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Hirano KI, Okamura S, Sugimura K, Miyauchi H, Nakano Y, Nochioka K, Hashimoto C, Iwanaga Y, Nakajima K, Yamaguchi S, Yasui Y, Shimamoto S, Hirano M, Okune M, Nishimura Y, Shimoyama H, Nagasawa Y, Amano T, Kuniyoshi S, Hui SP, Zaima N, Ikeda Y, Yamada T, Fujimoto S, Sakata Y, Kobayashi K. Long-term survival and durable recovery of heart failure in patients with triglyceride deposit cardiomyovasculopathy treated with tricaprin. NATURE CARDIOVASCULAR RESEARCH 2025; 4:266-274. [PMID: 39948308 DOI: 10.1038/s44161-025-00611-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Accepted: 01/09/2025] [Indexed: 03/19/2025]
Abstract
Heart disease is a major global threat. Triglyceride deposit cardiomyovasculopathy (TGCV) is an emerging, noncommunicable, adult-onset heart disease, first identified in Japanese patients with heart failure (HF) requiring cardiac transplantation1-3. In TGCV, defective intracellular lipolysis of long-chain triglycerides (TGs) results in cellular steatosis and energy failure mainly in cardiomyocytes4 and smooth muscle cells5, leading to HF, diffuse coronary artery disease with TG deposition and ventricular arrhythmias with high mortality6. Tricaprin, a class of medium-chain TGs, recently corrected myocardial TG lipolysis7. Here we report remarkable long-term survival and durable recovery of HF in patients with TGCV treated with supplemental tricaprin in registry studies. Our study offers a classification of heart disease caused by defective lipolysis and its possible practical treatment. Because myocardial lipid droplets are a common feature in HF and their potential as therapeutic targets has been discussed worldwide, our findings warrant investigation into other ethnicities.
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Affiliation(s)
- Ken-Ichi Hirano
- Department of Triglyceride Science, Graduate School of Medicine, Osaka University, Osaka, Japan.
- The Tochino Foundation, Osaka, Japan.
| | - Satomi Okamura
- Department of Medical Innovation, Osaka University Hospital, Osaka, Japan
| | - Koichiro Sugimura
- Department of Cardiovascular Medicine, Tohoku University, Graduate School of Medicine, Miyagi, Japan
- Department of Cardiology, IUHW Narita Hospital, Chiba, Japan
| | - Hideyuki Miyauchi
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Yusuke Nakano
- Department of Cardiology, Aichi Medical University, Aichi, Japan
| | - Kotaro Nochioka
- Department of Cardiovascular Medicine, Tohoku University, Graduate School of Medicine, Miyagi, Japan
| | | | - Yoshitaka Iwanaga
- Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Kenichi Nakajima
- Department of Functional Imaging and Artificial Intelligence, Kanazawa University, Kanazawa, Japan
| | | | - Yoko Yasui
- TGCV/NLSD Patient Association, Osaka, Japan
- Faculty of Human Life Science, Osaka Metropolitan University, Osaka, Japan
| | | | - Makito Hirano
- Department of Neurology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Mana Okune
- Department of Cardiovascular Medicine, Kindai University Faculty of Medicine, Osaka, Japan
| | - Yuki Nishimura
- Department of Medical Innovation, Osaka University Hospital, Osaka, Japan
| | | | - Yasuyuki Nagasawa
- Department of General Internal Medicine, Hyogo Medical University, Hyogo, Japan
| | - Tetsuya Amano
- Department of Cardiology, Aichi Medical University, Aichi, Japan
| | - Shimpei Kuniyoshi
- Department of Pathology, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - Shu-Ping Hui
- Faculty of Health Sciences, Hokkaido University, Sapporo, Japan
| | - Nobuhiro Zaima
- Department of Applied Biological Chemistry, Graduate School of Agriculture, Kindai University, Nara, Japan
| | - Yoshihiko Ikeda
- Department of Triglyceride Science, Graduate School of Medicine, Osaka University, Osaka, Japan
- Department of Pathology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Tomomi Yamada
- Department of Medical Innovation, Osaka University Hospital, Osaka, Japan
| | - Shinichiro Fujimoto
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Yasuhiko Sakata
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
- Department of Cardiovascular Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Kunihisa Kobayashi
- Department of Endocrinology and Diabetes Mellitus, Fukuoka University Chikushi Hospital, Fukuoka, Japan
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Yamamoto H, Ikeda Y, Satomi K, Hirano KI. Acute Coronary Syndrome in a 40-Year-Old Man with Triglyceride Deposit Cardiomyovasculopathy: A Case Report. CJC Open 2024; 6:1116-1120. [PMID: 39525815 PMCID: PMC11544283 DOI: 10.1016/j.cjco.2024.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2024] [Accepted: 06/11/2024] [Indexed: 11/16/2024] Open
