Nuclear Imaging Nuclear Imaging in Cardiology in Cardiology Dr. Muhammad Ayub Dr. Muhammad Ayub Diplomate Certification Board of Nuclear Cardiology Diplomate Certification Board of Nuclear Cardiology Diplomate Certification Board of Cardiovascular CT Diplomate Certification Board of Cardiovascular CT Assistant Professor of Cardiology Assistant Professor of Cardiology Punjab Institute of Cardiology, Lahore Punjab Institute of Cardiology, Lahore
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Dr. Muhammad AyubDr. Muhammad AyubDiplomate Certification Board of Nuclear CardiologyDiplomate Certification Board of Nuclear Cardiology
Diplomate Certification Board of Cardiovascular CTDiplomate Certification Board of Cardiovascular CT
Assistant Professor of CardiologyAssistant Professor of Cardiology
Punjab Institute of Cardiology, LahorePunjab Institute of Cardiology, Lahore
Applications of Nuclear Applications of Nuclear CardiologyCardiology
Coronary Artery DiseaseCoronary Artery Disease Assessment of LV /RV functionAssessment of LV /RV function Cardiomyopathy /MyocarditisCardiomyopathy /Myocarditis Valvular Heart DiseaseValvular Heart Disease Cardiac ShuntsCardiac Shunts Secondary HypertensionSecondary Hypertension Pulmonary HypertensionPulmonary Hypertension Assessment of Cardiac TransplantAssessment of Cardiac Transplant
Coronary Artery DiseaseCoronary Artery Disease Diagnosis of CADDiagnosis of CAD Assessment of Prognosis Assessment of Prognosis Risk StratificationRisk Stratification
Stable /Unstable AnginaStable /Unstable Angina Post MIPost MI PerioperativePerioperative DiabeticsDiabetics
Assessment of Myocardial ViabilityAssessment of Myocardial Viability Assessment of Revascularization ProcedureAssessment of Revascularization Procedure Acute chest pain management in ERAcute chest pain management in ER
High Risk Feature of SPECT High Risk Feature of SPECT MPIMPI
Following features demonstrate >3% Following features demonstrate >3% annual mortalityannual mortality Post-stress EF <35% (99m-Technetium).Post-stress EF <35% (99m-Technetium). Stress induced large perfusion defect.Stress induced large perfusion defect. Stress induced multiple perfusion defects of Stress induced multiple perfusion defects of
moderate size.moderate size. Large, fixed perfusion defect with LV dilation or Large, fixed perfusion defect with LV dilation or
increased lung uptake (Thallium-201).increased lung uptake (Thallium-201). Stress induced moderate perfusion defect with Stress induced moderate perfusion defect with
LV dilation or increased lung uptake (Thallium LV dilation or increased lung uptake (Thallium 201).201).
Assessment of LV FunctionAssessment of LV Function
Gated Myocardial Perfusion SPECT
Courtesy of M Atiar Rahman, MD, of Ochsner Clinic. LA
Perfusion and FunctionGated Myocardial Perfusion SPECT
LV FunctionLV Function
Blood pool gated SPECT
Assessment of Myocardial Assessment of Myocardial ViabilityViability
Patients with CAD and LVF carry bad Patients with CAD and LVF carry bad prognosisprognosis
Patients with CAD and LVF have Patients with CAD and LVF have higher mortality during higher mortality during revascularization procedurerevascularization procedure
Ischemic LVF patients can benefit Ischemic LVF patients can benefit from revascularization procedures if from revascularization procedures if there is evidence of myocardial there is evidence of myocardial viability viability
Hibernating MyocardiumHibernating Myocardium
Scar MyocardiumScar Myocardium
MyocarditisMyocarditisIndium 111 Antimyosin AB ScanIndium 111 Antimyosin AB Scan
Valvular Heart DiseaseValvular Heart Disease Baseline and Exercise EF Baseline and Exercise EF MUGA ScanMUGA Scan Regurgitation Index (Stroke Volume Ratio)Regurgitation Index (Stroke Volume Ratio)
Left to Right Shunt Left to Right Shunt First Pass First Pass StudyStudy
Normal First Pass StudyNormal First Pass Study
Left to Right Shunt
Qp/Qs= 2.6
A ratio of less than A ratio of less than 1.5 indicates a small 1.5 indicates a small left-to-right shunt. A left-to-right shunt. A ratio of 2.0 or more ratio of 2.0 or more indicates a large indicates a large left-to-right shuntleft-to-right shunt
Right to Left ShuntBody uptake of MAA > 6% of lung uptake
Secondary Secondary HypertensionHypertension
Renal Artery StenosisRenal Artery Stenosis Captopril Captopril Renogram StudyRenogram Study