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Assante R, Zampella E, D'Antonio A, Mannarino T, Gaudieri V, Nappi C, Arumugam P, Panico M, Buongiorno P, Petretta M, Cuocolo A, Acampa W. Impact on cardiovascular outcome of coronary revascularization-induced changes in ischemic perfusion defect and myocardial flow reserve. Eur J Nucl Med Mol Imaging 2024; 51:1612-1621. [PMID: 38191816 PMCID: PMC11043198 DOI: 10.1007/s00259-023-06588-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 12/26/2023] [Indexed: 01/10/2024]
Abstract
PURPOSE We evaluated the impact on cardiovascular outcome of coronary revascularization-induced changes in ischemic total perfusion defect (ITPD) and myocardial flow reserve (MFR) as assessed by 82Rb positron emission tomography (PET)/computed tomography (CT) imaging. METHODS The study included 102 patients referred to 82Rb PET/CT myocardial perfusion imaging before and after coronary revascularization. All patients were followed for the occurrence of cardiovascular events (cardiac death, nonfatal myocardial infarction, repeated revascularization, and heart failure) after the second imaging study. RESULTS During a median follow-up of 20 months, 21 events occurred. The clinical characteristics were comparable between patients with and without events. In the overall study population, after revascularization, there was a significant reduction (P < 0.001) of ITPD, while hyperemic myocardial blood flow (MBF) (P < 0.01) and MFR (P < 0.05) significantly improved. Event rate was higher in patients with ITPD (P < 0.005) or MFR (P < 0.001) worsening compared to those with unchanged or improved ITPD or MFR. At Cox univariable analysis, ITPD and MFR worsening resulted in predictors of events (both P < 0.05). Patients with worsening of both ITPD and MFR had the worst event-free survival (log-rank 32.9, P for trend < 0.001). CONCLUSIONS In patients with stable CAD, worsening of ITPD and MFR after revascularization procedures is associated with higher risk of cardiovascular events. Follow-up MPI with 82Rb PET/CT may improve risk stratification in patients submitted to coronary revascularization.
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Affiliation(s)
- Roberta Assante
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Via Sergio Pansini 5, 80131, Naples, Italy
| | - Emilia Zampella
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Via Sergio Pansini 5, 80131, Naples, Italy
| | - Adriana D'Antonio
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Via Sergio Pansini 5, 80131, Naples, Italy
| | - Teresa Mannarino
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Via Sergio Pansini 5, 80131, Naples, Italy
| | - Valeria Gaudieri
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Via Sergio Pansini 5, 80131, Naples, Italy
| | - Carmela Nappi
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Via Sergio Pansini 5, 80131, Naples, Italy
| | - Parthiban Arumugam
- Department of Nuclear Medicine, Central Manchester Foundation Trust, Manchester, UK
| | | | - Pietro Buongiorno
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Via Sergio Pansini 5, 80131, Naples, Italy
| | | | - Alberto Cuocolo
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Via Sergio Pansini 5, 80131, Naples, Italy
| | - Wanda Acampa
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Via Sergio Pansini 5, 80131, Naples, Italy.
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Kim HL, Joh HS, Lim WH, Seo JB, Kim SH, Zo JH, Kim MA. Estimated Pulse Wave Velocity in the Prediction of Clinical Outcomes in Patients Undergoing Drug-Eluting Stent Implantation. J Clin Med 2023; 12:5855. [PMID: 37762796 PMCID: PMC10531714 DOI: 10.3390/jcm12185855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 08/28/2023] [Accepted: 09/06/2023] [Indexed: 09/29/2023] Open
Abstract
Background The prognostic value of estimated pulse wave velocity (ePWV) has been infrequently explored in high-risk patient groups. Our study aimed to evaluate the prognostic significance of ePWV among patients undergoing a percutaneous coronary intervention (PCI) with a drug-eluting stent (DES). Methods A total of 4119 consecutive subjects who underwent a PCI with a DES (mean age, 67.1 ± 11.6 years and 33.1% were female) were retrospectively analyzed. ePWV was calculated based on the patient's age and mean blood pressure. Major adverse cardiovascular events (MACE), including cardiac death, non-fatal myocardial infarction, coronary revascularization, and ischemic stroke, were evaluated. Results During a median follow-up duration of 3.51 years (interquartile range, 1.35-6.37 years), there were 746 MACEs (18.1%). A multivariable analysis showed that a higher ePWV was associated with a higher MACE incidence (middle tertile vs. the lowest tertile: hazard ratio [HR], 2.49; 95% confidence interval [CI], 1.81-3.42; p < 0.001; the highest tertile vs. the lowest tertile: HR, 6.18; 95% CI, 4.33-8.80; p < 0.001) The inclusion of ePWV data significantly increased the global chi-square values when added to the clinical information (from 96 to 128; p < 0.001). Conclusion ePWV demonstrated a significant association with MACEs in patients who underwent DES implantation. Given its relative simplicity to calculate, ePWV could potentially serve as a valuable instrument for stratifying cardiovascular risks within this high-risk patient population.
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Affiliation(s)
- Hack-Lyoung Kim
- Division of Cardiology, Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul 07061, Republic of Korea; (H.S.J.); (W.-H.L.)
