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Leal GN, Astley C, Lima MS, de Fátima Rodrigues Diniz M, Lianza AC, Sawamura KSS, Menezes CRB, da Silva CLMR, Bain V, Imada R, Chalela W, Pereira MFB, de Sousa Marques HH, Buchpiguel CA, Gualano B, Silva CA. Segmental cardiac strain assessment by two-dimensional speckle-tracking echocardiography in surviving MIS-c patients: correlations with myocardial flow reserve (MFR) by 13 N-ammonia PET-CT. Microcirculation 2022; 29:e12750. [PMID: 35146846 DOI: 10.1111/micc.12750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 01/05/2022] [Accepted: 02/02/2022] [Indexed: 11/28/2022]
Abstract
MIS-c is associated with severe cardiovascular impairment and eventually death. Pathophysiological mechanisms involved in myocardial injury were scarcely investigated and cardiovascular outcomes are uncertain. Autopsy studies suggested that microvascular dysfunction may be relevant to LV impairment. we aimed to evaluate segmental LV longitudinal strain by 2DST echocardiography, as well as myocardial flow reserve (MFR) by 13 N-ammonia PET-CT, in surviving MIS-c patients. each patient generated 34 LV segments for combined 2DST and MRF analysis. MFR was considered abnormal when < 2, borderline when between 2 and 2.5 and normal when > 2.5. From July 2020 to February 2021, six patients were admitted with MIS-c: three males, aged 9.3 (6.6-15.7) years. Time from admission to the follow-up visit was 6.05 (2-10.3) months. Although all patients were asymptomatic and LV EF was ≥ 55%, 43/102 (42.1%) LV segments showed MFR < 2.5. There was a modest positive correlation between segmental peak systolic longitudinal strain and MFR: r = 0.36, p = 0.03 for basal segments; r = 0.41, p = 0.022 for mid segments; r = 0.42, p = 0.021 for apical segments. Median peak systolic longitudinal strain was different among MRF categories: 18% (12%-24%) for abnormal, 18.5% (11%-35%) for borderline and 21% (12%-32%) for normal MFR (p = 0.006). We provided preliminary evidence that surviving MIS-c patients may present subclinical impairment of myocardial microcirculation. Segmental cardiac strain assessment 2DST seems useful for MIS-c cardiovascular follow-up, given its good correlation with 13 N-ammonia PET-CT derived MFR.
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Affiliation(s)
- Gabriela Nunes Leal
- Laboratório de Ecocardiografia Pediátrica, Instituto da Criança e do Adolescente, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo-SP, Brasil
| | - Camila Astley
- Grupo de Pesquisa em Fisiologia Aplicada e Nutrição, Universidade de São Paulo, São Paulo-SP, Brasil
| | - Marcos Santos Lima
- Departamento de Radiologia e Oncologia da Faculdade de Medicina da, Universidade de São Paulo, São Paulo-SP, Brasil
| | - Maria de Fátima Rodrigues Diniz
- Laboratório de Ecocardiografia Pediátrica, Instituto da Criança e do Adolescente, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo-SP, Brasil
| | - Alessandro Cavalcanti Lianza
- Laboratório de Ecocardiografia Pediátrica, Instituto da Criança e do Adolescente, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo-SP, Brasil
| | - Karen Saori Shiraishi Sawamura
- Laboratório de Ecocardiografia Pediátrica, Instituto da Criança e do Adolescente, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo-SP, Brasil
| | - Carolina Rocha Brito Menezes
- Laboratório de Ecocardiografia Pediátrica, Instituto da Criança e do Adolescente, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo-SP, Brasil
| | - Camila Lino Martins Rodrigues da Silva
- Laboratório de Ecocardiografia Pediátrica, Instituto da Criança e do Adolescente, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo-SP, Brasil
| | - Vera Bain
- Departamento de Pediatria da Faculdade de Medicina da, Universidade de São Paulo, São Paulo-SP, Brasil
| | - Rodrigo Imada
- Instituto do Coração, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo-SP, Brasil
| | - William Chalela
- Instituto do Coração, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo-SP, Brasil
| | | | | | - Carlos Alberto Buchpiguel
- Departamento de Radiologia e Oncologia da Faculdade de Medicina da, Universidade de São Paulo, São Paulo-SP, Brasil
| | - Bruno Gualano
- Grupo de Pesquisa em Fisiologia Aplicada e Nutrição, Universidade de São Paulo, São Paulo-SP, Brasil
| | - Clovis Artur Silva
- Departamento de Pediatria da Faculdade de Medicina da, Universidade de São Paulo, São Paulo-SP, Brasil
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van Lavieren MA, Stegehuis VE, Bax M, Echavarría-Pinto M, Wijntjens GWM, de Winter RJ, Koch KT, Henriques JP, Escaned J, Meuwissen M, van de Hoef TP, Piek JJ. Time course of coronary flow capacity impairment in ST-segment elevation myocardial infarction. EUROPEAN HEART JOURNAL. ACUTE CARDIOVASCULAR CARE 2020; 10:2048872620918706. [PMID: 32450714 PMCID: PMC8248849 DOI: 10.1177/2048872620918706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 03/23/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Microvascular dysfunction in the setting of ST-elevated myocardial infarction (STEMI) plays an important role in long-term poor clinical outcome. Coronary flow reserve (CFR) is a well-established physiological parameter to interrogate the coronary microcirculation. Together with hyperaemic average peak flow velocity, CFR constitutes the coronary flow capacity (CFC), a validated risk stratification tool in ischaemic