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Influence of thyroid disorders on cardiac sympathetic nerve function
Journal of Nuclear Cardiology Volume 4, Number 1, Part 2
$41
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26.50 DEFT
Abstracts Monday afternoon, April 7, 1997
VENTRICLE DYSFUNCTION IN PATIENTS
R E C E I V I N G PACL1TAXEL. R.A. Vaid6s Olmos, W.W. ten Bokkcl Huinink, C.A. Hoefnagel. The Netherlands Cancer Institute, Amsterdam.
INFLUENCE OF THYROID DISORDERS ON CARDIAC SYMPATHETIC NERVE FUNCTION M.Nakamura, K.Mizoguchi, S, Yasuda, T.Mocbizuki, S.Koide Chigasaki Municipal Hospital, Kanagawa, Japan
Over the last years, paclitaxel, an effective antineoplastic agent, has been incorporated in the treatment o f advanced and refractory breast cancer. A[thongh transient cardiac rhythm disturbances have been described during or shortly after drug infusion, cardiac effects between drug courses or in the post-therapy period have not been documented. In this paper, we report an abnormal left ventricle ejection fraction (LVEF) decrease (10% or more to a EF-level below 50%) in 6 patients (age 44-67 years) treated with paclitaxel for advanced breast carcinoma: in 3 patients, without previous chemotherapy but with internal mammary lymph node chain irradiation 3-18 years previously, LVEF-decrease was observed 1-6 months after paclitaxel administration (dose range 525-1225 mg/mZ), ahd in 3 patients with doxorubicin refractory disease LVEF decreased when paclitaxel (dose range 350-875 mg/m -~) was administered 1-5 months after doxorubicin (dose range 420-530 mghn2); IIqn-antimyosin scan, used to document doxorub[cin-related myocyte damage, showed intense cardiac uptake in 1 case. These findings suggest that paclitaxel may induce left velm'icle dysfunction. LVEF monitoring is specially recommended in patients previously treated with anthracyclines and thoracic irradiation including the heart.
Thyroid hormone has direct inotropic and chronotropic effects on the heart. Thyroid diseases produce significant alternations in cardiac function. The cardiac sympathetic nerve (CSN) function was evaluated in 11 patients (pts) with hyperthyroidism (HPR; FT4 6.4"+'2.6ng/dl), 5 pts with hypothroidism (HPO; FT4 0.5-1-0.2ng/dl) and 12 control subjects (FT4 1.2-1-O.2ng/dl} using with I-123 metaiodobenzylguanidine (MIBG} myocardial scintigraphy. Planar images were obtained in anterior position 15 minutes (initial images} and 4 hours (delayed images)after injection of 111 MBq 1-123 MIBG. Image quantitation was based on the ratio of myocardial to mediastinal I-123 MIBG uptake (H/M) and the percentwashout from initial to delayed images. Plasma norepinephrine (NE) and fractional shortening of left ventricle (%FS) by echocardiography were determined. Results delayed H/M washout(%) NE (ng/ml) %FS HPR 1.76_4-0.23"* 34.7___16.7 0.29-1-0.17 33,8___11.3 Cotrol 2.14-{-0.11 31,6-1-5.7 0.43___0.19 33.7"4-3.4 HPO 2,48__.0.62* 32.2_14.5 0,51___0.25 32.2___5.4 ( ** p< 0.01, * p< 0.05 compared to controls) There was negative colleration between the delayed H/M ratio and the FT4 concentration ( r = -0.54, p( 0.01 }. Conclusion The CSN function shown by the MIBG uptake is decreased in HPR and increased in HPO. The CSN helps the heart ajust to pathophysiologic changes by the thyroid hormone.
26.51
26.53
DIAGNOSIS OF TRANSPLANT (~ORONARY ARTERY DISEASE (TCAD): STRESS 9~"Tc-TETROFOSMIN SPECT. O.Vegazo, R.Mufioz, P. Madariaga, J.A. Garcia Robles, C. Trampal, I. Almoguera, P. D o m i n g u e z , J.M. P6rez Vazquez. Hospital Gregorio Marafion. Madrid. Spain. Heart t r a n s p l a n t a t i o n is an accepted treatment of end-stage heart disease. With i m p r o v e m e n t in the treatment of infection and rejection, TCAD is the lead cause of late mortality in cardiac t r a n s p l a n t patients (CTP). The aim of this study was to investigate the usefulness of treadmill exercise 99mTc-TetrofosminSpect in the diagnosis and localization of TCAD. We studied 30 CTP (27 men, mean age 54.2 + 2.2 yrs), with mean survival 28.2 _+ 4.7 months p o s t - t r a u s p l a n t a t i o n . Coronary angiography, defined as the reference technique for the global and territorial evaluation of myocardial Spect, was p e r f o r m e d within 2 months prior to or after the Spect study (mean 54.9 + 8.2 days). The sensitivity, specificity and predictive accuracy for detection of TCAD were calculated. Kappa statistical values was also calculated. SPECT Overall TCAD TCAI)-DA TCAD-CX TCAD-CD Sensitivity(%) 91 43 29 70 Specificity(%) 6g 64 g4 g5 VI'P(%) 63 30 33 70 VPN(%) 93 80 79 85 Accuracy.(%) 77 63 70 80 Kappa 0.5415 0.1081 0.1176 0.5500 p value 0.0017 0.5416 0.5173 0.0026 In conclusion: treadmill exercise 99"Tc-Tetrofosmin cardiac Spect is an efficient alternative n o n - i n v a s i v e technique in the global detection of TCAD. The negative predictive value is very high (VPN=93%). For this reason a normal myocardial perfusion after a cardiac Spect could avoid the coronary arteriography.
