Clinical Nuclear Cardiology: State of the Art and Future Directions: Expert Consult: Online and Print, 4e

Clinical Nuclear Cardiology―now in its fourth edition―covers the tremendous clinical growth in this field, focusing on new instrumentation and techniques. Drs. Barry L. Zaret and George A Beller address the latest developments in technology, radiopharmaceuticals, molecular imaging, and perfusion imaging. Thoroughly revised to include 20 new chapters―Digital/Fast SPECT, Imaging in Revascularized Patients, and more―this new edition provides state-of-the-art guidance on key areas and hot topics with stunning visuals. Online access to the fully searchable text at expertconsult.com includes highly illustrated case studies that let you see the problem using a variety of imaging modalities. In other words, this is an invaluable resource no clinician or researcher in nuclear cardiology should be without.Features an editorial and contributing team of worldwide leaders in nuclear cardiology to provide you with current and authoritative guidance. Includes a section focusing on acute coronary syndromes to provide you with practical management tools for these conditions. Presents a full-color design that allows color images to be integrated throughout the text. Includes access to the fully searchable contents of the book online at expertconsult.com, along with highly illustrated case studies that let you see the problem using a variety of imaging modalities. Features 20 new chapters including Cellular Mechanisms of Tracer Uptake and Clearance; Attenuation/Scatter Corrections: Clinical Aspects; Hybrid Imaging; Digital/Fast SPECT; Imaging in Revascularized Patients; and more. Focuses on perfusion imaging in a section dedicated to this hot topic so you get all the information you need to stay current. Your purchase entitles you to access the web site until the next edition is published, or until the current edition is no longer offered for sale by Elsevier, whichever occurs first. Elsevier reserves the right to offer a suitable replacement product (such as a downloadable or CD-ROM-based electronic version) should access to the web site be discontinued. Front Cover Title Page Copyright Dedication Contributors Preface Section 1: Radiopharmaceuticals/Tracer Kinetics 1 Overview of Tracer Kinetics and Cellular Mechanisms of Uptake Introduction Cellular Uptake Of Myocardial Perfusion Agents Thallium-201 Monovalent Cationic Technetium-99m-Labeled Tracers Neutral Lipophilic Tracers Modeling Tracer Extraction Tracer Retention Redistribution The Mechanism Redistribution Versus Persistent Defect Reinjection (See Chapter 37) Tracers That Do Not Redistribute Reverse Redistribution Detection Of Coronary Artery Disease Myocardial Viability (See Chapters 37-39) Acute Coronary Syndrome Reduced Flow Reserve And "Balanced Ischemia" (See Chapter 23) Summary References 2 Principles of Myocardial Metabolism as They Relate to Imaging Introduction Overview Of Metabolic Regulation In The Normal Heart Fatty Acid Metabolism Glucose Metabolism Tricarboxylic Acid Cycle Metabolism and the Electron Transport Chain Metabolic Tracers Metabolic Responses To Disease States Myocardial Ischemia Congestive Heart Failure Diabetes Renal Disease Future Targets For Metabolic Imaging References 3 Role of Intact Biological Models for Evaluation of Radiotracers Introduction Selection Of Animal Model Use of Small Mammals for Definition of Biodistribution Use of Small Mammals for Evaluation of Specific Disease Processes (See Chapter 11) Use of Genetically Engineered Small Mammals for Evaluation of Specific Biological Processes and Radiotracers (See Chapter 45) Use of Large Mammals for Evaluation of Specific Disease Processes Selection Of Anesthesia Methods Of Measurement Dynamic Imaging Planar Imaging Single-Photon Emission Computed Tomography Positron Emission Tomography (See Chapter 11) Miniature Detectors Serial Myocardial Biopsy Postmortem Imaging Autoradiography Microautoradiography Macroautoradiography Postmortem Tissue Well Counting Evaluation of Tracer Kinetics and Kinetic Modeling Physiologic Models Myocardial Infarction Myocardial Stunning Myocardial Hibernation (See Chapter 36) Dilated Cardiomyopathy