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Weber B, Weisenfeld D, Massarotti E, Seyok T, Cremone G, Lam E, Golnik C, Brownmiller S, Liu F, Huang S, Todd DJ, Coblyn JS, Weinblatt ME, Cai T, Dahal K, Kohler M, Yinh J, Barrett L, Solomon DH, Plutzky J, Schelbert HR, Campisi R, Bolster MB, Di Carli M, Liao KP. Interplay Between Systemic Inflammation, Myocardial Injury, and Coronary Microvascular Dysfunction in Rheumatoid Arthritis: Results From the LiiRA Study. J Am Heart Assoc 2024; 13:e030387. [PMID: 38686879 DOI: 10.1161/jaha.123.030387] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 01/17/2024] [Indexed: 05/02/2024]
Abstract
BACKGROUND Coronary microvascular dysfunction as measured by myocardial flow reserve (MFR) is associated with increased cardiovascular risk in rheumatoid arthritis (RA). The objective of this study was to determine the association between reducing inflammation with MFR and other measures of cardiovascular risk. METHODS AND RESULTS Patients with RA with active disease about to initiate a tumor necrosis factor inhibitor were enrolled (NCT02714881). All subjects underwent a cardiac perfusion positron emission tomography scan to quantify MFR at baseline before tumor necrosis factor inhibitor initiation, and after tumor necrosis factor inhibitor initiation at 24 weeks. MFR <2.5 in the absence of obstructive coronary artery disease was defined as coronary microvascular dysfunction. Blood samples at baseline and 24 weeks were measured for inflammatory markers (eg, high-sensitivity C-reactive protein [hsCRP], interleukin-1b, and high-sensitivity cardiac troponin T [hs-cTnT]). The primary outcome was mean MFR before and after tumor necrosis factor inhibitor initiation, with Δhs-cTnT as the secondary outcome. Secondary and exploratory analyses included the correlation between ΔhsCRP and other inflammatory markers with MFR and hs-cTnT. We studied 66 subjects, 82% of which were women, mean RA duration 7.4 years. The median atherosclerotic cardiovascular disease risk was 2.5%; 47% had coronary microvascular dysfunction and 23% had detectable hs-cTnT. We observed no change in mean MFR before (2.65) and after treatment (2.64, P=0.6) or hs-cTnT. A correlation was observed between a reduction in hsCRP and interleukin-1b with a reduction in hs-cTnT. CONCLUSIONS In this RA cohort with low prevalence of cardiovascular risk factors, nearly 50% of subjects had coronary microvascular dysfunction at baseline. A reduction in inflammation was not associated with improved MFR. However, a modest reduction in interleukin-1b and no other inflammatory pathways was correlated with a reduction in subclinical myocardial injury. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifier: NCT02714881.
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Affiliation(s)
- Brittany Weber
- Division of Cardiovascular Medicine, Department of Medicine, Heart and Vascular Center Brigham and Women's Hospital, Harvard Medical School Boston MA
| | - Dana Weisenfeld
- Division of Rheumatology, Inflammation, and Immunity Brigham and Women's Hospital, Harvard Medical School Boston MA
| | - Elena Massarotti
- Division of Rheumatology, Inflammation, and Immunity Brigham and Women's Hospital, Harvard Medical School Boston MA
| | - Thany Seyok
- Division of Rheumatology, Inflammation, and Immunity Brigham and Women's Hospital, Harvard Medical School Boston MA
| | - Gabrielle Cremone
- Division of Rheumatology, Inflammation, and Immunity Brigham and Women's Hospital, Harvard Medical School Boston MA
| | - Ethan Lam
- Division of Rheumatology, Inflammation, and Immunity Brigham and Women's Hospital, Harvard Medical School Boston MA
| | - Charlotte Golnik
- Division of Rheumatology, Inflammation, and Immunity Brigham and Women's Hospital, Harvard Medical School Boston MA
| | - Seth Brownmiller
- Division of Rheumatology, Inflammation, and Immunity Brigham and Women's Hospital, Harvard Medical School Boston MA
| | - Feng Liu
- Division of Rheumatology, Inflammation, and Immunity Brigham and Women's Hospital, Harvard Medical School Boston MA
| | - Sicong Huang
- Division of Rheumatology, Inflammation, and Immunity Brigham and Women's Hospital, Harvard Medical School Boston MA
| | - Derrick J Todd
- Division of Rheumatology, Inflammation, and Immunity Brigham and Women's Hospital, Harvard Medical School Boston MA
| | - Jonathan S Coblyn
- Division of Rheumatology, Inflammation, and Immunity Brigham and Women's Hospital, Harvard Medical School Boston MA
| | - Michael E Weinblatt
- Division of Rheumatology, Inflammation, and Immunity Brigham and Women's Hospital, Harvard Medical School Boston MA
| | - Tianrun Cai
- Division of Rheumatology, Inflammation, and Immunity Brigham and Women's Hospital, Harvard Medical School Boston MA
| | - Kumar Dahal
- Division of Rheumatology, Inflammation, and Immunity Brigham and Women's Hospital, Harvard Medical School Boston MA
| | - Minna Kohler
- Division of Rheumatology, Allergy and Immunology Massachusetts General Hospital, Harvard Medical School Boston MA
| | - Janeth Yinh
- Division of Rheumatology, Allergy and Immunology Massachusetts General Hospital, Harvard Medical School Boston MA
| | - Leanne Barrett
- Division of Cardiovascular Medicine, Department of Medicine, Heart and Vascular Center Brigham and Women's Hospital, Harvard Medical School Boston MA
| | - Daniel H Solomon
- Division of Rheumatology, Inflammation, and Immunity Brigham and Women's Hospital, Harvard Medical School Boston MA
| | - Jorge Plutzky
- Division of Cardiovascular Medicine, Department of Medicine, Heart and Vascular Center Brigham and Women's Hospital, Harvard Medical School Boston MA
| | | | - Roxana Campisi
- Instituto Argentino de Diagnóstico y Tratamiento S.A. Buenos Aires Argentina
| | - Marcy B Bolster
- Division of Rheumatology, Allergy and Immunology Massachusetts General Hospital, Harvard Medical School Boston MA
| | - Marcelo Di Carli
- Division of Cardiovascular Medicine, Department of Medicine, Heart and Vascular Center Brigham and Women's Hospital, Harvard Medical School Boston MA
| | - Katherine P Liao
- Division of Rheumatology, Inflammation, and Immunity Brigham and Women's Hospital, Harvard Medical School Boston MA
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Dilsizian V, Bacharach SL, Beanlands RS, Bergmann SR, Delbeke D, Dorbala S, Gropler RJ, Knuuti J, Schelbert HR, Travin MI. Correction to: ASNC imaging guidelines/SNMMI procedure standard for positron emission tomography (PET) nuclear cardiology procedures. J Nucl Cardiol 2023; 30:2186. [PMID: 37563540 DOI: 10.1007/s12350-023-03357-6] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/12/2023]
Affiliation(s)
- Vasken Dilsizian
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD, USA.
| | - Stephen L Bacharach
- Department of Radiology, University of California-San Francisco, San Francisco, CA, USA
| | - Rob S Beanlands
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Canada
| | - Steven R Bergmann
- Pat and Jim Calhoun Cardiology Center, UConn Health, Farmington, CT, USA
| | - Dominique Delbeke
- Department of Radiology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Sharmila Dorbala
- Division of Nuclear Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Robert J Gropler
- Division of Nuclear Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Juhani Knuuti
- Turku PET Centre, Turku University Hospital, Turku, Finland
| | - Heinrich R Schelbert
- Department of Molecular and Medical Pharmacology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Mark I Travin
- Department of Radiology, Montefiore Medical Center, Bronx, NY, USA
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3
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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: 26] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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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Yun M, Nie B, Wen W, Zhu Z, Liu H, Nie S, Lanzenberger R, Wei Y, Hacker M, Shan B, Schelbert HR, Li X, Zhang X. Assessment of cerebral glucose metabolism in patients with heart failure by 18F-FDG PET/CT imaging. J Nucl Cardiol 2022; 29:476-488. [PMID: 32691347 DOI: 10.1007/s12350-020-02258-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 06/10/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND To evaluate the cerebral metabolism in patients with heart failure (HF). METHODS One hundred and two HF patients were prospectively enrolled, who underwent gated 99mTc-sestamibi single photon emission computed tomography (SPECT)/CT, cardiac and cerebral 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET)/CT. Fifteen healthy volunteers served as controls. Patients were stratified by extent of hibernating myocardium (HM) and left ventricular ejection fraction (LVEF) into 4 groups where Group1: HM < 10% (n = 33); Group2: HM ≥ 10%, LVEF < 25% (n = 34); Group3: HM ≥ 10%, 25% ≤ LVEF ≤ 40% (n = 16) and Group 4: LVEF > 40% (n = 19). The standardized uptake value (SUV) in the whole brain (SUVwhole-brain) and the SUV ratios (SUVR) in 24 cognition-related brain regions were determined. SUVwhole-brain and SUVRs were compared between the 4 patient groups and the healthy controls. RESULTS SUVwhole-brain (r = 0.245, P = 0.013) and SUVRs in frontal areas, hippocampus, and para-hippocampus (r: 0.213 to 0.308, all P < 0.05) were correlated with HM. SUVwhole-brain differed between four patient groups and the healthy volunteers (P = 0.016) and SUVwhole-brain in Group 1 was lower than that in healthy volunteers (P < 0.05). SUVRs of Group 3 in frontal areas were the highest among four patient subgroups (P < 0.05). CONCLUSIONS Cerebral metabolism in the whole brain was reduced but maintained in cognition-related frontal areas in HF patients with HM and moderately impaired global left ventricular function.
