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SPECT Myocardial Perfusion Imaging Evaluated in New-Onset Heart Failure Patients

By MedImaging International staff writers
Posted on 24 Feb 2009

A new study's findings provide insights on single-photon emission computed tomography's (SPECT) effectiveness for the diagnosis of coronary artery disease (CAD) in patients with new-onset heart failure.

Lantheus Medical Imaging, Inc. (North Billerica, MA, USA), an international company that develops medical imaging agents, reported that new data from a prospective, nonrandomized, multinational study that shows gated SPECT myocardial perfusion imaging (MPI) with Cardiolite (kit for the preparation of technetium Tc99m sestamibi for injection) had a 96% negative predictive value for diagnosing extensive coronary artery disease in patients hospitalized with their first episode of heart failure. The study findings were published in the January/February 2009 issue of The Journal of Nuclear Cardiology.

One of the most common causes of heart failure is CAD. Data from observational studies suggest that CAD is the underlying cause of up to 70% of patients with heart failure. MPI is often used to determine the presence and severity of physiologically significant CAD in patients with suspicious symptoms. This is the first study to explore myocardial perfusion imaging's diagnostic utility specifically in patients with new-onset heart failure.

"Because some patients with heart failure and extensive coronary artery disease may benefit from coronary revascularization and improve their quality of life and longevity, identifying the extent and severity of underlying CAD in these patients is a critical first step in the initial management of their care. As the first study to examine the utility of SPECT MPI for CAD detection in patients with new-onset heart failure, these results are very encouraging and point to gated SPECT as a potentially useful diagnostic modality for heart failure patients without angina or other clinical indicators of CAD,” said Prem Soman, M.D., Ph.D., F.R.C.P., associate director of nuclear cardiology, University of Pittsburgh Medical Center, Presbyterian University Hospital and lead author of The Investigation of Myocardial Gated SPECT Imaging in Heart Failure (IMAGING in HF) trial.

A SPECT scan is a nuclear imaging technique that involves injecting a radioactive liquid into the blood, then taking a series of images around the chest. A SPECT scan produces three-dimensional images that show how organs function. For myocardial perfusion imaging, SPECT remains the dominant modality at this time.

MPI is a noninvasive test that utilizes a small amount of radioactive material injected into the body to depict the distribution of blood flow to the heart. MPI is used to identify areas of reduced blood flow to the heart muscle to determine whether or not the heart is working correctly. Following the administration of the radiopharmaceutical, the heart rate is raised to induce myocardial stress, either by exercise or pharmacologically. Using SPECT technology, images of the heart muscle are then obtained and examined.

A normal stress SPECT MPI indicates a very low probability of extensive CAD in patients with heart failure, and therefore, invasive coronary angiography can be avoided. "These initial findings point to the need for further evaluation of the use of SPECT MPI for CAD detection in new-onset heart failure patients,” continued Dr. Soman.

The IMAGING in HF study was designed to explore the role of gated SPECT MPI using Cardiolite as an initial investigative strategy for diagnosing extensive CAD, which is potentially etiologically relevant to patients hospitalized with their first episode of heart failure. The observational study assessed 201 patients hospitalized with their first presentation of heart failure at 14 sites in the United States and the United Kingdom. All patients received a stress and rest SPECT MPI test using Cardiolite. Data were analyzed in a core laboratory and provided researchers with 99.5% interpretable stress images and 98.5% interpretable rest and stress images. Coronary arteriography was performed when clinically indicated.

SPECT MPI had 96% sensitivity, 56% specificity, and a 96% negative predictive value for the diagnosis of extensive CAD, defined conventionally as greater than or equal to 70% stenosis in two or more major epicardial coronary arteries, or greater than or equal to 70% in the left main coronary artery, proximal left anterior descending coronary artery, or single vessel disease with prior myocardial infarction or coronary revascularization. The diagnostic values of SPECT MPI for more limited CAD were 82% sensitivity, 57% specificity, and 75% negative predictive value. These definitions were used to differentiate heart failure patients with extensive, etiologically relevant CAD from those with more limited, coexisting CAD. The presence of extensive CAD indicates a causal relationship with heart failure and such patients are likely to benefit from coronary revascularization.