heart disease with significant prognostic value. This mechanistic study aims to elucidate the time course of the microcirculation as reflected by alterations in microcirculatory physiological parameters in the acute phase and during follow-up in STEMI patients. METHODS We assessed CFR and CFC in the culprit and non-culprit vessel in consecutive STEMI patients at baseline (n = 98) and after one-week (n = 64) and six-month follow-up (n = 65). RESULTS A significant trend for culprit CFC in infarct size as determined by peak troponin T (p = 0.004), time to reperfusion (p = 0.038), the incidence of final Thrombolysis In Myocardial Infarction 3 flow (p = 0.019) and systolic retrograde flow (p = 0.043) was observed. Non-culprit CFC linear contrast analysis revealed a significant trend in C-reactive protein (p = 0.027), peak troponin T (p < 0.001) and heart rate (p = 0.049). CFC improved both in the culprit and the non-culprit vessel at one-week (both p < 0.001) and six-month follow-up (p = 0.0013 and p < 0.001) compared with baseline. CONCLUSION This study demonstrates the importance of microcirculatory disturbances in the setting of STEMI, which is relevant for the interpretation of intracoronary diagnostic techniques which are influenced by both culprit and non-culprit vascular territories. Assessment of non-culprit vessel CFC in the setting of STEMI might improve risk stratification of these patients following coronary reperfusion of the culprit vessel.
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Affiliation(s)
- Martijn A van Lavieren
- Amsterdam University Medical Centres – location AMC, Amsterdam Cardiovascular Sciences, University of Amsterdam, The Netherlands
| | - Valérie E Stegehuis
- Amsterdam University Medical Centres – location AMC, Amsterdam Cardiovascular Sciences, University of Amsterdam, The Netherlands
| | - Matthijs Bax
- Department of Cardiology, Haga Teaching Hospital, The Hague, The Netherlands
| | - Mauro Echavarría-Pinto
- Amsterdam University Medical Centres – location AMC, Amsterdam Cardiovascular Sciences, University of Amsterdam, The Netherlands
- Cardiovascular institute, Hospital Clínico San Carlos, Madrid, Spain
- Faculty of Medicine, Autonomous University of Queretaro, Mexico
| | - Gilbert W M Wijntjens
- Amsterdam University Medical Centres – location AMC, Amsterdam Cardiovascular Sciences, University of Amsterdam, The Netherlands
| | - Robbert J de Winter
- Amsterdam University Medical Centres – location AMC, Amsterdam Cardiovascular Sciences, University of Amsterdam, The Netherlands
| | - Karel T Koch
- Amsterdam University Medical Centres – location AMC, Amsterdam Cardiovascular Sciences, University of Amsterdam, The Netherlands
| | - José P Henriques
- Amsterdam University Medical Centres – location AMC, Amsterdam Cardiovascular Sciences, University of Amsterdam, The Netherlands
| | - Javier Escaned
- Cardiovascular institute, Hospital Clínico San Carlos, Madrid, Spain
- Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain
- Faculty of Medicine, Complutense University of Madrid, Spain
| | | | - Tim P van de Hoef
- Amsterdam University Medical Centres – location AMC, Amsterdam Cardiovascular Sciences, University of Amsterdam, The Netherlands
| | - Jan J Piek
- Amsterdam University Medical Centres – location AMC, Amsterdam Cardiovascular Sciences, University of Amsterdam, The Netherlands
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3
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Acampa W, Rozza F, Zampella E, Assante R, Mannarino T, Nappi C, Mainolfi C, Petretta M, Trimarco B, Cuocolo A. Warranty period of normal stress myocardial perfusion imaging in hypertensive patients: A parametric survival analysis. J Nucl Cardiol 2020; 27:534-541. [PMID: 29679222 DOI: 10.1007/s12350-018-1285-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Accepted: 04/11/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND We evaluated the warranty period of a normal stress myocardial perfusion single-photon emission computed tomography (MPS) in hypertensive patients. METHODS AND RESULTS A total of 471 consecutive hypertensive patients with suspected coronary artery disease and normal perfusion at stress MPS were followed for a mean of 76 ± 21 months. Endpoint events were cardiac death or nonfatal myocardial infarction. With Cox analysis, age (hazard ratio 1.1, P < .005) and stress test type (hazard ratio 2.7, P < .005) were independent predictors of events. With parametric Weibull analysis, patients ≤60 years old undergoing exercise stress test remained at low risk for the entire length of follow-up, while the highest probability of events and the major risk acceleration were observed in those > 60 years old who underwent pharmacologic stress test. In patients undergoing exercise test, peak systolic blood pressure (BP; hazard ratio 1.1, P < .005) emerged as predictor of events, and only subjects with peak systolic BP < 160 mmHg remained at low risk for the entire length of follow-up. In contrast, for patients with peak systolic BP ≥180 mmHg, the time to achieve a cumulative cardiac risk level of 3% was 18 months. CONCLUSIONS In hypertensive patients, the warranty period of a normal stress MPS varies according to stress type and peak systolic BP. A normal stress MPS can be considered reassuring in subjects ≤60 years old who performed exercise stress test and a peak systolic BP < 160 mmHg.
