Papers by Milena Henzlova
Journal of Nuclear Cardiology, Feb 19, 2014
A Comparison of Coronary CTA and Stress Testing Using High-Efficiency SPECT MPI for the Evaluatio... more A Comparison of Coronary CTA and Stress Testing Using High-Efficiency SPECT MPI for the Evaluation of Chest Pain in the Emergency Department'' per his request. Instead the authors would like to acknowledge and thank him for his contributions to the project including his thoughtful editing and revisions to the manuscript.
Journal of Nuclear Cardiology, Feb 12, 2009
Journal of Nuclear Cardiology, Feb 11, 2009
Journal of Nuclear Cardiology, Mar 27, 2019
PubMed, 1978
The effect of postextrasystolic potentiation [PESP] on left ventricular [LV] function was assesse... more The effect of postextrasystolic potentiation [PESP] on left ventricular [LV] function was assessed by means of left ventricular cineangiography in 26 patients with ischaemic heart disease. Ventricular extrasystoles were induced by a catheter inserted into the LV during injection of the contrast agent. The values of parameters of segmental and global function of LV, found in potentiated and nonpotentiated sinus contractions, were compared. Segmental disturbances present at rest in 13 patients improved or disappeared after extrasystole in 8 patients. Improvements in contraction also took place in segments with normal resting contraction. Global LV function improved significantly; an improvement was observed even without an increase in the LV end-diastolic volume in the postextrasystolic beat. The advantages and limitations of the method for preoperative estimation of the effect of intended myocardial revascularization on the LV function are discussed.
PubMed, 1980
Function of the left ventricle was evaluated in 28 men during the early postoperative period afte... more Function of the left ventricle was evaluated in 28 men during the early postoperative period after myocardial revascularization by left ventricular cineangiograms. The group was characterized by patency of all aorto-coronary grafts and the absence of a new Q waves on the ECG. Improvement of the global left ventricular function occurred in a sub-group of patients with reduced ejection fraction before operation as well as in patients with segmental disturbances of left ventricular contraction. The segmental contractions improved significantly in the revascularized areas where prior to operation the function was impaired. The postoperative change was in some patients predicted before operation by administration of sublingual nitroglycerin and by means of postextrasystolic potentiation. We found the same trend of changes produced by the above stimuli and by revascularization.
PubMed, 1978
In 25 patients with ischaemic heart disease the effect of nitroglycerin [NTG] on segmental and gl... more In 25 patients with ischaemic heart disease the effect of nitroglycerin [NTG] on segmental and global function of the left ventricle was assessed by means of left ventricular cineangiography. In 14 patients a segmental disturbance of contraction at rest was found; in six of them the function inproved after NTG. After NTG, the left ventricular diastolic volume, end-diastolic pressure, and systolic blood pressure decreased, the heart rate increased. The global left ventricular function did not significantly change. In patients with ischaemic heart disease NTG helps to differentiate reversible and irreversible disturbances of left ventricular contraction.
Journal of Nuclear Cardiology, Aug 28, 2019
See related article, pp. 888-897 Amazingly, in spite of the arrival of newer imaging methods (str... more See related article, pp. 888-897 Amazingly, in spite of the arrival of newer imaging methods (stress echocardiography, coronary CTA, cardiac MRI), cardiac SPECT myocardial perfusion imaging (MPI) remains the most commonly used noninvasive test for detection of obstructive epicardial coronary artery disease (CAD). The diagnostic and prognostic value of cardiac SPECT has been well studied and documented over the years, intermittently punctuated by the advent of new tracers (Tc-99m sestamibi and Tc-99m tetrofosmin), new camera technology (dual-head and high-efficiency cameras), and new stressors (adenosine and regadenoson). Regardless of the time period, the limits of SPECT MPI's diagnostic accuracy include both ''false negatives'' and ''false positives.'' It is now accepted that SPECT perfusion may underestimate the extent of multivessel disease (3 vessel and left main disease). The inclusion of additional clinical data, stress results (e.g., ECG changes, exercise capacity, blood pressure changes, symptoms), gated SPECT data (including left ventricular ejection fraction at rest and post-stress) may decrease the proportion of false negatives and at times alert the clinician to more significant coronary anatomy and physiology than just the ''doughnut'' pattern. On the opposite end of the spectrum are false positive findings, i.e., the detection of perfusion defects in the absence of anatomical epicardial CAD. Apart from technical reasons (poor equipment QC, patient motion, adjacent tracer activity, and processing errors), the most common source of imaging artifact is the presence of ''soft tissue attenuation.'' Photons originating in the Reprint requests: W.
