A selection of recent original research papers
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From the Cardiovascular Institute, University of Pittsburgh, Pittsburgh, PA. Reprint requests: Prem Soman, MD, PhD, Cardiovascular Institute, University of Pittsburgh, Pittsburgh, PA; [email protected]. J Nucl Cardiol 2012;19:1095–8. 1071-3581/$34.00 Copyright Ó 2012 American Society of Nuclear Cardiology. doi:10.1007/s12350-012-9640-8
improvement in sensitivity afforded by the addition of MFR is striking. However, it must be noted that this analysis was performed in patients already referred for coronary angiography (CAD prevalence of 73%). The diagnostic specificity of an abnormal MFR alone in unselected patients referred for stress testing remains to be determined. Direct Quantification of Left Ventricular Motion and Thickening Changes Using Rest-Stress Myocardial Perfusion SPECT Los Angles, California and Springfield, Oregon Shahryar Karimi-Ashtiani, Reza Arsanjani, Mathews Fish, Paul Kavanagh, Guido Germano, Daniel Berman, and Piotr Slomka J Nucl Med 2012; 53:1392-1400 Context Changes in regional function between the rest and stress study may provide additive diagnostic information to perfusion data alone, particularly to improve the detection of multivessel coronary artery disease. Changes in myocardial wall motion and thickening during myocardial perfusion SPECT are typically assessed visually, separately from gated rest and stress studies for the presence of stress-induced functional abnormalities. These investigators sought to develop and validate a novel approach for automatic quantification of rest-stress myocardial motion and thickening changes (MTCs). Methods and Results Endocardial surfaces at the end-diastolic and end-systolic frames for rest-stress studies were registered automatically to each other by matching ventricular surfaces. Myocardial MTCs were computed, and normal limits of change were determined as the mean and SD for each polar sample. Normal limits were used to quantify the MTCs for each map, and the accumulated sample values were used for abnormality assessments in segmental regions. A hybrid method was devised by combining the total perfusion deficit (TPD) and MTC for each vessel territory. Normal limits were obtained from 100 subjects with low likelihood of coronary artery disease. For validation, 623 subjects with correlating invasive angiography were studied. All subjects underwent a rest-stress 99mTcsestamibi exercise or adenosine test and coronary angiography within 3 months of myocardial perfusion SPECT. All MTC and TPD measurements were derived automatically. The diagnostic accuracy for detection of coronary artery disease for MTC plus TPD was compared with TPD alone. Segmental normal values were 1095
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Soman A selection of recent original research papers
between -1.3 and -4.1 mm for motion change and between -30.1% and -9.8% for thickening change. MTC combined with TPD achieved 61% sensitivity for 3-vessel-disease (3VD), 63% for 2-vessel-disease (2VD), and 90% for 1-vessel-disease (1VD) detection, compared with 32% for 3VD (P \ .0001), 53% for 2VD (P \ .001), and 90% for
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