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Nuclear Stress Test for Heart Failure Can Identify More Than Blockages

By MedImaging International staff writers
Posted on 13 Aug 2008

A less invasive imaging test typically used to diagnose coronary disease may be used to detect one of the leading causes of heart failure.

Researchers from the Medical College of Georgia (MCG; Augusta, USA) are using a nuclear stress modality to look at how fast blood flows into the heart's left ventricle so that they can determine if it is having difficulty. When the ventricle fails to correctly fill with blood because it is stiff and unable to relax, it is termed diastolic dysfunction, accounting for 40-60% of patients with heart failure, according to the American Heart Association. When it occurs, the left side of the heart pumps too little blood while the right side continues to pump normally, and the lungs fill up with blood.

"If someone has a slow fill rate, that means the left ventricle is not relaxed enough to get enough blood,” said Dr. Dineshkumar Patel, internal medicine resident at MCG. "And if the left ventricle cannot receive enough blood, then it cannot collect enough blood to be pumped out to the rest of the body. There is a four-fold increase in morbidity and mortality when diastolic dysfunction is present in patients with coronary disease.”

It is easier for physicians to evaluate the systolic function using an echocardiogram and cardiac catheterization, according to Dr. Patel. An echocardiogram utilizes an ultrasound beam that travels through the front of the chest wall and lungs to the heart, while cardiac catheterization is a very invasive procedure using a thin plastic tube, which is inserted into an artery or vein in the arm or leg and advanced into the chambers of the heart.

"But not all patients can undergo this test because it is so invasive,” Dr. Patel added. "And it's difficult to diagnose diastolic dysfunction with these [tests] when the systolic function is normal because you can have a perfectly normal pumping heart and still have this condition.”

Dr. Patel and collaborator Dr. Vincent Robinson looked at 52 consecutive patients who underwent cardiac catheterization within 15 days of a nuclear stress test to evaluate the efficacy in diagnosing diastolic dysfunction. During a nuclear stress test, radioactive thallium is injected into the bloodstream to show how well blood flows to the heart muscle. Scans are taken shortly after an exercise test to show blood flow when the heart is stressed and two or three hours later to show blood flow during rest. "This test is usually used to identify blockages in the heart,” Dr. Patel explained. "But in addition to the blockages, we have demonstrated that it also shows the left ventricle filling pressure, thus giving us an excellent prognostic value in predicting diastolic dysfunction because when the filling pressure is too high, the left ventricle has a hard time receiving blood.”

Dr. Patel and the MCG nuclear cardiology researchers compared the diastolic filling pressure from the catheterization and from the nuclear stress test and found that the latter had 94% specificity in detecting diastolic dysfunction (i.e., high filling pressure at cardiac catheterization).

The nuclear stress test plots out a heartbeat in 16 frames, and that represents the diastolic filling curve at 16 points, like taking a melon and slicing it into 16 even pieces, according to Dr. Robinson, nuclear cardiologist at MCG and faculty adviser on the study. The slope of the filling portion of the curve is a representation of the left ventricle filling pressure used as a marker of diastolic dysfunction.

"We have discovered that just looking at these markers can tell us whether a patient has diastolic dysfunction or not,” noted Dr. Robinson. "Diastolic function is a major prognostic factor in these patients with coronary disease. Previously, the nuclear stress test was only detecting diastolic dysfunction in patients who were already sick, whose hearts were weak and barely pumping. In other words, the test only picked up patients who had diastolic and systolic dysfunction. But now, we can use the diastolic filling curve on a nuclear stress test to diagnose patients with diastolic dysfunction who have normally squeezing hearts.”

An individual can be in great physical shape and still have diastolic dysfunction, according to Dr. Patel. "We can prevent heart failure before you start complaining of chest pain and shortness of breath.”

The study was published in the May 2008, issue of the Journal of Nuclear Medicine (JNM).