Atherosclerosis (See Chapter 44) Models Of Plaque Rupture Models Of Aortic Aneurysms Short-Term And Long-Term Models Evaluation Of Pharmacologic Stressors Conclusions References Section 2: Instrumentation 4 SPECT Processing, Quantification, and Display Introduction Oblique Reorientation And Reslicing Motion Correction (See Chapter 5) Automated Perfusion Quantification Myocardial Isolation and Sampling Normal Databases and Criteria for Abnormality Quantitative Parameters Commercial Implementations New Databases Display Polar Maps Three-Dimensional Displays Artificial Intelligence Techniques Applied To Spect Expert System Analysis of Perfusion Tomograms Neural Networks Data Mining Commercial Implications Assessment Of Serial Studies Fusion Of Multimodality Cardiac Imagery Registration of Myocardial Perfusion and Magnetic Resonance Images Registration of Myocardial Perfusion Images and Coronary Artery Data from Angiography Fusion of Myocardial Perfusion Images and CT Angiography (See Chapter 8) Phase Analysis Of Gated Myocardial Perfusion Spect Images Mathematical Principles in Phase Analysis Processing and Quantification of Dyssynchrony Reproducibility Temporal Resolution Conclusion References 5 Single-Photon Emission Computed Tomography Artifacts Introduction Technical Artifacts Flood Field Nonuniformity Center of Rotation and Camera-Held Alignment Errors Errors in Selecting Oblique Cardiac Axes and Subsequent Polar Map Reconstruction Selection of Apex and Base for Polar Map Reconstruction Arrhythmias and Gating Errors Patient-Related Artifacts Soft-Tissue Attenuation (See Chapters 6 and 7) Breast Attenuation Lateral Chest-Wall Fat Attenuation Diffuse Depth-Dependent Soft-Tissue Attenuation Diaphragmatic Attenuation Apparent Worsening Of Attenuation Artifacts In Low-Dose Rest Images Advantages And Potential Disadvantages Of Attenuation Correction In Resolving Attenuation Artifacts (See Chapters 6 and 7) Scattered Abdominal Visceral Activity The Ramp Filter Artifact Motion Artifacts (See Chapter 4) Artifacts Related To Noncoronary Heart Disease Myocardial Hypertrophy Left Bundle Branch Block (See Chapter 16) Summary References 6 Attenuation/Scatter/Resolution Correction: Physics Aspects Introduction Impact Of Attenuation, Scatter, And Resolution On Cardiac Single-Photon Emission Computed Tomography (See Chapter 7) Interactions and Exponential Attenuation Attenuation Artifacts (See Chapter 6) Broad Beam Attenuation and Scatter Finite and Distance-Dependent Spatial Resolution Estimation Of Patient-Specific Attenuation Maps Basic Transmission Configurations Attenuation Correction Methods Statistically Based Reconstruction Methods Scatter Correction Methods Spatial Resolution Compensation Methods Example Observer Studies Illustrating The Utility Of Compensation Conclusions Acknowledgments References 7 Attenuation Correction and Scatter Correction of Myocardial Perfusion SPECT Images Introduction Historical Perspective Scientific Foundation Of Attenuation: Compton Scattering And The Photoelectric Effect (See Chapter 6) Physics Of Attenuation And Scatter Compensation Techniques Of Acquiring The Patient-Specific Attenuation Map Line Source Attenuation Correction Computed Tomography-Based Attenuation Correction Quality-Control Issues Applications For Attenuation Correction Stress Only Acute Imaging Quantitative Single-Photon Emission Computed Tomography Challenges For Attenuation Correction Conclusion References 8 Hybrid Cardiac Imaging Introduction (See Chapter 22) Technical Considerations Of Hybrid Imaging Hybrid Imaging: Comprehensive "One-Stop Shop" Value Of Hybrid Imaging For Attenuation Correction Prognostic And Diagnostic Value Of Coronary Artery Calcium Scores (See Chapter 20) Hybrid Scanners Versus Hybrid Imaging Perspectives Of Hybrid Imaging References 9 Digital/Fast SPECT: Systems and Software Introduction Dedicated Cardiac Imaging Systems Digirad Cardius 3 XPO CardiArc Spectrum Dynamics Multipinhole Systems Fast Myocardial Perfusion Imaging Software With Standard Systems Astonish GE Healthcare's Evolution Software Siemens Medical Solutions UltraSPECT Wide Beam Reconstruction Motion-Frozen Reconstruction Conclusions Acknowledgments References 