"The current professional society guidelines provide physicians with mixed direction regarding diagnostic procedures for patients with new-onset heart failure,” said James Udelson, M.D., lead investigator of the study and chief of cardiology at Tufts Medical Center (Boston, MA, USA). "These study findings build additional clinical evidence for the use of SPECT MPI with Cardiolite as a noninvasive procedure, prior to more invasive coronary angiography, to help physicians assess and select which patients would benefit most from revascularization.”

"Only 12% of patients had active anginal symptoms, making a CAD diagnosis difficult on clinical grounds, and increasing the importance of using imaging tests such as Cardiolite. These study findings further demonstrate the expanding role that SPECT imaging with Cardiolite plays in risk stratification for patients with their first episode of heart failure,” said Mark Hibberd, M.D. Ph.D., senior medical director, global medical affairs, Lantheus Medical Imaging.

Cardiolite is one of the world's most widely used cardiac imaging agents and has been used to image more than 40 million patients.

Lantheus Medical Imaging discovers, develops, and markets innovative medical imaging agents provides an unparalleled platform from which to bring forward breakthrough new tools for the diagnosis and management of disease.

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55 (86.069107055664): 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=294722164 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

56 (643.96858215332): 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=294722164 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

57 (!!!!! 2962.1124267578): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294722164 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294722164 AND published='1' LIMIT 1

58 (361.91940307617): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294722164 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294722164 AND published='1' LIMIT 1

59 (!!!!! 2120.0180053711): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294722164 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294722164 AND published='1' LIMIT 1

60 (326.87187194824): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294722164 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294722164 AND published='1' LIMIT 1

61 (!!!!! 2971.1723327637): 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 (891.92390441895): SELECT fid FROM jos_deeppockets WHERE id=294722164 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294722164 AND published='1' LIMIT 1

63 (869.9893951416): 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 (742.91229248047): select jos_twitters.link from jos_twitters where cat=10

65 (61.03515625): select jos_facebook.link from jos_facebook where cat=10

66 (51.021575927734): select jos_google_plus.link from jos_google_plus where cat=10

67 (35.04753112793): select jos_linkedin.link from jos_linkedin where cat=10

68 (50.067901611328): SELECT fid FROM jos_deeppockets WHERE id=294722164 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294722164 AND published='1' LIMIT 1

69 (51.975250244141): 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 (!!!!! 1081.9435119629): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294722164 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

71 (473.97613525391): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294722164 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

72 (61.988830566406): 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 (164.98565673828): SELECT show_live FROM jos_com_show_setting LIMIT 1

74 (154.97207641602): SELECT show_live FROM jos_com_show_setting LIMIT 1

75 (128.03077697754): SELECT show_live FROM jos_com_show_setting LIMIT 1

76 (122.0703125): SELECT show_live FROM jos_com_show_setting LIMIT 1

77 (141.14379882812): SELECT show_live FROM jos_com_show_setting LIMIT 1

78 (87.976455688477): SELECT show_live FROM jos_com_show_setting LIMIT 1

79 (81.062316894531): SELECT show_live FROM jos_com_show_setting LIMIT 1

80 (654.93583679199): SELECT show_live FROM jos_com_show_setting LIMIT 1

81 (198.8410949707): SELECT show_live FROM jos_com_show_setting LIMIT 1

82 (50.067901611328): SELECT show_live FROM jos_com_show_setting LIMIT 1

83 (45.061111450195): SELECT show_live FROM jos_com_show_setting LIMIT 1

84 (41.007995605469): SELECT show_live FROM jos_com_show_setting LIMIT 1

85 (101.08947753906): SELECT show_live FROM jos_com_show_setting LIMIT 1

86 (270.84350585938): SELECT show_live FROM jos_com_show_setting LIMIT 1

87 (191.92695617676): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294722164 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

88 (115.15617370605): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294722164 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

89 (152.1110534668): 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 (!!!!! 2557.9929351807): SELECT show_live FROM jos_com_show_setting LIMIT 1

