Aims The third Universal Definition of Myocardial Infarction (MI) Task Force classified MIs into... more Aims The third Universal Definition of Myocardial Infarction (MI) Task Force classified MIs into five types: Type 1, spontaneous; Type 2, related to oxygen supply/demand imbalance; Type 3, fatal without ascertainment of cardiac biomarkers; Type 4, related to percutaneous coronary intervention; and Type 5, related to coronary artery bypass surgery. Low-density lipoprotein cholesterol (LDL-C) reduction with statins and proprotein convertase subtilisin–kexin Type 9 (PCSK9) inhibitors reduces risk of MI, but less is known about effects on types of MI. ODYSSEY OUTCOMES compared the PCSK9 inhibitor alirocumab with placebo in 18 924 patients with recent acute coronary syndrome (ACS) and elevated LDL-C (≥1.8 mmol/L) despite intensive statin therapy. In a pre-specified analysis, we assessed the effects of alirocumab on types of MI. Methods and results Median follow-up was 2.8 years. Myocardial infarction types were prospectively adjudicated and classified. Of 1860 total MIs, 1223 (65.8%) w...
Radionuclide imaging techniques have played an important role in the evaluation of left ventricul... more Radionuclide imaging techniques have played an important role in the evaluation of left ventricular function, severity and extent of ischemia, viability and necrosis in patients with acute myocardial infarction. The information derived has formed a basis for risk stratification and selection of optimal treatment strategies for postinfarction patients in the prethrombolytic era. Reperfusion has altered the natural history of acute myocardial infarction. Effective early and sustained restoration of perfusion to acutely ischemic myocardium is the single most important factor in preserving myocardial function and reducing mortality and chronic disability. Current management strategies in acute myocardial infarction involve early diagnosis followed by prompt reperfusion, either pharmacologically or mechanically. Currently available thrombolytic agents achieve reperfusion in 75–80% of cases.1 When adequate reperfusion is not achieved with thrombolysis, immediate “salvage” angioplasty may be considered. Optimal utilization of reperfusion therapy would benefit from the availability of rapid non-invasive techniques for the early detection of reperfusion. Imaging may play a potential role in this as well as other areas in the diagnostic and therapeutic spectrum of reperfusion therapy in the modem era of coronary thrombolysis.
In this review, we summarize the major known cardiac toxicities of common chemotherapeutic agents... more In this review, we summarize the major known cardiac toxicities of common chemotherapeutic agents and the role of nuclear cardiac imaging for the surveillance and assessment of cancer therapeutics–related cardiac dysfunction in routine clinical practice. Cardiotoxicity from chemotherapy causes a significant mortality and limits potentially life-saving treatment in cancer patients. Close monitoring of cardiac function during chemotherapy is an accepted method for reducing these adverse effects especially in patients with cancer therapeutics–related cardiac dysfunction. Nuclear imaging is a sensitive, specific, and highly reproducible modality for assessment of cardiac function. Nuclear imaging techniques including equilibrium radio nucleotide angiography, myocardial perfusion imaging, and novel experimental molecular imaging are the various objective tools available in addition to conventional echocardiography and cardiac magnetic resonance imaging in the surveillance, assessment, and follow-up of cancer therapeutics–related cardiac dysfunction.
St. Jude mechanical prosthesis is the most commonly used prosthetic device with least valvular co... more St. Jude mechanical prosthesis is the most commonly used prosthetic device with least valvular complications with excellent hemodynamics. However, prosthetic valve thrombosis is one of the serious complications, with rates between 0.03% and 0.13% per patient-year depending on the type of anticoagulation used and compliance to the therapy. Transthoracic echocardiography (TTE) is the initial screening tool (class I) that would provide clues for the assessment of valvular hemodynamics. Fluoroscopy is an alternate imaging modality for the assessment of mechanical leaflet motion, especially in patients when prosthetic valves are difficult to image on TTE or transesophageal echocardiography. A complete fluoroscopic evaluation of a prosthetic valve includes assessment of valvular motion and structural integrity. Opening and closing angles can be measured fluoroscopically to determine whether a specific valve is functioning properly. We discuss a case of a 91-year-old man with thrombosis of bileaflet mechanical mitral prosthesis that was demonstrated on real-time fluoroscopy (not evident on TTE). An algorithmic approach to diagnosis and management of prosthetic heart valve thrombosis is outlined.
Nuclear imaging techniques play an important role in the non-invasive evaluation of patients with... more Nuclear imaging techniques play an important role in the non-invasive evaluation of patients with established or suspected coronary artery disease.1 A number of different radiopharmaceuticals and scintigraphic imaging techniques are available for obtaining important diagnostic and prognostic information about myocardial perfusion, cardiac function and myocardial necrosis in patients with cardiovascular disorders. This article briefly describes various cardiac nuclear imaging techniques, their applications in clinical practice and the recent developments in this field.
