Medical Dialogues
  • Dermatology
Login Register
This site is intended for healthcare professionals only
Login Register
  • MD Brand Connect
  • Vaccine Hub
  • MDTV
    • Breaking News
    • Medical News Today
    • Health News Today
    • Latest
    • Journal Club
    • Medico Legal Update
    • Latest Webinars
    • MD Shorts
    • Health Dialogues
  • Fact Check
  • Health Dialogues
Medical Dialogues
  • Medical News & Guidelines
      • Anesthesiology
      • Cardiology and CTVS
      • Critical Care
      • Dentistry
      • Dermatology
      • Diabetes and Endocrinology
      • ENT
      • Gastroenterology
      • Medicine
      • Nephrology
      • Neurology
      • Obstretics-Gynaecology
      • Oncology
      • Ophthalmology
      • Orthopaedics
      • Pediatrics-Neonatology
      • Psychiatry
      • Pulmonology
      • Radiology
      • Surgery
      • Urology
      • Laboratory Medicine
      • Diet
      • Nursing
      • Paramedical
      • Physiotherapy
  • Health news
      • Doctor News
      • Government Policies
      • Hospital & Diagnostics
      • International Health News
      • Medical Organization News
      • Medico Legal News
      • NBE News
      • NMC News
  • Fact Check
      • Bone Health Fact Check
      • Brain Health Fact Check
      • Cancer Related Fact Check
      • Child Care Fact Check
      • Dental and oral health fact check
      • Diabetes and metabolic health fact check
      • Diet and Nutrition Fact Check
      • Eye and ENT Care Fact Check
      • Fitness fact check
      • Gut health fact check
      • Heart health fact check
      • Kidney health fact check
      • Medical education fact check
      • Men's health fact check
      • Respiratory fact check
      • Skin and hair care fact check
      • Vaccine and Immunization fact check
      • Women's health fact check
  • AYUSH
    • Ayurveda
    • Homeopathy
    • Siddha
    • Unani
    • Yoga
  • State News
      • Andaman and Nicobar Islands
      • Andhra Pradesh
      • Arunachal Pradesh
      • Assam
      • Bihar
      • Chandigarh
      • Chattisgarh
      • Dadra and Nagar Haveli
      • Daman and Diu
      • Delhi
      • Goa
      • Gujarat
      • Haryana
      • Himachal Pradesh
      • Jammu & Kashmir
      • Jharkhand
      • Karnataka
      • Kerala
      • Ladakh
      • Lakshadweep
      • Madhya Pradesh
      • Maharashtra
      • Manipur
      • Meghalaya
      • Mizoram
      • Nagaland
      • Odisha
      • Puducherry
      • Punjab
      • Rajasthan
      • Sikkim
      • Tamil Nadu
      • Telangana
      • Tripura
      • Uttar Pradesh
      • Uttrakhand
      • West Bengal
  • Medical Education
      • Ayush Education News
      • Dentistry Education News
      • Medical Admission News
      • Medical Colleges News
      • Medical Courses News
      • Medical Universities News
      • Nursing education News
      • Paramedical Education News
      • Study Abroad
  • Industry
      • Health Investment News
      • Health Startup News
      • Medical Devices News
      • Pharma News
      • Pharmacy Education News
      • Industry Perspective
  • MDTV
      • Health Dialogues MDTV
      • Health News today MDTV
      • Latest Videos MDTV
      • Latest Webinars MDTV
      • MD shorts MDTV
      • Medical News Today MDTV
      • Medico Legal Update MDTV
      • Top Videos MDTV
      • Health Perspectives MDTV
      • Journal Club MDTV
      • Medical Dialogues Show
This site is intended for healthcare professionals only
LoginRegister
Medical Dialogues
LoginRegister
  • Home
  • Medical news & Guidelines
    • Anesthesiology
    • Cardiology and CTVS
    • Critical Care
    • Dentistry
    • Dermatology
    • Diabetes and Endocrinology
    • ENT
    • Gastroenterology
    • Medicine
    • Nephrology
    • Neurology
    • Obstretics-Gynaecology
    • Oncology
    • Ophthalmology
    • Orthopaedics
    • Pediatrics-Neonatology
    • Psychiatry
    • Pulmonology
    • Radiology
    • Surgery
    • Urology
    • Laboratory Medicine
    • Diet
    • Nursing
    • Paramedical
    • Physiotherapy
  • Health news
    • Doctor News
    • Government Policies
    • Hospital & Diagnostics
    • International Health News
    • Medical Organization News
    • Medico Legal News
    • NBE News
    • NMC News
  • Fact Check
    • Bone Health Fact Check
    • Brain Health Fact Check
    • Cancer Related Fact Check
    • Child Care Fact Check
    • Dental and oral health fact check
    • Diabetes and metabolic health fact check
    • Diet and Nutrition Fact Check
    • Eye and ENT Care Fact Check
    • Fitness fact check
    • Gut health fact check
    • Heart health fact check
    • Kidney health fact check
    • Medical education fact check
    • Men's health fact check
    • Respiratory fact check
    • Skin and hair care fact check
    • Vaccine and Immunization fact check
    • Women's health fact check
  • AYUSH
    • Ayurveda
      • Ayurveda Giuidelines
      • Ayurveda News
    • Homeopathy
      • Homeopathy Guidelines
      • Homeopathy News
    • Siddha
      • Siddha Guidelines
      • Siddha News
    • Unani
      • Unani Guidelines
      • Unani News
    • Yoga
      • Yoga Guidelines
      • Yoga News
  • State News
    • Andaman and Nicobar Islands
    • Andhra Pradesh
    • Arunachal Pradesh
    • Assam
    • Bihar
    • Chandigarh
    • Chattisgarh
    • Dadra and Nagar Haveli
    • Daman and Diu
    • Delhi
    • Goa
    • Gujarat
    • Haryana
    • Himachal Pradesh
    • Jammu & Kashmir
    • Jharkhand
    • Karnataka
    • Kerala
    • Ladakh
    • Lakshadweep
    • Madhya Pradesh
    • Maharashtra
    • Manipur
    • Meghalaya
    • Mizoram
    • Nagaland
    • Odisha
    • Puducherry
    • Punjab
    • Rajasthan
    • Sikkim
    • Tamil Nadu
    • Telangana
    • Tripura
    • Uttar Pradesh
    • Uttrakhand
    • West Bengal
  • Medical Education
    • Ayush Education News
    • Dentistry Education News
    • Medical Admission News
    • Medical Colleges News
    • Medical Courses News
    • Medical Universities News
    • Nursing education News
    • Paramedical Education News
    • Study Abroad
  • Industry
    • Health Investment News
    • Health Startup News
    • Medical Devices News
    • Pharma News
      • CDSCO (Central Drugs Standard Control Organisation) News
    • Pharmacy Education News
    • Industry Perspective
  • Home
  • Cardiology-CTVS
  • Cardiology & CTVS Guidelines
  • Top 10 takeaways from...