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Van Tosh A, Nichols KJ. SPECT measurements of myocardial blood flow and flow reserve: from development to implementation. J Nucl Cardiol 2023; 30:1437-1442. [PMID: 37160851 DOI: 10.1007/s12350-023-03273-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 04/04/2023] [Indexed: 05/11/2023]
Affiliation(s)
- Andrew Van Tosh
- Research Department, St. Francis Hospital, 100 Port Washington Blvd., Roslyn, NY, 11576-1348, USA.
| | - Kenneth J Nichols
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
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Sun R, Ma R, Wang M, Han K, Zhang Z, Wang L, Fang W. Prognostic value of myocardial flow reserve derived by quantitative SPECT for patients with intermediate coronary stenoses. J Nucl Cardiol 2023; 30:1427-1436. [PMID: 36593332 DOI: 10.1007/s12350-022-03186-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 12/04/2022] [Indexed: 01/04/2023]
Abstract
BACKGROUND Functional assessment of myocardial ischemia is critical for patients with intermediate coronary stenosis. As the diagnosis performance of absolute quantification of myocardial blood flow (MBF) and myocardial flow reserve (MFR) by single-photon emission tomography (SPECT) has been proven, its prognostic value in patients with intermediate coronary stenosis remains to be evaluated. METHODS Patients with one or more target lesions of ≥ 50% to ≤ 80% diameter stenoses on invasive coronary angiography were prospectively included in this study. All patients were scheduled for clinically indicated SPECT myocardial perfusion imaging (MPI) within 3 months and agreed to provide informed consent to participate in quantitative SPECT acquisitions to obtain MBF and MFR values. The primary endpoint was defined as a composite of the major adverse cardiac events (MACE): Cardiac death, myocardial infarction, late revascularization and heart failure or unstable angina-related rehospitalization. RESULTS One hundred and nineteen patients (mean age 57 ± 8 years, 62.2% men) were included in the analysis. The average lumen stenosis of patients was 67.0 ± 10.4%. Over a median follow-up duration of 1408 days (interquartile range 1297-1666 days), 18 patients (15.1%) had MACE. Patients with impaired MFR (MFR < 2) had a significantly higher incidence of events than those with preserved MFR (MFR ≥ 2) in Kaplan-Meier survival analysis (Log-rank = 8.105, P = 0.004), while no significant difference was found between patients with normal relative perfusion and those with relative perfusion abnormalities (log-rank = 0.098, P > 0.05). In a multivariate Cox hazards analysis, the SPECT-derived MFR remained an independent predictor of MACE (HR 0.352, 95% CI 0.145-0.854, P = 0.021). CONCLUSIONS In a cohort of patients with angiographic intermediate coronary lesions, SPECT-derived MFR was an independent predictor of prognosis.
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Affiliation(s)
- Ruoxi Sun
- Department of Nuclear Medicine, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, 167 Beilishi Road, Beijing, 100037, China
| | - Rongzheng Ma
- Department of Nuclear Medicine, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, 167 Beilishi Road, Beijing, 100037, China
| | - Meng Wang
- Department of Nuclear Medicine, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, 167 Beilishi Road, Beijing, 100037, China
| | - Kai Han
- Department of Nuclear Medicine, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, 167 Beilishi Road, Beijing, 100037, China
| | - Zongyao Zhang
- Department of Nuclear Medicine, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, 167 Beilishi Road, Beijing, 100037, China
| | - Lei Wang
- Department of Nuclear Medicine, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, 167 Beilishi Road, Beijing, 100037, China.
| | - Wei Fang
- Department of Nuclear Medicine, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, 167 Beilishi Road, Beijing, 100037, China.
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Zampella E, Assante R, Acampa W. Myocardial perfusion reserve by CZT cameras: A journey inside coronary microvascular circulation. Is it time to leave yet? J Nucl Cardiol 2023; 30:1668-1670. [PMID: 37311913 DOI: 10.1007/s12350-023-03313-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 05/24/2023] [Indexed: 06/15/2023]
Affiliation(s)
- Emilia Zampella
- Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy
| | - Roberta Assante
- Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy
| | - Wanda Acampa
- Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy.
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D'Antonio A, Assante R, Zampella E, Mannarino T, Buongiorno P, Cuocolo A, Acampa W. Myocardial blood flow evaluation with dynamic cadmium-zinc-telluride single-photon emission computed tomography: Bright and dark sides. Diagn Interv Imaging 2023; 104:323-329. [PMID: 36797156 DOI: 10.1016/j.diii.2023.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 02/01/2023] [Accepted: 02/01/2023] [Indexed: 02/16/2023]
Abstract
Myocardial blood flow (MBF) and myocardial perfusion reserve (MPR) assessment with non-invasive techniques represent an important tool to evaluate both coronary artery disease severity and extent. Currently, cardiac positron emission tomography-computed tomography (PET-CT) is the "gold standard" for the assessment of coronary function and provides accurate estimations of baseline and hyperemic MBF and MFR. Nevertheless, due to the high cost and complexity, PET-CT is not widely used in clinical practice. The introduction of cardiac-dedicated cadmium-zinc-telluride (CZT) cameras has renewed researchers' interest on MBF quantitation by single-photon emission computed tomography (SPECT). Indeed, many studies evaluated MPR and MBF measurements by dynamic CZT-SPECT in different cohorts of patients with suspected or overt coronary artery disease. As well, many others have compared the values obtained by CZT-SPECT to the ones by PET-CT, showing good correlations in detecting significant stenosis, although with different and non-standardized cut-off values. Nevertheless, the lack of standardized protocol for acquisition, reconstruction and elaboration makes more difficult to compare different studies and to further assess the real advantages of MBF quantitation by dynamic CZT-SPECT in clinical routine. Many are the issues involved in the bright and dark sides of dynamic CZT-SPECT. They include different type of CZT cameras, different execution protocols, different tracers with different myocardial extraction fraction and distribution, different software packages with different tools and algorithms, often requiring manual post-processing elaboration. This review article provides a clear summary of the state of the art on MBF and MPR evaluation by dynamic CZT-SPECT and outlines the major issues to solve to optimize this technique.