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60 (61.03515625): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294720028 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294720028 AND published='1' LIMIT 1

61 (71.048736572266): select cover from jos_number where journalid in (5) and cover is not null order by left(issue,2)+right(issue,2)*12 desc limit 1

62 (586.98654174805): SELECT fid FROM jos_deeppockets WHERE id=294720028 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294720028 AND published='1' LIMIT 1

63 (404.11949157715): SELECT id,name,sponsor_text FROM jos_deeppockets dp left outer join jos_channel_sponsor cs on dp.id=cs.fid WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id=211 ORDER BY `ordering`

64 (46.014785766602): select jos_twitters.link from jos_twitters where cat=10

65 (43.869018554688): select jos_facebook.link from jos_facebook where cat=10

66 (41.961669921875): select jos_google_plus.link from jos_google_plus where cat=10

67 (30.040740966797): select jos_linkedin.link from jos_linkedin where cat=10

68 (32.186508178711): SELECT fid FROM jos_deeppockets WHERE id=294720028 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294720028 AND published='1' LIMIT 1

69 (32.901763916016): SELECT id,name,sponsor_text FROM jos_deeppockets dp left outer join jos_channel_sponsor cs on dp.id=cs.fid WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id=211 ORDER BY `ordering`

70 (308.99047851562): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294720028 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

71 (208.13941955566): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294720028 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

72 (39.100646972656): SELECT id,name,title FROM jos_deeppockets WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id != 294743300 AND id != 294743301 AND id != 294743302 AND id != 294743303 AND id != 294743304 AND id != 294743305 AND id != 294743306 AND id != 294743307 AND id != 294743308 AND id != 294743309 AND id != 294743310 AND metakey != 'aacc' ORDER BY `ordering`

73 (51.021575927734): SELECT show_live FROM jos_com_show_setting LIMIT 1

74 (30.994415283203): SELECT show_live FROM jos_com_show_setting LIMIT 1

75 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

76 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

77 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

78 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

79 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

80 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

81 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

82 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

83 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

84 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

85 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

86 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

87 (47.922134399414): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294720028 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

88 (30.040740966797): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294720028 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

89 (34.093856811523): SELECT id,name,title FROM jos_deeppockets WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id != 294743300 AND id != 294743301 AND id != 294743302 AND id != 294743303 AND id != 294743304 AND id != 294743305 AND id != 294743306 AND id != 294743307 AND id != 294743308 AND id != 294743309 AND id != 294743310 AND metakey != 'aacc' ORDER BY `ordering`

90 (67.949295043945): SELECT show_live FROM jos_com_show_setting LIMIT 1

91 (36.954879760742): SELECT show_live FROM jos_com_show_setting LIMIT 1

92 (29.087066650391): SELECT show_live FROM jos_com_show_setting LIMIT 1

93 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

94 (30.994415283203): SELECT show_live FROM jos_com_show_setting LIMIT 1

95 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

96 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

97 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

98 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

99 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

100 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

101 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

102 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

103 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

104 (66.995620727539): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294720028 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294720028 AND published='1' LIMIT 1

105 (41.961669921875): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294720028 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294720028 AND published='1' LIMIT 1

106 (53.167343139648): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294720028 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

107 (46.968460083008): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294720028 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

108 (70.095062255859): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294720028 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294720028 AND published='1' LIMIT 1

109 (74.148178100586): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294720028 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294720028 AND published='1' LIMIT 1

110 (45.061111450195): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.id=294720028 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

111 (499.96376037598): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.id=294720028 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

112 (535.96496582031): SELECT dp.name, dp.id, dp2.name as channel, ex.name as author_name, ex.specialization, ex.images FROM jos_deeppockets as dp LEFT JOIN jos_experts as ex ON ex.id = dp.author LEFT JOIN jos_deeppockets as dp2 ON dp2.id = dp.fid WHERE dp.author != 0 AND dp.cat = 10 AND dp.published = 1 AND ( (dp.fid = 294743300) OR (dp.fid = 294743301) OR (dp.fid = 294743302) OR (dp.fid = 294743303) OR (dp.fid = 294743304) OR (dp.fid = 294743305) OR (dp.fid = 294743306) OR (dp.fid = 294743307) OR (dp.fid = 294743308) OR (dp.fid = 294743309) OR (dp.fid = 294743310) ) ORDER BY RAND() LIMIT 1

