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Biomedical subjects

I Kovác

Publications and source records attributed to I Kovác.

4 recordsLinked to original sources
PubMed2001

Pretest clinical diagnosis of coronary artery disease and stress myocardial perfusion scintigram.

BACKGROUND: To assess the probability of perfusion defects at exercise stress myocardial perfusion SPECT scintigraphy from pretest clinical diagnosis (medical personal history, previous ergometric investigation). To determine the value of clinical factors for probability of scintigraphic defects with respect to avoiding unnecessary investigation in subjects with low probability of abnormal scintigrams. MATERIAL AND METHODS: 2143 subjects (1235 men, 908 women) were investigated by SPECT perfusion scintigraphy at stepwise increasing exercise stress. They were divided into three groups with regard to their medical history and exercise test at scintigraphy: subjects without any signs of coronary artery disease (CAD), patients with high likelihood of CAD (i.e., typical anginal pain, in particular at stress, positive stress ECG changes, angiographically documented important CAD) and patients after myocardial infarction (MI). Important risk factors (hypertension, diabetes, age and sex), as well as the role of revascularisation procedures, were taken into account for multiple logistic regression in order to express their importance for the odds of scintigraphic defect visualisation. RESULTS: Perfusion scintigraphic defects (PSD) were found in 5.2% of subjects without signs of CAD, in contrast to patients with manifest CAD (68.8% with PSD) and in those after MI (90.2% with PSD). There were other important factors corroborating the likelihood of PSD (in decreasing order of importance): diabetes, male, ECG changes at stress, increasing age. Successful revascularisation improved scintigraphic images. CONCLUSION: The examination of CAD symptom-free subjects, in particular with atypical chest discomfort, is useless. SMPS in patients after documented MI is to be carried out for other intended purposes, not for CAD diagnosis only. SMPS is highly recommended in patients with CAD symptoms and high CAD probability in order to decide further treatment and prognosis.

Journal Article↗
PubMed1991

Myocardial scintigraphy using 99m-Tc-methoxyisobutylisonitrile (Tc-MIBI): Is it equivalent to 201-Tl?.

The results of selective coronary angiography, myocardial 201-Tl scintigraphy (stress and redistribution) and after 99m-Tc-methoxyisobutylisonitrile stress and rest injections (Tc-MIBI, Cardiolite, DuPont de Nemours, USA) were compared in 19 patients with manifest ischemic heart disease in identical three projections and after same ergometric load. All three investigations were carried out within three consecutive days. 16 patients had significant stenoses of 1-3 main coronary arteries inclusive of left coronary artery main stem, insignificant stenoses (less than 50%) were present in remaining 3 patients. Scintigraphic localizations of accumulation defects in both Tc-MIBI and 201-Tl stress scintigraphy were in accordance in 70.6% of evaluated left ventricular wall segments. A positive 201-Tl redistribution and rest-stress Tc-MIBI scintigraphic difference agreed in 52.6% images of all three projections with verified accumulation defects. The sensitivity of the detection of ischemic area in reference to the coronary angiography was nearly identical in 201-Tl (75%) and Tc-MIBI scintigraphy (81.2%). False positive accumulation defects in the apical area were revealed in three patients with insignificant coronaro-angographic findings equally after both radiopharmaceuticals. Better physical properties of 99m-Tc from the point of view of a gamma camera detection, a possibility to get markedly higher counting rate and sufficient accumulation of the radiopharmaceutical in the perfused myocardium enable to reach scintigraphic pictures with a high contrast after labelled Tc-MIBI injection, even in case of sequential impulse summation during heart cycle (gating). Thus MIBI labelled by 99m-Tc is equivalent to 201-Tl as used for myocardial scintigraphy in patients with ischemic heart disease.

Adult↗