Objective: to clarify and systematize the causes that can induce focal artefacts in skeletal scintigraphy with 99mTc-pyrophosphate (PyP), their semiotics, principles and methods of differentiation from bone pathology. Material and methods. Results of skeletal scintigraphy from 1568 patients were analyzed. Scanning in “whole body” mode started in 3 hours after 740 MBq of radiotracer activity intravenous administration, and performed in anterior and posterior projections in continuous table motion mode at rate of 12 cm per minute. Single photon emission computed tomography/computed tomography was additionally performed when necessary. Results. Focal artifacts were detected in 40 patients (2.55%) and were divided into “cold” and “hot” according to the nature of the bone system changes they simulated. “Cold” spots (n = 29) were the result of the shielding effect of metal accessories (n = 10), implants, endoprostheses (n = 18), and barium suspension residues in the large intestine (n = 1). “Hot” spots (n = 11) mimicking metastatic lesion of bone structures were the results of the projection effect of extraosseous uptake of 99mTc-PyP (n = 9) or urinary contamination (n = 2). “Hot” spots in the projection of the upper pole of the kidney (n = 5) could be the result of both calicostasis (n = 3) and injury of the adjacent rib (n = 2). The high uptake of 99mTc-PyP in thyroid nodule (n = 3) simulated a “hot” spot in the lateral part of the cervical vertebra. Abnormal accumulation of 99mTc-PyP in the nipple-areola areas of the breast was projected onto the posterior segments of the ribs. Urinary contamination imitated focal pathology of the pelvic bones. To differentiate the focal pathology of the ribs and calicostases, the patients were examined in the standing position. The “mask in” program was used to clarify the localization and projection correspondence of “hot” foci. Conclusion. Analysis of focal artefacts formation causes in skeletal scintigraphy contributes to an adequate assessment of the data obtained, allows to choose the necessary method for their diagnosis and to avoid false results of osteoscintigraphy.

The aim of our investigation was to assess the efficacy of enhanced external counterpulsation (EECP) in ischemic heart disease (IHD) patients depending on previous by-pass surgery. 30 IHD patients (pts) were treated with EECP using standard protocol (35 hours, 1 hour each procedure). All patients were divided into 2 groups. 1-st group (n=15) - pts after by-pass surgery, 2-nd group (n=15) - pts without previous coronary revascularisation. Pts were examined by ECG, echocardiography, bicycle test, radionuclide perfusion scintigraphy (SPECT) before and after EECP treatment. There was significant decreasing of perfusion defect severity for rest SPECT after EECP treatment (64.93+/-13.21 std and 58.53+/-17.28 std, respectively, p<0.01) and decreasing of size of perfusion defects - 26.10+/-15.76% before and 22.63+/-18.54% after EECP (p<0.05). Size and severity of perfusion defects estimated by SPECT at stress conditions didn't change. After EECP treatment the decreasing of perfusion defect severity (p<0.01) was registered in both groups, the decreasing of size of perfusion (p<0.05) - only in the 1-st group. In the 1-st group decreasing of perfusion defect severity and size of perfusion was more intensive. The efficacy of EECP depends on previous coronary revascularization.

Aim. To assess the effects of enhanced external counter-pulsation (EECP) on left ventricular (LV) myocardial perfusion.Material and methods. In total, 26 patients with coronary heart disease (CHD), stable angina, Functional Class (FC) I-IV, were treated with EECP. Treatment course included 35 one-hour procedures. At baseline and after EECP treatment, all patients underwent 99m-Tc-MIBI scintigraphy (single photon emission computed tomography, SPECT) at rest and during stress test.Results. After EECP treatment, perfusion defect severity assessed by SPECT at rest had significantly reduced (p<0,01). Pre- and post-EECP perfusion defect areas were 18,0 +/- 13,6 % and 17,2 +/- 15,7 %, respectively (p>0,05); pre- and post-EECP perfusion defect severity - 347,3 +/- 282,8 and 310 +/- 266,0 std, respectively (p<0,01). No significant dynamics of perfusion defect area or severity was observed for stress EECP.Conclusion. EECP treatment was associated with improved LV myocardial perfusion in CH D patients.

