Dr Mayowa Kolade, a consultant nuclear medicine specialist at the University College Hospital, Ibadan, in this interview with SADE OGUNTOLA, speaks about how a new imaging examination, the first in a public hospital, promises to revolutionize the detection and treatment of heart problems, including survival from heart failure in Nigeria.
This is the first time cardiac amyloid scintigraphy is provided in Nigeria’s public health space, how were you able to bring this to UCH, Ibadan
A: A tree does not make a forest, so this was, by GOD’s grace, a collaborative effort between the cardiology department of UCH and the nuclear medicine department, (with our exceptional team of doctors, radio-pharmacists, radiographers, medical physicists, nurses and support staff) and under the auspices of the management and leadership of the hospital under the Chief Medical Director – Prof Jesse Otegbayo, within the umbrella of the Federal ministry of health and social welfare.
Very many hurdles were surmounted to make this possible and available. Many limitations exist, and we hope the governmental agencies and well-meaning philanthropists will enable our provision of world-class services for which we have highly trained and internationally credentialed personnel who have sacrificed to stay back in the country against all odds.
Can you explain what cardiac amyloid scintigraphy does in nuclear medicine?
A: Imagine having a condition where abnormal proteins accumulate in your heart, threatening to disrupt its normal function-ing, and affecting its ability to pump blood efficiently. This is what happens in cardiac amyloidosis, a serious health issue that can lead to heart failure. Fortunately, a specialized imaging test called cardiac amyloid scintigraphy helps doctors diagnose and monitor this condition.
Cardiac amyloid scintigraphy is a non-invasive imaging test that helps doctors diagnose and monitor cardiac amyloidosis. The test uses a small amount of a harmless radioactive tracer to detect these amyloid deposits.
How does it work? A small amount of a harmless radioactive tracer is injected into the bloodstream through a vein (the blood vessel) in the arm. This tracer specifically targets and binds to the abnormal amyloid proteins in the heart.
After the injection, the patient lies on a table, and a special camera called a gamma camera takes detailed images of the heart.
This camera detects the radioactive tracer and creates pictures showing where the amyloid proteins have accumulated. The entire process typically takes about 30 minutes to an hour. Patients can resume normal activities immediately after the test, as the radioactive tracer poses no risk. The results provide valuable in-sights, enabling doctors to develop personalized treatment plans tailored to each patient’s needs.
Why will a doctor order cardiac amyloid scintigraphy?
Doctors order cardiac amyloid scintigraphy to diagnose cardiac amyloidosis, monitor disease progression, evaluate treatment effectiveness, identify the type of amyloidosis, and rule out other heart conditions.
For instance, if a patient experiences unexplained heart failure, abnormal heart rhythms, or thickened heart muscle, a doctor may suspect cardiac amyloidosis. This test helps confirm or rule out the diagnosis.
Additionally, cardiac amyloid scintigraphy guides treatment deci-sions. By monitoring the extent of amyloid buildup, doctors can adjust medication, plan future treatments, or assess the effectiveness of current therapies.
What advantages does a cardiac amyloid scan have over the previous methods used to diagnose cardiac amyloid?
A: Cardiac amyloid scintigraphy has revolutionized the diagnosis and monitoring of cardiac amyloidosis, offering significant advantages over previous methods. Unlike traditional heart biopsies, cardiac amyloid scans are non-invasive and pain-free.
This reduces the risk of complications and makes the diagnostic process more comfortable for patients. The scan provides rapid results, typically within hours or days, whereas traditional biopsy results may take weeks or even longer.
Also, the scan’s high sensitivity and specificity enable accurate detection of amyloid deposits, reducing false positives and negatives. It can assess the entire heart, providing a comprehensive understanding of amyloid distribution and extent with any risk of complications like bleeding, infection, or damage to organs surrounding the heart.
Of course, periodic scans (if required) enable doctors to track disease progression, assess treatment effectiveness, and adjust plans accordingly, whilst minimizing the need for repeat biopsies, reducing patient discomfort and risk. So, the scan results can inform personalized treatment plans, ensuring targeted therapies and improved patient outcomes.
Compared to endomyocardial biopsy (which is invasive, carries risks, and only samples a small area, echocardiography (which has limited sensitivity and specificity for amyloid detection), and MRI (which though can be very useful, may not detect amyloid deposits as accurately), cardiac amyloid scintigraphy offer a significant improvement in diagnostic accuracy, safety, and patient comfort.
The introduction of cardiac amyloid scintigraphy has transformed the diagnostic landscape, enabling earlier detection, more effective treatment, and improved patient outcomes. As nuclear medicine continues to evolve, patients can expect even more advanced diagnostic tools and personalized care.
What is the implication of late diagnosis of Cardiac Amyloidosis?
