Erick Alexanderson Rosas

Angiografía mediante tomografía computarizada cardiaca: una técnica versátil

Erick Alexánderson Rosas,* Aloha Meave González, and Moisés Jiménez-Santos a Departamento de Cardiologı́a Nuclear, División de Imagen Cardiovascular No Invasiva, Instituto Nacional de Cardiologı́a ‘‘Ignacio Chávez’’, Mexico City, Mexico b Departamento de Resonancia Magnética y Tomografı́a Cardiaca, División de Imagen Cardiovascular No Invasiva, Instituto Nacional de Cardiologı́a ‘‘Ignacio Chávez’’, Mexico City, Mexico c Unidad PET/CT Ciclotrón, Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, Mexico

Functional Impact of Coronary Stenosis Observed on Coronary Computed Tomography Angiography: Comparison with 13N-Ammonia PET

BACKGROUND AND AIMS We undertook this study to evaluate the functional impact of coronary abnormalities in patients with suspected coronary artery disease (CAD) by means of integrated positron emission tomography (PET) and coronary computed tomography angiography (CCTA) scan obtained on a hybrid state-of-the-art PET/CT scanner. METHODS We studied 29 consecutive, patients with a clinically suspected intermediate risk for CAD, using a hybrid PET/CT 64 slice scanner. During a single scanning session, CCTA was performed for coronary anatomy evaluation, and a rest/adenosine stress (13)N-ammonia PET was performed for myocardial perfusion assessment in 3D mode with CT attenuation correction. RESULTS Twenty four (82.7%) patients had atherosclerosis detected by CCTA; 15 patients had significant (≥50%) coronary stenoses and all 15 patients showed ischemia by PET; moreover, 10/15 patients had a Summed Stress Score >12.20/24 and 83.3% patients with atherosclerosis detected by CCTA showed ischemia by PET. Two of five patients with normal coronary arteries showed ischemia by PET. CCTA agreement in positive identification of PET ischemia was 91% and agreement in ruling out ischemia was 43%; PET agreement in detecting CCTA atherosclerosis was 83%, and agreement in ruling it out was 60%. CONCLUSIONS We found a strong relation between significant coronary stenosis identified by CCTA and ischemia by PET. However, in cases with low-grade stenosis, PET scan can assess the functional significance of atherosclerotic abnormalities.

DIAGNOSTIC UTILITY OF GOLDBERGER'S ELECTROCARDIOGRAPHIC TRIAD IN PREDICTING LEFT VENTRICULAR DYSFUNCTION IN CHAGAS’ HEART DISEASE

Background: Chagas’ disease is a serious problem in Latin America. Clinical settings where is managed might be limited; therefore simple diagnostic tools are needed to improve detection. Goldbergers electrocardiographic triad (SV1 or SV2 + RV5 or RV6 ≥ 3.5 mV, total QRS amplitude in limb leads

Metabolic Syndrome and Diabetes Mellitus in Mexico: the Role of PET/CT in Endothelial Dysfunction and Cardiovascular Disease Detection

Purpose of ReviewMetabolic syndrome (MetS) and diabetes mellitus (DM) have become over the past years a global burden of disease. They are one of the main risk factors for cardiovascular disease among others. CVDs represent the number one cause of death globally. Diabetes Mellitus’ prevalence, especially type 2, has increased dramatically in a short period increasing health care costs and mortality worldwide. Detecting coronary artery disease in diabetic patients with a myocardial perfusion imaging method such as PET/CT is the primary concern for this review.Recent FindingsThe most recent survey in Mexico done in 2012 reveals that an overall prevalence of 9.4% of the population has DM, which is roughly 6.4 million people with DM. Myocardial perfusion imaging with PET/CT has proven to be an accurate method to assess myocardial perfusion defects and viability in both symptomatic and asymptomatic patients with DM.SummaryIn this review, we briefly describe the latest data on DM in Mexico and the use of MPI with PET/CT for patients with this disease, creating a discussion of the use of this technique as a screening method for endothelial dysfunction to prevent cardiovascular outcomes.

13N-Ammonia pet-derived ventricular synchrony correlates with myocardial perfusion reserve better than left ventricular ejection fraction: A study in infarcted patients

Background: PET myocardial perfusion allows myocardial perfusion reserve (MPR) quantification as well as left ventricular ejection fraction (LVEF) and synchrony estimation through phase analysis. There is a relationship between MPR and LVEF and both have proven prognostic value in coronary artery disease (CAD). A relation between angiographic CAD extent and post-stress synchrony has been proposed with SPECT. We used 13N-ammonia PET to evaluate the relationship between MPR and ventricular synchrony in patients with a previous infarction and secondarily, to compare it to the relation MPR-LVEF. Methods: We studied 63 patients (64.4±11.1years) with a previous myocardial infarction with a rest/adenosine-stress 13N-ammoniaPET. Demographics and cardiovascular history were retrieved. MPR was calculated dividing the stress by the rest blood flow. Synchrony was evaluated through Entropy, systolic function through LVEF and the area of previous infarction through the resting total perfusion defect (TPD). Two multiple regressions were done: the first used Entropy as dependent variable and MPR, TPD and clinical variables as predictors; in the second LVEF replaced the dependent variable. The standardized regression coefficients were compared. Results: There were 49 males and 14 females, 39% with diabetes, 54% with hypertension, 54% with dyslipidemia, 42% of smokers and 44% with chest pain. Mean MPR=2.14±0.79, mean TPD=15.8%±11.2, mean LVEF=49%±17 and mean Entropy=53.4%±11.8. The first regression showed a significant independent relation between MPR and Entropy (β=-.384, p=0.006). This relation was greater than the one between MPR and LVEF (β=.292, p=0.013) in the second regression. In both, TPD (p=0.021, p=0.001) and gender (p=0.041, p=0.001) showed a significant correlation with the dependent variables. Conclusions: In patients with a previous myocardial infarction, PET-measured MPR significantly correlates to ventricular synchrony independently from the area of infarction. This correlation is stronger than the one between MPR and LVEF. Our results warrant further research into the added prognostic value of PET-measured ventricular synchrony and entropy in the setting of CAD.

STENT THROMBOSIS AFTER PERCUTANEOUS TREATMENT FOR AORTIC COARCTATION

The treatment of aortic coarctation with percutaneous stent placement has evolved rapidly in the past decade, and has proved to be an excellent alternative for surgical treatment for this common congenital defect. After stent placement, antiplatelet therapy has been suggested by some groups to

CHARACTERISTICS OF MYOCARDIAL BRIDGING EVALUATED BY CARDIAC COMPUTED TOMOGRAPHY ANGIOGRAPHY AND PRESENCE OF MYOCARDIAL ISCHEMIA BY SINGLE PHOTON EMISSION COMPUTED TOMOGRAPHY

The prevalence of Myocardial Bridging (MB) has been found in 58% in Coronary Computed Tomography Angiography (CCTA), systolic compression and ischemia have been reported. The aim of this study was to describe the MB characteristics in CCTA and the presence of ischemia by Myocardial Perfusion Single

THROMBOLYSIS WITH TENECTEPLASE IN A PATIENT PREVIOUSLY TREATED WITH TICAGRELOR LOADING DOSE

Thrombolysis in ST Elevation Acute Myocardial Infarction in combination with novel antiplatelet agents has not been studied, it is not adressed in the guidelines and risks are actually unkown. We report the case of a 64 year old patient who was admitted to the National Institute of Cardiology of