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The Evolution of Nuclear Cardiology Takes us Back to the Beginning to Develop Today’s “New Standard of Care” for Cardiac Imaging: How Quantifying Regional Radioactive Counts at Five and 60 Minutes Post-Stress Unmasks Hidden Ischemia

Authors:

Richard M. Fleming ,

Reno Nevada Cardiology, Reno, Nevada, US
About Richard M.
M.D.
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Gordon M. Harrington,

Reno Nevada Cardiology, Reno, Nevada, US
About Gordon M.
Ph.D.
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Riaz Baqir,

Reno Nevada Cardiology, Reno, Nevada, US
About Riaz
M.D.
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Scott Jay,

Reno Nevada Cardiology, Reno, Nevada, US
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M.D.
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Sridevi Challapalli,

Reno Nevada Cardiology, Reno, Nevada, US
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M.D.
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Kayla Avery,

Reno Nevada Cardiology, Reno, Nevada, US
About Kayla
M.D.
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Jim Green

Reno Nevada Cardiology, Reno, Nevada, US
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M.D.
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Abstract

In 1926, Blumgart1 published the first paper on nuclear cardiology. He demonstrated that a radioactive isotope injected into the venous system of the right arm could be sequentially measured over the next several minutes by calculating the amount of radioactivity in the arterial system of the left arm. This was termed "circulation time," and the longer the time required for detection, the weaker the heart muscle. It also established the need for multiple images under the same state of stress. By 1959, Gorlin2 demonstrated that resting studies could not be used to evaluate ischemia,3.4 which later proved to be the result of coronary flow reserve, a phenomenon associated with vasodilatory capacity of coronary arteries under stress and not under resting conditions.

The prognosis for nuclear cardiology was critical by the mid 1960s, when Love5 pointed out that there were no useful isotopes available to clinically evaluate the patient. This was remedied with the introduction of thallium-201 in 1975. By the late 1980s. the search for better imaging agents lead to the production of several compounds using the isotope technelium-99m. Despite the promise of rapid uptake and release. some of these agents6 would prove to be difficult to use in everyday practice. By contrast, the more lipophilic compound, sestamibi, would prove to be easier to use. Unfortunately, most clinical studies were being performed with rest-stress imaging for comparison despite the teachings of Blumgart and Gorlin.

By 1993, Crane7 established that sestamibi did not merely enter cells and remain there but underwent uptake and release dependent upon the level of ischemia present, which influenced mitochondrial calcium. In recent years, this understanding has been applied extensively in other areas of nuclear medicine to better detect disease and in some instances to better understand the responses of certain cancers to treatment.8·10 This knowledge of cellular and subcellular organelle (mitochondrial) uptake and release (washout) has yielded a better understanding and detection of congestive heart failure.11-14 cardiomyopathies,15-17 Prinzmetal’s angina,18 19 and ischemia.11 13 20·23

Recently, our group completed work demonstrating improved detection of ischemia and vulnerable plaque.4-26 which had been impossible to detect when comparing resting images to stress images. This report shares both a description of this new standard of care in cardiac imaging and an example of its contribution to clinical cardiology.

How to Cite: 1. Fleming RM, Harrington GM, Baqir R, et al.. The Evolution of Nuclear Cardiology Takes us Back to the Beginning to Develop Today’s “New Standard of Care” for Cardiac Imaging: How Quantifying Regional Radioactive Counts at Five and 60 Minutes Post-Stress Unmasks Hidden Ischemia. Methodist DeBakey Cardiovascular Journal. 2009;5(3):42-48. DOI: http://doi.org/10.14797/mdcvj.171
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Published on 01 Jan 2009.
Peer Reviewed

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