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Affiliation(s)
- Mingkai Yun
- Department of Nuclear Medicine, Laboratory for Molecular Imaging, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Upper Airway Dysfunction and Related Cardiovascular Diseases, Beijing, China
| | - Binbin Nie
- Division of Nuclear Technology and Applications, Institute of High Energy Physics, Chinese Academy of Sciences, Beijing, China
| | - Wanwan Wen
- Department of Nuclear Medicine, Laboratory for Molecular Imaging, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Upper Airway Dysfunction and Related Cardiovascular Diseases, Beijing, China
| | - Ziwei Zhu
- Department of Nuclear Medicine, Laboratory for Molecular Imaging, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Upper Airway Dysfunction and Related Cardiovascular Diseases, Beijing, China
| | - Hua Liu
- Division of Nuclear Technology and Applications, Institute of High Energy Physics, Chinese Academy of Sciences, Beijing, China
| | - Shaoping Nie
- Beijing Key Laboratory of Upper Airway Dysfunction and Related Cardiovascular Diseases, Beijing, China
- Division of Emergency & Critical Care Centre, Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Rupert Lanzenberger
- Neuroimaging Labs (NIL), Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Yongxiang Wei
- Department of Nuclear Medicine, Laboratory for Molecular Imaging, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Upper Airway Dysfunction and Related Cardiovascular Diseases, Beijing, China
| | - Marcus Hacker
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Baoci Shan
- Division of Nuclear Technology and Applications, Institute of High Energy Physics, Chinese Academy of Sciences, Beijing, China
| | - Heinrich R Schelbert
- Department of Molecular and Medical Pharmacology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Xiang Li
- Department of Nuclear Medicine, Laboratory for Molecular Imaging, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Xiaoli Zhang
- Department of Nuclear Medicine, Laboratory for Molecular Imaging, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
- Beijing Key Laboratory of Upper Airway Dysfunction and Related Cardiovascular Diseases, Beijing, China.
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5
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Schelbert HR. Daniel S. Berman, MD, born on July 15, 1944. J Nucl Cardiol 2021; 28:2479-2482. [PMID: 34668153 DOI: 10.1007/s12350-021-02823-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 09/28/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Heinrich R Schelbert
- Department of Molecular and Medical Pharmacology, David Geffen School of Medicine at UCLA, University of California at Los Angeles, Los Angeles, CA, USA.
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6
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Schelbert HR. Let's functionalize the myocardial flow reserve. J Nucl Cardiol 2021; 28:2459-2461. [PMID: 34729683 DOI: 10.1007/s12350-021-02851-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 10/19/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Heinrich R Schelbert
- Department of Molecular and Medical Pharmacology, David Geffen School of Medicine at UCLA, University of California at Los Angeles, Los Angeles, CA, USA.
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7
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Schelbert HR. On the Relativity of Dipyridamole and Dobutamine Flows. J Nucl Cardiol 2021; 28:46-49. [PMID: 32968970 DOI: 10.1007/s12350-020-02309-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 04/13/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Heinrich R Schelbert
- Department of Molecular and Medical Pharmacology, David Geffen School of Medicine at UCLA, Box 95648, B2-085J, 650 Charles E Young Drive South, Los Angeles, CA, 90095-6948, USA.
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8
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Hayrapetian A, Girgis MD, Yanagawa J, French SW, Schelbert HR, Auerbach MS, Czernin J, Calais J. Incidental Detection of Elastofibroma Dorsi With 68Ga-FAPI-46 and 18F-FDG PET/CT in a Patient With Esophageal Cancer. Clin Nucl Med 2021; 46:e86-e87. [PMID: 32701818 DOI: 10.1097/rlu.0000000000003218] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
ABSTRACT A 71-year-old man underwent 18F-FDG and 68Ga-FAPI-46 PET/CT for initial staging prior to surgery of a squamous cell carcinoma of the lower esophagus under the prospective study NCT04147494. Both scans showed increased uptake in the mid and distal esophagus without evidence of metastatic disease. A soft tissue right infrascapular mass with mild 18F-FDG and moderate 68Ga-FAPI-46 uptake was incidentally found. The patient underwent robotic-assisted Ivor-Lewis esophagectomy and excision of the right infrascapular mass. Histopathology of the right chest wall mass confirmed the diagnosis of elastofibroma.
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Affiliation(s)
- Artineh Hayrapetian
- From the Ahmanson Translational Theranostics Division, Department of Molecular and Medical Pharmacology
| | | | | | | | - Heinrich R Schelbert
- From the Ahmanson Translational Theranostics Division, Department of Molecular and Medical Pharmacology
| | - Martin S Auerbach
- From the Ahmanson Translational Theranostics Division, Department of Molecular and Medical Pharmacology
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9
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Schelbert HR. Capturing Photons More Efficiently. J Nucl Med 2020; 61:2S-3S. [PMID: 33293448 DOI: 10.2967/jnumed.120.248815] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 05/07/2020] [Indexed: 11/16/2022] Open
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10
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Schelbert HR. Recipes for Human Albumin Macroaggregates (perspective on “Suspensions of Radioalbumin Aggregates for Photoscanning the Liver, Spleen, Lung and Other Organs” J Nucl Med. 1964;5:259–275). J Nucl Med 2020; 61:12S-13S. [DOI: 10.2967/jnumed.120.248807] [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] [Received: 05/01/2020] [Accepted: 05/07/2020] [Indexed: 11/16/2022] Open
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11
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Affiliation(s)
- Heinrich R. Schelbert
- Department of Molecular and Medical Pharmacology, David Geffen School of Medicine at UCLA, University of California at Los Angeles
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12
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Gewirtz H, Iskandrian AE, Morgan C, Schelbert HR. Positron-Emission Tomography Quantitative Measurements of Myocardial Blood Flow. JACC Cardiovasc Imaging 2019; 12:1864-1867. [DOI: 10.1016/j.jcmg.2019.03.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 03/05/2019] [Accepted: 03/22/2019] [Indexed: 12/17/2022]
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13
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Schelbert HR, Dahlbom M. A good beginning with an uncertain future. J Nucl Cardiol 2019; 26:810-813. [PMID: 29086387 DOI: 10.1007/s12350-017-1091-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Accepted: 09/01/2017] [Indexed: 10/18/2022]
Affiliation(s)
- Heinrich R Schelbert
- Department of Molecular and Medical Pharmacology, David Geffen School of Medicine at UCLA, University of California at Los Angeles, B2-085J; Box 95648, 650 Charles E. Young Drive South, Los Angeles, CA, 90095-6948, USA.
| | - Magnus Dahlbom
- Department of Molecular and Medical Pharmacology, David Geffen School of Medicine at UCLA, University of California at Los Angeles, B2-085J; Box 95648, 650 Charles E. Young Drive South, Los Angeles, CA, 90095-6948, USA
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14
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Iskandrian AE, Dilsizian V, Garcia EV, Beanlands RS, Cerqueira M, Soman P, Berman DS, Cuocolo A, Einstein AJ, Morgan CJ, Hage FG, Schelbert HR, Bax JJ, Wu JC, Shaw LJ, Sadeghi MM, Tamaki N, Kaufmann PA, Gropler R, Dorbala S, Van Decker W. Myocardial perfusion imaging: Lessons learned and work to be done-update. J Nucl Cardiol 2018; 25:39-52. [PMID: 29110288 DOI: 10.1007/s12350-017-1093-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Accepted: 10/02/2017] [Indexed: 10/18/2022]
Abstract
As the second term of our commitment to Journal begins, we, the editors, would like to reflect on a few topics that have relevance today. These include prognostication and paradigm shifts; Serial testing: How to handle data? Is the change in perfusion predictive of outcome and which one? Ischemia-guided therapy: fractional flow reserve vs perfusion vs myocardial blood flow; positron emission tomography (PET) imaging using Rubidium-82 vs N-13 ammonia vs F-18 Flurpiridaz; How to differentiate microvascular disease from 3-vessel disease by PET? The imaging scene outside the United States, what are the differences and similarities? Radiation exposure; Special issues with the new cameras? Is attenuation correction needed? Are there normal databases and are these specific to each camera system? And finally, hybrid imaging with single-photon emission tomography or PET combined with computed tomography angiography or coronary calcium score. We hope these topics are of interest to our readers.