5-FLUOROURACIL (5-FU) CARDIOTOXICITY DETECTED BY DIPYRIDAMOLE THALLIUM-201 CARDIAC IMAGING T. Bishiniotis, G. Katseas, G. Pentheroudakis, N. Salem, G. Koutsibanis, A. Litos, D. Mouratidou, D. Hatseras. Theagenion Anticancer Hospital, Thessaloniki, Macedonia, Greece. 5-FU acute cardiotoxicity is frequent (12.5%) and its clinical manifestations include all forms of myocardial ischemia, cardiogenic shock and sudden cardiac death. The aim of this study was to investigate the effect of the drug in the coronary blood flow. 45 patients (M/F:39/6, mean age:59 years) with advanced head and neck cancer and normal cardiac function were included prospectively in a chemotherapeutic protocol with continuous IV infusion of 5-FU 1000mg/m2/day for 5 consecutive days. The evaluation of the myocardial perfusion was based on dipyridamole thallium-201 cardiac imaging and included 2 scans for every patient : (1) a dipyridamole thallium-201 heart scan before the initiation af chemotherapy, and (2) after one month, using the same imaging protocol and the same doses of dipyridamole and thallium-201, a heart scan while the patient was under the continuous IV infusion of 5-FU (3rd-4th day). The comparison of the 2 scans and the quantification of the results were based on the computer programme of the University of Alabama. There was a statistically significant decrease in the myocardial thallium-201 uptake during the IV 5-FU infusion (p<0.001). This decrease was equivalent to 24.5% and concerned equally all myocardial segments. Conclusion: 5-FU infusion results in great reduction (24.5%) of the myocardial thallium-201 uptake under pharmacologic vasodilation. This effect superimposed on preexisting coronary obstructions could explain the acute cardiotoxic effect of this chemotherapeutic agent.
N C A ¥ P IV A P B I L 7
$41
26.52
26.50 DEFT
Abstracts Monday afternoon, April 7, 1997
VENTRICLE DYSFUNCTION IN PATIENTS
R E C E I V I N G PACL1TAXEL. R.A. Vaid6s Olmos, W.W. ten Bokkcl Huinink, C.A. Hoefnagel. The Netherlands Cancer Institute, Amsterdam.
INFLUENCE OF THYROID DISORDERS ON CARDIAC SYMPATHETIC NERVE FUNCTION M.Nakamura, K.Mizoguchi, S, Yasuda, T.Mocbizuki, S.Koide Chigasaki Municipal Hospital, Kanagawa, Japan
Over the last years, paclitaxel, an effective antineoplastic agent, has been incorporated in the treatment o f advanced and refractory breast cancer. A[thongh transient cardiac rhythm disturbances have been described during or shortly after drug infusion, cardiac effects between drug courses or in the post-therapy period have not been documented. In this paper, we report an abnormal left ventricle ejection fraction (LVEF) decrease (10% or more to a EF-level below 50%) in 6 patients (age 44-67 years) treated with paclitaxel for advanced breast carcinoma: in 3 patients, without previous chemotherapy but with internal mammary lymph node chain irradiation 3-18 years previously, LVEF-decrease was observed 1-6 months after paclitaxel administration (dose range 525-1225 mg/mZ), ahd in 3 patients with doxorubicin refractory disease LVEF decreased when paclitaxel (dose range 350-875 mg/m -~) was administered 1-5 months after doxorubicin (dose range 420-530 mghn2); IIqn-antimyosin scan, used to document doxorub[cin-related myocyte damage, showed intense cardiac uptake in 1 case. These findings suggest that paclitaxel may induce left velm'icle dysfunction. LVEF monitoring is specially recommended in patients previously treated with anthracyclines and thoracic irradiation including the heart.
