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A E Iskandrian

Publications and source records attributed to A E Iskandrian.

48 records · Page 3Linked to original sources
PubMedDate not supplied

A cost-effective sestamibi protocol in the managed health care era.

BACKGROUND: In the managed health care era a need exists to lower the cost of diagnostic tests for coronary artery disease. One possible approach is to eliminate the rest study in the conventional stress-rest perfusion imaging protocol with single photon emission computed tomography. OBJECTIVE: The aim of the study was to determine the frequency with which single stress single photon emission computed tomography acquisition can be used to diagnose disease in normal patients compared with dual stress-rest protocol. STUDY GROUP: Two hundred patients without history of myocardial infarction, coronary revascularization, valvular disease, dilated cardiomyopathy, or left bundle branch block undergoing 1-day (n = 86) or 2-day (n = 114) stress-rest sestamibi imaging were studied. The stress was exercise in 147 patients and pharmacologic in 53 patients. RESULTS: On the basis of the stress study, 112 patients had normal images, and 88 patients had abnormal images. On the basis of the combined stress-rest images, 131 patients had normal images, and 69 patients had abnormal images (agreement 85%, kappa 0.68 +/- 0.05). Only 6 (5%) of the 112 patients with normal images based on the stress images were considered to have abnormal images by the combined stress and rest images. CONCLUSIONS: In patients with normal stress images elimination of the rest study rarely alters interpretation. Rest studies are most useful in patients with abnormal or equivocal stress images. Such selective elimination of the rest studies may decrease the cost of nuclear procedures and should be considered in the current managed care health system.

Adult↗
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Treadmill test scores: attributes and limitations.

As a general rule, clinicians should attempt to isolate those patient subsets whose posttest patient management may be optimally changed by the test referral. Use of testing in a heterogeneous population will lead to an increase in the false-positive rate with a resultant increase in the rate of normal catheterization and higher costs of care. By providing imprecise test results to the clinician, a higher rate of cardiac events may be observed as a result of lack of care for these patients. In addition, a high rate of normal coronary angiograms in patients with positive test results or admissions for subsequent myocardial infarctions in patients with normal test results may result in a lack of confidence in the imaging results leading to a change in referral to newer, untested modalities. Thus to integrate our knowledge of the benefits to exercise electrocardiography within the context of clinical decision making and the appropriate selection of a noninvasive test, it is clear that physicians may use aggregate indexes such as the Duke treadmill score to guide patient care, but they should not be relied on to provide definitive evidence. Nor can one make the statement that because of the risk stratification ability of the Duke treadmill score this modality may be used to supplant stress myocardial perfusion imaging. In fact, exercise electrocardiography should be the test of choice for lower risk patient populations. However, in more intermediate-risk populations (e.g., known coronary disease or abnormal resting electrocardiogram), stress perfusion imaging is of established diagnostic and prognostic value. Further, from the exercise treadmill test, patients with an intermediate Duke treadmill score would benefit from additional noninvasive testing with stress myocardial perfusion imaging. This strategy provides substantial prognostic information on which to guide subsequent patient care.

Cardiac Catheterization↗
PubMedDate not supplied

Nuclear cardiology: new developments and future directions.

New developments in the field of nuclear cardiology include attenuation, scatter and depth resolution correction, newly designed gamma cameras, newer tracers, and newer stress agents. These developments, together with many new applications, are likely to continue to place nuclear cardiology in the mainstream of management of cardiac patients.

Cardiology↗
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First-line testing.

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Coronary Disease↗
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Validation of left ventricular volume measurements by gated SPECT 99mTc-labeled sestamibi imaging.

BACKGROUND: Previous studies have shown that gated single photon emission computed tomography (SPECT) technetium 99-labeled sestamibi imaging provides accurate and reproducible measurement of left ventricular (LV) ejection fraction (EF), wall motion, and thickening. This study examined the reliability of gated SPECT sestamibi imaging in measuring LV end-diastolic volume (EDV), end-systolic volume (ESV), and stroke volume (SV). METHODS AND RESULTS: Gated SPECT measurements were compared with an independent nongeometric method based on thermodilution SV and first-pass radionuclide angiographic EF (using a multicrystal gamma camera). Twenty-four patients aged 58+/-11 years underwent cardiac catheterization and coronary angiography for evaluation of chest pain syndromes. None had primary valvular disease, intracardiac shunts, or atrial fibrillation. RESULTS: The correlation between the two methods were as follows: EDV: r = 0.89, P<.001; ESV: r = .938, P<.001; SV: r = 0.577, P<.001. Bland-Altman plots showed mean differences (+/-standard deviation [SD]) for EDV of -14.3+/-33.3 mL, for ESV of -0.4+/-23.7 mL, and for SV of -13.9+/-15.2 mL. The reproducibility of measuring EDV and ESV by gated SPECT was very high (r = 0.99 each). CONCLUSION: Gated 99mTc-labeled sestamibi SPECT provides reproducible LV volume measurements. With validation of volume measurement, gated SPECT provides comprehensive assessment of regional and global LV function. This information is important in many patient groups such as those with ischemic cardiomyopathy, concomitant coronary and valve disease, and those who have had myocardial infarction. It will also be useful to assess the incremental value of LV volumes in risk assessment.

Cardiac Output↗