ERICK DANIEL ORTEGA MENA - Academia.edu (original) (raw)

Papers by ERICK DANIEL ORTEGA MENA

Research Square (Research Square), Sep 11, 2020

Purpose: To analyse the evolution post-cardiac resynchronization therapy (CRT) in left ventricula... more Purpose: To analyse the evolution post-cardiac resynchronization therapy (CRT) in left ventricular noncompaction (LVNC) cardiomyopathy (CM) patients compared to other types of CM, according to clinical and functional variables, by using gated-SPECT myocardial perfusion imaging (MPI). Methods: Ninety-three patients (60 ± 11 years, 28% women) referred for pre-CRT assessment were studied and divided into three groups: 1 (non-ischemic CM with LVNC, 11 patients), 2 (ischemic CM, 28 patients), and 3 (non-ischemic CM, 53 patients). All were studied by a 99m Tc-MIBI gated-SPECT MPI at rest pre-CRT implantation, and 6±1 months after, including intraventricular dyssynchrony assessment by phase analysis. Quality of life was measured by the Minnesota Living with Heart Failure Questionnaire (MLHFQ). Results: No differences in sex, atherosclerotic risk factors other than smoking habit, and MLHFQ results were found among groups. LVNC CM patients were younger, with greater QRS width and lower left ventricular ejection fraction (LVEF) at baseline, but the differences were not signi cant. No signi cant differences were found at baseline regarding ventricular function, although end-systolic volume was slightly higher in LVNC CM patients. Mean SRS was signi cantly higher (p<0.0001) in ischemic patients (14.9) vs. non-ischemic ones (8.7 in group 1 and 9 in group 2). At baseline, LVNC CM patients were signi cantly more dyssynchronous: their phase standard deviation (PSD) was higher (89.5±14.2 degrees) vs. groups 2 (65.2±23.3 degrees) and 3 (69.7±21.7 degrees), p=0.007. Although the quality of life signi cantly improved in all groups, non-ischemic patients (with or without LVNC) showed a higher LVEF increase and volumes reduction at 6 months post-CRT. Dyssynchrony reduced post-CRT in all groups. Nevertheless, those more dyssynchronous at baseline (LVNC CM) exhibited the most signi cant intraventricular synchronism improvement: PSD was reduced from 89.5±14.2 degrees at baseline to 63.7±20.5 degrees post-CRT (p=0.028). Six months post-CRT, 89% of patients were responders: 11 (100%) of those with LVNC CM, 25 (86%) of those with ischemic CM, and 47 (89%) of patients with non-ischemic CM. No patient with LVNC CM had adverse events during the follow-up. Conclusion: CRT contributes to a marked improvement in non-ischemic CM patients with non-compaction myocardium. Phase analysis in gated-SPECT MPI is a valuable tool to assess the response to CRT.

