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Tsuda T, Patel G. Coronary microvascular dysfunction in childhood: An emerging pathological entity and its clinical implications. AMERICAN HEART JOURNAL PLUS : CARDIOLOGY RESEARCH AND PRACTICE 2024; 42:100392. [PMID: 38680649 PMCID: PMC11046079 DOI: 10.1016/j.ahjo.2024.100392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Accepted: 04/07/2024] [Indexed: 05/01/2024]
Abstract
Coronary microvascular dysfunction (CMD) encompasses a spectrum of structural and functional alterations in coronary microvasculature resulting in impaired coronary blood flow and consequent myocardial ischemia without obstruction in epicardial coronary artery. The pathogenesis of CMD is complex involving both functional and structural alteration in the coronary microcirculation. In adults, CMD is predominantly discussed in context with anginal chest pain or existing ischemic heart disease and its risk factors. The presence of CMD suggests increased risk of adverse cardiovascular events independent of coronary atherosclerosis. Coronary microvascular dysfunction is also known in children but is rarely recognized due to paucity of concommitent coronary artery disease. Thus, its clinical presentation, underlying mechanism of impaired microcirculation, and prognostic significance are poorly understood. In this review article, we will overview variable CMD reported in children and delineate its emerging clinical significance.
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Affiliation(s)
- Takeshi Tsuda
- Nemours Cardiac Center, Nemours Children's Health, Wilmington, DE 19803, USA
- Department of Pediatrics, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Gina Patel
- Nemours Cardiac Center, Nemours Children's Health, Wilmington, DE 19803, USA
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Valenta I, Schindler TH. PET-determined myocardial perfusion and flow in coronary artery disease characterization. J Med Imaging Radiat Sci 2024; 55:S44-S50. [PMID: 38403519 DOI: 10.1016/j.jmir.2024.02.010] [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: 01/16/2024] [Revised: 02/07/2024] [Accepted: 02/07/2024] [Indexed: 02/27/2024]
Abstract
Positron emission tomography (PET) myocardial perfusion imaging in conjunction with tracer-kinetic modeling enables the concurrent assessment of myocardial perfusion and regional myocardial blood flow (MBF) of the left ventricle in absolute terms in milliliters per gram per minute (mL/g/min). The non-invasive quantification of MBF during pharmacologically induced hyperemia, at rest, and corresponding myocardial flow reserve (MFR) opens a new avenue for the identification and characterization of classical or endogen type of coronary microvascular dysfunction (CMD) as functional substrate for microvascular angina in patients with non-obstructive coronary artery disease (CAD) and/or no CAD at all. Further, PET-MBF quantification expands the scope of conventional myocardial perfusion imaging from the identification of advanced, and flow-limiting, epicardial CAD to early stages of atherosclerosis and/or CMD. Adding MBF assessment to myocardial perfusion may also reliably unravel diffuse ischemia owing to significant left main stenosis and/or multivessel CAD, commonly confirmed by peak stress transient ischemic cavity dilation of the left ventricle during maximal vasomotor stress compared to rest on gated PET images. Owing to high spatial and contrast resolution in conjunction with photon-attenuation free myocardial perfusion PET images, PET is preferentially used for CAD detection in advanced obesity and women with pronounced breast habitus. With increasing clinical use of cardiac PET perfusion and MBF assessment, individualized, and image-guided cardiovascular treatment decisions in CAD patients is likely to ensue, while its translation into improved cardiovascular outcome remains to be investigated.
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Affiliation(s)
- Ines Valenta
- Washington University in St. Louis School of Medicine, Mallinckrodt Institute of Radiology, Division of Nuclear Medicine, St. Louis, MO, USA
| | - Thomas H Schindler
- Washington University in St. Louis School of Medicine, Mallinckrodt Institute of Radiology, Division of Nuclear Medicine, St. Louis, MO, USA.
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Tamanaha T, Makino H, Son C, Koezuka R, Tochiya M, Omura-Ohata Y, Takekawa T, Matsubara M, Noguchi M, Tomita T, Honda-Kohmo K, Matsuo M, Tateishi E, Fukuda T, Miyamoto Y, Yasuda S, Hosoda K. Effect of Luseogliflozin on Myocardial Flow Reserve in Patients with Type 2 Diabetes Mellitus (LUCENT-J Study). Diabetes Ther 2024; 15:1245-1254. [PMID: 38573468 PMCID: PMC11043273 DOI: 10.1007/s13300-024-01571-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 03/18/2024] [Indexed: 04/05/2024] Open
Abstract
INTRODUCTION In patients with type 2 diabetes (T2D), treatment with sodium-glucose cotransporter-2 (SGLT2) inhibitors has been shown to reduce hospital admission rates for heart failure (HF). However, the multiple mechanisms hypothesized and investigated to explain the cardioprotection of SGLT2 inhibitors are not fully understood. OBJECTIVES The effect of luseogliflozin on myocardial flow reserve (MFR) in patients with T2D (LUCENT-J) study aims to examine the effects of SGLT2 inhibitors on myocardial perfusion. METHODS The LUCENT-J study is a prospective, single-center, randomized, two-arm, parallel-group, open-label (i.e., the radiology readers are blinded), active-controlled study. A cohort of 40 patients with T2D with no or stable (with no history of myocardial infarction and with or without previous percutaneous coronary intervention) coronary artery disease will be included. Patients will be randomized in a 1:1 ratio to luseogliflozin or control and treated for 24 weeks. The primary outcome is the change in MFR, as measured by 13N-ammonia positron emission tomography/computed tomography, from baseline to 24 weeks after treatment initiation. PLANNED OUTCOMES The LUCENT-J study will elucidate the mechanisms of cardioprotection by SGLT2 inhibitors in patients with T2D. TRIAL REGISTRATION Japan Registry of Clinical Trials (JRCTs051220016).
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Affiliation(s)
- Tamiko Tamanaha
- Division of Diabetes and Lipid Metabolism, National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shimmachi, Suita, Osaka, 564-8565, Japan.
- Department of Advanced Cardiovascular Prevention and Epidemiology, Tohoku University Graduate School of Medicine and Tohoku University Hospital, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, Japan.
| | - Hisashi Makino
- Division of Diabetes and Lipid Metabolism, National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shimmachi, Suita, Osaka, 564-8565, Japan
| | - Cheol Son
- Division of Diabetes and Lipid Metabolism, National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shimmachi, Suita, Osaka, 564-8565, Japan
| | - Ryo Koezuka
- Division of Diabetes and Lipid Metabolism, National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shimmachi, Suita, Osaka, 564-8565, Japan
- Department of Advanced Cardiovascular Prevention and Epidemiology, Tohoku University Graduate School of Medicine and Tohoku University Hospital, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, Japan
| | - Mayu Tochiya
- Division of Diabetes and Lipid Metabolism, National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shimmachi, Suita, Osaka, 564-8565, Japan
- Department of Advanced Cardiovascular Prevention and Epidemiology, Tohoku University Graduate School of Medicine and Tohoku University Hospital, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, Japan
| | - Yoko Omura-Ohata
- Division of Diabetes and Lipid Metabolism, National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shimmachi, Suita, Osaka, 564-8565, Japan
- Department of Advanced Cardiovascular Prevention and Epidemiology, Tohoku University Graduate School of Medicine and Tohoku University Hospital, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, Japan
| | - Tatsuya Takekawa
- Division of Diabetes and Lipid Metabolism, National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shimmachi, Suita, Osaka, 564-8565, Japan
| | - Masaki Matsubara
- Division of Diabetes and Lipid Metabolism, National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shimmachi, Suita, Osaka, 564-8565, Japan
| | - Michio Noguchi
- Division of Diabetes and Lipid Metabolism, National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shimmachi, Suita, Osaka, 564-8565, Japan
| | - Tsutomu Tomita
- Division of Diabetes and Lipid Metabolism, National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shimmachi, Suita, Osaka, 564-8565, Japan
| | - Kyoko Honda-Kohmo
- Division of Diabetes and Lipid Metabolism, National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shimmachi, Suita, Osaka, 564-8565, Japan
| | - Miki Matsuo
- Division of Diabetes and Lipid Metabolism, National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shimmachi, Suita, Osaka, 564-8565, Japan
| | - Emi Tateishi
- Department of Radiology, National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shimmachi, Suita, Osaka, Japan
| | - Tetsuya Fukuda
- Department of Radiology, National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shimmachi, Suita, Osaka, Japan
| | - Yoshihiro Miyamoto
- Open Innovation Center, National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shimmachi, Suita, Osaka, Japan
- Department of Advanced Cardiovascular Prevention and Epidemiology, Tohoku University Graduate School of Medicine and Tohoku University Hospital, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, Japan
| | - Satoshi Yasuda
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine and Tohoku University Hospital, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, Japan
- Department of Advanced Cardiovascular Prevention and Epidemiology, Tohoku University Graduate School of Medicine and Tohoku University Hospital, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, Japan
| | - Kiminori Hosoda
- Division of Diabetes and Lipid Metabolism, National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shimmachi, Suita, Osaka, 564-8565, Japan
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Milasinovic D, Tesic M, Nedeljkovic Arsenovic O, Maksimovic R, Sobic Saranovic D, Jelic D, Zivkovic M, Dedovic V, Juricic S, Mehmedbegovic Z, Petrovic O, Trifunovic Zamaklar D, Djordjevic Dikic A, Giga V, Boskovic N, Klaric M, Zaharijev S, Travica L, Dukic D, Mladenovic D, Asanin M, Stankovic G. Correlation of Non-Invasive Transthoracic Doppler Echocardiography with Invasive Doppler Wire-Derived Coronary Flow Reserve and Their Impact on Infarct Size in Patients with ST-Segment Elevation Myocardial Infarction Treated with Primary Percutaneous Coronary Intervention. J Clin Med 2024; 13:2484. [PMID: 38731013 PMCID: PMC11084315 DOI: 10.3390/jcm13092484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Revised: 04/01/2024] [Accepted: 04/17/2024] [Indexed: 05/13/2024] Open
Abstract
Background: Coronary microvascular dysfunction is associated with adverse prognosis after ST-segment elevation myocardial infarction (STEMI). We aimed to compare the invasive, Doppler wire-based coronary flow reserve (CFR) with the non-invasive transthoracic Doppler echocardiography (TTDE)-derived CFR, and their ability to predict infarct size. Methods: We included 36 patients with invasive Doppler wire assessment on days 3-7 after STEMI treated with primary percutaneous coronary intervention (PCI), of which TTDE-derived CFR was measured in 47 vessels (29 patients) within 6 h of the invasive Doppler. Infarct size was assessed by cardiac magnetic resonance at a median of 8 months. Results: The correlation between invasive and non-invasive CFR was modest in the overall cohort (rho 0.400, p = 0.005). It improved when only measurements in the LAD artery were considered (rho 0.554, p = 0.002), with no significant correlation in the RCA artery (rho -0.190, p = 0.435). Both invasive (AUC 0.888) and non-invasive (AUC 0.868) CFR, measured in the recanalized culprit artery, showed a good ability to predict infarct sizes ≥18% of the left ventricular mass, with the optimal cut off values of 1.85 and 1.80, respectively. Conclusions: In patients with STEMI, TTDE- and Doppler wire-derived CFR exhibit significant correlation, when measured in the LAD artery, and both have a similarly strong association with the final infarct size.
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Affiliation(s)
- Dejan Milasinovic
- Department of Cardiology, University Clinical Center of Serbia, 11000 Belgrade, Serbia; (D.M.); (D.J.); (M.Z.); (V.D.); (S.J.); (Z.M.); (D.T.Z.); (V.G.); (N.B.); (M.K.); (S.Z.); (L.T.); (D.D.); (D.M.); (M.A.)
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (O.N.A.); (R.M.); (D.S.S.)
| | - Milorad Tesic
- Department of Cardiology, University Clinical Center of Serbia, 11000 Belgrade, Serbia; (D.M.); (D.J.); (M.Z.); (V.D.); (S.J.); (Z.M.); (D.T.Z.); (V.G.); (N.B.); (M.K.); (S.Z.); (L.T.); (D.D.); (D.M.); (M.A.)
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (O.N.A.); (R.M.); (D.S.S.)
| | - Olga Nedeljkovic Arsenovic
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (O.N.A.); (R.M.); (D.S.S.)
- Center for Radiology and Magnetic Resonance, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Ruzica Maksimovic
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (O.N.A.); (R.M.); (D.S.S.)
- Center for Radiology and Magnetic Resonance, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Dragana Sobic Saranovic
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (O.N.A.); (R.M.); (D.S.S.)
- Center for Nuclear Medicine with PET, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Dario Jelic
- Department of Cardiology, University Clinical Center of Serbia, 11000 Belgrade, Serbia; (D.M.); (D.J.); (M.Z.); (V.D.); (S.J.); (Z.M.); (D.T.Z.); (V.G.); (N.B.); (M.K.); (S.Z.); (L.T.); (D.D.); (D.M.); (M.A.)
| | - Milorad Zivkovic
- Department of Cardiology, University Clinical Center of Serbia, 11000 Belgrade, Serbia; (D.M.); (D.J.); (M.Z.); (V.D.); (S.J.); (Z.M.); (D.T.Z.); (V.G.); (N.B.); (M.K.); (S.Z.); (L.T.); (D.D.); (D.M.); (M.A.)
| | - Vladimir Dedovic
- Department of Cardiology, University Clinical Center of Serbia, 11000 Belgrade, Serbia; (D.M.); (D.J.); (M.Z.); (V.D.); (S.J.); (Z.M.); (D.T.Z.); (V.G.); (N.B.); (M.K.); (S.Z.); (L.T.); (D.D.); (D.M.); (M.A.)
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (O.N.A.); (R.M.); (D.S.S.)
| | - Stefan Juricic
- Department of Cardiology, University Clinical Center of Serbia, 11000 Belgrade, Serbia; (D.M.); (D.J.); (M.Z.); (V.D.); (S.J.); (Z.M.); (D.T.Z.); (V.G.); (N.B.); (M.K.); (S.Z.); (L.T.); (D.D.); (D.M.); (M.A.)
| | - Zlatko Mehmedbegovic
- Department of Cardiology, University Clinical Center of Serbia, 11000 Belgrade, Serbia; (D.M.); (D.J.); (M.Z.); (V.D.); (S.J.); (Z.M.); (D.T.Z.); (V.G.); (N.B.); (M.K.); (S.Z.); (L.T.); (D.D.); (D.M.); (M.A.)
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (O.N.A.); (R.M.); (D.S.S.)
| | - Olga Petrovic
- Department of Cardiology, University Clinical Center of Serbia, 11000 Belgrade, Serbia; (D.M.); (D.J.); (M.Z.); (V.D.); (S.J.); (Z.M.); (D.T.Z.); (V.G.); (N.B.); (M.K.); (S.Z.); (L.T.); (D.D.); (D.M.); (M.A.)
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (O.N.A.); (R.M.); (D.S.S.)
| | - Danijela Trifunovic Zamaklar
- Department of Cardiology, University Clinical Center of Serbia, 11000 Belgrade, Serbia; (D.M.); (D.J.); (M.Z.); (V.D.); (S.J.); (Z.M.); (D.T.Z.); (V.G.); (N.B.); (M.K.); (S.Z.); (L.T.); (D.D.); (D.M.); (M.A.)
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (O.N.A.); (R.M.); (D.S.S.)
| | - Ana Djordjevic Dikic
- Department of Cardiology, University Clinical Center of Serbia, 11000 Belgrade, Serbia; (D.M.); (D.J.); (M.Z.); (V.D.); (S.J.); (Z.M.); (D.T.Z.); (V.G.); (N.B.); (M.K.); (S.Z.); (L.T.); (D.D.); (D.M.); (M.A.)
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (O.N.A.); (R.M.); (D.S.S.)
| | - Vojislav Giga
- Department of Cardiology, University Clinical Center of Serbia, 11000 Belgrade, Serbia; (D.M.); (D.J.); (M.Z.); (V.D.); (S.J.); (Z.M.); (D.T.Z.); (V.G.); (N.B.); (M.K.); (S.Z.); (L.T.); (D.D.); (D.M.); (M.A.)