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Affiliation(s)
- 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
| | - Francesco Rozza
- Department of Advanced Biomedical Sciences, University Federico II, Via Pansini 5, 80131, Naples, Italy
| | - 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
| | - Teresa Mannarino
- 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
| | - Ciro Mainolfi
- Department of Advanced Biomedical Sciences, University Federico II, Via Pansini 5, 80131, Naples, Italy
| | - Mario Petretta
- Department of Translational Medical Sciences, University Federico II, Naples, Italy
| | - Bruno Trimarco
- Department of Advanced Biomedical Sciences, University Federico II, Via Pansini 5, 80131, Naples, Italy
| | - Alberto Cuocolo
- Department of Advanced Biomedical Sciences, University Federico II, Via Pansini 5, 80131, Naples, Italy.
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4
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Zhou Z, Lankhuizen IM, van Beusekom HM, Cheng C, Duncker DJ, Merkus D. Uridine Adenosine Tetraphosphate-Induced Coronary Relaxation Is Blunted in Swine With Pressure Overload: A Role for Vasoconstrictor Prostanoids. Front Pharmacol 2018; 9:255. [PMID: 29632487 PMCID: PMC5879110 DOI: 10.3389/fphar.2018.00255] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Accepted: 03/07/2018] [Indexed: 12/27/2022] Open
Abstract
Plasma levels of the vasoactive substance uridine adenosine tetraphosphate (Up4A) are elevated in hypertensive patients and Up4A-induced vascular contraction is exacerbated in various arteries isolated from hypertensive animals, suggesting a potential role of Up4A in development of hypertension. We previously demonstrated that Up4A produced potent and partially endothelium-dependent relaxation in the porcine coronary microvasculature. Since pressure-overload is accompanied by structural abnormalities in the coronary microvasculature as well as by endothelial dysfunction, we hypothesized that pressure-overload blunts the coronary vasodilator response to Up4A, and that the involvement of purinergic receptors and endothelium-derived factors is altered. The effects of Up4A were investigated using wire-myography in isolated coronary small arteries from Sham-operated swine and swine with prolonged (8 weeks) pressure overload of the left ventricle induced by aortic banding (AoB). Expression of purinergic receptors and endothelium-derived factors was assessed in isolated coronary small arteries using real-time PCR. Up4A (10-9 to 10-5 M) failed to produce contraction in isolated coronary small arteries from either Sham or AoB swine, but produced relaxation in preconstricted arteries, which was significantly blunted in AoB compared to Sham. Blockade of purinergic P1, and P2 receptors attenuated Up4A-induced coronary relaxation more, while the effect of P2X1-blockade was similar and the effects of A2A- and P2Y1-blockade were reduced in AoB as compared to Sham. mRNA expression of neither A1, A2, A3, nor P2X1, P2X7, P2Y1, P2Y2, nor P2Y6-receptors was altered in AoB as compared to Sham, while P2Y12 expression was higher in AoB. eNOS inhibition attenuated Up4A-induced coronary relaxation in both Sham and AoB. Additional blockade of cyclooxygenase enhanced Up4A-induced coronary relaxation in AoB but not Sham swine, suggesting the involvement of vasoconstrictor prostanoids. In endothelium-denuded coronary small arteries from normal swine, thromboxane synthase (TxS) inhibition enhanced relaxation to Up4A compared to endothelium-intact arteries, to a similar extent as P2Y12 inhibition, while the combination inhibition of P2Y12 and TxS had no additional effect. In conclusion, Up4A-induced coronary relaxation is blunted in swine with AoB, which appears to be due to the production of a vasoconstrictor prostanoid, likely thromboxane A2.