Revista de la Federacion Argentina de Cardiologia, 2015

INTRODUCTION Heart failure, primarily in the elderly, is a growing epidemic in today's world. It ... more INTRODUCTION Heart failure, primarily in the elderly, is a growing epidemic in today's world. It leads to high rates of disability and mortality, as well as significant health care expenditures, making it important to assess possible predictors of adverse cardiac events. In Cuba, heart failure mortality is 19.1/100,000 population. OBJECTIVES Assess the value of stress-rest protocol gated-SPECT for identifying patients with symptomatic heart failure likely to suffer adverse cardiac events. METHODS A study was conducted of 52 patients (mean age 59 years, SD 9; 62% women) with functional capacity II/III (New York Heart Association scale) and left ventricular ejection fraction <40%. Patients were divided into two groups based on coronary heart disease diagnosis: those with coronary heart disease (41), labeled ischemic; and those without (11), labeled nonischemic. All underwent gated SPECT myocardial perfusion scintigraphy with technetium-99m-labeled methoxyisobutyl isonitrile, using a two-day stress-rest protocol, including evaluation of intraventricular synchrony by phase analysis. Patients were followed over 36 months for adverse cardiac effects. RESULTS No signifi cant differences were observed between the two groups during the stress test with regard to exercise time, metabolic equivalents or percentage of maximal heart rate during maximal stress. Summed stress, rest and difference scores, however, were signifi cantly different between the ischemic and nonischemic groups: 16.82 (SD 6.37) vs. 7.54 (SD 5.8), p <0.001; 14.43 (SD 6.28) vs. 6.45 (SD 3.77), p = 0.001; and 2.39 (SD 4.89) vs. 1.09 (SD 3.7), p = 0.034. No differences were found in ventricular function, although stress-minus-rest left ventricular ejection fraction was slightly lower in patients with ischemic heart disease (-1.29, SD 5.8) than in patients without ischemic heart disease (1.27, SD 4.31). Dyssynchrony was greater in patients with ischemic heart disease than in those without, primarily during stress (p <0.01). The only variable that showed a possible association with the occurrence of adverse events was <5 metabolic equivalents on the stress test (p = 0.03), while resting phase SD showed only a tendency toward association (p = 0.05). CONCLUSIONS Information on myocardial perfusion, functional capacity and intraventricular synchrony obtained from stress-rest gated SPECT may help identify patients with symptomatic heart failure who are likely to develop adverse cardiac events, enabling better management of higher-risk cases and improved allocation of resources.

EJNMMI Research, 2020

Purpose To analyze the evolution post-cardiac resynchronization therapy (CRT) in left ventricular... more Purpose To analyze the evolution post-cardiac resynchronization therapy (CRT) in left ventricular non-compaction (LVNC) cardiomyopathy (CM) patients compared to other types of CM, according to clinical and functional variables, by using gated-SPECT myocardial perfusion imaging (MPI). Methods Ninety-three patients (60 ± 11 years, 28% women) referred for pre-CRT assessment were studied and divided into three groups: 1 (non-ischemic CM with LVNC, 11 patients), 2 (ischemic CM, 28 patients), and 3 (non-ischemic CM, 53 patients). All were studied by a 99mTc-MIBI gated-SPECT MPI at rest pre-CRT implantation and 6 ± 1 months after, including intraventricular dyssynchrony assessment by phase analysis. Quality of life was measured by the Minnesota Living with Heart Failure Questionnaire (MLHFQ). Results No differences in sex, atherosclerotic risk factors other than smoking habit, and MLHFQ results were found among groups. LVNC CM patients were younger, with greater QRS width and lower left ve...

Journal of Nuclear Cardiology, 2020

Background. Left ventricular contraction dyssynchrony (LVCD) has been related to induced ischemia... more Background. Left ventricular contraction dyssynchrony (LVCD) has been related to induced ischemia and transmural scar but the interplay of myocardial viability and dyssynchrony is unknown. The aim of the present study was to establish the role of dyssynchrony in the context of a viability study performed with nitrate augmentation gated single photon emission computed tomography (GSPECT) myocardial perfusion imaging (MPI). Methods. Fifty-four consecutive patients with ischemic dilated cardiomyopathy (IDC) and depressed left ventricular ejection fraction (LVEF) were included. They underwent a two-day rest/ nitroglycerine (NTG) study GSPECT MPI to determine the myocardial viability. Patients with a nitrate-induced uptake increase of > 10% vs baseline, in at least, two consecutive dysfunctional segments were considered viable as well as those who showed no improvement in the uptake but the uptake was > 50% on post NTG study. Patients with no nitrate-induced uptake increase of > 10% and the uptake of < 50% were considered non-viable. Perfusion, function and LVCD were compared in 25 viable patients vs 29 non-viable patients at baseline and after NTG administration. Results. After NTG administration, in the viable group, the LVEF increased (36.44 ± 6.64% vs 39.84 ± 6.39%) and the end-systolic volume decreased significantly (119.28 ± 31.77 mL vs 109.08 ± 33.17 mL) (P < 0.01). These patients also experienced a significant reduction in the LVCD variables: phase standard deviation was reduced in the post NTG study (57.77°± 19.47°vs 52.02°± 17.09°) as well as the phase histogram bandwidth (190.20°± 78.83°vs 178.0°± 76.14°) (P < 0.05). Functional and LVCD variables remained similar in the non-viable patients (P > 0.05). Conclusion. In patients with IDC and depressed LVEF, the myocardial viability detected by rest/ NTG GSPECT MPI, might determine LVCD improvement. (J Nucl Cardiol 2020) Key Words: GSPECT MPI AE myocardial viability AE left ventricular contraction dyssynchrony AE ischemic dilated cardiomyopathy Electronic supplementary material The online version of this article (