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (O.N.A.); (R.M.); (D.S.S.)
| | - Nikola Boskovic
- Department of Cardiology, University Clinical Center of Serbia, 11000 Belgrade, Serbia; (D.M.); (D.J.); (M.Z.); (V.D.); (S.J.); (Z.M.); (D.T.Z.); (V.G.); (N.B.); (M.K.); (S.Z.); (L.T.); (D.D.); (D.M.); (M.A.)
| | - Marija Klaric
- Department of Cardiology, University Clinical Center of Serbia, 11000 Belgrade, Serbia; (D.M.); (D.J.); (M.Z.); (V.D.); (S.J.); (Z.M.); (D.T.Z.); (V.G.); (N.B.); (M.K.); (S.Z.); (L.T.); (D.D.); (D.M.); (M.A.)
| | - Stefan Zaharijev
- Department of Cardiology, University Clinical Center of Serbia, 11000 Belgrade, Serbia; (D.M.); (D.J.); (M.Z.); (V.D.); (S.J.); (Z.M.); (D.T.Z.); (V.G.); (N.B.); (M.K.); (S.Z.); (L.T.); (D.D.); (D.M.); (M.A.)
| | - Lazar Travica
- Department of Cardiology, University Clinical Center of Serbia, 11000 Belgrade, Serbia; (D.M.); (D.J.); (M.Z.); (V.D.); (S.J.); (Z.M.); (D.T.Z.); (V.G.); (N.B.); (M.K.); (S.Z.); (L.T.); (D.D.); (D.M.); (M.A.)
| | - Djordje Dukic
- Department of Cardiology, University Clinical Center of Serbia, 11000 Belgrade, Serbia; (D.M.); (D.J.); (M.Z.); (V.D.); (S.J.); (Z.M.); (D.T.Z.); (V.G.); (N.B.); (M.K.); (S.Z.); (L.T.); (D.D.); (D.M.); (M.A.)
| | - Djordje Mladenovic
- Department of Cardiology, University Clinical Center of Serbia, 11000 Belgrade, Serbia; (D.M.); (D.J.); (M.Z.); (V.D.); (S.J.); (Z.M.); (D.T.Z.); (V.G.); (N.B.); (M.K.); (S.Z.); (L.T.); (D.D.); (D.M.); (M.A.)
| | - Milika Asanin
- Department of Cardiology, University Clinical Center of Serbia, 11000 Belgrade, Serbia; (D.M.); (D.J.); (M.Z.); (V.D.); (S.J.); (Z.M.); (D.T.Z.); (V.G.); (N.B.); (M.K.); (S.Z.); (L.T.); (D.D.); (D.M.); (M.A.)
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (O.N.A.); (R.M.); (D.S.S.)
| | - Goran Stankovic
- Department of Cardiology, University Clinical Center of Serbia, 11000 Belgrade, Serbia; (D.M.); (D.J.); (M.Z.); (V.D.); (S.J.); (Z.M.); (D.T.Z.); (V.G.); (N.B.); (M.K.); (S.Z.); (L.T.); (D.D.); (D.M.); (M.A.)
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (O.N.A.); (R.M.); (D.S.S.)
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Mochula A, Maltseva A, Kopeva K, Grakova E, Mochula O, Zavadovsky K. The Influence of Kinetic Models and Attenuation Correction on Cadmium-Zinc-Telluride Single-Photon Emission Computed Tomography (CZT SPECT)-Derived Myocardial Blood Flow and Reserve: Correlation with Invasive Angiography Data. J Clin Med 2024; 13:1271. [PMID: 38592092 PMCID: PMC10932033 DOI: 10.3390/jcm13051271] [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: 12/05/2023] [Revised: 02/13/2024] [Accepted: 02/19/2024] [Indexed: 04/10/2024] Open
Abstract
(1) Background: The objective of this study was to determine the optimal post-processing model for dynamic cadmium-zinc-telluride single-photon emission computed tomography (CZT-SPECT). (2) Methods: A total of 235 patients who underwent diagnostic invasive coronary angiography within three months of the SPECT and those who had coronary computed tomography angiography (CCTA) before SPECT (within 3 months) were enrolled in this study. Each SPECT study was processed to obtain global and regional stress myocardial blood flow (sMBF), rest-MBF (rMBF), myocardial flow reserve (MFR) and flow difference (FD) estimates obtained with 1-tissue-compartment (1TCM) and net retention (NR) modes, both with and without attenuation correction. (3) Results: The use of AC led to significantly higher sMBF, rMBF and DF values obtained by 1TCM compared those values derived by 1TCM with NAC; the lowest values of stress MBF and rest MBF were obtained by 1TCM_NAC. The resting flow, MFR and DF were significantly (p < 0.005) higher in the AC model than in NAC. All quantitative variables were significantly (p < 0.05) higher in NR_NAC than in the 1TC_NAC model. Finally, sMBF, rMBF and FD showed significantly (p < 0.05) higher values by using 1TMC_AC compared to NR_AC. (4) Conclusions: We suggested that 1-compartment and net retention models correctly reflect coronary microcirculation and can be used for clinical practice for evaluating quantitative myocardial perfusion by dynamic SPECT. Attenuation correction is an important step in post-processing dynamic SPECT data, which increases the consistency and diagnostic accuracy of models.
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Affiliation(s)
- Andrey Mochula
- Nuclear Department, Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, Tomsk 634012, Russia; (A.M.); (A.M.); (K.Z.)
| | - Alina Maltseva
- Nuclear Department, Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, Tomsk 634012, Russia; (A.M.); (A.M.); (K.Z.)
| | - Kristina Kopeva
- Department of Myocardial Pathology, Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, Tomsk 634012, Russia;
| | - Elena Grakova
- Department of Myocardial Pathology, Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, Tomsk 634012, Russia;
| | - Olga Mochula
- Department of Radiology and Tomography, Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, Tomsk 634012, Russia;
| | - Konstantin Zavadovsky
- Nuclear Department, Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, Tomsk 634012, Russia; (A.M.); (A.M.); (K.Z.)
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Zou L, Zhang Y, Cheraga N, Abodunrin OD, Qu KY, Qiao L, Ma YQ, Hang Y, Huang NP, Chen LJ. M2 Macrophage Membrane-Camouflaged Fe 3 O 4 -Cy7 Nanoparticles with Reduced Immunogenicity for Targeted NIR/MR Imaging of Atherosclerosis. SMALL (WEINHEIM AN DER BERGSTRASSE, GERMANY) 2024; 20:e2304110. [PMID: 37806756 DOI: 10.1002/smll.202304110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 08/27/2023] [Indexed: 10/10/2023]
Abstract
Atherosclerosis (AS) is the primary reason behind cardiovascular diseases, leading to approximately one-third of global deaths. Developing a novel multi-model probe to detect AS is urgently required. Macrophages are the primary cells from which AS genesis occurs. Utilizing natural macrophage membranes coated on the surface of nanoparticles is an efficient delivery method to target plaque sites. Herein, Fe3 O4 -Cy7 nanoparticles (Fe3 O4 -Cy7 NPs), functionalized using an M2 macrophage membrane and a liposome extruder for Near-infrared fluorescence and Magnetic resonance imaging, are synthesized. These macrophage membrane-coated nanoparticles (Fe3 O4 @M2 NPs) enhance the recognition and uptake using active macrophages. Moreover, they inhibit uptake using inactive macrophages and human coronary artery endothelial cells. The macrophage membrane-coated nanoparticles (Fe3 O4 @M0 NPs, Fe3 O4 @M1 NPs, Fe3 O4 @M2 NPs) can target specific sites depending on the macrophage membrane type and are related to C-C chemofactor receptor type 2 protein content. Moreover, Fe3 O4 @M2 NPs demonstrate excellent biosafety in vivo after injection, showing a significantly higher Fe concentration in the blood than Fe3 O4 -Cy7 NPs. Therefore, Fe3 O4 @M2 NPs effectively retain the physicochemical properties of nanoparticles and depict reduced immunological response in blood circulation. These NPs mainly reveal enhanced targeting imaging capability for atherosclerotic plaque lesions.
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Affiliation(s)
- Lin Zou
- State Key Laboratory of Digital Medical Engineering, School of Biological Science and Medical Engineering, Southeast University, 210096, Nanjing, China
| | - Yao Zhang
- Department of Cardiology, Zhongda Hospital, School of Medicine, Southeast University, 210009, Nanjing, China
| | - Nihad Cheraga
- State Key Laboratory of Digital Medical Engineering, School of Biological Science and Medical Engineering, Southeast University, 210096, Nanjing, China
| | - Oluwatosin David Abodunrin
- State Key Laboratory of Digital Medical Engineering, School of Biological Science and Medical Engineering, Southeast University, 210096, Nanjing, China
| | - Kai-Yun Qu
- State Key Laboratory of Digital Medical Engineering, School of Biological Science and Medical Engineering, Southeast University, 210096, Nanjing, China
| | - Li Qiao
- State Key Laboratory of Digital Medical Engineering, School of Biological Science and Medical Engineering, Southeast University, 210096, Nanjing, China
| | - Yu-Qing Ma
- State Key Laboratory of Digital Medical Engineering, School of Biological Science and Medical Engineering, Southeast University, 210096, Nanjing, China
| | - Yue Hang
- State Key Laboratory of Digital Medical Engineering, School of Biological Science and Medical Engineering, Southeast University, 210096, Nanjing, China
| | - Ning-Ping Huang
- State Key Laboratory of Digital Medical Engineering, School of Biological Science and Medical Engineering, Southeast University, 210096, Nanjing, China
| | - Li-Juan Chen
- Department of Cardiology, Zhongda Hospital, School of Medicine, Southeast University, 210009, Nanjing, China
- Department of Cardiology, Nanjing Lishui People's Hospital, Zhongda Hospital Lishui Branch, 211200, Nanjing, China
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Keramati H, de Vecchi A, Rajani R, Niederer SA. Using Gaussian process for velocity reconstruction after coronary stenosis applicable in positron emission particle tracking: An in-silico study. PLoS One 2023; 18:e0295789. [PMID: 38096169 PMCID: PMC10721050 DOI: 10.1371/journal.pone.0295789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 11/28/2023] [Indexed: 12/17/2023] Open
Abstract
Accurate velocity reconstruction is essential for assessing coronary artery disease. We propose a Gaussian process method to reconstruct the velocity profile using the sparse data of the positron emission particle tracking (PEPT) in a biological environment, which allows the measurement of tracer particle velocity to infer fluid velocity fields. We investigated the influence of tracer particle quantity and detection time interval on flow reconstruction accuracy. Three models were used to represent different levels of stenosis and anatomical complexity: a narrowed straight tube, an idealized coronary bifurcation with stenosis, and patient-specific coronary arteries with a stenotic left circumflex artery. Computational fluid dynamics (CFD), particle tracking, and the Gaussian process of kriging were employed to simulate and reconstruct the pulsatile flow field. The study examined the error and uncertainty in velocity profile reconstruction after stenosis by comparing particle-derived flow velocity with the CFD solution. Using 600 particles (15 batches of 40 particles) released in the main coronary artery, the time-averaged error in velocity reconstruction ranged from 13.4% (no occlusion) to 161% (70% occlusion) in patient-specific anatomy. The error in maximum cross-sectional velocity at peak flow was consistently below 10% in all cases. PEPT and kriging tended to overestimate area-averaged velocity in higher occlusion cases but accurately predicted maximum cross-sectional velocity, particularly at peak flow. Kriging was shown to be useful to estimate the maximum velocity after the stenosis in the absence of negative near-wall velocity.
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Affiliation(s)
- Hamed Keramati
- School of Bioengineering and Imaging Sciences, King’s College London, London, United Kingdom
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Adelaide de Vecchi
- School of Bioengineering and Imaging Sciences, King’s College London, London, United Kingdom
| | - Ronak Rajani
- School of Bioengineering and Imaging Sciences, King’s College London, London, United Kingdom
- Cardiology Department, Guy’s and St, Thomas’s Hospital, London, United Kingdom
| | - Steven A. Niederer
- School of Bioengineering and Imaging Sciences, King’s College London, London, United Kingdom
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
- Turing Research and Innovation Cluster in Digital Twins (TRIC: DT), The Alan Turing Institute, London, United Kingdom
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8
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Li A, Yang B, Naganawa M, Fontaine K, Toyonaga T, Carson RE, Tang J. Dose reduction in dynamic synaptic vesicle glycoprotein 2A PET imaging using artificial neural networks. Phys Med Biol 2023; 68:245006. [PMID: 37857316 PMCID: PMC10739622 DOI: 10.1088/1361-6560/ad0535] [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: 07/20/2022] [Revised: 10/02/2023] [Accepted: 10/19/2023] [Indexed: 10/21/2023]
Abstract
Objective. Reducing dose in positron emission tomography (PET) imaging increases noise in reconstructed dynamic frames, which inevitably results in higher noise and possible bias in subsequently estimated images of kinetic parameters than those estimated in the standard dose case. We report the development of a spatiotemporal denoising technique for reduced-count dynamic frames through integrating a cascade artificial neural network (ANN) with the highly constrained back-projection (HYPR) scheme to improve low-dose parametric imaging.Approach. We implemented and assessed the proposed method using imaging data acquired with11C-UCB-J, a PET radioligand bound to synaptic vesicle glycoprotein 2A (SV2A) in the human brain. The patch-based ANN was trained with a reduced-count frame and its full-count correspondence of a subject and was used in cascade to process dynamic frames of other subjects to further take advantage of its denoising capability. The HYPR strategy was then applied to the spatial ANN processed image frames to make use of the temporal information from the entire dynamic scan.Main results. In all the testing subjects including healthy volunteers and Parkinson's disease patients, the proposed method reduced more noise while introducing minimal bias in dynamic frames and the resulting parametric images, as compared with conventional denoising methods.Significance. Achieving 80% noise reduction with a bias of -2% in dynamic frames, which translates into 75% and 70% of noise reduction in the tracer uptake (bias, -2%) and distribution volume (bias, -5%) images, the proposed ANN+HYPR technique demonstrates the denoising capability equivalent to a 11-fold dose increase for dynamic SV2A PET imaging with11C-UCB-J.
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Affiliation(s)
- Andi Li
- Department of Biomedical Engineering, University of Cincinnati, Cincinnati, OH, United States of America
| | - Bao Yang
- School of Biomedical Engineering, Southern Medical University, Guangzhou, Guangdong, People’s Republic of China
| | - Mika Naganawa
- Positron Emission Tomography Center, Department of Radiology and Biomedical Imaging, Yale University, New Haven, CT, United States of America
| | - Kathryn Fontaine
- Positron Emission Tomography Center, Department of Radiology and Biomedical Imaging, Yale University, New Haven, CT, United States of America
| | - Takuya Toyonaga
- Positron Emission Tomography Center, Department of Radiology and Biomedical Imaging, Yale University, New Haven, CT, United States of America
| | - Richard E Carson
- Positron Emission Tomography Center, Department of Radiology and Biomedical Imaging, Yale University, New Haven, CT, United States of America
| | - Jing Tang
- Department of Biomedical Engineering, University of Cincinnati, Cincinnati, OH, United States of America
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9
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Zhang J, Xie J, Li M, Fang W, Hsu B. SPECT myocardial blood flow quantitation for the detection of angiographic stenoses with cardiac-dedicated CZT SPECT. J Nucl Cardiol 2023; 30:2618-2632. [PMID: 37491508 DOI: 10.1007/s12350-023-03334-z] [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: 02/11/2023] [Accepted: 06/16/2023] [Indexed: 07/27/2023]
Abstract
PURPOSE CZT SPECT with the enhanced imaging characteristic facilitates SPECT myocardial blood flow (MBF) quantitation moving toward a clinical utility to uncover myocardial ischemia. The purpose of this study was to investigate the diagnostic performance of stress MBF, myocardial flow reserve (MFR) and myocardial flow capacity (MFC) derived from CZT SPECT in the detection of coronary artery disease (CAD). METHODS One-hundred and eighty patients underwent two-day rest/adenosine-stress scans for SPECT MBF quantitation. All dynamic SPECT images were reconstructed and corrected with necessary corrections. The one-tissue two-compartment kinetic model was utilized to fit kinetic parameters (K1, k2 and FBV) by numeric optimization and converted to MBF from K1. Rest MBF, stress MBF and MFR in left ventricle and coronary territories were calculated from flow polar maps. MFC was assessed by extents of moderately and severely abnormal flow statuses using an integrated flow diagram. Per-patient and per-vessel analyses were performed to determine cutoff values for the detection of angiographically obstructive and flow-limited CAD. RESULTS Using the threshold of ≥ 50% stenosis, 149 patients (82.78%) were classified to have obstructive lesions in 355 vessels (65.74%). Using the threshold of ≥ 70% stenosis, 113 patients (62.78%) were classified to have flow-limited lesions in 282 vessels (52.22%). On per-patient analysis, the optimal cutoff values of stress MBF and MFR to detect ≥ 50% stenosis were (1.44 ml/min/g, 1.96) and (1.34 ml/min/g and 1.75) to detect ≥ 70% stenosis. The optimal cutoff values for severely and combined moderately severely abnormal MFC extents were (2.3-2.5%, 23.1%) and (7.5%, 29.4%), respectively. The overall sensitivity of MFC (0.84-0.86, 0.86-0.90) to detect ≥ 50% and ≥ 70% lesions surpassed those of stress MBF (0.78. 0.78) and MFR (0.80, 0.75) (all p < 0.05) with similar specificity (MFC = 0.84-0.90, 0.87-0.91; stress MBF = 0.87, 0.91; MFR = 0.84, 0.89) (all p≥ 0.05). CONCLUSION The non-invasive SPECT MBF quantitation using CZT SPECT is a reliable method to detect angiographically obstructive and flow-limited CAD. Myocardial flow capacity can outperform with higher diagnostic sensitivity than stress MBF or MFR alone.
