The Journal of Nuclear Cardiology Classic Articles

Online Nuclear Cardiology Training Curriculum: Open Access


The Journal of Nuclear Cardiology Classic Articles

Nuclear Imaging Modalities for Cardiac Amyloidosis 
Sabahat Bokhari, MD, Reehan Shahzad, MD, Adam Castano, MD, Mathew Maurer, MD
J Nucl Cardiol. 2014;21:175-184.
Cardiac amyloidosis is often challenging to diagnose and is almost always associated with a poor prognosis and is an underdiagnosed cause of heart failure with preserved ejection fraction. It involves deposits of monoclonal light chain (AL) or transthyretin (ATTR, mutant or wild-type ) types in the majority of cases. With the emergence of subtype-specific treatments, nuclear imaging plays an important role in identifying myocardial involvement and differentiating amyloid subtypes. In this article, Dr. Bokhari and colleagues review the role nuclear imaging in detection of cardiac amyloid. 

The Evolving Landscape of Nuclear Imaging in Cardiac Amyloidosis 
Steven J. Promislow, MD, Terrence D. Ruddy, MD
J Nucl Cardiol. 2018 May 18. doi: 10.1007/s12350-018-1295-7. 
With the improvements in treatments for light chain amyloidosis and promising new treatments option for transthyretin amyloid, there is a need for early and accurate diagnosis of cardiac amyloidosis and distinguishing between the two common subtypes. This recent editorial comments on a small study using of 11C-PIB (Pittsburgh compound B) to identify a subset of patients with cardiac amyloid who have a poor prognosis. The editorial discusses the use of 11C-PIB and it limitations and points out, that in the future ,other PET tracers may offer prognostic data, as well monitor disease progression in patients with cardiac amyloidosis.

Gated SPECT in Assessment of Regional and Global Left Ventricular Function: Major Tool of Modern Nuclear Imaging
Aiden Abidov, MD, PhD, Guido Germano, PhD, Rory Hachamovitch, MD, MSc, Daniel S. Berman, MD
J Nucl Cardiol. 2006;13:261-79. – 2006
In this Major Achievements in Nuclear Cardiology article, Abidov and colleagues discuss the use of ECG–gated SPECT and the ability to measure left ventricular ejection fraction(LVEF) and ventricular volumes, as well as evaluate the presence of regional wall motion abnormalities (RWMAs), as a routine part of clinical protocols. The 2003 ACC/AHA/ASNC  guidelines for the clinical use of cardiac radionuclide imaging considered ECG-gated SPECT as the “current state of the art” citing the ability to observe myocardial contraction in segments with apparent perfusion defects permits the nuclear test reader to discern attenuation artifacts from true perfusion abnormalities increasing diagnostic accuracy. In addition, the ability of gated SPECT to provide measurement of LVEF, segmental wall motion, and absolute LV volumes adds to the prognostic information derived from a SPECT study. The authors review the technical milestones, acquisition algorithms, analysis and added value gated-SPECT brings to the diagnostic and prognostic information available from myocardial perfusion imaging. 

Gated SPECT in Assessment of Regional and Global Left Ventricular Function: An Update
Aiden Abidov, MD, PhD, Guido Germano, PhD, Rory Hachamovitch, MD, MSc, Piotr Slomka, PhD, Daniel Berman, MD
J Nucl Cardiol. 2013;20:1118-1143.
Gated myocardial SPECT is a routine part of myocardial perfusion imaging protocols.  It can be used to obtain quantitative information about myocardial perfusion, thickness, and contractility including  calculations of left ventricular ejection fraction, stroke volume, and cardiac output. In this ASNC 20th anniversary article, Abidov and colleagues review the development, technical advancements, and clinical utility of gated myocardial perfusion SPECT imaging.

Prognostic Value of Myocardial Perfusion Imaging: State of the Art and New Developments
Kenneth A. Brown, MD
J Nucl Cardiol. 1996;3:516-537.
Dr. Brown was a leader in establishing the prognostic value of myocardial perfusion imaging. In 1983 in JACC, Brown and colleagues published an article describing the value of exercise thallium-201 imaging in patients presenting for evaluation of chest pain to predict future cardiac events (cardiovascular death or nonfatal myocardial infarction). Data was correlated with clinical, coronary and left ventricular angiographic and exercise electrocardiographic information.  Much has been published regarding the prognostic value of myocardial perfusion imaging since that first article, but this 1996 review provides the fundamentals of how this information has shaped nuclear cardiology today.

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