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Affiliation(s)
- Ami E Iskandrian
- Division of Cardiovascular Diseases, Department of Medicine, University of Alabama at Birmingham, 318 LHRB/ 1900 University BLVD, Birmingham, AL, 35294, USA.
| | - Vasken Dilsizian
- University of Maryland School of Medicine, Baltimore, 21201, USA
| | | | | | - Manuel Cerqueira
- Cleveland Clinic, Lerner College of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Prem Soman
- University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Daniel S Berman
- Cedars-Sinai Medical Center, University of California at Los Angeles, Los Angeles, CA, USA
| | | | | | | | - Fadi G Hage
- University of Alabama at Birmingham, Birmingham, AL, USA
- Birmingham Veterans Affairs Medical Center, Birmingham, AL, USA
| | | | - Jeroen J Bax
- Leiden University Medical Center, Leiden, The Netherlands
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15
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Dilsizian V, Bacharach SL, Beanlands RS, Bergmann SR, Delbeke D, Dorbala S, Gropler RJ, Knuuti J, Schelbert HR, Travin MI. ASNC imaging guidelines/SNMMI procedure standard for positron emission tomography (PET) nuclear cardiology procedures. J Nucl Cardiol 2016; 23:1187-1226. [PMID: 27392702 DOI: 10.1007/s12350-016-0522-3] [Citation(s) in RCA: 384] [Impact Index Per Article: 48.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Accepted: 03/25/2016] [Indexed: 12/15/2022]
Affiliation(s)
- Vasken Dilsizian
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, South Greene Street, Rm N2W78, Baltimore, MD, 21201-1595, USA.
| | - Stephen L Bacharach
- Department of Radiology, University of California-San Francisco, San Francisco, CA, USA
| | - Rob S Beanlands
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Canada
| | - Steven R Bergmann
- Pat and Jim Calhoun Cardiology Center, UConn Health, Farmington, CT, USA
| | - Dominique Delbeke
- Department of Radiology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Sharmila Dorbala
- Division of Nuclear Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Robert J Gropler
- Division of Nuclear Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Juhani Knuuti
- Turku PET Centre, Turku University Hospital, Turku, Finland
| | - Heinrich R Schelbert
- Department of Molecular and Medical Pharmacology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Mark I Travin
- Department of Radiology, Montefiore Medical Center, Bronx, NY, USA
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Mosessian S, Duarte-Vogel SM, Stout DB, Roos KP, Lawson GW, Jordan MC, Ogden A, Matter C, Sadeghi S, Mills GQ, Schelbert HR, Radu CG, Czernin J, Couto M, Phelps ME. INDs for PET molecular imaging probes-approach by an academic institution. Mol Imaging Biol 2014; 16:441-8. [PMID: 24733693 PMCID: PMC4097325 DOI: 10.1007/s11307-014-0735-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
We have developed an efficient, streamlined, cost-effective approach to obtain Investigational New Drug (IND) approvals from the Food and Drug Administration (FDA) for positron emission tomography (PET) imaging probes (while the FDA uses the terminology PET drugs, we are using "PET imaging probes," "PET probes," or "probes" as the descriptive terms). The required application and supporting data for the INDs were collected in a collaborative effort involving appropriate scientific disciplines. This path to INDs was successfully used to translate three [(18) F]fluoro-arabinofuranosylcytosine (FAC) analog PET probes to phase 1 clinical trials. In doing this, a mechanism has been established to fulfill the FDA regulatory requirements for translating promising PET imaging probes from preclinical research into human clinical trials in an efficient and cost-effective manner.
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Affiliation(s)
- Sherly Mosessian
- Department of Molecular and Medical Pharmacology, David Geffen School of Medicine at University of California Los Angeles, 650 Charles E. Young Dr. South, CHS 23-148, Los Angeles, CA, 90095, USA,
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Gould KL, Johnson NP, Bateman TM, Beanlands RS, Bengel FM, Bober R, Camici PG, Cerqueira MD, Chow BJW, Di Carli MF, Dorbala S, Gewirtz H, Gropler RJ, Kaufmann PA, Knaapen P, Knuuti J, Merhige ME, Rentrop KP, Ruddy TD, Schelbert HR, Schindler TH, Schwaiger M, Sdringola S, Vitarello J, Williams KA, Gordon D, Dilsizian V, Narula J. Anatomic versus physiologic assessment of coronary artery disease. Role of coronary flow reserve, fractional flow reserve, and positron emission tomography imaging in revascularization decision-making. J Am Coll Cardiol 2013; 62:1639-1653. [PMID: 23954338 DOI: 10.1016/j.jacc.2013.07.076] [Citation(s) in RCA: 405] [Impact Index Per Article: 36.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2013] [Revised: 07/01/2013] [Accepted: 07/24/2013] [Indexed: 12/22/2022]
Abstract
Angiographic severity of coronary artery stenosis has historically been the primary guide to revascularization or medical management of coronary artery disease. However, physiologic severity defined by coronary pressure and/or flow has resurged into clinical prominence as a potential, fundamental change from anatomically to physiologically guided management. This review addresses clinical coronary physiology-pressure and flow-as clinical tools for treating patients. We clarify the basic concepts that hold true for whatever technology measures coronary physiology directly and reliably, here focusing on positron emission tomography and its interplay with intracoronary measurements.
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Affiliation(s)
- K Lance Gould
- Weatherhead PET Center for Preventing and Reversing Atherosclerosis, Division of Cardiology, Department of Medicine, University of Texas Medical School at Houston, Houston, Texas.
| | - Nils P Johnson
- Weatherhead PET Center for Preventing and Reversing Atherosclerosis, Division of Cardiology, Department of Medicine, University of Texas Medical School at Houston, Houston, Texas
| | - Timothy M Bateman
- Mid America Heart Institute, Cardiovascular Consultants PA, and the University of Missouri-Kansas City, Kansas City, Missouri
| | - Rob S Beanlands
- Department of Medicine (Cardiology), University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Frank M Bengel
- Klinik für Nuklearmedizin, Medizinische Hochschule Hannover, Hannover, Germany
| | | | - Paolo G Camici
- Vita-Salute University San Raffaele and San Raffaele Scientific Institute, Milan, Italy
| | - Manuel D Cerqueira
- Department of Molecular & Functional Imaging, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Benjamin J W Chow
- Department of Medicine (Cardiology), University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Marcelo F Di Carli
- Cardiovascular Imaging Program, Division of Cardiovascular Medicine, and Division of Nuclear Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Sharmila Dorbala
- Cardiovascular Imaging Program, Division of Cardiovascular Medicine, and Division of Nuclear Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Henry Gewirtz
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Robert J Gropler
- Division of Radiological Sciences, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri
| | - Philipp A Kaufmann
- Cardiac Imaging and Zurich Center for Integrative Human Physiology, University Hospital Zurich, Zurich, Switzerland
| | - Paul Knaapen
- Department of Cardiology, VU University Medical Center, Amsterdam, the Netherlands
| | - Juhani Knuuti
- Turku PET Centre, University of Turku and Turku University Hospital, Turku, Finland
| | | | | | - Terrence D Ruddy
- Department of Medicine (Cardiology), University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Heinrich R Schelbert
- Department of Molecular and Medical Pharmacology, David Geffen School of Medicine at UCLA, University of California at Los Angeles, Los Angeles, California
| | - Thomas H Schindler
- Department of Specialties in Medicine, Division of Cardiology, University Hospitals of Geneva, Geneva, Switzerland
| | - Markus Schwaiger
- Nuklearmedizinische Klinik und Poliklinik der Technischen Universität München, München, Germany
| | - Stefano Sdringola
- Weatherhead PET Center for Preventing and Reversing Atherosclerosis, Division of Cardiology, Department of Medicine, University of Texas Medical School at Houston, Houston, Texas
| | - John Vitarello
- Cardiovascular Specialists of Frederick, Frederick, Maryland
| | - Kim A Williams
- Division of Cardiovascular Medicine, Wayne State University School of Medicine, Detroit, Michigan
| | - Donald Gordon
- Cardiovascular Associates of the Southeast, Birmingham, Alabama
| | - Vasken Dilsizian
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - Jagat Narula
- Zena and Michael A. Weiner Cardiovascular Institute, Mount Sinai School of Medicine, New York, New York
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Zhang X, Schindler TH, Prior JO, Sayre J, Dahlbom M, Huang SC, Schelbert HR. Blood flow, flow reserve, and glucose utilization in viable and nonviable myocardium in patients with ischemic cardiomyopathy. Eur J Nucl Med Mol Imaging 2013; 40:532-41. [PMID: 23287994 DOI: 10.1007/s00259-012-2311-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2012] [Accepted: 11/21/2012] [Indexed: 11/26/2022]
Abstract
PURPOSE The aim of the study was to determine whether glucose uptake in viable myocardium of ischemic cardiomyopathy patients depends on rest myocardial blood flow (MBF) and the residual myocardial flow reserve (MFR). METHODS Thirty-six patients with ischemic cardiomyopathy (left ventricular ejection fraction 25 ± 10 %) were studied with (13)N-ammonia and (18)F-fluorodeoxyglucose (FDG) positron emission tomography (PET). Twenty age-matched normals served as controls. Regional MBF was determined at rest and during dipyridamole hyperemia and regional FDG extraction was estimated from regional FDG to (13)N-ammonia activity ratios. RESULTS Rest MBF was reduced in viable (0.42 ± 0.18 ml/min per g) and nonviable regions (0.32 ± 0.09 ml/min per g) relative to remote regions (0.68 ± 0.23 ml/min per g, p < 0.001) and to normals (0.63 ± 0.13 ml/min per g). Dipyridamole raised MBFs in controls, remote, viable, and nonviable regions. MBFs at rest (p < 0.05) and stress (p < 0.05) in viable regions were significantly higher than that in nonviable regions, while MFRs did not differ significantly (p > 0.05). Compared to MFR in remote myocardium, MFRs in viable regions were similar (1.39 ± 0.56 vs 1.70 ± 0.45, p > 0.05) but were significantly lower in nonviable regions (1.23 ± 0.43, p < 0.001). Moreover, the FDG and thus glucose extraction was higher in viable than in remote (1.40 ± 0.14 vs 0.90 ± 0.20, p < 0.001) and in nonviable regions (1.13 ± 0.21, p < 0.001). The extraction of FDG in viable regions was independent of rest MBF but correlated inversely with MFRs (r =-0.424, p < 0.05). No correlation between the FDG extraction and MFR was observed in nonviable regions. CONCLUSION As in the animal model, decreasing MFRs in viable myocardium are associated with increasing glucose extraction that likely reflects a metabolic adaptation of remodeling hibernating myocytes.