10 Radiation Considerations for Cardiac Nuclear and Computed Tomography Imaging Introduction Radiation Dosimetry Fundamentals, Definitions, and Quantities Environmental Sources of Radiation Exposure Radiation Dosimetry of Single-Photon Emission Computed Tomography Myocardial Perfusion Tracers Radiation Dosimetry for Cardiac Positron Emission Tomography Tracers Models For Radiation Risk The Linear No-Threshold Model for Radiation Risk Attributable Lifetime Risk from Radiation Exposure Occupational Radiation Exposure and Limitations "As Low As Reasonably Achievable" Principle Computed Tomography (See Chapter 21) CT Radiation Dosimetry: Fundamentals, Definitions, and Quantities Dose Reduction Techniques for Cardiac Computed Tomography Tube Current Modulation ECG-Pulse Modulation Organ and Breast Shielding Dosimetry Values for Cardiac CT Procedures X-Ray And Radionuclide Source-Based Radiation Exposure For Pet And Spect Attenuation Correction Summary References 11 State-of-the-Art Instrumentation for PET and SPECT Imaging in Small Animals Introduction Micro-Positron Emission Tomography Positron Emission Tomography Imaging Of The Rodent Heart Imaging The Cardiovascular System In Mice And Rats Experimental Coronary Occlusions in the Rat Studies in Genetically Modified Mice Development of Novel Radiotracer Assay Approaches Quantification of Functional Processes Measurements of Myocardial Activity Concentrations Assays of Time-Dependent Changes in Tissue Activity Concentrations Measurements of Absolute Blood Flow in the Myocardium of Rats Semiquantitative Estimates of Changes in Myocardial Blood Flow in Mice Limitations and Challenges Micro-Single-Photon Emission Computed Tomography MicroSPECT Instrumentation Uses of MicroSPECT Instrumentation for Cardiovascular Molecular Imaging Myocardial Perfusion and LV Function Quantitative Assessment of Myocardial Viability Using Technetium-99m-Glucarate Dual-Isotope Imaging of Myocardial Perfusion and Inflammation Monocyte Trafficking in Atherosclerosis Imaging Matrix Metalloproteinase Expression in Vascular Remodeling Limitations and Challenges References Section 3: Ventricular Function 12 Cardiac Performance Introduction Equilibrium Radionuclide Angiocardiography Technical Issues Gated Blood Pool Single-Photon Emission Computed Tomography Performance Phase Imaging Ambulatory Monitoring First-Pass Radionuclide Angiocardiography Shunt Detection Comparison of First-Pass and Equilibrium Techniques Clinical Applications Resting Ventricular Performance Coronary Artery Disease Exercise Studies Silent Myocardial Ischemia Valvular Heart Disease Congestive Heart Failure Chronic Obstructive Pulmonary Disease References 13 Regional and Global Ventricular Function and Volumes from SPECT Perfusion Imaging Introduction Acquisition Importance of "Bad Beat" Rejection Cardiac Beat Length Acceptance Window as a Tool for "Bad Beat" Rejection Gating Errors Processing Quantification The Cedars-Sinai Approach: Quantitative Gated SPECT The Emory University Approach: Emory Cardiac Toolbox The University of Michigan Approach: 4D-MSPECT The Yale University Approach Ejection Fraction End-Systolic and End-Diastolic Volume Regional Systolic Function Diastolic Function Phase Analysis Right Ventricular Function Blood Pool Spect Diagnostic Value of Gated Spect Prognostic Value of Gated Spect Assessing Myocardial Viability References Section 4: Perfusion Imaging 14 Coronary Artery Disease Detection Introduction Physiology of Exercise Stress Testing Exercise Protocols Preparation for Exercise Basis of Stress Imaging Injection of Radiotracer Imaging Protocols Diagnostic Value of Exercise Spect Imaging Ecg-Gated Spect Motion Correction State-of-the-Art Myocardial Perfusion Spect with Attenuation Correction Display of Exercise Spect Images Semiquantitative Visual Analysis and Quantitative Analysis of Myocardial Perfusion Images Interpretation of Exercise Spect Studies Image Interpretation Low-risk and high-risk Image Patterns Low-Risk Patterns High-Risk Patterns Reporting Spect Imaging Results References 15 Coronary Artery Disease Detection Introduction Pharmacology Adenosine Dipyridamole Dobutamine Myocardial Blood Flow Myocardial Blood Flow in