Comparative prognostic utility of visual grade and heart-to-contralateral lung ratio in patients undergoing 99mTc-pyrophosphate radiotracer cardiac scintigraphy

Introduction

Transthyretin (ATTR) cardiac amyloidosis (CA) is an underdiagnosed form of restrictive cardiomyopathy leading to a rapid progression into heart failure. 99mTc-labeled radiotracer cardiac scintigraphy is crucial for the evaluation of CA. Semiquantitative (Perugini visual grade) and quantitative (heart-to-contralateral lung ratio, H/CL) parameters are used to assessing CA via cardiac scintigraphy.

Purpose

We aimed to assess the comparative prognostic utility of the Perugini visual grade and heart to contralateral lung ratio.

Methods

The study population was identified based on an institutional registry of consecutive patients undergoing 99mTc-PYP radiotracer cardiac scintigraphy for suspected CA between January 2020-October 2021. The H/CL is calculated by the fraction of heart region of interest (ROI) mean uptake counts to the contralateral chest ROI. The visual scoring system compares uptake between bone (rib) and heart where 0 = absent cardiac uptake, 1 = uptake less than bone, 2 = uptake equal to bone, and 3 = is uptake greater than bone. Ejection fraction (EF) was obtained from echocardiographic studies done around the time of cardiac scintigraphy. MACE was defined as a composite of inclusive of all-cause death, myocardial infarction, admission for heart failure and late revascularization – percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG) >90 days after imaging.

Results

A total of 330 patients (mean age 70.9±12.2 years, 62.2% male) were included in the analysis. Risk factors were prevalent (59.7% hypertension, Heart Failure 68.3%, 26.5% dyslipidemia, 26.2% diabetes) (Table 1). In total, 32.6% of the cohort had studies suggestive of ATTR CA. Median time between echocardiography and cardiac scintigraphy was 7 days (IQR 5–42 days). A higher frequency of MACE was reported in patients with a 2+ visual grade (30% vs 42%, p=0.03). A H/CL >1.5 was associated with borderline significance (43% vs 35% p=0.07).

Conclusion

Our analysis showed that the Perugini visual grading of transthyretin cardiac amyloidosis conferred the best prognostic utility contrary to heart to contralateral lung ratio in 99mTc-PYP radiotracer cardiac scintigraphy.

Funding Acknowledgement

Type of funding sources: None.

The prognostic role of PET myocardial perfusion imaging in patients with cardiac sarcoidosis: a systematic review

Funding Acknowledgements

Type of funding sources: None.

Background

Sarcoidosis is a multi-systemic inflammatory disease of unknown etiology. Cardiac Sarcoidosis (CS) has been reported in as much as 25% of patients with systemic involvement. 18Fluorodeoxyglucose (FDG) Positron Emission Tomography (PET) has a high diagnostic sensitivity/specificity in the diagnosis of CS.

Purpose

The aim of this review is to summarize evidence on the prognostic role of FDG PET.

Methods

Studies were identified by searching MEDLINE from inception to October 2020. Medical Subject Headings (MeSH) terms for sarcoidosis; cardiac and FDG PET imaging were used. Studies of any design assessing the prognostic role of FDG PET in patients with either suspected or confirmed cardiac sarcoidosis imaging done at baseline were included. Abnormal PET was defined as abnormal metabolism (presence of focal or focal-on-diffuse uptake of FDG) OR abnormal metabolism and a perfusion defect. Studies reporting any outcome measure were included. Pooled risk ratio for the composite outcome of MACE was done.

Results

A total of 6 studies were selected for final inclusion (515 patients, 53.4% women, 19.8% racial minorities.) Studies were institution based, retrospective in design and enrolled consecutive patients. All were observational in nature and published in English. All studies used a qualitative assessment of PET scans (abnormal FDG uptake with or without abnormal perfusion). Two studies assessed quantitative metrics (summed stress score in segments with abnormal FDG uptake, standardized uptake value and cardiac metabolic activity.) All studies reported Major Adverse Cardiovascular Events (MACE) as a composite outcome. After a mean follow up ranging from 1.4 to 4.1 years, there were a total of 105 MACE. All studies included death (either all-cause death or sudden cardiac death) and ventricular arrhythmia (ventricular tachycardia or ventricular fibrillation) as a component of MACE. Four of the six studies adjusted for several characteristics in their analysis. All four studies used Left Ventricular Ejection Fraction (LVEF). However, other adjustment variables were not consistent across studies. Five studies found a positive prognostic association with the primary outcome, two of which assessing right ventricular uptake.