Affiliation(s)
- Hiroyuki Yamamoto
- Department of Cardiology, Tokyo Medical University Hospital, Tokyo, Japan
- Department of Cardiovascular Medicine, Narita-Tomisato Tokushukai Hospital, Chiba, Japan
| | - Yoshihiko Ikeda
- Department of Pathology, National Cerebral and Cardiovascular Centre, Osaka, Japan
| | - Kazuhiro Satomi
- Department of Cardiology, Tokyo Medical University Hospital, Tokyo, Japan
| | - Ken-ichi Hirano
- Department of Triglyceride Science, Graduate School of Medicine, Osaka University, Osaka, Japan
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Nakamura M. Lipotoxicity as a therapeutic target in obesity and diabetic cardiomyopathy. JOURNAL OF PHARMACY & PHARMACEUTICAL SCIENCES : A PUBLICATION OF THE CANADIAN SOCIETY FOR PHARMACEUTICAL SCIENCES, SOCIETE CANADIENNE DES SCIENCES PHARMACEUTIQUES 2024; 27:12568. [PMID: 38706718 PMCID: PMC11066298 DOI: 10.3389/jpps.2024.12568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 04/09/2024] [Indexed: 05/07/2024]
Abstract
Unhealthy sources of fats, ultra-processed foods with added sugars, and a sedentary lifestyle make humans more susceptible to developing overweight and obesity. While lipids constitute an integral component of the organism, excessive and abnormal lipid accumulation that exceeds the storage capacity of lipid droplets disrupts the intracellular composition of fatty acids and results in the release of deleterious lipid species, thereby giving rise to a pathological state termed lipotoxicity. This condition induces endoplasmic reticulum stress, mitochondrial dysfunction, inflammatory responses, and cell death. Recent advances in omics technologies and analytical methodologies and clinical research have provided novel insights into the mechanisms of lipotoxicity, including gut dysbiosis, epigenetic and epitranscriptomic modifications, dysfunction of lipid droplets, post-translational modifications, and altered membrane lipid composition. In this review, we discuss the recent knowledge on the mechanisms underlying the development of lipotoxicity and lipotoxic cardiometabolic disease in obesity, with a particular focus on lipotoxic and diabetic cardiomyopathy.
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Affiliation(s)
- Michinari Nakamura
- Department of Cell Biology and Molecular Medicine, Rutgers New Jersey Medical School, Rutgers Biomedical and Health Sciences, Newark, United States
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Nakano Y, Hirano KI, Onishi T, Ando H, Amano T. Prevalence of triglyceride deposit cardiomyovasculopathy among patients with acute coronary syndrome. EUROPEAN HEART JOURNAL. ACUTE CARDIOVASCULAR CARE 2024; 13:293-295. [PMID: 38207089 PMCID: PMC10927025 DOI: 10.1093/ehjacc/zuae005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 12/11/2023] [Accepted: 01/11/2024] [Indexed: 01/13/2024]
Affiliation(s)
- Yusuke Nakano
- Department of Cardiology, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi 480-1195, Japan
| | - Ken-ichi Hirano
- Department of Triglyceride Science, Laboratory of Cardiovascular Disease, Novel, Non-invasive, and Nutritional Therapeutics, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Tomohiro Onishi
- Department of Cardiology, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi 480-1195, Japan
| | - Hirohiko Ando
- Department of Cardiology, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi 480-1195, Japan
| | - Tetsuya Amano
- Department of Cardiology, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi 480-1195, Japan
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Nakajima K, Miyauchi H, Hirano KI, Fujimoto S, Kawahito M, Iimori T, Kudo T. Practice recommendation for measuring washout rates in 123I-BMIPP fatty acid images. Ann Nucl Med 2024; 38:1-8. [PMID: 37691078 PMCID: PMC10766729 DOI: 10.1007/s12149-023-01863-8] [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: 07/28/2023] [Accepted: 08/01/2023] [Indexed: 09/12/2023]
Abstract
The purpose of this practice recommendation is to specifically identify the critical steps involved in performing and interpreting 123I-β-methyl-iodophenyl-pentadecanoic acid (BMIPP) single-photon emission computed tomography (SPECT) and measurement of washout rate (WR) from the heart. This document will cover backgrounds, patient preparation, testing procedure, visual image interpretation, quantitation methods using planar and SPECT studies, and reporting of WR. The pitfall and some tips for the calculation of 123I-BMIPP WR are also included. The targets of global and regional WR calculation include ischemic heart disease, cardiomyopathy, heart failure, and triglyceride deposit cardiomyovasculopathy, an emerging rare heart disease.