Normal Patients Myocardial Blood Flow with Modified Pharmacologic Stress Protocols Myocardial Blood Flow in Patients with CAD Myocardial Blood Flow and Perfusion Imaging Perfusion Imaging Protocols Safety and Side Effects Hemodynamic Effects Vasodilators Dobutamine Ischemic Response Vasodilators Dobutamine Lung Thallium Uptake Transient Ischemic Dilatation Poststress Left Ventricular Dysfunction Diagnosis of Coronary Artery Disease Vasodilators Dobutamine Comparison of Pharmacologic Myocardial Perfusion Imaging Comparison to Exercise Results in Women Detection of Left Main or Three-Vessel Disease Hybrid Protocols Abbreviated Adenosine Protocols Vasodilators and Exercise Modified Dobutamine Protocols Special Patients Patients With Left Bundle Branch Block Patients with Permanent Ventricular Pacing Patients with Left Ventricular Hypertrophy or Cardiomyopathy Effect of Anti-Ischemia Medications New Agent Development Binodenoson Regadenoson Summary References 16 Prognostic Implications of MPI Stress SPECT Introduction Principles of Risk Stratification: Patient Selection and Metrics of Risk Risk of Adverse Events After a Normal Imaging Study Relationship Between Risk and the Extent and Severity of Imaging Results Added Value of Gated SPECT Use of mps in Specific Patient Populations Patient Cohorts Defined by CAD Likelihood and ECG Criteria Patients With an Intermediate Likelihood of CAD or Indeterminate Treadmill Test Patients With Normal Resting ECG Able to Exercise Patients With Normal Resting ECG Unable to Exercise Patients With High Pretest Likelihood of CAD Patients With Left Bundle Branch Block (See Chapter 5) Patients With LVH or Atrial Fibrillation Patient Cohorts Defined by Risk Factors and Demographics Asymptomatic Patients Nuclear Imaging in Patients With Diabetes Mellitus Gender-Based Differences in the Prognostic Value of MPS Nuclear Imaging in Elderly Patients MPS in Patients With Chronic Kidney Disease MPS in Ethnic Minority Patients Evidence Supporting Nuclear Imaging for Obese Patients MPS After Other Noninvasive Testing MPS After Coronary Calcium Screening or Coronary CT Angiography (See Chapter 20) MPS in Patients with Prior CAD Patients After Percutaneous Coronary Intervention Evidence Supporting Nuclear Testing for Patients After CABG Use of mps in Guiding Decisions for Catheterization Estimating the True Prognostic value of mps and Posttest Referral Bias Incremental Prognostic value of Pre-mps Data Understanding and Estimating Posttest Risk The Need for Imaging Scores in Risk Estimation and Reporting Using mps for Medical Decision Making: Identifying risk Versus Identifying Potential Survival Benefit Imaging in the Post-COURAGE Era New Paradigm: The Added Value Of a Modality Is Its Ability to Identify Candidates for Expensive Rx Resulting in Enhanced Clini. Where and When Will MPS be Used? Important Questions to Help Define the Role and Value of MPS Conclusions References 17 Myocardial Perfusion Introduction Basic Principle of Image Preparation and Acquisition Approaches to Image Analysis Semiquantitative Perfusion Cardiac Magnetic Resonance Fully Quantitative Perfusion CMR Future Directions Nephrogenic Systemic Fibrosis Conclusions References 18 Myocardial Perfusion Imaging with Contrast Echocardiography Introduction Ultrasound Contrast Agents Imaging Microbubbles in Tissue Quantification of Myocardial Blood Flow Myocardial Contrast Echocardiography for Cad Detection Mce in acute Myocardial Infarction Assessment of Myocardial Viability Summary References 19 Diagnosis and Prognosis in Cardiac Disease Using Cardiac PET Perfusion Imaging Introduction Practical Aspects of imaging and Analysis General Principles of PET Imaging Myocardial PET Perfusion Tracers Nitrogen-13 Ammonia Rubidium-82 Oxygen-15 Water Carbon-11-Acetate Cu-62 PTSM, Cu-62 ETS Recent Advances in PET Imaging: Novel Myocardial Blood Flow Tracers Myocardial Imaging Protocols and Acquisition Patient Preparation Stress Testing Protocols Myocardial Perfusion Imaging Protocols 13N Ammonia 82Rubidium Image Evaluation for Technical Sources of Errors: Quality Control Image Analysis and Interpretation of Perfusion Images Absolute Myocardial Blood Flow Quantification Advantages of