Scintigraphic Evaluation of Contractile and Coronary Reserve in Patients With Ischemic Cardiomyopathy
Condition: Ischemic Cardiomyopathy
MeSH terms: Cardiomyopathies; Ischemia
Study type: Observational

Summary: 
      According to single-photon emission computed tomography, the left ventricular contractile and
      coronary flow reserve (CFR) will be assessed in patients with ischemic cardiomyopathy.
      According to these data, the criteria for predicting the effectiveness of complex surgical
      treatment of this pathology will be evaluated.
    

Detailed description: 
      Before surgical intervention, all patients pass routine clinical analyzes undergo coronary
      angiography and 2D echocardiography. Some of patients in the ICM-1 and ICM-2 groups undergo
      stress echocardiography with dobutamine.

      Coronary arteriography is performed using the Axiom Artis (Siemens; Erlangen, Germany) and
      transthoracic two-dimensional Doppler echocardiography (TTE) with the Acuson Sequoia 512
      (Siemens; Erlangen, Germany)).

      Besides, all of the ICM-1 and ICM-2 groups patients undergo myocardial perfusion imaging.
      Standard two-day stress-rest imaging protocol is used. Adenosine at a dosage of 140
      mcg/kg/min (for 4 min) is used as a pharmaceutical stress agent.

      ICM-1 group and Control group for GBPS undergo gated blood pool SPECT (GBPS) at rest and
      during increasing doses of dobutamine (5/10/15 μg/kg/min) (n = 60) ICM-2 group and Control
      group for CFR undergo dynamic SPECT (n = 40). This investigation is combined with routine
      myocardial perfusion imaging so patients are not exposed to extra stress.

      Than ICM patients undergo surgical treatment of ICM in different volume. All of them receive
      coronary bypass grafting (CABG); some patients undergo the left ventricular reconstruction
      and intervention on the mitral valve.

      In the early postoperative period (7-14 days), the ICM-1 group undergo rest GBPS and ICM-2
      group undergo dynamic SPECT by two-day protocol. All patients undergo TTE too.

      After at least 12 month, all patients undergo TTE to assess the presence of left ventricular
      (LV) remodeling.
    

Intervention name(s): Stress Gated blood pool SPECT; Dynamic SPECT
Intervention type(s): Diagnostic Test; Diagnostic Test
Intervention description(s): After labeling of red blood cells in vivo, a sequential series of acquisition is carried out at rest and during increasing doses of dobutamine (5/10/15 μg / kg / min). The duration of acquisition is 300 seconds.
The acquisitions are carried out on dedicated cardiac gamma-camera with ultrafast Cadmium zinc telluride (CZT) detectors (DiscoveryNM530c, General electric Healthcare Israel, Israel); The passage of a radiopharmaceutical bolus through the cavities of the heart and myocardium at rest and during infusion of adenosine at a dosage of 140 mcg / kg / min (for 4 minutes) is recorded.
At the peak of the stress test (after 2 minutes of administration of adenosine), a 5 ml bolus (dose 260-444 MBq) of 99mTc-methoxyisobutylisonitrile (MIBI) is administered at a rate of 1 ml / s. Immediately after the end of tracer administration, 30 ml of 0.9% sodium chloride (NaCl) is infused. A scintigraphic recording of the study begins 5 seconds before the administration of the radiopharmaceutical.
The next day, the study at rest is carried out. Scintigraphic images are recorded in tomographic mode with ECG synchronization for 600 s, at list mode.
The acquisitions are carried out on dedicated cardiac gamma-camera with ultrafast CZT detectors (DiscoveryNM530c, General electric Healthcare Israel, Israel)
Other intervention name(s): Stress radionuclide angiography; Stress radionuclide ventriculography; Radionuclide coronary flow reserve assessement
Observational model: Case-Control
Time perspective: Prospective
Sampling method: Probability Sample
Study population: 
        Patients being living in Russian Federation (inc.ethnic minorities)
      
Keywords: Ischemic Cardiomyopathy; Single photon emission computed tomography; Gated blood pool SPECT; Coronary flow reserve; Prognosis