Journal of Nuclear Cardiology, Jan 6, 2023
Journal of Nuclear Cardiology, Feb 27, 2019
Background. Although the diagnostic accuracy and prognostic utility of vasodilator stress MPI hav... more Background. Although the diagnostic accuracy and prognostic utility of vasodilator stress MPI have been well established in the non-acute setting, the efficacy of all of the vasodilator stressors in risk stratifying post-MI patients as well as the evaluation of cardiac troponin elevation of unclear etiology is not established. Accordingly, the aim of the present study was to investigate the prognostic efficacy of vasodilator stress MPI in the setting of elevated cardiac troponin to accurately risk stratify these higher-risk patients. Methods. All patients from two tertiary centers, from 1/1/2010 through 12/31/2012, with elevated cardiac biomarkers within < 7 days and undergoing stress SPECT MPI testing were studied. Results of stress MPI were scored using a 17-segment model based on semiquantitative scoring as normal or abnormal (mild, moderate, or severe) using a total perfusion defect (TPD) of 0%, 1-10%, 10-20%, and > 20%. Mortality data through the year 2014 were obtained from the National Death Index, and survival analyses were performed. The primary endpoint was all-cause mortality with the secondary endpoint being cardiac mortality. Results. A total of 503 patients were followed for an average of 33.6 ± 16.2 months, with a mean age of 69.3 years; 53.7% male; and a majority (88.7%) of them undergoing vasodilator stress. A significant increase in all-cause mortality was seen based on the severity of TPD results for all vasodilators (P < .0001) and regadenoson (P < .0001). Similar prognostic ability was seen for all-cause mortality. This association was maintained even after adjustment for cardiac risk factors, previous coronary disease, and troponin quartiles. MPI results (stress TPD and LVEF) added to traditional cardiac risk factors, and troponin values resulted in a significant incremental increase in the ability to predict all-cause and cardiac mortality, and stress TPD remained independently predictive for both all-cause and cardiac mortality in a multivariate model. Conclusion. Vasodilator stress (including regadenoson) MPI effectively risk stratifies patients with recently elevated cardiac biomarkers, with the increasing risk of mortality with the increasing severity of perfusion defects. It provides incremental prognostic value, in addition to clinical factors and degree of troponin elevation. (J Nucl Cardiol 2019
Journal of Nuclear Cardiology, Mar 26, 2019
Journal of Nuclear Cardiology, Jul 1, 2005
American Heart Journal, Apr 1, 1983
Seventeen patients with chronic aortic regurgitation (AR) were examined by echocardiography and l... more Seventeen patients with chronic aortic regurgitation (AR) were examined by echocardiography and left and right heart catheterization. Cardiac output and regurgitation volume were measured by the dye dilution method. Administration of single and four repeated doses of prazosin (PZ) led to reductions of left ventricular (LV) end-diastolic, end-systolic, and left atrial end-systolic diameters, and decrease of left ventricular filling pressure. Regurgitation fraction, regurgitation flow, and volume indexes decreased significantly (p less than 0.01). Total left ventricular output decreased (p less than 0.001) as did derived parameters of left ventricular work and performance. Fractional shortening, ejection fraction, and mean circumferential fiber shortening velocity increased as did LV dP/dt and dP/dt/P. Changes in heart rate and cardiac and stroke indexes after PZ were not significant. Preload reduction (dilation of the venous bed and reduction of regurgitation) seems to be the most important effect of PZ in AR. We found PZ to be a suitable and effective drug for oral treatment of chronic AR.