Absolute Quantitative Analysis Models for Flow Quantification Three-Dimensional Imaging Mode for Absolute Blood Flow Quantification Radiotracers and Myocardial Blood Flow Quantification Oxygen-15-Water Nitrogen-13-Ammonia Rubidium-82 Physiologic Parameters for Absolute Quantification Fusion of Structure and Function: Insights of Integrated Pet/ct Systems Clinical Applications for Myocardial Perfusion Imaging with pet Selection of Patients Diagnosis of Coronary Artery Disease Prognosis of Coronary Artery Disease Potential Clinical Applications of Pet Absolute Quantification Preclinical Diagnosis of Cardiovascular Disease Significance of Endothelial and Microvessel Dysfunction Methods to Assess Microvascular Structure and Function Functional Significance of Cardiovascular Risk Factors on MBF and CFR Myocardial Blood Flow Parameters in Established Cardiovascular Disease Myocardial Blood Flow Parameters in Nonatherosclerotic Microvascular Disease Myocardial Blood Flow Parameters as Surrogate Markers MBF and CFR for the Follow-up of Current Medical Managements MBF and CFR for the Assessment of Interventional Therapies Myocardial Blood Flow Parameters and Novel Therapeutic Approaches Hybrid Imaging: Fusion Images of CTA and MBF Summary and Conclusions References 20 Coronary Artery Calcification Introduction Types of Arterial Calcification Pathogenesis of Coronary Artery Calcification Clinical Relevance of Coronary Artery Calcification Biochemical Factors Implicated in Coronary Calcification Coronary Artery Calcium Imaging using Electron Beam Computed Tomography/Multislice Computed Tomography Algorithms for Quantification of Coronary Calcium Agatston Score Volume Score Mass Score Coronary Artery Calcium Score: What Does It Mean? Role of cac Imaging in risk Stratification The Significance of Risk Stratification in Coronary Artery Disease Correlation Between Coronary Artery Calcium and Conventional Cardiovascular Risk Factors Who Should Undergo CAC Screening? The Prognostic Value of cac: Available Evidence Limitations of CAC Imaging as a Screening Tool in the General Population Role of CAC Imaging in the Diagnosis of CAD in Symptomatic Patients Comparison of cac with other Diagnostic Tests CAC and Stress Electrocardiography CAC and Myocardial Perfusion Scintigraphy: Role of Synergistic Imaging CAC and Other Stress Tests Proposed Algorithm for Sequential Screening Cac Imaging in Patients with Diabetes Mellitus and Cardiometabolic Syndrome Effect of Ethnicity on Prevalence and Prognostic Significance of Coronary Calcium Progression of Coronary Calcium-Causes and Consequences Effect of Treatment on Progression of Coronary Calcium Cost-Effectiveness of cac Imaging Future Directions: can ct Coronary Angiography Replace cac Imaging? References 21 Coronary Artery Computed Tomography Angiography Introduction Computed Tomography Coronary Artery Angiography: Technologic Considerations Comparison of Coronary Computed Tomography Angiography with Invasive Angiography for the Detection of Luminal Stenosis Native Coronary Arteries (Figs. 21-4 and 21-5) Coronary CTA for Evaluation of Bypass Grafts (Fig. 21-6) Coronary CTA for Evaluation of Coronary Stent Patency (Fig. 21-7) Coronary Computed Tomography Angiography: Comparison with Nuclear Myocardial Perfusion Imaging Coronary Computed Tomography Angiography to Perform Myocardial Perfusion Imaging and Assess Viability Assessment of Left Ventricular Function and Mass by Cardiac Computed Tomography Prognosis of Patients Undergoing Computed Tomography Angiography to Diagnose Coronary Artery Disease Other uses of Computed Tomography Angiography Noncalcified Atherosclerotic Plaque Coronary Artery Anomalies Guidance Prior to Attempting Angioplasty of a Chronic Total Occlusion Presurgical Risk Stratification Assessment of Etiology of Left Ventricular Dysfunction Radiation Exposure (See Chapter 10) When Should Coronary Computed Tomography be Utilized? Acknowledgements References 22 PET/CT and SPECT/CT Hybrid Imaging Introduction Rationale for Integrating Nuclear Imaging and ct Myocardial Perfusion Imaging (See Chapters 14-16) Cardiac Computed Tomography (See Chapter 21) Clinical Applications of Dual-Modality Imaging Attenuation