Thyroid hormone has direct inotropic and chronotropic effects on the heart. Thyroid diseases produce significant alternations in cardiac function. The cardiac sympathetic nerve (CSN) function was evaluated in 11 patients (pts) with hyperthyroidism (HPR; FT4 6.4"+'2.6ng/dl), 5 pts with hypothroidism (HPO; FT4 0.5-1-0.2ng/dl) and 12 control subjects (FT4 1.2-1-O.2ng/dl} using with I-123 metaiodobenzylguanidine (MIBG} myocardial scintigraphy. Planar images were obtained in anterior position 15 minutes (initial images} and 4 hours (delayed images)after injection of 111 MBq 1-123 MIBG. Image quantitation was based on the ratio of myocardial to mediastinal I-123 MIBG uptake (H/M) and the percentwashout from initial to delayed images. Plasma norepinephrine (NE) and fractional shortening of left ventricle (%FS) by echocardiography were determined. Results delayed H/M washout(%) NE (ng/ml) %FS HPR 1.76_4-0.23"* 34.7___16.7 0.29-1-0.17 33,8___11.3 Cotrol 2.14-{-0.11 31,6-1-5.7 0.43___0.19 33.7"4-3.4 HPO 2,48__.0.62* 32.2_14.5 0,51___0.25 32.2___5.4 ( ** p< 0.01, * p< 0.05 compared to controls) There was negative colleration between the delayed H/M ratio and the FT4 concentration ( r = -0.54, p( 0.01 }. Conclusion The CSN function shown by the MIBG uptake is decreased in HPR and increased in HPO. The CSN helps the heart ajust to pathophysiologic changes by the thyroid hormone.
26.51
26.53
DIAGNOSIS OF TRANSPLANT (~ORONARY ARTERY DISEASE (TCAD): STRESS 9~"Tc-TETROFOSMIN SPECT. O.Vegazo, R.Mufioz, P. Madariaga, J.A. Garcia Robles, C. Trampal, I. Almoguera, P. D o m i n g u e z , J.M. P6rez Vazquez. Hospital Gregorio Marafion. Madrid. Spain. Heart t r a n s p l a n t a t i o n is an accepted treatment of end-stage heart disease. With i m p r o v e m e n t in the treatment of infection and rejection, TCAD is the lead cause of late mortality in cardiac t r a n s p l a n t patients (CTP). The aim of this study was to investigate the usefulness of treadmill exercise 99mTc-TetrofosminSpect in the diagnosis and localization of TCAD. We studied 30 CTP (27 men, mean age 54.2 + 2.2 yrs), with mean survival 28.2 _+ 4.7 months p o s t - t r a u s p l a n t a t i o n . Coronary angiography, defined as the reference technique for the global and territorial evaluation of myocardial Spect, was p e r f o r m e d within 2 months prior to or after the Spect study (mean 54.9 + 8.2 days). The sensitivity, specificity and predictive accuracy for detection of TCAD were calculated. Kappa statistical values was also calculated. SPECT Overall TCAD TCAI)-DA TCAD-CX TCAD-CD Sensitivity(%) 91 43 29 70 Specificity(%) 6g 64 g4 g5 VI'P(%) 63 30 33 70 VPN(%) 93 80 79 85 Accuracy.(%) 77 63 70 80 Kappa 0.5415 0.1081 0.1176 0.5500 p value 0.0017 0.5416 0.5173 0.0026 In conclusion: treadmill exercise 99"Tc-Tetrofosmin cardiac Spect is an efficient alternative n o n - i n v a s i v e technique in the global detection of TCAD. The negative predictive value is very high (VPN=93%). For this reason a normal myocardial perfusion after a cardiac Spect could avoid the coronary arteriography.
5-FLUOROURACIL (5-FU) CARDIOTOXICITY DETECTED BY DIPYRIDAMOLE THALLIUM-201 CARDIAC IMAGING T. Bishiniotis, G. Katseas, G. Pentheroudakis, N. Salem, G. Koutsibanis, A. Litos, D. Mouratidou, D. Hatseras. Theagenion Anticancer Hospital, Thessaloniki, Macedonia, Greece. 5-FU acute cardiotoxicity is frequent (12.5%) and its clinical manifestations include all forms of myocardial ischemia, cardiogenic shock and sudden cardiac death. The aim of this study was to investigate the effect of the drug in the coronary blood flow. 45 patients (M/F:39/6, mean age:59 years) with advanced head and neck cancer and normal cardiac function were included prospectively in a chemotherapeutic protocol with continuous IV infusion of 5-FU 1000mg/m2/day for 5 consecutive days. The evaluation of the myocardial perfusion was based on dipyridamole thallium-201 cardiac imaging and included 2 scans for every patient : (1) a dipyridamole thallium-201 heart scan before the initiation af chemotherapy, and (2) after one month, using the same imaging protocol and the same doses of dipyridamole and thallium-201, a heart scan while the patient was under the continuous IV infusion of 5-FU (3rd-4th day). The comparison of the 2 scans and the quantification of the results were based on the computer programme of the University of Alabama. There was a statistically significant decrease in the myocardial thallium-201 uptake during the IV 5-FU infusion (p<0.001). This decrease was equivalent to 24.5% and concerned equally all myocardial segments. Conclusion: 5-FU infusion results in great reduction (24.5%) of the myocardial thallium-201 uptake under pharmacologic vasodilation. This effect superimposed on preexisting coronary obstructions could explain the acute cardiotoxic effect of this chemotherapeutic agent.
N C A ¥ P IV A P B I L 7