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Schindler TH, Bhandiwad A. Coronary Microvascular Dysfunction: Linking Inflammation and Cardiac Dysfunction? JACC Basic Transl Sci 2023; 8:152-154. [PMID: 36908668 PMCID: PMC9998456 DOI: 10.1016/j.jacbts.2022.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Affiliation(s)
- Thomas H Schindler
- Washington University in St. Louis School of Medicine, Mallinckrodt Institute of Radiology, Division of Nuclear Medicine-Cardiovascular, St. Louis, Missouri, USA
| | - Anita Bhandiwad
- Washington University in St. Louis School of Medicine, John T. Milliken Department of Internal Medicine, Cardiovascular Division, St. Louis, Missouri, USA
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Mhlanga J, Haq A, Derenoncourt P, Bhandiwad A, Laforest R, Siegel B, Dehdashti F, Gropler RJ, Schindler TH. 18F-FDG Positron Emission Tomography in Myocardial Viability Assessment: A Practical and Time Efficient Protocol. J Nucl Med 2021; 63:602-608. [PMID: 34503961 DOI: 10.2967/jnumed.121.262432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 08/13/2021] [Indexed: 11/16/2022] Open
Abstract
We assessed image quality using a practical and time-efficient protocol for intravenous glucose loading and insulin injection prior to administration of 18F-fluorodeoxyglucose (18F-FDG) for PET myocardial viability evaluation in patients with ischemic cardiomyopathy, with and without type 2 diabetes mellitus. Methods: Metabolic preparation period (MPP) or optimal cardiac 18F-FDG uptake was determined from the time of intravenous infusion of 12.5 or 25 gram of 50% dextrose to the time of 18F-FDG injection. Cardiac 18F-FDG image quality was evaluated according to a 5-point scoring system (5=excellent to 1=non-diagnostic) by two independent observers. In cases of disagreement, consensus was achieved in a joint reading. Fifteen patients with ischemic cardiomyopathy, who underwent oral glucose loading and i.v. insulin administration, served as reference for MPP comparisons. Results: 59 consecutive patients (age: 63±10yrs, men n = 48 and women n = 11) underwent rest 99mTc-tetrofosmin SPECT/CT and 18F-FDG PET/CT for the evaluation of myocardial viability. FDG image quality was scored as excellent in 42%, very good in 36%, good in 17%, fair in 3%, and non-diagnostic in 2%. Comparing diabetic and non-diabetic patients, the quality scores were excellent in 29% vs. 76% , very good in 41% vs. 18%, good in 24% vs. 6%, fair in 4% vs. 0% , and non-diagnostic in 2% vs. 0%. The mean (±SD) quality score was 4.12±0.95 and overall it was better in non-diabetic than in diabetic patients (4.71±0.59 vs 3.88±0.96; p<0.0001). Notably, the average MPP was significantly less with i.v. glucose loading when compared to oral glucose loading (51±15 vs. 132±29 min; p<0.0001), paralleled by higher insulin doses (6.3 ± 2.2 vs. 2.0 ± 1.69 U; p<0.001). Conclusion: Using a practical and time efficient protocol for i.v. glucose loading and insulin administration prior to 18F-FDG injection reduces the MPP by 61% as compared to oral glucose challenge that affords good-to-excellent image quality in 95% of ischemic cardiomyopathy patients.
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Affiliation(s)
- Joyce Mhlanga
- Washington University in St Louis School of Medicine, Mallinckrodt Institute of Radiology, Division of Nuclear Medicine, United States
| | - Adeel Haq
- Washington University School of Medicine, Mallinckrodt Institute of Radiology- Division of Nuclear Medicine, United States
| | - Paul Derenoncourt
- Washington University School of Medicine, Mallinckrodt Institute of Radiology- Division of Nuclear Medicine, United States
| | - Anita Bhandiwad
- Washington University School of Medicine, John T. Milliken Department of Internal Medicine, Cardiovascular Division, United States
| | - Richard Laforest
- Washington University in St. Louis, Mallinckrodt Institute of Radiology- Division of Nuclear Medicine, United States
| | - Barry Siegel
- Washington University in St. Louis, Mallinckrodt Institute of Radiology- Division of Nuclear Medicine, United States
| | - Farrokh Dehdashti
- Washington University in St. Louis, Mallinckrodt Institute of Radiology- Division of Nuclear Medicine, United States
| | - Robert J Gropler
- Washington University in St. Louis, Mallinckrodt Institute of Radiology- Division of Nuclear Medicine, United States
| | - Thomas Hellmut Schindler
- Washington University in St. Louis School of Medicine, Mallinckrodt Institute of Radiology, Division of Nuclear Medicine, United States
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Schindler TH, Leucker TM, Bhandiwad A. Entering a new era of the identification and characterization of myocardial ischemic burden with 15O-water PET? Int J Cardiol 2021; 341:22-23. [PMID: 34329679 DOI: 10.1016/j.ijcard.2021.07.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 07/21/2021] [Indexed: 11/17/2022]
Affiliation(s)
- Thomas H Schindler
- Mallinckrodt Institute of Radiology, Division of Nuclear Medicine, Cardiovascular Medicine, Washington University School of Medicine, St. Louis, MO, USA; Department of Medicine, Division of Cardiology, Johns Hopkins University, Baltimore, MD, USA; Cardiovascular Division, John T. Milliken Department of Internal Medicine, Washington University School of Medicine, St. Louis, MO, USA.