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Affiliation(s)
- Zhichao Zhou
- Division of Experimental Cardiology, Department of Cardiology, Thoraxcenter, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, Netherlands.,Cardiovascular Research School Erasmus University Rotterdam, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, Netherlands.,Division of Cardiology, Department of Medicine, Karolinska University Hospital, Karolinska Institutet, Solna, Sweden
| | - Inge M Lankhuizen
- Division of Experimental Cardiology, Department of Cardiology, Thoraxcenter, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, Netherlands.,Cardiovascular Research School Erasmus University Rotterdam, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Heleen M van Beusekom
- Division of Experimental Cardiology, Department of Cardiology, Thoraxcenter, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, Netherlands.,Cardiovascular Research School Erasmus University Rotterdam, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Caroline Cheng
- Division of Experimental Cardiology, Department of Cardiology, Thoraxcenter, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, Netherlands.,Cardiovascular Research School Erasmus University Rotterdam, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, Netherlands.,Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht, Netherlands
| | - Dirk J Duncker
- Division of Experimental Cardiology, Department of Cardiology, Thoraxcenter, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, Netherlands.,Cardiovascular Research School Erasmus University Rotterdam, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Daphne Merkus
- Division of Experimental Cardiology, Department of Cardiology, Thoraxcenter, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, Netherlands.,Cardiovascular Research School Erasmus University Rotterdam, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, Netherlands
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5
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Murthy VL, Bateman TM, Beanlands RS, Berman DS, Borges-Neto S, Chareonthaitawee P, Cerqueira MD, deKemp RA, DePuey EG, Dilsizian V, Dorbala S, Ficaro EP, Garcia EV, Gewirtz H, Heller GV, Lewin HC, Malhotra S, Mann A, Ruddy TD, Schindler TH, Schwartz RG, Slomka PJ, Soman P, Di Carli MF, Einstein A, Russell R, Corbett JR. Clinical Quantification of Myocardial Blood Flow Using PET: Joint Position Paper of the SNMMI Cardiovascular Council and the ASNC. J Nucl Cardiol 2018; 25:269-297. [PMID: 29243073 DOI: 10.1007/s12350-017-1110-x] [Citation(s) in RCA: 133] [Impact Index Per Article: 22.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Venkatesh L Murthy
- Frankel Cardiovascular Center, Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA.
| | | | - Rob S Beanlands
- National Cardiac PET Centre, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Daniel S Berman
- Departments of Imaging and Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Salvador Borges-Neto
- Division of Nuclear Medicine, Department of Radiology, and Division of Cardiology, Department of Medicine, Duke University School of Medicine, Duke University Health System, Durham, NC, USA
| | | | | | - Robert A deKemp
- National Cardiac PET Centre, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - E Gordon DePuey
- Division of Nuclear Medicine, Department of Radiology, Mt. Sinai St. Luke's and Mt. Sinai West Hospitals, Icahn School of Medicine at Mt. Sinai, New York, NY, USA
| | - Vasken Dilsizian
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Sharmila Dorbala
- Cardiovascular Imaging Program, Brigham and Women's Hospital, Boston, MA, USA
| | - Edward P Ficaro
- Division of Nuclear Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Ernest V Garcia
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA, USA
| | - Henry Gewirtz
- Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Gary V Heller
- Gagnon Cardiovascular Institute, Morristown Medical Center, Morristown, NJ, USA
| | | | - Saurabh Malhotra
- Division of Cardiovascular Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
| | | | - Terrence D Ruddy
- National Cardiac PET Centre, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Thomas H Schindler
- Division of Nuclear Medicine, Department of Radiology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Ronald G Schwartz
- Cardiology Division, Department of Medicine, and Nuclear Medicine Division, Department of Imaging Sciences, University of Rochester Medical Center, Rochester, NY, USA
| | - Piotr J Slomka
- Departments of Imaging and Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Prem Soman
- Division of Cardiology, Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Marcelo F Di Carli
- Cardiovascular Imaging Program, Brigham and Women's Hospital, Boston, MA, USA
| | - Andrew Einstein
- Division of Cardiology, Department of Medicine, and Department of Radiology, Columbia University Medical Center and New York-Presbyterian Hospital, New York, NY, USA