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Affiliation(s)
- Kenichi Nakajima
- Department of Functional Imaging and Artificial Intelligence, Kanazawa University, 13-1 Takara-Machi, Kanazawa, 920-8640, Japan.
| | - Hideyuki Miyauchi
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Ken-Ichi Hirano
- Department of Triglyceride Science, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Shinichiro Fujimoto
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Michitomo Kawahito
- Department of Cardiology, Shizuoka City Shizuoka Hospital, Shizuoka, Japan
| | - Takashi Iimori
- Department of Radiation Technology, Chiba University Hospital, Chiba, Japan
| | - Takashi Kudo
- Department of Radioisotope Medicine, Atomic Bomb Disease and Hibakusha Medicine Unit, Atomic Bomb Disease Institute, Nagasaki University, Nagasaki, Japan
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Tamaki N, Manabe O. Current status and perspectives of nuclear cardiology. Ann Nucl Med 2024; 38:20-30. [PMID: 37891375 DOI: 10.1007/s12149-023-01878-1] [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: 08/02/2023] [Accepted: 09/29/2023] [Indexed: 10/29/2023]
Abstract
Nuclear cardiology has long been used to identify myocardial ischemia for appropriate treatment strategies for stable coronary artery disease (CAD). After the Ischemia Trial, it is time to reevaluate the significance of ischemia assessment. Functional imaging continues to play pivotal role in detecting microcirculatory disturbances. PET provides a clear image of blood flow distribution and is useful for the quantitative evaluation of myocardial flow reserve (MFR), which plays an important role in predicting treatment strategies and improving prognosis in CAD. Heart failure has become a major area of focus in cardiovascular medicine. Radionuclide imaging has been widely applied in this field. FDG PET is useful in identifying cardiac sarcoidosis and active inflammation. Clinical values of I-123 MIBG and BMIPP SPECT have been reported worldwide from Japan. Additionally, clinical experiences of Tc-99m pyrophosphate imaging have recently gained attention for assessing cardiac amyloidosis. Cardiac PET/CT and PET/MR imaging permit combined assessment of metabolic/functional/structural analyses of various cardiac diseases. While other non-invasive imaging modalities have rapidly been developed, the roles of radionuclide imaging remain to be valuable for early and accurate diagnosis and patient management in most cases of chronic CAD and various cardiovascular diseases.
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Affiliation(s)
- Nagara Tamaki
- Kyoto College of Medical Science, Kyoto, Japan.
- Department of Radiology, Kyoto Prefectural University of Medicine, Kyoto, Japan.