Conclusion

Although available evidence indicates FDG PET can be used in the risk stratification of patients with CS, our findings show further studies are needed to quantify the effect in this patient group.

Safe blood transfusion practices in blood banks of Karachi, Pakistan

BACKGROUND

Since 1997, legislations pertaining to safe blood transfusion (SBT) have evolved considerably in Pakistan. The objective of this study was to evaluate the SBT practices in the blood banks of Pakistan.

METHODS

Twenty-three blood banks were randomly selected from a list of registered 40 in Karachi, the largest city in Pakistan. To evaluate the SBT practices in the selected blood banks, a questionnaire and a checklist were administered during 2007-2008.

RESULTS

Of the 23 blood banks surveyed, 4 (17%) were affiliated with government or a semi-government institution; 16 (70%) blood banks had a healthy donor recruitment program and 2 (9%) of the blood banks agreed that they recruited remunerated (paid) blood donors. Donors were screened for HIV, Hepatitis B, Hepatitis C and syphilis by all 23 blood banks, whereas malaria was screened by all blood banks but one.

CONCLUSION

SBT practices in Karachi have improved since 1995; an active role by the government in policy-making has proven effective.

Determining the risk factors and prevalence of osteoporosis using quantitative ultrasonography in Pakistani adult women

INTRODUCTION

Osteoporosis-related bone fractures are a significant public health problem. The aim of this study was to determine the prevalence of osteoporosis among Pakistani women and identify modifiable risk factors.

METHODS

A cross-sectional study was conducted in an obstetrics / gynaecology setting during March-April 2007 in Quetta, Pakistan. A total of 334 women older than 20 years of age underwent quantitative ultrasonography and were interviewed to find out the risk factors for osteoporosis. Bone mineral density was assessed by the speed of sound using a quantitative ultrasound device. The sociodemographic characteristics of normal, osteopenic and osteoporotic women were compared using the chi-square test for categorical variables and ANOVA for continuous variables. Binary logistic regression was used to determine the independent predictors of being osteopenic or osteoporotic.

RESULTS

146 (43.7 percent) women were reported to be normal, 145 (43.4 percent) were osteopenic and 43 (12.9 percent) were osteoporotic. The mean age and standard deviation of the participants were 36.7 years +/- 13.0 years, with a body mass index (BMI) of 25.81 (standard deviation 5.10) kg per square metre. In the univariate analysis, factors that were associated with osteoporosis / osteopenia included age, parity, BMI, smoking (pack years), consumption of calcium-rich food/week, personal and family history of osteoporosis, education and socioeconomic status (p-value is less than 0.05). Using binary logistic regression with osteoporosis / osteopenia as an outcome compared to normal individuals, BMI, smoking pack years, a family history of osteoporosis / fracture and house ownership were found to be independent predictors of the outcome.

CONCLUSION

The prevalence of osteoporosis and osteopenia is high, especially among young Pakistani women, and is associated with modifiable risk factors.

[The value of alizapride in the treatment of vomiting in infants and children]

An open, three-day trial was carried out in 49 infants and children with vomiting related to an acute gastrointestinal or ENT infection (63.3% of cases), a gastroesophageal reflux (20.4%), or an attack of malaria (14.3%). Mean age of patients was 21.9 months. Number of episodes of vomiting exceeded six per day in 89.8% of patients. Alizapride (Plitican) was given as oral drops in a dosage of 3 mg/kg/d. Five patients were prematurely withdrawn from the trial for clinical deterioration requiring discontinuation of enteral nutrition. Under treatment, vomiting resolved completely in 35 patients, i.e. 71.4% of the initial study group. Six patients exhibited incomplete improvement of vomiting and eight (including the 5 dropouts) continued to have a significant number of episodes of vomiting. Overall effectiveness evaluated on the frequency of episodes of vomiting, weight changes, and the investigator's clinical judgement was considered as excellent or good in 81.6% of cases. No significant adverse effects were recorded but the product's bitter taste was involved in the persistence of vomiting in one of the dropouts and in the development of moderate nausea in another patient who was able to continue treatment. The therapeutic value of alizapride, evaluated using an analog scale, proved significant in this indication.