|Year : 2012 | Volume
| Issue : 3 | Page : 118-121
Pre-conference Symposium on Nuclear Cardiology
|Date of Web Publication||10-Nov-2012|
|How to cite this article:|
. Pre-conference Symposium on Nuclear Cardiology. World J Nucl Med 2012;11:118-21
Myocardial Viability: Implications for Clinicians
C. D. Libhaber
Nuclear Cardiology, University of Witwatersrand, Johannesburg, South Africa
As therapies and interventions in myocardial infarctions acute coronary syndromes improve, and patients live longer, there are an increasing number of patients with disabling heart conditions related to left ventricular (LV) dysfunction. In most countries of the world, two-thirds of cases with LV dysfunction are the result of coronary artery disease (CAD). These patients are at increased risk for: cardiac death, severe morbidities, recurrent hospital admissions for heart failure, and severe limitations in their lifestyles. Although there have been significant advances in medical therapy for LV dysfunction and resulting symptoms of heart failure, prognosis from heart failure remains extremely poor, with an annual mortality ranging from 10 to 50% per year. After an initial ischemic injury, various processes can lead to LV dysfunction. Other than cell death, these processes are, to an extent, reversible, and LV function often can be improved, resulting in better patient outcome. Stunned myocardium is defined as myocardium that has become dysfunctional because of a transient coronary occlusion, has been salvaged by coronary reperfusion, yet exhibits prolonged but transient post-ischemic dysfunction, lasting hours to weeks. Hibernating myocardium is defined as a state of persistently impaired LV function at rest as the result of reduced coronary blood flow. It is important to identify stunned or hibernating myocardium not only because ventricular function will generally improve after revascularization or other therapies, but also because literature has shown that among patients with abnormal LV systolic function, those with hibernating (viable) myocardium have the poorest prognosis if they are not referred for a revascularization procedure. Myocardial viability can be evaluated with stress-delayed Tl-201, Rest-delayed Tl-201, Tc-99m Sestamibi, Dobutamine stress Echocardiography, and MRI. PET imaging using 18F-FDG has been considered "gold standard" for assessment of myocardial viability using metabolic tracers. Studies done including histology demonstrated that tracer uptake represents a continuous variable, with the amount of tracer uptake directly reflecting the magnitude of preserved viability. As such, it is incorrect to consider viability simply on a yes or no basis. With the increasing aging of the population and the predicted greater prevalence of patients with Congestive heart failure (CHF) and LV dysfunction attributable to CAD, it will become extremely important to identify patients who will benefit from interventions such as revascularization.
Role of Radionuclide Imaging in Heart Failure
Prof. Zuo-Xiang He
Nuclear Medicine, Fu Wai Hospital and Cardiovascular Institute, Beijing, China
New Experimental Tracers for Myocardial Perfusion
Department of Nuclear Medicine, Chonnam National University Hwasun Hospital, South Korea
New experimental myocardial perfusion tracers are developed to overcome the disadvantages of the current Tc-99m imaging agents. Appropriate lipophilicity and structure of ligands is needed for proper uptake to myocardium. Neutral radiotracers include 99m Tc(N)(NOEt) 2 , 99m Tc(N)(DMCHDTC) 2 , and 99m Tc(N)(IPEXT)2, and cationic complexes include 99m Tc(N)(DTC-Ln)(PNP), 99m TcN(PNP5)(DMCHDTC), and 99m Tc(N)(DBODC)(PNP5). Many new agents are using N3− ligand (nitrido) because the nitride N3-ligand is known to be the strongest p donor and may act as a terminal or bridging atom which stabilizes the metal at high oxidation states. Successful installation of positron emission tomography/computed tomography (PET/CT) systems around the world drives development of new PET agents for myocardial perfusion labeled by 18 F, 11 C, 64 Cu, and 68 Ga. Mitochondrial membrane potential targeting 18 F-labeled agents include lipophilic cations 18 F-TPP, 18 F-FBnTP, 18 F-FHTP, 18 F-FETP, 18 F-FETMP, and 18 F-FERhB. Mitochondrial complex I inhibitors including 18 F-FDHR, 18 F-RP1003/04/05, BMS-747158-02, and 18 F-FP3OP are also introduced. A substrate of neuronal norepinephrine transporter was also labeled with 18 F. Blocking myocardial HERG potassium channels is tested for myocardial perfusion imaging using 18 F labeled ammonium salt. 11 C labeled ammonium salt chemical skeleton was introduced as a potential candidate for the imaging of myocardial blood flow. Platelet endothelial cell adhesion molecule (PECAM) was successfully labeled with 64 Cu newly developed ligands were labeled with 68 Ga to make lipophilic cations.