| | - Osamu Manabe
- Department of Radiology, Jichi Medical University Saitama Medical Center, Saitama, Japan
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Ezaki O, Abe S. Medium-chain triglycerides (8:0 and 10:0) increase muscle mass and function in frail older adults: a combined data analysis of clinical trials. Front Nutr 2023; 10:1284497. [PMID: 38111605 PMCID: PMC10725933 DOI: 10.3389/fnut.2023.1284497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 11/14/2023] [Indexed: 12/20/2023] Open
Abstract
Background Three clinical trials have examined the chronic effects of medium-chain triglycerides (MCTs) on muscle mass and function in frail older adults (mean age 85 years old). However, significant increases in muscle mass and some muscle function relative to long-chain triglycerides (LCTs) have yet to be shown, possibly due to the small number of participants in each trial. Objective We re-analyzed these previous clinical trials to clarify whether MCT supplementation can increase muscle mass and function. Analysis After adding post hoc tests to the original report, we compared changes in measurement between the MCT and LCT groups in the first 2 trials and conducted a combined data analysis. Methods In a combined data analysis, changes from baseline in measurements at the 3 months intervention in the MCTs- and LCTs-containing groups were assessed by analysis of covariance adjusted for baseline values of each measurement, age, sex, BMI, allocation to trial, habitual intakes in energy, protein, leucine, octanoic acid, decanoic acid, and vitamin D during the baseline period. The Mann-Whitney U test was used to analyze data on right and left knee extension times. Results MCT supplementation for 3 months increased muscle function relative to LCT supplementation with and without an L-leucine (1.2 g) and vitamin D (cholecalciferol, 20 μg)-enriched supplement. In a combined data analysis (n = 29 in MCTs, n = 27 in LCTs), relative to supplementation with 6 g LCTs/day, supplementation with 6 g MCTs/day at dinner for 3 months significantly increased body weight (adjusted mean change from baseline: MCTs 1.2 vs. LCTs 0.2 kg, p = 0.023), right arm muscle area (MCTs 1.4 vs. LCTs-0.7 cm2, p = 0.002), left calf circumference (p = 0.015), right-hand grip strength (MCTs 1.6 vs. LCTs 0.3 kg, p = 0.017), right knee extension time (p = 0.021), left knee extension time (p = 0.034), walking speed (p = 0.002), and number of iterations in leg open and close test (p < 0.001) and decreased right triceps skinfold thickness (p = 0.016). Conclusion In frail older adults, supplementation for 3 months with a low dose (6 g/day) of MCTs (C8:0 and C10:0) increased muscle mass and function. These findings indicate the potential for the practical use of MCTs in daily life in treating sarcopenia.
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Affiliation(s)
- Osamu Ezaki
- Institute of Women’s Health Science, Showa Women’s University, Tokyo, Japan
| | - Sakiko Abe
- Department of Food and Nutrition, Faculty of Contemporary Human Life Science, Tezukayama University, Nara, Japan
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Nakajima K, Miyauchi H, Hirano KI, Fujimoto S, Kawahito M, Iimori T, Kudo T, Japanese Society of Nuclear Cardiology working group. Practice Recommendation for Measuring Washout Rates in 123I-BMIPP Fatty Acid Images. ANNALS OF NUCLEAR CARDIOLOGY 2023; 9:3-10. [PMID: 38058580 PMCID: PMC10696152 DOI: 10.17996/anc.23-00005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 07/19/2023] [Accepted: 07/20/2023] [Indexed: 12/08/2023]
Abstract
The purpose of this practice recommendation is to specifically identify the critical steps involved in performing and interpreting 123I-β-methyl-iodophenyl-pentadecanoic acid (BMIPP) single-photon emission computed tomography (SPECT) and measurement of washout rate (WR) from the heart. This document will cover backgrounds, patient preparation, testing procedure, visual image interpretation, quantitation methods using planar and SPECT studies, and reporting of WR. The pitfall and some tips for the calculation of 123I-BMIPP WR are also included. The targets of global and regional WR calculation include ischemic heart disease, cardiomyopathy, heart failure, and triglyceride deposit cardiomyovasculopathy, an emerging rare heart disease.