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Affiliation(s)
- Adriana D'Antonio
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy
| | - Roberta Assante
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy
| | - Emilia Zampella
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy
| | - Teresa Mannarino
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy
| | - Pietro Buongiorno
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy
| | - Alberto Cuocolo
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy
| | - Wanda Acampa
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy
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Mannarino T, Assante R, D'Antonio A, Zampella E, Cuocolo A, Acampa W. Radionuclide Tracers for Myocardial Perfusion Imaging and Blood Flow Quantification. Cardiol Clin 2023; 41:141-150. [PMID: 37003672 DOI: 10.1016/j.ccl.2023.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
Myocardial perfusion imaging by nuclear cardiology is widely validated for the diagnosis, risk stratification, and management of patients with suspected or known coronary artery disease. Numerous radiopharmaceuticals are available for single-photon emission computed tomography and PET modalities. Each tracer shows advantages and limitations that should be taken into account in performing an imaging examination. This review aimed to summarize the state-of-the-art radiotracers used for myocardial perfusion imaging and blood flow quantification, highlighting the new technologic advances and promising possible applications.
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Affiliation(s)
- Teresa Mannarino
- Department of Advanced Biomedical Sciences, University Federico II, Via Sergio Pansini 5, Naples 80131, Italy
| | - Roberta Assante
- Department of Advanced Biomedical Sciences, University Federico II, Via Sergio Pansini 5, Naples 80131, Italy
| | - Adriana D'Antonio
- Department of Advanced Biomedical Sciences, University Federico II, Via Sergio Pansini 5, Naples 80131, Italy
| | - Emilia Zampella
- Department of Advanced Biomedical Sciences, University Federico II, Via Sergio Pansini 5, Naples 80131, Italy
| | - Alberto Cuocolo
- Department of Advanced Biomedical Sciences, University Federico II, Via Sergio Pansini 5, Naples 80131, Italy
| | - Wanda Acampa
- Department of Advanced Biomedical Sciences, University Federico II, Via Sergio Pansini 5, Naples 80131, Italy.
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8
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D'Antonio A, Assante R, Zampella E, Acampa W. High technology by CZT cameras: It is time to join forces. J Nucl Cardiol 2022; 29:2322-2324. [PMID: 34426936 DOI: 10.1007/s12350-021-02777-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 08/05/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Adriana D'Antonio
- Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy
| | - Roberta Assante
- Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy
| | - Emilia Zampella
- Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy
| | - Wanda Acampa
- Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy.
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Kelshiker MA, Seligman H, Howard JP, Rahman H, Foley M, Nowbar AN, Rajkumar CA, Shun-Shin MJ, Ahmad Y, Sen S, Al-Lamee R, Petraco R. Coronary flow reserve and cardiovascular outcomes: a systematic review and meta-analysis. Eur Heart J 2022; 43:1582-1593. [PMID: 34849697 PMCID: PMC9020988 DOI: 10.1093/eurheartj/ehab775] [Citation(s) in RCA: 113] [Impact Index Per Article: 56.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 09/07/2021] [Accepted: 10/26/2021] [Indexed: 01/04/2023] Open
Abstract
AIMS This meta-analysis aims to quantify the association of reduced coronary flow with all-cause mortality and major adverse cardiovascular events (MACE) across a broad range of patient groups and pathologies. METHODS AND RESULTS We systematically identified all studies between 1 January 2000 and 1 August 2020, where coronary flow was measured and clinical outcomes were reported. The endpoints were all-cause mortality and MACE. Estimates of effect were calculated from published hazard ratios (HRs) using a random-effects model. Seventy-nine studies with a total of 59 740 subjects were included. Abnormal coronary flow reserve (CFR) was associated with a higher incidence of all-cause mortality [HR: 3.78, 95% confidence interval (CI): 2.39-5.97] and a higher incidence of MACE (HR 3.42, 95% CI: 2.92-3.99). Each 0.1 unit reduction in CFR was associated with a proportional increase in mortality (per 0.1 CFR unit HR: 1.16, 95% CI: 1.04-1.29) and MACE (per 0.1 CFR unit HR: 1.08, 95% CI: 1.04-1.11). In patients with isolated coronary microvascular dysfunction, an abnormal CFR was associated with a higher incidence of mortality (HR: 5.44, 95% CI: 3.78-7.83) and MACE (HR: 3.56, 95% CI: 2.14-5.90). Abnormal CFR was also associated with a higher incidence of MACE in patients with acute coronary syndromes (HR: 3.76, 95% CI: 2.35-6.00), heart failure (HR: 6.38, 95% CI: 1.95-20.90), heart transplant (HR: 3.32, 95% CI: 2.34-4.71), and diabetes mellitus (HR: 7.47, 95% CI: 3.37-16.55). CONCLUSION Reduced coronary flow is strongly associated with increased risk of all-cause mortality and MACE across a wide range of pathological processes. This finding supports recent recommendations that coronary flow should be measured more routinely in clinical practice, to target aggressive vascular risk modification for individuals at higher risk.