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Affiliation(s)
- Xiaoli Zhang
- Department of Molecular and Medical Pharmacology, David Geffen School of Medicine at UCLA, University of California at Los Angeles, Los Angeles, CA 90095-6948, USA
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Affiliation(s)
- Heinrich R Schelbert
- Department of Molecular and Medical Pharmacology, David Geffen School of Medicine at UCLA, B2-085J CHS, Los Angeles, CA 90095, USA.
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Abstract
The growth of molecular imaging heightens the promise of clinical nuclear medicine as a tool for individualization of patient care and for improvement of health-care outcomes. Together with greater use of integrated structure-function imaging, clinical nuclear medicine reaches beyond traditional specialty borders into diagnostic radiology and oncology. Yet, there are concerns about the future of nuclear medicine, including progressively declining reimbursement, the competitive advantages of diagnostic radiology, limited translation of research accomplishments to clinical diagnostic imaging and patient care, and an insufficient pool of incoming highly qualified nuclear medicine clinicians. Thus, nuclear medicine views itself as being at a critical crossroads. What will be important is for nuclear medicine to be positioned as the quintessential molecular imaging modality more centrally within medical imaging and for the integration of nuclear medicine with primary care specialties to be driven more by patient needs than by specialty needs. In this way, the full potential of nuclear medicine as an effective and efficient tool for improving patient outcomes can be realized.
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Affiliation(s)
- Heinrich R Schelbert
- Department of Molecular and Medical Pharmacology, David Geffen School of Medicine at UCLA, Los Angeles, California 90095, USA.
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Valenta I, Dilsizian V, Quercioli A, Schelbert HR, Schindler TH. The Influence of Insulin Resistance, Obesity, and Diabetes Mellitus on Vascular Tone and Myocardial Blood Flow. Curr Cardiol Rep 2011; 14:217-25. [PMID: 22205177 DOI: 10.1007/s11886-011-0240-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Ines Valenta
- Department of Specialities in Medicine, Divisions of Cardiology and Nuclear Medicine, University Hospitals of Geneva, Geneva, Switzerland
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Kreissl MC, Stout DB, Wong KP, Wu HM, Caglayan E, Ladno W, Zhang X, Prior JO, Reiners C, Huang SC, Schelbert HR. Influence of dietary state and insulin on myocardial, skeletal muscle and brain [F]-fluorodeoxyglucose kinetics in mice. EJNMMI Res 2011; 1:8. [PMID: 21841971 PMCID: PMC3155201 DOI: 10.1186/2191-219x-1-8] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND We evaluated the effect of insulin stimulation and dietary changes on myocardial, skeletal muscle and brain [(18)F]-fluorodeoxyglucose (FDG) kinetics and uptake in vivo in intact mice. METHODS Mice were anesthetized with isoflurane and imaged under different conditions: non-fasted (n = 7; "controls"), non-fasted with insulin (2 IU/kg body weight) injected subcutaneously immediately prior to FDG (n = 6), fasted (n = 5), and fasted with insulin injection (n = 5). A 60-min small-animal PET with serial blood sampling and kinetic modeling was performed. RESULTS We found comparable FDG standardized uptake values (SUVs) in myocardium in the non-fasted controls and non-fasted-insulin injected group (SUV 45-60 min, 9.58 ± 1.62 vs. 9.98 ± 2.44; p = 0.74), a lower myocardial SUV was noted in the fasted group (3.48 ± 1.73; p < 0.001). In contrast, the FDG uptake rate constant (K(i)) for myocardium increased significantly by 47% in non-fasted mice by insulin (13.4 ± 3.9 ml/min/100 g vs. 19.8 ± 3.3 ml/min/100 g; p = 0.030); in fasted mice, a lower myocardial K(i) as compared to controls was observed (3.3 ± 1.9 ml/min/100 g; p < 0.001). Skeletal muscle SUVs and K(i) values were increased by insulin independent of dietary state, whereas in the brain, those parameters were not influenced by fasting or administration of insulin. Fasting led to a reduction in glucose metabolic rate in the myocardium (19.41 ± 5.39 vs. 3.26 ± 1.97 mg/min/100 g; p < 0.001), the skeletal muscle (1.06 ± 0.34 vs. 0.34 ± 0.08 mg/min/100 g; p = 0.001) but not the brain (3.21 ± 0.53 vs. 2.85 ±0.25 mg/min/100 g; p = 0.19). CONCLUSIONS Changes in organ SUVs, uptake rate constants and metabolic rates induced by fasting and insulin administration as observed in intact mice by small-animal PET imaging are consistent with those observed in isolated heart/muscle preparations and, more importantly, in vivo studies in larger animals and in humans. When assessing the effect of insulin on the myocardial glucose metabolism of non-fasted mice, it is not sufficient to just calculate the SUV - dynamic imaging with kinetic modeling is necessary.
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Affiliation(s)
- Michael C Kreissl
- Department of Molecular and Medical Pharmacology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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Di Carli MF, Charytan D, McMahon GT, Ganz P, Dorbala S, Schelbert HR. Coronary circulatory function in patients with the metabolic syndrome. J Nucl Med 2011; 52:1369-77. [PMID: 21849399 DOI: 10.2967/jnumed.110.082883] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
UNLABELLED The metabolic syndrome affects 25% of the U.S. population and greatly increases the risk of diabetes and coronary artery disease (CAD). We tested the hypothesis that the metabolic syndrome is associated with impaired coronary vasodilator function, a marker of atherosclerotic disease activity. METHODS Four hundred sixty-two patients at risk for CAD, as defined by a low-density lipoprotein cholesterol ≥ 160 mg/dL with fewer than 2 coronary risk factors, a low-density lipoprotein cholesterol ≥ 130 mg/dL with 2 or more coronary risk factors, or with documented CAD were included. A subset of 234 individuals underwent repeated PET at 1 y. Myocardial blood flow (MBF) and vasodilator reserve were assessed by PET. Modified criteria of the National Cholesterol Education Program, Adult Treatment Panel III were used to characterize the metabolic syndrome. RESULTS Adenosine- and cold-stimulated MBF were similar in patients with and without metabolic syndrome, whereas baseline MBF showed a stepwise increase with increasing features of the syndrome. Consequently, patients with metabolic syndrome showed a lower coronary flow reserve (CFR) (2.5 ± 1.0) than those without metabolic syndrome (3.0 ± 0.9, P = 0.004). Differences in CFR were no longer present after correcting rest flows for the rate-pressure product. Change in MBF and CFR at 1 y were not different across groups of patients with increasing features of the metabolic syndrome. CONCLUSION Patients with metabolic syndrome demonstrate impaired CFR, which is related to the augmentation in resting coronary blood flow caused by hypertension. In high-risk individuals, peak adenosine- and cold-stimulated blood flows are impaired even in the absence of the metabolic syndrome.
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Affiliation(s)
- Marcelo F Di Carli
- Departments of Medicine Cardiology and Radiology, and Division of Nuclear Medicine and Molecular Imaging, Brigham and Women's Hospital, Harvard Medical School, Boston Massachusetts, USA.