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Affiliation(s)
- Jie Zhang
- Department of Nuclear Medicine, Henan Provincial People's Hospital, Central China Fuwai Hospital, Central China Fuwai Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Jian Xie
- Department of Nuclear Medicine, Henan Provincial People's Hospital, Central China Fuwai Hospital, Central China Fuwai Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Muwei Li
- Department of Nuclear Medicine, Henan Provincial People's Hospital, Central China Fuwai Hospital, Central China Fuwai Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Wei Fang
- Department of Nuclear Medicine, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Bailing Hsu
- Nuclear Science and Engineering Institute, University of Missouri-Columbia, E2433 Lafferre Hall, Columbia, MO, 65211, USA.
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10
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Mazini B, Dietz M, Maréchal B, Corredor-Jerez R, Prior JO, Dunet V. Interrelation between cardiac and brain small-vessel disease: a pilot quantitative PET and MRI study. Eur J Hybrid Imaging 2023; 7:20. [PMID: 37926793 PMCID: PMC10625923 DOI: 10.1186/s41824-023-00180-7] [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: 08/07/2023] [Accepted: 09/14/2023] [Indexed: 11/07/2023] Open
Abstract
BACKGROUND Small-vessel disease (SVD) plays a crucial role in cardiac and brain ischemia, but little is known about potential interrelation between both. We retrospectively evaluated 370 patients, aiming at assessing the interrelation between cardiac and brain SVD by using quantitative 82Rb cardiac PET/CT and brain MRI. RESULTS In our population of 370 patients, 176 had normal myocardial perfusion, 38 had pure cardiac SVD and 156 had obstructive coronary artery disease. All underwent both a cardiac 82Rb PET/CT and a brain 1.5T or 3T MRI. Left-ventricle myocardial blood flow (LV-MBF) and flow reserve (LV-MFR) were recorded from 82Rb PET/CT, while Fazekas score, white matter lesion (WMab) volume, deep gray matter lesion (GMab) volume, and brain morphometry (for z-score calculation) using the MorphoBox research application were derived from MRI. Groups were compared with Kruskal-Wallis test, and the potential interrelation between heart and brain SVD markers was assessed using Pearson's correlation coefficient. Patients with cardiac SVD had lower stress LV-MBF and MFR (P < 0.001) than patients with normal myocardial perfusion; Fazekas scores and WMab volumes were similar in those two groups (P > 0.45). In patients with cardiac SVD only, higher rest LV-MBF was associated with a lower left-putamen (rho = - 0.62, P = 0.033), right-thalamus (rho = 0.64, P = 0.026), and right-pallidum (rho = 0.60, P = 0.039) z-scores and with a higher GMab volume. Lower stress LV-MBF was associated with lower left-caudate z-score (rho = 0.69, P = 0.014), while lower LV-MFR was associated with lower left (rho = 0.75, P = 0.005)- and right (rho = 0.59, P = 0.045)-putamen z-scores, as well as higher right-thalamus GMab volume (rho = - 0.72, P = 0.009). CONCLUSION Significant interrelations between cardiac and cerebral SVD markers were found, especially regarding deep gray matter alterations, which supports the hypothesis of SVD as a systemic disease.
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Affiliation(s)
- Bianca Mazini
- Department of Diagnostic and Interventional Radiology, Neuroradiology Unit, Lausanne University Hospital, Rue du Bugnon 46, CH-1011, Lausanne, Switzerland
| | - Matthieu Dietz
- Nuclear Medicine and Molecular Imaging Department, Lausanne University Hospital, Rue du Bugnon 46, CH-1011, Lausanne, Switzerland
- INSERM U1060, CarMeN Laboratory, University of Lyon, Lyon, France
| | - Bénédicte Maréchal
- Department of Diagnostic and Interventional Radiology, Neuroradiology Unit, Lausanne University Hospital, Rue du Bugnon 46, CH-1011, Lausanne, Switzerland
- Advanced Clinical Imaging Technology, Siemens Healthineers International AG, Lausanne, Switzerland
- LTS5, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - Ricardo Corredor-Jerez
- Department of Diagnostic and Interventional Radiology, Neuroradiology Unit, Lausanne University Hospital, Rue du Bugnon 46, CH-1011, Lausanne, Switzerland
- Advanced Clinical Imaging Technology, Siemens Healthineers International AG, Lausanne, Switzerland
- LTS5, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - John O Prior
- Nuclear Medicine and Molecular Imaging Department, Lausanne University Hospital, Rue du Bugnon 46, CH-1011, Lausanne, Switzerland.
- University of Lausanne, Lausanne, Switzerland.
| | - Vincent Dunet
- Department of Diagnostic and Interventional Radiology, Neuroradiology Unit, Lausanne University Hospital, Rue du Bugnon 46, CH-1011, Lausanne, Switzerland
- University of Lausanne, Lausanne, Switzerland
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11
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Mohammed AQ, Abdu FA, Liu L, Yin G, Mareai RM, Mohammed AA, Xu Y, Che W. Coronary microvascular dysfunction and myocardial infarction with non-obstructive coronary arteries: Where do we stand? Eur J Intern Med 2023; 117:8-20. [PMID: 37482469 DOI: 10.1016/j.ejim.2023.07.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 06/15/2023] [Accepted: 07/11/2023] [Indexed: 07/25/2023]
Abstract
In the past decade, scientific and clinical research has provided a translational perspective on myocardial infarction (MI) with non-obstructive coronary arteries (MINOCA). MINOCA is characterized by clinical documentation of an acute MI but angiography shows no significant coronary artery obstruction (stenosis <50%). The prevalence of MINOCA is estimated to range from approximately 6 to 10% among MI patients, and those with this condition have a poor prognosis, experiencing high rates of mortality, rehospitalization, and socioeconomic burden. MINOCA represents a major unmet need in cardiovascular medicine, with uncertain clinical management. It is a complex condition that can be caused by various factors, including atherosclerosis, plaque rupture, coronary vasospasm, and microvascular dysfunction. Effective management of MINOCA depends on identifying the underlying mechanism of the infarction, thus a systematic diagnostic approach is recommended. Contemporary data shows that a significant number of patients exhibit structural and functional abnormalities in coronary microcirculation, which is referred to as coronary microvascular dysfunction (CMD). CMD plays a crucial role in patients with signs and symptoms of myocardial ischemia and non-obstructive coronary artery stenosis, including MINOCA. Furthermore, conducting a thorough evaluation of coronary function can have significant prognostic and therapeutic implications, since personalized patient management strategies based on this assessment have been shown to improve symptoms and prognosis. Therefore, an accurate and timely diagnosis of CMD is essential for effective patient management, which can be achieved through various invasive and non-invasive methods. This review will discuss the pathophysiological understanding, current diagnostic techniques, and management strategies of patients with MINOCA and CMD.
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Affiliation(s)
- Abdul-Quddus Mohammed
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Fuad A Abdu
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Lu Liu
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Guoqing Yin
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Redhwan M Mareai
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Ayman A Mohammed
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yawei Xu
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Wenliang Che
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China; Department of Cardiology, Shanghai Tenth People's Hospital Chongming Branch, Shanghai, China.
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12
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Mills RM. What Becomes of the Brokenhearted? Am J Cardiol 2023; 205:500-501. [PMID: 37666728 DOI: 10.1016/j.amjcard.2023.08.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 08/08/2023] [Indexed: 09/06/2023]
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Cherry SR, Diekmann J, Bengel FM. Total-Body Positron Emission Tomography: Adding New Perspectives to Cardiovascular Research. JACC Cardiovasc Imaging 2023; 16:1335-1347. [PMID: 37676207 DOI: 10.1016/j.jcmg.2023.06.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 06/26/2023] [Accepted: 06/27/2023] [Indexed: 09/08/2023]
Abstract
The recent advent of positron emission tomography (PET) scanners that can image the entire human body opens up intriguing possibilities for cardiovascular research and future clinical applications. These new systems permit radiotracer kinetics to be measured in all organs simultaneously. They are particularly well suited to study cardiovascular disease and its effects on the entire body. They could also play a role in quantitatively measuring physiologic, metabolic, and immunologic responses in healthy individuals to a variety of stressors and lifestyle interventions, and may ultimately be instrumental for evaluating novel therapeutic agents and their molecular effects across different tissues. In this review, we summarize recent progress in PET technology and methodology, discuss several emerging cardiovascular applications for total-body PET, and place this in the context of multiorgan and systems medicine. Finally, we discuss opportunities that will be enabled by the technology, while also pointing to some of the challenges that still need to be addressed.
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Affiliation(s)
- Simon R Cherry
- Departments of Biomedical Engineering and Radiology, University of California, Davis, California, USA.
| | - Johanna Diekmann
- Departments of Biomedical Engineering and Radiology, University of California, Davis, California, USA; Department of Nuclear Medicine, Hannover Medical School, Hannover, Germany
| | - Frank M Bengel
- Department of Nuclear Medicine, Hannover Medical School, Hannover, Germany
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14
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Ahmed AI, Saad JM, Alahdab F, Han Y, Nayfeh M, Alfawara MS, Al-Rifai M, Al-Mallah M. Prognostic value of positron emission tomography derived myocardial flow reserve: A systematic review and meta-analysis. Atherosclerosis 2023; 382:117280. [PMID: 37742396 DOI: 10.1016/j.atherosclerosis.2023.117280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 09/01/2023] [Accepted: 09/05/2023] [Indexed: 09/26/2023]
Abstract
BACKGROUND AND AIMS Positron Emission Tomography (PET)-derived myocardial flow reserve (MFR) has been shown to have a role in the diagnosis and prognosis of patients with coronary artery disease (CAD). We performed a systematic review and meta-analysis to summarize the body of literature and synthesize the evidence on the prognostic role of PET-derived MFR in patients with known or suspected CAD. METHODS A comprehensive literature search of the Medline database from its inception to August 2023, in humans, in any language, was conducted for clinical studies examining the prognostic value of PET imaging in patients of any age, sex, and CAD status. Systematic screening and data extraction of the identified studies were followed by quantitative meta-analysis of PET-MFR's role in predicting adverse clinical events using random effect model. Studies were appraised using the modified Newcastle-Ottawa tool. RESULTS A total of 21 studies assessing the prognostic role of PET derived MFR in 46,815 patients with known and/or suspected CAD were included (mean (SD) age 66 (4) years, 48% women). The mean follow-up duration was 36 months (range 10-96). Cardiovascular risk factors were prevalent (73% hypertension, 35% diabetes and 67% dyslipidemia). The definition of the composite outcome varied between studies, with various combinations of mortality, non-fatal myocardial infarction, hospitalization, and coronary revascularization. Pooled impaired MFR was significantly associated with an increased risk of adverse outcomes (RR = 2.94, 95% CI 2.42-3.56, p < 0.001). Results were similar in a subgroup of patients with suspected CAD. CONCLUSIONS The available body of evidence shows that impaired PET-derived MFR measured using different tracers and PET systems is strongly associated with an increased risk of adverse cardiovascular events. Limitations of this review include observational nature of studies, marked heterogeneity in patient populations, inconsistency in thresholds to define abnormal MFR, and differing components for the composite outcome.
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Affiliation(s)
- Ahmed Ibrahim Ahmed
- Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA; Yale School of Medicine, New Haven, CT, USA
| | - Jean Michel Saad
- Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA
| | - Fares Alahdab
- Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA
| | - Yushui Han
- Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA
| | - Malek Nayfeh
- Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA
| | | | - Mahmoud Al-Rifai
- Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA
| | - Mouaz Al-Mallah
- Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA.
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15
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Schindler TH, Fearon WF. Angiography-Derived FFR as Novel Parameter in Assessing Flow-Limiting CAD? JACC Cardiovasc Imaging 2023; 16:1332-1334. [PMID: 37115161 DOI: 10.1016/j.jcmg.2023.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 03/02/2023] [Indexed: 04/29/2023]
Affiliation(s)
- Thomas H Schindler
- Division of Nuclear Medicine, Mallinckrodt Institute of Radiology, Washington University, Saint Louis, Missouri, USA.
| | - William F Fearon
- Division of Cardiovascular Medicine and Cardiovascular Institute, Stanford University School of Medicine, Stanford, California, USA
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16
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Boczar KE, Beanlands RS, Glassman SJ, Wang J, Zeng W, deKemp RA, Ward NC, Fehlmann CA, Wells GA, Karsh J, Dwivedi G. Anti-inflammatory effect of biologic therapy in patients with psoriatic disease: A prospective cohort FDG PET study. J Nucl Cardiol 2023; 30:1642-1652. [PMID: 36754934 PMCID: PMC10372102 DOI: 10.1007/s12350-023-03204-8] [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: 06/23/2022] [Accepted: 12/07/2022] [Indexed: 02/10/2023]
Abstract
AIM The aim of the study was to evaluate the changes in central vascular inflammation measured by FDG PET and myocardial blood flow reserve (MFR) determined by 82Rb PET following therapy with biologic agents for 6 months in patients with psoriatic arthritis (PsA) and/or cutaneous psoriasis (PsO) (group 1) and compare with PsO subjects receiving non-biologic therapy (group 2) and controls (group 3). METHODS AND RESULTS Target-to-background ratio (TBR) by FDG PET in the most diseased segment of the ascending aorta (TBRmax) was measured to assess vascular inflammation. 82Rb PET studies were used to assess changes in left ventricular MFR. A total of 34 participants were enrolled in the study (11 in group 1, 13 in group 2, and 10 controls). A significant drop in the thoracic aorta uptake was observed in the biologic-treated group (ΔTBRmax: - .46 ± .55) compared to the PsO group treated with non-biologic therapy (ΔTBRmax: .23 ± .67). Those showing response to biologic agents maintained MFR compared to who showed no response. CONCLUSION In a cohort of psoriasis patients treated with biologics, FDG uptake in the thoracic aorta decreased over the study period. Patients who demonstrated a significant anti-inflammatory response on FDG PET imaging maintained their MFR compared to non-responders.
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Affiliation(s)
- Kevin E Boczar
- University of Ottawa Heart Institute, Ottawa, ON, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
- University of Ottawa, Ottawa, ON, Canada
- Division of Cardiology, Department of Medicine, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, USA
| | | | | | - Jerry Wang
- University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Wanzhen Zeng
- University of Ottawa Heart Institute, Ottawa, ON, Canada
- University of Ottawa, Ottawa, ON, Canada
| | | | - Natalie C Ward
- School of Medicine, University of Western Australia, Perth, WA, Australia
| | - Christophe A Fehlmann
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
- The Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Division of Emergency Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - George A Wells
- University of Ottawa Heart Institute, Ottawa, ON, Canada
- Research Methods Centre, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Jacob Karsh
- Division of Rheumatology, The Ottawa Hospital, Ottawa, ON, Canada
| | - Girish Dwivedi
- University of Ottawa Heart Institute, Ottawa, ON, Canada.
- University of Ottawa, Ottawa, ON, Canada.
- School of Medicine, University of Western Australia, Perth, WA, Australia.
- Department of Advanced Clinical and Translational Cardiovascular Imaging, Harry Perkins Institute of Medical Research, Murdoch, Australia.
- Department of Cardiology, Fiona Stanley Hospital, Murdoch, WA, Australia.
- School of Biomedical Sciences, Curtin University, Bentley, WA, Australia.
