Anna Rita Sorrentino

University of Naples Federico II, Napoli, Campania, Italy

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Publications (11)37.5 Total impact

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    ABSTRACT: We assessed coronary flow reserve (CFR) by sestamibi imaging in patients with typical chest pain, positive exercise stress test and normal coronary vessels.Thirty-five patients with typical chest pain and normal angiogram and 12 control subjects with atypical chest pain underwent dipyridamole/rest 99mTc-sestamibi imaging. Myocardial blood flow (MBF) was estimated by measuring first transit counts in the pulmonary artery and myocardial counts from SPECT images. Estimated CFR was expressed as the ratio of stress to rest MBF. Rest MBF and CFR were corrected for rate–pressure product (RPP) and expressed as normalised MBF (MBFn) and normalised CFR (CFRn). Coronary vascular resistances (CVR) were calculated as the ratio between mean arterial pressure and estimated MBF.At rest, estimated MBF and MBFn were lower in controls than in patients (0.98 ± 0.4 vs 1.30 ± 0.3 counts/pixel/s and 1.14 ± 0.5 vs 1.64 ± 0.6 counts/pixel/s, respectively, both p p=NS). Estimated CFR was 2.40 ± 0.3 in controls and 1.54 ± 0.3 in patients (p n was still higher in controls than in patients (2.1 ± 0.5 vs 1.29 ± 0.5, p p p r = −0.88, p SPECT might represent a useful non-invasive method for assessing coronary vascular function in patients with angina and a normal coronary angiogram.
    European journal of nuclear medicine and molecular imaging 10/2008; 35(9):1744. · 5.22 Impact Factor
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    ABSTRACT: We determined the impact of viability assessment by nitrate single-photon emission computed tomography (SPECT) on cardiac events during long-term follow-up in patients with previous myocardial infarction, impaired left ventricular (LV) function, and no evidence of inducible ischemia. Sestamibi SPECT after nitrate was performed in 93 medically treated patients with previous myocardial infarction and LV dysfunction (ejection fraction < 40%). Viability was defined as > or = 2 dysfunctional segments with preserved tracer uptake (> or = 55% of peak activity). Cardiac events were cardiac death, myocardial infarction and late revascularization. Sixty-five (70%) patients had evidence of viability at SPECT, whereas 28 (30%) did not. During 43 +/- 24 months of follow-up, cardiac events occurred in 32 (49%) of the 65 patients with viability and in 5 (18%) of the 28 patients without (P < .001). At Cox analysis, only the extent of viability predicted cardiac events (hazards ratio 1.6, 95% CI 1.3-2.0, global chi-square 14.3, P < .0001). Cumulative probability of event-free survival was 22% in patients with viability and 81% in those without (P < .001). The presence of viable myocardium at nitrate SPECT imaging predicts major cardiac events at long-term follow-up and the risk increases with the extent of viability.
    Journal of cardiac failure 11/2007; 13(9):765-8. · 3.07 Impact Factor
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    ABSTRACT: We assessed coronary flow reserve (CFR) by sestamibi imaging in patients with typical chest pain, positive exercise stress test and normal coronary vessels. Thirty-five patients with typical chest pain and normal angiogram and 12 control subjects with atypical chest pain underwent dipyridamole/rest (99m)Tc-sestamibi imaging. Myocardial blood flow (MBF) was estimated by measuring first transit counts in the pulmonary artery and myocardial counts from SPECT images. Estimated CFR was expressed as the ratio of stress to rest MBF. Rest MBF and CFR were corrected for rate-pressure product (RPP) and expressed as normalised MBF (MBF(n)) and normalised CFR (CFR(n)). Coronary vascular resistances (CVR) were calculated as the ratio between mean arterial pressure and estimated MBF. At rest, estimated MBF and MBF(n) were lower in controls than in patients (0.98 +/- 0.4 vs 1.30 +/- 0.3 counts/pixel/s and 1.14 +/- 0.5 vs 1.64 +/- 0.6 counts/pixel/s, respectively, both p < 0.02). Stress MBF was not different between controls and patients (2.34 +/- 0.8 vs 2.01 +/- 0.7 counts/pixel/s, p=NS). Estimated CFR was 2.40 +/- 0.3 in controls and 1.54 +/- 0.3 in patients (p < 0.0001). After correction for the RPP, CFR(n) was still higher in controls than in patients (2.1 +/- 0.5 vs 1.29 +/- 0.5, p < 0.0001). At baseline, CVR values were lower (p < 0.01) in patients than in controls. Dipyridamole-induced changes in CVR were greater (p < 0.0001) in controls (-63%) than in patients (-35%). In the overall study population, a significant correlation between dipyridamole-induced changes in CVR and CFR was observed (r = -0.88, p < 0.0001). SPECT might represent a useful non-invasive method for assessing coronary vascular function in patients with angina and a normal coronary angiogram.