Correction (See Chapters 6 and 7) Localization of Targeted Molecular Imaging Agents Integrating Calcium Scoring with Myocardial Perfusion Imaging Integrating CT Coronary Angiography and Myocardial Perfusion Imaging for Diagnosis and Management of CAD Challenges, Potential Opportunities, and Unresolved Issues for Hybrid Imaging Single-Setting Dual-Modality Versus Sequential Imaging Radiation Dosimetry Conclusions References 23 Comparison of Noninvasive Techniques for Myocardial Perfusion Imaging Introduction Radionuclide Myocardial Perfusion Imaging (See Chapters 14 to 16) Positron Emission Tomography (See Chapter 19) Cardiac Magnetic Resonance Perfusion Imaging (See Chapter 17) Computed Tomography Perfusion Imaging Perfusion Imaging with Myocardial Contrast Echocardiography (See Chapter 18) Summary References 24 Cost-Effectiveness of Myocardial Perfusion Single-Photon Emission Computed Tomography Introduction Health Care Costs for Cardiovascular Disease Evaluating Procedural Cost Adding Downstream Costs Defining Incremental Effectiveness Defining Incremental Cost-Effectiveness Ratio Use of Intermediate Outcome Measures High-Risk Cost-Effectiveness Models Economic Impact of Nuclear Cardiology as a Gatekeeper to the Diagnostic Catheterization laboratory Cost Minimization or Savings Cost-Effectiveness of Myocardial Perfusion SPECT Compared to Other Diagnostic Procedures American Society of Nuclear Cardiology Statement on Cost-Effectiveness of Nuclear Cardiology Conclusions References 25 Appropriate Use of Nuclear Cardiology References Section 5: Disease/Gender-Specific Issues 26 Imaging in Women Introduction Diagnosing Coronary Artery Disease In Women Exercise Tolerance Testing Stress Myocardial Perfusion Imaging in Women Pharmacologic Myocardial Perfusion Imaging (See Chapter 15) Gender-Related Challenges in the Diagnosis of Coronary Artery Disease Risk Stratification in Women (See Chapter 16) Conclusions References 27 Imaging for Preoperative Risk Stratification Introduction Step One: Determine the Urgency of the Surgery Step Two: Evaluate and Treat Active Cardiac Conditions Step Three: Determine Whether the Planned Procedure is low-risk Surgery Step Four: Assess Functional Capacity Step Five: Assess Clinical Risk in Symptomatic Patients or Patients with Poor/Unknown Functional Capacity Clinical Risk Score Surgical Risk Vascular Surgery Transplant Surgery The Decision to Obtain Preoperative Testing: a Shortcut Approach Risk Assessment with Preoperative Stress Imaging Perioperative Medical Treatment Coronary Angiography and Revascularization Long-term Prognosis after Noncardiac Surgery Utilizing Preoperative Testing for Long-term Prognosis Conclusion: use of Guidelines for cost-effective Risk Assessment References 28 Nuclear Imaging in Revascularized Patients with Coronary Artery Disease Background Evaluation After Coronary Artery Bypass Graft Detection of Graft Disease Anatomy Versus Physiology Considerations Prognostic Implications of Stress Nuclear MPI after CABG Assessment Early After CABG (2 to 3 Years) Assessment Late After CABG (Beyond 5 Years) Evaluation After Percutaneous Coronary Intervention Early After PCI 3 to 6 Months After PCI Late After PCI Time Dependency of Risk Novel Revascularization Methods and Research Trends Summary References 29 Stress Myocardial Perfusion Imaging in Patients with Diabetes Mellitus Introduction Early Detection of Coronary Artery Disease in Diabetes Mellitus Stress Modality Prevalence of Silent Myocardial Ischemia Endothelial Dysfunction Abnormal Myocardial Perfusion Imaging in Patients with Suspected or Known Coronary Artery Disease (See Chapter 16) Clinical Predictors of Silent Myocardial Ischemia Multimodality Approach for Detection of cad in Diabetes Mellitus (See Chapter 20) Treatment of Silent Myocardial Ischemia in Patients with Diabetes References 30 Radionuclide Imaging in Heart Failure Introduction Established uses of Radionuclide Imaging in Heart Failure Determining Heart Failure Etiology Measuring Left Ventricular (Dys)Function (See Chapters 12 and 13) Predicting Benefit from Coronary Revascularization: Assessment of Myocardial Viability (See Chapters 37 and 38)... Evolving Applications of Radionuclide