Journal of Nuclear Cardiology, Nov 15, 2012
Journal of Nuclear Cardiology, Jul 1, 2006
Sensitivity FIT(%) Sensitivity NC(%) SpecificityFIT(%) Specificity NC(%) Accuracy FIT(%) Accuracy... more Sensitivity FIT(%) Sensitivity NC(%) SpecificityFIT(%) Specificity NC(%) Accuracy FIT(%) Accuracy NC(%) GR 0.80* 0.78* 0.65* 4 13* 54 70 65 60** 59 65 CE 0.81* 3.5 12* 54 67 62 30 58 61 *pϽ0.0001 **pϽ0.02
Journal of Nuclear Cardiology, Jul 1, 2006
Background: Single photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI)... more Background: Single photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) is a powerful noninvasive diagnostic and prognostic tool in patients with suspected coronary artery disease (CAD) with a Ͻ1% annual cardiac event rate in patients with normal studies. However, the length of the test and radiation exposure are often cited as negative attributes. In traditional rest-stress studies where the stress perfusion is normal, the rest portion of the test appears to be redundant. The purpose of our study was to ascertain the prognosis of a normal stress-only SPECT MPI study. Methods: We retrospectively analyzed the 3 month prognosis of all patients who had Tc-99m gated stress SPECT imaging between January 2004 and March 2005 using a single stress dose of isotope. Patients with abnormal stress MPI were scheduled for follow-up rest imaging. Stressors included exercise or coronary vasodilators (dipyridamole or adenosine). The decision not to perform the rest part of the study was decided by the attending nuclear cardiologist based on available clinical data, rest ECG's, patient's weight, and level of cooperation. Pre-test probability of CAD was calculated using a validated clinical score. Patients with documented CAD were classified as high pre-test probability. A normal stress study was defined as the absence of perfusion defects on stress images and an ejection fraction of 50%. Three month survival was assessed in all patients through medical records and the Social Security Death Index. Results: A total of 379 patients were found where 53% were female with a mean age 52 Ϯ 14 years and 47 (12%) had diabetes with 7 (2%) having known CAD. The pre-test probability of CAD was high in 39 (10.3%), intermediate in 205 (54.1%), and low in 135 (35.6%). Normal stress perfusion and normal LVEF was present in 326 (86%) patients; 14 patients (4%) had normal perfusion but abnormal ejection fraction (cardiomyopathy); and 39 patients (10%) had abnormal perfusion. Of those with a normal "stress-only" MPI study, 8 patients (2.5%) had died by 3 months. Six patients (1.5%) died of noncardiac causes and the cause of death in 2 patients (0.5%) was unknown and was considered cardiac. Therefore, based on a worse case scenerio, the 3 month cardiac mortality in this cohort was Յ0.5%. Conclusions: Normal "stress-only" gated Tc-99m SPECT MPI imaging has excellent short-term prognosis. The shortened test duration, lower received radiation dose, and excellent prognosis suggest that the "stress-only" study is an attractive option in appropriately selected patients.
JAMA, Jul 18, 2007
Context Computed tomography coronary angiography (CTCA) has become a common diagnostic test, yet ... more Context Computed tomography coronary angiography (CTCA) has become a common diagnostic test, yet there are little data on its associated cancer risk. The recent Biological Effects of Ionizing Radiation (BEIR) VII Phase 2 report provides a framework for estimating lifetime attributable risk (LAR) of cancer incidence associated with radiation exposure from a CTCA study, using the most current data available on health effects of radiation. Objectives To determine the LAR of cancer incidence associated with radiation exposure from a 64-slice CTCA study and to evaluate the influence of age, sex, and scan protocol on cancer risk. Design, Setting, and Patients Organ doses from 64-slice CTCA to standardized phantom (computational model) male and female patients were estimated using Monte Carlo simulation methods, using standard spiral CT protocols. Age-and sex-specific LARs of individual cancers were estimated using the approach of BEIR VII and summed to obtain whole-body LARs. Main Outcome Measures Whole-body and organ LARs of cancer incidence. Results Organ doses ranged from 42 to 91 mSv for the lungs and 50 to 80 mSv for the female breast. Lifetime cancer risk estimates for standard cardiac scans varied from 1 in 143 for a 20-year-old woman to 1 in 3261 for an 80-year-old man. Use of simulated electrocardiographically controlled tube current modulation (ECTCM) decreased these risk estimates to 1 in 219 and 1 in 5017, respectively. Estimated cancer risks using ECTCM for a 60-year-old woman and a 60-year-old man were 1 in 715 and 1 in 1911, respectively. A combined scan of the heart and aorta had higher LARs, up to 1 in 114 for a 20-year-old woman. The highest organ LARs were for lung cancer and, in younger women, breast cancer. Conclusions These estimates derived from our simulation models suggest that use of 64-slice CTCA is associated with a nonnegligible LAR of cancer. This risk varies markedly and is considerably greater for women, younger patients, and for combined cardiac and aortic scans.
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Papers by Milena Henzlova