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Schindler TH, Cadenas J, Facta AD, Li Y, Olschewski M, Sayre J, Goldin J, Schelbert HR. Improvement in coronary endothelial function is independently associated with a slowed progression of coronary artery calcification in type 2 diabetes mellitus. Eur Heart J 2011; 30:3064-73. [PMID: 19914919 DOI: 10.1093/eurheartj/ehp482] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
AIMS To examine a relationship between alterations of structure and function of the arterial wall in response to glucose-lowering therapy in type 2 diabetes mellitus (DM) after a 1-year follow-up (FU). METHODS AND RESULTS In DM (n = 22) and in healthy controls (n = 17), coronary artery calcification (CAC) was assessed with electron beam tomography and carotid intima-media thickness (IMT) with ultrasound, whereas coronary function was determined with positron emission tomography-measured myocardial blood flow (MBF) at rest, during cold pressor testing (CPT), and during adenosine stimulation at baseline and after FU. The decrease in plasma glucose in DM after a mean FU of 14 +/- 1.9 months correlated with a lower progression of CAC and carotid IMT (r = 0.48, P < or = 0.036 and r = 0.46, P < or = 0.055) and with an improvement in endothelium-related DeltaMBF to CPT and to adenosine (r = 0.46, P < or = 0.038 and r = 0.36, P < or = 0.056). After adjusting for metabolic parameters by multivariate analysis, the increases in DeltaMBF to CPT after glucose-lowering treatment remained a statistically significant independent predictor of the progression of CAC (P < or = 0.001 by one-way analysis of variance). CONCLUSION In DM, glucose-lowering treatment may beneficially affect structure and function of the vascular wall, whereas the observed improvement in endothelium-related coronary artery function may also mediate direct preventive effects on the progression of CAC.
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Affiliation(s)
- Thomas H Schindler
- Department of Molecular and Medical Pharmacology, David Geffen School of Medicine at UCLA, University of California at Los Angeles, 650 Charles E. Young Drive South, B2-085J CHS, Box 95648, Los Angeles, CA 90095-6948, USA
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Schindler TH, Schelbert HR, Quercioli A, Dilsizian V. Cardiac PET imaging for the detection and monitoring of coronary artery disease and microvascular health. JACC Cardiovasc Imaging 2010; 3:623-40. [PMID: 20541718 DOI: 10.1016/j.jcmg.2010.04.007] [Citation(s) in RCA: 278] [Impact Index Per Article: 19.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2010] [Revised: 04/21/2010] [Accepted: 04/26/2010] [Indexed: 12/11/2022]
Abstract
Positron emission tomography (PET) myocardial perfusion imaging in concert with tracer-kinetic modeling affords the assessment of regional myocardial blood flow (MBF) of the left ventricle in absolute terms (milliliters per gram per minute). Assessment of MBF both at rest and during various forms of vasomotor stress provides insight into early and subclinical abnormalities in coronary arterial vascular function and/or structure, noninvasively. The noninvasive evaluation and quantification of MBF and myocardial flow reserve (MFR) extend the scope of conventional myocardial perfusion imaging from detection of end-stage, advanced, and flow-limiting, epicardial coronary artery disease (CAD) to early stages of atherosclerosis or microvascular dysfunction. Recent studies have shown that impaired hyperemic MBF or MFR with PET, with or without accompanying CAD, is predictive of increased relative risk of death or progression of heart failure. Quantitative approaches that measure MBF with PET identify multivessel CAD and offer the opportunity to monitor responses to lifestyle and/or risk factor modification and to therapeutic interventions. Whether improvement or normalization of hyperemic MBF and/or the MFR will translate to improvement in long-term cardiovascular outcome remains clinically untested. In the meantime, absolute measures of MBF with PET can be used as a surrogate marker for coronary vascular health, and to monitor therapeutic interventions. Although the assessment of myocardial perfusion with PET has become an indispensable tool in cardiac research, it remains underutilized in clinical practice. Individualized, image-guided cardiovascular therapy may likely change this paradigm in the near future.
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Affiliation(s)
- Thomas H Schindler
- Nuclear Cardiology and Cardiac Imaging, Division of Cardiology, Department of Medicine, University Hospitals of Geneva, Geneva, Switzerland.
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Affiliation(s)
- Heinrich R Schelbert
- Department of Molecular and Medical Pharmacology, David Geffen School of Medicine at UCLA, University of California at Los Angeles, B2-085J CHS, 650 Charles E. Young Drive South, Los Angeles, CA 90095, USA.
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Abstract
Quantification of regional myocardial blood flow and of its responses to targeted physiologic and pharmacologic interventions, which is now available with positron emitting tracers of blood flow and positron emission tomography (PET), extends the diagnostic potential of standard myocardial perfusion imaging. These noninvasive flow measurements serve as tools for quantifying functional consequences of epicardial coronary artery disease, as well as of impairments in microcirculatory reactivity that escape detection by standard perfusion imaging. Flow measurements are clinically useful for more comprehensively assessing the extent and severity of coronary vascular disease or impairments in microcirculatory function in noncoronary cardiac disease. Flow estimates in these disorders contain independent or unique prognostic information about future major cardiac events. Flow measurements are also useful for assessing the coronary risk, for predicting long-term cardiovascular events, and for monitoring the effectiveness of risk reduction strategies.
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Affiliation(s)
- Heinrich R Schelbert
- Department of Molecular and Medical Pharmacology, David Geffen School of Medicine at UCLA, University of California at Los Angeles, Los Angeles, CA 90095-6948, USA.
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Dilsizian V, Bacharach SL, Beanlands RS, Bergmann SR, Delbeke D, Gropler RJ, Knuuti J, Schelbert HR, Travin MI. PET myocardial perfusion and metabolism clinical imaging. J Nucl Cardiol 2009. [DOI: 10.1007/s12350-009-9094-9] [Citation(s) in RCA: 112] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Knaapen P, Camici PG, Marques KM, Nijveldt R, Bax JJ, Westerhof N, Götte MJW, Jerosch-Herold M, Schelbert HR, Lammertsma AA, van Rossum AC. Coronary microvascular resistance: methods for its quantification in humans. Basic Res Cardiol 2009; 104:485-98. [PMID: 19468781 PMCID: PMC2722717 DOI: 10.1007/s00395-009-0037-z] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2008] [Revised: 05/11/2009] [Accepted: 05/13/2009] [Indexed: 12/20/2022]
Abstract
Coronary microvascular dysfunction is a topic that has recently gained considerable interest in the medical community owing to the growing awareness that microvascular dysfunction occurs in a number of myocardial disease states and has important prognostic implications. With this growing awareness, comes the desire to accurately assess the functional capacity of the coronary microcirculation for diagnostic purposes as well as to monitor the effects of therapeutic interventions that are targeted at reversing the extent of coronary microvascular dysfunction. Measurements of coronary microvascular resistance play a pivotal role in achieving that goal and several invasive and noninvasive methods have been developed for its quantification. This review is intended to provide an update pertaining to the methodology of these different imaging techniques, including the discussion of their strengths and weaknesses.
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Affiliation(s)
- Paul Knaapen
- Department of Cardiology, VU University Medical Center, Amsterdam, The Netherlands.
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Schindler TH, Campisi R, Dorsey D, Prior JO, Olschewski M, Sayre J, Schelbert HR. Effect of hormone replacement therapy on vasomotor function of the coronary microcirculation in post-menopausal women with medically treated cardiovascular risk factors. Eur Heart J 2009; 30:978-86. [PMID: 19251725 DOI: 10.1093/eurheartj/ehp013] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
AIMS The aim of this study was to evaluate the effect of hormone replacement therapy (HRT) on coronary vasomotor function in post-menopausal women (PM) with medically treated cardiovascular risk factors (RFs) in a cross-sectional and a longitudinal follow-up (FU) study. METHODS AND RESULTS Myocardial blood flow (MBF) response to cold pressor testing (CPT) and during pharmacologically induced hyperaemia was measured with positron emission tomography in pre-menopausal women (CON), in PM with HRT and without HRT, and repeated in PM after a mean FU of 24 +/- 14 months. When compared with CON at baseline, the endothelium-related change in MBF (DeltaMBF) to CPT progressively declined in PM with HRT and without HRT (0.35 +/- 0.23 vs. 0.24 +/- 0.20 and 0.16 +/- 0.12 mL/g/min; P = 0.171 and P = 0.021). In PM without HRT and in those with HRT at baseline but with discontinuation of HRT during FU, the endothelium-related DeltaMBF to CPT was significantly less at FU than at baseline (0.05 +/- 0.19 vs. 0.16 +/- 0.12 and -0.03 +/- 0.14 vs. 0.25 +/- 0.18 mL/g/min; P = 0.023 and P = 0.001), whereas no significant change was observed in PM with HRT (0.19 +/- 0.22 vs. 0.23 +/- 0.22 mL/g/min; P = 0.453). Impaired hyperaemic MBFs when compared with CON were not significantly altered from those at baseline exam. CONCLUSION Long-term administration of oestrogen may contribute to maintain endothelium-dependent coronary function in PM with medically treated cardiovascular RFs.
