News Update on Nuclear Cardiology : Nov 2020


EANM/ESC procedural guidelines for myocardial perfusion imaging in nuclear cardiology

The European procedural guidelines for radionuclide imaging of myocardial perfusion and viability are presented in 13 sections covering patient information, radiopharmaceuticals, injected activities and dosimetry, stress tests, imaging protocols and acquisition, quality control and reconstruction methods, gated studies and attenuation-scatter compensation, data analysis, reports and image display, and positron emission tomography. If the specific recommendations given could not be based on evidence from original, scientific studies, we tried to express this state-of-art. The guidelines are designed to assist in the practice of performing, interpreting and reporting myocardial perfusion SPET. The guidelines do not discuss clinical indications, benefits or drawbacks of radionuclide myocardial imaging compared to non-nuclear techniques, nor do they cover cost benefit or cost effectiveness. [1]

Contributions of Nuclear Cardiology to Diagnosis and Prognosis of Patients With Coronary Artery Disease

In the past decade, significant advances have been made in the ability to image the heart with radionuclide tracers under stress and resting conditions in patients with suspected or known coronary artery disease (CAD) for the detection of ischemia, determination of prognosis, assessment of myocardial viability, preoperative risk assessment for patients undergoing noncardiac surgery, and evaluation of the efficacy of revascularization in patients undergoing coronary artery bypass surgery or an interventional procedure.1

For many years, planar imaging and SPECT with 201Tl constituted the only scintigraphic techniques available for detecting CAD and assessing prognosis in patients undergoing stress perfusion imaging. The major limitation of 201Tl scintigraphy is the high false-positive rate observed in many laboratories, which is attributed predominantly to image attenuation artifacts and variants of normal that are interpreted as defects consequent to a significant coronary artery stenosis. Although quantification of 201Tl images improves specificity, the false-positive rate remains problematic, particularly in women and in obese patients. Breast attenuation artifacts in women are sometimes difficult to distinguish from perfusion abnormalities secondary to inducible ischemia or myocardial scar. [2]

The increasing role of quantification in clinical nuclear cardiology: The Emory approach

Single photon emission computed tomography (SPECT) myocardial perfusion imaging has attained widespread clinical acceptance as a standard of care for patients with known or suspected coronary artery disease. A significant contribution to this success has been the use of computer techniques to provide objective quantitative assessment in interpreting these studies. We have implemented the Emory Cardiac Toolbox (ECTb) as a pipeline to distribute the software tools that we and others have researched, developed, and validated to be clinically useful so that diagnosticians everywhere can benefit from our work. Our experience has demonstrated that integration of all software tools in a common platform is the optimal approach to promote both accuracy and efficiency. Important attributes of the ECTb approach are (1) our extensive number of normal perfusion databases for SPECT and positron emission tomography (PET) studies, each created with at least 150 patients: (2) our use of Fourier analysis of regional thickening to ensure proper temporal resolution and to allow accurate measurement of left ventricular function and dyssynchrony: (3) our development of PET tools to quantify myocardial hibernation and viability; (4) our development of 3-dimensional displays and the use of these displays as a platform for image fusion of perfusion and computed tomography angiography; and (5) the use of expert systems for decision support. ECTb is an important tool for extracting quantitative parameters from all types of cardiac radionuclide distributions. ECTb should continue to play an important role in establishing cardiac SPECT and PET for flow, function, metabolism, and innervation clinical applications.[3]

The Adverse Effects of Wealth on Cardiovascular Health: A Scientific Statement of the International College of Cardiology

Background and Aims: Increase in economic status may be associated with increased consumption of Western type of foods and sedentary behaviour. In the present review, we discuss that increase in wealth may be associated with adverse effects on health behaviour.

Study Design and Methods: Internet search and discussion with colleagues.

Results: Review of studies indicate that with increase in wealth, there is increased consumption of high fat, ready prepared foods and decrease in physical activity in most of  the  countries resulting in obesity and metabolic syndrome, leading to cardiovascular diseases (CVDs) and other chronic conditions. Many experts during the United Nations High Level Meeting in Sept 2011, misinterpreted the WHO estimates and proposed that, of total deaths, 22·4 million arise in the poorest countries, and 13.7 million in high-income and upper-middle-income countries and therefore poverty may be the major cause of  deaths due to non-communicable diseases (NCDs). A recent study shows that 57.0 % of deaths in adults (aged 25-64 years) were due to CVDs and other chronic diseases, 25.5% due to communicable diseases and 15.9% due to injury and accidents. The deaths due to NCDs were highly prevalent among higher social classes compared to lower social classes who had greater deaths due to communicable diseases. It is interesting to know from new data from United States, that there is ‘Wealth’ without cardiovascular health in America. The whole world is likely to have the same scenario in the near future.