Aims The third Universal Definition of Myocardial Infarction (MI) Task Force classified MIs into... more Aims The third Universal Definition of Myocardial Infarction (MI) Task Force classified MIs into five types: Type 1, spontaneous; Type 2, related to oxygen supply/demand imbalance; Type 3, fatal without ascertainment of cardiac biomarkers; Type 4, related to percutaneous coronary intervention; and Type 5, related to coronary artery bypass surgery. Low-density lipoprotein cholesterol (LDL-C) reduction with statins and proprotein convertase subtilisin–kexin Type 9 (PCSK9) inhibitors reduces risk of MI, but less is known about effects on types of MI. ODYSSEY OUTCOMES compared the PCSK9 inhibitor alirocumab with placebo in 18 924 patients with recent acute coronary syndrome (ACS) and elevated LDL-C (≥1.8 mmol/L) despite intensive statin therapy. In a pre-specified analysis, we assessed the effects of alirocumab on types of MI. Methods and results Median follow-up was 2.8 years. Myocardial infarction types were prospectively adjudicated and classified. Of 1860 total MIs, 1223 (65.8%) w...
Radionuclide imaging techniques have played an important role in the evaluation of left ventricul... more Radionuclide imaging techniques have played an important role in the evaluation of left ventricular function, severity and extent of ischemia, viability and necrosis in patients with acute myocardial infarction. The information derived has formed a basis for risk stratification and selection of optimal treatment strategies for postinfarction patients in the prethrombolytic era. Reperfusion has altered the natural history of acute myocardial infarction. Effective early and sustained restoration of perfusion to acutely ischemic myocardium is the single most important factor in preserving myocardial function and reducing mortality and chronic disability. Current management strategies in acute myocardial infarction involve early diagnosis followed by prompt reperfusion, either pharmacologically or mechanically. Currently available thrombolytic agents achieve reperfusion in 75–80% of cases.1 When adequate reperfusion is not achieved with thrombolysis, immediate “salvage” angioplasty may be considered. Optimal utilization of reperfusion therapy would benefit from the availability of rapid non-invasive techniques for the early detection of reperfusion. Imaging may play a potential role in this as well as other areas in the diagnostic and therapeutic spectrum of reperfusion therapy in the modem era of coronary thrombolysis.
In this review, we summarize the major known cardiac toxicities of common chemotherapeutic agents... more In this review, we summarize the major known cardiac toxicities of common chemotherapeutic agents and the role of nuclear cardiac imaging for the surveillance and assessment of cancer therapeutics–related cardiac dysfunction in routine clinical practice. Cardiotoxicity from chemotherapy causes a significant mortality and limits potentially life-saving treatment in cancer patients. Close monitoring of cardiac function during chemotherapy is an accepted method for reducing these adverse effects especially in patients with cancer therapeutics–related cardiac dysfunction. Nuclear imaging is a sensitive, specific, and highly reproducible modality for assessment of cardiac function. Nuclear imaging techniques including equilibrium radio nucleotide angiography, myocardial perfusion imaging, and novel experimental molecular imaging are the various objective tools available in addition to conventional echocardiography and cardiac magnetic resonance imaging in the surveillance, assessment, and follow-up of cancer therapeutics–related cardiac dysfunction.
St. Jude mechanical prosthesis is the most commonly used prosthetic device with least valvular co... more St. Jude mechanical prosthesis is the most commonly used prosthetic device with least valvular complications with excellent hemodynamics. However, prosthetic valve thrombosis is one of the serious complications, with rates between 0.03% and 0.13% per patient-year depending on the type of anticoagulation used and compliance to the therapy. Transthoracic echocardiography (TTE) is the initial screening tool (class I) that would provide clues for the assessment of valvular hemodynamics. Fluoroscopy is an alternate imaging modality for the assessment of mechanical leaflet motion, especially in patients when prosthetic valves are difficult to image on TTE or transesophageal echocardiography. A complete fluoroscopic evaluation of a prosthetic valve includes assessment of valvular motion and structural integrity. Opening and closing angles can be measured fluoroscopically to determine whether a specific valve is functioning properly. We discuss a case of a 91-year-old man with thrombosis of bileaflet mechanical mitral prosthesis that was demonstrated on real-time fluoroscopy (not evident on TTE). An algorithmic approach to diagnosis and management of prosthetic heart valve thrombosis is outlined.
Nuclear imaging techniques play an important role in the non-invasive evaluation of patients with... more Nuclear imaging techniques play an important role in the non-invasive evaluation of patients with established or suspected coronary artery disease.1 A number of different radiopharmaceuticals and scintigraphic imaging techniques are available for obtaining important diagnostic and prognostic information about myocardial perfusion, cardiac function and myocardial necrosis in patients with cardiovascular disorders. This article briefly describes various cardiac nuclear imaging techniques, their applications in clinical practice and the recent developments in this field.
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Papers by Diwakar Jain