Techniques in Heart Failure Targeted Molecular Imaging and Imaging Myocardial Metabolism (See Chapters 40 and 41) Imaging Cellular Mechanisms in Heart Failure Assessing LV Remodeling: Shape Indices Assessment of LV Mechanical (Dys)Synchrony Conclusion References 31 Imaging in Patients Receiving Cardiotoxic Chemotherapy Introduction Mechanisms of Cardiotoxicity Pathology Incidence of Cardiotoxicity Clinical Course Monitoring for Cardiotoxicity Trastuzumab (Herceptin) Cardiotoxicity References 32 Mechanistic and Methodological Considerations for the Imaging of Mental Stress Ischemia Introduction Mental Stress Ischemia Evidence Base for MSI-An Historical Perspective ECG Changes During Mental Stress Left Ventricular Dysfunction During Mental Stress Studies Using Radionuclide Angiography Studies Using Echocardiography Myocardial Perfusion During Mental Stress Comparison Between Mental Stress Imaging and Standard Exercise and Pharmacologic MPI Prognostic Significance of Myocardial Stress Ischemia Psychological Factors and Prognosis in Mental Stress Ischemia Pathophysiology of Mental Stress Ischemia Mental Stress and Vascular Function Mental Stress and Inflammation Cholinergic Antiinflammatory Reflex Neurocardiac Central Nervous System Correlates Functional PET Brain Imaging Imaging of Cardiac Neuronal Integrity Mental Stress and Disease-Emerging Areas Takotsubo Cardiomyopathy Electrophysiologic Abnormalities and Arrhythmic Heart Disease Suggested Protocol for Mental Stress Spect Imaging Mental Stress Protocol Processing and Interpretation Conclusion References 33 Myocardial Blood Flow Measurement: Evaluating Coronary Pathophysiology and Monitoring Therapy Introduction Methodology of Blood Flow Measurement Pet Tracers of Myocardial Blood Flow (See Chapter 19) 13N-Ammonia Rubidium-82 15O-Water Determinants of Myocardial Blood Flow and Flow Reserve Coronary Circulatory Function: Definitions Noninvasive Assessment of Coronary Circulatory Function Myocardial Blood Flow at Rest Assessment of Coronary Reactivity Total Integrated Vasodilator Capacity and Coronary Flow Reserve Sympathetic Stimulation with Cold Pressor Testing Perfusion Heterogeneity and Base-to-Apex Myocardial Perfusion Gradient Reproducibility of Measurements of Myocardial Blood Flow and Responses to Stressors Altered Coronary Circulatory Function and Cardiovascular Events Insights Into Mechanisms of Coronary Circulatory Dysfunction by PET Vascular Inflammatory States Smoking, Vascular Oxidation-Reduction State, and Hypertension Obesity, Insulin-Resistance, and Adipocytokines Delineation of Coronary risk and Monitoring of Therapeutic Strategies Hormone Replacement Therapy in Postmenopausal Women Responses to Lipid-Lowering Treatments Insulin Resistance, Impaired Glucose Tolerance, and Diabetes Mellitus Summary and Future Directions Acknowledgments References Section 6: Acute Coronary Syndromes 34 Imaging Patients with Chest Pain in the Emergency Department Introduction Acute Myocardial Perfusion Imaging Diagnostic Value Sensitivity in Acute Myocardial Infarction Acute Coronary Syndrome Without Myocardial Infarction Negative Predictive Value and Prognosis Incremental Diagnostic Value Cost-Effectiveness Comparison with Troponin Risk Area Other Issues Radiopharmaceuticals Timing of Tracer Injection Special Populations Limitations of Acute Myocardial Perfusion Imaging Incorporation Into Emergency Department Chest-Pain Evaluation Summary References 35 Risk Stratification after Acute ST-Segment Elevation and Non-ST-Segment Elevation Myocardial Infarction Introduction Clinical Predictors of Risk Imaging Predictors of Risk Infarct Size Left Ventricular Ejection Fraction Left Ventricular Volumes Myocardial Ischemia Risk Stratification Following Acute Myocardial Infarction Exercise Stress Testing Gated Radionuclide Angiography Exercise Myocardial Perfusion Scintigraphy Pharmacologic Stress Perfusion Scintigraphy Dipyridamole SPECT Adenosine SPECT Risk Stratification in the Thrombolytic Era Risk Stratification with Nuclear Cardiac Imaging in the era of Interventional Cardiology Rationale for an Invasive Approach Rationale for a Conservative Approach Clinical Trial Support for Either Strategy The Inspire