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Affiliation(s)
- Kenichi Nakajima
- Department of Functional Imaging and Artificial Intelligence, Kanazawa University, Japan
| | - Hideyuki Miyauchi
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Japan
| | - Ken-ichi Hirano
- Department of Triglyceride Science, Graduate School of Medicine, Osaka University, Japan
| | - Shinichiro Fujimoto
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Japan
| | | | - Takashi Iimori
- Department of Radiation Technology, Chiba University Hospital, Japan
| | - Takashi Kudo
- Department of Radioisotope Medicine, Atomic Bomb Disease and Hibakusha Medicine Unit, Atomic Bomb Disease Institute, Nagasaki University, Japan
| | - Japanese Society of Nuclear Cardiology working group
- Department of Functional Imaging and Artificial Intelligence, Kanazawa University, Japan
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Japan
- Department of Triglyceride Science, Graduate School of Medicine, Osaka University, Japan
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Japan
- Department of Cardiology, Shizuoka City Shizuoka Hospital, Japan
- Department of Radiation Technology, Chiba University Hospital, Japan
- Department of Radioisotope Medicine, Atomic Bomb Disease and Hibakusha Medicine Unit, Atomic Bomb Disease Institute, Nagasaki University, Japan
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Hirano KI, Miyauchi H, Nakano Y, Kawaguchi Y, Okamura S, Nishimura Y, Onishi T, Fujimoto S, Yamada T, Amano T, Japan TGCV Study Group †. Overall Survival Rate of Patients With Triglyceride Deposit Cardiomyovasculopathy. JACC. ADVANCES 2023; 2:100347. [PMID: 38938259 PMCID: PMC11198209 DOI: 10.1016/j.jacadv.2023.100347] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 06/29/2024]
Affiliation(s)
- Ken-ichi Hirano
- Laboratory of Cardiovascular Disease, Novel, Non-invasive, and Nutritional Therapeutics (CNT) and Triglyceride Research Center (TGRC), Department of Triglyceride Science, Graduate School of Medicine, Osaka University, 6-2-4, Furuedai, Suita, Osaka 565-0874, Japan.
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Chen Z, Nakajima K, Hirano KI, Kamiya T, Yoshida S, Saito S, Kinuya S. Methods of calculating 123I-β-methyl-P-iodophenyl-pentadecanoic acid washout rates in triglyceride deposit cardiomyovasculopathy. Ann Nucl Med 2022; 36:986-997. [PMID: 36155888 PMCID: PMC9587944 DOI: 10.1007/s12149-022-01787-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 09/14/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE This study aimed to optimize various methods of calculating washout rates (WRs) of 123I-β-methyl-p-iodophenyl-pentadecanoic (BMIPP), as they are essential to diagnose triglyceride deposit cardiomyovasculopathy (TGCV) which is a rare disease entity identified in Japan and has been encoded in Orphanet (ORPHA code 565612). METHODS We calculated WRs of 123I-BMIPP from early (20 min) and delayed (200 min) images. We evaluated six methods of calculating WRs to discriminate TGVC patients (age, 56.8 ± 14.6 y; male, n = 13; female, n = 4) and 21 123I-BMIPP studies were involved including 4 follow-up studies. Washout rates were calculated by two planar methods using anterior images with cardiac and background regions of interest (ROIs) and by four SPECT methods using either array and polar plots or summed short-axis images. The final diagnoses of TGCV were confirmed according to the 2020 diagnostic criteria, and the diagnostic accuracy of WRs calculated using the six methods was analyzed using the area under receiver-operating characteristics curves (ROC-AUC). Multiple scatter-plot matrix methods were evaluated with correlations for comparison. RESULTS All six methods were useful for diagnosis and did not significantly differ. The four SPECT methods showed excellent diagnostic accuracy (AUC 1.0), whereas the planar methods with and without background correction could be acceptable (AUC 0.857 and 0.964, respectively). The WRs were relatively lower for patients with CAD and remarkable metabolic defects than for patients with TGCV but without defects. CONCLUSIONS For the diagnosis of TGCV, the WR cutoff of 10% of 123I-BMIPP functioned well in planar and SPECT discrimination based on computational methods as a classifier. However, calculation optimization should improve TGCV diagnoses.
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Affiliation(s)
- Zhuoqing Chen
- Department of Nuclear Medicine, Kanazawa University, Kanazawa, Ishikawa Japan
| | - Kenichi Nakajima
- Department of Functional Imaging and Artificial Intelligence, Kanazawa University, Kanazawa, Ishikawa 920-8640 Japan
| | - Ken-ichi Hirano
- Department of Triglyceride Science, Graduate School of Medicine, Osaka University, Suita, Osaka Japan
| | - Takashi Kamiya
- Department of Medical Technology, Osaka University Hospital, Suita, Osaka Japan
| | - Shohei Yoshida
- Department of Cardiology, Kanazawa University Hospital, Kanazawa, Ishikawa Japan
| | - Shintaro Saito
- Department of Nuclear Medicine, Kanazawa University, Kanazawa, Ishikawa Japan
| | - Seigo Kinuya
- Department of Nuclear Medicine, Kanazawa University, Kanazawa, Ishikawa Japan
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