Journal of Nuclear Cardiology, 2016

Combined assessment of perfusion and function improves diagnostic and prognostic power of gated-S... more Combined assessment of perfusion and function improves diagnostic and prognostic power of gated-SPECT in patients with coronary artery disease. The aim of this study was to investigate whether the presence of stress-induced ischemia is associated with abnormal resting left ventricular (LV) function and intraventricular dyssynchrony. Gated-SPECT myocardial perfusion imaging (MPI) at rest and 15 min post-stress was performed in 101 patients, who were divided into three groups: those with stress-induced ischemia (Group 1, n = 58), those with normal scans (Group 2, n = 28), and those with scar but no ischemia (Group 3, n = 15). More extensive perfusion defects were found in patients of Groups 1 and 3 [Summed stress score (SSS): 13 ± 8 and 21 ± 9, respectively]. In Group 2, the mean SSS was 1.5. The mean change in LV ejection fraction (LVEF at stress - LVEF at rest) was higher in Group 1 v. Group 2 patients: -5.54% ± 6.24% vs -2.46% ± 5.56%, p = 0.02. Group 3 patients also had higher values, similar to Group 1: -6.47% ± 8.82%. Patients with ischemia had almost 50% higher end-diastolic volumes than patients with normal MPI. Similarly, end-systolic volumes were almost twice as high in this group (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.0001). In addition, the histogram bandwidth, a measure of intraventricular dyssynchrony, was greater in Group 1. Baseline differences in left ventricular volumes and degree of dyssynchrony are associated with inducible ischemia on stress testing in a gated-SPECT MPI. Stress-induced ischemia increases the degree of intraventricular dyssynchrony.

Nuclear Medicine Communications, 2015

Objective The aim of the study was to identify the possible association among myocardial perfusio... more Objective The aim of the study was to identify the possible association among myocardial perfusion imaging (MPI) variables, coronary calcium score (CCS), and adverse events at medium term in type 2 asymptomatic diabetes mellitus patients. Materials and methods Patients who participated in a first study that included a stress-rest MPI and a CCS assessment were asked to take part in this study. The present study protocol required a control single-photon emission computerized tomography after 3 years. Forty-one patients gave their informed consent. Results Of the 41 patients, 13 (32%) showed perfusion defects at the initial MPI. Of them, at 3 years, five continued showing perfusion defects, whereas another two had new defects (incidence of ischemia of 17%). Thus, 61% of the initial positive MPIs were normal at 3 years (P = 0.04). In these cases the therapy was modified between the two studies. Left ventricular ejection fraction at stress showed a slight increase at 3 years (P = NS). Ventricular volumes significantly decreased at 3 years (P < 0.01). Three patients (7.3%) developed an event during the follow-up (FU): two noncardiac deaths and one non-ST elevation myocardial infarction. The only variables that showed a possible association with the occurrence of events at FU were a CCS higher than 100 and less than 5 metabolic equivalents (METS) reached during the stress test (P = 0.01). Conclusion A CCS higher than 100 and a low functional capacity (< 5 METS), but not an abnormal MPI, can be associated with cardiac events at 3-year FU in asymptomatic type 2 diabetic patients. Nucl Med Commun

