Volume 31, Issue 3 (2020), pp. 523–538
This study aims to evaluate patients with limited state of changes in coronary arteries detected by coronary angiography, the dynamics of these changes over the two years, identify the relevant diagnostic criteria, and assess the efficacy of applied treatment by using speckle tracking echocardiography. Peak radial and circumferential strain and SR (systolic, early, and late diastolic strains) were measured based on the short-axis view; peak longitudinal strain and SR were measured from the apical side of four- two- and three-chamber views. Radial, longitudinal (GLS), circumferential global and regional strains were calculated as an average of measurements. All patients $(n-146)$ were assigned to normal (control) and CAD groups according to cardiac angiography results. 128 of them were evaluated repeatedly after two years. Depending on angiography findings, LAD (85.83%) stenosis predominate, when subsequently fewer instances of RCA (52.5%) or LCX (40.83%) were observed. Most (about 80%) of the patients had one or two-vessel disease and only 20% had systemic all three-vessel disease. Analysis of STE data in groups during a two-year study period showed statistically reliable differences associated with a particular coronary artery. In the control group: RCA – myocardial circumferential strain $(p-0.037)$; LAD – no changes; LCX – early $(p-0.013)$ and late diastolic longitudinal $(p-0.033)$ strains. Subsequently, in the CAD group: RCA – diastolic circumferential strain rate $(p-0.007)$; LAD – myocardial longitudinal strain $(p-0.006)$, systolic longitudinal $(p-0.038)$ and circumferential strain $(p-0.012)$ rates, early diastolic circumferential $(p-0.008)$ and late diastolic longitudinal $(p-0.037)$ strain rates; LCX – myocardial longitudinal $(p-0.049)$ strain. Between groups, we detected significant changes in such circumferential strain rates, respectively: RCA – systolic $(p=0.037)$, early diastolic $(p=0.019)$, and late diastolic $(p=0.024)$ strain rates; LAD – no changes; LCX – early diastolic longitudinal strain $(p-0.004)$. The clinical condition of our patients over the two years has improved both in control and CAD groups, according to GLS. We hold the opinion that microvascular angina (MVA) may be responsible for such an improvement because the main diagnostic criteria and common treatment with ACE inhibitors, statins, β-blockers, antithrombotic, and nitrates was typical and effective for MVA treatment.
Pub. online:1 Jan 2018Type:Research ArticleOpen Access
Volume 29, Issue 3 (2018), pp. 421–438
We attempted to determine the most common localizations of epileptogenic foci by using common functional (EEG and PET/CT) and structural (MRI) imaging methods. Also, we compared the number of epileptogenic foci detected with all diagnostic methods and determined the success rate of surgery in the operated patients when the epileptogenic foci coincided on all three imaging methods. 35 patients (including children) with clinically proven refractory epilepsy were included into the study. All patients underwent an MRI scan with epilepsy protocol, Fluorodeoxyglucose-18-PET/CT scan, and an EEG prior to a PET study. 14 patients underwent neurosurgery for removal of epileptogenic foci. We found a statistically significant difference between the number of epileptogenic foci which were found in PET/CT and EEG studies but there was no significant difference between MRI and PET/CT lesion numbers. The most common localization of epileptogenic activity on EEG was right temporal lobe (54.3%); the most common lobe with structural changes on MRI was right temporal lobe (42.9%); the most common hypometabolism zone on PET/CT was in right temporal lobe (45.7%). 10 out of 14 patients who underwent surgery demonstrated excellent postsurgical outcomes, with no epileptic seizures one year or more after the operation; 3/14 patients had 1–2 seizures after surgery and one patient had the same count or more epileptic seizures in duration of one year or more. The measure of Agreement Kappa between PET/CT and EEG value was 0.613 $(p<0.05)$. Between PET/CT and MRI the value was 0.035 $(p>0.05)$. Surgical treatment may offer hope for patients with intractable epileptic seizures. PET/CT was an extremely useful imaging method to assist in the localization of epileptogenic zones. The dynamic functional information that brain PET/CT provides is complementary to anatomical imaging of MRI and functional information of EEG.