ORIGINAL ARTICLES 

The Quarterly Journal of Nuclear Medicine 2002 December;46(4):323-30

Copyright © 2009 EDIZIONI MINERVA MEDICA

language: English

Nuclear medicine procedures in cardiovascular diseases. An evidence based approach

Acampa W. ^{1, 3}, Petretta M. ², Cuocolo A. ^{1, 3}

¹ Department of Biomorphological and Functional Sciences Biostructure and Bioimaging Institute of the National Council of Research (CNR), Naples, Italy 2 Institute of Internal Medicine, Cardiology and Heart Surgery University Federico II, Naples, Italy 3 RCCS Neuromed, Pozzilli, Italy

The aim of evi­dence-­based med­i­cine is to inte­grate indi­vidual clin­ical exper­tise ­with the ­best avail­able ­external clin­ical evi­dence ­from system­atic ­research. The aim of ­this ­article is to intro­duce the con­cept of evi­dence ­based med­i­cine and to ­review the evi­dence for ­applying car­di­o­vas­cular ­nuclear med­i­cine in var­ious clin­ical set­tings. A system­atic ­review is ­defined as a sci­en­tific tech­nique to iden­tify and sum­marize evi­dence on effec­tive­ness of inter­ven­tions and to ­allow the con­sis­tency of ­research. Dif­ferent clin­ical appli­ca­tions of ­nuclear med­i­cine pro­ce­dures in car­di­ology ­have ­been ­reviewed. Radio­nu­clide ­imaging tech­niques ­appear to be appro­priate in ­risk assess­ment, prog­nosis and eval­u­a­tion of ­therapy in ­patients ­after ­acute myo­car­dial infarc­tion. In ­patients ­with ­unstable ­angina, radio­nu­clide ­testing is indi­cated in the iden­tifi­ca­tion of ­ischemia ­within the dis­tri­bu­tion of the “cul­prit” ­lesion or in ­remote ­areas. Exer­cise and phar­mac­o­log­ical car­diac per­fu­sion ­imaging are appro­priate and ­useful in the diag­nosis and prog­nosis of ­chronic cor­o­nary ­artery dis­ease. ­Nuclear med­i­cine pro­ce­dures are ­also ­useful in the assess­ment of myo­car­dial ­viability in ­patients ­with ­left ven­tric­ular dys­func­tion, in the assess­ment of inter­ven­tions for the eval­u­a­tion of ­patients ­after per­cut­aneous trans­lu­minal cor­o­nary angio­plasty and cor­o­nary ­artery ­bypass ­grafting. ­There has ­been ­rapid evo­lu­tion in radio­nu­clide ­imaging tech­nol­o­gies and ­both the ­number and the com­plexity of ­choices for the cli­ni­cian ­have ­increased. Fur­ther ­progress in tech­nology and clin­ical appli­ca­tions of ­nuclear car­di­ology may be ­expected. The devel­op­ment of new instru­men­ta­tion and of new ­agents ­will ­allow con­sis­tent ­progress and ­improve the ­state-of-art of ­nuclear car­di­ology. ­Thus, guide­lines for the use of car­diac radio­nu­clide ­imaging ­have ­been dif­fi­cult to ­develop and ­apply. An evi­dence-­based ­approach may be ­useful for the ­best use of ­nuclear med­i­cine pro­ce­dures in car­di­o­vas­cular dis­eases.