Journal of Nuclear Cardiology, 2007

Background: Cardiovascular events increased as the glomerular filtration rate (GFR) declined. Ear... more Background: Cardiovascular events increased as the glomerular filtration rate (GFR) declined. Early diagnosis of CVD by myocardial perfusion imaging (MPI), might have an important impact on long-term outcomes. The aim of this study was to evaluate the prognostic value of MPI in pts with decreased GFR. Methods: The study population consisted of 137 pts that underwent a stressredistribution Tl-201 SPECT MPI and had an estimated GFR of less than 60 ml/min (mean eGFR was 26.3Ϯ16.4 mg/dl). MPI was visually assessed and defined normal or abnormal MPI by the presence thallium defects either fixed, reversible or combined. The follow up period was 18 month minimum after nuclear testing. Cardiac events (CE) were classified as hard events (HE), defined as either cardiac death or nonfatal myocardial infarction and soft events (SE) as coronary revascularization (PCI or CABG) or unstable angina hospitalization. Comparison between patient groups with and without CE was assessed by use of the chi-square test. Results: The mean age patient population was 67.4Ϯ9.6 years old, 100 of the pts (73%) were male. Normal MPI was present in 42(30.7%) of the pts. During the follow-up period, 47 (34.3%) pts developed CE (HE ϭ22and SEϭ25). In comparison with those that did not have any CE, they were significantly older and had more often a previous history of CAD (70.2 vs 38.9%, pϭ 0.0005). No significant differences were observed between the two groups regarding: gender, incidence of risk factors (hypertension, diabetes, hypercholesterolemia, smoking), PVD, resting ECG. However, a significant difference in MPI results was present between the groups, 45 (95.7%) of the 47 pts that developed a CE showed an abnormal MPI, in contrast to only 2 (4.3%) with a normal MPI, pϽ 0.0001. Moreover, none of the 22 pts that develop a HE had a normal MPI. While, 50 pts (55.6%) without any CE showed an abnormal MPI. Resulting in a negative and positive predictive value of 95.2% and 47.4%, respectively. Conclusions: In patients with decreased estimated glomerular filtration rate, a normal stress MPI indicates a low risk patient group. However, MPI abnomality confers a poor prognosis. Stress Tl-201 SPECT MPI significantly improves the risk stratification in this high risk population.

Journal of Nuclear Cardiology, 2011

Background. Coronary artery disease is a leading cause of death among diabetics, and silent ische... more Background. Coronary artery disease is a leading cause of death among diabetics, and silent ischemia is a major concern in patients with diabetes mellitus (DM). Methods. To detect the prevalence of ischemia in diabetics by myocardial perfusion imaging (MPI), and compare it to a control group without DM but with coronary risk factors, as well as to explore the relationship between silent ischemia, endothelial dysfunction, and coronary calcium, 59 patients (Group I) and 42 controls (Group II) were included. All underwent clinical and laboratory evaluations, gated MPI, brachial artery vasodilation measured by ultrasonography, and coronary calcium score (CCS). Results. Twenty diabetics showed perfusion defects, vs seven controls (P 5 .04). There was no significant difference between both groups regarding the brachial artery vasodilator responsiveness: 4.49% ± 4.26% (diabetics) vs 4.70% ± 4.98% (controls). Mean CCS was 74 in diabetics vs five in controls (P 5 .01). The only risk factor significantly associated with an abnormal MPI was the presence of diabetes (P 5 .03). In the whole population of patients and in diabetics, the abnormal endothelium-dependent vasodilation, the CCS >100, and the cholesterol/HDL ratio >4, showed an OR >1. CCS exhibited the higher OR among the whole population: OR 2.15 [95% CI 0.42-10.99]; while for diabetics it was the cholesterol/HDL ratio: OR 3.95 [95% CI 0.71-21.84]. Conclusions. Reversible perfusion defects and coronary calcium are more frequent in diabetics. CCS, abnormal endothelium-dependent vasodilation, and cholesterol/HDL ratio higher than 4, showed an association with perfusion abnormalities in asymptomatic diabetics.