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17
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Garcia-Cardenas M, Espejel-Guzman A, Antonio-Villa NE, Michel-Vasquez A, Hernandez-Sandoval S, Serrano-Roman J, Fernandez-Badillo V, Solorzano-Pinot E, Zagal-Cardoso D, Keirns C, Alexanderson-Rosas E, Espinola-Zavaleta N. Diagnosis, performance and added value of assessing ventricular dyssynchrony by phase analysis in patients with three-vessel disease: A single-center cross-sectional study in Mexico. J Nucl Cardiol 2023; 30:1219-1229. [PMID: 36348246 DOI: 10.1007/s12350-022-03136-9] [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: 04/26/2022] [Accepted: 10/11/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND Three-vessel disease (3VD) is a cardiovascular disorder that affects the three main coronary arteries. Gated myocardial perfusion SPECT (GMPS) evaluates ventricular function, synchrony, and myocardial perfusion. However, the diagnostic performance of GMPS parameters to assess 3VD has not been fully explored. AIMS To assess the univariate performance capacity of GMPS parameters, and to evaluate whether phase parameters could provide additional predictive value for the detection of patients with 3VD compared to control subjects. METHODS We designed paired retrospective samples of GMPS images of patients with 3VD (stenosis > 70% of left anterior descending, right coronary, and circumflex coronary arteries) and without 3VD. A GMPS in rest-stress protocol was performed using 99mTc-Sestamibi and thallium and analyzed with the 3D method. Area under the receiver-operating characteristic curves (AUROC), decision curve analyses and diagnostic test performance were obtained for univariable analyses and stepwise binomial logistic regression for multivariable performance. RESULTS 474 Patients were included: 237 with 3VD (84% males, mean age 61.7 ± 9.9 years) and 237 with normal GMPS (51% women, mean age 63.8 ± 10.6 years). The highest AUROC for perfusion parameters were recorded for SSS, SRS and TID. For dyssynchrony parameters, both entropy and bandwidth in rest and stress phases displayed the highest AUROC and diagnostic capacity to detect 3VD. A multivariate model with SRS ≥ 4, SDS ≥ 2, TID > 1.19 and sBW ≥ 48° displayed the highest diagnostic capacity (0.923 [95% CI 0.897-0.923]) to detect 3VD. CONCLUSION Perfusion and dyssynchrony were the parameters which were most able to discriminate patients with 3VD from those who did not have CAD.
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Affiliation(s)
- Mauricio Garcia-Cardenas
- Department of Nuclear Cardiology, National Institute of Cardiology Ignacio Chavez, Juan Badiano No 1, Colonia Seccion XVI, Tlalpan, 14080, Mexico, Mexico
| | - Adrian Espejel-Guzman
- Department of Nuclear Cardiology, National Institute of Cardiology Ignacio Chavez, Juan Badiano No 1, Colonia Seccion XVI, Tlalpan, 14080, Mexico, Mexico
| | | | - Ana Michel-Vasquez
- Department of Nuclear Cardiology, National Institute of Cardiology Ignacio Chavez, Juan Badiano No 1, Colonia Seccion XVI, Tlalpan, 14080, Mexico, Mexico
| | - Salvador Hernandez-Sandoval
- Department of Nuclear Cardiology, National Institute of Cardiology Ignacio Chavez, Juan Badiano No 1, Colonia Seccion XVI, Tlalpan, 14080, Mexico, Mexico
| | - Javier Serrano-Roman
- Department of Nuclear Cardiology, National Institute of Cardiology Ignacio Chavez, Juan Badiano No 1, Colonia Seccion XVI, Tlalpan, 14080, Mexico, Mexico
| | - Valente Fernandez-Badillo
- Department of Nuclear Cardiology, National Institute of Cardiology Ignacio Chavez, Juan Badiano No 1, Colonia Seccion XVI, Tlalpan, 14080, Mexico, Mexico
| | - Enrique Solorzano-Pinot
- Department of Nuclear Cardiology, National Institute of Cardiology Ignacio Chavez, Juan Badiano No 1, Colonia Seccion XVI, Tlalpan, 14080, Mexico, Mexico
| | - Daniel Zagal-Cardoso
- M.D./Ph.D. (PECEM), Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico, Mexico
| | - Candace Keirns
- Shelby County Health Department, 814 Jefferson Ave., Memphis, TN, 38103, USA
| | - Erick Alexanderson-Rosas
- Department of Nuclear Cardiology, National Institute of Cardiology Ignacio Chavez, Juan Badiano No 1, Colonia Seccion XVI, Tlalpan, 14080, Mexico, Mexico
| | - Nilda Espinola-Zavaleta
- Department of Nuclear Cardiology, National Institute of Cardiology Ignacio Chavez, Juan Badiano No 1, Colonia Seccion XVI, Tlalpan, 14080, Mexico, Mexico.
- Department of Echocardiography, ABC Medical Center, P.A.I., Mexico, Mexico.
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Bhandiwad AR, Valenta I, Jain S, Schindler TH. PET-determined prevalence of coronary microvascular dysfunction and different types in a cardio-metabolic risk population. IJC HEART & VASCULATURE 2023; 46:101206. [PMID: 37113650 PMCID: PMC10127120 DOI: 10.1016/j.ijcha.2023.101206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 03/30/2023] [Accepted: 04/05/2023] [Indexed: 04/29/2023]
Abstract
Background The aim was to investigate the prevalence of "classical" (predominantly related to alterations in hyperemic MBFs) and "endogen" (predominantly related to alterations in resting MBF) normal coronary microvascular function (nCMF) or coronary microvascular dysfunction (CMD) in a clinical population without flow-limiting obstructive CAD. Methods We prospectively enrolled 239 symptomatic patients with normal pharmacologically-stress and rest myocardial perfusion on 13N-ammonia PET/CT. 13N-ammonia PET/CT concurrently assessed myocardial flow reserve (MFR = MBF stress/MBF rest). Normal nCMF was defined by a MFR of ≥ 2.0, while an abnormal MFR of < 2.0 signified CMD. In addition, patients were subgrouped into classical and endogen type of nCMF and CMD, respectively. Results In the whole study population, CMD was present in 54% (130/239). The classical type was more prevalent than the endogen type of CMD (65% vs 35%, p ≤ 0.008). The classical type of CMD was paralleled by a high prevalence of diabetes mellitus, metabolic syndrome, and obesity, while the endogen type of CMD was accompanied by a higher prevalence of arterial hypertension, obesity, and/or morbid obesity. Further, the classical type of nCMF was more frequently observed that the endogen type (74% vs. 26%, p ≤ 0.007). The endogen type of nCMF was related to lower heart rate and/or arterial blood pressures. Conclusions In this contemporary clinical study population, slightly more than half of symptomatic patients had CMD with predominance of the classical type. These observations emphasize the need for standardized reporting of CMD to gear individualized and/or intensified medical treatment to improve symptoms and/or clinical outcome in these patients.
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Affiliation(s)
- Anita R. Bhandiwad
- Mallinckrodt Institute of Radiology, Division of Nuclear Medicine, Cardiovascular Medicine, Washington University School of Medicine, St. Louis, MO, USA
- John T. Milliken Department of Internal Medicine, Cardiovascular Division, Washington University School of Medicine, St. Louis, MO, USA
| | - Ines Valenta
- John T. Milliken Department of Internal Medicine, Cardiovascular Division, Washington University School of Medicine, St. Louis, MO, USA
| | - Sudhir Jain
- Mallinckrodt Institute of Radiology, Division of Nuclear Medicine, Cardiovascular Medicine, Washington University School of Medicine, St. Louis, MO, USA
- John T. Milliken Department of Internal Medicine, Cardiovascular Division, Washington University School of Medicine, St. Louis, MO, USA
| | - Thomas H. Schindler
- Mallinckrodt Institute of Radiology, Division of Nuclear Medicine, Cardiovascular Medicine, Washington University School of Medicine, St. Louis, MO, USA
- John T. Milliken Department of Internal Medicine, Cardiovascular Division, Washington University School of Medicine, St. Louis, MO, USA
- Corresponding author at: Washington University in St. Louis, Mallinckrodt Institute of Radiology, Division of Nuclear Medicine, 510 S. Kingshighway, Campus Box 8223, St. Louis, MO 63110, USA.
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19
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Garcia EV, Piccinelli M. Preparing for the Artificial Intelligence Revolution in Nuclear Cardiology. Nucl Med Mol Imaging 2023; 57:51-60. [PMID: 36998588 PMCID: PMC10043081 DOI: 10.1007/s13139-021-00733-3] [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: 12/07/2021] [Revised: 12/18/2021] [Accepted: 12/19/2021] [Indexed: 10/19/2022] Open
Abstract
A major opportunity in nuclear cardiology is the many significant artificial intelligence (AI) applications that have recently been reported. These developments include using deep learning (DL) for reducing the needed injected dose and acquisition time in perfusion acquisitions also due to DL improvements in image reconstruction and filtering, SPECT attenuation correction using DL without need for transmission images, DL and machine learning (ML) use for feature extraction to define myocardial left ventricular (LV) borders for functional measurements and improved detection of the LV valve plane and AI, ML, and DL implementations for MPI diagnosis, prognosis, and structured reporting. Although some have, most of these applications have yet to make it to widespread commercial distribution due to the recency of their developments, most reported in 2020. We must be prepared both technically and socio-economically to fully benefit from these and a tsunami of other AI applications that are coming.
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Affiliation(s)
- Ernest V. Garcia
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, 101 Woodruff Circle, Room 1203, GA 30322 Atlanta, USA
| | - Marina Piccinelli
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, 101 Woodruff Circle, Room 1203, GA 30322 Atlanta, USA
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20
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Servito M, Gill I, Durbin J, Ghasemlou N, Popov AF, Stephen CD, El-Diasty M. Management of Coronary Artery Disease in CADASIL Patients: Review of Current Literature. Medicina (B Aires) 2023; 59:medicina59030586. [PMID: 36984587 PMCID: PMC10059795 DOI: 10.3390/medicina59030586] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 02/27/2023] [Accepted: 03/06/2023] [Indexed: 03/19/2023] Open
Abstract
Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is the most common heritable form of vascular dementia in adults. It is well-established that CADASIL results in neurocognitive dysfunction and mood disturbance. There is also cumulative evidence that CADASIL patients are more susceptible to ischemic heart disease. The aim of this study is to review the current literature regarding the incidence of coronary artery disease in CADASIL patients with a focus on the various management options and the clinical challenges associated with each of these treatment strategies. We conducted a literature search using Cochrane, MEDLINE, and EMBASE for papers that reported the occurrence of coronary artery disease in patients with CADASIL. We supplemented the search with a manual search in Google Scholar. Only case reports, case series, and original articles were included. The search resulted in six reports indicating the association between coronary artery disease and CADASIL and its management. Evidence suggests that extracranial manifestations of CADASIL may include coronary artery disease, presenting as a more extensive burden of disease in younger patients. Surgical and percutaneous revascularization strategies are feasible, but the incidence of peri-procedural stroke remains significant and should be weighed against the potential benefit derived from either of these strategies. A multidisciplinary approach to therapy, with perspectives from neurologists, cardiologists, and cardiac surgeons, is needed to provide the appropriate treatment to the CADASIL patient with severe coronary artery disease. Future studies should be directed toward the development of targeted therapies that may help with the early detection and prevention of disease progress in these patients.
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Affiliation(s)
- Maria Servito
- Department of Cardiac Surgery, University of Manitoba, Winnipeg, MB R2H 2A6, Canada
| | - Isha Gill
- Department of Biomedical and Molecular Sciences, Queen’s University, Kingston, ON K7L 2V7, Canada
| | - Joshua Durbin
- Division of Cardiology, Department of Medicine, Queen’s University, Kingston, ON K7L 2V7, Canada
| | - Nader Ghasemlou
- Department of Anaesthesiology, Queen’s University, Kingston, ON K7L 2V7, Canada
| | - Aron-Frederik Popov
- Department of Cardiothoracic Surgery, Helios Clinic, 53721 Siegburg, Germany
- Correspondence:
| | - Christopher D. Stephen
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Mohammad El-Diasty
- Division of Cardiac Surgery, Department of Surgery, Queen’s University, Kingston, ON K7L 2V7, Canada
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21
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Yan M, Shang H, Hao L, Guo X, Zheng H, Li H, Zhao Y. A preliminary study of dobutamine myocardial flow reserve on 99mTc-Sestamibi CZT-SPECT. Ann Nucl Med 2023; 37:349-359. [PMID: 36892730 DOI: 10.1007/s12149-023-01829-w] [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: 01/16/2023] [Accepted: 02/27/2023] [Indexed: 03/10/2023]
Abstract
BACKGROUND With improved resolution and sensitivity, the cadmium zinc telluride (CZT) detector measures myocardial blood flow (MBF) and myocardial flow reserve (MFR) via single photon emission computed tomography (SPECT). Recently, many studies have used vasodilator stress to obtain quantitative indexes. However, dobutamine used as a pharmaceutical stress has been rarely used to quantify myocardial perfusion using CZT-SPECT. Our study retrospectively analyzed the blood flow performance of 99mTc-Sestamibi (99mTc -MIBI) CZT-SPECT comparing dobutamine to adenosine. PURPOSE The study aims to explore whether dobutamine stress can be used for the myocardial perfusion quantitative analysis via CZT-SPECT as well as compare dobutamine MBF and MFR to adenosine. METHODS It was a retrospective study. A total of 68 patients with suspected or known coronary artery disease (CAD) were consecutively enrolled in this study. Thirty-four patients underwent dobutamine stress 99mTc-MIBI CZT-SPECT. Another thirty-four patients underwent adenosine stress 99mTc-MIBI CZT-SPECT. Patient characteristics, myocardial perfusion imaging (MPI) results, gated-myocardial perfusion imaging (G-MPI) results and quantitative analysis of MBF and MFR were collected. RESULTS In dobutamine stress group, stress MBF was significantly higher than rest MBF (median [interquartile range], 1.63 [1.46-1.94] vs. 0.89 [0.73-1.06], P < 0.001). In adenosine stress group, similar results were observed (median [interquartile range], 2.01 [1.34-2.20] vs. 0.88 [0.75-1.01], P < 0.001). When comparing the dobutamine and adenosine stress group, global MFR showed significant differences (median [interquartile range], the dobutamine group: 1.88 [1.67-2.38] vs. the adenosine group: 2.19 [1.87-2.64], P = 0.037). CONCLUSION MBF and MFR can be measured using dobutamine 99mTc -MIBI CZT-SPECT. In small sample single-center study, there was a difference in MFR produced by adenosine and dobutamine within the suspected or the known CAD population.
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Affiliation(s)
- Ming Yan
- Department of Nuclear Medicine, The Second Hospital of Hebei Medical University, No. 215, Heping West Road, Xinhua District, Shijiazhuang, 050000, Hebei, China
| | - Hua Shang
- Department of Nuclear Medicine, The Second Hospital of Hebei Medical University, No. 215, Heping West Road, Xinhua District, Shijiazhuang, 050000, Hebei, China.
| | - Luping Hao
- Department of Nuclear Medicine, The Second Hospital of Hebei Medical University, No. 215, Heping West Road, Xinhua District, Shijiazhuang, 050000, Hebei, China
| | - Xiaorui Guo
- Department of Nuclear Medicine, The Second Hospital of Hebei Medical University, No. 215, Heping West Road, Xinhua District, Shijiazhuang, 050000, Hebei, China
| | - Hongming Zheng
- Department of Nuclear Medicine, The Second Hospital of Hebei Medical University, No. 215, Heping West Road, Xinhua District, Shijiazhuang, 050000, Hebei, China
| | - Hongmei Li
- Department of Nuclear Medicine, The Second Hospital of Hebei Medical University, No. 215, Heping West Road, Xinhua District, Shijiazhuang, 050000, Hebei, China
| | - Yuchan Zhao
- Department of Nuclear Medicine, The Second Hospital of Hebei Medical University, No. 215, Heping West Road, Xinhua District, Shijiazhuang, 050000, Hebei, China
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22
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Mochula AV, Kopeva KV, Maltseva AN, Grakova EV, Gulya M, Smorgon AV, Gusakova A, Zavadovsky KV. The myocardial flow reserve in patients with heart failure with preserved ejection fraction. Heart Vessels 2023; 38:348-360. [PMID: 36045268 DOI: 10.1007/s00380-022-02161-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 08/18/2022] [Indexed: 02/07/2023]
Abstract
To evaluate the myocardial flow reserve (MFR) and myocardial blood flow (MBF) parameters in patients with heart failure with preserved ejection fraction (HFpEF) and to assess their relationship with the severity of HF and the levels of soluble ST2 (sST2). A total of 59 consecutive patients (median age of 65.0 (58.0; 69.0) years) with non-obstructive coronary artery disease (CAD) and preserved EF were enrolled. Serum levels biomarkers were measured by enzyme immunoassay. MBF and MFR parameters were evaluated by dynamic CZT-SPECT. All patients were divided into two groups: group 1 comprised patients (n = 41) with HFpEF, and group 2 comprised those (n = 18) without HFpEF. In group 1 global MFR (gMFR) values were lower by 27.8% (p = 0.003) than in group 2. The values of gMFR correlated with NT-proBNP (r = - 0.290) and sST2 (r = -0.331) levels. Based on ROC-analysis, gMFR ≤ 2.27 (AUC = 0.746; p < 0.001) were associated with the presence of HFpEF. In patients with HFpEF (n = 41) the values of gMFR were related to NYHA classes (p < 0.001) and the parameters of diastolic dysfunction (p < 0.001). The values of gMFR ≤ 2.27 may be used for the evaluation of microvascular changes in patients with HFpEF and non-obstructive CAD.