    European journal of nuclear medicine and molecular imaging 09/2007; 34(8):1156-61. · 5.22 Impact Factor
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    ABSTRACT: We assessed coronary flow reserve (CFR) by sestamibi imaging in patients with type 2 diabetes without coronary artery disease and normal coronary vessels. Dipyridamole/rest technetium 99m sestamibi imaging was performed in 33 patients with type 2 diabetes without a history of coronary artery disease and normal coronary vessels at angiography and in 12 control subjects. Myocardial blood flow (MBF) was estimated by measuring first-transit counts in the pulmonary artery and myocardial counts from tomographic images. Estimated CFR was expressed as the ratio of stress MBF to rest MBF. Rest MBF and CFR were corrected for rate-pressure product and expressed as normalized MBF and normalized CFR. At rest, estimated MBF and normalized MBF were not different in control subjects versus patients (0.98 +/- 0.4 counts x pixel(-1) x s(-1) vs 1.42 +/- 0.9 counts x pixel(-1) x s(-1) and 1.14 +/- 0.5 counts x pixel(-1) x s(-1) vs 1.61 +/- 0.9 counts x pixel(-1) x s(-1), respectively). Conversely, stress MBF was higher in control subjects than in patients (2.34 +/- 0.8 counts x pixel(-1) x s(-1) vs 1.55 +/- 0.8 counts.pixel(-1) x s(-1), P < .01). Thus estimated CFR was higher in control subjects than in patients (2.40 +/- 0.3 vs 1.36 +/- 0.8, P < .0001). After correction for the rate-pressure product, normalized CFR was still higher in control subjects than in patients (2.10 +/- 0.5 vs 1.28 +/- 0.8, P < .001). Sestamibi imaging may detect impaired coronary vascular function in response to dipyridamole in type 2 diabetic patients without a history of coronary artery disease and with normal coronary arteries.
    Journal of Nuclear Cardiology 05/2007; 14(2):194-9. · 2.65 Impact Factor
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    ABSTRACT: We compared the prognostic value of 99mTc-tetrofosmin single-photon emission computed tomography (SPECT) after nitrate administration and positron emission tomography (PET) with 18F-fluorodeoxyglucose (FDG) in patients with ischaemic left ventricular (LV) dysfunction. Eighty-nine patients with previous myocardial infarction and LV dysfunction (LV ejection fraction 33 +/- 10%) underwent 99mTc-tetrofosmin SPECT under control conditions (baseline) and after sublingual administration of 10 mg of isosorbide dinitrate (nitrate). Within 1 week, all patients underwent PET imaging with 18F-FDG. Four patients were excluded because of inadequate FDG uptake caused by severe diabetes. Follow-up data were obtained by phone contact with patients and by review of hospital or physicians' records. Cardiac death, myocardial infarction and late revascularisation for unstable angina were considered as events. Follow-up data were not available in three patients. Follow-up was 96% complete at a mean period of 29 +/- 19 months. At baseline SPECT, 59 (72%) patients had evidence of viable myocardium, while 23 did not. Of these latter patients, 12 (52%) demonstrated viable myocardium after nitrate and 13 (56%) had preserved metabolic activity. Cardiac events (cardiac death, myocardial infarction and late revascularisation for unstable angina) occurred in 24 (29%) patients. Event-free survival was similar in patients with and patients without viable myocardium at baseline SPECT (p = 0.8). In contrast, event-free survival was lower in patients with viable myocardium at nitrate SPECT and PET compared to those without viable myocardium (both p<0.05). In patients with ischaemic LV dysfunction, the prognostic value of SPECT imaging after nitrate is comparable to that of PET metabolic imaging.
    European journal of nuclear medicine and molecular imaging 04/2007; 34(4):558-62. · 5.22 Impact Factor
  • Journal of Nuclear Cardiology 03/2007; 14(2):S9. · 2.65 Impact Factor
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    ABSTRACT: The aim of this study was to assess the relationship between brachial artery flow-mediated dilation (FMD) and coronary flow reserve (CFR) in patients with peripheral artery disease (PAD). Thirty patients who had PAD, who showed no cardiac symptoms, and who had normal stress SPECT cardiac imaging results and 28 control subjects underwent brachial artery FMD assessment by ultrasound and dipyridamole 99mTc-sestamibi imaging. Myocardial blood flow (MBF) was estimated by measuring first-transit counts in the pulmonary artery and myocardial counts from SPECT images. Estimated CFR was expressed as the ratio of MBF at stress to MBF at rest. Patients with PAD were separated into 2 groups according to the median value of overall FMD (6.85%): group 1 (n=15) with FMD above the median (mean+/-SD, 8.78%+/-1.3%) and group 2 (n=15) with FMD below the median (mean+/-SD, 5.14%+/-0.94%). FMD was significantly higher in control subjects (11.4%+/-3.4%) than in both groups of PAD patients (P<0.001 for both). In control subjects, estimated CFR was 2.2+/-0.4-significantly higher than CFR in both groups of PAD patients (P<0.001 for both). In addition, in PAD patients of group 1, estimated CFR was 1.5+/-0.4-higher than CFR in group 2 (1.0+/-0.4) (P<0.01). When all PAD patients were considered, a significant correlation between FMD and estimated CFR was observed (r=0.56, P<0.005). Estimated CFR is significantly lower in patients with PAD than in control subjects, and CFR impairment correlates with the degree of peripheral endothelial dysfunction.