91 (540.01808166504): SELECT show_live FROM jos_com_show_setting LIMIT 1

92 (87.02278137207): SELECT show_live FROM jos_com_show_setting LIMIT 1

93 (79.154968261719): SELECT show_live FROM jos_com_show_setting LIMIT 1

94 (316.14303588867): SELECT show_live FROM jos_com_show_setting LIMIT 1

95 (53.882598876953): SELECT show_live FROM jos_com_show_setting LIMIT 1

96 (66.995620727539): SELECT show_live FROM jos_com_show_setting LIMIT 1

97 (117.77877807617): SELECT show_live FROM jos_com_show_setting LIMIT 1

98 (148.05793762207): SELECT show_live FROM jos_com_show_setting LIMIT 1

99 (!!!!! 1266.0026550293): SELECT show_live FROM jos_com_show_setting LIMIT 1

100 (294.92378234863): SELECT show_live FROM jos_com_show_setting LIMIT 1

101 (150.91896057129): SELECT show_live FROM jos_com_show_setting LIMIT 1

102 (477.07557678223): SELECT show_live FROM jos_com_show_setting LIMIT 1

103 (231.98127746582): SELECT show_live FROM jos_com_show_setting LIMIT 1

104 (!!!!! 1247.1675872803): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294722164 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294722164 AND published='1' LIMIT 1

105 (624.8950958252): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294722164 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294722164 AND published='1' LIMIT 1

106 (72.956085205078): 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=294722164 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

107 (159.02519226074): 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=294722164 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

108 (!!!!! 3195.04737854): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294722164 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294722164 AND published='1' LIMIT 1

109 (425.10032653809): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294722164 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294722164 AND published='1' LIMIT 1

110 (!!!!! 1479.8641204834): 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=294722164 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

111 (898.83804321289): 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=294722164 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

112 (746.01173400879): 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 (602.96058654785): 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 (207.90100097656): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294722164 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294722164 AND published='1' LIMIT 1

115 (77.962875366211): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294722164 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294722164 AND published='1' LIMIT 1

116 (113.96408081055): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294722164 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294722164 AND published='1' LIMIT 1

117 (64.849853515625): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294722164 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294722164 AND published='1' LIMIT 1

118 (85.115432739258): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294722164 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294722164 AND published='1' LIMIT 1

119 (61.988830566406): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294722164 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294722164 AND published='1' LIMIT 1

120 (83.92333984375): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294722164 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294722164 AND published='1' LIMIT 1

121 (58.174133300781): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294722164 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294722164 AND published='1' LIMIT 1

122 (465.86990356445): SELECT * FROM trending_articles WHERE `journal_id` = 10 AND `timestamp` <= NOW() + INTERVAL 7 DAY ORDER BY `order`

123 (!!!!! 30334.949493408): 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 (813.00735473633): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294722164 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294722164 AND type='deeppockets_item' AND published='1' LIMIT 1

125 (!!!!! 11562.10899353): ( 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 (115.87142944336): ( 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 (77.962875366211): 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 (43.869018554688): 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 (94.890594482422): 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 (46.968460083008): 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 (524.99771118164): 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 (65.088272094727): 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 (56.028366088867): 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 (43.153762817383): 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 (648.97537231445): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294722164 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

136 (560.99891662598): SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294722164 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

137 (420.80879211426): SELECT name FROM jos_deeppockets WHERE id=211

138 (58.174133300781): SELECT name FROM jos_deeppockets WHERE id=211

139 (!!!!! 1024.0077972412): 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 (802.04010009766): 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 (121.8318939209): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294722164 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294722164 AND published='1' LIMIT 1

142 (86.069107055664): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294722164 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294722164 AND published='1' LIMIT 1

143 (!!!!! 30318.975448608): TRUNCATE TABLE jos_trademed_module

144 (191.92695617676): 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=294722164 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

145 (97.036361694336): 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=294722164 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

146 (663.04206848145): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294722164 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

147 (77.962875366211): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294722164 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

148 (72.002410888672): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294722164 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294722164 AND published='1' LIMIT 1

149 (50.067901611328): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294722164 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294722164 AND published='1' LIMIT 1

150 (!!!!! 1459.1217041016): 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 (123.02398681641): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294722164 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294722164 AND published='1' LIMIT 1

152 (78.916549682617): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294722164 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294722164 AND published='1' LIMIT 1

153 (100.13580322266): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294722164 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294722164 AND type='deeppockets_item' AND published='1' LIMIT 1

154 (54.836273193359): 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 (45.061111450195): 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 (72.002410888672): SELECT livesite FROM jos_dp_categories WHERE id=10 AND published='1' LIMIT 1

157 (293.01643371582): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294722164 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294722164 AND published='1' LIMIT 1

158 (108.00361633301): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294722164 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294722164 AND published='1' LIMIT 1

159 (90.122222900391): select jos_twitters.link from jos_twitters where cat=10

160 (50.783157348633): 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 (41.961669921875): select jos_linkedin.link from jos_linkedin where cat=10

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