Top 10 takeaways from cardiac imaging: ECHO and Nuclear imaging

Written By : dr. Abhimanyu Uppal |Medically Reviewed By : Dr. Kamal Kant Kohli Published On 2021-07-30T10:00:24+05:30  |  Updated On 30 July 2021 3:01 PM IST
Top 10 takeaways from cardiac imaging: ECHO and Nuclear imaging
  • facebook
  • twitter
  • linkedin
  • whatsapp
  • Telegram
  • Email

The "ASPC Top Ten Imaging" summarizes ten things to know about ten important CVD-related imaging studies. In our last section, we discussed about the application aspects of coronary calcium estimation and coronary artery CT angiography. In the second section of this series, we bring to you the most important aspects of how, when and for whom to use echocardiography and nuclear imaging in cardiovascular diseases.

1. Cardiac ultrasound (echocardiography):

Echocardiography utilizes ultrasound waves to provide hemodynamic information about heart function. When accompanied by stress testing, echocardiography is often used to assess myocardial ischemia (i.e., coronary artery atherosclerosis), left ventricular function (i.e. heart failure, cardiomyopathy) and structural heart disease (i.e., valvulopathy, congenital heart disease, aneurysm, cardiac tumor, pericarditis, endocarditis, aortic dissection, heart chamber thrombosis).