113 (313.99726867676): SELECT dp.name, dp.id, dp2.name as channel, ex.name as author_name, ex.specialization, ex.images FROM jos_deeppockets as dp LEFT JOIN jos_experts as ex ON ex.id = dp.author LEFT JOIN jos_deeppockets as dp2 ON dp2.id = dp.fid WHERE dp.author != 0 AND dp.cat = 10 AND dp.published = 1 AND ( (dp.fid = 294743300) OR (dp.fid = 294743301) OR (dp.fid = 294743302) OR (dp.fid = 294743303) OR (dp.fid = 294743304) OR (dp.fid = 294743305) OR (dp.fid = 294743306) OR (dp.fid = 294743307) OR (dp.fid = 294743308) OR (dp.fid = 294743309) OR (dp.fid = 294743310) ) ORDER BY RAND() LIMIT 1

114 (77.009201049805): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294720028 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294720028 AND published='1' LIMIT 1

115 (46.014785766602): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294720028 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294720028 AND published='1' LIMIT 1

116 (47.206878662109): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294720028 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294720028 AND published='1' LIMIT 1

117 (73.19450378418): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294720028 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294720028 AND published='1' LIMIT 1

118 (44.822692871094): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294720028 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294720028 AND published='1' LIMIT 1

119 (35.04753112793): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294720028 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294720028 AND published='1' LIMIT 1

120 (42.915344238281): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294720028 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294720028 AND published='1' LIMIT 1

121 (36.001205444336): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294720028 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294720028 AND published='1' LIMIT 1

122 (247.00164794922): SELECT * FROM trending_articles WHERE `journal_id` = 10 AND `timestamp` <= NOW() + INTERVAL 7 DAY ORDER BY `order`

123 (!!!!! 19967.079162598): SELECT * FROM jos_deeppockets WHERE jos_deeppockets.cat = 10 AND jos_deeppockets.type = 'deeppockets_item' AND jos_deeppockets.published = 1 AND jos_deeppockets.created + INTERVAL 14 DAY >= NOW() ORDER BY jos_deeppockets.hits DESC LIMIT 7

124 (653.98216247559): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294720028 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294720028 AND type='deeppockets_item' AND published='1' LIMIT 1

125 (!!!!! 7533.7886810303): ( SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.video != '' AND dp.video_source != '' AND dp.cat = 10 AND dp.published = 1 AND dp.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) UNION ( SELECT dpa.id, dpa.name, dpa.title, dpa.video, dpa.video_source, dpa.created FROM jos_deeppockets_archive AS dpa WHERE dpa.video != '' AND dpa.video_source != '' AND dpa.cat = 10 AND dpa.published = 1 AND dpa.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) ORDER BY created DESC LIMIT 3

126 (111.81831359863): ( SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.video != '' AND dp.video_source != '' AND dp.cat = 10 AND dp.published = 1 AND dp.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) UNION ( SELECT dpa.id, dpa.name, dpa.title, dpa.video, dpa.video_source, dpa.created FROM jos_deeppockets_archive AS dpa WHERE dpa.video != '' AND dpa.video_source != '' AND dpa.cat = 10 AND dpa.published = 1 AND dpa.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) ORDER BY created DESC LIMIT 3

127 (39.100646972656): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294803337 LIMIT 1

128 (30.040740966797): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294803337 LIMIT 1

129 (46.014785766602): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294803276 LIMIT 1

130 (29.087066650391): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294803276 LIMIT 1

131 (324.01084899902): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets_archive AS dp WHERE dp.id = 294803276 LIMIT 1

132 (45.061111450195): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets_archive AS dp WHERE dp.id = 294803276 LIMIT 1

133 (37.908554077148): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294802958 LIMIT 1

134 (36.001205444336): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294802958 LIMIT 1

135 (469.92301940918): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294720028 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

136 (316.85829162598): SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294720028 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