Coronary Artery Disease, 2012

Objective To assess the ability of rest myocardial perfusion imaging (MPI) to rule out an acute c... more Objective To assess the ability of rest myocardial perfusion imaging (MPI) to rule out an acute coronary syndrome (ACS) in emergency department patients, as well as to investigate whether there exists a concordance between MPI and coronary calcium. Materials and methods Fifty-five patients with chest pain and a normal or nondiagnostic ECG were included. Clinical follow-up was carried out within 1 year. Results Sixteen patients (29%) showed an abnormal rest MPI, and in 11 (20%) the MPI was equivocal. There was a weak concordance between MPI and coronary arteries calcium score (CACS) (j: 0.25). Coronary angiogram driven by a positive MPI was performed in 12 patients (23%), resulting in percutaneous coronary intervention in nine cases (75%). A positive MPI (abnormal or equivocal results) was associated with the occurrence of events in the follow-up (v 2 = 19.961, P < 0.0001). For a patient presenting to the emergency department with acute chest pain and a normal or nondiagnostic ECG, with a positive MPI, the relative risk of having events during the first year was 7.5 (95% confidence interval: 2.8-19.2), P < 0.05, but with a positive CACS this was 1.77 (95% confidence interval: 0.69-4.56), P = NS. At 1 year 68.6% of patients were free of events. Conclusion Patients presenting with acute chest pain and a low-to-intermediate likelihood of coronary artery disease with a normal rest MPI have a very low probability of cardiac events during the first year. Coronary calcium score was not helpful in risk-stratifying these patients. Coron Artery Dis 23:438-444

Clinical Nuclear Medicine, 2014

The purpose of this study was to evaluate the ability of rest gated SPECT myocardial perfusion im... more The purpose of this study was to evaluate the ability of rest gated SPECT myocardial perfusion imaging (MPI) and intraventricular synchronism, to identify heart failure (HF) patients most likely to experience cardiac events. Methods: We studied 165 patients with left ventricular ejection fraction of less than 40%, who were divided in 2 groups according to the diagnosis of coronary artery disease (group 1: 136 patients) or not (group 2: 29 patients). All underwent a rest gated SPECT MPI. Results: In 160 patients, the MPI was abnormal. Mean summed rest score was 17 T 6 (group 1) versus 10 T 6 (group 2), P G 0.0001. Mean volumes showed a marked ventricular dilation, slightly higher among nonischemic. The mean value of the phase-derived SD was 70 T 19 (group 1) versus 59 T 21 degrees (group 2), P = 0.016. The histogram bandwidth showed no significant differences. Forty-four (39%) of 114 patients showed some kind of event during the follow-up. The more frequent events were HF progression (13%) and acute coronary syndrome (11%). The highest odds ratios for prediction of events were 1.91 (phase SD), 1.66 (etiology), and 1.55 (summed rest score), although the association was not significant. Conclusions: A rest gated SPECT is a valid approach to identify HF patients most likely to experience cardiac events.

Value in Health, Nov 1, 2010

diagnoses during 2007 in the SouthWest region of Sweden. Sixty-two percent of the patients had at... more diagnoses during 2007 in the SouthWest region of Sweden. Sixty-two percent of the patients had at least one visit to the primary care, 35% had been treated as outpatient , 9% had been treated by private physician, and 7% had been treated by in-patient care; 73% had at least one dispensed drug. The total health care cost, including drug cost, was 683 million SEK. 35% were from drugs and 23%, 26%, 14%, and 1% were from in-patient, outpatient , primary, and private care. During 2007 the average drug cost per patient, who utilize the current treatment, was 8847 SEK for drugs. The average cost for in-patient care was 64,576 SEK and 13,859 SEK for outpatient care. For primary and private care the average cost was 4268 SEK and 1342 SEK. CONCLUSIONS: The cost for antidepressant drugs was the largest part of the total health care cost for MDD, 35%. The in-patient care was the greatest cost per patient. The relevant question is what mix of drugs should be prescribed in order to minimize the total health care cost. Further research needs to be preformed.