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Affiliation(s)
- Mihir A Kelshiker
- National Heart and Lung Institute, Imperial College London, Hammersmith Campus, 72 Du Cane Road, London W12 0HS, UK
| | - Henry Seligman
- National Heart and Lung Institute, Imperial College London, Hammersmith Campus, 72 Du Cane Road, London W12 0HS, UK
| | - James P Howard
- National Heart and Lung Institute, Imperial College London, Hammersmith Campus, 72 Du Cane Road, London W12 0HS, UK
| | - Haseeb Rahman
- National Heart and Lung Institute, Imperial College London, Hammersmith Campus, 72 Du Cane Road, London W12 0HS, UK
| | - Michael Foley
- National Heart and Lung Institute, Imperial College London, Hammersmith Campus, 72 Du Cane Road, London W12 0HS, UK
| | - Alexandra N Nowbar
- National Heart and Lung Institute, Imperial College London, Hammersmith Campus, 72 Du Cane Road, London W12 0HS, UK
| | - Christopher A Rajkumar
- National Heart and Lung Institute, Imperial College London, Hammersmith Campus, 72 Du Cane Road, London W12 0HS, UK
| | - Matthew J Shun-Shin
- National Heart and Lung Institute, Imperial College London, Hammersmith Campus, 72 Du Cane Road, London W12 0HS, UK
| | - Yousif Ahmad
- Yale School of Medicine, Yale University, 333 Cedar St, New Haven, Connecticut 06510, USA
| | - Sayan Sen
- National Heart and Lung Institute, Imperial College London, Hammersmith Campus, 72 Du Cane Road, London W12 0HS, UK
| | - Rasha Al-Lamee
- National Heart and Lung Institute, Imperial College London, Hammersmith Campus, 72 Du Cane Road, London W12 0HS, UK
| | - Ricardo Petraco
- National Heart and Lung Institute, Imperial College London, Hammersmith Campus, 72 Du Cane Road, London W12 0HS, UK
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Zampella E, Assante R, Gaudieri V, Nappi C, Acampa W, Cuocolo A. Myocardial perfusion reserve by using CZT: It's a long way to the top if you wanna standardize. J Nucl Cardiol 2021; 28:885-887. [PMID: 31290103 DOI: 10.1007/s12350-019-01817-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 07/02/2019] [Indexed: 12/23/2022]
Affiliation(s)
- Emilia Zampella
- Department of Advanced Biomedical Sciences, University "Federico II", Via Pansini 5, 80131, Naples, Italy
| | - Roberta Assante
- Department of Advanced Biomedical Sciences, University "Federico II", Via Pansini 5, 80131, Naples, Italy
| | - Valeria Gaudieri
- Department of Advanced Biomedical Sciences, University "Federico II", Via Pansini 5, 80131, Naples, Italy
| | - Carmela Nappi
- Department of Advanced Biomedical Sciences, University "Federico II", Via Pansini 5, 80131, Naples, Italy
| | - Wanda Acampa
- Department of Advanced Biomedical Sciences, University "Federico II", Via Pansini 5, 80131, Naples, Italy
- Institute of Biostructure and Bioimaging, National Council of Research, Naples, Italy
| | - Alberto Cuocolo
- Department of Advanced Biomedical Sciences, University "Federico II", Via Pansini 5, 80131, Naples, Italy.
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de Souza ACDAH, Gonçalves BKD, Tedeschi AL, Lima RSL. Quantification of myocardial flow reserve using a gamma camera with solid-state cadmium-zinc-telluride detectors: Relation to angiographic coronary artery disease. J Nucl Cardiol 2021; 28:876-884. [PMID: 31222529 DOI: 10.1007/s12350-019-01775-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 05/23/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Previous studies have suggested using gamma cameras with cadmium-zinc-telluride (CZT) detectors to quantify myocardial blood flow (MBF) and flow reserve (MFR). In this study, we aimed to evaluate the feasibility and accuracy of MFR quantification using a CZT camera compared to coronary angiography. METHODS Forty-one participants referred for coronary angiography underwent a rest/stress one-day myocardial perfusion imaging protocol using a CZT gamma camera. Rest and stress dynamic phases were followed by acquisition of traditional perfusion images and time-activity curves were generated. Angiographic and perfusion results were compared to MFR. RESULTS Patients with abnormal perfusion presented reduced MFR (2.01 [1.48-2.77] vs. 2.94 [2.38-3.64], P = 0.002), and reduced stress MBF. Patients with high-risk CAD had lower global MFR compared to patients without obstructive disease (1.99 [1.22-2.84] vs. 2.89 [2.22-3.58], P = 0.026). Obstructed vessels showed lower regional MFR when compared to non-obstructed (1.81 [1.19-2.67] vs. 2.75 [2.13-3.42], P < 0.001). A regional MFR of 2.2 provided a sensitivity of 63.2% and specificity of 74.1% to identify an obstructive lesion in the corresponding artery. CONCLUSION In patients undergoing invasive coronary angiography for the evaluation of CAD, quantifying MBF and MFR in a CZT gamma camera is feasible and reflects underlying disease. In these patients, reduced regional MFR suggests the presence of obstructive lesion(s).
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Affiliation(s)
| | | | - Angelo L Tedeschi
- Department of Cardiology, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Ronaldo S L Lima
- Department of Cardiology, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
- Fonte Imagem, Rua Fonte da Saudade, 277, Rio de Janeiro, 22471-210, Brazil
- Clínica de Diagnóstico por Imagem, Rio de Janeiro, Brazil
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Gallucci G, Capobianco A, Molinari S, Storto G. Sex and gender issues in cardiotoxicity: Are we ready for gynecardiooncology? J Nucl Cardiol 2019; 26:1018. [PMID: 28828719 DOI: 10.1007/s12350-017-1042-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Accepted: 07/17/2017] [Indexed: 10/19/2022]
Affiliation(s)
- Giuseppina Gallucci
- Department of Clinical Governance, IRCCS Referral Cancer Center of Basilicata, via Padre Pio 1, 85028, Rionero in Vulture, Potenza, Italy.