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Affiliation(s)
- Andrew V Mochula
- Cardiology Research Institute, Tomsk National Research Medical Center (TNRMC), Russian Academy of Sciences (RAS), 111a, Kievskaya Str., Tomsk, 634012, Russian Federation.
| | - Kristina V Kopeva
- Cardiology Research Institute, Tomsk National Research Medical Center (TNRMC), Russian Academy of Sciences (RAS), 111a, Kievskaya Str., Tomsk, 634012, Russian Federation
| | - Alina N Maltseva
- Cardiology Research Institute, Tomsk National Research Medical Center (TNRMC), Russian Academy of Sciences (RAS), 111a, Kievskaya Str., Tomsk, 634012, Russian Federation
| | - Elena V Grakova
- Cardiology Research Institute, Tomsk National Research Medical Center (TNRMC), Russian Academy of Sciences (RAS), 111a, Kievskaya Str., Tomsk, 634012, Russian Federation
| | - Marina Gulya
- Cardiology Research Institute, Tomsk National Research Medical Center (TNRMC), Russian Academy of Sciences (RAS), 111a, Kievskaya Str., Tomsk, 634012, Russian Federation
| | - Andrey V Smorgon
- Cardiology Research Institute, Tomsk National Research Medical Center (TNRMC), Russian Academy of Sciences (RAS), 111a, Kievskaya Str., Tomsk, 634012, Russian Federation
| | - Anna Gusakova
- Cardiology Research Institute, Tomsk National Research Medical Center (TNRMC), Russian Academy of Sciences (RAS), 111a, Kievskaya Str., Tomsk, 634012, Russian Federation
| | - Konstantin V Zavadovsky
- Cardiology Research Institute, Tomsk National Research Medical Center (TNRMC), Russian Academy of Sciences (RAS), 111a, Kievskaya Str., Tomsk, 634012, Russian Federation
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23
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Schindler TH, Jain S, Bhandiwad AR. Assessment of coronary anatomy and flow for optimized diagnosis and prognostication in CAD. Eur Heart J Cardiovasc Imaging 2023; 24:312-313. [PMID: 36617212 DOI: 10.1093/ehjci/jeac267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Affiliation(s)
- Thomas H Schindler
- Mallinckrodt Institute of Radiology, Division of Nuclear Medicine, Cardiovascular Medicine, Washington University School of Medicine, 510 S. Kingshighway, Campus Box 8223, St. Louis, MO 63110, USA.,John T. Milliken Department of Internal Medicine, Cardiovascular Division, Washington University School of Medicine, 4921 Parkview Plaza, St. Louis, MO 63110, USA
| | | | - Anita R Bhandiwad
- John T. Milliken Department of Internal Medicine, Cardiovascular Division, Washington University School of Medicine, 4921 Parkview Plaza, St. Louis, MO 63110, USA
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24
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Myocardial ischemia in patients with large prior infarction: Clinical decision making and review of literature. Radiol Case Rep 2023; 18:538-544. [DOI: 10.1016/j.radcr.2022.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 10/30/2022] [Accepted: 11/01/2022] [Indexed: 11/27/2022] Open
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Rehan R, Yong A, Ng M, Weaver J, Puranik R. Coronary microvascular dysfunction: A review of recent progress and clinical implications. Front Cardiovasc Med 2023; 10:1111721. [PMID: 36776251 PMCID: PMC9908997 DOI: 10.3389/fcvm.2023.1111721] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 01/09/2023] [Indexed: 01/28/2023] Open
Abstract
The coronary microcirculation plays a cardinal role in regulating coronary blood flow to meet the changing metabolic demands of the myocardium. Coronary microvascular dysfunction (CMD) refers to structural and functional remodeling of the coronary microcirculation. CMD plays a role in the pathogenesis of obstructive and non-obstructive coronary syndromes as well as myocardial diseases, including heart failure with preserved ejection fraction (HFpEF). Despite recent diagnostic advancements, CMD is often under-appreciated in clinical practice, and may allow for the development of novel therapeutic targets. This review explores the diagnosis and pathogenic role of CMD across a range of cardiovascular diseases, its prognostic significance, and the current therapeutic landscape.
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Affiliation(s)
- Rajan Rehan
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia,Department of Cardiology, Concord Hospital, Sydney, NSW, Australia,Sydney Medical School, University of Sydney, Darlington, NSW, Australia
| | - Andy Yong
- Department of Cardiology, Concord Hospital, Sydney, NSW, Australia,Sydney Medical School, University of Sydney, Darlington, NSW, Australia
| | - Martin Ng
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia,Sydney Medical School, University of Sydney, Darlington, NSW, Australia
| | - James Weaver
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Rajesh Puranik
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia,Sydney Medical School, University of Sydney, Darlington, NSW, Australia,*Correspondence: Rajesh Puranik,
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26
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Ahmed AI, Al Rifai M, Alahdab F, Saad JM, Han Y, Alfawara MS, Nabi F, Mahmarian JJ, Al-Mallah MH. Incremental prognostic value of digital positron emission tomography derived myocardial flow reserve: A prospective cohort study. Int J Cardiol 2023; 371:465-471. [PMID: 36096273 DOI: 10.1016/j.ijcard.2022.09.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 08/23/2022] [Accepted: 09/07/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Positron Emission Tomography (PET) Myocardial Perfusion Imaging (MPI) is a robust diagnostic and prognostic test in patients with suspected or known coronary artery disease (CAD). We aimed to assess the incremental prognostic value of myocardial flow reserve (MFR) using the latest generation of digital PET scanners. METHODS Consecutive patients with clinically indicated PET MPI for suspected or known CAD were included. Myocardial blood flow (MBF) in ml/min/g was obtained from dynamic images at rest and peak hyperemia, and the myocardial flow reserve (MFR) was calculated as the ratio of stress to rest MBF. Patients were followed from the date of PET imaging for the occurrence of the primary outcome (composite of all-cause death, myocardial infarction, and Percutaneous Coronary Intervention or Coronary Artery Bypass Graft occurring >90 days after imaging). Nested multivariable Cox regression models were used to assess the incremental prognostic role of MFR over traditional risk factors and PET relative perfusion parameters. RESULTS The final cohort consisted of 3534 patients (mean age 67 ± 12 years, 48% female, 67% Caucasian, 53% obese, 55% hypertension, 32% diabetes, 42% dyslipidemia). During a median follow-up of 8.5 (3.0-15.4) months, 229 patients (6.5%, 6.4 per 1000 person-years) experienced the primary outcome. In nested multivariable Cox models, impaired MFR (MFR < 2) was significantly associated with the primary outcome (HR 2.9, 95% CI 2.0-4.1, p < 0.001) and significantly improved discrimination (Harrell's C 0.77, p = 0.002). CONCLUSION MFR derived from digital PET scanners has an independent and incremental prognostic role in patients with suspected or known CAD.
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Affiliation(s)
| | - Mahmoud Al Rifai
- Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA
| | - Fares Alahdab
- Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA
| | - Jean Michel Saad
- Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA
| | - Yushui Han
- Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA
| | | | - Faisal Nabi
- Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA
| | - John J Mahmarian
- Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA
| | - Mouaz H Al-Mallah
- Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA.
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27
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Schindler TH, Fearon WF, Pelletier-Galarneau M, Ambrosio G, Sechtem U, Ruddy TD, Patel KK, Bhatt DL, Bateman TM, Gewirtz H, Shirani J, Knuuti J, Gropler RJ, Chareonthaitawee P, Slart RHJA, Windecker S, Kaufmann PA, Abraham MR, Taqueti VR, Ford TJ, Camici PG, Schelbert HR, Dilsizian V. PET for Detection and Reporting Coronary Microvascular Dysfunction: A JACC: Cardiovascular Imaging Expert Panel Statement. JACC Cardiovasc Imaging 2023; 16:536-548. [PMID: 36881418 DOI: 10.1016/j.jcmg.2022.12.015] [Citation(s) in RCA: 27] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 11/14/2022] [Accepted: 12/02/2022] [Indexed: 02/11/2023]
Abstract
Angina pectoris and dyspnea in patients with normal or nonobstructive coronary vessels remains a diagnostic challenge. Invasive coronary angiography may identify up to 60% of patients with nonobstructive coronary artery disease (CAD), of whom nearly two-thirds may, in fact, have coronary microvascular dysfunction (CMD) that may account for their symptoms. Positron emission tomography (PET) determined absolute quantitative myocardial blood flow (MBF) at rest and during hyperemic vasodilation with subsequent derivation of myocardial flow reserve (MFR) affords the noninvasive detection and delineation of CMD. Individualized or intensified medical therapies with nitrates, calcium-channel blockers, statins, angiotensin-converting enzyme inhibitors, angiotensin II type 1-receptor blockers, beta-blockers, ivabradine, or ranolazine may improve symptoms, quality of life, and outcome in these patients. Standardized diagnosis and reporting criteria for ischemic symptoms caused by CMD are critical for optimized and individualized treatment decisions in such patients. In this respect, it was proposed by the cardiovascular council leadership of the Society of Nuclear Medicine and Molecular Imaging to convene thoughtful leaders from around the world to serve as an independent expert panel to develop standardized diagnosis, nomenclature and nosology, and cardiac PET reporting criteria for CMD. This consensus document aims to provide an overview of the pathophysiology and clinical evidence of CMD, its invasive and noninvasive assessment, standardization of PET-determined MBFs and MFR into "classical" (predominantly related to hyperemic MBFs) and "endogen" (predominantly related to resting MBF) normal coronary microvascular function or CMD that may be critical for diagnosis of microvascular angina, subsequent patient care, and outcome of clinical CMD trials.
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Affiliation(s)
- Thomas H Schindler
- Mallinckrodt Institute of Radiology, Division of Nuclear Medicine-Cardiovascular, Washington University in St Louis School of Medicine, St Louis, Missouri, USA.
| | - William F Fearon
- Division of Cardiovascular Medicine and Cardiovascular Institute, Stanford University School of Medicine, Stanford, California, USA; VA Palo Alto Health Care System, Palo Alto, California, USA
| | | | - Giuseppe Ambrosio
- University of Perugia School of Medicine Ospedale S. Maria della Misericordia Perugia, Italy
| | - Udo Sechtem
- Cardiologicum Stuttgart, Stuttgart, Baden-Wuerttemberg, Germany
| | | | - Krishna K Patel
- Icahn School of Medicine at Mount Sinai, Zena, New York, New York, USA; Michael A. Wiener Cardiovascular Institute, New York, New York, USA
| | - Deepak L Bhatt
- Mount Sinai Heart, Icahn School of Medicine at Mount Sinai Health System, New York, New York, USA
| | - Timothy M Bateman
- Saint-Lukes Health System and the Mid-America Heart Institute, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri, USA
| | - Henry Gewirtz
- Cardiac Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Jamshid Shirani
- Cardiology, St Luke's University Health Network, Bethlehem, Pennsylvania, USA
| | - Juhani Knuuti
- Heart Center, Turku University Hospital, Turku, Finland
| | - Robert J Gropler
- Mallinckrodt Institute of Radiology, Division of Nuclear Medicine-Cardiovascular, Washington University in St Louis School of Medicine, St Louis, Missouri, USA
| | | | - Riemer H J A Slart
- Medical Imaging Center, Departments of Radiology and Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Stephan Windecker
- Department of Cardiology, Inselspital, University of Bern, Switzerland
| | - Philipp A Kaufmann
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Zurich, Switzerland
| | - Maria R Abraham
- Hypertrophic Cardiomyopathy Center of Excellence, University of California, San Francisco, California, USA
| | - Viviany R Taqueti
- Cardiovascular Imaging Program, Departments of Radiology and Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Thomas J Ford
- The University of Newcastle, Faculty of Medicine, Newcastle, Australia
| | - Paolo G Camici
- San Raffaele Hospital, Milan Italy; Vita Salute University, Milan, Italy
| | - Heinrich R Schelbert
- Department of Molecular Imaging and Medical Pharmacology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Vasken Dilsizian
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
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Verma A, Ramayya T, Upadhyaya A, Valenta I, Lyons M, Marschall J, Dehdashti F, Gropler RJ, Woodard PK, Schindler TH. Post COVID-19 syndrome with impairment of flow-mediated epicardial vasodilation and flow reserve. Eur J Clin Invest 2022; 52:e13871. [PMID: 36083297 PMCID: PMC9538977 DOI: 10.1111/eci.13871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Revised: 08/15/2022] [Accepted: 09/08/2022] [Indexed: 01/08/2023]
Abstract
AIMS The aim of this study is to evaluate whether post-acute sequelae of COVID-19 cardiovascular syndrome (PASC-CVS) is associated with alterations in coronary circulatory function. MATERIALS AND METHODS In individuals with PASC-CVS but without known cardiovascular risk factors (n = 23) and in healthy controls (CON, n = 23), myocardial blood flow (MBF) was assessed with 13 N-ammonia and PET/CT in mL/g/min during regadenoson-stimulated hyperemia, at rest, and the global myocardial flow reserve (MFR) was calculated. MBF was also measured in the mid and mid-distal myocardium of the left ventricle (LV). The Δ longitudinal MBF gradient (hyperemia minus rest) as a reflection of an impairment of flow-mediated epicardial vasodilation, was calculated. RESULTS Resting MBF was significantly higher in PASC-CVS than in CON (1.29 ± 0.27 vs. 1.08 ± 0.20 ml/g/min, p ≤ .024), while hyperemic MBFs did not differ significantly among groups (2.46 ± 0.53 and 2.40 ± 0.34 ml/g/min, p = .621). The MFR was significantly less in PASC-CVS than in CON (1.97 ± 0.54 vs. 2.27 ± 0.43, p ≤ .031). In addition, there was a Δ longitudinal MBF gradient in PASC-CVS, not observed in CON (-0.17 ± 0.18 vs. 0.04 ± 0.11 ml/g/min, p < .0001). CONCLUSIONS Post-acute sequelae of COVID-19 cardiovascular syndrome may be associated with an impairment of flow-mediated epicardial vasodilation, while reductions in coronary vasodilator capacity appear predominantly related to increases in resting flow in women deserving further investigations.
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Affiliation(s)
- Amanda Verma
- Division of Nuclear Medicine, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri, USA.,Cardiovascular Division, John T. Milliken Department of Internal Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Tarun Ramayya
- Cardiovascular Division, John T. Milliken Department of Internal Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Anand Upadhyaya
- Division of Nuclear Medicine, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Ines Valenta
- Division of Nuclear Medicine, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Maureen Lyons
- Infectious Disease Division, John T. Milliken Department of Internal Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Jonas Marschall
- Infectious Disease Division, John T. Milliken Department of Internal Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Farrokh Dehdashti
- Division of Nuclear Medicine, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Robert J Gropler
- Division of Nuclear Medicine, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Pamela K Woodard
- Division of Nuclear Medicine, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Thomas Hellmut Schindler
- Division of Nuclear Medicine, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri, USA.,Cardiovascular Division, John T. Milliken Department of Internal Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
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Spinelli L. Left ventricular strain analysis by positron emission tomography: Beyond myocardial perfusion. J Nucl Cardiol 2022; 29:2115-2118. [PMID: 34318396 DOI: 10.1007/s12350-021-02747-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Accepted: 07/07/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Letizia Spinelli
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Via Pansini 5, 80131, Naples, Italy.
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Nelson LM, Christensen TE, Rossing K, Hasbak P, Gustafsson F. Prognostic value of myocardial flow reserve obtained by 82-rubidium positron emission tomography in long-term follow-up after heart transplantation. J Nucl Cardiol 2022; 29:2555-2567. [PMID: 34414554 DOI: 10.1007/s12350-021-02742-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 06/25/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Cardiac allograft vasculopathy (CAV) is a leading cause of death following heart transplantation (HTx) and non-invasive prognostic methods in long-term CAV surveillance are needed. We evaluated the prognostic value of myocardial flow reserve (MFR) obtained by 82-rubidium (82Rb) positron emission tomography (PET). METHODS Recipients undergoing dynamic rest-stress 82Rb PET between April 2013 and June 2017 were retrospectively evaluated in a single-center study. Evaluation by PET included quantitative myocardial blood flow and semiquantitative myocardial perfusion imaging. Patients were grouped by MFR (MFR ≤ 2.0 vs MFR > 2.0) and the primary outcome was all-cause mortality. RESULTS A total of 50 patients (68% men, median age 57 [IQR: 43 to 68]) were included. Median time from HTx to PET was 10.0 (6.7 to 16.0) years. In 58% of patients CAV was documented prior to PET. During a median follow-up of 3.6 (2.3 to 4.3) years 12 events occurred. Survival probability by Kaplan-Meier method was significantly higher in the high-MFR group (log-rank P = .02). Revascularization (n = 1), new CAV diagnosis (n = 1), and graft failure (n = 4) were more frequent in low-MFR patients. No retransplantation occurred. CONCLUSIONS Myocardial flow reserve appears to offer prognostic value in selected long-term HTx recipients and holds promise as a non-invasive method for CAV surveillance possibly guiding management strategy.