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Affiliation(s)
- Thomas H Schindler
- Department of Molecular and Medical Pharmacology, David Geffen School of Medicine at UCLA, University of California at Los Angeles, 10833 Le Conte Ave, 23-120 CHS, Box 173517, Los Angeles, CA 90095-1735, USA
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Schelbert HR. Coronary Circulatory Function Abnormalities in Insulin Resistance. J Am Coll Cardiol 2009; 53:S3-8. [DOI: 10.1016/j.jacc.2008.09.053] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2008] [Revised: 09/16/2008] [Accepted: 09/29/2008] [Indexed: 11/28/2022]
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Zhang XL, Liu XJ, Hu SS, Thomas S, Tian YQ, Gao RL, Wu QY, Wei HX, Yang XB, Wang H, He ZX, Schelbert HR. [Impact of viable myocardium assessed by 99Tcm-MIBI SPECT and 18F-FDG PET imaging on clinical outcome of patients with left ventricular aneurysm underwent revascularization]. Zhonghua Xin Xue Guan Bing Za Zhi 2008; 36:999-1003. [PMID: 19102913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
OBJECTIVE To evaluate the impact of viable myocardium assessed by (99)Tc()m-MIBI SPECT and (18)F-fluorodeoxyglucose (FDG) PET imaging in patients with left ventricular aneurysm (LVA) underwent revascularization (RVS). METHODS Forty-six consecutive patients with LVA (mean LVEF 36% +/- 7%), underwent (99)Tc(m)-sestamibi SPECT and (18)F-FDG PET examinations and received RVS therapy, were followed-up for a mean period of 80 +/- 27 months. Viable myocardium in aneurysm was defined as perfusion-metabolism mismatch score (MMS) >/= 2.0. Patients were divided into four groups by aneurysm viability and aneurysmectomy. Group A1 (n = 8): viability-; Group A2 (n = 15): viability-, aneurysmectomy; Group B1 (n = 10): viability +; and Group B2 (n = 13): viability +, aneurysmectomy. RESULTS The cardiac event rates during follow up were similar among groups [A1 (25%, 2/8), B1 (40%, 6/15), A2 (20%, 2/10) and B2 (31%, 4/13; P > 0.05)]. After revascularization, LVEF was improved (> 10%) in groups A2, B1 and B2 (P < 0.05). Multivariate logistic regression analysis showed that LV-MMS (OR = 2.34, 95% CI 1.08 - 5.06, P < 0.05), distal vessel disease (OR = 0.008, 95% CI 0.001 - 0.560, P < 0.05) and nonaneurysm perfusion score (OR = 0.24, 95% CI 0.07 - 0.85, P < 0.05) were significantly associated with the improvement of LVEF after revascularization. CONCLUSIONS Long term cardiac events rate post revascularization was not affected by viable myocardium or aneurysmectomy in LVA patients. Viable myocardium in LVA patients was associated with better LVEF improvement after revascularization.
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Affiliation(s)
- Xiao-li Zhang
- Department of Nuclear Medicine, Cardiovascular Institute and Fu Wai Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100037, China.
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Schindler TH, Facta AD, Prior JO, Cadenas J, Zhang XL, Li Y, Sayre J, Goldin J, Schelbert HR. Structural alterations of the coronary arterial wall are associated with myocardial flow heterogeneity in type 2 diabetes mellitus. Eur J Nucl Med Mol Imaging 2008; 36:219-29. [PMID: 18704406 DOI: 10.1007/s00259-008-0885-z] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2007] [Accepted: 07/11/2008] [Indexed: 11/26/2022]
Abstract
PURPOSE To determine the relationship between carotid intima-media thickness (IMT), coronary artery calcification (CAC), and myocardial blood flow (MBF) at rest and during vasomotor stress in type 2 diabetes mellitus (DM). METHODS In 68 individuals, carotid IMT was measured using high-resolution vascular ultrasound, while the presence of CAC was determined with electron beam tomography (EBT). Global and regional MBF was determined in milliliters per gram per minute with (13)N-ammonia and positron emission tomography (PET) at rest, during cold pressor testing (CPT), and during adenosine (ADO) stimulation. RESULTS There was neither a relationship between carotid IMT and CAC (r = 0.10, p = 0.32) nor between carotid IMT and coronary circulatory function in response to CPT and during ADO (r = -0.18, p = 0.25 and r = 0.10, p = 0.54, respectively). In 33 individuals, EBT detected CAC with a mean Agatston-derived calcium score of 44 +/- 18. There was a significant difference in regional MBFs between territories with and without CAC at rest and during ADO-stimulated hyperemia (0.69 +/- 0.24 vs. 0.74 +/- 0.23 and 1.82 +/- 0.50 vs. 1.95 +/- 0.51 ml/g/min; p < or = 0.05, respectively) and also during CPT in DM but less pronounced (0.81 +/- 0.24 vs. 0.83 +/- 0.23 ml/g/min; p = ns). The increase in CAC was paralleled with a progressive regional decrease in resting as well as in CPT- and ADO-related MBFs (r = -0.36, p < or = 0.014; r = -0.46, p < or = 0.007; and r = -0.33, p < or = 0.041, respectively). CONCLUSIONS The absence of any correlation between carotid IMT and coronary circulatory function in type 2 DM suggests different features and stages of early atherosclerosis in the peripheral and coronary circulation. PET-measured MBF heterogeneity at rest and during vasomotor stress may reflect downstream fluid dynamic effects of coronary artery disease (CAD)-related early structural alterations of the arterial wall.
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Affiliation(s)
- Thomas H Schindler
- Department of Molecular and Medical Pharmacology, Radiological Science, David Geffen School of Medicine, University of California at Los Angeles, 10833 Le Conte Avenue, 23-120 CHS, P.O. Box 173517, Los Angeles, CA 90095-1735, USA
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Strauss HW, Miller DD, Wittry MD, Cerqueira MD, Garcia EV, Iskandrian AS, Schelbert HR, Wackers FJ, Balon HR, Lang O, Machac J. Procedure guideline for myocardial perfusion imaging 3.3. J Nucl Med Technol 2008; 36:155-61. [PMID: 18703619 DOI: 10.2967/jnmt.108.056465] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- H William Strauss
- Memorial Sloan Kettering Cancer Center, New York, New York 10021, USA.
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Zhang X, Liu XJ, Hu S, Schindler TH, Tian Y, He ZX, Gao R, Wu Q, Wei H, Sayre JW, Schelbert HR. Long-Term Survival of Patients with Viable and Nonviable Aneurysms Assessed by 99mTc-MIBI SPECT and 18F-FDG PET: A Comparative Study of Medical and Surgical Treatment. J Nucl Med 2008; 49:1288-98. [DOI: 10.2967/jnumed.107.046730] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Affiliation(s)
- Thomas H Schindler
- Nuclear Cardiology, Cardiovascular Center, University Hospital of Geneva, Geneva, Switzerland.
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Schindler TH, Zhang XL, Prior JO, Cadenas J, Dahlbom M, Sayre J, Schelbert HR. Assessment of intra- and interobserver reproducibility of rest and cold pressor test-stimulated myocardial blood flow with 13N-ammonia and PET. Eur J Nucl Med Mol Imaging 2007; 34:1178-88. [PMID: 17334762 DOI: 10.1007/s00259-007-0378-5] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2006] [Accepted: 01/04/2007] [Indexed: 10/23/2022]
Abstract
PURPOSE We investigated the intraobserver reproducibility of myocardial blood flow (MBF) measurements with PET at rest and during cold pressor test (CPT), and the interobserver agreement. METHODS Twenty normal volunteers were studied. Using (13)N-ammonia, MBF was measured at rest and during CPT and measurement was repeated in a 1-day session (short-term reproducibility; SR). After a follow-up of 2 weeks, MBF was measured again at rest and during CPT and compared with the initial baseline measurement (long-term reproducibility; LR). In addition, adenosine-induced hyperemic MBF increases were assessed. RESULTS Assessment of the SR did not show a significant absolute difference in MBF at rest, MBF during CPT or the endothelium-related change in MBF from rest to CPT (DeltaMBF) (0.09 +/- 0.10, 0.11 +/- 0.09, and 0.08 +/- 0.05 ml/g/min; p = NS), and they were linearly correlated (r = 0.72, r = 0.76 and r = 0.84; p < 0.0001). Corresponding values for standard error of the estimate (SEE), as indicative for the range of MBF measurement error, were 0.14, 0.14, and 0.09 ml/g/min. The LR yielded relatively higher but non-significant absolute differences in the MBF at rest, MBF during CPT and DeltaMBF (0.10 +/- 0.10, 0.14 +/- 0.10, and 0.19 +/- 0.10 ml/g/min; p = NS), and paired MBFs significantly correlated (r = 0.75, r = 0.71, and r = 0.60; p < 0.001). Corresponding SEEs were 0.13, 0.15, and 0.16 ml/g/min. The interobserver analysis yielded a high correlation for MBF at rest, MBF during CPT, and hyperemic MBF (r = 0.96, SEE=0.04; r = 0.78, SEE=0.11; and r = 0.87, SEE=0.28; p < 0.0001, respectively), and also a good interobserver correlation for DeltaMBF (r = 0.62, SEE=0.09; p < 0.003). CONCLUSION Short- and long-term MBF responses to CPT, as an index for endothelium-related coronary vasomotion, can be measured reproducibly with (13)N-ammonia PET. In addition, the high interobserver reproducibility for repeat analysis of MBF values suggests the measurements to be largely operator independent.
