Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology
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Glucarate is a 6-carbon dicarboxylic acid shown to be taken up by necrotic myocytes, binding to nuclear histones in animal models of coronary occlusion, resulting in infarction. This study investigated glucarate uptake in a model of severe ischemia. ⋯ Uptake of Tc-99m glucarate was seen in the RR in a swine model of ischemia severe enough to produce myocyte injury and early cell death.
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Comparative Study
Comparison of acute rest myocardial perfusion imaging and serum markers of myocardial injury in patients with chest pain syndromes.
Newer diagnostic modalities such as serum markers and acute rest myocardial perfusion imaging (MPI) have been evaluated diagnostically in patients with chest pain in the emergency department (ED), but never concurrently. We compared these two modalities in distinguishing patients in the ED with symptomatic myocardial ischemia from those with non-cardiac causes. ⋯ At the time of presentation and 8 to 24 hours later, acute rest MPI has a better sensitivity and similar specificity for patients with objective evidence of CAD when compared with serum markers.
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In patients suspected of having coronary artery disease (CAD), noninvasive testing has been playing an increasing role in selecting patients who would require coronary angiography for either the "definitive" diagnosis of CAD or as a prelude to planning myocardial revascularization. A mathematic model is presented that defines cost-effective utility of nuclear cardiology testing for diagnosis of CAD and selection of appropriate candidates for coronary angiography, according to quantitative methods of decision analysis. Clinical utility or effectiveness was defined in terms of percent correct diagnosis of CAD. ⋯ The latter patients would then be candidates for coronary angiography. In all patients with an abnormal rest electrocardiogram, the most cost-effective strategy is uniform referral to nuclear cardiac testing (which is performed in conjunction with exercise electrocardiography), regardless of the pretest likelihood of CAD; a negative or a positive nuclear test result would indicate low or high risk for coronary events, respectively. The latter group would be proper candidates for referral to coronary angiography.
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Dipyridamole thallium scintigraphy has previously been shown to have predictive value for both perioperative and late cardiac events in patients undergoing vascular surgery. However, despite the prognostic utility of this technique, the relative importance of clinical factors and scintigraphic information is not well known. The purpose of this study was to evaluate the value of commonly used clinical risk indexes, composed of historic variables, and dipyridamole thallium scintigraphy for predicting perioperative cardiac event-free survival rates. ⋯ Preoperative clinical indexes are predictive of both perioperative and late cardiac events in patients undergoing vascular surgery. However, dipyridamole thallium scintigraphy is more powerful prognostically than these clinical indexes and provides supplemental value to clinical risk stratification.
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The results of multicenter trials indicate that patients with left ventricular dysfunction and either three-vessel or left main coronary artery disease have improved prognosis when treated surgically. ⋯ Although exercise radionuclide angiography in patients with minimal symptoms of coronary artery disease and left ventricular dysfunction is not precise in predicting three-vessel or left main coronary artery disease, it provides important functional information regarding subsequent prognosis during medical therapy.