Radionuclide Ventriculography in Assessment of Cardiac Synchrony and Left Ventricular Ejection Fraction in Patients with Dilated Cardiomyopathy: Comparison between Narrow and Wide QRS Duration with Ventricular Synchrony
C. Patel, A. Singhal, S. Singla, H. Singh, S. Seth 1 , A. Malhotra
Department of Nuclear Medicine, 1 Cardiology, All India Institute of Medical Sciences, New Delhi, India
Objectives: Patients with severe, symptomatic heart failure and a wide QRS complex have shown benefits from cardiac resynchronization therapy (CRT). However, about one-third of patients who receive CRT based on these criteria fail to respond to CRT therapy. Mechanical ventricular dyssynchrony, instead of electrical dyssynchrony, is being recognized as a more accurate parameter and essential substrate for response in left ventricular function. The study aims to compare parameters of mechanical ventricular synchrony on radionuclide ventriculography (RNV), among patients with narrow and wide QRS duration, in dilated cardiomyopathy (DCM) and the effect of dyssynchrony on left ventricular ejection fraction (LVEF).
Materials and Methods: Thirty-eight patients (27 M, 11 F; age 42 ± 10 years) with DCM underwent RNV. Quantitative phase analysis was performed on the left anterior oblique/best septal image using first component of Fourier harmonics. Interventricular synchrony was measured as the difference between left ventricle (LV) and right ventricle (RV) mean phase angles (LV-RVmPA) expressed in milliseconds (ms). LV intraventricular synchrony was measured as the standard deviation of the mean phase angle for LV (SD LVmPA) in degrees. For calculating the upper reference limits (mean + 2SD), RNV studies of 100 patients with normal LV function and no history of cardiac disease were analyzed retrospectively. To diagnose dyssynchrony, the cut-off values used for LV-RVmPA and SD LVmPA were ≥40 ms and ≥14°, respectively.
Results: Patients were divided into two groups: Group A (QRS 120 ms, 25 patients) and Group B (QRS >120 ms, 13 patients). The LV-RVmPA values were significantly different in Group A and B patients [23.6 ± 15.7 ms and 47.8 ± 24.8 ms, respectively (P = 0.004)]. Interventricular dyssynchrony was noted in 3/25 (12%) and 8/13 (62%) patients in Group A and B, respectively (P = 0.005). However, no significant difference was observed in SD LVmPA values in Group A and B [19.7 ± 11.1° and 24.7 ± 16.5°, respectively (P = 0.278)]. Intraventricular dyssynchrony was observed in 14/25 (56%) and 9/13 (69%) patients in Group A and B, respectively (P = 0.659). The mean LVEF of all the patients recruited was 28 ± 11% (range 15-49%). The LVEF in patients with LV-RVmPA ≥40 ms was 27 ± 9, which was comparable to 28 ± 11 in patients with LV-RVmPA <40 ms (P = 0.792). However, the LVEF was significantly higher in patients with SD LVmPA <14°, being 35 ± 12, compared to 23 ± 6 in patients with SD LVmPA ≥14° (P < 0.001).
Conclusion: The results showed that in patients of DCM, QRS width is related with interventricular synchrony but not with intra left ventricular synchrony.