| | - Raymond Russell
- Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - James R Corbett
- Frankel Cardiovascular Center, Division of Cardiovascular Medicine, Department of Internal Medicine, and Division of Nuclear Medicine, Department of Radiology, University of Michigan, Ann Arbor, MI, USA
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6
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PET myocardial perfusion quantification: anatomy of a spreading functional technique. Clin Transl Imaging 2018. [DOI: 10.1007/s40336-018-0263-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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7
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Murthy VL, Bateman TM, Beanlands RS, Berman DS, Borges-Neto S, Chareonthaitawee P, Cerqueira MD, deKemp RA, DePuey EG, Dilsizian V, Dorbala S, Ficaro EP, Garcia EV, Gewirtz H, Heller GV, Lewin HC, Malhotra S, Mann A, Ruddy TD, Schindler TH, Schwartz RG, Slomka PJ, Soman P, Di Carli MF. Clinical Quantification of Myocardial Blood Flow Using PET: Joint Position Paper of the SNMMI Cardiovascular Council and the ASNC. J Nucl Med 2017; 59:273-293. [PMID: 29242396 DOI: 10.2967/jnumed.117.201368] [Citation(s) in RCA: 140] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Accepted: 09/11/2017] [Indexed: 12/30/2022] Open
Affiliation(s)
- Venkatesh L Murthy
- Frankel Cardiovascular Center, Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | | | - Rob S Beanlands
- National Cardiac PET Centre, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Daniel S Berman
- Departments of Imaging and Medicine, Cedars-Sinai Medical Center, Los Angeles, California
| | - Salvador Borges-Neto
- Division of Nuclear Medicine, Department of Radiology, and Division of Cardiology, Department of Medicine, Duke University School of Medicine, Duke University Health System, Durham, North Carolina
| | | | | | - Robert A deKemp
- National Cardiac PET Centre, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - E Gordon DePuey
- Division of Nuclear Medicine, Department of Radiology, Mt. Sinai St. Luke's and Mt. Sinai West Hospitals, Icahn School of Medicine at Mt. Sinai, New York, New York
| | - Vasken Dilsizian
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - Sharmila Dorbala
- Cardiovascular Imaging Program, Brigham and Women's Hospital, Boston, Massachusetts
| | - Edward P Ficaro
- Division of Nuclear Medicine, University of Michigan, Ann Arbor, Michigan
| | - Ernest V Garcia
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, Georgia
| | - Henry Gewirtz
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Gary V Heller
- Gagnon Cardiovascular Institute, Morristown Medical Center, Morristown, NJ, USA
| | | | - Saurabh Malhotra
- Division of Cardiovascular Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York
| | - April Mann
- Hartford Hospital, Hartford, Connecticut
| | - Terrence D Ruddy
- National Cardiac PET Centre, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Thomas H Schindler
- Division of Nuclear Medicine, Department of Radiology, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Ronald G Schwartz
- Cardiology Division, Department of Medicine, and Nuclear Medicine Division, Department of Imaging Sciences, University of Rochester Medical Center, Rochester, New York; and
| | - Piotr J Slomka
- Departments of Imaging and Medicine, Cedars-Sinai Medical Center, Los Angeles, California
| | - Prem Soman
- Division of Cardiology, Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Marcelo F Di Carli
- Cardiovascular Imaging Program, Brigham and Women's Hospital, Boston, Massachusetts
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8
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Rosas EA, Castro JB, Anaya DAV, del Moral Díez JJ, Bueso JSM, Niño AJ, Germán AGA, Rodríguez EDM, Sánchez CAG, González AM. Metabolic Syndrome and Diabetes Mellitus in Mexico: the Role of PET/CT in Endothelial Dysfunction and Cardiovascular Disease Detection. CURRENT CARDIOVASCULAR IMAGING REPORTS 2017. [DOI: 10.1007/s12410-017-9404-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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9
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Abstract
The risks associated with hypertension emerge through a series of complex interactions. Myocardial ischemia is the major contributor to this risk. The mechanisms driving ischemia reflect many of the key factors in hypertension, including endothelial and neurohumoral factors, fibrosis, and hemodynamics. Left ventricular hypertrophy and fibrosis are of fundamental importance and together with hemodynamics provide an optimal template for myocardial ischemia. Understanding the pathophysiology has aided a more rational management approach but challenges remain which, if surmounted, will have an impact on the morbidity and mortality caused by myocardial ischemia in patients with hypertension.