Trial-Implications for risk Stratification Current Guidelines for Stratifying risk in St-Elevation ami Current Guidelines for Stratifying risk in Non-St-Elevation ami Conclusion References Section 7: Viability 36 Pathophysiologic Basis of Hibernating Myocardium Introduction Irreversible Ischemia and the Evolution of Myocardial Infarction Evolution of Acute Myocardial Injury Residual Coronary Flow Limits Infarction Mechanisms of Myocyte Death Functional Consequences of Acute Reversible Ischemia Stunned Myocardium Short-Term Hibernation During Prolonged Moderate Ischemia Pathophysiology of Chronic Repetitive Ischemia Chronically Stunned Myocardium Chronic Hibernating Myocardium Metabolic and Energetic Adaptations to Chronic Ischemia Myocardial Glucose Uptake Oxygen Consumption Fatty Acid Metabolism Pathologic Remodeling in Hibernating Myocardium Myofibrillar Loss and Glycogen Accumulation Myocardial Fibrosis, Cell Death, and Myocyte Hypertrophy Global Versus Regional Changes Molecular Remodeling in Hibernating Myocardium Mitochondrial Proteins and Metabolism Contractile Proteins and Cellular Calcium Handling Cell Survival Program and Antiapoptotic Program in Response to Repetitive Ischemia Inhomogeneity in Sympathetic Innervation and beta-Adrenergic Signaling Translation of Mechanistic Studies to the Clinical Assessment of Viability Blunted Contractile Reserve in Viable Myocardium Roles of Myocyte Loss and Cellular Remodeling in Limiting Functional Recovery The Impact of Hibernating Myocardium on Prognosis (See Chapters 37 and 38) Summary References 37 Assessment of Myocardial Viability with Thallium-201 and Technetium-Based Agents Introduction (See Chapter 36) Thallium-201 Imaging to Assess Myocardial Viability Stress-Redistribution Imaging Late Thallium-Redistribution Imaging Thallium-Reinjection Techniques Rest-Redistribution Thallium Imaging Quantitative Analysis of Thallium Data Technetium-99m Perfusion Imaging to Assess Viability Other Technetium-99m-Based Tracers Dual-Isotope Imaging Clinical Implications Viability Assessment and Patient Outcome References 38 Assessment of Myocardial Viability with Positron Emission Tomography Introduction Methods for Assessing Myocardial Viability with Pet Myocardial Perfusion Tracers Fluorine-18-Deoxyglucose (See Chapter 40) Physiologic Basis Protocols Patient Preparation for FDG Imaging Myocardial Perfusion and Glucose-Loaded FDG Patterns Special Considerations for the Hybrid Myocardial Perfusion SPECT and FDG PET Approach Gated FDG Study Hybrid FDG Positron Emission Tomography and Computed Tomography Carbon- Clinical Nuclear Cardiology-now In Its Fourth Edition-covers The Tremendous Clinical Growth In This Field, Focusing On New Instrumentation And Techniques. Drs. Barry L. Zaret And George A Beller Address The Latest Developments In Technology, Radiopharmaceuticals, Molecular Imaging, And Perfusion Imaging. Thoroughly Revised To Include 20 New Chapters-digital/fast Spect, Imaging In Revascularized Patients, And More-this New Edition Provides State-of-the-art Guidance On Key Areas And Hot Topics With Stunning Visuals. Online Access To The Fully Searchable Text At Expertconsult.com Includes Highly Illustrated Case Studies That Let You See The Problem Using A Variety Of Imaging Modalities. In Other Words, This Is An Invaluable Resource No Clinician Or Researcher In Nuclear Cardiology Should Be Without. Features An Editorial And Contributing Team Of Worldwide Leaders In Nuclear Cardiology To Provide You With Current And Authoritative Guidance. Includes A Section Focusing On Acute Coronary Syndromes To Provide You With Practical Management Tools For These Conditions. Presents A Full-color Design That Allows Color Images To Be Integrated Throughout The Text. Section 1. Radiopharmaceuticals/tracer Kinetics -- Section 2. Instrumentation -- Section 3. Ventricular Function -- Section 4. Perfusion Imaging -- Section 5. Disease/gender-specific Issues -- Section 6. Acute Coronary Syndromes -- Section 7. Viability -- Section 8. Tracer Specific Imaging Techniques -- Section 9. New Molecular Approaches. [edited By] Barry L. Zaret, George A. Beller. Includes Bibliographical References And Index. Mode Of Access: World Wide Web.