Pre-congress Symposium on Arctic Environment
Hospitals, Hospitality, and Hosting Health: An Arctic Avenue
Director, Multidimensional Tourism Institute, University of Lapland, Finland
Hospitals and hospitality have more in common than the similarity between the words describing the two concepts, even though the two initially might seem quite far apart cognitively. An etymological enquiry shows naturally that the words have developed from the same base, the Latin word "hospes" which means "guest," and later "hospitalitem" referring to "friendliness to guests," that created "hospitale" meaning "guest-house," "inn," and also "shelter for the needy." Investigating other related words shows that there are more connections. Hostel can equally describe two separate things, one related to health care and the other to the hospitality industry, and restaurant is also built on a base that is shared with health care through rest and restore. Though, beyond the words also lie a variety of other similarities starting from building planning and architecture, services processes, and service delivery, to modern-day management procedures aiming at occupancy rates, post-care treatment, and return customer databases. The primary aim of this paper is therefore to show how the two fields can gainfully cross-fertilize one another on advances in respective field. Secondary aims are to raise awareness of opportunities for actors in the fields, considering alternative funding sources and ways of equaling seasonal variety in demand, which currently is a large problem in the Arctic area.
Human Thermal Responses during Reindeer Safaris in Cold
Arctic Centre, University of Lapland, Finland
Northern Lights through the Eyes of a Space Scientist
Director, Sodankyla Geophysical Observatory, University of Oulu, Oulu, Finland
Glaciological Research in Svalbard
Arctic Centre, University of Lapland, Finland
Svalbard is an archipelago in the Arctic Ocean. Nordaustlandet is the second largest island and has two major icecaps: Austfonna and Vestfonna. Both icecaps feature fast-flowing outlet glaciers, many of which are known to exhibit surge behavior. Extensive observations exist documenting some of these surge events, but Nordaustlandet surge events have not yet been successfully reproduced in transient simulations using an ice sheet model (ISM) that fully resolves all the stresses in the ice. The ability to simulate surging behavior is essential in order to carry out accurate quantitative future projections of Nordaustlandet behavior under given climate forcing scenarios. The spatial pattern of basal drag is inferred from measured surface velocities using a Robin inverse method for different years: 1995, 2008, and 2011. We present the basal drag patterns for Vestfonna. Motivated by the expectation that surge behavior is governed largely by basal hydrology (especially basal water pressure) and that basal hydrology is related to basal temperature, we investigate whether implementing a relationship between basal temperature and sliding behavior is sufficient to simulate surging events in the absence of a full hydrology model. The velocity field obtained through inverse modeling based on observed velocities from 1995 and 2008 is used to study different parameters and processes governing the temperature distribution in the ice. Specifically, surface temperature, geothermal heat flux, friction, strain, and firm heating-all impact on the temperature distribution and potentially on basal sliding, a key feature of surge behavior.
Arctic Sculptures, Snow, and Ice
University of Lapland, Finland
Many Faces of Love
Vice President, University of Lapland, Finland
Why to study love? People live in a network of relationship and their ability to build and maintain relationships is an important strength. Love has many definitions and also many faces. The purpose of the presentation is to provide a comprehensive analysis on love in various areas of human life-romantic love and its ups and downs in various phases of life, love in education, love for work, for fellow humans as caring-and in relation to other phenomena, such as friendship, play, and creativity. When dissecting love along the course of life, parental love secures children's well-being and teachers' pedagogical love trusts in pupils' learning. The first taste of falling in love can manifest itself in the form of the sweet poison of love and still is quite far from actual love. The ability to love is an important, yet difficult, skill. There are numerous theories that explain the phases of long-lasting marriages and divorces, too. Nevertheless, love does not retire and the fascination of love does not fade, not even in senior age. There are also negative manifestations of love, and morbid love has been compared to addiction. A topical phenomenon of today is also the phenomenon of love for work and the successful combination of work and family. Love in its whole gamut is connected to human well-being and development in different areas and phases of human life. Love, as its best, is manifested by the endeavor to make things develop, grow, and come forward, whether love falls on other people, art, science, ideas, or nature. Love-in its various forms-makes the best health insurance.
The presentation is based on the project of Love-based Leadership-An Interdisciplinary Approach, one of the strategic leads of the University of Lapland (http://www.ulapland.fi/lovebasedleadership). The upcoming book by the authors Kaarina Määttä and Satu Uusiautti, The Many faces of Love, will be published by Sense Publishers at the beginning of 2013.
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