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Affiliation(s)
- Thomas H Schindler
- Department of Molecular and Medical Pharmacology, David Geffen School of Medicine at UCLA, University of California at Los Angeles, 10833 Le Conte Avenue, Los Angeles, CA 90095-1735, USA.
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Machac J, Bacharach SL, Bateman TM, Bax JJ, Beanlands R, Bengel F, Bergmann SR, Brunken RC, Case J, Delbeke D, DiCarli MF, Garcia EV, Goldstein RA, Gropler RJ, Travin M, Patterson R, Schelbert HR. Positron emission tomography myocardial perfusion and glucose metabolism imaging. J Nucl Cardiol 2007; 13:e121-51. [PMID: 17174789 DOI: 10.1016/j.nuclcard.2006.08.009] [Citation(s) in RCA: 104] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Czernin J, Schelbert HR. PET/CT in cancer patient management. Introduction. J Nucl Med 2007; 48 Suppl 1:2S-3S. [PMID: 17204715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2023] Open
Affiliation(s)
- Johannes Czernin
- David Geffen School of Medicine, UCLA, Los Angeles, California, USA
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Czernin J, Allen-Auerbach M, Schelbert HR. Improvements in cancer staging with PET/CT: literature-based evidence as of September 2006. J Nucl Med 2007; 48 Suppl 1:78S-88S. [PMID: 17204723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2023] Open
Abstract
PET/CT with 18F-FDG is increasingly being used for staging, restaging, and treatment monitoring for cancer patients. CT is still frequently used only for attenuation correction and lesion localization. However, increasing sales of high-end scanners that combine PET with 64-detector CT strongly suggest that the field is moving toward a comprehensive concept, whereby diagnostic CT studies during intravenous contrast material application are combined with the highest-quality PET studies. At many institutions, in-line PET/CT has replaced separately acquired PET and CT examinations for many oncologic indications. This replacement has occurred despite the fact that only a relatively small number of well-designed prospective studies have verified imaging findings against the gold standard of histopathologic tissue evaluation. However, a large number of studies have used acceptable reference standards, such as pathology, imaging, and other clinical follow-up findings, for validating PET/CT findings. From these data, we believe, has emerged reliable evidence in support of the notion that PET/CT offers diagnostic advantages over its individual components for the major cancers.
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Affiliation(s)
- Johannes Czernin
- Department of Molecular and Medical Pharmacology, Ahmanson Biological Imaging Clinic/Nuclear Medicine, David Geffen School of Medicine, UCLA, Los Angeles, California 90095-6948, USA.
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Dorbala S, Hassan A, Heinonen T, Schelbert HR, Di Carli MF. Coronary vasodilator reserve and Framingham risk scores in subjects at risk for coronary artery disease. J Nucl Cardiol 2006; 13:761-7. [PMID: 17174807 DOI: 10.1016/j.nuclcard.2006.09.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2006] [Accepted: 09/21/2006] [Indexed: 10/23/2022]
Abstract
BACKGROUND The relationship between coronary vasodilator reserve and risk of coronary heart disease (CHD) in subjects without coronary artery disease (CAD) is not well known. METHODS AND RESULTS We studied 289 subjects (mean age, 58 +/- 10 years) without overt CAD and at low (< 10%) to intermediate risk (10%-20%) for CHD based on Framingham risk scores (RAMPART [Relative and Absolute Myocardial Perfusion changes as measured by Positron Emission Tomography to Assess the Effects of ACAT Inhibition: A Double-Blind, Randomized, Controlled, Multicenter Trial]). Coronary flow reserve (CFR) and coronary vascular resistance (CVR) were calculated from rest and adenosine nitrogen 13 ammonia positron emission tomography studies. Framingham-estimated CHD risk was used to as a surrogate for outcomes. Compared with subjects with low-risk scores (n = 150), those with intermediate-risk scores (n = 139) had a higher minimal CVR (49.3 +/- 17.41 mm Hg x mL(-1) x min(-1) x g(-1) vs 52.4 +/- 16.4 mm Hg x mL(-1) x min(-1) x g(-1), P = .05) and lower CFR (2.8 +/- 1.0 vs 2.5 +/- 0.8, P = .02). CFR was inversely related to CHD risk (R = -0.2, P = .006), and CVR was directly related to CHD risk (R = 0.2, P < .001). The mean CFR was significantly lower in patients in the first quartile of CHD risk compared with those in the fourth quartile (2.3 +/- 0.7 vs 2.8 +/- 1.0, P = .02), and the minimal CVR was significantly higher (44 +/- 15 mm Hg x mL(-1) x min(-1) x g(-1) vs 53 +/- 14 mm Hg x mL(-1) x min(-1) x g(-1), P < or = .05). CONCLUSIONS In subjects without clinical CAD and at low to intermediate risk, CFR assessed by positron emission tomography is inversely related to estimated 10-year CHD risk.
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Affiliation(s)
- Sharmila Dorbala
- Division of Nuclear Medicine/PET, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass, USA.
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Schindler TH, Facta AD, Prior JO, Cadenas J, Hsueh WA, Quinones MJ, Schelbert HR. Improvement in coronary vascular dysfunction produced with euglycaemic control in patients with type 2 diabetes. Heart 2006; 93:345-9. [PMID: 16940388 PMCID: PMC1861464 DOI: 10.1136/hrt.2006.094128] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To determine the effect of plasma glucose lowering on coronary circulatory function in type 2 diabetes mellitus. METHODS Twenty patients with type 2 diabetes and 18 weight-matched controls were studied. At baseline, myocardial blood flow (MBF) was measured with [(13)N]ammonia and positron emission tomography at rest, during cold pressor testing (CPT), and during adenosine hyperaemia. In diabetic patients, MBF and blood chemistry were analysed again after 3 months of glucose-lowering treatment with glyburide and metformin. RESULTS Although hyperaemic MBF did not differ significantly between the patients and controls (1.81 (0.38) v 1.97 (0.43) ml/min/g; mean (SD)), the CPT-induced MBF increase (DeltaMBF) was significantly less in diabetic patients than in controls (0.07 (0.07) v 0.25 (0.12) ml/min/g; p<0.001). Treatment with glyburide and metformin significantly decreased plasma glucose concentrations from 207 (76) to 134 (52) mg/dl (p<0.001). This decrease in plasma glucose was paralleled by a significant increase in DeltaMBF in response to CPT (0.20 (0.16) from 0.07 (0.07) ml/min/g; p<0.001), which tended to be lower than in controls at baseline (0.20 (0.16) v 0.25 (0.12) ml/min/g; p = NS). The decrease in plasma glucose concentrations correlated significantly with the improvement in DeltaMBF in response to CPT (r = 0.67, p<0.01). CONCLUSIONS Type 2 diabetes mellitus is associated with abnormal MBF response to CPT, which can be significantly improved by euglycaemic control with glyburide and metformin. The close association between the decrease in plasma glucose concentration and the improvement in coronary vasomotor function in response to CPT suggests a direct adverse effect of raised plasma glucose concentration on diabetes-related coronary vascular disease.
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Affiliation(s)
- T H Schindler
- Department of Molecular and Medical Pharmacology, David Geffen School of Medicine at UCLA, University of California at Los Angeles, Los Angeles, CA 90095-1735, USA
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Prior JO, Schindler TH, Facta AD, Hernandez-Pampaloni M, Campisi R, Dahlbom M, Schelbert HR. Determinants of myocardial blood flow response to cold pressor testing and pharmacologic vasodilation in healthy humans. Eur J Nucl Med Mol Imaging 2006; 34:20-7. [PMID: 16902794 DOI: 10.1007/s00259-006-0193-4] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2006] [Revised: 05/06/2006] [Accepted: 06/09/2006] [Indexed: 10/24/2022]
Abstract
PURPOSE Response of myocardial blood flow (MBF) to sympathetic stimulation with cold is modulated by endothelium-related factors and is typically altered in the presence of coronary risk factors. Determinants of flow response to cold pressor testing (CPT) in normal volunteers at low risk for CAD remain less well defined, especially relative to baseline conditions such as hemodynamics and MBF, plasma substrate and lipid levels, and total pharmacologically stimulated vasodilator capacity. METHODS In 50 normal volunteers (42+/-13 years; 31 women) without coronary risk factors, insulin resistance, or family history of diabetes/premature CAD, MBF was measured with (13)N-ammonia and PET at baseline, during CPT, and during pharmacologic hyperemia. RESULTS Sympathetic stimulation with CPT raised heart rate and blood pressure and thus MBF (Delta MBF=0.23+/-0.09 ml/min/g). MBF response, defined in absolute flow units as the difference between CPT and baseline, was independent of age, gender, heart rate, and blood pressure and rate-pressure product (RPP) at baseline as well as plasma substrate and lipid levels with the exception of an association with HDL cholesterol (rho=0.40, p=0.005) but depended on the change in RPP from rest (rho=0.33, p=0.019). Finally, changes in coronary vascular resistance in response to CPT were associated with changes in pharmacologic vasodilation (rho=0.56, p<0.0001). CONCLUSION MBF response to sympathetic stimulation with cold (NO-mediated endothelium-dependent vasomotion), reflecting the functional state of the coronary endothelium, was independent of gender, age, and resting heart conditions. It was modulated by HDL cholesterol levels, even in healthy volunteers, and also related to pharmacologically stimulated vasodilator capacity at the coronary vascular resistance level.