| | - Alba Capobianco
- Department of Clinical Governance, IRCCS Referral Cancer Center of Basilicata, via Padre Pio 1, 85028, Rionero in Vulture, Potenza, Italy
| | - Sergio Molinari
- Department of Health Care, IRCCS Referral Cancer Center of Basilicata, via Padre Pio 1, 85028, Rionero in Vulture, Potenza, Italy
| | - Giovanni Storto
- Department of Clinical Governance, IRCCS Referral Cancer Center of Basilicata, via Padre Pio 1, 85028, Rionero in Vulture, Potenza, Italy
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Agostini D, Roule V, Nganoa C, Roth N, Baavour R, Parienti JJ, Beygui F, Manrique A. First validation of myocardial flow reserve assessed by dynamic 99mTc-sestamibi CZT-SPECT camera: head to head comparison with 15O-water PET and fractional flow reserve in patients with suspected coronary artery disease. The WATERDAY study. Eur J Nucl Med Mol Imaging 2018; 45:1079-1090. [PMID: 29497801 PMCID: PMC5953996 DOI: 10.1007/s00259-018-3958-7] [Citation(s) in RCA: 132] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Accepted: 01/22/2018] [Indexed: 12/23/2022]
Abstract
PURPOSE We assessed the feasibility of myocardial blood flow (MBF) and flow reserve (MFR) estimation using dynamic SPECT with a novel CZT camera in patients with stable CAD, in comparison with 15O-water PET and fractional flow reserve (FFR). METHODS Thirty patients were prospectively included and underwent FFR measurements in the main coronary arteries (LAD, LCx, RCA). A stenosis ≥50% was considered obstructive and a FFR abnormal if ≤0.8. All patients underwent a dynamic rest/stress 99mTc-sestamibi CZT-SPECT and 15O-water PET for MBF and MFR calculation. Net retention kinetic modeling was applied to SPECT data to estimate global uptake values, and MBF was derived using Leppo correction. Ischemia by PET and CZT-SPECT was considered present if MFR was lower than 2 and 2.1, respectively. RESULTS CZT-SPECT yielded higher stress and rest MBF compared to PET for global and LAD and LCx territories, but not in RCA territory. MFR was similar in global and each vessel territory for both modalities. The sensitivity, specificity, accuracy, positive and negative predictive value of CZT-SPECT were, respectively, 83.3, 95.8, 93.3, 100 and 85.7% for the detection of ischemia and 58.3, 84.6, 81.1, 36.8 and 93% for the detection of hemodynamically significant stenosis (FFR ≤ 0.8). CONCLUSIONS Dynamic 99mTc-sestamibi CZT-SPECT was technically feasible and provided similar MFR compared to 15O-water PET and high diagnostic value for detecting impaired MFR and abnormal FFR in patients with stable CAD.
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Affiliation(s)
- Denis Agostini
- Department of Nuclear Medicine, CHU Caen, CHU Cote de Nacre, Caen, France.
- Normandy University, EA 4650, Caen, France.
| | | | - Catherine Nganoa
- Department of Nuclear Medicine, CHU Caen, CHU Cote de Nacre, Caen, France
| | | | | | | | - Farzin Beygui
- Normandy University, EA 4650, Caen, France
- Department of Cardiology, CHU Caen, Caen, France
| | - Alain Manrique
- Department of Nuclear Medicine, CHU Caen, CHU Cote de Nacre, Caen, France
- Normandy University, EA 4650, Caen, France
- Cyceron PET Center, Caen, France
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14
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Petretta M, Petretta A, Cuocolo A. Assessment of asynchrony by gated myocardial perfusion imaging improves patient management: Pro. J Nucl Cardiol 2018; 25:532-535. [PMID: 28795346 DOI: 10.1007/s12350-017-1021-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Accepted: 03/10/2017] [Indexed: 10/19/2022]
Affiliation(s)
- Mario Petretta
- Department of Translational Medical Sciences, University Federico II, Naples, Italy
| | - Andrea Petretta
- Department of Arrhythmology, Maria Cecilia Hospital, GVM Care and Research, Cotignola, Italy
| | - Alberto Cuocolo
- Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy.
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15
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Assante R, Acampa W, Zampella E, Arumugam P, Nappi C, Gaudieri V, Mainolfi CG, Panico M, Magliulo M, Tonge CM, Petretta M, Cuocolo A. Prognostic value of atherosclerotic burden and coronary vascular function in patients with suspected coronary artery disease. Eur J Nucl Med Mol Imaging 2017; 44:2290-2298. [PMID: 28815291 DOI: 10.1007/s00259-017-3800-7] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Accepted: 08/03/2017] [Indexed: 12/19/2022]
Abstract
PURPOSE To evaluate the prognostic value of coronary atherosclerotic burden, assessed by coronary artery calcium (CAC) score, and coronary vascular function, assessed by coronary flow reserve (CFR) in patients with suspected coronary artery disease (CAD). METHODS We studied 436 patients undergoing hybrid 82Rb positron emission tomography/computed tomography imaging. CAC score was measured according to the Agatston method, and patients were categorized into three groups (0, <400, and ≥400). CFR was calculated as the ratio of hyperemic to baseline myocardial blood flow, and it was considered reduced when <2. RESULTS Follow-up was 94% complete during a mean period of 47±15 months. During follow-up, 17 events occurred (4% cumulative event rate). Event-free survival decreased with worsening of CAC score category (p < 0.001) and in patients with reduced CFR (p < 0.005). At multivariable analysis, CAC score ≥400 (p < 0.01) and CFR (p < 0.005) were independent predictors of events. Including CFR in the prognostic model, continuous net reclassification improvement was 0.51 (0.14 in patients with events and 0.37 in those without). At classification and regression tree analysis, the initial split was on CAC score. For patients with a CAC score < 400, no further split was performed, while patients with a CAC score ≥400 were further stratified by CFR values. Decision curve analyses indicate that the model including CFR resulted in a higher net benefit across a wide range of decision threshold probabilities. CONCLUSIONS In patients with suspected CAD, CFR provides significant incremental risk stratification over established cardiac risk factors and CAC score for prediction of adverse cardiac events.
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Affiliation(s)
- Roberta Assante
- Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy
| | - Wanda Acampa
- Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy.,Institute of Biostructure and Bioimaging, National Council of Research, Naples, Italy
| | - Emilia Zampella
- Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy
| | - Parthiban Arumugam
- Nuclear Medicine Center, Central Manchester University Teaching Hospitals, Manchester, UK
| | - Carmela Nappi
- Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy
| | - Valeria Gaudieri
- Institute of Biostructure and Bioimaging, National Council of Research, Naples, Italy
| | | | - Mariarosaria Panico
- Institute of Biostructure and Bioimaging, National Council of Research, Naples, Italy
| | - Mario Magliulo
- Institute of Biostructure and Bioimaging, National Council of Research, Naples, Italy
| | - Christine M Tonge
- Nuclear Medicine Center, Central Manchester University Teaching Hospitals, Manchester, UK
| | - Mario Petretta
- Department of Translational Medical Sciences, University Federico II, Naples, Italy
| | - Alberto Cuocolo
- Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy.