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Affiliation(s)
- Lærke Marie Nelson
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark.
| | - Thomas Emil Christensen
- Department of Clinical Physiology, Nuclear Medicine and PET, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Department of Medicine, Holbæk Hospital, Holbæk, Region Zealand, Denmark
| | - Kasper Rossing
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Philip Hasbak
- Department of Clinical Physiology, Nuclear Medicine and PET, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Finn Gustafsson
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Caiati C, Iacovelli F, Mancini G, Lepera ME. Hidden Coronary Atherosclerosis Assessment but Not Coronary Flow Reserve Helps to Explain the Slow Coronary Flow Phenomenon in Patients with Angiographically Normal Coronary Arteries. Diagnostics (Basel) 2022; 12:diagnostics12092173. [PMID: 36140575 PMCID: PMC9497914 DOI: 10.3390/diagnostics12092173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 08/27/2022] [Accepted: 08/31/2022] [Indexed: 11/16/2022] Open
Abstract
The significance of the slow coronary flow phenomenon (SCFph), as visualized in patients (pts) with angiographically normal coronary arteries, is controversial. Absolute coronary flow reserve (CFR) in the left anterior descending coronary artery (LAD), non-invasively assessed by a transthoracic color-guided pulsed-wave Doppler (E-Doppler TTE), is a reliable parameter to assess coronary microcirculatory dysfunction (CMD). Mild and angiographically hidden epicardial atherosclerosis (Hath), as visualized by intracoronary ultrasound (IVUS), which could be the clue to atherosclerotic coronary microvascular involvement, has never been investigated together with CFR in patients. This study was aimed at assessing the value of CFR and HA in explaining the SCFph. Methods. Both non-invasive assessment of CFR in the LAD and corrected TIMI frame count assessment of the coronary contrast runoff were performed in 124 pts with angiographically normal coronary arteries. Among the whole group, 32 patients also underwent intracoronary ultrasounds in the LMCA and LAD, and the maximal plaque burden was assessed (Lesion external elastic (EEM) cross sectional area (CSA)—Lesion Lumen CSA/Lesion EEM CSA * 100). We found that 24 of the 124 pts (group 1) had the SCFph and the remaining 100 had a normal runoff (group 2). CFR, evaluated in both groups, was not significantly different, being 2.79 ± 0.79 (Mean ± SD) in group 1 and 2.90 ± 0.8 in group 2 (p = ns); in the pts also examined by IVUS (32 pts), the SCFph was always associated with hidden atherosclerosis, and a plaque burden of ≥33%. On the contrary, in the normal runoff group, any grade of PB was observed (from no athero to a PB > 70%) and remarkably, 10 pts had no signs of athero or just a minimal plaque burden. This resulted in a ROC curve analysis in which PB < 33% had a high negative predictive value (100%) in ruling out the SCFph. In addition, considering a CFR value < 2.21 as an index of coronary microcirculatory dysfunction, we found CMD in 15 pts (15%) in group 1 and in 7 pts (29%) in group 2 (p = ns). In conclusion, the SCFph is strongly connected to epicardial athero to the extent that the absence of hidden coronary athero has a very high negative predictive power in ruling out SCFph. CFR that is based on an endothelium-independent mechanism remains fairly normal in this condition. An endothelium-dependent microcirculatory constriction at rest due to atherosclerotic involvement of the coronary microvascular network is a possible explanation of the SCFph.
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Affiliation(s)
- Carlo Caiati
- Correspondence: ; Tel.: +39-080-5592117; Fax: +39-080-5478796
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Liu J, Ren S, Wang R, Mirian N, Tsai YJ, Kulon M, Pucar D, Chen MK, Liu C. Virtual high-count PET image generation using a deep learning method. Med Phys 2022; 49:5830-5840. [PMID: 35880541 PMCID: PMC9474624 DOI: 10.1002/mp.15867] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 06/07/2022] [Accepted: 07/18/2022] [Indexed: 11/10/2022] Open
Abstract
PURPOSE Recently, deep learning-based methods have been established to denoise the low-count positron emission tomography (PET) images and predict their standard-count image counterparts, which could achieve reduction of injected dosage and scan time, and improve image quality for equivalent lesion detectability and clinical diagnosis. In clinical settings, the majority scans are still acquired using standard injection dose with standard scan time. In this work, we applied a 3D U-Net network to reduce the noise of standard-count PET images to obtain the virtual-high-count (VHC) PET images for identifying the potential benefits of the obtained VHC PET images. METHODS The training datasets, including down-sampled standard-count PET images as the network input and high-count images as the desired network output, were derived from 27 whole-body PET datasets, which were acquired using 90-min dynamic scan. The down-sampled standard-count PET images were rebinned with matched noise level of 195 clinical static PET datasets, by matching the normalized standard derivation (NSTD) inside 3D liver region of interests (ROIs). Cross-validation was performed on 27 PET datasets. Normalized mean square error (NMSE), peak signal to noise ratio (PSNR), structural similarity index (SSIM), and standard uptake value (SUV) bias of lesions were used for evaluation on standard-count and VHC PET images, with real-high-count PET image of 90 min as the gold standard. In addition, the network trained with 27 dynamic PET datasets was applied to 195 clinical static datasets to obtain VHC PET images. The NSTD and mean/max SUV of hypermetabolic lesions in standard-count and VHC PET images were evaluated. Three experienced nuclear medicine physicians evaluated the overall image quality of randomly selected 50 out of 195 patients' standard-count and VHC images and conducted 5-score ranking. A Wilcoxon signed-rank test was used to compare differences in the grading of standard-count and VHC images. RESULTS The cross-validation results showed that VHC PET images had improved quantitative metrics scores than the standard-count PET images. The mean/max SUVs of 35 lesions in the standard-count and true-high-count PET images did not show significantly statistical difference. Similarly, the mean/max SUVs of VHC and true-high-count PET images did not show significantly statistical difference. For the 195 clinical data, the VHC PET images had a significantly lower NSTD than the standard-count images. The mean/max SUVs of 215 hypermetabolic lesions in the VHC and standard-count images showed no statistically significant difference. In the image quality evaluation by three experienced nuclear medicine physicians, standard-count images and VHC images received scores with mean and standard deviation of 3.34±0.80 and 4.26 ± 0.72 from Physician 1, 3.02 ± 0.87 and 3.96 ± 0.73 from Physician 2, and 3.74 ± 1.10 and 4.58 ± 0.57 from Physician 3, respectively. The VHC images were consistently ranked higher than the standard-count images. The Wilcoxon signed-rank test also indicated that the image quality evaluation between standard-count and VHC images had significant difference. CONCLUSIONS A DL method was proposed to convert the standard-count images to the VHC images. The VHC images had reduced noise level. No significant difference in mean/max SUV to the standard-count images was observed. VHC images improved image quality for better lesion detectability and clinical diagnosis.
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Affiliation(s)
- Juan Liu
- Department of Radiology and Biomedical Imaging, Yale University, New Haven, 06520, USA
| | - Sijin Ren
- Department of Radiology and Biomedical Imaging, Yale University, New Haven, 06520, USA
| | - Rui Wang
- Department of Radiology and Biomedical Imaging, Yale University, New Haven, 06520, USA
- Department of Engineering Physics, Tsinghua University, Beijing, 100084, China
| | - Niloufarsadat Mirian
- Department of Radiology and Biomedical Imaging, Yale University, New Haven, 06520, USA
| | - Yu-Jung Tsai
- Department of Radiology and Biomedical Imaging, Yale University, New Haven, 06520, USA
| | - Michal Kulon
- Department of Radiology and Biomedical Imaging, Yale University, New Haven, 06520, USA
| | - Darko Pucar
- Department of Radiology and Biomedical Imaging, Yale University, New Haven, 06520, USA
| | - Ming-Kai Chen
- Department of Radiology and Biomedical Imaging, Yale University, New Haven, 06520, USA
| | - Chi Liu
- Department of Radiology and Biomedical Imaging, Yale University, New Haven, 06520, USA
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Generation of Digital Brain Phantom for Machine Learning Application of Dopamine Transporter Radionuclide Imaging. Diagnostics (Basel) 2022; 12:diagnostics12081945. [PMID: 36010295 PMCID: PMC9406894 DOI: 10.3390/diagnostics12081945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 08/03/2022] [Accepted: 08/11/2022] [Indexed: 11/16/2022] Open
Abstract
While machine learning (ML) methods may significantly improve image quality for SPECT imaging for the diagnosis and monitoring of Parkinson’s disease (PD), they require a large amount of data for training. It is often difficult to collect a large population of patient data to support the ML research, and the ground truth of lesion is also unknown. This paper leverages a generative adversarial network (GAN) to generate digital brain phantoms for training ML-based PD SPECT algorithms. A total of 594 PET 3D brain models from 155 patients (113 male and 42 female) were reviewed and 1597 2D slices containing the full or a portion of the striatum were selected. Corresponding attenuation maps were also generated based on these images. The data were then used to develop a GAN for generating 2D brain phantoms, where each phantom consisted of a radioactivity image and the corresponding attenuation map. Statistical methods including histogram, Fréchet distance, and structural similarity were used to evaluate the generator based on 10,000 generated phantoms. When the generated phantoms and training dataset were both passed to the discriminator, similar normal distributions were obtained, which indicated the discriminator was unable to distinguish the generated phantoms from the training datasets. The generated digital phantoms can be used for 2D SPECT simulation and serve as the ground truth to develop ML-based reconstruction algorithms. The cumulated experience from this work also laid the foundation for building a 3D GAN for the same application.
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Park E, Ito K, Iqbal R, Amigues I, Bokhari S, Van Eyk J, Depender C, Giles JT, Bathon J. Prospective changes in diastolic function in patients with rheumatoid arthritis. Arthritis Res Ther 2022; 24:184. [PMID: 35932048 PMCID: PMC9354314 DOI: 10.1186/s13075-022-02864-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 07/02/2022] [Indexed: 11/21/2022] Open
Abstract
Background Diastolic dysfunction (DD) is more prevalent in patients with rheumatoid arthritis (RA) compared to the general population. However, its evolution over time and its significant clinical predictors remain uncharacterized. We report on baseline and prospective changes in diastolic function and its associated RA and cardiovascular (CV) predictors. Methods In this study, 158 RA patients without clinical CV disease (CVD) were enrolled and followed up at 4 to 6 years, undergoing baseline and follow-up echocardiography to assess for DD, as well as extensive characterization of RA disease activity and CV risk factors. Novel measures of myocardial inflammation and perfusion were obtained at baseline only. Using baseline and follow-up composite DD (E/e′, Left Atrial Volume Index (LAVI) or peak tricuspid regurgitation (TR) velocity; ≥ 1 in top 25%) as the outcome, multivariable regression models were constructed to identify predictors of DD. Results DD was prevalent in RA patients without clinical heart failure (HF) (40.7% at baseline) and significantly progressed on follow-up (to 57.9%). Baseline composite DD was associated with baseline RA disease activity (Clinical Disease Activity Index; CDAI) (OR 1.39; 95% CI 1.02–1.90; p=0.034). Several individual diastolic parameters (baseline E/e′ and LAVI) were associated with troponin-I and brain natriuretic peptide (BNP). Baseline and follow-up composite DD, however, were not associated with myocardial inflammation, myocardial microvascular dysfunction, or subclinical atherosclerosis. Conclusions DD is prevalent in RA patients without clinical HF and increases to >50% over time. Higher RA disease activity at baseline predicted baseline composite DD. Future longitudinal studies should explore whether adverse changes in diastolic function lead to clinical HF and are attenuated by disease-modifying antirheumatic drugs (DMARDs). Supplementary Information The online version contains supplementary material available at 10.1186/s13075-022-02864-0.
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Affiliation(s)
- Elizabeth Park
- Division of Rheumatology, Department of Medicine, Columbia University Irving Medical Center/New York Presbyterian Hospital, 630 W 168th St, P&S 3-450, New York, NY, 10032, USA.
| | - Kazato Ito
- Division of Cardiology, Columbia University Vagelos College of Physicians and Surgeons and New York Presbyterian Hospital, New York, NY, USA
| | - Rabia Iqbal
- Division of Rheumatology, Department of Medicine, Columbia University Irving Medical Center/New York Presbyterian Hospital, 630 W 168th St, P&S 3-450, New York, NY, 10032, USA
| | - Isabelle Amigues
- Division of Rheumatology, National Jewish Health, Denver, CO, USA
| | - Sabahat Bokhari
- Lehigh Valley Heart and Vascular Institute, Allentown, PA, USA
| | - Jennifer Van Eyk
- Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Christopher Depender
- Division of Rheumatology, Department of Medicine, Columbia University Irving Medical Center/New York Presbyterian Hospital, 630 W 168th St, P&S 3-450, New York, NY, 10032, USA
| | - Jon T Giles
- Division of Rheumatology, Department of Medicine, Columbia University Irving Medical Center/New York Presbyterian Hospital, 630 W 168th St, P&S 3-450, New York, NY, 10032, USA
| | - Joan Bathon
- Division of Rheumatology, Department of Medicine, Columbia University Irving Medical Center/New York Presbyterian Hospital, 630 W 168th St, P&S 3-450, New York, NY, 10032, USA
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Yaşar E, Bayramoğlu A. Systemic Immune-Inflammation Index as a Predictor of Microvascular Dysfunction in Patients With Cardiac Syndrome X. Angiology 2022; 73:615-621. [PMID: 35403436 DOI: 10.1177/00033197221087777] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The systemic immune inflammation index (SII; platelet count x neutrophil-lymphocyte ratio), a new marker, predicts adverse clinical outcomes in many conditions, including acute and chronic coronary syndromes, pulmonary embolism, cancers, and contrast nephropathy. The aim of this study was to determine the relationship between SII and microvascular dysfunction in patients with Cardiac Syndrome X (CSX); 105 patients with CSX and 105 patients with normal coronary arteries were included. Microvascular dysfunction was determined angiographically using myocardial blush grade (MBG) and total myocardial blush score (TMBS). We observed that the SII levels were higher in the CSX (+) group (687 [355-2211] vs 418 [198-1614], P<.001). The SII levels were also found to be significant independent predictors for CSX in multiple regression analysis (P=.001). SII levels >440 had 83.8% sensitivity and 55.2% specificity (area under the curve [AUC]: .923, 95% CI: .895-.999, P<.001) for predicting CSX. There is a significant correlation between SII levels and CSX.
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Affiliation(s)
- Erdoğan Yaşar
- 506082Malatya Training and Research Hospital, Department of Cardiology, Malatya, Turkey
| | - Adil Bayramoğlu
- 175667İnönü University, Faculty of Medicine, Department of Cardiology, Malatya, Turkey
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Kamshilin AA, Zaytsev VV, Belaventseva AV, Podolyan NP, Volynsky MA, Sakovskaia AV, Romashko RV, Mamontov OV. Novel Method to Assess Endothelial Function via Monitoring of Perfusion Response to Local Heating by Imaging Photoplethysmography. SENSORS (BASEL, SWITZERLAND) 2022; 22:5727. [PMID: 35957284 PMCID: PMC9370951 DOI: 10.3390/s22155727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 07/26/2022] [Accepted: 07/28/2022] [Indexed: 06/15/2023]
Abstract
Endothelial dysfunction is one of the most important markers of the risk of cardiovascular complications. This study is aimed to demonstrate the feasibility of imaging photoplethysmography to assess microcirculation response to local heating in order to develop a novel technology for assessing endothelial function. As a measure of vasodilation, we used the relative dynamics of the pulsatile component of the photoplethysmographic waveform, which was assessed in a large area of the outer surface of the middle third of the subject's forearm. The perfusion response was evaluated in six healthy volunteers during a test with local skin heating up to 40-42 °C and subsequent relaxation. The proposed method is featured by accurate control of the parameters affecting the microcirculation during the prolonged study. It was found that in response to local hyperthermia, a multiple increase in the pulsation component, which has a biphasic character, was observed. The amplitude of the first phase of the perfusion reaction depends on both the initial skin temperature and the difference between the basal and heating temperatures. The proposed method allows the assessment of a reproducible perfusion increase in response to hyperthermia developed due to humoral factors associated with the endothelium, thus allowing detection of its dysfunction.