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Affiliation(s)
- John O Prior
- Department of Molecular and Medical Pharmacology, David Geffen School of Medicine at UCLA, B2-085J CHS, 10833 Le Conte Ave, Box 956948, Los Angeles, CA 90095-6948, USA
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Kreissl MC, Wu HM, Stout DB, Ladno W, Schindler TH, Zhang X, Prior JO, Prins ML, Chatziioannou AF, Huang SC, Schelbert HR. Noninvasive measurement of cardiovascular function in mice with high-temporal-resolution small-animal PET. J Nucl Med 2006; 47:974-80. [PMID: 16741307 PMCID: PMC4348007] [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] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/09/2023] Open
Abstract
UNLABELLED The aim of this study was to explore the feasibility of determining parameters of cardiovascular function in mice noninvasively by high-temporal-resolution imaging with a dedicated small-animal PET system. METHODS Twenty-five anesthetized mice (28.8 +/- 4.6 g) were injected via an intravenous catheter with a 30-microL bolus of (18)F-FDG (8-44 MBq). The first 9 s of data were reconstructed into 30 frames of 0.3 s using filtered backprojection. The time-activity curve derived from a left ventricle volume of interest was corrected for tracer recirculation and partial volume. Cardiac output was calculated by the Stewart-Hamilton method, in which cardiac output is total injected activity divided by the area under the left ventricle time-activity curve. Cardiac output divided by body weight was defined as cardiac index; cardiac output divided by heart rate yielded the stroke volume. In 5 mice, measurements were repeated 2-4 times to assess reproducibility. In 4 mice, the hemodynamic response to dobutamine was examined by measuring heart rate, cardiac output, and stroke volume. RESULTS The cardiac output averaged 20.4 +/- 3.4 mL/min; in the repeated measurements, the parameter displayed a mean percentage SD per mouse of 10% +/- 6%. The cardiac index averaged 0.73 +/- 0.19 mL/min/g and the stroke volume 45.0 +/- 6.9 microL, and both correlated with heart rate (r = 0.53, P = 0.007, and r = 0.49, P = 0.01, respectively). During dobutamine stress, heart rate increased from 423 +/- 50 to 603 +/- 30 beats/min (P = 0.002) and cardiac output increased from 18.5 +/- 1.9 to 32.0 +/- 4.2 mL/min (P = 0.008). CONCLUSION Parameters of cardiovascular function can be measured in mice noninvasively by radionuclide angiography using high-temporal-resolution small-animal PET. Measured values of cardiac output and stroke volume are reproducible and comparable to those obtained with MRI. The approach permits the monitoring of changes in cardiovascular function in response to pharmacologic intervention.
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Affiliation(s)
- Michael C Kreissl
- Department of Molecular and Medical Pharmacology, David Geffen School of Medicine at UCLA, University of California, Los Angeles, California, USA.
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Schindler TH, Facta AD, Prior JO, Campisi R, Inubushi M, Kreissl MC, Zhang XL, Sayre J, Dahlbom M, Schelbert HR. PET-measured heterogeneity in longitudinal myocardial blood flow in response to sympathetic and pharmacologic stress as a non-invasive probe of epicardial vasomotor dysfunction. Eur J Nucl Med Mol Imaging 2006; 33:1140-9. [PMID: 16639609 DOI: 10.1007/s00259-006-0069-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2005] [Accepted: 12/16/2005] [Indexed: 10/24/2022]
Abstract
PURPOSE We investigated whether a myocardial perfusion gradient during pharmacologically induced hyperemia also occurred during sympathetic stimulation with cold pressor testing (CPT), which commonly induces a paradoxical coronary vasoconstriction in individuals with coronary risk factors. METHODS Myocardial blood flow (MBF) was measured in absolute units (ml/g/min) with 13N-ammonia and PET at rest, during CPT, and during pharmacologic vasodilation in 59 participants with coronary risk factors ("at risk") and in 43 healthy individuals (controls). MBF was assessed globally as mean MBF, and in the mid and mid-distal myocardium of the left ventricle (LV). A decrease in MBF from mid to mid-distal LV myocardium was defined as MBF difference indicative of a perfusion gradient. RESULTS The change in mean MBF to CPT (DeltaMBF) in the at-risk group was significantly reduced compared with controls (0.05+/-0.19 vs 0.31+/-0.20 ml/g/min, p<0.0001), whereas mean MBF during pharmacologic vasodilation in the at-risk group tended to be lower than in controls (1.72+/-0.71 vs 2.00+/-0.64 ml/g/min, p=NS). Absolute MBFs during CPT and pharmacologic vasodilation were significantly lower in the mid-distal than in the mid LV myocardium, resulting in a significant MBF difference in the at-risk group (0.15+/-0.06 and 0.27+/-0.12 ml/g/min, p<0.0001) that was not observed in controls (0.007+/-0.05 and 0.014+/-0.10 ml/g/min, p=NS). In the at-risk group there was a significant correlation between the difference of mid to mid-distal MBF during CPT and that during pharmacologic vasodilation (r=0.43, p<0.004), suggesting functional alterations of epicardial vessels as the predominant cause for the observed MBF difference. CONCLUSION The relative decrease in MBF from the mid to the mid-distal left-ventricular myocardium suggests an intracoronary pressure decline during CPT and pharmacologic vasodilation, which is likely to reflect an impairment of flow-mediated epicardial vasomotor function.
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Affiliation(s)
- Thomas H Schindler
- Department of Molecular and Medical Pharmacology, David Geffen School of Medicine at UCLA, University of California at Los Angeles, 10833 Le Conte Ave, 23-120 CHS, P.O. Box 173517, Los Angeles, CA 90095-1735, USA
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Schindler TH, Cardenas J, Prior JO, Facta AD, Kreissl MC, Zhang XL, Sayre J, Dahlbom M, Licinio J, Schelbert HR. Relationship between increasing body weight, insulin resistance, inflammation, adipocytokine leptin, and coronary circulatory function. J Am Coll Cardiol 2006; 47:1188-95. [PMID: 16545651 DOI: 10.1016/j.jacc.2005.10.062] [Citation(s) in RCA: 162] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2005] [Revised: 09/30/2005] [Accepted: 10/10/2005] [Indexed: 10/25/2022]
Abstract
OBJECTIVES We sought to evaluate effects of obesity, insulin resistance, and inflammation on coronary circulatory function and its relationship to leptin plasma levels. BACKGROUND It is not known whether obesity, commonly paralleled by insulin resistance, inflammation, and leptin, is independently associated with coronary circulatory dysfunction. METHODS Myocardial blood flow (MBF) responses to cold pressor test (CPT) and pharmacologic vasodilation was measured with positron emission tomography and 13N-ammonia. Study participants were divided into three groups based on their body mass index (BMI, kg/m2): control, 20 < or = BMI <25 (n = 19); overweight, 25 < or = BMI <30 (n = 21); and obese, BMI >30 (n = 32). RESULTS Body mass index was significantly correlated to the Homeostasis Model Assessment Index of insulin resistance and C-reactive protein levels (r = 0.60 and r = 0.47, p < 0.0001). Compared with control subjects, endothelium-related change in MBF (DeltaMBF) to CPT progressively declined in overweight and obese groups (0.32 +/- 0.09 vs. 0.21 +/- 0.19 and 0.07 +/- 0.16 ml/g/min; p < 0.03 and p < 0.0001). The dipyridamole-induced total vasodilator capacity was significantly lower in obese than in control subjects (1.77 +/- 0.51 vs. 2.04 +/- 0.37 ml/g/min, p < 0.02). On multivariate analysis, BMI (p < 0.012) and age (p < 0.035) were significant independent predictors of DeltaMBF. Finally, only in the obese group leptin plasma levels significantly correlated with DeltaMBF (r = 0.37, p < 0.036). CONCLUSIONS Increased body weight is independently associated with abnormal coronary circulatory function that progresses from an impairment in endothelium-related coronary vasomotion in overweight individuals to an impairment of the total vasodilator capacity in obese individuals. The findings that elevated leptin plasma levels in patients that are obese might exert beneficial effects on the coronary endothelium to counterbalance the adverse effects of increases in body weight on coronary circulatory function should be tested.
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Affiliation(s)
- Thomas H Schindler
- Department of Molecular, David Geffen School of Medicine at UCLA, University of California at Los Angeles, Los Angeles, California 90095-1735, USA
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