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16
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Nkoulou R, Fuchs TA, Pazhenkottil AP, Kuest SM, Ghadri JR, Stehli J, Fiechter M, Herzog BA, Gaemperli O, Buechel RR, Kaufmann PA. Absolute Myocardial Blood Flow and Flow Reserve Assessed by Gated SPECT with Cadmium–Zinc–Telluride Detectors Using 99mTc-Tetrofosmin: Head-to-Head Comparison with 13N-Ammonia PET. J Nucl Med 2016; 57:1887-1892. [DOI: 10.2967/jnumed.115.165498] [Citation(s) in RCA: 89] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Accepted: 05/31/2016] [Indexed: 12/17/2022] Open
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17
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Prediction Models for Cardiac Risk Classification with Nuclear Cardiology Techniques. CURRENT CARDIOVASCULAR IMAGING REPORTS 2016. [DOI: 10.1007/s12410-015-9365-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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18
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Ben Bouallègue F, Roubille F, Lattuca B, Cung TT, Macia JC, Gervasoni R, Leclercq F, Mariano-Goulart D. SPECT Myocardial Perfusion Reserve in Patients with Multivessel Coronary Disease: Correlation with Angiographic Findings and Invasive Fractional Flow Reserve Measurements. J Nucl Med 2015; 56:1712-7. [DOI: 10.2967/jnumed.114.143164] [Citation(s) in RCA: 89] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Accepted: 08/10/2015] [Indexed: 11/16/2022] Open
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19
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Timmins R, Klein R, Petryk J, Marvin B, Wei L, deKemp RA, Ruddy TD, Wells RG. Reduced dose measurement of absolute myocardial blood flow using dynamic SPECT imaging in a porcine model. Med Phys 2015; 42:5075-83. [DOI: 10.1118/1.4927723] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
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20
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Apostolopoulos DJ, Kaspiri A, Spyridonidis T, Patsouras N, Savvopoulos CA, Davlouros P, Vassilakos PJ, Alexopoulos D. Assessment of absolute Tc-99m tetrofosmin retention in the myocardium as an index of myocardial blood flow and coronary flow reserve by gated-SPECT/CT: a feasibility study. Ann Nucl Med 2015; 29:588-602. [DOI: 10.1007/s12149-015-0982-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Accepted: 05/06/2015] [Indexed: 12/24/2022]
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21
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Petretta M, Storto G, Pellegrino T, Bonaduce D, Cuocolo A. Quantitative Assessment of Myocardial Blood Flow with SPECT. Prog Cardiovasc Dis 2015; 57:607-14. [PMID: 25560327 DOI: 10.1016/j.pcad.2014.12.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The quantitative assessment of myocardial blood flow (MBF) and coronary flow reserve (CFR) may be useful for the functional evaluation of coronary artery disease, allowing judgment of its severity, tracking of disease progression, and evaluation of the anti-ischemic efficacy of therapeutic strategies. Quantitative estimates of myocardial perfusion and CFR can be derived from single-photon emission computed tomography (SPECT) myocardial perfusion images by use of equipment, tracers, and techniques that are available in most nuclear cardiology laboratories. However, this method underestimates CFR, particularly at high flow rates. The recent introduction of cardiac-dedicated gamma cameras with solid-state detectors provides very fast perfusion imaging with improved resolution, allowing fast acquisition of serial dynamic images during the first pass of a flow agent. This new technology holds great promise for MBF and CFR quantification with dynamic SPECT. Future studies will clarify the effectiveness of dynamic SPECT flow imaging.
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Affiliation(s)
- Mario Petretta
- Department of Translational Medical Sciences, University Federico II, Naples, Italy
| | - Giovanni Storto
- Nuclear Medicine Unit, IRCCS Regional Cancer Hospital CROB, Rionero in Vulture, Italy
| | - Teresa Pellegrino
- Institute of Biostructure and Bioimaging, National Council of Research, Naples, Italy
| | - Domenico Bonaduce
- Department of Translational Medical Sciences, University Federico II, Naples, Italy
| | - Alberto Cuocolo
- Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy.
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22
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Ben-Haim S, Agostini D. Dynamic SPECT: evolution of a widely available tool for the assessment of coronary flow reserve. Eur J Nucl Med Mol Imaging 2014; 42:302-4. [DOI: 10.1007/s00259-014-2929-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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23
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Wells RG, Timmins R, Klein R, Lockwood J, Marvin B, deKemp RA, Wei L, Ruddy TD. Dynamic SPECT measurement of absolute myocardial blood flow in a porcine model. J Nucl Med 2014; 55:1685-91. [PMID: 25189340 DOI: 10.2967/jnumed.114.139782] [Citation(s) in RCA: 109] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
UNLABELLED Absolute myocardial blood flow (MBF) and myocardial flow reserve (MFR) provide incremental diagnostic and prognostic information over relative perfusion alone. Recent development of dedicated cardiac SPECT cameras with better sensitivity and temporal resolution make dynamic SPECT imaging more practical. In this study, we evaluate the measurement of MBF using a multipinhole dedicated cardiac SPECT camera in a pig model of rest and transient occlusion at stress using 3 common tracers: (201)Tl, (99m)Tc-tetrofosmin, and (99m)Tc-sestamibi. METHODS Animals (n = 19) were injected at rest/stress with (99m)Tc radiotracers (370/1,100 MBq) or (201)Tl (37/110 MBq) with a 1-h delay between rest and dipyridamole stress. With each tracer, microspheres were injected simultaneously as the gold standard measurement for MBF. Dynamic images were obtained for 11 min starting with each injection. Residual resting activity was subtracted from stress data and images reconstructed with CT-based attenuation correction and energy window-based scatter correction. Dynamic images were processed with kinetic analysis software using a 1-tissue-compartment model to obtain the uptake rate constant K(1) as a function of microsphere MBF. RESULTS Measured extraction fractions agree with those obtained previously using ex vivo techniques. Converting K(1) back to MBF using the measured extraction fractions produced accurate values and good correlations with microsphere MBF: r = 0.75-0.90 (P < 0.01 for all). The correlation in the MFR was between r = 0.57 and 0.94 (P < 0.01). CONCLUSION Noninvasive measurement of absolute MBF with stationary dedicated cardiac SPECT is feasible using common perfusion tracers.