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Affiliation(s)
- Alexei A. Kamshilin
- Institute of Automation and Control Processes of the Far Eastern Branch of the Russian Academy of Sciences, Vladivostok 690041, Russia; (V.V.Z.); (A.V.B.); (N.P.P.); (M.A.V.); (A.V.S.); (R.V.R.); (O.V.M.)
| | - Valeriy V. Zaytsev
- Institute of Automation and Control Processes of the Far Eastern Branch of the Russian Academy of Sciences, Vladivostok 690041, Russia; (V.V.Z.); (A.V.B.); (N.P.P.); (M.A.V.); (A.V.S.); (R.V.R.); (O.V.M.)
- Department of Circulation Physiology, Almazov National Medical Research Centre, Saint Petersburg 197341, Russia
| | - Anzhelika V. Belaventseva
- Institute of Automation and Control Processes of the Far Eastern Branch of the Russian Academy of Sciences, Vladivostok 690041, Russia; (V.V.Z.); (A.V.B.); (N.P.P.); (M.A.V.); (A.V.S.); (R.V.R.); (O.V.M.)
| | - Natalia P. Podolyan
- Institute of Automation and Control Processes of the Far Eastern Branch of the Russian Academy of Sciences, Vladivostok 690041, Russia; (V.V.Z.); (A.V.B.); (N.P.P.); (M.A.V.); (A.V.S.); (R.V.R.); (O.V.M.)
| | - Maxim A. Volynsky
- Institute of Automation and Control Processes of the Far Eastern Branch of the Russian Academy of Sciences, Vladivostok 690041, Russia; (V.V.Z.); (A.V.B.); (N.P.P.); (M.A.V.); (A.V.S.); (R.V.R.); (O.V.M.)
- School of Physics and Engineering, ITMO University, Saint Petersburg 197101, Russia
| | - Anastasiia V. Sakovskaia
- Institute of Automation and Control Processes of the Far Eastern Branch of the Russian Academy of Sciences, Vladivostok 690041, Russia; (V.V.Z.); (A.V.B.); (N.P.P.); (M.A.V.); (A.V.S.); (R.V.R.); (O.V.M.)
- Institute of Therapy and Instrumental Diagnostics, Pacific State Medical University, Vladivostok 690002, Russia
| | - Roman V. Romashko
- Institute of Automation and Control Processes of the Far Eastern Branch of the Russian Academy of Sciences, Vladivostok 690041, Russia; (V.V.Z.); (A.V.B.); (N.P.P.); (M.A.V.); (A.V.S.); (R.V.R.); (O.V.M.)
| | - Oleg V. Mamontov
- Institute of Automation and Control Processes of the Far Eastern Branch of the Russian Academy of Sciences, Vladivostok 690041, Russia; (V.V.Z.); (A.V.B.); (N.P.P.); (M.A.V.); (A.V.S.); (R.V.R.); (O.V.M.)
- Department of Circulation Physiology, Almazov National Medical Research Centre, Saint Petersburg 197341, Russia
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Liu Q, Liu H, Mirian N, Ren S, Viswanath V, Karp J, Surti S, Liu C. A personalized deep learning denoising strategy for low-count PET images. Phys Med Biol 2022; 67:10.1088/1361-6560/ac783d. [PMID: 35697017 PMCID: PMC9321225 DOI: 10.1088/1361-6560/ac783d] [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: 02/13/2022] [Accepted: 06/13/2022] [Indexed: 11/12/2022]
Abstract
Objective. Deep learning denoising networks are typically trained with images that are representative of the testing data. Due to the large variability of the noise levels in positron emission tomography (PET) images, it is challenging to develop a proper training set for general clinical use. Our work aims to develop a personalized denoising strategy for the low-count PET images at various noise levels.Approach.We first investigated the impact of the noise level in the training images on the model performance. Five 3D U-Net models were trained on five groups of images at different noise levels, and a one-size-fits-all model was trained on images covering a wider range of noise levels. We then developed a personalized weighting method by linearly blending the results from two models trained on 20%-count level images and 60%-count level images to balance the trade-off between noise reduction and spatial blurring. By adjusting the weighting factor, denoising can be conducted in a personalized and task-dependent way.Main results.The evaluation results of the six models showed that models trained on noisier images had better performance in denoising but introduced more spatial blurriness, and the one-size-fits-all model did not generalize well when deployed for testing images with a wide range of noise levels. The personalized denoising results showed that noisier images require higher weights on noise reduction to maximize the structural similarity and mean squared error. And model trained on 20%-count level images can produce the best liver lesion detectability.Significance.Our study demonstrated that in deep learning-based low dose PET denoising, noise levels in the training input images have a substantial impact on the model performance. The proposed personalized denoising strategy utilized two training sets to overcome the drawbacks introduced by each individual network and provided a series of denoised results for clinical reading.
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Affiliation(s)
- Qiong Liu
- Department of Biomedical Engineering, Yale University, United States of America
| | - Hui Liu
- Department of Radiology and Biomedical Imaging, Yale University, United States of America
- Department of Engineering Physics, Tsinghua University, People's Republic of China
- Key Laboratory of Particle&Radiation Imaging, Tsinghua University, People's Republic of China
| | - Niloufar Mirian
- Department of Radiology and Biomedical Imaging, Yale University, United States of America
| | - Sijin Ren
- Department of Radiology and Biomedical Imaging, Yale University, United States of America
| | - Varsha Viswanath
- Department of Radiology, University of Pennsylvania, United States of America
| | - Joel Karp
- Department of Radiology, University of Pennsylvania, United States of America
| | - Suleman Surti
- Department of Radiology, University of Pennsylvania, United States of America
| | - Chi Liu
- Department of Biomedical Engineering, Yale University, United States of America
- Department of Radiology and Biomedical Imaging, Yale University, United States of America
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Zhan J, Zhong L, Wu J. Assessment and Treatment for Coronary Microvascular Dysfunction by Contrast Enhanced Ultrasound. Front Cardiovasc Med 2022; 9:899099. [PMID: 35795368 PMCID: PMC9251174 DOI: 10.3389/fcvm.2022.899099] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 05/26/2022] [Indexed: 11/17/2022] Open
Abstract
With growing evidence in clinical practice, the understanding of coronary syndromes has gradually evolved out of focusing on the well-established link between stenosis of epicardial coronary artery and myocardial ischemia to the structural and functional abnormalities at the level of coronary microcirculation, known as coronary microvascular dysfunction (CMD). CMD encompasses several pathophysiological mechanisms of coronary microcirculation and is considered as an important cause of myocardial ischemia in patients with angina symptoms without obstructive coronary artery disease (CAD). As a result of growing knowledge of the understanding of CMD assessed by multiple non-invasive modalities, CMD has also been found to be involved in other cardiovascular diseases, including primary cardiomyopathies as well as heart failure with preserved ejection fraction (HFpEF). In the past 2 decades, almost all the imaging modalities have been used to non-invasively quantify myocardial blood flow (MBF) and promote a better understanding of CMD. Myocardial contrast echocardiography (MCE) is a breakthrough as a non-invasive technique, which enables assessment of myocardial perfusion and quantification of MBF, exhibiting promising diagnostic performances that were comparable to other non-invasive techniques. With unique advantages over other non-invasive techniques, MCE has gradually developed into a novel modality for assessment of the coronary microvasculature, which may provide novel insights into the pathophysiological role of CMD in different clinical conditions. Moreover, the sonothrombolysis and the application of artificial intelligence (AI) will offer the opportunity to extend the use of contrast ultrasound theragnostics.
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Kozor R, Abiodun A, Kott K, Manisty C. Non-invasive Imaging in Women With Heart Failure - Diagnosis and Insights Into Disease Mechanisms. Curr Heart Fail Rep 2022; 19:114-125. [PMID: 35507121 PMCID: PMC9177491 DOI: 10.1007/s11897-022-00545-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/22/2022] [Indexed: 11/18/2022]
Abstract
PURPOSE OF REVIEW To summarise the role of different imaging techniques for diagnosis and investigation of heart failure in women. RECENT FINDINGS Although sex differences in heart failure are well recognised, and the scope of imaging techniques is expanding, there are currently no specific guidelines for imaging of heart failure in women. Diagnosis and stratification of heart failure is generally performed first line using transthoracic echocardiography. Understanding the aetiology of heart failure is central to ongoing management, and with non-ischaemic causes more common in women, a multimodality approach is generally required using advanced imaging techniques including cardiovascular magnetic resonance imaging, nuclear imaging techniques, and cardiac computed tomography. There are specific considerations for imaging in women including radiation risks and challenges during pregnancy, highlighting the clear unmet need for cardiology and imaging societies to provide imaging guidelines specifically for women with heart failure.
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Affiliation(s)
- Rebecca Kozor
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
- Royal North Shore Hospital, Sydney, Australia
| | - Aderonke Abiodun
- Institute of Cardiovascular Science, University College London, London, UK
| | | | - Charlotte Manisty
- Institute of Cardiovascular Science, University College London, London, UK
- Barts Heart Centre, St Bartholomew’s Hospital, West Smithfield, London, UK
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Smith DL, Graham EL, Douglas JA, Jack K, Conner MJ, Arena R, Chaudhry S. Subclinical Cardiac Dysfunction is Associated with Reduced Cardiorespiratory Fitness and Cardiometabolic Risk Factors in Firefighters. Am J Med 2022; 135:752-760.e3. [PMID: 35134370 DOI: 10.1016/j.amjmed.2021.12.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 12/08/2021] [Accepted: 12/08/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND Past studies have documented the ability of cardiopulmonary exercise testing to detect cardiac dysfunction in symptomatic patients with coronary artery disease. Firefighters are at high risk for work-related cardiac events. This observational study investigated the association of subclinical cardiac dysfunction detected by cardiopulmonary exercise testing with modifiable cardiometabolic risk factors in asymptomatic firefighters. METHODS As part of mandatory firefighter medical evaluations, study subjects were assessed at 2 occupational health clinics serving 21 different fire departments. Mixed effects logistic regression analyses were used to estimate odds ratios (ORs) and account for clustering by fire department. RESULTS Of the 967 male firefighters (ages 20-60 years; 84% non-Hispanic white; 14% on cardiovascular medications), nearly two-thirds (63%) had cardiac dysfunction despite having normal predicted cardiorespiratory fitness (median peak VO2 = 102%). In unadjusted analyses, cardiac dysfunction was significantly associated with advanced age, obesity, diastolic hypertension, high triglycerides, low high-density lipoprotein (HDL) cholesterol, and reduced cardiorespiratory fitness (all P values < .05). After adjusting for age and ethnicity, the odds of having cardiac dysfunction were approximately one-third higher among firefighters with obesity and diastolic hypertension (OR = 1.39, 95% confidence interval [CI] = 1.03-1.87 and OR = 1.36, 95% CI = 1.03-1.80) and more than 5 times higher among firefighters with reduced cardiorespiratory fitness (OR = 5.41, 95% CI = 3.29-8.90). CONCLUSION Subclinical cardiac dysfunction detected by cardiopulmonary exercise testing is a common finding in career firefighters and is associated with substantially reduced cardiorespiratory fitness and cardiometabolic risk factors. These individuals should be targeted for aggressive risk factor modification to increase cardiorespiratory fitness as part of an outpatient prevention strategy to improve health and safety.
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Affiliation(s)
- Denise L Smith
- First Responder Health and Safety Lab, Department of Health and Human Physiological Sciences, Skidmore College, Saratoga Springs, NY
| | - Elliot L Graham
- First Responder Health and Safety Lab, Department of Health and Human Physiological Sciences, Skidmore College, Saratoga Springs, NY
| | - Julie A Douglas
- Department of Mathematics and Statistics, Skidmore College, Saratoga Springs, NY; Department of Human Genetics, University of Michigan, Ann Arbor
| | | | | | - Ross Arena
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois, Chicago, Chicago; Healthy Living for Pandemic Event Protection (HL-PIVOT) Network, Chicago, Ill
| | - Sundeep Chaudhry
- Healthy Living for Pandemic Event Protection (HL-PIVOT) Network, Chicago, Ill; Research and Development, MET-TEST, Atlanta, Ga.
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Upadhyaya A, Bhandiwad A, Lang J, Sadhu JS, Barrs C, Jain S, Brown DL, Peterson LR, Dehdashti F, Gropler RJ, Schindler TH. Coronary circulatory function with increasing obesity: A complex U-turn. Eur J Clin Invest 2022; 52:e13755. [PMID: 35103996 DOI: 10.1111/eci.13755] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 01/17/2022] [Accepted: 01/29/2022] [Indexed: 11/29/2022]
Abstract
AIMS The aim of this investigation was to explore and characterize alterations in coronary circulatory function in function of increasing body weight with medically controlled cardiovascular risk factors and, thus, "metabolically" unhealthy obesity. MATERIALS AND METHODS We prospectively enrolled 106 patients with suspected CAD but with normal stress-rest myocardial perfusion on 13 N-ammonia PET/CT and with medically controlled or no cardiovascular risk factors. 13 N-ammonia PET/CT concurrently determined myocardial blood flow (MBF) during pharmacologically induced hyperaemia and at rest. Based on body mass index (BMI), patients were grouped into normal weight (BMI: 20.0-24.9 kg/m2 , n = 22), overweight (BMI: 25.0-29.9 kg/m2 , n = 27), obese (BMI: 30.0-39.9 kg/m2 , n = 31), and morbidly obese (BMI ≥ 40kg/m2 , n = 26). RESULTS Resting MBF was comparable among groups (1.09 ± 0.18 vs. 1.00 ± 0.15 vs. 0.96 ± 0.18 vs.. 1.06 ± 0.31 ml/g/min; p = .279 by ANOVA). Compared to normal weight individuals, the hyperaemic MBF progressively decreased in in overweight and obese groups, respectively (2.54 ± 0.48 vs. 2.02 ± 0.27 and 1.75 ± 0.39 ml/g/min; p < .0001), while it increased again in the group of morbidly obese individuals comparable to normal weight (2.44 ± 0.41 vs. 2.54 ± 0.48 ml/g/min, p = .192). The BMI of the study population correlated with the hyperaemic MBF in a quadratic or U-turn fashion (r = .34, SEE = 0.46; p ≤ .002). CONCLUSIONS The U-turn of hyperaemic MBF from obesity to morbid obesity is likely to reflect contrasting effects of abdominal versus subcutaneous adipose tissue on coronary circulatory function indicative of two different disease entities, but needing further investigations.
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Affiliation(s)
- Anand Upadhyaya
- Division of Nuclear Medicine, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri, USA.,Cardiovascular Division, John T. Milliken Department of Internal Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Anita Bhandiwad
- Cardiovascular Division, John T. Milliken Department of Internal Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Jordan Lang
- Division of Nuclear Medicine, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Justin S Sadhu
- Cardiovascular Division, John T. Milliken Department of Internal Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Chadwick Barrs
- Division of Nuclear Medicine, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Sudhir Jain
- Cardiovascular Division, John T. Milliken Department of Internal Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
| | - David L Brown
- Cardiovascular Division, John T. Milliken Department of Internal Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Linda R Peterson
- Cardiovascular Division, John T. Milliken Department of Internal Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Farrokh Dehdashti
- Division of Nuclear Medicine, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Robert J Gropler
- Division of Nuclear Medicine, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Thomas Hellmuth Schindler
- Division of Nuclear Medicine, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri, USA.,Cardiovascular Division, John T. Milliken Department of Internal Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
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Cardiac Imaging on COVID-19 Pandemic Era: the Stand, The Lost, and Found. CURRENT CARDIOVASCULAR IMAGING REPORTS 2022; 15:23-28. [PMID: 35668865 PMCID: PMC9142344 DOI: 10.1007/s12410-022-09565-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/04/2022] [Indexed: 11/10/2022]
Abstract
Purpose of Review The present review will outline the main effects of COVID-19 pandemic on cardiovascular pathologies, focusing on the role of modern non-invasive cardiac imaging techniques in this setting. Recent Findings Multimodality cardiac imaging seems particularly suited for the in-depth characterization of patients with COVID-19, allowing the assessment of the variegated impact of the disease on the different aspects of myocardial perfusion, structure, and function. Summary The infection of SARS-CoV-2, leading to the coronavirus disease-19 (COVID-19), has represented a consistent challenge for the organization of the healthcare systems, associating to a significant increase of the fatality rate of different acute and chronic disease. Moreover, the reallocation of healthcare providers led to a significant reduction of the availability of tests and therapies, with the deferral of non-urgent tests and non-lifesaving procedures.
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Positron Emission Tomography in Coronary Heart Disease. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12094704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
With advances in scanner technology, postprocessing techniques, and the development of novel positron emission tomography (PET) tracers, the applications of PET for the study of coronary heart disease have been gaining momentum in the last few years. Depending on the tracer and acquisition protocol, cardiac PET can be used to evaluate the atherosclerotic lesion (plaque imaging) and to assess its potential consequences—ischemic versus nonischemic (perfusion imaging) and viable versus scarred (viability imaging) myocardium. The scope of this review is to summarize the role of PET in coronary heart disease.