| | - Thorsten M Leucker
- Department of Medicine, Division of Cardiology, Johns Hopkins University, Baltimore, MD, USA
| | - Anita Bhandiwad
- Cardiovascular Division, John T. Milliken Department of Internal Medicine, Washington University School of Medicine, St. Louis, MO, USA
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Schindler TH, Sharma V, Bhandiwad A. Cardiac computed tomography-derived extracellular volume fraction in the identification of cardiotoxicity: Another emerging imaging option. Int J Cardiol Heart Vasc 2021; 34:100806. [PMID: 34141861 PMCID: PMC8188043 DOI: 10.1016/j.ijcha.2021.100806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 05/21/2021] [Indexed: 11/01/2022]
Affiliation(s)
- Thomas H Schindler
- Mallinckrodt Institute of Radiology, Division of Nuclear Medicine, Washington University School of Medicine, St. Louis, MO, USA.,Cardiovascular Division, John T. Milliken Department of Internal Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Vijay Sharma
- Mallinckrodt Institute of Radiology, Division of Nuclear Medicine, Washington University School of Medicine, St. Louis, MO, USA.,Department of Biomedical Engineering, School of Engineering & Applied Science, Washington University, St. Louis, MO, USA
| | - Anita Bhandiwad
- Cardiovascular Division, John T. Milliken Department of Internal Medicine, Washington University School of Medicine, St. Louis, MO, USA
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Schindler TH, Bhandiwad A. Cardiac Magnetic Resonance Determined T1 Reactivity Holds Promise for a New Avenue of Coronary Circulatory Function Characterization. Circ Cardiovasc Imaging 2021; 14:e012429. [PMID: 33706539 DOI: 10.1161/circimaging.121.012429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Thomas H Schindler
- Division of Nuclear Medicine (T.H.S.), Washington University in St. Louis School of Medicine, St. Louis, MO.,Mallinckrodt Institute of Radiology and Cardiovascular Division, John T. Milliken Department of Internal Medicine (T.H.S. and A.B.). Washington University in St. Louis School of Medicine, St. Louis, MO
| | - Anita Bhandiwad
- Mallinckrodt Institute of Radiology and Cardiovascular Division, John T. Milliken Department of Internal Medicine (T.H.S. and A.B.). Washington University in St. Louis School of Medicine, St. Louis, MO
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Kulkarni M, Kumar GV, Bhandiwad A. Eight years of prevention of parent to child transmission of HIV-AIDS programme (PPTCT) in a tertiary care hospital in India. Int J Infect Dis 2012. [DOI: 10.1016/j.ijid.2012.05.748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Müller H, End C, Weiss C, Renner M, Bhandiwad A, Helmke BM, Gassler N, Hafner M, Poustka A, Mollenhauer J, Poeschl J. Respiratory Deleted in Malignant Brain Tumours 1 (DMBT1) levels increase during lung maturation and infection. Clin Exp Immunol 2007; 151:123-9. [PMID: 17991292 DOI: 10.1111/j.1365-2249.2007.03528.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Deleted in Malignant Brain Tumours 1 (DMBT1) is a secreted scavenger receptor cysteine-rich protein that binds and aggregates various bacteria and viruses in vitro. Studies in adults have shown that DMBT1 is expressed mainly by mucosal epithelia and glands, in particular within the respiratory tract, and plays a role in innate immune defence. We hypothesized that respiratory DMBT1 levels may be influenced by various developmental and clinical factors such as maturity, age and bacterial infection. DMBT1 levels were studied in 205 tracheal aspirate samples of 82 ventilated preterm and full-term infants by enzyme-linked immunosorbent assay. Possible effects of various clinical parameters were tested by multiple regression analysis. DMBT1 levels increased significantly with lung maturity (P < 0.0001 for both gestational and postnatal age) and in small-for-gestational-age infants (P = 0.0179). An increase of respiratory DMBT1 levels was detected in neonatal infections (P < 0.0001). These results were supported by Western blotting. Immunohistochemical analyses of archived newborn lung sections (n = 17) demonstrated high concentrations of DMBT1 in lungs of neonates with bacterial infections. Our data show that preterm infants are able to up-regulate DMBT1 in infection as an unspecific immune reaction.
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Affiliation(s)
- H Müller
- Division of Neonatology, Department of Pediatrics, University of Heidelberg, Heidelberg, Germany.
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Müller H, End C, Bhandiwad A, Weiß C, Renner M, Bauer J, Beedgen B, Hafner M, Mollenhauer J, Linderkamp O. Pulmonale Expression von DMBT1 bei beatmeten Früh- und Neugeborenen. Z Geburtshilfe Neonatol 2005. [DOI: 10.1055/s-2005-871404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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