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Affiliation(s)
- R Glenn Wells
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; and
| | - Rachel Timmins
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; and
| | - Ran Klein
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; and
| | - Julia Lockwood
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; and
| | - Brian Marvin
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; and
| | - Robert A deKemp
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; and
| | - Lihui Wei
- Nordion Inc., Ottawa, Ontario, Canada
| | - Terrence D Ruddy
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; and
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24
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George B, Seals S, Aban I. Survival analysis and regression models. J Nucl Cardiol 2014; 21:686-94. [PMID: 24810431 PMCID: PMC4111957 DOI: 10.1007/s12350-014-9908-2] [Citation(s) in RCA: 211] [Impact Index Per Article: 21.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Accepted: 04/10/2014] [Indexed: 10/25/2022]
Abstract
Time-to-event outcomes are common in medical research as they offer more information than simply whether or not an event occurred. To handle these outcomes, as well as censored observations where the event was not observed during follow-up, survival analysis methods should be used. Kaplan-Meier estimation can be used to create graphs of the observed survival curves, while the log-rank test can be used to compare curves from different groups. If it is desired to test continuous predictors or to test multiple covariates at once, survival regression models such as the Cox model or the accelerated failure time model (AFT) should be used. The choice of model should depend on whether or not the assumption of the model (proportional hazards for the Cox model, a parametric distribution of the event times for the AFT model) is met. The goal of this paper is to review basic concepts of survival analysis. Discussions relating the Cox model and the AFT model will be provided. The use and interpretation of the survival methods model are illustrated using an artificially simulated dataset.
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Affiliation(s)
- Brandon George
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL
| | - Samantha Seals
- Center of Biostatistics and Bioinformatics, University of Mississippi Medical Center, Jackson, MS
| | - Inmaculada Aban
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL
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25
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Ben-Haim S, Murthy VL, Breault C, Allie R, Sitek A, Roth N, Fantony J, Moore SC, Park MA, Kijewski M, Haroon A, Slomka P, Erlandsson K, Baavour R, Zilberstien Y, Bomanji J, Di Carli MF. Quantification of Myocardial Perfusion Reserve Using Dynamic SPECT Imaging in Humans: A Feasibility Study. J Nucl Med 2013; 54:873-9. [PMID: 23578996 PMCID: PMC3951831 DOI: 10.2967/jnumed.112.109652] [Citation(s) in RCA: 170] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
UNLABELLED Myocardial perfusion imaging (MPI) is well established in the diagnosis and workup of patients with known or suspected coronary artery disease (CAD); however, it can underestimate the extent of obstructive CAD. Quantification of myocardial perfusion reserve with PET can assist in the diagnosis of multivessel CAD. We evaluated the feasibility of dynamic tomographic SPECT imaging and quantification of a retention index to describe global and regional myocardial perfusion reserve using a dedicated solid-state cardiac camera. METHODS Ninety-five consecutive patients (64 men and 31 women; median age, 67 y) underwent dynamic SPECT imaging with (99m)Tc-sestamibi at rest and at peak vasodilator stress, followed by standard gated MPI. The dynamic images were reconstructed into 60-70 frames, 3-6 s/frame, using ordered-subsets expectation maximization with 4 iterations and 32 subsets. Factor analysis was used to estimate blood-pool time-activity curves, used as input functions in a 2-compartment kinetic model. K1 values ((99m)Tc-sestamibi uptake) were calculated for the stress and rest images, and K2 values ((99m)Tc-sestamibi washout) were set to zero. Myocardial perfusion reserve (MPR) index was calculated as the ratio of the stress and rest K1 values. Standard MPI was evaluated semiquantitatively, and total perfusion deficit (TPD) of at least 5% was defined as abnormal. RESULTS Global MPR index was higher in patients with normal MPI (n = 51) than in patients with abnormal MPI (1.61 [interquartile range (IQR), 1.33-2.03] vs. 1.27 [IQR, 1.12-1.61], P = 0.0002). By multivariable regression analysis, global MPR index was associated with global stress TPD, age, and smoking. Regional MPR index was associated with the same variables and with regional stress TPD. Sixteen patients undergoing invasive coronary angiography had 20 vessels with stenosis of at least 50%. The MPR index was 1.11 (IQR, 1.01-1.21) versus 1.30 (IQR, 1.12-1.67) in territories supplied by obstructed and nonobstructed arteries, respectively (P = 0.02). MPR index showed a stepwise reduction with increasing extent of obstructive CAD (P = 0.02). CONCLUSION Dynamic tomographic imaging and quantification of a retention index describing global and regional perfusion reserve are feasible using a solid-state camera. Preliminary results show that the MPR index is lower in patients with perfusion defects and in regions supplied by obstructed coronary arteries. Further studies are needed to establish the clinical role of this technique as an aid to semiquantitative analysis of MPI.
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Affiliation(s)
- Simona Ben-Haim
- Institute of Nuclear Medicine, University College London Hospitals, NHS Trust, London, United Kingdom.
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26
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1,25-Dihydroxy vitamin D and coronary microvascular function. Eur J Nucl Med Mol Imaging 2012; 40:280-9. [DOI: 10.1007/s00259-012-2271-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2012] [Accepted: 10/01/2012] [Indexed: 12/19/2022]
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27
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Shaw LJ, Hage FG, Berman DS, Hachamovitch R, Iskandrian A. Prognosis in the era of comparative effectiveness research: where is nuclear cardiology now and where should it be? J Nucl Cardiol 2012; 19:1026-43. [PMID: 22760523 DOI: 10.1007/s12350-012-9593-y] [Citation(s) in RCA: 86] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
- Leslee J Shaw
- Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, 1462 Clifton Road NE, Room 529, Atlanta, GA 30324, USA.