Conclusions: Increase in wealth may be associated with altered health behaviour; greater consumption of unhealthy foods, tobacco consumption, mental load and sedentary behaviour resulting in increased risk of deaths due to CVDs and other chronic diseases which may change with knowledge about health education. Wealth may cause extension in life by buying of expensive drug therapy, intervention and surgery which are known to add income and employment in the west . [4]

Impact of Socioeconomic and Risk Factors on Cardiovascular Diseases among People in Bangladesh: A Cross-sectional Health Survey

Aims: The burden of non-communicable diseases especially cardiovascular diseases (CVDs) are rising rapidly in the developing countries particularly in Bangladesh. Therefore, the present study was undertaken to assess the impact of socioeconomic and risk factors affecting cardiovascular diseases among people in Bangladesh.

Study Design: We conducted this study with standard structured questionnaires following WHO STEPS Surveillance Manual.

Place and Duration of Study: Department of cardiology, ward number 32, Rajshahi Medical College Hospital, Rajshahi, Bangladesh, from July  to December 2015.

Methodology: We enrolled 650 patients randomly (469 men, 181 women; age range 11 to 70 years) with cardiac complications. Data were collected via interview of the patients/guardians and medical records using WHO-NCD STEP wise approach questionnaires. Descriptive statistics was applied to analyze the data.

Results: In this study we found that the prevalence of CVDs was more among rural people (61.5%) than urban residence (38.5%). Majority of participants (74.6%) came from lower socio-economic class, patients of age 50-60 years (30%) had greater risk than others, male (72.1%) had greater risk of suffering from CVDs than female (27.9%), families with low income (10000-20000 taka) 44.3%, family members (4-5) 46.8%, high cholesterol diet 75.2%, hypertension 79.1%, patients with no physical exercise 45.7% were commonly suffering from cardiovascular diseases.

Conclusion: Our present study showed that CVDs risk factors such as habit of salt intake during meals in the table, high cholesterol diet, smoking, hypertension, heredity, obesity, diabetes & no physical exercise was persistent among the study populations. Therefore social awareness should be developed among people of Bangladesh especially in rural community through educational programs & by mass media. [5]


[1] Hesse, B., Tägil, K., Cuocolo, A., Anagnostopoulos, C., Bardiès, M., Bax, J.E.A.N.M., Bengel, F., Sokole, E.B., Davies, G., Dondi, M. and Edenbrandt, L., 2005. EANM/ESC procedural guidelines for myocardial perfusion imaging in nuclear cardiology. European journal of nuclear medicine and molecular imaging32(7), pp.855-897.

[2] Beller, G.A. and Zaret, B.L., 2000. Contributions of nuclear cardiology to diagnosis and prognosis of patients with coronary artery disease. Circulation101(12), pp.1465-1478.

[3] Garcia, E.V., Faber, T.L., Cooke, C.D., Folks, R.D., Chen, J. and Santana, C., 2007. The increasing role of quantification in clinical nuclear cardiology: the Emory approach. Journal of nuclear cardiology14(4), pp.420-432.

[4] B. Singh, R., Hristova, K., V. Muthusamy, V., S. Rastogi, S., K. Basu, T., Toda, E., Takahashi, T., Fedacko, J., Pella, D., De Meester, F., W. Wilson, D., N. Mondal, R., Ishaq, M. and R. Mohideen, M. (2013) “The Adverse Effects of Wealth on Cardiovascular Health: A Scientific Statement of the International College of Cardiology”, Cardiology and Angiology: An International Journal, 1(1), pp. 9-22. doi: 10.9734/CA/2013/3375.

[5] Haque, M. U., Khatun, M., Barik, S. M. A., Islam, M., Islam, M. N. and Islam, M. (2017) “Impact of Socioeconomic and Risk Factors on Cardiovascular Diseases among People in Bangladesh: A Cross-sectional Health Survey”, Journal of Pharmaceutical Research International, 15(2), pp. 1-8. doi: 10.9734/BJPR/2017/32024.


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