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Affiliation(s)
- Tony Stanton
- Nambour Hospital, School of Medicine, University of Queensland, Medical Suites, Level 2, Nambour, Queensland 4556, Australia
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10
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Tomiyama T, Ishihara K, Suda M, Kanaya K, Sakurai M, Takahashi N, Takano H, Nitta K, Hakozaki K, Kumita SI. Impact of time-of-flight on qualitative and quantitative analyses of myocardial perfusion PET studies using (13)N-ammonia. J Nucl Cardiol 2015; 22:998-1007. [PMID: 25467250 PMCID: PMC4575376 DOI: 10.1007/s12350-014-0037-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Accepted: 10/24/2014] [Indexed: 11/12/2022]
Abstract
BACKGROUND The impact of time-of-flight (TOF) in myocardial perfusion (13)N-ammonia positron emission tomography (PET) is unclear. METHODS AND RESULTS Twenty consecutive subjects underwent rest and adenosine stress (13)N-ammonia myocardial perfusion PET. Two sets of images were reconstructed using TOF-ordered subset expectation maximization (TOF-OSEM) and 3-dimensional row-action maximum likelihood algorithm (3D-RAMLA). Qualitative and quantitative analyses from the TOF-OSEM and 3D-RAMLA reconstructions were compared. Count profile curves revealed that TOF relatively increased the uptake of (13)N-ammonia at the lateral walls, and apical thinning was emphasized on the TOF images. Both segmental rest and stress myocardial blood flow (MBF) values were higher with TOF-OSEM use than with 3D-RAMLA use (rest MBF: 0.955 ± 0.201 vs 0.836 ± 0.185, P < .001; stress MBF: 2.149 ± 0.697 vs 2.058 ± 0.721, P < .001). The differentiation of MBF between reconstructions was more enhanced under rest conditions. Thus, segmental myocardial flow reserve (MFR) observed using TOF-OSEM reconstruction was lower than that observed using 3D-RAMLA (2.25 ± 0.57 vs 2.46 ± 0.75, P < .001). No remarkable differences were observed between segmental and territorial results. CONCLUSIONS TOF increased lateral wall counts and emphasized apical thinning. Quantitatively, TOF reconstruction showed increased MBF, especially under relatively low perfusion conditions.
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Affiliation(s)
- Takeshi Tomiyama
- Department of Radiology, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan.
| | - Keiichi Ishihara
- Clinical Imaging Center for Healthcare, Nippon Medical School, Tokyo, Japan
| | - Masaya Suda
- Clinical Imaging Center for Healthcare, Nippon Medical School, Tokyo, Japan
| | - Koji Kanaya
- Clinical Imaging Center for Healthcare, Nippon Medical School, Tokyo, Japan
| | - Minoru Sakurai
- Clinical Imaging Center for Healthcare, Nippon Medical School, Tokyo, Japan
| | - Naoto Takahashi
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
| | - Hitoshi Takano
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
| | - Koichi Nitta
- NM & RT System Sales Division, Hitachi Medical Corporation, Tokyo, Japan
| | - Kenta Hakozaki
- Clinical Imaging Center for Healthcare, Nippon Medical School, Tokyo, Japan
| | - Shin-ichiro Kumita
- Department of Radiology, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
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An Increasing Mexican Population with Metabolic Syndrome-Emerging Role of Hybrid SPECT/CT and PET/CT in Cardiovascular Disease Detection. CURRENT CARDIOVASCULAR IMAGING REPORTS 2015. [DOI: 10.1007/s12410-015-9348-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Alexanderson-Rosas E, Berríos-Bárcenas E, Meave A, de la Fuente-Mancera JC, Oropeza-Aguilar M, Barrero-Mier A, Monroy-González ADG, Cruz-Mendoza R, Guinto-Nishimura GY. Novel contributions of multimodality imaging in hypertension: A narrative review. World J Hypertens 2015; 5:28-40. [DOI: 10.5494/wjh.v5.i2.28] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Revised: 12/05/2014] [Accepted: 03/05/2015] [Indexed: 02/06/2023] Open
Abstract
Hypertension is currently one of the most prevalent illnesses worldwide, and is the second most common cause of heart failure, only behind ischemic cardiomyopathy. The development of novel multimodality imaging techniques in recent years has broadened the diagnostic methods, risk stratification and monitoring of treatment of cardiovascular diseases available for clinicians. Cardiovascular magnetic resonance (CMR) has a great capacity to evaluate cardiac dimensions and ventricular function, is extremely useful in ruling-out ischemic cardiomyopathy, the evaluation of the vascular system, in making the differential diagnosis for resistant hypertension and risk stratification for hypertensive cardiomyopathy and constitutes today, the method of choice to evaluate left ventricular systolic function. Computed tomography (CT) is the method of choice for the evaluation of vascular anatomy, including coronary arteries, and is also able to provide both functional and structural information. Finally, nuclear cardiology studies have been traditionally used to evaluate myocardial ischemia, along with offering the capacity to evaluate ventricular, endothelial and cardiac innervation function; information that is key in directing the treatment of the patient. In this narrative review, the most recent contributions of multimodality imaging to the patient with hypertension (CMR, CT and nuclear cardiology) will be reviewed.
