Clinical Applications of Radionuclide Cardiac Imaging; Computer Image Quantification
Radionuclide cardiac imaging allows for noninvasive assessment of cardiac function and regional blood flow. Dr. Wackers’ interest is specifically directed towards cardiac imaging of patients with acute ischemic syndromes: acute infarction and unstable angina. Radionuclide imaging is an intrinsically quantitative methodology since emanated photons generate digital image data. Quantification of images is of clinical importance since the degree of abnormalities is directly related to patients¹ prognosis and outcomes.
Work in our laboratory has shown that acute ischemia can reliably be detected by noninvasive imaging of intravenously administered radiotracers that accumulate in the heart proportional to blood flow. In acute heart attacks the area at risk for infarction can be visualized and quantified. The results and effectiveness of interventions that restore blood flow can thus be quantified noninvasively as well. We have pioneered the use of radionuclide imaging for evaluating and triaging patients with acute chest pain in the emergency department. A long time focus of research and development in our laboratory has been on the reliable and reproducible quantification of regional abnormalities in blood flow during physical and pharmacological stress. These methods have been applied to a number of clinical trials with new radiotracers.
The laboratory has also been the central radionuclide core laboratory for numerous multicenter clinical trials using radionuclide imaging as endpoints. The laboratory has the capability to convert image data acquired on a wide variety of computers to one uniform format, for uniform image data analysis. The laboratory performed comparative studies on the clinical effectiveness using a number of new radiotracers for cardiac imaging under a variety of acute and chronic clinical conditions. Another recent area of interest is the development of pathways and algorithms for optimal and cost-effective utilization of various noninvasive imaging modalities.
- Tandon S, Wackers FJTh, Inzucchi SE, Bansal S, Staib LH, Chyun DA, Davey JA, Young LH. Gender-based divergence of cardiovascular outcomes in asymptomatic patients with type 2 diabetes. Results from the DIAD study. Diabetes Vasc Dis Res 2012 (in press)
- Jain M, Nkonde C, Lin BA, Walker A, Wackers FJTh. 85% of maximal age-predicted heart rate is not a valid endpoint for exercise testing. J Nucl Cardiol 18: 1026-1035, 2011.
- Bansal S, Wackers FJTh, Inzucchi SE, Chyun DA, Davey JA, Staib LH, Young LH, for the DIAD Investigators. Five-Year Outcomes in “High-Risk” Participants in the Detection of Ischemia in Asymptomatic Diabetics (DIAD) Study. A Post-Hoc Analysis. Diabetes Care 2011; 34:204-209.
- Young LH, Wackers FJTh, Chyun DA, Davey JA, Barrett EJ, Taillefer R, Heller GV, Iskandrian AE, Wittlin SD, Filipchuk N, Ratner RE, Inzucchi SE, for the DIAD investigators. Cardiac outcomes after screening for asymptomatic coronary artery disease in patients with type 2 diabetes in the DIAD study. A randomized controlled trial. JAMA 2009; 301: 1547-1555.
- Wackers FJTh. Customized exercise testing. Editorial Comment. J Am Col Cardiol 2009; 54: 546-548
- Wackers FJTh, Bruni W, Zaret BL. Nuclear Cardiology, The Basics How to Set Up and Maintain a Laboratory. Second Edition, Humana Press, NJ, 2007.
- Wackers FJTh, Chyun DA, Young LH, Heller GV, Iskandrian AE, Davey JA, Barrett EJ, Taillefer R, Wittlin SD, Filipchuk N, Ratner RE, Inzucchi SE. Resolution of Asymptomatic Myocardial Ischemia in Patients with Type 2 Diabetes in the Detection of Ischemia in Asymptomatic Diabetes DIAD Study. Diabetes Care 30:2892-2898, 2007.
- Russell RR, Abbott BG, Arrighi JA, Mengel FM, Cohen MC, Garcia EV, Hendel RC, Holly TA, Mieres JH, Shaw LJ, Thomas GS, Thompson RC, Wackers FJTh, Bax JJ. Highlights of the 2007 Scientific Sessions of the American Society of Nuclear Cardiology. J Am Coll Cardiol 50:2336-2343, 2007.
- Abu-Khalaf M, Juneja V, Chung G, DiGiovanna M, Sipples R, McGurk M, Zelterman D, Haffty B, Reiss M, Wackers FJTh, Lee F, Burtness B. Long term assessment of cardiac function after dose –dense and –intense sequential doxorubicin (A), paclitaxel (T) and cyclophosphamide (C) as adjuvant therapy for high risk breast cancer. Breast Cancer Research and Treatment 104:341-349, 2007.
- Papaioannou GI, Kasapis C, Seip RL, Grey NJ, Katten D, Wackers FJTh, Inzucchi SE, Engel S, Taylor A, Young LH, Chyun DA, Davey JA, Iskandrian AE, Ratner RE, Robinson EC, Carolan S, Heller GV. Value of peripheral vascular endothelial function in the detection of relative myocardial ischemia in asymptomatic type 2 diabetic patients who underwent myocardial perfusion imaging. J Nucl Cardiol 12: 362-368, 2006.