AIM OF THE WORK:To assess effect of programmed external counterpulsation (ECP) on clinico-functional status, quality of life of patients with chronic heart failure (CHF) of ischemic origin, stable functional class (FC) II-IV angina refractory to drug therapy.MATERIAL AND METHODS:Patients (n=30) with ischemic heart disease (IHD) stable FC II-IV angina (mean age 65.5 +/- 7.9 years) went though complete curative course of ECP which included 35 1-hour procedures 5-6 times a week. Signs of CHF NYHA FC I-II were noted in 18, FC III-IV - in 12 patients. In 8 patients left ventricular (LV) ejection fraction (EF) did not exceed 35%. Methods of investigation used before and after course of ECP included clinical examination, echoCG, VEM-test, perfusion myocardial scintigraphy with 99MTc-MIBI, 24-hour ECG monitoring, assessment of quality of life with the use of Minnesota questionnaire and of dynamics of plasma content of natriuretic peptides (pro-ANP and pro-BNP) measured by immunoenzyme assay.RESULTS:Absolute majority of patients noted improvement of self feeling with significant (p < 0.001) betterment of parameters of quality of life. Number of attacks of angina and nitrate requirement decreased more than two times. Significantly (p < 0.01) rose tolerance to physical work load. In most patients decreases of depth and extent of myocardial perfusion defects were noted. With this positive dynamics of functional status, quality of life and severity of angina was noted irrespective of manifestations of heart failure and degree of suppression of LV contractile function. Significant (p < 0.001) improvement of contractile function of the myocardium according to data of echoCG was noted predominantly in patients with initial LVEF < 35%. According to data of 24-hour ECG monitoring significant (p < 0.01) decrease of average heart rate was also noted.CONCLUSION:The obtained results evidence for high efficacy and safety of ECP in complex treatment of patients with CHF of ischemic origin with resistant to drug therapy angina pectoris.

Aim. To estimate the capabilities of the new technique radionuclide 4D-tomoventriculography (4D-RTVG) versus conventional methods, such as radionuclide equilibrium ventriculography (REVG), ECG-synchronized single photon emission computerized tomography (SPECT), and echocardiography (EchoCG), in the evaluation of systolic and diastolic dysfunction in patients with coronary heart disease (CHD).Materials and methods. The study included 29 patients (19 males and 10 females) aged 43 to 66 years who had CHD. The diagnosis of CHD was established on the basis of coronary angiographic findings when the signs of coronary atherosclerosis were found. All the patients underwent 4D-RTVG, REVG, myocardial ECG-synchronized SPECT, and EchoCG.Results. There was a strong correlation of the values obtained by 4D-RTVG versus REVG and Echo CG when ejection fraction and left ventricular (LV) end-diastolic volume and the indices reflecting LV blood filling and ejection velocity were estimated. The correlation between the values provided by 4D-RTVG and myocardial ECG-synchronized SPECT females was slightly weaker.Conclusion. The findings suggest that 4D-RTVG is highly reliable in evaluating both LV systolic and diastolic functions. That fact the technique is easy-to-use and mini-invasive shows that it may be clinically applied.

Aim. To estimate an effect of metabolic corrector mildronate on cardiac hemodynamics and endothelium function in patients with ischemic heart disease (IHD) and heart failure (HF)Material and methods. 60 patients with IHD and HF of I-III functional class according to NYHA were included into the study. 30 patients of the main group received mildronate at a daily dose of 1000 mg during 3 months additionally to standard therapy. Patients of the control group took standard therapy only. Cardiac function was estimated by 4D Gated Equilibrium Radionuclide Ventriculography. The endothelium function was measured as endothelium dependent vasodilation.Results. During 3 months mildronate therapy resulted in increase of left ventricular (LV) ejection fraction, peak filling and peak ejecting rate of LV.Conclusion. Metabolic corrector mildronate has positive effect on cardiac function in patients with IHD and CHF.