137 (194.07272338867): SELECT name FROM jos_deeppockets WHERE id=211

138 (36.954879760742): SELECT name FROM jos_deeppockets WHERE id=211

139 (524.04403686523): SELECT *, DATE_FORMAT(publish_up,'%d %b %Y') AS date_publish_up, DATE_FORMAT(publish_down,'%d %b %Y') AS date_publish_down FROM jos_events WHERE state=1 AND publish_up > NOW() and extra_info REGEXP '((;)|(^))211((;)|($))' AND catid IN (0,110) ORDER BY publish_up ASC LIMIT 3

140 (468.01567077637): SELECT *, DATE_FORMAT(publish_up,'%d %b %Y') AS date_publish_up, DATE_FORMAT(publish_down,'%d %b %Y') AS date_publish_down FROM jos_events WHERE state=1 AND publish_up > NOW() and extra_info REGEXP '((;)|(^))211((;)|($))' AND catid IN (0,110) ORDER BY publish_up ASC LIMIT 3

141 (62.942504882812): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294720028 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294720028 AND published='1' LIMIT 1

142 (46.014785766602): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294720028 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294720028 AND published='1' LIMIT 1

143 (!!!!! 12401.103973389): TRUNCATE TABLE jos_trademed_module

144 (138.99803161621): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294720028 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

145 (56.982040405273): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294720028 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

146 (461.10153198242): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294720028 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

147 (99.897384643555): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294720028 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

148 (430.10711669922): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294720028 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294720028 AND published='1' LIMIT 1

149 (64.13459777832): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294720028 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294720028 AND published='1' LIMIT 1

150 (!!!!! 1157.0453643799): SELECT jos_item.* FROM jos_item INNER JOIN jos_number ON jos_item.numberID=jos_number.id WHERE 1=1 AND (jos_item.imgMini<>'') AND jos_item.type='L' AND jos_item.numberID= ( SELECT jos_number.id FROM jos_number WHERE jos_number.journalID IN (10) and jos_number.id in (select distinct jos_number.id from jos_number join jos_item on jos_item.numberid=jos_number.id where jos_item.type='P') ORDER BY (CONVERT(SUBSTRING(issue,1,2),SIGNED) + (CONVERT(SUBSTRING(issue,3,2),SIGNED)*100)) DESC LIMIT 0,1 ) ORDER BY RAND() DESC LIMIT 6

151 (65.088272094727): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294720028 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294720028 AND published='1' LIMIT 1

152 (51.021575927734): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294720028 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294720028 AND published='1' LIMIT 1

153 (41.007995605469): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294720028 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294720028 AND type='deeppockets_item' AND published='1' LIMIT 1

154 (34.093856811523): select distinct links.* from jos_textlinks links join jos_textlinks_placement placement on links.id=placement.link_id where journal_id=(10) and (channel_id=211 or channel_id is null)

155 (31.948089599609): select distinct links.* from jos_textlinks links join jos_textlinks_placement placement on links.id=placement.link_id where journal_id=(10) and (channel_id=211 or channel_id is null)

156 (33.855438232422): SELECT livesite FROM jos_dp_categories WHERE id=10 AND published='1' LIMIT 1

157 (63.896179199219): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294720028 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294720028 AND published='1' LIMIT 1

158 (44.107437133789): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294720028 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294720028 AND published='1' LIMIT 1

159 (45.061111450195): select jos_twitters.link from jos_twitters where cat=10

160 (60.796737670898): select jos_facebook.link from jos_facebook where cat=10

161 (44.107437133789): select jos_google_plus.link from jos_google_plus where cat=10

162 (40.054321289062): select jos_linkedin.link from jos_linkedin where cat=10

163 (313.04359436035): update jos_bannersmanager_banner set impmade=impmade+1 where id in(14615,14202,14203)

164 (!!!!! 1084.0892791748): insert into jos_banners_delta values (14615,'2025-08-24 17:26:29','216.73.216.171','view'),(14202,'2025-08-24 17:26:29','216.73.216.171','view'),(14203,'2025-08-24 17:26:29','216.73.216.171','view')

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