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Tomiyama T, Kumita SI, Ishihara K, Suda M, Sakurai M, Hakozaki K, Hashimoto H, Takahashi N, Takano H, Kobayashi Y, Kiriyama T, Fukushima Y, Shimizu W. Patients with reduced heart rate response to adenosine infusion have low myocardial flow reserve in (13)N-ammonia PET studies. Int J Cardiovasc Imaging 2015; 31:1089-95. [PMID: 25846547 PMCID: PMC4446519 DOI: 10.1007/s10554-015-0654-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Accepted: 03/30/2015] [Indexed: 11/29/2022]
Abstract
To assess the effect of adenosine infusion by evaluating the relationship between heart rate (HR) response to adenosine and myocardial flow reserve (MFR) of remote regions supplied by normal coronary arteries in 13N-ammonia PET. Thirty-one consecutive subjects (20 known coronary artery disease patients, 4 chronic heart failure patients, and 7 normal volunteers) except cases having 3-vessel disease underwent rest and adenosine stress 13N-ammonia myocardial perfusion PET. Semi-quantitative, quantitative, and gated analyses were performed. Subjects were divided into two groups with regard to HR response to adenosine. Twenty-two subjects had normal HR response (peak/rest HR > 1.20), while reduced HR response (≤1.20) was observed in nine subjects. There were no differences in rest myocardial blood flow (MBF) of remote regions between the groups. Subjects with reduced HR response had significantly lower stress MBF and MFR of remote regions than those with normal HR response (stress MBF: 1.559 ± 0.517 vs. 2.279 ± 0.530, p = 0.004, MFR: 1.59 ± 0.36 vs. 2.35 ± 0.53, p = 0.001). There were no significant differences between the groups by means of semi-quantitative scoring. Rest and stress ejection fraction (EF) in the reduced HR response group was lower than that in the normal HR response group. In a multiple stepwise regression analysis, HR ratio, dyslipidemia, and Brinkman index were identified as predictors of the change in MFR of remote regions. Subjects with reduced HR response to adenosine had lower stress MBF and MFR of remote regions and lower EF. Moreover, HR response was one of the predictors of the change in MFR of remote regions.
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Affiliation(s)
- Takeshi Tomiyama
- Department of Radiology, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan,
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Croteau E, Renaud JM, Archer C, Klein R, DaSilva JN, Ruddy TD, Beanlands RS, deKemp RA. β2-adrenergic stress evaluation of coronary endothelial-dependent vasodilator function in mice using (11)C-acetate micro-PET imaging of myocardial blood flow and oxidative metabolism. EJNMMI Res 2015; 4:68. [PMID: 25621195 PMCID: PMC4293492 DOI: 10.1186/s13550-014-0068-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Accepted: 11/22/2014] [Indexed: 11/22/2022] Open
Abstract
Background Endothelial dysfunction is associated with vascular risk factors such as dyslipidemia, hypertension, and diabetes, leading to coronary atherosclerosis. Sympathetic stress using cold-pressor testing (CPT) has been used to measure coronary endothelial function in humans with positron emission tomography (PET) myocardial blood flow (MBF) imaging, but is not practical in small animal models. This study characterized coronary vasomotor function in mice with [11C]acetate micro-PET measurements of nitric-oxide-mediated endothelial flow reserve (EFRNOM) (adrenergic-stress/rest MBF) and myocardial oxygen consumption (MVO2) using salbutamol β2-adrenergic-activation. Methods [11C]acetate PET MBF was performed at rest + salbutamol (SB 0.2, 1.0 μg/kg/min) and norepinephrine (NE 3.2 μg/kg/min) stress to measure an index of MBF response. β-adrenergic specificity of NE was evaluated by pretreatment with α-adrenergic-antagonist phentolamine (PHE), and β2-selectivity was assessed using SB. Results Adjusting for changes in heart rate × systolic blood pressure product (RPP), the same stress/rest MBF ratio of 1.4 was measured using low-dose SB and NE in normal mice (equivalent to human CPT response). The MBF response was correlated with changes in MVO2 (p = 0.02). Nitric oxide synthase (NOS)-inhibited mice (Ng-nitro-L-arginine methyl ester (L-NAME) pretreatment and endothelial nitric oxide synthase (eNOS) knockout) were used to assess the EFRNOM, in which the low-dose SB- and NE-stress MBF responses were completely blocked (p = 0.02). With high-dose SB-stress, the MBF ratio was reduced by 0.4 following NOS inhibition (p = 0.03). Conclusions Low-dose salbutamol β2-adrenergic-stress [11C]acetate micro-PET imaging can be used to measure coronary-specific EFRNOM in mice and may be suitable for assessment of endothelial dysfunction in small animal models of disease and evaluation of new therapies. Electronic supplementary material The online version of this article (doi:10.1186/s13550-014-0068-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Etienne Croteau
- National Cardiac PET Centre, Department of Medicine, Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, K1Y 4W7 ON Canada
| | - Jennifer M Renaud
- National Cardiac PET Centre, Department of Medicine, Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, K1Y 4W7 ON Canada
| | - Christine Archer
- National Cardiac PET Centre, Department of Medicine, Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, K1Y 4W7 ON Canada
| | - Ran Klein