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Markousis-Mavrogenis G, Bacopoulou F, Mavragani C, Voulgari P, Kolovou G, Kitas GD, Chrousos GP, Mavrogeni SI. Coronary microvascular disease: The "Meeting Point" of Cardiology, Rheumatology and Endocrinology. Eur J Clin Invest 2022; 52:e13737. [PMID: 34939183 DOI: 10.1111/eci.13737] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 12/19/2021] [Accepted: 12/20/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Exertional chest pain/dyspnea or chest pain at rest are the main symptoms of coronary artery disease (CAD), which are traditionally attributed to insufficiency of the epicardial coronary arteries. However, 2/3 of women and 1/3 of men with angina and 10% of patients with acute myocardial infarction have no evidence of epicardial coronary artery stenosis in X-ray coronary angiography. In these cases, coronary microvascular disease (CMD) is the main causative factor. AIMS To present the pathophysiology of CMD in Cardiology, Rheumatology and Endocrinology. MATERIALS-METHODS The pathophysiology of CMD in Cardiology, Rheumatology and Endocrinology was evaluated. It includes impaired microvascular vasodilatation, which leads to inability of the organism to deal with myocardial oxygen needs and, hence, development of ischemic pain. CMD, observed in inflammatory autoimmune rheumatic and endocrine/metabolic disorders, brings together Cardiology, Rheumatology and Endocrinology. Causative factors include persistent systemic inflammation and endocrine/metabolic abnormalities influencing directly the coronary microvasculature. In the past, the evaluation of microcirculation was feasible only with the use of invasive techniques, such as coronary flow reserve assessment. Currently, the application of advanced imaging modalities, such as cardiovascular magnetic resonance (CMR), can evaluate CMD non-invasively and without ionizing radiation. RESULTS CMD may present with a variety of symptoms with 1/3 to 2/3 of them expressed as typical chest pain in effort, more commonly found in women during menopause than in men. Atypical presentation includes chest pain at rest or exertional dyspnea,but post exercise symptoms are not uncommon. The treatment with nitrates is less effective in CMD, because their vasodilator action in coronary micro-circulation is less pronounced than in the epicardial coronary arteries. DISCUSSION Although both classic and new medications have been used in the treatment of CMD, there are still many questions regarding both the pathophysiology and the treatment of this disorder. The potential effects of anti-rheumatic and endocrine medications on the evolution of CMD need further evaluation. CONCLUSION CMD is a multifactorial disease leading to myocardial ischemia/fibrosis alone or in combination with epicardial coronary artery disease. Endothelial dysfunction/vasospasm, systemic inflammation, and/or neuroendocrine activation may act as causative factors and bring Cardiology, Rheumatology and Endocrinology together. Currently, the application of advanced imaging modalities, and specifically CMR, allows reliable assessment of the extent and severity of CMD. These measurements should not be limited to "pure cardiac patients", as it is known that CMD affects the majority of patients with autoimmune rheumatic and endocrine/metabolic disorders.
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Affiliation(s)
| | - Flora Bacopoulou
- University Research Institute of Maternal and Child Health and Precision Medicine, UNESCO Chair on Adolescent Health Care, National and Kapodistrian University of Athens, Aghia Sophia Children's Hospital, Athens, Greece
| | - Clio Mavragani
- Pathophysiology Department, University of Athens, Athens, Greece
| | | | - Genovefa Kolovou
- Onassis Cardiac Surgery Hospital, Athens, Greece.,Epidemiology Department, University of Manchester, Manchester, UK
| | - George D Kitas
- Epidemiology Department, University of Manchester, Manchester, UK
| | - George P Chrousos
- University Research Institute of Maternal and Child Health and Precision Medicine, UNESCO Chair on Adolescent Health Care, National and Kapodistrian University of Athens, Aghia Sophia Children's Hospital, Athens, Greece
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Minhas AS, Goerlich E, Corretti MC, Arbab-Zadeh A, Kelle S, Leucker T, Lerman A, Hays AG. Imaging Assessment of Endothelial Function: An Index of Cardiovascular Health. Front Cardiovasc Med 2022; 9:778762. [PMID: 35498006 PMCID: PMC9051238 DOI: 10.3389/fcvm.2022.778762] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 02/28/2022] [Indexed: 11/18/2022] Open
Abstract
Endothelial dysfunction is a key early mechanism in a variety of cardiovascular diseases and can be observed in larger conduit arteries as well as smaller resistance vessels (microvascular dysfunction). The presence of endothelial dysfunction is a strong prognosticator for cardiovascular events and mortality, and assessment of endothelial function can aid in selecting therapies and testing their response. While the gold standard method of measuring coronary endothelial function remains invasive angiography, several non-invasive imaging techniques have emerged for investigating both coronary and peripheral endothelial function. In this review, we will explore and summarize the current invasive and non-invasive modalities available for endothelial function assessment for clinical and research use, and discuss the strengths, limitations and future applications of each technique.
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Affiliation(s)
- Anum S. Minhas
- Division of Cardiology, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, United States
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Erin Goerlich
- Division of Cardiology, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Mary C. Corretti
- Division of Cardiology, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Armin Arbab-Zadeh
- Division of Cardiology, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Sebastian Kelle
- Department of Internal Medicine and Cardiology, German Heart Center Berlin, Berlin, Germany
| | - Thorsten Leucker
- Division of Cardiology, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Amir Lerman
- Division of Ischemic Heart Disease and Critical Care, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States
| | - Allison G. Hays
- Division of Cardiology, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, United States
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Kamar F, Kovacs MS, Hicks JW. Low cost and open source purification apparatus for GMP [ 13N]Ammonia production. Appl Radiat Isot 2022; 185:110214. [PMID: 35397362 DOI: 10.1016/j.apradiso.2022.110214] [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: 10/22/2021] [Revised: 03/14/2022] [Accepted: 03/20/2022] [Indexed: 11/26/2022]
Abstract
Nitrogen-13 labeled ammonia ([13N]NH3) has been used for myocardial perfusion imaging with Positron Emission Tomography for decades. Recent increases to regulatory oversight have led to stricter adherence to Good Manufacturing Practice (GMP) when producing this short half-life (9.97 min) radiopharmaceutical. This has increased production costs. Our cyclotron facility initially developed a manual GMP production method, but it was prone to human error. With increased costs in mind, we developed and validated an Arduino-based device to purifying [13N]NH3 for clinical use. Construction, programming, and GMP validation results are discussed. The automated method was found to produce equivalent quality radiopharmaceutical but was more reproducible and robust.
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Affiliation(s)
- Farah Kamar
- Medical Biophysics, Western University, London, ON, Canada
| | - Michael S Kovacs
- Medical Biophysics, Western University, London, ON, Canada; Medical Imaging, Western University, London, ON, Canada; Cyclotron and Radiochemistry Facility, Lawson Health Research Institute, London, ON, Canada
| | - Justin W Hicks
- Medical Biophysics, Western University, London, ON, Canada; Cyclotron and Radiochemistry Facility, Lawson Health Research Institute, London, ON, Canada.
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Yamamoto A, Nagao M, Ando K, Nakao R, Matsuo Y, Sakai A, Momose M, Kaneko K, Hagiwara N, Sakai S. First Validation of Myocardial Flow Reserve Derived from Dynamic 99mTc-Sestamibi CZT-SPECT Camera Compared with 13N-Ammonia PET. Int Heart J 2022; 63:202-209. [PMID: 35354742 DOI: 10.1536/ihj.21-487] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
13N-ammonia positron emission tomography (NH3-PET) can evaluate myocardial blood flow (MBF) at rest, stress, and myocardial flow reserve (MFR) as well as the ratio of MBF at stress to that at rest. MFR is useful in predicting the prognoses of patients with various heart diseases. Cadmium-zinc-telluride single photon emission computed tomography (CZT-SPECT) enables us to acquire dynamic images of radiotracer kinetics and measure original MBF and MFR using 99mTc-sestamibi. This study aimed to investigate the utility of CZT-SPECT for quantitative assessment of MBF compared to NH3-PET. We validated the correlation of MBF and MFR between CZT-SPECT and NH3-PET. Fourteen patients using one-day rest/stress CZT-SPECT, D-SPECT followed by NH3-PET within 1 month were enrolled and analyzed prospectively. The reproducibility of the MBF and MFR obtained with these two methods was examined using Spearman's correlation coefficient and Bland-Altman plot analysis. The diagnostic value of D-SPECT for abnormal MFR defined using NH3-PET results as MFR < 2.0 was assessed using receiver-operating characteristic (ROC) analysis. The median duration between D-SPECT and NH3-PET was 20 days. Although MBF was overestimated by D-SPECT compared to NH3-PET at high value (mean difference, 0.43 [0.34-0.53]), MBF and MFR were correlated with the two modalities (MBF: r = 0.71, P < 0.0001, MFR: r = 0.60, P < 0.0001). The ROC curve analysis demonstrated a cutoff of 1.6 for detecting abnormal MFR with D-SPECT (sensitivity, 68%; specificity, 91%; AUC, 0.75). MBF and MFR obtained using D-SPECT and NH3-PET had a good correlation, suggesting that the quantitative MFR evaluation by CZT-SPECT may help understand the trend of NH3-PET MFR.
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Affiliation(s)
- Atsushi Yamamoto
- Department of Cardiology, Tokyo Women's Medical University.,Department of Imaging Diagnosis and Nuclear Medicine, Tokyo Women's Medical University
| | - Michinobu Nagao
- Department of Imaging Diagnosis and Nuclear Medicine, Tokyo Women's Medical University
| | - Kiyoe Ando
- Department of Cardiology, Tokyo Women's Medical University
| | - Risako Nakao
- Department of Cardiology, Tokyo Women's Medical University
| | - Yuka Matsuo
- Department of Imaging Diagnosis and Nuclear Medicine, Tokyo Women's Medical University
| | - Akiko Sakai
- Department of Cardiology, Tokyo Women's Medical University
| | - Mitsuru Momose
- Department of Imaging Diagnosis and Nuclear Medicine, Tokyo Women's Medical University
| | - Koichiro Kaneko
- Department of Imaging Diagnosis and Nuclear Medicine, Tokyo Women's Medical University
| | | | - Shuji Sakai
- Department of Imaging Diagnosis and Nuclear Medicine, Tokyo Women's Medical University
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Cesarec S, Edgar F, Lai T, Plisson C, White AJP, Miller PW. Synthesis of carbon-11 radiolabelled transition metal complexes using 11C-dithiocarbamates. Dalton Trans 2022; 51:5004-5008. [PMID: 35293415 DOI: 10.1039/d2dt00266c] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
A novel radiolabelling method exploiting 11C-dithiocarbamate ligands has been used to generate 11C-labelled Au(I), Au(III), Pd(II) and Pt(II) complexes in high radiochemical yields (71-99%). Labelled complexes were prepared in a rapid one-pot procedure via the substitution reaction of 11C-dithiocarbamate ligands with appropriate transition metal chloride precursors.
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Affiliation(s)
- Sara Cesarec
- Department of Chemistry, Imperial College London, Molecular Sciences Research Hub, White City Campus, Wood Lane, London, W12 OBZ, UK.
| | - Fraser Edgar
- Department of Chemistry, Imperial College London, Molecular Sciences Research Hub, White City Campus, Wood Lane, London, W12 OBZ, UK. .,School of Biomedical Engineering and Imaging Sciences, King's College London, 4th Floor Lambeth Wing, St Thomas' Hospital, London, UK
| | - Titan Lai
- Department of Chemistry, Imperial College London, Molecular Sciences Research Hub, White City Campus, Wood Lane, London, W12 OBZ, UK.
| | - Christophe Plisson
- Invicro, Burlington Danes Building, Hammersmith Hospital, Du Cane Road, London, UK
| | - Andrew J P White
- Department of Chemistry, Imperial College London, Molecular Sciences Research Hub, White City Campus, Wood Lane, London, W12 OBZ, UK.
| | - Philip W Miller
- Department of Chemistry, Imperial College London, Molecular Sciences Research Hub, White City Campus, Wood Lane, London, W12 OBZ, UK.
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The Utility of Noninvasive PET/CT Myocardial Perfusion Imaging in Adult Liver Transplant Candidates. Transplant Direct 2022; 8:e1311. [PMID: 35372676 PMCID: PMC8963847 DOI: 10.1097/txd.0000000000001311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 12/29/2021] [Accepted: 01/14/2022] [Indexed: 11/26/2022] Open
Abstract
Background. The optimal cardiovascular (CV) risk stratification in liver transplant (LT) candidates remains unclear. The aim of this study was to evaluate concordance of findings between dobutamine stress echocardiography (DSE), positron emission tomography/computed tomography myocardial perfusion imaging (PET/CT MPI), and left heart catheterization in adult LT candidates. Methods. Data on 234 consecutive adult LT candidates from February 2015 to June 2018 with PET/CT MPI were reviewed. Adverse CV outcomes were adjudicated via chart review by a board-certified cardiologist. Results. Median age was 60.8, body mass index 30.2 kg/m2, and model of end-stage liver disease–sodium 14; 61% were male, and 54% had diabetes. Thirty-seven percent had nonalcoholic steatohepatitis and 29% alcohol-related liver disease. Sixty-five percent of patients had a DSE, of which 41% were nondiagnostic. No factors were independently associated with having a nondiagnostic DSE. The median global myocardial flow reserve correlated positively with hemoglobin and negatively with model of end-stage liver disease–sodium, age, ejection fraction, and body mass index. Moderate/high-risk MPIs were associated with older age and known CV disease. In patients with 2 cardiac testing modalities, findings were concordant in 87%. Eleven of 53 LT recipients experienced an adverse CV outcome, but no independent predictors were identified for this outcome. Conclusions. Results of different cardiac risk-stratification modalities were concordant across modalities the majority of the time in LT candidates, although these findings were not independently correlated with risk of post-LT CV outcomes. Given the high rates of nondiagnostic DSEs in this population, PET/CT MPI may be the preferred CV risk-stratification modality in older patients and those with known CV disease.
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Aleksandric S, Banovic M, Beleslin B. Challenges in Diagnosis and Functional Assessment of Coronary Artery Disease in Patients With Severe Aortic Stenosis. Front Cardiovasc Med 2022; 9:849032. [PMID: 35360024 PMCID: PMC8961810 DOI: 10.3389/fcvm.2022.849032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 02/16/2022] [Indexed: 01/10/2023] Open
Abstract
More than half of patients with severe aortic stenosis (AS) over 70 years old have coronary artery disease (CAD). Exertional angina is often present in AS-patients, even in the absence of significant CAD, as a result of oxygen supply/demand mismatch and exercise-induced myocardial ischemia. Moreover, persistent myocardial ischemia leads to extensive myocardial fibrosis and subsequent coronary microvascular dysfunction (CMD) which is defined as reduced coronary vasodilatory capacity below ischemic threshold. Therefore, angina, as well as noninvasive stress tests, have a low specificity and positive predictive value (PPV) for the assessment of epicardial coronary stenosis severity in AS-patients. Moreover, in symptomatic patients with severe AS exercise testing is even contraindicated. Given the limitations of noninvasive stress tests, coronary angiography remains the standard examination for determining the presence and severity of CAD in AS-patients, although angiography alone has poor accuracy in the evaluation of its functional severity. To overcome this limitation, the well-established invasive indices for the assessment of coronary stenosis severity, such as fractional flow reserve (FFR) and instantaneous wave-free ratio (iFR), are now in focus, especially in the contemporary era with the rapid increment of transcatheter aortic valve replacement (TAVR) for the treatment of AS-patients. TAVR induces an immediate decrease in hyperemic microcirculatory resistance and a concomitant increase in hyperemic flow velocity, whereas resting coronary hemodynamics remain unaltered. These findings suggest that FFR may underestimate coronary stenosis severity in AS-patients, whereas iFR as the non-hyperemic index is independent of the AS severity. However, because resting coronary hemodynamics do not improve immediately after TAVR, the coronary vasodilatory capacity in AS-patients treated by TAVR remain impaired, and thus the iFR may overestimate coronary stenosis severity in these patients. The optimal method for evaluating myocardial ischemia in patients with AS and co-existing CAD has not yet been fully established, and this important issue is under further investigation. This review is focused on challenges, limitations, and future perspectives in the functional assessment of coronary stenosis severity in these patients, bearing in mind the complexity of coronary physiology in the presence of this valvular heart disease.
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Affiliation(s)
- Srdjan Aleksandric
- Cardiology Clinic, University Clinical Center of Serbia, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- *Correspondence: Srdjan Aleksandric
| | - Marko Banovic
- Cardiology Clinic, University Clinical Center of Serbia, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Branko Beleslin
- Cardiology Clinic, University Clinical Center of Serbia, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
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