there were 28 donor arteries, with mean severity of stenosis 71.3 ± 0.65%. In group II, there were 36 recipient arteries and mean severity of stenosis was 94.8 ± 0.26%. In group III, there were 20 arteries, and all of them had either no or poorly developed collaterals (mean severity of stenosis 60.4 ± 2%). In 3 cases, 2 donor arteries gave collaterals to 1 recipient artery, while in 11 cases, a single donor artery gave collaterals to 2 recipient arteries, and in 11 cases there was 1 donor to 1 recipient artery. A total of 1120 MPS segments were analyzed (560 at rest and 560 after nitroglycerine). The number of segments in groups I, II, and III were 204, 242, and 144, respectively. Mean number of segments per donor artery was 7.2 ± 0.7, mean number of segments per recipient artery was 7.0 ± 0.3, and mean number of segments in the territory of arteries without collaterals was 5.5 ± 0.5. In the territory of donor arteries, the mean number of segments with normal, decreased, and absent perfusion at rest was 1.6 ± 0.07, 5.67 ± 0.07, and 0.6 ± 0.03, respectively. After nitroglycerine administration, the mean number of above-mentioned segments was 1.2 ± 0.07, 6.07 ± 0.06, and 2.3 ± 0.06, respectively. There was no significant difference in the mean number of segments with normal and decreased perfusion at rest and after nitroglycerine administration (P =...

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Section: Discussionmentioning

confidence: 99%

“…[1] Nitroglycerine causes marked relaxation of all components of the vascular system and dramatically decreases pulmonary vascular pressure, intraventricular pressure, chamber size, and cardiac output. Nitroglycerine improves myocardial perfusion via a reduction in wall tension and myocardia l oxygen demand.…”

Section: Introductionmentioning

confidence: 99%

Observed influence of nitroglycerine on myocardial perfusion scintigraphy in patients with multiple vessel coronary artery disease and well-developed collaterals

et al. 2012

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“…Despite improvements in prevention and treatment strategies, cardiovascular diseases continue to represent a leading public health problem worldwide [1-4]. A plethora of studies have assessed the benefits of new technologies used in cardiology and support their use in clinical practice.…”

Section: Introductionmentioning

confidence: 99%

Assessing the outcomes of implantable cardioverter defibrillator treatment in a real world setting: results from hospital record data

Ghislandi

Torbica

Boriani

2013

BMC Health Serv Res

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BackgroundA plethora of clinical studies have assessed the benefits of implantable cardioverter defibrillators (ICDs) and supported their use in clinical practice. However, evidence on the safety and efficacy of ICDs appears insufficient to support expansion of their use in clinical practice, and more information on their impact in real life settings is warranted. This paper aims to investigate the impact of ICDs using a large administrative dataset reflecting actual clinical practice.MethodsData were obtained from the hospital discharge database of the Friuli Venezia Giulia region in Italy containing patient-level information on 169,488 cases. Data on mortality outside hospital were obtained from regional sources. Exact matching method was used to estimate the outcomes associated with ICDs: mortality, length of stay, re-hospitalization and regional expenditure. The method was applied in two steps. First, patients with ICDs were matched with those without using the following: age class (by 5 years), gender, year of admission, type of admission (day hospital vs. ordinary) and primary diagnosis. In the second step, matching included also Charlson Comorbidities Index. Exact matching average treatment effect on the treated (ATT) was used as a main measure of impact.ResultsCompared with matched controls, treatment with ICDs was associated with lower mortality (absolute risk reduction 10.6% at 1 year and 8.3% at 2 and 8.4% at 3 years, p < 0.001 and hazard ratio 0.80, p < 0.001), greater regional expenditure at index hospitalization (ATT: €9459.64, p < 0.001) and during follow up (ATT: €1707.29, p < 0.001) and higher re-hospitalization rate (ATT: 0.53, p < 0.001). No significant difference was found for length of stay (9.07 vs. 8.86 days). The results were maintained after more restrictive matching was applied.ConclusionsAssessing the impact of innovative, expensive medical technologies on the basis of real world data is warranted, especially when there are barriers to implementation. Hospital administrative datasets can be of great value when a technology such as the ICD is implemented in a relatively small sample of patients, to allow use of exact matching techniques.

