Practical Applications of Nuclear Cardiology

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Citation
US Cardiology 2004;2004:1(1):1-5

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Background

Heart disease, specifically coronary artery disease (CAD), is the leading cause of death and disability among both men and women in the US. Reductions in blood supply due to narrowings of the arteries that supply the heart muscle with oxygen and nutrients (coronary arteries) result in chest pain and shortness of breath and may lead to permanent scarring of the heart muscle, as in the setting of a heart attack (myocardial infarction) or cause sudden death, due to irregular heart rhythms. Additionally, CAD is the most frequent cause of heart failure, which is the leading cause of hospitalization in the US. Therefore, ischemic heart disease has important ramifications for the morbidity and mortality, as well as a substantial impact on healthcare expenditures.

Nuclear cardiology studies allow for the detection of abnormal blood flow to the heart muscle, as well as the assessment of the pumping function of the heart. The most common procedure is myocardial perfusion imaging (MPI) or single-photon emission computed tomography (SPECT). Small amounts of radioactive material are injected intravenously and these tracers are taken up and retained in the heart tissue in proportion to regional blood supply. Usually, two scans are obtained after tracer injection, one at rest and one in which the agent is injected during exercise or medication-induced stress, such as with adenosine, dipyridamole, or dobutamine. Areas with reduced blood supply, either under resting conditions or following stress testing, indicates regions of scar or reversible perfusion alterations (ischemia), respectively.

Nuclear Cardiology Procedures

Nuclear cardiology has experienced explosive growth during the past decade, founded on the solid evidence that this discipline provides the clinician with an accurate assessment of patients with suspected ischemic heart disease.

It is estimated that approximately 7.8 million MPI studies were performed in the US during 2002, an almost four-fold increase in procedural volume during the past decade and an 11% increase over the preceding year. The vast majority of in-hospital studies are in small (<400 bed), non-teaching institutions, indicating the penetrance of the procedure into routine clinical care. However, double digit annual growth has occurred primarily in the setting of office-based laboratories, with an increasing percentage of studies being performed by cardiologists.

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