A: If cardiac amyloidosis is not diagnosed early, it can lead to severe consequences. The condition can progress silently, causing irreversible damage to the heart. Late diagnosis can result in heart failure (where the heart struggles to pump enough blood), abnormal heart rhythms (increasing the risk of sudden cardiac death, reduced quality of life (with symptoms worsening over time), fewer treatment options (reducing the chances of effective management), and increased risk of complications such as heart attacks, strokes, and kidney damage.
Early detection of cardiac amyloidosis is crucial to prevent long-term damage and improve treatment outcomes.
With timely diagnosis, doctors can develop personalized treatment plans to slow disease progression, monitor the condition closely to adjust treatment as needed, and improve quality of life by managing symptoms effectively.
If you or a loved one experiences unexplained shortness of breath, fatigue, or swelling, consult a doctor, especially a heart health specialist (cardiologist). Early diagnosis and treatment can significantly improve cardiac amyloidosis outcomes. Therefore, via regular check-ups, monitoring of symptoms, and seeking medical attention promptly, individuals can take proactive steps to protect their heart health.
What should Nigerians expect with the introduction of cardiac amyloid scintigraphy into public services in Nigeria’s healthcare service? How will it transform the care of persons with heart problems?
A: Nigerians can expect a significant boost in heart health care with the introduction of cardiac amyloid scintigraphy into the country’s public healthcare services at the Department of Nu-clear Medicine, University College Hospital, Ibadan. This advanced imaging test will improve diagnosis, patient care, and health outcomes for those affected by cardiac amyloidosis. Accurate detection and tailored treatments will reduce misdiagnosis, delayed treatment, and complications. Nigerians will no longer need to travel abroad for advanced care, reducing costs and increasing accessibility.
Local research and collaborations will also advance the understanding of cardiac amyloidosis in the Nigerian population.
Healthcare professionals will benefit from training and capacity building in cardiac amyloid scintigraphy, enhancing their expertise. Awareness campaigns will educate the public about cardiac amyloidosis symptoms, promoting early detection. Overall, cardiac amyloid scintigraphy (alongside additional cardiac scintigraphy modalities we are introducing soon) will revolutionize heart health care in Nigeria, leading to better quality of life and survival rates for patients.
What is a cardiac scintigraphy scan bringing to the table for other conditions, aside from cardiac amyloidosis?
A: Cardiac scintigraphy is a helpful tool for many heart conditions. It assists doctors in diagnosing heart diseases like coronary artery disease (narrowing or blockage of heart arteries) and heart failure (heart unable to pump enough blood), and monitoring treatment effectiveness; the detection of heart problems related to cancer treatment and other diseases like sarcoidosis (inflammatory cells in organs) and to detecting dead or damaged heart muscle while also making it possible to be able to assess if a transplanted heart is function properly.
These nuclear medicine diagnostic tests provide personalized care, leading to better health outcomes.
Researchers also use cardiac scintigraphy to study heart diseases and develop new treatments. In essence, cardiac scintigraphy helps doctors understand the heart’s condition, make accurate diagnoses, and provide effective care.
How is this test going to reduce increasing cases of deaths from heart problems in Nigeria?
A: Cardiac scintigraphy and cardiac amyloid scans will significantly reduce heart-related deaths in Nigeria. These tests enable early detection, accurate diagnosis, and effective monitoring, allowing for personalized care and improved health outcomes.
By making advanced diagnostic tools available locally, Nigerians will no longer need to travel abroad for care, reducing delays and complications. These tests will also promote awareness and education among patients, families, and healthcare professionals.
Additionally, the data from these tests will inform local research and guidelines on heart disease management, tailoring treatment to the Nigerian population’s needs. Overall, these advanced diagnostic tools will enhance cardiovascular health, improve quality of life, and reduce heart-related deaths in Nigeria.
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What other things do nuclear medicine do its prompt diagnosis both in UCH and Nigeria?
A: Nuclear medicine facilitates prompt diagnosis in several areas, including capacity for cancer diagnosis and staging: detecting cancer cells. tracking spread, and monitoring treatment; guiding biopsies and cancer treatment and identifying sources of occult infection, prosthetic joint infection and differentiating infection from inflammation.
Diagnosing and treating hyperthyroidism, hypothyroidism, and thyroid cancer can also be done through nuclear medicine, likewise bone scans for cancer, metastases, and non-cancerous bone-related/orthopaedic conditions.
Other uses of nuclear medicine include evaluation of kidney function if there are damages, obstruction or any disease; diagnosing and monitoring liver and gall-bladder function and/or disease; assessment of the intestine and stomach for bleeding problems or poor bowel function; as well as in detecting portions of the brain at risk for a stroke, differentiating recurrent brain tumours from mimics and confirming diagnoses of Parkinson’s disease, Alzheimer’s and other dementias.
Nuclear medicine at the UCH Ibadan leads in a new field called theranostics where molecularly targeted radionuclide therapy can be administered for advanced cancers. Lutetium-177 PSMA treatment for advanced prostate cancer will be starting a few months from now, GOD willing.