    Journal of Nuclear Medicine 12/2005; 46(12):1997-2002. · 5.56 Impact Factor
  • Journal of Nuclear Cardiology 03/2005; 12(2). · 2.65 Impact Factor
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    ABSTRACT: This study compared coronary flow reserve (CFR) estimated by technetium 99m sestamibi imaging with the results obtained with intracoronary Doppler in patients with coronary artery disease. Intraobserver and interobserver reproducibility of the radionuclide-estimated CFR was also assessed. Fourteen consecutive patients (mean age, 54 +/- 7 years) with documented coronary artery disease in whom percutaneous coronary intervention was planned underwent dipyridamole (0.74 mg/kg) sestamibi imaging and intracoronary Doppler within 5 days. Myocardial blood flow (MBF) was estimated by measurement of first transit counts in the pulmonary artery and myocardial counts from single photon emission computed tomography images. Estimated CFR was expressed as the ratio of stress MBF to rest MBF. In the study vessels, CFR was 1.36 +/- 0.43 as estimated by sestamibi and 1.39 +/- 0.42 by intracoronary Doppler ( P = .69). A significant relationship between CFR estimated by sestamibi and CFR obtained by intracoronary Doppler was observed ( r = 0.85, P < .001). On Bland-Altman analysis, the mean difference between CFR by sestamibi and by Doppler was 0.03 and the intraclass correlation coefficients for intraobserver and interobserver reproducibility were high (all P < .001) for both global and regional CFR. This study demonstrates a good agreement between CFR estimated by sestamibi imaging and by intracoronary Doppler results and a lack of intraobserver and interobserver variability of this noninvasive approach.
    Journal of Nuclear Cardiology 12/2004; 11(6):682-8. · 2.65 Impact Factor
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    ABSTRACT: In patients with ischemic left ventricular (LV) dysfunction, myocardial perfusion imaging after nitrate administration may improve the identification of dysfunctional but viable myocardium. This study was designed to assess the relationship between tetrofosmin uptake after nitrate administration and metabolic activity as assessed by positron emission tomography (PET) in patients with ischemic LV dysfunction. Thirty-six patients with chronic myocardial infarction and LV dysfunction (ejection fraction, 35% +/- 6%) underwent resting technetium 99m tetrofosmin single photon emission computed tomography (SPECT) imaging under control conditions (baseline) and after sublingual administration of 10 mg isosorbide dinitrate. Within 1 week, all patients underwent metabolic PET imaging with fluorine 18-fluorodeoxyglucose. Tetrofosmin uptake and metabolic activity were measured in 13 segments/patient. Regional LV function was assessed in corresponding segments by echocardiography. On baseline tetrofosmin imaging, 53 (40%) of the 131 akinetic or dyskinetic segments had reduced (<55% of peak activity) tracer uptake. Of these segments, 14 (26%) showed enhanced tetrofosmin uptake after nitrate administration (>/=10% vs baseline) and the remaining 38 (74%) did not change. The sensitivity and specificity of baseline tetrofosmin SPECT for detecting preserved metabolic activity were 69% and 86%, respectively. After nitrate administration, the sensitivity was higher (81%, P <.05 vs baseline) whereas the specificity was not different (86%, P = not significant). Concordance between tetrofosmin SPECT and PET in differentiating viable and necrotic myocardium was observed in 94 (72%) of the 131 akinetic or dyskinetic segments at baseline (kappa = 0.35) and in 108 segments (82%) after nitrate administration (kappa = 0.53). After nitrate administration, tetrofosmin uptake in dysfunctional segments correlated with metabolic activity as assessed by fluorodeoxyglucose PET imaging better than baseline. Thus tetrofosmin SPECT after nitrate administration may improve the identification of ischemic but still viable myocardium in patients with chronic ischemic LV dysfunction.
    Journal of Nuclear Cardiology 01/2003; 10(6):599-606. · 2.65 Impact Factor