The advent of 3D echocardiography beyond the routinely used conventional parameters like M-mode, Doppler etc. aids in characterization of mitral valve structure, atrial septal defect size estimation, etc.

Stress echocardiography is reasonably sensitive and specific for diagnosing coronary artery disease in symptomatic patients. Being a non-invasive procedure without any radiation exposure, its remarkable safety makes it applicable in almost all patient scenarios, including pregnancy. Following points are our top 10 nuggets for echocardiography:


1. Transthoracic echocardiography is the most common approach, with transesophageal echocardiography preferred in patients with conditions that compromise transthoracic imaging quality (e.g., obesity, certain lung conditions). Contrast options include agitated saline or commercial ultrasound contrast agents
2. Transesophageal echocardiography may provide better resolution images of the left heart, evidence of potential endocarditis, mitral and aortic valves, and aorta (i.e., aortic dissection).
3. Doppler echocardiography can assess stroke volume, heart chamber pressure gradients, valvular regurgitations, and intracardiac shunts.
4. echocardiography can help diagnose alternative cardiac etiologies of chest pain, identify regional wall-motion abnormalities, determine left ventricular ejection fraction, and evaluate diastolic dysfunction for stratification purposes.
5. stress echocardiography provides cardiac functional assessment.
6. Echocardiography is commonly used to assess left ventricular ejection fraction.
7. While heart failure can occur with reduced ejection fraction, symptomatic heart failure can also occur with preserved ejection fraction (HFpEF) (i.e., ejection fraction ≥ 50%).
8. Echocardiography may provide helpful information regarding microcirculatory dysfunction that may contribute to angina without obstructive lesions in major coronary arteries
9. echocardiogram assessment of heart function and anatomy can provide peri-operative risk stratification.
10. Echocardiogram assessment can provide cross-sectional and longitudinal cardiac assessment in patients undergoing chemotherapy, helping to monitor for potential adverse effects of chemotherapy on cardiac structure and function. in this aspect strain imaging is emerging as an important tool to detect subclinical dysfunction.

2. Nuclear myocardial perfusion imaging (MPI)

Nuclear myocardial perfusion imaging through Single Photon Emission Computed Tomography (SPECT) utilizes small amounts of nuclear tracer (i.e., the isotope technetium-99 or thallium-201) injected into the blood to assess myocardial segments that do not take up the tracer (i.e., damaged myocardium) or areas with delayed uptake of the tracer (i.e., ischemic myocardium).

The radiotracers are generally injected into the blood with imaging occurring at rest, or with exercise, or both. For patients unable to physically exercise, then an A2A adenosine receptor agonist (i.e., regadenoson) can be injected as an alternative to exercise.

A positron emission tomography (PET) scan of the heart utilizes a radiotracer (i.e., often 82rubidium or 13ammonia for rest and stress perfusion). Uptake of the radiotracer by the myocardium is proportional to myocardial blood flow.

Strengths of PET MPI include high diagnostic accuracy, safety with low radiation exposure (lower than SPECT), efficient with 5-min image acquisition times (may take only 30 minutes to perform), ability to accommodate ill or higherrisk patients, ability to assess patients with large body habitus, and ability to assess non-obstructive coronary microvascular dysfunction.

The most significant facets off nuclear imaging are summarised below:

1. SPECT is a perfusion imaging study that typically uses technetium-99 (99mTc). 99mTc produces less radiation than thallium-201 (201TI), ~6 mSVversus ~17 mSV respectively. Thus technetium is most commonly used.
2. MPI may utilize different tracers, depending upon the imaging device, and purpose of the imaging (e.g., perfusion imaging, atherosclerosis imaging, metabolic imaging, inflammation imaging, and/or innervation/sympathetic imaging)
3. . Appropriate use of MPI can help stratify CVD risk; inappropriate use of MPI may not help stratify CVD risk
4. MPI may help augment CAC CVD risk stratification.
5. MPI imaging may help identify obstructive coronary artery disease as the etiology of chest pain.
6. MPI can be used in patients with immobility, cardiac rhythm disorders, impaired kidney function, or presence of cardiac devices.
7. Over 50% of patients may be unable to adequately exercise during MPI, with an inability to achieve 85% of maximum predicted heart rate and 5 metabolic equivalents (METS). This often prompts the alternative of pharmacologic stress testing.
8. If stress MPI is normal, resting MPI may be redundant and not necessary. Employing stress MPI results alone may reduce radiation and cost.
9. PET has a high sensitivity and specificity to detect anatomic and functional atherosclerotic lesions useful for CVD risk stratification.
10. PET may help identify functional abnormalities suggestive of microvascular CAD.

Stress echocardiogram (Echo) has a sensitivity of 85% and specificity of 82% to detect significant CAD. Positron emission tomography (PET) has sensitivity of 90% and specificity of 85% in this regard.

Source: American Journal of Preventive Cardiology: https://doi.org/10.1016/j.ajpc.2021.100176


cardiac imagingpreventive cardiologycardiovascular diagnosis
dr. Abhimanyu Uppal
dr. Abhimanyu Uppal

    MBBS, MD , DM Cardiology

    Dr Abhimanyu Uppal completed his M. B. B. S and M. D. in internal medicine from the SMS Medical College in Jaipur. He got selected for D. M. Cardiology course in the prestigious G. B. Pant Institute, New Delhi in 2017. After completing his D. M. Degree he continues to work as Post DM senior resident in G. B. pant hospital. He is actively involved in various research activities of the department and has assisted and performed a multitude of cardiac procedures under the guidance of esteemed faculty of this Institute. He can be contacted at editorial@medicaldialogues.in.

    Dr. Kamal Kant Kohli
    Dr. Kamal Kant Kohli

    Dr Kamal Kant Kohli-MBBS, DTCD- a chest specialist with more than 30 years of practice and a flair for writing clinical articles, Dr Kamal Kant Kohli joined Medical Dialogues as a Chief Editor of Medical News. Besides writing articles, as an editor, he proofreads and verifies all the medical content published on Medical Dialogues including those coming from journals, studies,medical conferences,guidelines etc. Email: drkohli@medicaldialogues.in. Contact no. 011-43720751

    Show Full Article
    Next Story

    Editorial

    Aspirin in Primary Prevention: Prudent Guideline-Based Approach

    Aspirin in Primary Prevention: Prudent Guideline-Based Approach

    Prediabetes and CKD: An Overlooked Interaction in Early Metabolic Disease

    Prediabetes and CKD: An Overlooked Interaction in Early Metabolic Disease

    Environmental Impact on Seborrheic Dermatitis, Tinea versicolor and Dandruff: The Role of Selenium Sulfide in Seborrheic Dermatitis Management

    Environmental Impact on Seborrheic Dermatitis, Tinea versicolor and Dandruff: The Role of Selenium...

    Real-World Case study: Darbepoetin Alfa for Chemotherapy-Induced Anemia in stage IV metastatic gallbladder cancer - Dr AVS Suresh

    Real-World Case study: Darbepoetin Alfa for Chemotherapy-Induced Anemia in stage IV metastatic...

    ABYSS Trial Finds Elevated BP, HR & Deleterious CV Outcomes After Beta blocker Withdrawal Post-MI: EuroPCR 2025 Update

    ABYSS Trial Finds Elevated BP, HR & Deleterious CV Outcomes After Beta blocker Withdrawal Post-MI:...

    View All

    Journal Club Today

    Study Links Low Oral Microbiome Diversity to Depression Symptoms

    Study Links Low Oral Microbiome Diversity to Depression Symptoms

    View All

    Health News Today

    Health Bulletin 13/June/2025

    Health Bulletin 13/June/2025

    View All
    © 2022 All Rights Reserved.
    Powered By: Hocalwire
    X
    We use cookies for analytics, advertising and to improve our site. You agree to our use of cookies by continuing to use our site. To know more, see our Cookie Policy and Cookie Settings.Ok