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Atypical case of acute coronary syndrome due to coronary-pulmonary steal syndrome secondary to pulmonary embolism

et al. 2010

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on chronic oxygen therapy due to chronic obstructive pulmonary disease (COPD) in the setting of a bronchiectasic disease, referred to our hospital in September 2009 because of a micturition-nocturnal-syncope preceded by dizziness. The patient had neither a personal history of coronary artery disease nor known cardiovascular risk factors. In the emergency department (ED) the patient presented preserved consciousness and mild dyspnea despite low flows of inhalatory O 2 (2 l/min); chest examination was characterized by sibilant and sonorous rales in addition to bibasilar thin crackles; hemo-gas analysis (HGA) showed severe hypoxemic-hypercapnic acidosis (pH 7.18, pCO 2 85 mmHg, pO 2 58 mmHg, sO 2 84%, HCO 3 -23.5, 5); the ECG demonstrated sinus tachycardia, mild and non-specific ST segment elevation V1-V3; the chest X-ray study showed a COPD pattern, right-basal paracardiac radio-opacity, enlargement of the left cardiac chambers. Blood tests demonstrated a leukocytosis with a mild elevation of LDH and D-Dimer [WBC 19,860, Hb 13.4 g/dL, creatinine 0.85 mg/dL, troponin I (T I ) 0.02 ng/mL, CPK e CPK-MB ns, D-Dimer 678 mg/dL, BNP 37 pg/mL]. In the ED, the patient was started on inhalatory salbutamol, furosemide, steroids and empiric i.v.antibiotic-therapy with piperacillin/tazobactam. An HGA executed 2 h later, documented resolution of the acidosis and of the hypoxia, clear reduction of the pCO 2 (pH 7.4, pO 2 70 mmHg, pCO 2 55 mmHg, sO 2 95%). In the afternoon, the patient was transferred to the department of Internal Medicine. About 1 h after admission, he presented sudden, severe shortness of breath and diaphoresis, the ECG demonstrated sinus tachycardia, a new onset of mild ST segment elevation V3-V6; an HGA showed severe respiratory hypoxic-hypercapnic acidosis (pH 7.16 pCO 2 91 mmHg, pO 2 56 mmHg, sO 2 79%). IV steroids and inhaled salbutamol were again administered with subsequent resolution of the dyspnea and improvement of gas exchange. Blood tests revealed a mild, initial increase of T I (0.77 ng/mL at time 0 min, 0.17 ng/mL 6 h later) with persistently normal LDH, AST, and CK. The ECG presented giant and symmetrical negative T-waves in inferiorlateral derivations (D1-D3, V4-V6). Preliminary diagnosisDr. Squizzato, Prof. Ageno: After cardiologic consultation, on the basis of the ECG abnormalities and a positive marker for myocardial necrosis, therapy with ASA, nitrates and a therapeutic dose of low molecular weight heparin was started. The cardio-thoracic examination was unchanged. A trans-thoracic echocardiogram revealed a mild eccentric left ventricular hypertrophy; a wellpreserved global and segmentary wall-motion (ejection fraction 60%); an altered diastolic function with a pseudonormalized pattern at color-Doppler and tissue-Dopplerimaging; an absence of tricuspidal regurgitation and a normal systolic pulmonary artery pressure; a high-resistance Doppler flow pattern in the first tract of pulmonary

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Miocárdio viável pela tomografia computadorizada com Tc-99m (MIBI) sensibilizada por nitroglicerina endovenosa

Cited by 4 publications

References 24 publications

Observed influence of nitroglycerine on myocardial perfusion scintigraphy in patients with multiple vessel coronary artery disease and well-developed collaterals

Observed influence of nitroglycerine on myocardial perfusion scintigraphy in patients with multiple vessel coronary artery disease and well-developed collaterals

Assessing the outcomes of implantable cardioverter defibrillator treatment in a real world setting: results from hospital record data

Atypical case of acute coronary syndrome due to coronary-pulmonary steal syndrome secondary to pulmonary embolism

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