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28
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Mc Ardle B, Ziadi MC, Ruddy TD, Beanlands RS. Nuclear perfusion imaging for functional evaluation of patients with known or suspected coronary artery disease: the future is now. Future Cardiol 2012; 8:603-22. [DOI: 10.2217/fca.12.40] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Nuclear imaging, with both single-photon emission computed tomography and PET, has a well-established role in the assessment of patients with known or suspected coronary artery disease. There is a large body of evidence regarding the diagnostic accuracy and prognostic value of these modalities, however, they continue to evolve rapidly with advances in camera and tracer technology, as well as changes in imaging protocols to increase lab efficiency, improve image quality and to decrease radiation exposure to patients. Nuclear imaging also provides insights into atherogenesis at a molecular level and can be combined with other imaging modalities, providing both functional and structural data and complimentary information on the presence of coronary disease and its functional implications.
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Affiliation(s)
- Brian Mc Ardle
- The National Cardiac PET Centre, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Maria Cecilia Ziadi
- The National Cardiac PET Centre, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Terrence D Ruddy
- The National Cardiac PET Centre, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Rob S Beanlands
- The National Cardiac PET Centre, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, ON, Canada
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29
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Winant CD, Aparici CM, Zelnik YR, Reutter BW, Sitek A, Bacharach SL, Gullberg GT. Investigation of dynamic SPECT measurements of the arterial input function in human subjects using simulation, phantom and human studies. Phys Med Biol 2012; 57:375-93. [PMID: 22170801 PMCID: PMC3325151 DOI: 10.1088/0031-9155/57/2/375] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Computer simulations, a phantom study and a human study were performed to determine whether a slowly rotating single-photon computed emission tomography (SPECT) system could provide accurate arterial input functions for quantification of myocardial perfusion imaging using kinetic models. The errors induced by data inconsistency associated with imaging with slow camera rotation during tracer injection were evaluated with an approach called SPECT/P (dynamic SPECT from positron emission tomography (PET)) and SPECT/D (dynamic SPECT from database of SPECT phantom projections). SPECT/P simulated SPECT-like dynamic projections using reprojections of reconstructed dynamic (94)Tc-methoxyisobutylisonitrile ((94)Tc-MIBI) PET images acquired in three human subjects (1 min infusion). This approach was used to evaluate the accuracy of estimating myocardial wash-in rate parameters K(1) for rotation speeds providing 180° of projection data every 27 or 54 s. Blood input and myocardium tissue time-activity curves (TACs) were estimated using spatiotemporal splines. These were fit to a one-compartment perfusion model to obtain wash-in rate parameters K(1). For the second method (SPECT/D), an anthropomorphic cardiac torso phantom was used to create real SPECT dynamic projection data of a tracer distribution derived from (94)Tc-MIBI PET scans in the blood pool, myocardium, liver and background. This method introduced attenuation, collimation and scatter into the modeling of dynamic SPECT projections. Both approaches were used to evaluate the accuracy of estimating myocardial wash-in parameters for rotation speeds providing 180° of projection data every 27 and 54 s. Dynamic cardiac SPECT was also performed in a human subject at rest using a hybrid SPECT/CT scanner. Dynamic measurements of (99m)Tc-tetrofosmin in the myocardium were obtained using an infusion time of 2 min. Blood input, myocardium tissue and liver TACs were estimated using the same spatiotemporal splines. The spatiotemporal maximum-likelihood expectation-maximization (4D ML-EM) reconstructions gave more accurate reconstructions than did standard frame-by-frame static 3D ML-EM reconstructions. The SPECT/P results showed that 4D ML-EM reconstruction gave higher and more accurate estimates of K(1) than did 3D ML-EM, yielding anywhere from a 44% underestimation to 24% overestimation for the three patients. The SPECT/D results showed that 4D ML-EM reconstruction gave an overestimation of 28% and 3D ML-EM gave an underestimation of 1% for K(1). For the patient study the 4D ML-EM reconstruction provided continuous images as a function of time of the concentration in both ventricular cavities and myocardium during the 2 min infusion. It is demonstrated that a 2 min infusion with a two-headed SPECT system rotating 180° every 54 s can produce measurements of blood pool and myocardial TACs, though the SPECT simulation studies showed that one must sample at least every 30 s to capture a 1 min infusion input function.
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Affiliation(s)
- Celeste D Winant
- UCSF Physics Research Laboratory, Department of Radiology, University of California San Francisco, 185 Berry St, Suite 350, PO Box 0946, San Francisco, CA 94107, USA
| | - Carina Mari Aparici
- UCSF Physics Research Laboratory, Department of Radiology, University of California San Francisco, 185 Berry St, Suite 350, PO Box 0946, San Francisco, CA 94107, USA
| | - Yuval R Zelnik
- Edmond J Safra Campus, Hebrew University, Jerusalem 91904, Israel
| | - Bryan W Reutter
- Lawrence Berkeley National Laboratory, One Cyclotron Road, Berkeley, CA 94720, USA
| | - Arkadiusz Sitek
- Department of Radiology, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA 02115, USA
| | - Stephen L Bacharach
- UCSF Physics Research Laboratory, Department of Radiology, University of California San Francisco, 185 Berry St, Suite 350, PO Box 0946, San Francisco, CA 94107, USA
| | - Grant T Gullberg
- UCSF Physics Research Laboratory, Department of Radiology, University of California San Francisco, 185 Berry St, Suite 350, PO Box 0946, San Francisco, CA 94107, USA
- Lawrence Berkeley National Laboratory, One Cyclotron Road, Berkeley, CA 94720, USA
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30
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Dekemp RA, Trottier M, Beanlands RSB. Incremental prognostic value of coronary flow reserve assessed with single-photon emission computed tomography. J Nucl Cardiol 2011; 18:541-3. [PMID: 21671147 DOI: 10.1007/s12350-011-9408-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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