- National Cardiac PET Centre, Department of Medicine, Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, K1Y 4W7 ON Canada
| | - Jean N DaSilva
- National Cardiac PET Centre, Department of Medicine, Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, K1Y 4W7 ON Canada
| | - Terrence D Ruddy
- National Cardiac PET Centre, Department of Medicine, Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, K1Y 4W7 ON Canada
| | - Rob Sb Beanlands
- National Cardiac PET Centre, Department of Medicine, Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, K1Y 4W7 ON Canada
| | - Robert A deKemp
- National Cardiac PET Centre, Department of Medicine, Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, K1Y 4W7 ON Canada
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Advanced tracers in PET imaging of cardiovascular disease. BIOMED RESEARCH INTERNATIONAL 2014; 2014:504532. [PMID: 25389529 PMCID: PMC4214169 DOI: 10.1155/2014/504532] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/21/2014] [Revised: 07/07/2014] [Accepted: 08/08/2014] [Indexed: 02/04/2023]
Abstract
Cardiovascular disease is the leading cause of death worldwide. Molecular imaging with targeted tracers by positron emission tomography (PET) allows for the noninvasive detection and characterization of biological changes at the molecular level, leading to earlier disease detection, objective monitoring of therapies, and better prognostication of cardiovascular diseases progression. Here we review, the current role of PET in cardiovascular disease, with emphasize on tracers developed for PET imaging of cardiovascular diseases.
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McArdle B, Dowsley TF, Cocker MS, Ohira H, deKemp RA, DaSilva J, Ruddy TD, Chow BJ, Beanlands RS. Cardiac PET: metabolic and functional imaging of the myocardium. Semin Nucl Med 2014; 43:434-48. [PMID: 24094711 DOI: 10.1053/j.semnuclmed.2013.06.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Cardiac PET has evolved over the past 30 years to gain wider acceptance as a valuable modality for a variety of cardiac conditions. Wider availability of scanners as well as changes in reimbursement policies in more recent years has further increased its use. Moreover, with the emergence of novel radionuclides as well as further advances in scanner technology, the use of cardiac PET can be expected to increase further in both clinical practice and the research arena. PET has demonstrated superior diagnostic accuracy for the diagnosis of coronary artery disease in comparison with single-photon emission tomography while it provides robust prognostic value. The addition of absolute flow quantification increases sensitivity for 3-vessel disease as well as providing incremental functional and prognostic information. Metabolic imaging using (18)F-fluorodeoxyglucose can be used to guide revascularization in the setting of heart failure and also to detect active inflammation in conditions such as cardiac sarcoidosis and within atherosclerotic plaque, improving our understanding of the processes that underlie these conditions. However, although the pace of new developments is rapid, there remains a gap in evidence for many of these advances and further studies are required.
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Affiliation(s)
- Brian McArdle
- National Cardiac PET Centre, Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
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Pharmacologic manipulation of coronary vascular physiology for the evaluation of coronary artery disease. Pharmacol Ther 2013; 140:121-32. [DOI: 10.1016/j.pharmthera.2013.06.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2013] [Accepted: 05/23/2013] [Indexed: 11/24/2022]
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Ghotbi AA, Kjaer A, Hasbak P. Review: comparison of PET rubidium-82 with conventional SPECT myocardial perfusion imaging. Clin Physiol Funct Imaging 2013; 34:163-70. [PMID: 24028171 PMCID: PMC4204510 DOI: 10.1111/cpf.12083] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2013] [Accepted: 08/14/2013] [Indexed: 12/01/2022]
Abstract
Nuclear cardiology has for many years been focused on gamma camera technology. With ever improving cameras and software applications, this modality has developed into an important assessment tool for ischaemic heart disease. However, the development of new perfusion tracers has been scarce. While cardiac positron emission tomography (PET) so far largely has been limited to centres with on-site cyclotron, recent developments with generator produced perfusion tracers such as rubidium-82, as well as an increasing number of PET scanners installed, may enable a larger patient flow that may supersede that of gamma camera myocardial perfusion imaging.
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Affiliation(s)
- Adam A Ghotbi
- Department of Clinical Physiology, Nuclear Medicine & PET and Cluster for Molecular Imaging, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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Myocardial perfusion reserve in spared myocardium: one more tessera of the complex mosaic of LV remodelling after myocardial infarction. Eur J Nucl Med Mol Imaging 2013; 40:1146-7. [PMID: 23715904 DOI: 10.1007/s00259-013-2453-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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